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Zhai G, Qi J, Zhang X, Zhou W, Wang J. A comparison of the effect of diurnal temperature range and apparent temperature on cardiovascular disease among farmers in Qingyang, Northwest China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:28946-28956. [PMID: 34988800 DOI: 10.1007/s11356-021-17785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
Climate change is increasing the incidence of extreme weather events which have a significant impact on public health. Cardiovascular diseases (CVDs) are the number one cause of death globally (40%). Apparent temperature (AT) and diurnal temperature range (DTR) have been extensively used to evaluate the effects of temperature on cardiovascular disease (CVD). However, the relevant information is quite limited from analysis and comparison of effects and differing pathogenesis of DTR and AT on CVD especially in less-developed, rural areas of China. This is the first attempt to analyze different effects between AT and DTR on CVD using distributed lag nonlinear modeling (DLNM) in rural area. Data on CVD hospital admission in Qingyang (Northwest China) in 2014-2017 originated from the New Rural Cooperative Medical System (NRCMS) of Gansu Province, and meteorological variables were provided by the Meteorological Science Data Sharing Service. Both AT and DTR had significant nonlinear and delayed impacts on hospital admissions for CVD. DTR had a stronger and more persistent effect on CVD incidence than AT. Females were more affected by high AT and low DTR than were males, while males were more vulnerable to low AT and high DTR. Temperature effects were not significantly different between people above and below 65 years of age. These findings provide local public health authorities with reference concerning sensitive temperature indices for susceptible populations with a view to improve CVD preventive strategies in rural areas.
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Affiliation(s)
- Guangyu Zhai
- School of Economics and Management, Lanzhou University of Technology, Lanzhou, 730050, China
- School of Management, Lanzhou University, Lanzhou, 730000, China
| | - Jintao Qi
- School of Economics and Management, Lanzhou University of Technology, Lanzhou, 730050, China.
| | - Xuemei Zhang
- School of Economics and Management, Lanzhou University of Technology, Lanzhou, 730050, China
| | - Wenjuan Zhou
- Gansu Provincial Hospital, Lanzhou, 730000, China
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López-Jaramillo P, Barbosa E, Molina DI, Sanchez R, Diaz M, Camacho PA, Lanas F, Pasquel M, Accini JL, Ponte-Negretti CI, Alcocer L, Cobos L, Wyss F, Sebba-Barroso W, Coca A, Zanchetti A. Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome. J Hypertens 2020; 37:1126-1147. [PMID: 30882601 DOI: 10.1097/hjh.0000000000002072] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
: The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.
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Affiliation(s)
- Patricio López-Jaramillo
- Clinica de Síndrome Metabolico, Prediabetes y Diabetes, Direccion de Investigaciones FOSCAL y Facultad de Salud, Universidad de Santander (UDES), Bucaramanga, Colombia
| | | | - Dora I Molina
- Universidad de Caldas e IPS Médicos Internistas de Caldas, Manizales, Colombia
| | - Ramiro Sanchez
- Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - Paul A Camacho
- Direccion de Investigaciones FOSCAL y Facultad de Salud, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | | | | | - José L Accini
- Fundacion Hospital Universidad del Norte y Universidad Libre, Barranquilla, Colombia
| | | | - Luis Alcocer
- Instituto Mexicano de Salud Cardiovascular, Ciudad de Mexico, Mexico
| | - Leonardo Cobos
- Unidad de Cardiologia, Hospital El Pino, Santiago, Chile
| | - Fernando Wyss
- Servicios y Tecnologica Cardiovascular de Gautemala, S.A., Guatemala
| | | | - Antonio Coca
- Hospital Clínico, Universidad de Barcelona, Spain
| | - Alberto Zanchetti
- Istituto Auxologico Italiano, IRCCS, and Università degli Studi of Milan, Italy
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Chu SH, Loucks EB, Kelsey KT, Gilman SE, Agha G, Eaton CB, Buka SL, Huang YT. Sex-specific epigenetic mediators between early life social disadvantage and adulthood BMI. Epigenomics 2018; 10:707-722. [PMID: 29888956 DOI: 10.2217/epi-2017-0146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM The objective of this study was to identify potential epigenetic mediating pathways linking early life social disadvantage (ELSD) to adulthood BMI. METHODS Sex-specific epigenome-wide two-stage mediation analyses were conducted in blood and adipose tissue, and mediation estimates were obtained using cross-product mediation analysis. Pathway analyses were conducted using GREAT software (Bejerano Lab, CA, USA). RESULTS Candidate mediation CpG sites were identified in adipose tissue, but not blood, and were sex-specific. Significant mediation sites in females included CpG loci in genes: PKHG1, BCAR3, ADAM5P, PIEZO1, FGFRL1, FASN and DPP9, among others. Pathway analyses revealed evidence of enrichment for processes associated with TFG-β signaling and immunologic signatures. In males, significant mediation loci included sites in MAP3K5 and RPTOR, which have previously been associated with adipogenesis, inflammation and insulin resistance. CONCLUSION Our findings provide supportive evidence for the mediating role of epigenetic mechanisms in the effect of early life social disadvantage on adulthood BMI.
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Affiliation(s)
- Su H Chu
- Department of Epidemiology, Brown School of Public Health, Providence, RI, 02912, USA.,Channing Division of Network Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, 02115, USA
| | - Eric B Loucks
- Department of Epidemiology, Brown School of Public Health, Providence, RI, 02912, USA
| | - Karl T Kelsey
- Department of Epidemiology, Brown School of Public Health, Providence, RI, 02912, USA.,Department of Pathology & Laboratory Medicine, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA
| | - Stephen E Gilman
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Bethesda, MD, 20892, USA.,Department of Social & Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, 02115, USA.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, 02115, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Golareh Agha
- Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Charles B Eaton
- Department of Epidemiology, Brown School of Public Health, Providence, RI, 02912, USA.,Department of Family Medicine, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA
| | - Stephen L Buka
- Department of Epidemiology, Brown School of Public Health, Providence, RI, 02912, USA
| | - Yen-Tsung Huang
- Department of Epidemiology, Brown School of Public Health, Providence, RI, 02912, USA.,Department of Biostatistics, Brown School of Public Health, Providence, RI, 02912, USA.,Institute of Statistical Science, Academia Sinica, Taipei, 11529, Taiwan
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San Martin R, Brito J, Siques P, León-Velarde F. Obesity as a Conditioning Factor for High-Altitude Diseases. Obes Facts 2017; 10:363-372. [PMID: 28810235 PMCID: PMC5644942 DOI: 10.1159/000477461] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 05/10/2017] [Indexed: 12/19/2022] Open
Abstract
Obesity, a worldwide epidemic, has become a major health burden because it is usually accompanied by an increased risk for insulin resistance, diabetes, hypertension, cardiovascular diseases, and even some kinds of cancer. It also results in associated increases in healthcare expenditures and labor and economic consequences. There are also other fields of medicine and biology where obesity or being overweight play a major role, such as high-altitude illnesses (acute mountain sickness, hypoxic pulmonary hypertension, and chronic mountain sickness), where an increasing relationship among these two morbid statuses has been demonstrated. This association could be rooted in the interactions between obesity-related metabolic alterations and critical ventilation impairments due to obesity, which would aggravate hypobaric hypoxia at high altitudes, leading to hypoxemia, which is a trigger for developing high-altitude diseases. This review examines the current literature to support the idea that obesity or overweight could be major conditioning factors at high altitude.
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Affiliation(s)
- Rocío San Martin
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile
| | - Julio Brito
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile
- *Julio Brito, Institute of Health Studies, Universidad Arturo Prat, Avda. Arturo Prat 2120, Iquique, 1110939, Chile,
| | - Patricia Siques
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile
| | - Fabiola León-Velarde
- Department of Biological and Physiological Sciences. Facultad de Ciencias y Filosofía/ IIA, Universidad Peruana Cayetano Heredia, Lima, Perú
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Savitsky B, Manor O, Friedlander Y, Burger A, Lawrence G, Calderon-Margalit R, Siscovick DS, Enquobahrie DA, Williams MA, Hochner H. Associations of socioeconomic position in childhood and young adulthood with cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-Up Study. J Epidemiol Community Health 2016; 71:43-51. [PMID: 27417428 DOI: 10.1136/jech-2014-204323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/30/2015] [Accepted: 06/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several stages in the life course have been identified as important to the development of cardiovascular disease. This study aimed to assess the associations of childhood and adulthood socioeconomic position (SEP) and social mobility with cardiometabolic risk factors (CMRs) later in life. METHODS We conducted follow-up examinations of 1132 offspring, aged 32, within a population-based cohort of all births in Jerusalem from 1974 to 1976. SEP was indicated by parents' occupation and education, and adulthood SEP was based on offspring's occupation and education recorded at age 32. Linear regression models were used to investigate the associations of SEP and social mobility with CMRs. RESULTS Childhood-occupational SEP was negatively associated with body mass index (BMI; β=-0.29, p=0.031), fat percentage (fat%; β=-0.58, p=0.005), insulin (β=-0.01, p=0.031), triglycerides (β=-0.02, p=0.024) and low-density lipoprotein cholesterol (LDL-C; β=-1.91, p=0.015), independent of adulthood SEP. Adulthood-occupational SEP was negatively associated with waist-to-hip ratio (WHR; β=-0.01, p=0.002), and positively with high-density lipoprotein cholesterol (HDL-C; β=0.87, p=0.030). Results remained similar after adjustment for smoking and inactivity. Childhood-educational SEP was associated with decreased WHR and LDL-C level (p=0.0002), and adulthood-educational SEP was inversely associated with BMI (p=0.001), waist circumference (p=0.008), WHR (p=0.001) and fat% (p=0.0002) and positively associated with HDL-C (p=0.030). Additionally, social mobility (mainly upward) was shown to have adverse cardiometabolic outcomes. CONCLUSIONS Both childhood and adulthood SEP contribute independently to CMR. The match-mismatch hypothesis may explain the elevated CMRs among participants experiencing social mobility. Identification of life-course SEP-related aspects that translate into social inequality in cardiovascular risk may facilitate efforts for improving health and for reducing disparities in cardiovascular disease.
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Affiliation(s)
- B Savitsky
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Y Friedlander
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - A Burger
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - G Lawrence
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - R Calderon-Margalit
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - D S Siscovick
- Cardiovascular Health Research Unit, Department of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - D A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - M A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Hochner
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Nieto-Martínez R, González-Rivas JP, Lima-Martínez M, Stepenka V, Rísquez A, Mechanick JI. Diabetes Care in Venezuela. Ann Glob Health 2016; 81:776-91. [DOI: 10.1016/j.aogh.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Galvis V, López-Jaramillo P, Tello A, Castellanos-Castellanos YA, Camacho PA, Cohen DD, Gómez-Arbeláez D, Merayo-Lloves J. Is myopia another clinical manifestation of insulin resistance? Med Hypotheses 2016; 90:32-40. [PMID: 27063082 DOI: 10.1016/j.mehy.2016.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 02/08/2016] [Indexed: 12/28/2022]
Abstract
Myopia is a multifactorial visual refraction disease, in which the light rays from distant objects are focused in front of retina, causing blurry vision. Myopic eyes are characterized by an increased corneal curvature and/or ocular axial length. The prevalence of myopia has increased in recent decades, a trend that cannot be attributed exclusively to genetic factors. Low and middle income countries have a higher burden of refractive error, which we propose could be a consequence of a shorter exposure time to a westernized lifestyle, a phenomenon that may also explain the rapid increase in cardiometabolic diseases, such as diabetes, among those populations. We suggest that interactions between genetic, epigenetic and a rapidly changing environment are also involved in myopia onset and progression. Furthermore, we discuss several possible mechanisms by which insulin resistance may promote abnormal ocular growth and myopia to support the hypothesis that insulin resistance and hyperinsulinemia are involved in its pathogenesis, providing a link between trends in myopia and those of cardiometabolic diseases. There is evidence that insulin have direct ocular growth promoting effects as well an indirect effect via the induction of insulin-like growth factors leading to decreases insulin-like growth factor-binding protein, also implicated in ocular growth.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia; Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia
| | - Patricio López-Jaramillo
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia; Instituto MASIRA, Facultad de Ciencias de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia.
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Santander, Colombia; Departamento de Cirugía, Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Santander, Colombia
| | | | - Paul Anthony Camacho
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia
| | - Daniel Dylan Cohen
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia; Instituto MASIRA, Facultad de Ciencias de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
| | - Diego Gómez-Arbeláez
- Fundación Oftalmológica de Santander - FOSCAL, Floridablanca, Santander, Colombia
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Spain
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Cohen DD. Neuromuscular performance deficits in low birthweight children: a target for physical activity interventions? Dev Med Child Neurol 2015; 57:406-7. [PMID: 25640481 DOI: 10.1111/dmcn.12682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel D Cohen
- Masira Institute, Faculty of Life Sciences, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
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López-Jaramillo P, Sánchez RA, Diaz M, Cobos L, Bryce A, Parra-Carrillo JZ, Lizcano F, Lanas F, Sinay I, Sierra ID, Peñaherrera E, Bendersky M, Schmid H, Botero R, Urina M, Lara J, Foss MC, Márquez G, Harrap S, Ramírez AJ, Zanchetti A. [Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome]. ACTA ACUST UNITED AC 2015; 58:205-25. [PMID: 24863082 DOI: 10.1590/0004-2730000003019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/06/2014] [Indexed: 12/30/2022]
Abstract
The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
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Affiliation(s)
- Patricio López-Jaramillo
- Fundación Oftalmológica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colômbia
| | - Ramiro A Sánchez
- Unidad de Metabolismo e Hipertensión Arterial, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | | | | | | | | | - Fernando Lizcano
- Asociación Colombiana de Endocrinología, Universidad de la Sabana, Bogotá, Colômbia
| | | | - Isaac Sinay
- Instituto Cardiológico de Buenos Aires, Buenos aires, Argentina
| | - Iván D Sierra
- Asociación Latinoamericana de Diabetes, Bogotá, Colômbia
| | | | | | - Helena Schmid
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | - Manuel Urina
- Sociedad Colombiana de Cardiología, Bogotá, Colômbia
| | - Joffre Lara
- Sociedad Ecuatoriana de Aterosclerosis, Guayaquil, Equador
| | | | | | | | - Agustín J Ramírez
- Unidad de Metabolismo e Hipertensión Arterial, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
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Kristjansson E, Francis DK, Liberato S, Benkhalti Jandu M, Welch V, Batal M, Greenhalgh T, Rader T, Noonan E, Shea B, Janzen L, Wells GA, Petticrew M. Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years. Cochrane Database Syst Rev 2015; 2015:CD009924. [PMID: 25739460 PMCID: PMC6885042 DOI: 10.1002/14651858.cd009924.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Undernutrition contributes to five million deaths of children under five each year. Furthermore, throughout the life cycle, undernutrition contributes to increased risk of infection, poor cognitive functioning, chronic disease, and mortality. It is thus important for decision-makers to have evidence about the effectiveness of nutrition interventions for young children. OBJECTIVES Primary objective1. To assess the effectiveness of supplementary feeding interventions, alone or with co-intervention, for improving the physical and psychosocial health of disadvantaged children aged three months to five years.Secondary objectives1. To assess the potential of such programmes to reduce socio-economic inequalities in undernutrition.2. To evaluate implementation and to understand how this may impact on outcomes.3. To determine whether there are any adverse effects of supplementary feeding. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE, PsycINFO, and seven other databases for all available years up to January 2014. We also searched ClinicalTrials.gov and several sources of grey literature. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished trials. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs, controlled clinical trials (CCTs), controlled before-and-after studies (CBAs), and interrupted time series (ITS) that provided supplementary food (with or without co-intervention) to children aged three months to five years, from all countries. Adjunctive treatments, such as nutrition education, were allowed. Controls had to be untreated. DATA COLLECTION AND ANALYSIS Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data, and assessed risk of bias. We conducted meta-analyses for continuous data using the mean difference (MD) or the standardised mean difference (SMD) with a 95% confidence interval (CI), correcting for clustering if necessary. We analysed studies from low- and middle-income countries and from high-income countries separately, and RCTs separately from CBAs. We conducted a process evaluation to understand which factors impact on effectiveness. MAIN RESULTS We included 32 studies (21 RCTs and 11 CBAs); 26 of these (16 RCTs and 10 CBAs) were in meta-analyses. More than 50% of the RCTs were judged to have low risk of bias for random selection and incomplete outcome assessment. We judged most RCTS to be unclear for allocation concealment, blinding of outcome assessment, and selective outcome reporting. Because children and parents knew that they were given food, we judged blinding of participants and personnel to be at high risk for all studies.Growth. Supplementary feeding had positive effects on growth in low- and middle-income countries. Meta-analysis of the RCTs showed that supplemented children gained an average of 0.12 kg more than controls over six months (95% confidence interval (CI) 0.05 to 0.18, 9 trials, 1057 participants, moderate quality evidence). In the CBAs, the effect was similar; 0.24 kg over a year (95% CI 0.09 to 0.39, 1784 participants, very low quality evidence). In high-income countries, one RCT found no difference in weight, but in a CBA with 116 Aboriginal children in Australia, the effect on weight was 0.95 kg (95% CI 0.58 to 1.33). For height, meta-analysis of nine RCTs revealed that supplemented children grew an average of 0.27 cm more over six months than those who were not supplemented (95% CI 0.07 to 0.48, 1463 participants, moderate quality evidence). Meta-analysis of seven CBAs showed no evidence of an effect (mean difference (MD) 0.52 cm, 95% CI -0.07 to 1.10, 7 trials, 1782 participants, very low quality evidence). Meta-analyses of the RCTs demonstrated benefits for weight-for-age z-scores (WAZ) (MD 0.15, 95% CI 0.05 to 0.24, 8 trials, 1565 participants, moderate quality evidence), and height-for-age z-scores (HAZ) (MD 0.15, 95% CI 0.06 to 0.24, 9 trials, 4638 participants, moderate quality evidence), but not for weight-for-height z-scores MD 0.10 (95% CI -0.02 to 0.22, 7 trials, 4176 participants, moderate quality evidence). Meta-analyses of the CBAs showed no effects on WAZ, HAZ, or WHZ (very low quality evidence). We found moderate positive effects for haemoglobin (SMD 0.49, 95% CI 0.07 to 0.91, 5 trials, 300 participants) in a meta-analysis of the RCTs.Psychosocial outcomes. Eight RCTs in low- and middle-income countries assessed psychosocial outcomes. Our meta-analysis of two studies showed moderate positive effects of feeding on psychomotor development (SMD 0.41, 95% CI 0.10 to 0.72, 178 participants). The evidence of effects on cognitive development was sparse and mixed.We found evidence of substantial leakage. When feeding was given at home, children benefited from only 36% of the energy in the supplement. However, when the supplementary food was given in day cares or feeding centres, there was less leakage; children took in 85% of the energy provided in the supplement. Supplementary food was generally more effective for younger children (less than two years of age) and for those who were poorer/ less well-nourished. Results for sex were equivocal. Our results also suggested that feeding programmes which were given in day-care/feeding centres and those which provided a moderate-to-high proportion of the recommended daily intake (% RDI) for energy were more effective. AUTHORS' CONCLUSIONS Feeding programmes for young children in low- and middle-income countries can work, but good implementation is key.
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Affiliation(s)
- Elizabeth Kristjansson
- University of OttawaSchool of Psychology, Faculty of Social SciencesRoom 407C, Montpetit Hall125 UniversityOttawaCanadaK1N 6N5
| | - Damian K Francis
- University of West IndiesEpidemiology Research UnitMona Kingston 7Jamaica
| | - Selma Liberato
- Menzies School of Health Research, Charles Darwin UniversityNutrition Research TeamPO Box 41096DarwinAustralia0811
| | - Maria Benkhalti Jandu
- University of OttawaCentre for Global Health, Institute of Population Health1 Stewart StreetOttawaCanadaK1N 6N5
| | - Vivian Welch
- University of OttawaBruyère Research Institute85 Primrose StreetOttawaCanadaK1N 5C8
| | - Malek Batal
- University of MontrealWHO Collaborating Centre on Nutrition Changes and Development (TRANSNUT), Nutrition Department, Faculty of MedicinePavillon Liliane de Stewart2405, Chemin de la Côte‐Sainte‐Catherine l MontréalQuebecCanadaH3C 3J7
| | - Trish Greenhalgh
- Barts and the London School of Medicine and DentistryCentre for Primary Care and Public Health58 Turner StWhitechapelLondonUKE1 2AB
| | - Tamara Rader
- Cochrane Musculoskeletal GroupOttawa Hospital Research Institute501 Smyth RoadOttawaCanadaK1H 8L6
| | - Eamonn Noonan
- Norwegian Knowledge Centre for the Health ServicesPO Box 7004St Olavs plassOsloNorwayN‐0130
| | - Beverley Shea
- University of OttawaDepartment of Epidemiology and Community Medicine501 Smyth RoadOttawaCanadaK1H 8L6
| | - Laura Janzen
- The Hospital for Sick ChildrenDepartment of Psychology & Division of Haematology/Oncology555 University AvenueTorontoCanadaM5G 1X8
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community Medicine501 Smyth RoadOttawaCanadaK1H 8L6
| | - Mark Petticrew
- London School of Hygiene and Tropical MedicineDepartment of Social & Environmental Health Research, Faculty of Public Health & Policy15‐17 Tavistock PlaceLondonUKWC1H 9SH
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Lopez-Jaramillo P, Gomez-Arbelaez D, Sotomayor-Rubio A, Mantilla-Garcia D, Lopez-Lopez J. Maternal undernutrition and cardiometabolic disease: a Latin American perspective. BMC Med 2015; 13:41. [PMID: 25858591 PMCID: PMC4346113 DOI: 10.1186/s12916-015-0293-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/12/2015] [Indexed: 02/07/2023] Open
Abstract
The current epidemic of obesity and cardiometabolic diseases in developing countries is described as being driven by socioeconomic inequalities. These populations have a greater vulnerability to cardiometabolic diseases due to the discrepancy between the maternal undernutrition and its consequence, low-birth weight progeny, and the subsequent modern lifestyles which are associated with socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Maternal undernutrition can generate epigenetic modifications, with potential long-term consequences. Throughout life, people are faced with the challenge of adapting to changes in their environment, such as excessive intake of high energy density foods and sedentary behavior. However, a mismatch between conditions experienced during fetal programming and current environmental conditions will make adaptation difficult for them, and will increase their susceptibility to obesity and cardiovascular diseases. It is important to conduct research in the Latin American context, in order to define the best strategies to prevent the epidemic of cardiometabolic diseases in the region.
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D'Addario M, Cappelletti E, Sarini M, Greco A, Monzani D, Pancani L, Steca P. Communication and disease management: a qualitative study on coronary disease. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1026823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Burrows R, Correa-Burrows P, Reyes M, Blanco E, Albala C, Gahagan S. Healthy Chilean Adolescents with HOMA-IR ≥ 2.6 Have Increased Cardiometabolic Risk: Association with Genetic, Biological, and Environmental Factors. J Diabetes Res 2015; 2015:783296. [PMID: 26273675 PMCID: PMC4530255 DOI: 10.1155/2015/783296] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To determine the optimal cutoff of the homeostasis model assessment-insulin resistance (HOMA-IR) for diagnosis of the metabolic syndrome (MetS) in adolescents and examine whether insulin resistance (IR), determined by this method, was related to genetic, biological, and environmental factors. METHODS In 667 adolescents (16.8 ± 0.3 y), BMI, waist circumference, glucose, insulin, adiponectin, diet, and physical activity were measured. Fat and fat-free mass were assessed by dual-energy X-ray absorptiometry. Family history of type 2 diabetes (FHDM) was reported. We determined the optimal cutoff of HOMA-IR to diagnose MetS (IDF criteria) using ROC analysis. IR was defined as HOMA-IR values above the cutoff. We tested the influence of genetic, biological, and environmental factors on IR using logistic regression analyses. RESULTS Of the participants, 16% were obese and 9.4 % met criteria for MetS. The optimal cutoff for MetS diagnosis was a HOMA-IR value of 2.6. Based on this value, 16.3% of participants had IR. Adolescents with IR had a significantly higher prevalence of obesity, abdominal obesity, fasting hyperglycemia, and MetS compared to those who were not IR. FHDM, sarcopenia, obesity, and low adiponectin significantly increased the risk of IR. CONCLUSIONS In adolescents, HOMA-IR ≥ 2.6 was associated with greater cardiometabolic risk.
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Affiliation(s)
- R. Burrows
- Institute of Nutrition and Food Technology, University of Chile, Avenida El Líbano 5524, Macul, 7840390 Santiago, Chile
- *R. Burrows:
| | - P. Correa-Burrows
- Institute of Nutrition and Food Technology, University of Chile, Avenida El Líbano 5524, Macul, 7840390 Santiago, Chile
| | - M. Reyes
- Institute of Nutrition and Food Technology, University of Chile, Avenida El Líbano 5524, Macul, 7840390 Santiago, Chile
| | - E. Blanco
- Division of Child Development and Community Health, University of California, San Diego, 9500 Gilman Drive, MC 0927, La Jolla, San Diego, CA 92093-0927, USA
| | - C. Albala
- Institute of Nutrition and Food Technology, University of Chile, Avenida El Líbano 5524, Macul, 7840390 Santiago, Chile
| | - S. Gahagan
- Division of Child Development and Community Health, University of California, San Diego, 9500 Gilman Drive, MC 0927, La Jolla, San Diego, CA 92093-0927, USA
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López-Jaramillo P, Velandia-Carrillo C, Gómez-Arbeláez D, Aldana-Campos M. Is the present cut-point to define type 2 diabetes appropriate in Latin-Americans? World J Diabetes 2014; 5:747-755. [PMID: 25512777 PMCID: PMC4265861 DOI: 10.4239/wjd.v5.i6.747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/25/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
The diagnosis of diabetes mellitus type 2 (DM2) is based either on increased plasma glucose or Glycated hemoglobin levels. Since these measures are the only means for diagnosis of DM2, they must be well adapted to each population according to their metabolic characteristics, given that these may vary in each population. The World Health Organization (WHO) determined the cut-points of plasma glucose levels for the diagnosis of DM2 by associating hyperglycemia with the risk of a specific microvascular complication-retinopathy. Cardiovascular diseases are however the principal causes of mortality in patients with DM2 and we reported that in the Colombo-Ecuadorian population impaired fasting glucose and impaired glucose tolerance are both risk markers for myocardial infarction. We propose that the current cut-points accepted by the WHO need to be revaluated in populations such as Latin America and that there should be lower cut points for glycaemia in this population, to reduce the prevalence of cardiovascular complications associated with DM2.
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López-Jaramillo P, Camacho PA, Forero-Naranjo L. The role of environment and epigenetics in hypertension. Expert Rev Cardiovasc Ther 2014; 11:1455-7. [PMID: 24160576 DOI: 10.1586/14779072.2013.846217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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López-Jaramillo P, Sánchez RA, Díaz M, Cobos L, Bryce A, Parra-Carrillo JZ, Lizcano F, Lanas F, Sinay I, Sierra ID, Peñaherrera E, Benderky M, Schmid H, Botero R, Urina M, Lara J, Foos MC, Márquez G, Harrap S, Ramírez AJ, Zanchetti A. Consenso latinoamericano de hipertensión en pacientes con diabetes tipo 2 y síndrome metabólico. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:85-103. [DOI: 10.1016/j.arteri.2013.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022]
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Inflammation and hypertension: are there regional differences? Int J Hypertens 2013; 2013:492094. [PMID: 23573414 PMCID: PMC3618944 DOI: 10.1155/2013/492094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/19/2013] [Indexed: 12/16/2022] Open
Abstract
Hypertension is a chronic disease with global prevalence and incidence rapidly increasing in low and medium income countries. The surveillance of cardiovascular risk factors, such as hypertension, is a global health priority in order to estimate the burden and trends, to appropriately direct resources, and to measure the effect of interventions. We propose here that the adoption of Western lifestyles in low and middle incomes countries has dramatically increased the prevalence of abdominal obesity, which is the main source of proinflammatory cytokines, and that the vascular systemic inflammation produced by adipose tissue contributes to the development of hypertension. The concentration of proinflammatory cytokines is higher in the Latin American population than that reported in developed countries, suggesting a higher susceptibility to develop systemic low-degree inflammation at a given level of abdominal obesity. These particularities are important to be considered when planning resources for health care programs. Moreover, studying these singularities may provide a better understanding of the causes of the burden of cardiovascular risk factors and the remarkable variability in the prevalence of these medical conditions within and between countries.
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Ramírez R. Programación fetal de la hipertensión arterial del adulto: mecanismos celulares y moleculares. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Szabó K, Kemény L. Studying the genetic predisposing factors in the pathogenesis of acne vulgaris. Hum Immunol 2011; 72:766-73. [PMID: 21669244 DOI: 10.1016/j.humimm.2011.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/28/2011] [Accepted: 05/13/2011] [Indexed: 02/04/2023]
Abstract
Acne is one of the most common dermatologic diseases in the developed regions of the world, affecting a large percentage of the population. Despite the great improvement in the number and quality of studies of the molecular etiology of this disease in the past 3 decades, the detailed molecular pathogenesis and the cause of the large individual variations in severity of skin symptoms remain unknown. The roles of genetic inheritance and special genetic susceptibility and protective factors have been suggested for over 100 years, but their identification and determination started only in the 1990s. To date, only a small number of genetic polymorphisms affecting the expression and/or function of a handful of genes have been investigated. This review surveys the major findings of the classic and molecular genetic studies that have been conducted in this field, draws conclusions, and indicates how the available data help our current understanding of the pathogenesis of this common skin disease.
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Affiliation(s)
- Kornélia Szabó
- Dermatological Research Group of the Hungarian Academy of Sciences, Szeged, Hungary.
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Lopez-Jaramillo P, Lahera V, Lopez-Lopez J. Epidemic of cardiometabolic diseases: a Latin American point of view. Ther Adv Cardiovasc Dis 2011; 5:119-31. [PMID: 21406494 DOI: 10.1177/1753944711403189] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Poor early nutrition has varying effects on subsequent cardiometabolic disease (CMD) rates. Fetal and neonatal periods are critical for the development and growth of the systems involved in CMD. The increased rates of hypertension, metabolic syndrome, diabetes mellitus type 2, renal failure and heart failure observed nowadays in Latin America could be the result of the discrepancy between the nutritional environment during fetal and early life and the adult environment. This discrepancy causes a mismatch between the fetal programming of the subject and its adult circumstances created by the imposition of new life styles. The two largest international studies on cardiovascular risk factors for a first myocardial infarction (INTERHEART) and stroke (INTERSTROKE) demonstrated that in Latin America the factor with the highest attributable population risk was abdominal obesity. The conflict between the earlier programming and the later presence of abdominal obesity produced a higher sensitivity of this population to develop a state of low-degree inflammation, insulin resistance and the epidemic of CMD to lower levels of abdominal adiposity. The relative roles played by genetic and environmental factors and the interaction between the two are the still subjects of great debate. We have reviewed the relationship between maternal malnutrition, early growth restriction, epigenetic adaptations, and the later occurrence of abdominal obesity and CMD in Latin America.
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Affiliation(s)
- Patricio Lopez-Jaramillo
- Research Direction, Fundacion Oftalmologica de Santander-Clinica Carlos Ardila-Lulle, Floridablanca, Santander, Colombia.
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Nonalcoholic fatty liver disease is associated with insulin resistance in a young Hispanic population. Prev Med 2011; 52:174-7. [PMID: 21147154 DOI: 10.1016/j.ypmed.2010.11.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 11/15/2010] [Accepted: 11/21/2010] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate whether nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) in a young Hispanic population. METHODS A cross-sectional study was performed in Bogotá, Colombia, during 2006 in 263 males from the Colombian Air Force (age range 29-54 years). Anthropometric measurements and biochemical determinations (glycemia, lipid profile, insulin, and HOMA-IR) were obtained in order to determine the presence of metabolic syndrome (MS) criteria and insulin resistance in this population. In addition, ultrasound studies were performed to evaluate the presence of NAFLD. RESULTS NAFLD was detected in 26.6% (n=70) of the subjects. Thirty four individuals had complete MS criteria (48.5%). The presence of NAFLD was associated with higher insulin levels (11.0±5.1 vs. 6.6±3.6, p=0.001), and its prevalence increased from 11% (n=8), to 24% (n=17) to 64% (n=45) from the lowest to the highest HOMA-IR tertile. Body mass index, triglycerides and subcutaneous and visceral fat were found to be independent predictors of NAFLD. CONCLUSIONS These results suggest that NAFLD is associated with insulin resistance and extrahepatic adiposity in nondiabetic young Hispanic population.
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Fetal programming and cardiometabolic diseases: the role of angiotensin II and inflammation. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2010. [DOI: 10.1016/s0214-9168(10)70030-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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López-Jaramillo P, López-López J. Lecciones aprendidas de dos grandes estudios epidemiológicos de enfermedades cardio-cerebrovasculares en las que ha participado colombia. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70240-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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López-Jaramillo P. Tratamiento de la hipertensión arterial en el paciente con síndrome metabólico. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70214-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hyperinsulinemia is a predictor of new cardiovascular events in Colombian patients with a first myocardial infarction. Int J Cardiol 2009; 148:85-90. [PMID: 19923024 DOI: 10.1016/j.ijcard.2009.10.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/30/2009] [Accepted: 10/15/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute Myocardial Infarction (AMI) is one of the main causes of mortality and disability in Colombia. The factors associated to a new event in surviving subjects to a first AMI in our population have not yet been fully identified. METHODS Two hundred and ninety five surviving subjects to a first AMI (58.8±12.6 years) were included in a prospective cohort study between 2000 and 2006. Lipid profile, glycemia and plasma insulin levels were measured. Deaths of cardiovascular origin, a new AMI, unstable angina, heart failure, stroke, new myocardial revascularization or angioplasty were considered new cardiovascular events. RESULTS The study included 61 (20.6%) women and 234 (79.4%) men. The mean follow up time was 50±30 months with a 38.9% incidence of new events. Fifty five patients (18.6%) were diabetic. Bi-varied analysis identified as risk factors for a new cardiovascular event the presence of: hypertension, anterior descending coronary artery stenosis, intrahospital cardiac failure, age over 55, low income, lack of education, Killip III-IV, heart rate over 76 bpm, pulse pressure over 80 mmHg, total cholesterol over 200 mg/dl and insulin over 10 IU/ml. After logistic regression analysis, the log values of insulin remained as the only significant predictor for new cardiovascular events. CONCLUSIONS Hyperinsulinism was the most important factor associated to the occurrence of new cardiovascular events in Colombian patients with AMI, which emphasizes the pivotal role of insulin resistance in the physiopathologic mechanisms of atherosclerosis, especially in undeveloped countries.
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López-Jaramillo P. Cardiometabolic disease in latin america: the role of fetal programming in response to maternal malnutrition. Rev Esp Cardiol 2009; 62:670-6. [PMID: 19480763 DOI: 10.1016/s1885-5857(09)72231-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Latin America is experiencing an epidemic of cardiovascular disease and type-2 diabetes mellitus. The rise in life-expectancy and increasingly rapid urbanization have resulted in a greater prevalence of overweight, obesity and metabolic syndrome. In Latin America, there is a high level of susceptibility to the development of insulin resistance and low-grade inflammation at relatively low levels of abdominal obesity. This susceptibility is associated with the adaptive response of the fetus to deficient fetal nutrition, which results in a loss of anatomical structures such as nephrons, cardiomyocytes and pancreatic beta cells. These adaptations may prove detrimental if food becomes abundant again after birth. In Latin America, the high prevalence of maternal and fetal malnutrition could mean that the resulting fetal adaptations may contribute to an increased risk of cardiometabolic disease. The socioeconomic differences that exist between developed and underdeveloped countries may be reflected in different biological adaptations, which could invalidate the diagnostic criteria and preventive and therapeutic approaches that have been recommended on the basis of research carried out in populations with different characteristics. Clinical studies are needed to evaluate the effectiveness of interventions recommended for preventing and aiding recovery from cardiometabolic disease in Latin America.
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Affiliation(s)
- Patricio López-Jaramillo
- Dirección de Investigaciones de la Fundación Cardiovascular de Colombia y de la Facultad de Medicina de la Universidad de Santander UDES, Bucaramanga, Colombia.
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Abstract
Hypertension is a highly prevalent cardiovascular risk factor in the world and particularly overwhelming in low and middle-income countries. Recent reports from the WHO and the World Bank highlight the importance of chronic diseases such as hypertension as an obstacle to the achievement of good health status. It must be added that for most low and middle-income countries, deficient strategies of primary healthcare are the major obstacles for blood pressure control. Furthermore, the epidemiology of hypertension and related diseases, healthcare resources and priorities, the socioeconomic status of the population vary considerably in different countries and in different regions of individual countries. Considering the low rates of blood pressure control achieved in Latin America and the benefits that can be expected from an improved control, it was decided to invite specialists from different Latin American countries to analyze the regional situation and to provide a consensus document on detection, evaluation and treatment of hypertension that may prove to be cost-utility adequate. The recommendations here included are the result of preparatory documents by invited experts and a subsequent very active debate by different discussion panels, held during a 2-day sessions in Asuncion, Paraguay, in May 2008. Finally, in order to improve clinical practice, the publication of the guidelines should be followed by implementation of effective interventions capable of overcoming barriers (cognitive, behavioral and affective) preventing attitude changes in both physicians and patients.
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Zhao WS, Zhai JJ, Wang YH, Xie PS, Yin XJ, Li LX, Cheng KL. Conjugated linoleic acid supplementation enhances antihypertensive effect of ramipril in Chinese patients with obesity-related hypertension. Am J Hypertens 2009; 22:680-6. [PMID: 19300423 DOI: 10.1038/ajh.2009.56] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Conjugated linoleic acid (CLA) refers to a group of positional and geometrical conjugated dienoic isomers of linoleic acid. Our aim was to investigate the effect of 8-week dietary CLA supplementation on blood pressure, concentrations of plasma adiponecin, leptin, and as well as angiotensin-converting enzyme (ACE) activity in obese hypertensive subjects. METHODS Eighty obese individuals with stage 1 uncontrolled essential hypertension were randomized in a double-blind, placebo-controlled trial. Participants were randomized to a daily dose of 4.5 g/day CLA (nine 0.5-g capsules; a 50:50 isomer blend of c 9,t 11 and t 10,c 12 CLA) with 37.5 mg/day ramipril (group 1) or placebo with 37.5 mg/day ramipril (group 2) for 8 weeks. Baseline and endpoint systolic BP, diastolic BP, and concentrations of plasma adiponecin, leptin, angiotensinogen, and ACE activity were measured. RESULTS Treatment with CLA significantly enhanced the reduction effect of ramipril on systolic BP and diastolic BP (P < 0.05). It also increased plasma adiponectin concentration (P < 0.05) and decreased plasma concentrations of leptin and angiotensinogen (P < 0.05); however, significant change was not observed in ACE activity. CONCLUSIONS An 8-week long supplementation of CLA enhanced the effect of ramipril on blood pressure reduction in treated obese hypertensive patients. The antihypertensive effect of CLA might be related to the changed secretion of hypertensive adipocytokines in plasma.
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Enfermedades cardiometabólicas en Iberoamérica: papel de la programación fetal en respuesta a la desnutrición materna. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71334-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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