1
|
Martinis O, Čoklo M, Aladrović J, Belavić A, Missoni S. ANTHROPOMETRIC MEASUREMENTS, DIETARY HABITS, SERUM LIPID AND GLUCOSE LEVELS IN RELATION TO HIGH BLOOD PRESSURE AMONG ADOLESCENT BOYS AND GIRLS IN CROATIA. Acta Clin Croat 2020; 59:672-685. [PMID: 34285438 PMCID: PMC8253067 DOI: 10.20471/acc.2020.59.04.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
The aim was to determine differences in anthropometric measurements, dietary habits, serum lipid and glucose levels in relation to high blood pressure (BP) among adolescent boys and girls in Croatia. The specific aim was to determine the effect of dietary habits and lifestyle on high BP in adolescents according to sex. The study included 260 (68.2%) adolescent girls and 121 (31.8%) boys with anthropometric data obtained (without missing values) from 246 girls and 111 boys. Participants answered questions from the questionnaire and anthropometric BP and blood test values were obtained. Non-parametric tests were used in analyses of reference intervals of systolic and diastolic BP in adolescent boys and girls according to age. High BP was defined as ≥90th percentile for adolescent girls and boys, with a value of ≥135/87.5 mm Hg. Mann-Whitney U test was used to analyze differences in anthropometric and laboratory values between the groups of girls and boys with high (≤90th percentile) and normal BP. Increase in systolic and diastolic BP was noted in the adolescents. In girls, BP values showed a decreasing systolic and increasing diastolic BP trend with age. Girls with high BP had a significantly higher body mass index (BMI) (p=0.020), waist circumference (WC) (p=0.002), waist-to-height ratio (WHtR) (p=0.016), waist-to-hip ratio (WHR) (p=0.043), hip circumference (HC) (p=0.015), triglyceride (TG) levels (p=0.021), higher prevalence of unhealthy diet at school breakfast (p=0.008) and lower prevalence of eating fish (p=0.02). Boys with high BP had a significantly higher BMI (p=0.045), WC (p=0.004), WHtR (p=0.017), WHR (p=0.022) and higher prevalence of eating meat products (p=0.015). Effective health interventions are needed to reduce the risk of developing cardiovascular diseases and preventing age-related illness.
Collapse
Affiliation(s)
| | - Miran Čoklo
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Jasna Aladrović
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Anja Belavić
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| | - Saša Missoni
- 1Croatian Education and Teacher Training Agency, Zagreb, Croatia; 2Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, Croatia; 3University of Zagreb, Faculty of Veterinary Medicine, Zagreb, Croatia; 4Croatian Institute of Public Health, Zagreb, Croatia; 5Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 6Institute for Anthropological Research, Zagreb, Croatia
| |
Collapse
|
2
|
Castro-Correia C, Santos-Silva R, Pinheiro M, Costa C, Fontoura M. Metabolic risk factors in adolescent girls with type 1 diabetes. J Pediatr Endocrinol Metab 2018; 31:631-635. [PMID: 29750655 DOI: 10.1515/jpem-2018-0053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of pediatric metabolic syndrome (MS) has progressively increased. The incidence of type 1 diabetes mellitus (T1DM) has also increased. Thus, some children and adolescents with T1DM exhibit MS parameters. The aim of the study was to evaluate the presence of MS parameters in female adolescents with T1DM based on their nutritional status. METHODS We evaluated 44 adolescents with T1DM (consecutive non-randomized sample) aged between 14 and 18 years, who were on intensive therapy with insulin. Patients were subdivided according to their body mass index (BMI). Variables evaluated include: age, age at diagnosis, weight, height, BMI, abdominal circumference, blood pressure, glycated hemoglobin (HbA1c), abdominal and pelvic ultrasound and lipoprotein profile. Gynecological history data were also collected. RESULTS Lipid profile changes were identified in 32% of overweight or obese girls and in 23% of those with an adequate weight. Hypertension (HT) was observed in 19% of overweight or obese girls and in 14% of those with a BMI≥85th percentile (Pc). The only statistically significant difference between the groups was the presence of abdominal adiposity. All other features, including the presence of dyslipidemia, HT, abdominal adiposity, non-alcoholic steatohepatitis (NASH) and polycystic ovarian syndrome (PCOS), were present in both groups. CONCLUSIONS Although being overweight and/or obese aggravates the risk of cardiovascular disease, MS is already present in many young adolescents with T1DM of normal weight. It is necessary that MS risk factors are routinely evaluated in all diabetic adolescents, including those with an adequate BMI.
Collapse
Affiliation(s)
- Cíntia Castro-Correia
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
| | - Rita Santos-Silva
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
| | - Marta Pinheiro
- Pediatric Service, São João Integrated Pediatric Hospital, Alameda Hernâni Monteiro, Porto, Portugal
| | - Carla Costa
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
| | - Manuel Fontoura
- Pediatric Endocrinology Unit, Pediatrics Service, São João Integrated Pediatric Hospital, Alameda Hernani Monteiro, University of Porto Medical School, Porto, Portugal
| |
Collapse
|
3
|
Póvoa TIR, Jardim TV, Carneiro CDS, Ferreira VR, Mendonça KL, Morais PRSD, Nascente FMN, Souza WKSBD, Sousa ALL, Jardim PCBV. Home Blood Pressure Monitoring as an Alternative to Confirm Diagnoses of Hypertension in Adolescents with Elevated Office Blood Pressure from a Brazilian State Capital. Arq Bras Cardiol 2017; 109:241-247. [PMID: 28793045 PMCID: PMC5586231 DOI: 10.5935/abc.20170114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/12/2017] [Indexed: 01/23/2023] Open
Abstract
Background Regional differences of using home blood pressure monitoring (HBPM) as an
alternative to ambulatory blood pressure monitoring (ABPM) in hypertensive
adolescents are unknown. Objectives Define if HBPM is an option to confirm diagnoses of hypertension in
adolescents from a Brazilian capital with elevated office blood pressure
(BP). Methods Adolescents (12-18years) from public and private schools with BP > 90th
percentile were studied to compare and evaluate the agreement among office
BP measurements, HBPM and ambulatory BP monitoring. Office BP measurements,
HBPM and ABPM were performed according to guidelines recommendations.
Semi-automatic devices were used for BP measurements. Values of p < 0.05
were considered significant. Results We included 133 predominantly males (63.2%) adolescents with a mean age of
15±1.6 years. HBPM systolic blood pressure and diastolic blood
pressure mean values were similar to the daytime ABPM values (120.3 ±
12.6 mmHg x 121.5 ± 9.8 mmHg - p = 0.111 and 69.4 ± 7.7 mmHg x
70.2 ± 6.6 mmHg - p = 0.139) and lower than the office measurement
values (127.3 ± 13.8 mmHg over 74.4 ± 9.5 mmHg - p <
0,001). The Bland-Altman plots showed good agreement between HBPM and
ABPM. Conclusions HBPM is an option to confirm diagnoses of hypertension in adolescents from a
Brazilian state capital with elevated office BP and can be used as an
alternative to ABPM.
Collapse
Affiliation(s)
- Thaís Inacio Rolim Póvoa
- Liga de Hipertensão Arterial - Universidade Federal de Goiás, Goiânia, GO - Brazil.,Escola Superior de Educação Física e Fisioterapia de Goiás (ESEFFEGO) - Universidade Estadual de Goiás (UEG), Goiânia, GO - Brazil
| | - Thiago Veiga Jardim
- Liga de Hipertensão Arterial - Universidade Federal de Goiás, Goiânia, GO - Brazil
| | | | | | | | | | | | | | - Ana Luiza Lima Sousa
- Liga de Hipertensão Arterial - Universidade Federal de Goiás, Goiânia, GO - Brazil
| | | |
Collapse
|
4
|
Giacchi V, Timpanaro T, Lo Presti D, Passanisi S, Mattia C, Betta P, Grasso C, Caruso M, Sciacca P. Prehypertension in adolescents with cardiovascular risk: a comparison between type 1 diabetic patients and overweight subjects. BMC Res Notes 2016; 9:122. [PMID: 26911143 PMCID: PMC4766686 DOI: 10.1186/s13104-016-1839-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/06/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Adolescents with type 1 diabetes and obesity present higher cardiovascular risk and ambulatory blood pressure measurements (ABPM) has been shown to predict vascular events, especially by identifying the nondipper status. The aim of our observational cross-sectional study conducted in adolescents with type 1 diabetes, overweight subjects and healthy controls was to assess mean blood pressure parameters to identify subclinical cardiovascular risk. METHODS The study included adolescents patients with type 1 diabetes followed in our Pediatric Department in University of Catania between January 2011 and 2013. A total of 60 patients were enrolled, and 48 (32 male and 16 female) completed the study. For each subject we performed systolic and diastolic Ambulatory Blood Pressure Measurements (ABPM) during wakefulness and sleep recording blood pressure every 30 min for 24 h with the Tonoport V/2 GE CardioSoft V6.51 device. We compared the data of patients with those of overweight subjects and healthy controls. RESULTS ABPM revealed no significant difference between type 1 diabetic patients and overweight subjects in 24 h Systolic, 24 h Diastolic, Day-time Systolic, Night-time systolic and Day-time Diastolic blood pressure values but significantly different values in Night-time Diastolic blood pressure values (p < 0.001). We found significant differences between type 1 diabetic patients and healthy controls in all 24 h Systolic (p < 0.001), 24 h Diastolic (p < 0.01), Day-time Systolic (p < 0.01), Night-time Systolic (p < 0.001), Day-time Diastolic (p < 0.05) and Night-time Diastolic (p < 0.001) blood pressure values. We detected hypertension in 12/48 (25%) type 1 diabetic patients and in 10/48 overweight subjects (p = 0.62; OR 1.2; CI 0.48-3.29), whereas no-one of healthy controls presented hypertension (p < 0.001). We observed nondipper pattern in 40/48 (83.3%) type 1 diabetic patients, in 33/48 (68.8%) overweight subjects (p = 0.094; OR 2.27; CI 0.85-6.01), and in 16/48 (33.3%) of healthy controls (p < 0.001; OR 10; CI 3.79-26.3). CONCLUSIONS ABPM studies might help to define a subset of patients at increased risk for the development of hypertension. In evaluating blood pressure in type 1 diabetes and overweight subjects, ABPM should be used since a reduced dipping can indicate incipient hypertension.
Collapse
Affiliation(s)
- Valentina Giacchi
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Tiziana Timpanaro
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Donatella Lo Presti
- Pediatric Endocrinology, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Stefano Passanisi
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Carmine Mattia
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Pasqua Betta
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Chiara Grasso
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Manuela Caruso
- Pediatric Endocrinology, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| | - Pietro Sciacca
- Pediatric Cardiology, AOU Policlinico-Vittorio Emanuele, via Santa Sofia 78, 95123, Catania, Italy.
| |
Collapse
|
5
|
Jurko A, Minarik M, Jurko T, Tonhajzerova I. White coat hypertension in pediatrics. Ital J Pediatr 2016; 42:4. [PMID: 26786497 PMCID: PMC4717664 DOI: 10.1186/s13052-016-0213-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/10/2016] [Indexed: 02/07/2023] Open
Abstract
The article summarizes current information on blood pressure changes in children during clinic visit. White coat as a general dressing of physicians and health care personnel has been widely accepted at the end of the 19th century. Two problems can be associated with the use of white coat: white coat phenomenon and white coat hypertension. Children often attribute pain and other unpleasant experience to the white coat and refuse afterwards cooperation with examinations. Definition of white coat hypertension in the literature is not uniform. It has been defined as elevated blood pressure in the hospital or clinic with normal blood pressure at home measured during the day by ambulatory blood pressure monitoring system. White coat effect is defined as temporary increase in blood pressure before and during visit in the clinic, regardless what the average daily ambulatory blood pressure values are. Clinical importance of white coat hypertension is mainly because of higher risk for cardiovascular accidents that are dependent on end organ damage (heart, vessels, kidney). Current data do not allow any clear recommendations for the treatment. Pharmacological therapy is usually started in the presence of hypertrophic left ventricle, changes in intimal/medial wall thickness of carotic arteries, microalbuminuria and other cardiovascular risk factors. Nonpharmacological therapy is less controversial and certainly more appropriate. Patients have to change their life style, need to eliminate as much cardiovascular risk factors as possible and sustain a regular blood pressure monitoring.
Collapse
Affiliation(s)
- Alexander Jurko
- Pediatric Cardiology Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 03601, Martin, Slovak Republic.
| | - Milan Minarik
- Faculty of Health Care, Catholic University in Ruzomberok, Ruzomberok, Slovak Republic.
| | - Tomas Jurko
- Department of Neonatology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
| | - Ingrid Tonhajzerova
- Department of Physiology and Martin Centre for Biomedicine (BioMed), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
| |
Collapse
|
6
|
Lee H, Kong YH, Kim KH, Huh J, Kang IS, Song J. Left ventricular hypertrophy and diastolic function in children and adolescents with essential hypertension. Clin Hypertens 2015; 21:21. [PMID: 26893931 PMCID: PMC4750793 DOI: 10.1186/s40885-015-0031-8] [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] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Left ventricular hypertrophy and diastolic dysfunction in children and adolescents with essential hypertension tend to be underdiagnosed. The aims of this study were to investigate left ventricular hypertrophy and diastolic dysfunction in the subjects with essential hypertension defined by ambulatory blood pressure monitoring. Methods A total of 38 Korean subjects aged 9–19 years without secondary causes of hypertension were reviewed. Ambulatory blood pressure monitoring was done in the 38 subjects to diagnose hypertension and gain the information of blood pressure pattern. The subjects were divided into two groups: a group with elevated blood pressure (BP) index (n = 29) and a group with normal BP index (n = 9). Two-dimensional ultrasound with M-mode imaging and tissue Doppler imaging were performed to measure left ventricular mass index and to assess the left ventricular diastolic dysfunction. Results Left ventricular mass index(g/m2.7) was significantly higher in the group with elevated BP index than the group with normal BP index, but there were no differences in left ventricular diastolic dysfunction evaluated by E/A ratio and E/E’ ratio. Left ventricular mass index was related only with body mass index, while any of the ambulatory blood pressure monitoring parameters did not predict left ventricular hypertrophy. In terms of diastolic dysfunction in essential hypertension, E/E’ ratio in the subjects with left ventricular hypertrophy was higher than that in the other subjects without left ventricular hypertrophy. Discussion Left ventricular mass index is significantly correlated with body mass index in children and adolescents with essential hypertension, and the diastolic dysfunction could be in higher risk in subjects with left ventricular hypertrophy.
Collapse
Affiliation(s)
- Heirim Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 South Korea
| | - Young-Hwa Kong
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 South Korea
| | - Kyung-Hee Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 South Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 South Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 South Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710 South Korea
| |
Collapse
|
7
|
Barbiero SM, D'Azevedo Sica C, Schuh DS, Cesa CC, de Oliveira Petkowicz R, Pellanda LC. Overweight and obesity in children with congenital heart disease: combination of risks for the future? BMC Pediatr 2014; 14:271. [PMID: 25323400 PMCID: PMC4287310 DOI: 10.1186/1471-2431-14-271] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Children who have unhealthy lifestyles are predisposed to develop hypertension, dyslipidemia and other complications. The epidemic of obesity is also affecting children with congenital heart disease. The aim of this study is to estimate the prevalence of obesity and describe associated risk factors, including family history in children with congenital heart disease. Methods A cross-sectional study with 316 children and adolescents with congenital heart disease seen in an outpatient clinic of a reference hospital. Collected sociodemographic data included family history of chronic disease, dietary habits, laboratory tests (total cholesterol, HDL and LDL/cholesterol, triglycerides, fasting glucose, CRP, hematocrit and hemoglobin), and anthropometric assessment. Anthropometric data of the caregivers was self-reported. Results The prevalence of excess weight was 26.9%. Altered levels of total cholesterol were observed in 46.9%, of HDL in 32.7%, LDL in 23.6% and of triglycerides levels in 20.0%. A higher frequency of family history of obesity (42.6%; p = 0.001), dyslipidemia (48.1%; p = <0.001), diabetes (47.4%; p = 0.002), hypertension (39.2%; p = 0.006) and ischemic disease (43.7%; p = 0.023), as well as significantly higher values of triglycerides (p = 0.017), glycemia (p = 0.004) and C-reactive protein (p = 0.002) were observed among patients with excess weight. Conclusion The presence of modifiable risk factors and the variables associated to excess weight in this population was similar to that described in the literature for children without congenital disease. As these children already present the risks associated to heart disease, it is particularly important to promote a healthy lifestyle in this group.
Collapse
Affiliation(s)
| | | | | | | | | | - Lucia Campos Pellanda
- Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
| |
Collapse
|
8
|
Rurik I, Torzsa P, Ilyés I, Szigethy E, Halmy E, Iski G, Kolozsvári LR, Mester L, Móczár C, Rinfel J, Nagy L, Kalabay L. Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians. BMC FAMILY PRACTICE 2013; 14:156. [PMID: 24138355 PMCID: PMC3853764 DOI: 10.1186/1471-2296-14-156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/15/2013] [Indexed: 12/02/2022]
Abstract
Background Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. Methods The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. Results The knowledge about multimorbidity, a main consequence of obesity was balanced. Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue. There were wider differences regarding attitudes and practice, influenced by the the doctors’ age, gender, known BMI, previous qualification, less by working location. GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77% vs 68%). They measured their patients’ waist circumference and waist/hip ratio (72% vs 62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors. Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65% vs 44%) and offered dietary records for patients significantly more frequently (65% vs 52%). Most of the younger doctors agreed that obesity management was a primary care issue. Doctors in the normal BMI range were unanimous that they should be a model for their patients (94% vs 81%). Conclusion More education of primary care physicians, available practical guidelines and higher community involvement are needed to improve the obesity management in Hungary.
Collapse
Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, Medical and Health Science Center, University of Debrecen, Nagyerdei krt, 98, 4032, Debrecen, Hungary.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Primary care of patients with high cardiovascular risk : Blood pressure, lipid and diabetic target levels and their achievement in Hungary. Wien Klin Wochenschr 2013; 125:371-80. [PMID: 23824265 DOI: 10.1007/s00508-013-0379-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 05/12/2013] [Indexed: 12/19/2022]
Abstract
Cardiovascular diseases are responsible for the majority of premature deaths in Hungary as well. Most of them could be prevented with healthy lifestyle of patients and adequate drug prescription of primary care physicians. Earlier European surveys found wide differences between the practices and achievements of different countries in this field. The study was based on and designed according to the framework of previous European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) studies and aimed presenting Hungarian results and comparing with the achievements of other countries and previous Hungarian surveys. Among rural and urban settings, 679 patients under continuous care (236 diabetics, 218 with dyslipidaemia, and 225 with hypertension) were consecutively selected by 20 experienced general practitioners. The mean age of patients was 60.3 years (men) and 64.0 years (women). Among diabetics, less than 7 % of glycated hemoglobin (HbA1c) values were found in 42.5 % patients, while only 11.4 % patients had fasting plasma sugar less than 6.0 mmol/L. Of the patients treated for dyslipidaemia, the target level of triglyceride was reached by 40.6 %, recommended total cholesterol by 14.2 % and the HDL-cholesterol by 71.8 %. The therapeutic control of total and HDL-cholesterol was better in men, although women had better triglyceride values. The achievement among patients with hypertension was 42.0 %. Significantly higher blood pressure was measured by patients who were treated with not recommended combinations of antihypertensive medication. A remarkable improvement could be observed in Hungary in the field of secondary prevention. It was greater among patients with hypertension and dyslipidaemia and smaller in diabetes care. Compared to the results of published European surveys, Hungary occupies a good position, but further improvement is still required.
Collapse
|
10
|
Yates KF, Sweat V, Yau PL, Turchiano MM, Convit A. Impact of metabolic syndrome on cognition and brain: a selected review of the literature. Arterioscler Thromb Vasc Biol 2012; 32:2060-7. [PMID: 22895667 PMCID: PMC3442257 DOI: 10.1161/atvbaha.112.252759] [Citation(s) in RCA: 301] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Metabolic syndrome (MetS), a clustering of risk factors for type 2 diabetes mellitus and cardiovascular disease, has been associated with cognitive dysfunction and brain abnormalities. This review describes the literature on the impact of MetS on brain and cognition and suggests directions for future research. A literature search for reports of MetS and cognition and brain imaging was conducted for both nonelderly adults and adolescents. No studies were found describing MetS and brain or cognition among adolescents; therefore, we also included studies investigating individual components of MetS in this age group. Most studies found associations between MetS and cognitive dysfunction. Multiple cognitive domains were affected by MetS in adults. In adolescents, the majority of findings were in executive functioning. Brain imaging literature in adults implicated MetS in ischemic stroke, white matter alterations, and altered brain metabolism. For adolescents, individual MetS factors were linked to volume losses in the hippocampus and frontal lobes. MetS negatively impacts cognitive performance and brain structure. Potential explanatory models include impaired vascular reactivity, neuroinflammation, oxidative stress, and abnormal brain lipid metabolism. We posit that insulin resistance-associated impairment in cerebrovascular reactivity is an important mechanism underlying brain deficits seen in MetS.
Collapse
Affiliation(s)
- Kathy F. Yates
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Orangeburg, NY 10962 USA
| | - Victoria Sweat
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Po Lai Yau
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Michael M. Turchiano
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
- Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY 10016 USA
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Orangeburg, NY 10962 USA
| |
Collapse
|