1
|
Gallegos-Cabriales EC, Rodriguez-Ayala E, Laviada-Molina HA, Nava-Gonzalez EJ, Salinas-Osornio RA, Orozco L, Leal-Berumen I, Castillo-Pineda JC, Gonzalez-Lopez L, Escudero-Lourdes C, Cornejo-Barrera J, Escalante-Araiza F, Huerta-Avila EE, Buenfil-Rello FA, Peschard VG, Silva E, Veloz-Garza RA, Martinez-Hernandez A, Barajas-Olmos FM, Molina-Segui F, Gonzalez-Ramirez L, Arjona-Villicaña RD, Hernandez-Escalante VM, Gaytan-Saucedo JF, Vaquera Z, Acebo-Martinez M, Murillo-Ramirez A, Diaz-Tena SP, Figueroa-Nuñez B, Valencia-Rendon ME, Garzon-Zamora R, Viveros-Paredes JM, Valdovinos-Chavez SB, Comuzzie AG, Haack K, Thorsell AA, Han X, Cole SA, Bastarrachea RA. Replication of Integrative Data Analysis for Adipose Tissue Dysfunction, Low-Grade Inflammation, Postprandial Responses and OMICs Signatures in Symptom-Free Adults. BIOLOGY 2021; 10:1342. [PMID: 34943258 PMCID: PMC8698545 DOI: 10.3390/biology10121342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
We previously reported preliminary characterization of adipose tissue (AT) dysfunction through the adiponectin/leptin ratio (ALR) and fasting/postprandial (F/P) gene expression in subcutaneous (SQ) adipose tissue (AT) biopsies obtained from participants in the GEMM study, a precision medicine research project. Here we present integrative data replication of previous findings from an increased number of GEMM symptom-free (SF) adults (N = 124) to improve characterization of early biomarkers for cardiovascular (CV)/immunometabolic risk in SF adults with AT dysfunction. We achieved this goal by taking advantage of the rich set of GEMM F/P 5 h time course data and three tissue samples collected at the same time and frequency on each adult participant (F/P blood, biopsies of SQAT and skeletal muscle (SKM)). We classified them with the presence/absence of AT dysfunction: low (<1) or high (>1) ALR. We also examined the presence of metabolically healthy (MH)/unhealthy (MUH) individuals through low-grade chronic subclinical inflammation (high sensitivity C-reactive protein (hsCRP)), whole body insulin sensitivity (Matsuda Index) and Metabolic Syndrome criteria in people with/without AT dysfunction. Molecular data directly measured from three tissues in a subset of participants allowed fine-scale multi-OMIC profiling of individual postprandial responses (RNA-seq in SKM and SQAT, miRNA from plasma exosomes and shotgun lipidomics in blood). Dynamic postprandial immunometabolic molecular endophenotypes were obtained to move towards a personalized, patient-defined medicine. This study offers an example of integrative translational research, which applies bench-to-bedside research to clinical medicine. Our F/P study design has the potential to characterize CV/immunometabolic early risk detection in support of precision medicine and discovery in SF individuals.
Collapse
Affiliation(s)
- Esther C. Gallegos-Cabriales
- Facultad de Enfermería, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico; (E.C.G.-C.); (R.A.V.-G.); (S.B.V.-C.)
| | - Ernesto Rodriguez-Ayala
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Norte, Lomas Anahuac 52786, Mexico; (E.R.-A.); (F.E.-A.); (V.-G.P.); (E.S.)
| | - Hugo A. Laviada-Molina
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Mérida 97300, Mexico; (H.A.L.-M.); (F.M.-S.); (L.G.-R.); (R.D.A.-V.); (V.M.H.-E.)
| | | | - Rocío A. Salinas-Osornio
- Departamento de Nutrición, Universidad del Valle de Atemajac (UNIVA), Zapopan 45050, Mexico; (R.A.S.-O.); (L.G.-L.); (M.E.V.-R.); (R.G.-Z.); (J.M.V.-P.)
| | - Lorena Orozco
- Laboratorio de Inmunogenómica y Enfermedades Metabólicas, Instituto Nacional de Medicina Genómica, SS, Ciudad de México 14610, Mexico; (L.O.); (E.E.H.-A.); (A.M.-H.); (F.M.B.-O.)
| | - Irene Leal-Berumen
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua 31125, Mexico;
| | - Juan Carlos Castillo-Pineda
- Departamento de Nutrición Humana, Universidad Latina de América, Morelia 58170, Mexico; (J.C.C.-P.); (A.M.-R.); (S.P.D.-T.)
| | - Laura Gonzalez-Lopez
- Departamento de Nutrición, Universidad del Valle de Atemajac (UNIVA), Zapopan 45050, Mexico; (R.A.S.-O.); (L.G.-L.); (M.E.V.-R.); (R.G.-Z.); (J.M.V.-P.)
| | - Claudia Escudero-Lourdes
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi 78240, Mexico; (C.E.-L.); (M.A.-M.)
| | - Judith Cornejo-Barrera
- Departamento de Enseñanza, Postgrado e Investigación, Hospital Infantil de Tamaulipas, Ciudad Victoria 87150, Mexico;
| | - Fabiola Escalante-Araiza
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Norte, Lomas Anahuac 52786, Mexico; (E.R.-A.); (F.E.-A.); (V.-G.P.); (E.S.)
- Laboratorio de Inmunogenómica y Enfermedades Metabólicas, Instituto Nacional de Medicina Genómica, SS, Ciudad de México 14610, Mexico; (L.O.); (E.E.H.-A.); (A.M.-H.); (F.M.B.-O.)
| | - Eira E. Huerta-Avila
- Laboratorio de Inmunogenómica y Enfermedades Metabólicas, Instituto Nacional de Medicina Genómica, SS, Ciudad de México 14610, Mexico; (L.O.); (E.E.H.-A.); (A.M.-H.); (F.M.B.-O.)
| | - Fatima A. Buenfil-Rello
- Population Health Program, Southwest National Primate Research Center (SNPRC), Texas Biomedical Research Institute, San Antonio, TX 78227-0549, USA; (F.A.B.-R.); (J.F.G.-S.); (Z.V.); (K.H.); (S.A.C.)
| | - Vanessa-Giselle Peschard
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Norte, Lomas Anahuac 52786, Mexico; (E.R.-A.); (F.E.-A.); (V.-G.P.); (E.S.)
| | - Eliud Silva
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac Norte, Lomas Anahuac 52786, Mexico; (E.R.-A.); (F.E.-A.); (V.-G.P.); (E.S.)
| | - Rosa A. Veloz-Garza
- Facultad de Enfermería, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico; (E.C.G.-C.); (R.A.V.-G.); (S.B.V.-C.)
| | - Angelica Martinez-Hernandez
- Laboratorio de Inmunogenómica y Enfermedades Metabólicas, Instituto Nacional de Medicina Genómica, SS, Ciudad de México 14610, Mexico; (L.O.); (E.E.H.-A.); (A.M.-H.); (F.M.B.-O.)
| | - Francisco M. Barajas-Olmos
- Laboratorio de Inmunogenómica y Enfermedades Metabólicas, Instituto Nacional de Medicina Genómica, SS, Ciudad de México 14610, Mexico; (L.O.); (E.E.H.-A.); (A.M.-H.); (F.M.B.-O.)
| | - Fernanda Molina-Segui
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Mérida 97300, Mexico; (H.A.L.-M.); (F.M.-S.); (L.G.-R.); (R.D.A.-V.); (V.M.H.-E.)
| | - Lucia Gonzalez-Ramirez
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Mérida 97300, Mexico; (H.A.L.-M.); (F.M.-S.); (L.G.-R.); (R.D.A.-V.); (V.M.H.-E.)
| | - Ruy D. Arjona-Villicaña
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Mérida 97300, Mexico; (H.A.L.-M.); (F.M.-S.); (L.G.-R.); (R.D.A.-V.); (V.M.H.-E.)
| | - Victor M. Hernandez-Escalante
- Escuela de Ciencias de la Salud, Universidad Marista de Mérida, Mérida 97300, Mexico; (H.A.L.-M.); (F.M.-S.); (L.G.-R.); (R.D.A.-V.); (V.M.H.-E.)
| | - Janeth F. Gaytan-Saucedo
- Population Health Program, Southwest National Primate Research Center (SNPRC), Texas Biomedical Research Institute, San Antonio, TX 78227-0549, USA; (F.A.B.-R.); (J.F.G.-S.); (Z.V.); (K.H.); (S.A.C.)
| | - Zoila Vaquera
- Population Health Program, Southwest National Primate Research Center (SNPRC), Texas Biomedical Research Institute, San Antonio, TX 78227-0549, USA; (F.A.B.-R.); (J.F.G.-S.); (Z.V.); (K.H.); (S.A.C.)
| | - Monica Acebo-Martinez
- Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosi 78240, Mexico; (C.E.-L.); (M.A.-M.)
| | - Areli Murillo-Ramirez
- Departamento de Nutrición Humana, Universidad Latina de América, Morelia 58170, Mexico; (J.C.C.-P.); (A.M.-R.); (S.P.D.-T.)
| | - Sara P. Diaz-Tena
- Departamento de Nutrición Humana, Universidad Latina de América, Morelia 58170, Mexico; (J.C.C.-P.); (A.M.-R.); (S.P.D.-T.)
| | - Benigno Figueroa-Nuñez
- Clínica de Enfermedades Crónicas y Procedimientos Especiales (CECYPE), Morelia 58249, Mexico;
| | - Melesio E. Valencia-Rendon
- Departamento de Nutrición, Universidad del Valle de Atemajac (UNIVA), Zapopan 45050, Mexico; (R.A.S.-O.); (L.G.-L.); (M.E.V.-R.); (R.G.-Z.); (J.M.V.-P.)
| | - Rafael Garzon-Zamora
- Departamento de Nutrición, Universidad del Valle de Atemajac (UNIVA), Zapopan 45050, Mexico; (R.A.S.-O.); (L.G.-L.); (M.E.V.-R.); (R.G.-Z.); (J.M.V.-P.)
| | - Juan Manuel Viveros-Paredes
- Departamento de Nutrición, Universidad del Valle de Atemajac (UNIVA), Zapopan 45050, Mexico; (R.A.S.-O.); (L.G.-L.); (M.E.V.-R.); (R.G.-Z.); (J.M.V.-P.)
| | - Salvador B. Valdovinos-Chavez
- Facultad de Enfermería, Universidad Autónoma de Nuevo León (UANL), Monterrey 64460, Mexico; (E.C.G.-C.); (R.A.V.-G.); (S.B.V.-C.)
| | | | - Karin Haack
- Population Health Program, Southwest National Primate Research Center (SNPRC), Texas Biomedical Research Institute, San Antonio, TX 78227-0549, USA; (F.A.B.-R.); (J.F.G.-S.); (Z.V.); (K.H.); (S.A.C.)
| | | | - Xianlin Han
- Department of Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health San Antonio, San Antonio, TX 78229, USA;
| | - Shelley A. Cole
- Population Health Program, Southwest National Primate Research Center (SNPRC), Texas Biomedical Research Institute, San Antonio, TX 78227-0549, USA; (F.A.B.-R.); (J.F.G.-S.); (Z.V.); (K.H.); (S.A.C.)
| | - Raul A. Bastarrachea
- Population Health Program, Southwest National Primate Research Center (SNPRC), Texas Biomedical Research Institute, San Antonio, TX 78227-0549, USA; (F.A.B.-R.); (J.F.G.-S.); (Z.V.); (K.H.); (S.A.C.)
- Sansum Diabetes Research Institute, Santa Barbara, CA 93105, USA;
| |
Collapse
|
2
|
Rivas-Castro A, Leguísamo-Peñate I, Puello-Viloria Y. Estilo de vida en pacientes con Diabetes Mellitus tipo II de una institución de salud en Santa Marta, Colombia, 2017. DUAZARY 2020. [DOI: 10.21676/2389783x.3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Determinar el estilo de vida de los pacientes con diabetes mellitus tipo II de una institución de salud en la ciudad de santa marta. Estudio cuantitativo, descriptivo y transversal. Se describe la variable estilo de vida medido a través de siete dominios: nutrición, actividad física, consumo de tabaco, consumo de alcohol, información sobre diabetes, emociones y adherencia terapéutica, la muestra estuvo representada por 105 pacientes, que asistían a control en una institución de primer nivel de atención. Se evidencia que el 53% son mujeres, los pacientes se encuentran en edades de 18-35 años (9%), 36-59 años (44%) y mayor de 60 años (47%). El 55% de los pacientes manifiesta inadecuado estilo de vida, establecido esto por el consumo de alcohol (10%), algunos fuman (5%), y otros consumen alimentos entre comidas (60%); además refieren autoestima de media a baja, a la vez el 75% refiere buena adherencia al tratamiento. Los participantes de este estudio a pesar de tener conductas de responsabilidad de su salud, aún tienen conductas que modificar relacionados con el alcohol, cigarrillo y la nutrición como dominio predominante; esto es lo que determina un estilo de vida inadecuado.
Collapse
|
3
|
Geographic Variations in Intertrochanteric Femoral Fractures in China. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8396723. [PMID: 31772937 PMCID: PMC6854944 DOI: 10.1155/2019/8396723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022]
Abstract
Background Hip fracture is one of the major risk factors of global mortality and disability. The aim of this study was to map the pattern of intertrochanteric femoral fractures in China, providing a pilot national dataset and basis for medical policy proposals. Methods A multistage probability sampling strategy was applied in the national baseline survey. Thirty provinces in mainland China were included in this survey. A standardized questionnaire survey was conducted to collect information about basic characteristics such as age, working seniority, hospital level, and residence, with two other parts including perioperative and postoperative treatment parameters. Odds ratios and 95% confidence interval were used to determine essential statistical differences. The proportion of the options in each region was compared using the chi-square (χ 2) test. The histogram and choropleth map of the monthly number of admissions were created using Excel 2016 to show the distribution characteristics. Results In total, 1065 valid responses were included, representing a 96.7% survey capture rate. Perioperative treatment and postoperative care distinctly varied across regions and hospital levels. The monthly number of admissions was relatively lower in the Northern region, with higher proportion of hospitalizations to secondary hospitals compared with the Eastern region. The patients in the Eastern region or tertiary hospitals had shorter preoperative waiting time and hospitalization period. Conclusions We found apparent geographic variations in intertrochanteric femoral fractures in this study, and the data can be used for drafting national healthcare plans and medical policies.
Collapse
|
4
|
Roderick P, Turner V, Readshaw A, Dogar O, Siddiqi K. The global prevalence of tobacco use in type 2 diabetes mellitus patients: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 154:52-65. [PMID: 31202865 DOI: 10.1016/j.diabres.2019.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND A multi-layered association between tobacco use and type 2 diabetes mellitus (T2DM) is well established. However, global epidemiological patterns of tobacco use among T2DM patients are not well documented; this review thus aims to estimate the overall global burden of tobacco use in T2DM. METHODS A systematic review of studies published from Jan 1, 1990 to October 5, 2017 was undertaken, comprising: a comprehensive literature search on multiple electronic databases; quality assessment of studies; data extraction for the primary (prevalence of tobacco use in T2DM patients) and secondary outcomes (patterns of tobacco use in T2DM patients); and a meta-analysis. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A protocol for this review is available on PROSPERO (CRD42016038793). FINDINGS 74 studies were included in the review, reporting data from 3.2 million participants across 33 countries. Global mean prevalence of tobacco use in T2DM was 20·81% (95% CI 18·93-22·76), and was higher in the WHO East Asia and Pacific and South Asia regions, compared to the Americas, Middle East and North Africa, Europe and Central Asia. In studies which compared prevalence of tobacco use in patients to non-patients, patients with T2DM were 26% less likely to use tobacco (pooled OR = 0·74 (CI 0·61-0·88). INTERPRETATION Tobacco is used by one in five T2DM patients globally, but usage is less likely in patients than in non-patients. Global patterns of use demonstrated by this review have implications for both prevention and The understanding of diabetes burden, and the success of tobacco cessation strategies.
Collapse
Affiliation(s)
| | | | - Anne Readshaw
- Department of Health Sciences, University of York, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, United Kingdom
| |
Collapse
|
5
|
Arellano-Campos O, Gómez-Velasco DV, Bello-Chavolla OY, Cruz-Bautista I, Melgarejo-Hernandez MA, Muñoz-Hernandez L, Guillén LE, Garduño-Garcia JDJ, Alvirde U, Ono-Yoshikawa Y, Choza-Romero R, Sauque-Reyna L, Garay-Sevilla ME, Malacara-Hernandez JM, Tusie-Luna MT, Gutierrez-Robledo LM, Gómez-Pérez FJ, Rojas R, Aguilar-Salinas CA. Development and validation of a predictive model for incident type 2 diabetes in middle-aged Mexican adults: the metabolic syndrome cohort. BMC Endocr Disord 2019; 19:41. [PMID: 31030672 PMCID: PMC6486953 DOI: 10.1186/s12902-019-0361-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) is a leading cause of morbidity and mortality in Mexico. Here, we aimed to report incidence rates (IR) of type 2 diabetes in middle-aged apparently-healthy Mexican adults, identify risk factors associated to ID and develop a predictive model for ID in a high-risk population. METHODS Prospective 3-year observational cohort, comprised of apparently-healthy adults from urban settings of central Mexico in whom demographic, anthropometric and biochemical data was collected. We evaluated risk factors for ID using Cox proportional hazard regression and developed predictive models for ID. RESULTS We included 7636 participants of whom 6144 completed follow-up. We observed 331 ID cases (IR: 21.9 per 1000 person-years, 95%CI 21.37-22.47). Risk factors for ID included family history of diabetes, age, abdominal obesity, waist-height ratio, impaired fasting glucose (IFG), HOMA2-IR and metabolic syndrome. Early-onset ID was also high (IR 14.77 per 1000 person-years, 95%CI 14.21-15.35), and risk factors included HOMA-IR and IFG. Our ID predictive model included age, hypertriglyceridemia, IFG, hypertension and abdominal obesity as predictors (Dxy = 0.487, c-statistic = 0.741) and had higher predictive accuracy compared to FINDRISC and Cambridge risk scores. CONCLUSIONS ID in apparently healthy middle-aged Mexican adults is currently at an alarming rate. The constructed models can be implemented to predict diabetes risk and represent the largest prospective effort for the study metabolic diseases in Latin-American population.
Collapse
Affiliation(s)
- Olimpia Arellano-Campos
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 Mexico City, Mexico
| | - Donaji V. Gómez-Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 Mexico City, Mexico
| | - Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Ivette Cruz-Bautista
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 Mexico City, Mexico
| | - Marco A. Melgarejo-Hernandez
- Departamento de Endocrinología, Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Liliana Muñoz-Hernandez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 Mexico City, Mexico
| | - Luz E. Guillén
- Departamento de Endocrinología, Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Ulices Alvirde
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 Mexico City, Mexico
| | | | | | | | | | | | - Maria Teresa Tusie-Luna
- Unidad de Biología Molecular y Medicina Genómica, Instituto de Investigaciones Biomédicas, Mexico City, Mexico
| | | | - Francisco J. Gómez-Pérez
- Departamento de Endocrinología, Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rosalba Rojas
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos Mexico
| | - Carlos A. Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, 14000 Mexico City, Mexico
- Departamento de Endocrinología, Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| |
Collapse
|
6
|
Geiss LS, Bullard KM, Brinks R, Gregg EW. Considerations in Epidemiologic Definitions of Undiagnosed Diabetes. Diabetes Care 2018; 41:1835-1838. [PMID: 30135196 DOI: 10.2337/dc17-1838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/31/2018] [Indexed: 02/03/2023]
Abstract
Accurately quantifying undiagnosed type 2 diabetes is an important challenge for conducting diabetes surveillance and identifying the potential missed opportunities for preventing complications. However, there has been little focused attention on how undiagnosed diabetes is defined in epidemiologic surveys and how limitations in methods used to ascertain undiagnosed diabetes may impact our understanding of the magnitude of this important public health problem. This Perspective highlights weaknesses in how undiagnosed diabetes is quantified in epidemiologic research and the biases and caveats that should be considered when using estimates of undiagnosed diabetes to influence public health policy.
Collapse
Affiliation(s)
- Linda S Geiss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ralph Brinks
- German Diabetes Center, Institute for Biometry and Epidemiology, Duesseldorf, Germany
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
7
|
Castrejón-Pérez RC, Aguilar-Salinas CA, Gutiérrez-Robledo LM, Cesari M, Pérez-Zepeda MU. Frailty, diabetes, and the convergence of chronic disease in an age-related condition: a population-based nationwide cross-sectional analysis of the Mexican nutrition and health survey. Aging Clin Exp Res 2018; 30:935-941. [PMID: 29181767 DOI: 10.1007/s40520-017-0852-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/04/2017] [Indexed: 01/19/2023]
Abstract
AIMS To describe the associations of frailty with diabetes mellitus and related conditions in older adults. METHODS We conducted a cross-sectional analysis of a representative sample of older adults (n = 5379). We generated a 35-item frailty index (FI) and obtained information on diabetes and related conditions (peripheral neuropathy, lower limb amputation, diabetic coma, number of physician visits due to diabetes-related conditions, all-cause hospitalizations in the past year, years since diabetes diagnosis, and type of treatment). Logistic and Poisson regression models were used to determine the associations between frailty and diabetes and its complications. RESULTS The mean age was 70.3 years (± 7.8); 54.7% were women. Those with an FI ≤ 0.082 composed the reference group. Multivariate analysis showed an OR of 2.32 (95% CI 1.93-2.73, p < 0.001) for the association between diabetes and frailty. People who were hospitalized for any cause during the previous year, those receiving both insulin and an oral compound to manage diabetes, and those with peripheral neuropathy showed ORs of 2.32 (95% CI 1.69-3.18, p < 0.001), 5.6 (95% CI 1.58-19.8, p = 0.008), and 2.02 (95% CI 1.42-2.86, p < 0.001), respectively, for being in the most frail group. CONCLUSIONS People with diabetes have higher frailty scores. Furthermore, older adults with diabetes and higher burden of frailty have more diabetes-related complications.
Collapse
|
8
|
Villamil-Salcedo V, Vargas-Terrez BE, Caraveo-Anduaga J, González-Olvera J, Díaz-Anzaldúa A, Cortés-Sotres J, Pérez-Ávila M. Glucose and cholesterol stabilization in patients with type 2 diabetes mellitus with depressive and anxiety symptoms by problem-solving therapy in primary care centers in Mexico City. Prim Health Care Res Dev 2018; 19:33-41. [PMID: 28870280 PMCID: PMC6452974 DOI: 10.1017/s1463423617000512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/07/2017] [Accepted: 07/16/2017] [Indexed: 12/11/2022] Open
Abstract
Aim The aim of this study was to determine if the problem-solving therapy (PST) helps control metabolic variables in patients with type 2 diabetes mellitus (T2DM) who show depressive and anxiety symptoms. BACKGROUND T2DM is a chronic-degenerative multifactorial disease. It is considered one of the main public health problems in the world, and it represents an important social and economic burden. It is frequently associated with major depression and anxiety disorders, which are related with high glycated hemoglobin (HbA1c) concentrations and poor metabolic control. METHOD We initially included 123 patients diagnosed with T2DM from five primary care centers (PCC) in Mexico City. HbA1c, central glucose, and lipid profile were measured in each patient. In addition, the Kessler psychological distress scale (K-10), the Beck Depression Inventory, and the Beck Anxiety Inventory were applied at the beginning and, to those who continued, at the end of the PST, as well as four months later. Findings In total, 36 patients completed the PST and the follow-up. There was a significant decrease in depressive and anxiety symptoms (P<0.001), as well as in total cholesterol (P=0.002), HbA1c (P=0.05), and low-density lipoprotein (LDL) (P=0.022). The PST helps reduce depressive and anxiety symptoms and may help stabilize glucose and cholesterol up to four months. Further studies on this area are recommended. If our findings are confirmed, the PST could help improve the quality of life of thousands of individuals with psychiatric-metabolic co-morbidity who only visit PCC.
Collapse
Affiliation(s)
- Valerio Villamil-Salcedo
- Investigator from Department of Clinical Investigations Branch, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Blanca E. Vargas-Terrez
- Chief of Community Psychiatry Service from the Clinical Services Branch, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jorge Caraveo-Anduaga
- Investigator from the Epidemiology and Psychosocial Investigations Branch, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jorge González-Olvera
- Head of the Clinical Investigations Branch, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Adriana Díaz-Anzaldúa
- Investigator from Department of Genetics, Clinical Investigations Branch, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - José Cortés-Sotres
- Engineer, Department of Education, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Magdalena Pérez-Ávila
- M.D. Physician from Department of Clinical Investigations Branch, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| |
Collapse
|
9
|
Avilés-Santa ML, Colón-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Pérez CM. From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne) 2017; 8:298. [PMID: 29176960 PMCID: PMC5687125 DOI: 10.3389/fendo.2017.00298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.
Collapse
Affiliation(s)
- M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, United States
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Nangel M. Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francisco J. Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Cynthia M. Pérez
- University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
| |
Collapse
|
10
|
Bello-Chavolla OY, Rojas-Martinez R, Aguilar-Salinas CA, Hernández-Avila M. Epidemiology of diabetes mellitus in Mexico. Nutr Rev 2017; 75:4-12. [PMID: 28049745 DOI: 10.1093/nutrit/nuw030] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Type 2 diabetes is the main health problem in Mexico. The large and growing number of cases and the remarkable economic impact of the disease support this statement. The condition is expressed at an earlier age and at a lower body mass index in Mexican mestizos compared with the age and body mass index reported in Caucasians. In addition, Mexican mestizos have an increased susceptibility to developing diabetic nephropathy. The Mexican health system needs major adjustments in order to prevent and treat type 2 diabetes. Treatment is not currently based on the needs and expectations of the patient. As a result, it is insufficient, belated, and costly. Close to 20% of the preventable deaths in Mexico are caused by diabetes and related metabolic diseases. Even a small decrease in this rate could result in substantial savings for the Mexican healthcare system.
Collapse
Affiliation(s)
- Omar Y Bello-Chavolla
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rosalba Rojas-Martinez
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Mauricio Hernández-Avila
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| |
Collapse
|
11
|
Tapia-Conyer R, Saucedo-Martínez R, Mújica-Rosales R, Gallardo-Rincón H, Lee E, Waugh C, Guajardo L, Torres-Beltrán B, Quijano-González Ú, López-Mendez M, Atkinson ER. A Policy Analysis on the Proactive Prevention of Chronic Disease: Learnings from the Initial Implementation of Integrated Measurement for Early Detection (MIDO). Int J Health Policy Manag 2017; 6:339-344. [PMID: 28812826 PMCID: PMC5458795 DOI: 10.15171/ijhpm.2017.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/08/2017] [Indexed: 11/09/2022] Open
Abstract
Mexico, like many low- and middle-income countries (LMICs), faces an epidemic of chronic non-communicable diseases (NCDs), specifically diabetes, hypertension, obesity, and lipid disorders. Many people with these NCDs may not be aware that they have a disease, pointing to the need for broader screening programs. The traditional prevention policy in Mexico was based on screening with a paper-based risk factor questionnaire. However, this was used to screen patients already seeking healthcare services at facilities, and screening goals were set as a function of the number of questionnaires applied, not number of individuals screened. Due to this, Fundación Carlos Slim developed Medición Integrada para la Detección Oportuna (MIDOTM), or Integrated Measurement for Early Detection, an NCD screening and proactive prevention policy. This document is a policy analysis based on early learnings from the initial implementation of MIDO in eight primary healthcare centers in two central Mexican states. MIDO was found to expand screening programs beyond clinic walls, systematize community screening strategies, emphasize the detection of pre-disease phases, incorporate lifestyle counseling, and propose screening goals based on population targets. In collaboration with the Mexican Ministry of Health, MIDO has successfully screened over 500 000 individuals-about 40% of whom would not have been screened under previous policies. Of these more than 500 000 screened individuals, 13.4% had pre-diabetes (fasting glucose between 100 and 125 mg/dL), and 5.8% had undiagnosed diabetes (defined as fasting glucose above 126 mg/dL or random glucose above 200 mg/dL). However, there is still room for improvement in linking positive results from screening with disease confirmation and with patient incorporation into disease management. The experience of implementing MIDO in Mexico suggests that primary and secondary prevention programs in other parts of the world should consider the need for population-based screening targets, a greater focus on pre-disease stages, and the streamlining of the transition between screening, confirmation of diagnosis, and incorporation of patients into the healthcare system.
Collapse
Affiliation(s)
| | | | | | | | - Evan Lee
- Eli Lilly and Company, Lilly Global Health, Geneva, Switzerland
| | - Craig Waugh
- Lilly NCD Partnership, Indianapolis, IN, USA
| | | | | | | | | | | |
Collapse
|
12
|
Rivera-Hernandez M, Rahman M, Mor V, Galarraga O. The Impact of Social Health Insurance on Diabetes and Hypertension Process Indicators among Older Adults in Mexico. Health Serv Res 2017; 51:1323-46. [PMID: 27417264 DOI: 10.1111/1475-6773.12404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the impact of Seguro Popular (Mexican social health insurance for the poor; SP) on diabetes and hypertension care, intermediate process indicators for older adults (>50 years): pharmacological treatment, blood glucose tests, the use of complementary and alternative medicine (CAM), and adherence to their nutrition and exercise program. (CAM was defined as products or practices that were not part of the medical standard of care.) DATA SOURCES/STUDY SETTING Repeated cross-sectional surveys from Encuesta Nacional de Salud y Nutrición (Mexican Health and Nutrition Survey, ENSANUT), a nationally representative health and nutrition survey sampling N = 45,294 older adults in 2000, N = 45,241 older adults in 2005-2006, and N = 46,277 older adults in 2011-2012. STUDY DESIGN Fixed-effects instrumental variable (FE-IV) repeated cross-sectional at the individual level with municipality fixed-effects estimation was performed. PRINCIPAL FINDINGS We found a marginally significant effect of SP on the use of insulin and oral agents (40 percentage points). Contrary to that expected, no other significant differences were found for diabetes or hypertension treatment and care indicators. CONCLUSIONS Social health insurance for the poor improved some but not all health care process indicators among diabetic and hypertensive older people in Mexico.
Collapse
Affiliation(s)
| | - Momotazur Rahman
- Department of Health Services, Policy and Practice, Brown University, Providence, RI
| | - Vincent Mor
- Department of Health Services, Policy and Practice, Brown University, Providence, RI
| | - Omar Galarraga
- Department of Health Services, Policy and Practice, Brown University, Providence, RI
| |
Collapse
|
13
|
Córdova Villalobos JÁ. [Obesity: the real pandemic of the 21(st) century]. CIR CIR 2016; 84:351-5. [PMID: 27601182 DOI: 10.1016/j.circir.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
|
14
|
Peterson MD, McGrath R, Zhang P, Markides KS, Al Snih S, Wong R. Muscle Weakness Is Associated With Diabetes in Older Mexicans: The Mexican Health and Aging Study. J Am Med Dir Assoc 2016; 17:933-8. [PMID: 27450948 DOI: 10.1016/j.jamda.2016.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The risk of cardiovascular problems due to diabetes mellitus is highest among older Mexicans, and yet what remains to be determined is the association between muscle weakness and diabetes in this population. Therefore, the purpose of this study was to determine the association between muscle strength and diabetes among Mexican adults greater than 50 years of age. DESIGN Cross-sectional. SETTING National sample of households in both urban and rural areas. PARTICIPANTS A subsample of 1841 individuals aged 50 years and older was included from the 2012 Mexican Health and Aging Study. MEASUREMENTS Strength was assessed using a hand-held dynamometer, and the single largest reading from either hand was normalized to body mass (normalized grip strength [NGS]). Conditional inference tree analyses were used to identify sex-specific NGS weakness thresholds. Linear regression was used to examine the association between NGS and HbA1c, and logistic regression was used to assess the association between weakness and risk of diabetes (HbA1c ≥ 6.5% [≥48 mmol/mol]), after controlling for age, sex, and waist circumference. RESULTS NGS was inversely associated with HbA1c (β = -1.56; P < .001). Optimal sex-specific NGS weakness thresholds to detect diabetes were ≤0.46 and ≤0.30 for men and women, respectively. Weakness was associated with significantly increased odds of diabetes (odds ratio, 1.69; 95% confidence interval, 1.37-2.10), even after adjusting for age, sex, and waist circumference. CONCLUSIONS NGS was robustly associated with diabetes and other cardiometabolic risk factors in older Mexicans. This simple screen may serve as a valuable tool to identify adults that are at risk for negative health consequences or early mortality and who might benefit from lifestyle interventions to reduce risk.
Collapse
Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Ryan McGrath
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Peng Zhang
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Kyriakos S Markides
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, Department of Internal Medicine/Division of Geriatrics, University of Texas Medical Branch, Galveston, TX
| | - Rebeca Wong
- Sealy Center on Aging; Preventive Medicine & Community Health; WHO/PAHO Collaborating Center on Aging and Health, University of Texas Medical Branch, Galveston, TX
| |
Collapse
|
15
|
Salas A, Acosta D, Ferri CP, Guerra M, Huang Y, Jacob KS, Jimenez-Velazquez IZ, Llibre Rodriguez JJ, Sosa AL, Uwakwe R, Williams JD, Jotheeswaran AT, Liu Z, Lopez Medina AM, Salinas-Contreras RM, Prince MJ. The Prevalence, Correlates, Detection and Control of Diabetes among Older People in Low and Middle Income Countries. A 10/66 Dementia Research Group Population-Based Survey. PLoS One 2016; 11:e0149616. [PMID: 26913752 PMCID: PMC4767439 DOI: 10.1371/journal.pone.0149616] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/02/2016] [Indexed: 12/04/2022] Open
Abstract
Background Little is known of the epidemiology of diabetes among older people in low and middle income countries. We aimed to study and compare prevalence, social patterning, correlates, detection, treatment and control of diabetes among older people in Latin America, India, China and Nigeria. Methods Cross-sectional surveys in 13 catchment area sites in nine countries. Diagnosed diabetes was assessed in all sites through self-reported diagnosis. Undiagnosed diabetes was assessed in seven Latin American sites through fasting blood samples (glucose > = 7mmol/L). Results Total diabetes prevalence in catchment sites in Cuba (prevalence 24.2%, SMR 116), Puerto Rico (43.4%, 197), and urban (27.0%, 125), and rural Mexico (23.7%, 111) already exceeds that in the USA, while that in Venezuela (20.9%, 100) is similar. Diagnosed diabetes prevalence varied very widely, between low prevalences in sites in rural China (0.9%), rural India (6.6%) and Nigeria (6.0%). and 32.1% in Puerto Rico, explained mainly by access to health services. Treatment coverage varied substantially between sites. Diabetes control (40 to 61% of those diagnosed) was modest in the Latin American sites where this was studied. Diabetes was independently associated with less education, but more assets. Hypertension, central obesity and hypertriglyceridaemia, but not hypercholesterolaemia were consistently associated with total diabetes. Conclusions Diabetes prevalence is already high in most sites. Identifying undiagnosed cases is essential to quantify population burden, particularly in least developed settings where diagnosis is uncommon. Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data. Given the high prevalence among older people, more population research is indicated to quantify the impact of diabetes, and to monitor the effect of prevention and health system strengthening on prevalence, treatment and control.
Collapse
Affiliation(s)
- Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic
| | - Cleusa P. Ferri
- Universidade Fedral de São Paulo, Department of Psychobiology, Sao Paulo, Brasil
| | - Mariella Guerra
- Psychogeriatric Unit, National Institute of Mental Health “Honorio Delgado Hideyo Noguchi”, Lima, Peru
| | - Yueqin Huang
- Peking University, Institute of Mental Health, Beijing, China
| | | | - Ivonne Z. Jimenez-Velazquez
- Internal Medicine Dept., Geriatrics Program, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Ana L. Sosa
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Richard Uwakwe
- Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Joseph D. Williams
- Department of Community Health, Voluntary Health Services, Chennai, India
| | | | - Zhaorui Liu
- Peking University, Institute of Mental Health, Beijing, China
| | | | - Rosa Maria Salinas-Contreras
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Martin J. Prince
- King’s College London, Institute of Psychiatry, Health Service and Population Research Department, London, United Kingdom
- * E-mail:
| |
Collapse
|
16
|
Meza R, Barrientos-Gutierrez T, Rojas-Martinez R, Reynoso-Noverón N, Palacio-Mejia LS, Lazcano-Ponce E, Hernández-Ávila M. Burden of type 2 diabetes in Mexico: past, current and future prevalence and incidence rates. Prev Med 2015; 81:445-50. [PMID: 26546108 PMCID: PMC4679631 DOI: 10.1016/j.ypmed.2015.10.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/16/2015] [Accepted: 10/28/2015] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Mexico diabetes prevalence has increased dramatically in recent years. However, no national incidence estimates exist, hampering the assessment of diabetes trends and precluding the development of burden of disease analyses to inform public health policy decision-making. Here we provide evidence regarding current magnitude of diabetes in Mexico and its future trends. METHODS We used data from the Mexico National Health and Nutrition Survey, and age-period-cohort models to estimate prevalence and incidence of self-reported diagnosed diabetes by age, sex, calendar-year (1960-2012), and birth-cohort (1920-1980). We project future rates under three alternative incidence scenarios using demographic projections of the Mexican population from 2010-2050 and a Multi-cohort Diabetes Markov Model. RESULTS Adult (ages 20+) diagnosed diabetes prevalence in Mexico increased from 7% to 8.9% from 2006 to 2012. Diabetes prevalence increases with age, peaking around ages 65-68 to then decrease. Age-specific incidence follows similar patterns, but peaks around ages 57-59. We estimate that diagnosed diabetes incidence increased exponentially during 1960-2012, roughly doubling every 10 years. Projected rates under three age-specific incidence scenarios suggest diabetes prevalence among adults (ages 20+) may reach 13.7-22.5% by 2050, affecting 15-25 million individuals, with a lifetime risk of 1 in 3 to 1 in 2. CONCLUSIONS Diabetes prevalence in Mexico will continue to increase even if current incidence rates remain unchanged. Continued implementation of policies to reduce obesity rates, increase physical activity, and improve population diet, in tandem with diabetes surveillance and other risk control measures is paramount to substantially reduce the burden of diabetes in Mexico.
Collapse
Affiliation(s)
- Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI USA.
| | | | - Rosalba Rojas-Martinez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos Mexico
| | | | | | - Eduardo Lazcano-Ponce
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos Mexico
| | | |
Collapse
|
17
|
Ureña-Bogarín EL, Martínez-Ramírez HR, Torres-Sánchez JR, Hernández-Herrera A, Cortés-Sanabria L, Cueto-Manzano AM. Prevalence of pre-diabetes in young Mexican adults in primary health care. Fam Pract 2015; 32:159-64. [PMID: 25199520 DOI: 10.1093/fampra/cmu047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-diabetes in young people is frequently unrecognized or not treated on time, with the consequent loss of opportunity for diabetes prevention. In Mexico, there is scarce information about the prevalence of pre-diabetes in young adults. OBJECTIVE To determine the prevalence and risk factors for pre-diabetes in young Mexican adults in primary health care. METHODS In a cross-sectional study, 288 subjects, aged 18-30 years, from a primary care unit were included. Pre-diabetes was diagnosed (according to the criteria of the American Diabetes Association) as impaired fasting glucose (8-12 hours fasting plasma glucose level: 100-125 mg/dl) or impaired glucose tolerance (140-199 mg/dl after a 2-hour oral glucose tolerance test). RESULTS Prevalence of pre-diabetes was 14.6% [95% confidence interval (CI): 10.7-19.2], whereas that of diabetes was 2.4% (95% CI: 1.0-4.9). A high proportion of patients had history of obesity, diabetes, hypertension and consumption of tobacco and alcohol. Pre-diabetic patients were older than normoglycaemics (pre-diabetic patients: 26±4 years versus normoglycaemic subjects: 24±3 years, P = 0.003) and had higher body mass index (BMI; pre-diabetic patients: 29.4±6.8 kg/m(2) versus normoglycaemic subjects: 26.8±5.8 kg/m(2); P = 0.009), particularly in the case of men (pre-diabetic men: 29.3±7.0 kg/m(2) versus normoglycaemic men: 26.4±5.1 kg/m(2); P = 0.03). Although waist circumference showed a trend to be higher among pre-diabetics, no significant differences were found according to gender (among males: pre-diabetics: 99.5±18.8 cm versus normoglycaemics: 93.3±14.4 cm, P = 0.09; among females: pre-diabetics: 91.5±13.8 cm versus normoglycaemics: 85.8±15.9 cm, P = 0.16). Only age and BMI were significantly associated with the presence of pre-diabetes. CONCLUSIONS Almost 15% of these young adults had pre-diabetes. Many modifiable and non-modifiable risk factors were present in these patients, but only age and a higher BMI were independent variables significantly associated with pre-diabetes. Timely interventions in primary health care are needed to prevent or delay the progression to diabetes.
Collapse
Affiliation(s)
- Enrique L Ureña-Bogarín
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Héctor R Martínez-Ramírez
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - José R Torres-Sánchez
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Aurora Hernández-Herrera
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Laura Cortés-Sanabria
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico
| | - Alfonso M Cueto-Manzano
- Medical Research Unit in Renal Disease, Specialities Hospital, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
| |
Collapse
|
18
|
Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O'Donnell M, Sullivan R, Yusuf S. The burden of disease in older people and implications for health policy and practice. Lancet 2015; 385:549-62. [PMID: 25468153 DOI: 10.1016/s0140-6736(14)61347-7] [Citation(s) in RCA: 1171] [Impact Index Per Article: 130.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
23% of the total global burden of disease is attributable to disorders in people aged 60 years and older. Although the proportion of the burden arising from older people (≥60 years) is highest in high-income regions, disability-adjusted life years (DALYs) per head are 40% higher in low-income and middle-income regions, accounted for by the increased burden per head of population arising from cardiovascular diseases, and sensory, respiratory, and infectious disorders. The leading contributors to disease burden in older people are cardiovascular diseases (30·3% of the total burden in people aged 60 years and older), malignant neoplasms (15·1%), chronic respiratory diseases (9·5%), musculoskeletal diseases (7·5%), and neurological and mental disorders (6·6%). A substantial and increased proportion of morbidity and mortality due to chronic disease occurs in older people. Primary prevention in adults aged younger than 60 years will improve health in successive cohorts of older people, but much of the potential to reduce disease burden will come from more effective primary, secondary, and tertiary prevention targeting older people. Obstacles include misplaced global health priorities, ageism, the poor preparedness of health systems to deliver age-appropriate care for chronic diseases, and the complexity of integrating care for complex multimorbidities. Although population ageing is driving the worldwide epidemic of chronic diseases, substantial untapped potential exists to modify the relation between chronological age and health. This objective is especially important for the most age-dependent disorders (ie, dementia, stroke, chronic obstructive pulmonary disease, and vision impairment), for which the burden of disease arises more from disability than from mortality, and for which long-term care costs outweigh health expenditure. The societal cost of these disorders is enormous.
Collapse
Affiliation(s)
| | - Fan Wu
- Shanghai Institutes of Preventative Medicine and the Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Luis M Gutierrez Robledo
- Instituto Nacional De Geriatría, and Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | | | - Richard Sullivan
- Kings Health Partners Cancer Centre, and Institute of Cancer Policy, Kings Health Partners Integrated Cancer, and Centre for Global Health, King's College London, London, UK
| | | |
Collapse
|
19
|
Afable-Munsuz A, Mayeda ER, Pérez-Stable EJ, Haan MN. Immigrant generation and diabetes risk among Mexican Americans: the Sacramento area Latino study on aging. Am J Public Health 2014; 104 Suppl 2:S234-50. [PMID: 24899459 DOI: 10.2105/ajph.2012.300969r] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population. METHODS We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.
Collapse
Affiliation(s)
- Aimee Afable-Munsuz
- At the time the analysis was conducted, Aimee Afable-Munsuz was a research fellow with the Division of General Internal Medicine, Department of Medicine, University of California, San Francisco. Elizabeth Rose Mayeda and Mary N. Haan are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eliseo J. Pérez-Stable is with the Medical Effectiveness Research Center for Diverse Populations, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | | | | | | |
Collapse
|
20
|
Afable-Munsuz A, Mayeda ER, Pérez-Stable EJ, Haan MN. Las generaciones de inmigrantes y sus descendientes y el riesgo de diabetes en la población de los Estados Unidos de origen o ascendencia mexicana: el Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA). Am J Public Health 2014. [DOI: 10.2105/ajph.2012.300969s] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objetivo. Se investigó si la aculturación de los inmigrantes y sus descendientes y la generación a la que pertenecen, un marcador de la asimilación, se relacionan con el riesgo de diabetes en una población de adultos mayores de ascendencia u origen mexicano. Métodos. Se analizaron los datos sobre 1 789 adultos de 60 a 101 años de edad del Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA). Se determinó la presencia de diabetes tipo 2 con base en el uso de medicamentos antidiabéticos, la mención por el paciente del diagnóstico de un médico, o una glucosa en ayunas de 126 mg/dL o mayor. Se aplicó un modelo de regresión logística para la prevalencia de diabetes. Resultados. Tras ajustar por edad y sexo, se observaron asociaciones significativas pero divergentes entre las generaciones de inmigrantes y sus descendientes, la aculturación y el riesgo de diabetes. En relación con los adultos de la primera generación, los de la segunda tuvieron una razón de posibilidades (odds ratio, OR) de padecer diabetes de 1,8 (intervalo de confianza [IC] de 95% = 1,4, 2,4) y los adultos de la tercera generación tuvieron una OR de 2,1 (IC de 95% = 1,4, 3,1). Sin embargo, una mayor aculturación a los Estados Unidos se relacionó con una tasa ligeramente menor de diabetes. En el modelo completo, tras la incorporación de ajustes para tener en cuenta los factores socioeconómicos y del modo de vida, la relación entre la generación y la diabetes seguía siendo significativa, no así la relación de esta última con la aculturación. Conclusiones. El presente estudio respalda la idea, anteriormente cuestionada, de que la asimilación se relaciona con un mayor riesgo de diabetes entre los inmigrantes de origen mexicano. Los investigadores deben analizar más detalladamente la presencia de una relación causal entre la asimilación y la salud.
Collapse
|
21
|
Everett M, Wieland JN. DIABETES AMONG OAXACA'S TRANSNATIONAL POPULATION: AN EMERGING SYNDEMIC. ANNALS OF ANTHROPOLOGICAL PRACTICE 2013. [DOI: 10.1111/napa.12005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
22
|
Afable-Munsuz A, Gregorich SE, Markides KS, Pérez-Stable EJ. Diabetes risk in older Mexican Americans: effects of language acculturation, generation and socioeconomic status. J Cross Cult Gerontol 2013; 28:359-73. [PMID: 23990075 DOI: 10.1007/s10823-013-9200-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The effect of language acculturation, socioeconomic status (SES), and immigrant generation on development of diabetes among Mexican Americans was evaluated in the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE). HEPESE is a longitudinal cohort study of 3,050 non-institutionalized Mexican Americans aged 65 years at baseline (1993-1994) from 5 Southwestern states. Diabetes incidence was ascertained in 4 follow-up surveys to 2004-05 by respondent self-reported physician-diagnosis of diabetes, high blood glucose, or sugar in the urine. Language of interview, immigrant generation, gender, age, education, family history of diabetes, smoking status, alcohol use, health insurance type and self-reported height and weight were assessed. High socioeconomic status (SES) was defined by high school graduation and non-Medicaid insurance. Cox's proportional hazards models were fit to evaluate the effects of language acculturation, generation and SES on incident diabetes. 845 of 3,050 (27.7%) Mexican Americans had diabetes at baseline and were younger, more educated, and more likely to have health insurance than those without diabetes. Risk of developing diabetes increased for Spanish-speaking respondents with low SES from 1st to 3rd generation (HR = 1.76, 95% CI = 1.02-3.03) and from 2nd to 3rd generation (HR = 2.15, 95% CI = 1.20-3.84). Among English-speaking, high SES participants, generation had a protective effect on developing diabetes: HR = 0.45 (95% CI = 0.22-0.91) when comparing 3rd versus 1st generation. The effect of language acculturation and immigrant generation on incident diabetes is moderated by SES status in HEPESE participants.
Collapse
Affiliation(s)
- Aimee Afable-Munsuz
- Department of Community Health Sciences, SUNY Downstate School of Public Health, New York, NY, USA
| | | | | | | |
Collapse
|
23
|
Mudaliar U, Kim WC, Kirk K, Rouse C, Narayan KMV, Ali M. Are recommended standards for diabetes care met in Central and South America? A systematic review. Diabetes Res Clin Pract 2013; 100:306-29. [PMID: 23375230 DOI: 10.1016/j.diabres.2013.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/30/2012] [Accepted: 01/07/2013] [Indexed: 11/28/2022]
Abstract
AIMS We evaluated quality of diabetes care in low- and middle-income countries (LMIC) of Central and South America by documenting the ability to meet the guideline-recommended targets. We also identified barriers to achieving goals of treatment and characteristics of successful programs. METHODS We searched the National Library of Medicine and Embase databases to systematically compile literature that reported on guideline-recommended processes of care (annual foot, eye, urine examinations, and regular blood glucose testing) and risk factor control (glycemic, blood pressure, and lipid levels) among people with diabetes since 1980. We compared risk factor control across clinic and household populations and benchmarked against the IDF guidelines. RESULTS The available literature was largely from Mexico, Jamaica, and Brazil with little data from rural regions or smaller countries. Twenty-nine clinic-based and ten population-based studies showed a consistent failure to meet recommended care goals due to multiple underlying social and economic themes. Across all studies, the proportion of those not meeting targets ranged from 13.0 to 92.2% for glycemic control, 4.6 to 92.0% for blood pressure, and 28.2 to 78.3% for lipids. CONCLUSIONS Few studies report quality of diabetes care in LMICs of the Americas, and heterogeneity across studies limits our understanding. Greater regard for audits, use of standardized reporting methods, and an emphasis on overcoming barriers to care are required.
Collapse
Affiliation(s)
- Uma Mudaliar
- School of Medicine, Emory University, Atlanta, GA, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Afable-Munsuz A, Mayeda ER, Pérez-Stable EJ, Haan MN. Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging. Am J Public Health 2013; 103:e45-52. [PMID: 23488481 DOI: 10.2105/ajph.2012.300969] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican-origin population. METHODS We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.
Collapse
Affiliation(s)
- Aimee Afable-Munsuz
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
| | | | | | | |
Collapse
|
25
|
Chary A, Greiner M, Bowers C, Rohloff P. Determining adult type 2 diabetes-related health care needs in an indigenous population from rural Guatemala: a mixed-methods preliminary study. BMC Health Serv Res 2012; 12:476. [PMID: 23260013 PMCID: PMC3546905 DOI: 10.1186/1472-6963-12-476] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Guatemala, diabetes is an emerging public health concern. Guatemala has one of the largest indigenous populations in Latin America, and this population frequently does not access the formal health care system. Therefore, knowledge about the emergence of diabetes in this population is limited. METHODS Interview participants (n=23) were recruited from a convenience sample of indigenous adults with type 2 diabetes at one rural diabetes clinic in Guatemala. A structured interview was used to assess knowledge about diabetes and its complications; access to diabetes-related health care and treatment; dietary and lifestyle changes; and family and social supports for individuals living with diabetes. Interviews were supplemented with two group interviews with community leaders and health care providers. Thematic analysis was used to produce insights into diabetes knowledge, attitudes, and practices. In addition, a chart review of the clinic's electronic medical record identified all adult patients (n=80) presenting in one calendar year for a first-time diabetic consultation. Sociodemographic and clinical variables were extracted and summarized from these records. RESULTS Salient demographic factors in both the structured interview and chart review samples included low educational levels and high indigenous language preference. In the interview sample, major gaps in biomedical knowledge about diabetes included understanding the causes, chronicity, and long-term end-organ complications of diabetes. Medication costs, medical pluralism, and limited social supports for dietary and lifestyles changes were major practical barriers to disease management. Quantitative data from medical records review revealed high rates of poor glycemic control, overweight and obesity, and medication prescription. CONCLUSIONS This study provides a preliminary sketch of type 2 diabetes in an indigenous Guatemalan population. Combined qualitative and quantitative data point towards particular needs for implementation and future research, including the need to address gaps in diabetes knowledge, to improve social support systems, and to address the cost barriers associated with disease treatment.
Collapse
Affiliation(s)
- Anita Chary
- Wuqu’ Kawoq, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Miranda Greiner
- Wuqu’ Kawoq, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Cody Bowers
- Wuqu’ Kawoq, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Peter Rohloff
- Wuqu’ Kawoq, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| |
Collapse
|
26
|
|
27
|
Lavalle-González FJ, Chiquete E, de la Luz J, Ochoa-Guzmán A, Sánchez-Orozco LV, Godínez-gutiérrez SA. Achievement of therapeutic targets in Mexican patients with diabetes mellitus. ACTA ACUST UNITED AC 2012; 59:591-8. [DOI: 10.1016/j.endonu.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 06/25/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
|
28
|
Hypoglycemic Activity of Aqueous Extracts from Catharanthus roseus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:934258. [PMID: 23056144 PMCID: PMC3463976 DOI: 10.1155/2012/934258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/07/2012] [Accepted: 08/10/2012] [Indexed: 11/17/2022]
Abstract
Introduction. Catharanthus roseus (L.) is used in some countries to treat diabetes. The aim of this study was to evaluate the hypoglycemic activity of extracts from the flower, leaf, stem, and root in normal and alloxan-induced diabetic mice. Methods. Roots, leaves, flowers, and stems were separated to obtain organic and aqueous extracts. The blood glucose lowering activity of these extracts was determinate in healthy and alloxan-induced (75 mg/Kg) diabetic mice, after intraperitoneal administration (250 mg/Kg body weight). Blood samples were obtained and blood glucose levels were analyzed employing a glucometer. The data were statistically compared by ANOVA. The most active extract was fractioned. Phytochemical screen and chromatographic studies were also done. Results. The aqueous extracts from C. roseus reduced the blood glucose of both healthy and diabetic mice. The aqueous stem extract (250 mg/Kg) and its alkaloid-free fraction (300 mg/Kg) significantly (P < 0.05) reduced blood glucose in diabetic mice by 52.90 and 51.21%. Their hypoglycemic activity was comparable to tolbutamide (58.1%, P < 0.05). Conclusions. The best hypoglycemic activity was presented for the aqueous extracts and by alkaloid-free stem aqueous fraction. This fraction is formed by three polyphenols compounds.
Collapse
|
29
|
Weller SC, Baer RD, Garcia de Alba Garcia J, Salcedo Rocha AL. Explanatory models of diabetes in the U.S. and Mexico: the patient-provider gap and cultural competence. Soc Sci Med 2012; 75:1088-96. [PMID: 22703883 DOI: 10.1016/j.socscimed.2012.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 01/09/2023]
Abstract
Successful management of type 2 diabetes requires support and collaboration between diabetic patients, their health care providers, family and community. Using data collected in 1994-2001, we describe illness beliefs of physicians, patients, and representative samples of community members in the US and Mexico. We test whether differences in conceptualizations of diabetes are greater across national and linguistic boundaries or between physicians and lay groups. Interviews were conducted in southern Texas on the Mexican border and in Guadalajara, Mexico. Culturally appropriate interview materials were developed with a mixed-methods approach. Qualitative interviews elicited beliefs about causes, risks, symptoms, and treatments for diabetes and salient themes were incorporated into structured interviews. A cultural consensus analysis was used to verify salient themes within each of the six samples. The consistency in responses in each of the six samples indicated a shared core of beliefs that transcended individual variations. The greatest differences occurred between physician and lay samples; patient and community models were more similar to one another than to the physician models. Differences between physicians and patients may affect optimal management of diabetes, but these differences do not appear to be simply a function of differences in national culture and language, as the largest differences occurred in Mexico. This suggests that rather than cultural competence per se, formal educational levels and class differences may also play an important role in patient understanding and the gap in patient-provider understanding.
Collapse
Affiliation(s)
- Susan C Weller
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1153, United States.
| | | | | | | |
Collapse
|
30
|
Polack S, Yorston D, López-Ramos A, Lepe-Orta S, Baia RM, Alves L, Grau-Alvidrez C, Gomez-Bastar P, Kuper H. Rapid Assessment of Avoidable Blindness and Diabetic Retinopathy in Chiapas, Mexico. Ophthalmology 2012; 119:1033-40. [DOI: 10.1016/j.ophtha.2011.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 09/02/2011] [Accepted: 11/01/2011] [Indexed: 01/13/2023] Open
|
31
|
Barcelo A, Gregg EW, Gerzoff RB, Wong R, Perez Flores E, Ramirez-Zea M, Cafiero E, Altamirano L, Ascencio Rivera M, de Cosio G, de Maza MD, del Aguila R, Emanuel E, Gil E, Gough E, Jenkins V, Orellana P, Palma R, Palomo R, Pastora M, Peña R, Pineda E, Rodriguez B, Tacsan L, Thompson L, Villagra L. Prevalence of diabetes and intermediate hyperglycemia among adults from the first multinational study of noncommunicable diseases in six Central American countries: the Central America Diabetes Initiative (CAMDI). Diabetes Care 2012; 35:738-40. [PMID: 22323417 PMCID: PMC3308278 DOI: 10.2337/dc11-1614] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The increasing burdens of obesity and diabetes are two of the most prominent threats to the health of populations of developed and developing countries alike. The Central America Diabetes Initiative (CAMDI) is the first study to examine the prevalence of diabetes in Central America. RESEARCH DESIGN AND METHODS The CAMDI survey was a cross-sectional survey based on a probabilistic sample of the noninstitutionalized population of five Central American populations conducted between 2003 and 2006. The total sample population was 10,822, of whom 7,234 (67%) underwent anthropometry measurement and a fasting blood glucose or 2-h oral glucose tolerance test. RESULTS The total prevalence of diabetes was 8.5%, but was higher in Belize (12.9%) and lower in Honduras (5.4%). Of the screened population, 18.6% had impaired glucose tolerance/impaired fasting glucose. CONCLUSIONS As this population ages, the prevalence of diabetes is likely to continue to rise in a dramatic and devastating manner. Preventive strategies must be quickly introduced.
Collapse
Affiliation(s)
- Alberto Barcelo
- Chronic Diseases, Pan American Health Organization, Washington, District of Columbia, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
The influence of indigenous status and community indigenous composition on obesity and diabetes among Mexican adults. Soc Sci Med 2011; 73:1635-43. [PMID: 22033376 DOI: 10.1016/j.socscimed.2011.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 05/01/2011] [Accepted: 09/06/2011] [Indexed: 01/20/2023]
Abstract
In many high-income countries, indigenous populations bear a higher burden of obesity and diabetes than non-indigenous populations. Less is known about these patterns in lower- and middle-income countries. We assessed the hypothesis that obesity and diabetes were less prevalent among indigenous than non-indigenous adults in Mexico, home to the largest indigenous population in Latin America. We investigated socioeconomic explanations for differences. In a related line of inquiry, we examine whether adults in communities with higher versus lower percentages of indigenous residents were buffered against these conditions. We assessed whether differences were partially explained by lower development in higher-indigenous communities. Obesity was based on measured height and weight, and diabetes on a diagnosis from a healthcare professional. The analysis for obesity included 19 577 adults aged 20 and older from the Mexican Family Life Survey (2002), a nationally representative survey of Mexican households and communities; for diabetes, we restricted analysis to adults with health insurance. We used multilevel logistic regression to estimate the odds of obesity and diabetes by indigenous status and community percent indigenous. Results suggest that indigenous adults had significantly lower odds of obesity and diabetes than non-indigenous adults. This advantage was not explained by the lower socioeconomic status of indigenous individuals. A higher percentage of indigenous individuals in communities provided protection against obesity, although not for diabetes. Differences for obesity were not accounted for by community development. Findings suggest that an opportunity may exist to prevent disparities in obesity and diabetes from developing by indigenous characteristics in Mexico. Identifying the sources of protective effects of individual and community indigenous characteristics relative to these health conditions should be a priority, given global implications for prevention.
Collapse
|
33
|
Espinosa-de-los-Monteros AL, González B, Vargas G, Sosa E, Mercado M. Clinical and biochemical characteristics of acromegalic patients with different abnormalities in glucose metabolism. Pituitary 2011; 14:231-5. [PMID: 21161601 DOI: 10.1007/s11102-010-0284-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To determine the prevalence of diabetes, glucose intolerance and impaired fasting glucose in Mexican patients with acromegaly and establish associations with clinical, anthropometric and biochemical variables. 257 patients with acromegaly were evaluated by a 75 g-oral glucose tolerance test with measurements of both GH and glucose (0, 30, 60, 90 120 min) as well as baseline IGF-1. Normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes (DM) were defined based on the 2003 ADA criteria. NGT, IFG, IGT and DM were found in 27.6, 8.9, 31.6 and 31.9% of the subjects, respectively; 42 of the DM patients were unaware of the diagnosis. Patients with diabetes were older than subjects in the other 3 categories (P = 0.001), and the proportion of women was significantly higher in the DM (74%) and IGT (68%) groups than in the NGT group (52%) (P = 0.004). Odds ratio for the development of DM was 3.29 (95% CI 3.28-3.3). GH and IGF-1 levels were comparable among the different groups. In a multivariable analysis DM was significantly associated with age, presence of a macroadenoma, disease duration and a basal GH > 30 μg/dl. DM and probably IGT are more prevalent in acromegaly than in the general Mexican population. DM was more frequent in females of all ages, in subjects with severely elevated GH concentrations, in patients with macroadenomas, and long-standing disease duration. The odds ratio for DM in our subjects with acromegaly is more than 3 times higher than in the general population.
Collapse
Affiliation(s)
- Ana Laura Espinosa-de-los-Monteros
- Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Aristóteles 68, Polanco, 11560, Mexico City, Mexico
| | | | | | | | | |
Collapse
|
34
|
Everett M. They say it runs in the family: Diabetes and inheritance in Oaxaca, Mexico. Soc Sci Med 2011; 72:1776-83. [DOI: 10.1016/j.socscimed.2011.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 12/11/2022]
|
35
|
Reynoso-Noverón N, Mehta R, Almeda-Valdes P, Rojas-Martinez R, Villalpando S, Hernández-Ávila M, Aguilar-Salinas CA. Estimated incidence of cardiovascular complications related to type 2 diabetes in Mexico using the UKPDS outcome model and a population-based survey. Cardiovasc Diabetol 2011; 10:1. [PMID: 21214916 PMCID: PMC3023678 DOI: 10.1186/1475-2840-10-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To estimate the incidence of complications, life expectancy and diabetes related mortality in the Mexican diabetic population over the next two decades using data from a nation-wide, population based survey and the United Kingdom Prospective Diabetes Study (UKPDS) outcome model. METHODS The cohort included all patients with type 2 diabetes evaluated during the National Health and Nutrition Survey (ENSANut) 2006. ENSANut is a probabilistic multistage stratified survey whose aim was to measure the prevalence of chronic diseases. A total of 47,152 households were visited. Results are shown stratified by gender, time since diagnosis (> or ≤ to 10 years) and age at the time of diagnosis (> or ≤ 40 years). RESULTS The prevalence of diabetes in our cohort was 14.4%. The predicted 20 year-incidence for chronic complications per 1000 individuals are: ischemic heart disease 112, myocardial infarction 260, heart failure 113, stroke 101, and amputation 62. Furthermore, 539 per 1000 patients will have a diabetes-related premature death. The average life expectancy for the diabetic population is 10.9 years (95%CI 10.7-11.2); this decreases to 8.3 years after adjusting for quality of life (CI95% 8.1-8.5). Male sex and cases diagnosed after age 40 have the highest risk for developing at least one major complication during the next 20 years. CONCLUSIONS Based on the current clinical profile of Mexican patients with diabetes, the burden of disease related complications will be tremendous over the next two decades.
Collapse
Affiliation(s)
- Nancy Reynoso-Noverón
- Oficina del Subsecretario de Salud, Secretaria de Salud, (Lieja 7, Colonia Juárez), México City (06600) México
| | | | | | | | | | | | | |
Collapse
|
36
|
Huang C, Soldo BJ, Elo IT. Do early-life conditions predict functional health status in adulthood? The case of Mexico. Soc Sci Med 2011; 72:100-7. [PMID: 21074924 PMCID: PMC3020092 DOI: 10.1016/j.socscimed.2010.09.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 08/01/2010] [Accepted: 09/07/2010] [Indexed: 11/16/2022]
Abstract
Relatively few researchers have investigated early antecedents of adult functional limitations in developing countries. In this study, we assessed associations between childhood conditions and adult lower-body functional limitations (LBFL) as well as the potential mediating role of adult socioeconomic status, smoking, body mass index, and chronic diseases or symptoms. Based on data from the Mexican Health and Aging Study (MHAS) of individuals born prior to 1951 and contacted in 2001 and 2003, we found that childhood nutritional deprivation, serious health problems, and family background predict adult LBFL in Mexico. Adjustment for the potential mediators in adulthood attenuates these associations only to a modest degree.
Collapse
Affiliation(s)
- Cheng Huang
- Emory University, Rollins School of Public Health, 1518 Clifton RD NE, Rm 738, Atlanta, GA 30322, USA.
| | | | | |
Collapse
|
37
|
Affiliation(s)
- Iliana V. Kohler
- a Population Studies Center , University of Pennsylvania , 239 McNeil Building, 3718 Locust Walk, Philadelphia , PA , 19104–6298 E-mail:
| | - Beth J. Soldo
- b Population Studies Center , University of Pennsylvania
| |
Collapse
|
38
|
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87:4-14. [PMID: 19896746 DOI: 10.1016/j.diabres.2009.10.007] [Citation(s) in RCA: 4280] [Impact Index Per Article: 305.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 10/12/2009] [Indexed: 12/01/2022]
Abstract
AIM We estimated the number of people worldwide with diabetes for the years 2010 and 2030. METHODS Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. RESULTS The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. CONCLUSION These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries.
Collapse
Affiliation(s)
- J E Shaw
- Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | | | | |
Collapse
|
39
|
Positive change in the utilization of antihypertensive and lipid-lowering drugs among adult diabetics in Finland. Results from large national database between 2000 and 2006. J Hypertens 2009; 27:2283-93. [DOI: 10.1097/hjh.0b013e328330b6bf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Aguilar-Santamaría L, Ramírez G, Nicasio P, Alegría-Reyes C, Herrera-Arellano A. Antidiabetic activities of Tecoma stans (L.) Juss. ex Kunth. JOURNAL OF ETHNOPHARMACOLOGY 2009; 124:284-288. [PMID: 19397980 DOI: 10.1016/j.jep.2009.04.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 04/09/2009] [Accepted: 04/19/2009] [Indexed: 05/27/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tecoma stans aqueous extract (TAE) is widely used as a traditional antidiabetic remedy in Mexico; its rational use is controversial. We provide evidence of its main antidiabetic activities. AIM OF THE STUDY To evaluate in vivo and in vitro intestinal alpha-glucosidases inhibition as the possible mode of action of TAE on type 2 diabetes mellitus (DM2) animal models, and to test the effects of its sub-chronic administration on lipids and glucose blood levels. MATERIALS AND METHODS In healthy and streptozotocin (STZ)-induced diabetic male Sprague-Dawley rats, glucose or cornstarch was administered after an oral dose of TAE, acarbose, tolbutamide or vehicle, in order to build starch and glucose tolerance curves (STC and GTC). An intestinal brush border preparation was used to evaluate the TAE alpha-glucosidases inhibitory activity. Moreover, in STZ-induced diabetic rats TAE, tolbutamide or vehicle was administered for 21 days for evaluate their effects on fasting glucose cholesterol and triglycerides. Also, TAE total phenolic compounds were quantified. RESULTS In STC, TAE decreased hyperglycemic peak values in both healthy and STZ-treated rats, in a magnitude similar to that of acarbose. The in vitro preparation showed a dose-dependent inhibition of glucose release from starch. Sub-chronic administration of TAE significantly reduced cholesterol and triglycerides levels. Moreover, we confirmed that acute and sub-chronic administration of TAE (500mg/kg) in both rat models did not diminish fasting glucose and did not modify the GTC. CONCLUSIONS The study present evidence that the main antidiabetic effect of TAE is due to intestinal alpha-glucosidase inhibition by decreasing the postprandial hyper-glycaemia peak; in addition, TAE sub-chronic administration reduces triglycerides and cholesterol, without modifying fasting glucose.
Collapse
Affiliation(s)
- L Aguilar-Santamaría
- Centro de Investigación Biomédica del Sur, Instituto Mexicano del Seguro Social (IMSS), Argentina # 1, Xochitepec, Morelos 62790, Mexico
| | | | | | | | | |
Collapse
|
41
|
Kuri-Morales P, Emberson J, Alegre-Díaz J, Tapia-Conyer R, Collins R, Peto R, Whitlock G. The prevalence of chronic diseases and major disease risk factors at different ages among 150,000 men and women living in Mexico City: cross-sectional analyses of a prospective study. BMC Public Health 2009; 9:9. [PMID: 19134207 PMCID: PMC2645387 DOI: 10.1186/1471-2458-9-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 01/09/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While most of the global burden from chronic diseases, and especially vascular diseases, is now borne by low and middle-income countries, few large-scale epidemiological studies of chronic diseases in such countries have been performed. METHODS From 1998-2004, 52 584 men and 106 962 women aged > or =35 years were visited in their homes in Mexico City. Self reported diagnoses of chronic diseases and major disease risk factors were ascertained and physical measurements taken. Age- and sex-specific prevalences and means were analysed. RESULTS After about age 50 years, diabetes was extremely common - for example, 23.8% of men and 26.9% of women aged 65-74 reported a diagnosis. By comparison, ischaemic heart disease was reported by 4.8% of men and 3.0% of women aged 65-74, a history of stroke by 2.8% and 2.3%, respectively, and a history of cancer by 1.3% and 2.1%. Cancer history was generally more common among women than men - the excess being largest in middle-age, due to breast and cervical cancer. At older ages, the gap narrowed because of an increasing prevalence of prostate cancer. 51% of men and 25% of women aged 35-54 smoked cigarettes, while 29% of men and 41% of women aged 35-54 were obese (i.e. BMI > or =30 kg/m2). The prevalence of treated hypertension or measured blood pressure > or =140/90 mmHg increased about 50% more steeply with age among women than men, to 66% of women and 58% of men aged 65-74. Physical inactivity was highly prevalent but daily alcohol drinking was relatively uncommon. CONCLUSION Diabetes, obesity and tobacco smoking are highly prevalent among adults living in Mexico City. Long-term follow-up of this and other cohorts will establish the relevance of such factors to the major causes of death and disability in Mexico.
Collapse
Affiliation(s)
- Pablo Kuri-Morales
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | | | | | | | | | | | | |
Collapse
|
42
|
Mental disorders among persons with diabetes--results from the World Mental Health Surveys. J Psychosom Res 2008; 65:571-80. [PMID: 19027447 PMCID: PMC3672403 DOI: 10.1016/j.jpsychores.2008.06.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 12/07/2007] [Accepted: 06/13/2008] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate 12-month prevalence rate of mood, anxiety, and alcohol-use disorders among community samples of diabetic persons. We assess whether associations of specific mental disorders with diabetes are consistent across diverse countries after controlling for age and gender. RESEARCH DESIGN AND METHODS Eighteen surveys of household-residing adults were conducted in two phases across 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific (Part 1, N=85,088). Mental disorders, identified by the World Mental Health-Composite International Diagnostic Interview, included anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder, and social phobia), mood disorders (dysthymia and major depressive disorder), and alcohol abuse/dependence. Diabetes was ascertained by self-report (Part 2, N=42,697). Association was assessed by age-gender adjusted odds ratios. RESULTS Risk of mood and anxiety disorders was slightly higher among persons with diabetes relative to those without: odds ratio of 1.38 for depression (95% CI=1.15-1.66) and 1.20 for anxiety disorders, (95 % CI=1.01-1.42), after adjusting for age and gender. Odds ratio estimates across countries did not differ more than chance expectation. Alcohol-use disorders were uncommon among persons with diabetes in most countries, and not associated with diabetes in pooled survey data. CONCLUSIONS Population sample surveys revealed mood and anxiety disorders occurred with somewhat greater frequency among persons with diabetes than those without diabetes. Prevalence of major depression among persons with diabetes was lower in the general population than suggested by prior studies of clinical samples. Strength of association did not differ significantly across disorders or countries.
Collapse
|
43
|
Fernald LCH, Gertler PJ, Hou X. Cash component of conditional cash transfer program is associated with higher body mass index and blood pressure in adults. J Nutr 2008; 138:2250-7. [PMID: 18936227 PMCID: PMC3151439 DOI: 10.3945/jn.108.090506] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 05/12/2008] [Accepted: 08/25/2008] [Indexed: 11/14/2022] Open
Abstract
The cash component of Oportunidades, a large conditional cash transfer (CCT) program in Mexico, has previously been shown to be associated with better outcomes for child growth and development. The objective of this analysis was to determine whether the cash transfers were also associated with positive outcomes for adult health. Oportunidades was originally randomized across 506 rural (<2500 inhabitants) communities assigned to immediate incorporation into the program in 1997 or incorporation 18 mo later. Adults (n = 1649 early, n = 2039 late intervention) aged 18-65 y were then assessed in 2003. All of the households included in the analysis reported here complied with Oportunidades's requirements for the entire period, but some received higher cumulative cash transfers because they were living in communities randomized to begin receiving transfers earlier and/or they accumulated cash at a faster rate because they had more school-aged children at baseline. Our primary findings were that a doubling of cumulative cash transfers to the household was associated with higher BMI (beta = +0.83, 95% CI 0.46, 1.20; P < 0.0001), higher diastolic blood pressure (beta = +1.19, 95% CI 0.09, 2.29; P = 0.03), and higher prevalence of overweight [odds ratio (OR) = 1.41, 95% CI 1.18, 1.67; P < 0.0001), grade I obesity (OR = 1.41, 95% CI 1.14, 1.75; P = 0.002), and grade II obesity (OR = 1.57, 95% CI 1.05, 2.36; P = 0.03), while controlling for a wide range of covariates, including household composition at baseline. Oportunidades has been portrayed as a model for CCT programs worldwide, but the results reported here support the notion that the cash component of Oportunidades may be negatively associated with some adult health outcomes.
Collapse
Affiliation(s)
- Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
| | | | | |
Collapse
|
44
|
Salinas JJ, Peek MK. Work experience and gender differences in chronic disease risk in older Mexicans. Ann Epidemiol 2008; 18:628-30. [PMID: 18652980 PMCID: PMC2527781 DOI: 10.1016/j.annepidem.2008.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 04/01/2008] [Accepted: 04/06/2008] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to examine the relationship between labor force participation and gender differences in the prevalence of arthritis, diabetes, and hypertension. METHODS The Mexican Health and Aging Survey (MHAS) data is nationally representative sample of older Mexicans 50 years and older. Binomial logistic regression models were performed to examine differences between older Mexican men and women in the prevalence of arthritis, diabetes, and hypertension. Interaction effects were also estimated between gender and occupation, length of time in the labor force, and pension eligibility. RESULTS Older Mexican women have a significantly greater risk of having arthritis, diabetes, and hypertension. Findings from this study suggest that within the same occupational classification, women suffer from the damaging effects on health to a greater extent than men. Interaction effects show that women who work in services or in client's home are particularly susceptible to arthritis. Moreover, women who work in sales were at a significantly greater risk of hypertension than men. CONCLUSIONS Older Mexican women are at greater risk of chronic disease and part of their vulnerability is a result of the type of work that they do.
Collapse
Affiliation(s)
- Jennifer J Salinas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0460, USA.
| | | |
Collapse
|
45
|
Alonso-Castro AJ, Salazar-Olivo LA. The anti-diabetic properties of Guazuma ulmifolia Lam are mediated by the stimulation of glucose uptake in normal and diabetic adipocytes without inducing adipogenesis. JOURNAL OF ETHNOPHARMACOLOGY 2008; 118:252-256. [PMID: 18487028 DOI: 10.1016/j.jep.2008.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 04/02/2008] [Accepted: 04/05/2008] [Indexed: 05/26/2023]
Abstract
ETHNOPHARMACOLOGICAL IMPORTANCE Guazuma ulmifolia Lam (Sterculiaceae) is a plant extensively used in México for the empirical treatment of type 2 diabetes. AIM OF THE STUDY To investigate the anti-diabetic mechanisms of Guazuma ulmifolia. MATERIALS AND METHODS Non-toxic concentrations of Guazuma ulmifolia aqueous extracts (GAE) were assayed on adipogenesis and 2-NBDglucose uptake in the murine 3T3-F442A preadipose cell line. RESULTS GAE added to adipogenic medium (AM) did not affect adipogenesis at any of the tested concentrations (1-70 microg/ml), whereas in AM lacking insulin GAE 70 microg/ml induced triglyceride accumulation by 23%. On the other hand, GAE 70 microg/ml stimulated 2-NBDG uptake by 40% in insulin-sensitive 3T3-F442A adipocytes and by 24% in insulin-resistant adipocytes, with respect to the incorporation showed by insulin-sensitive adipocytes stimulated with the hormone. CONCLUSION Guazuma ulmifolia exerts its anti-diabetic effects by stimulating glucose uptake in both insulin-sensitive and insulin-resistant adipocytes without inducing adipogenesis.
Collapse
Affiliation(s)
- Angel Josabad Alonso-Castro
- Instituto Potosino de Investigación Científica y Tecnológica, División de Biología Molecular, Camino a la Presa San José 2055, Lomas 4a secc., 78216 San Luis Potosí, SLP, Mexico
| | | |
Collapse
|
46
|
Fonseca-Alaniz MH, Takada J, Andreotti S, de Campos TBF, Campaña AB, Borges-Silva CN, Lima FB. High sodium intake enhances insulin-stimulated glucose uptake in rat epididymal adipose tissue. Obesity (Silver Spring) 2008; 16:1186-92. [PMID: 18369340 DOI: 10.1038/oby.2008.69] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study investigated the effect of different sodium content diets on rat adipose tissue carbohydrate metabolism and insulin sensitivity. METHODS AND PROCEDURES Male Wistar rats were fed on normal- (0.5% Na(+); NS), high- (3.12% Na(+); HS),or low-sodium (0.06% Na(+); LS) diets for 3, 6, and 9 weeks after weaning. Blood pressure (BP) was measured using a computerized tail-cuff system. An intravenous insulin tolerance test (ivITT) was performed in fasted animals. At the end of each period, rats were killed and blood samples were collected for glucose and insulin determinations. The white adipose tissue (WAT) from abdominal and inguinal subcutaneous (SC) and periepididymal (PE) depots were weighed and processed for adipocyte isolation and measurement of in vitro rates of insulin-stimulated 2-deoxy-D-[(3)H]-glucose uptake (2DGU) and conversion of -[U-(14)C]-glucose into (14)CO(2). RESULTS After 6 weeks, HS diet significantly increased the BP, SC and PE WAT masses, PE adipocyte size, and plasma insulin concentration. The sodium dietary content did not influence the whole-body insulin sensitivity. A higher half-maximal effective insulin concentration (EC(50)) from the dose-response curve of 2DGU and an increase in the insulin-stimulated glucose oxidation rate were observed in the isolated PE adipocytes from HS rats. DISCUSSION The chronic salt overload enhanced the adipocyte insulin sensitivity for glucose uptake and the insulin-induced glucose metabolization, contributing to promote adipocyte hypertrophy and increase the mass of several adipose depots, particularly the PE fat pad.
Collapse
MESH Headings
- Adipocytes, White/drug effects
- Adipocytes, White/metabolism
- Adipocytes, White/pathology
- Adipose Tissue/pathology
- Adipose Tissue, White/drug effects
- Adipose Tissue, White/metabolism
- Adipose Tissue, White/pathology
- Animals
- Biological Transport/drug effects
- Blood Glucose/metabolism
- Blood Pressure/drug effects
- Body Weight/physiology
- Cells, Cultured
- Dose-Response Relationship, Drug
- Epididymis/drug effects
- Epididymis/metabolism
- Epididymis/pathology
- Glucose/metabolism
- Glucose/pharmacokinetics
- Heart Rate/drug effects
- Hypertrophy
- Insulin/blood
- Insulin/pharmacology
- Male
- Rats
- Rats, Wistar
- Sodium, Dietary/pharmacology
Collapse
Affiliation(s)
- Miriam H Fonseca-Alaniz
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
47
|
Salcedo-Rocha AL, Alba-García JEGD, Sevila E. Dominio cultural del autocuidado en diabeticos tipo 2 con y sin control glucémico en México. Rev Saude Publica 2008; 42:256-64. [DOI: 10.1590/s0034-89102008000200010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 09/10/2007] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar los principales elementos relacionados con el dominio cultural del autocuidado de la salud, entre pacientes con diabetes tipo 2 con y sin controle glucémico. MÉTODOS: Estudio descriptivo en 57 diabéticos controlados y 76 sin control glucémico, con promedio de 60 años de edad en una clínica del Seguro Social en México en 2003. Se aplicaron técnicas de antropología cognitiva de listas libres y cuestionario estructurado para obtener modelo semántico y promedio de conocimiento cultural a seis preguntas sobre su padecimiento por análisis de consenso. RESULTADOS: Los datos sociodemográficos de ambos grupos no mostraron diferencias significativas. Todos los modelos de respuesta comparados presentaron estructuras semánticas similares, con excepción a: "Qué se entiende como ejercicio" (p<0.05). El promedio de conocimiento cultural sobre los aspectos analizados fue similar en ambos grupos, solamente el nivel de conocimiento relacionado a "Cómo debe ayudar la familia a un adulto para estar sano" fue estadísticamente significativamente mayor en pacientes controlados. CONCLUSIONES: Los hallazgos muestran a diferente estructura semántica sobre la concepción del ejercicio entre los grupos de pacientes y la diferencia en el promedio de conocimiento cultural sobre el apoyo familiar para la salud de paciente. Estas informaciones deben ser tomadas en cuenta al elaborar programas educativos, de auto atención y atención médica adaptados a la cultura del paciente con diabetes tipo 2.
Collapse
|
48
|
Neufeld LM, Hernández-Cordero S, Fernald LC, Ramakrishnan U. Overweight and obesity doubled over a 6-year period in young women living in poverty in Mexico. Obesity (Silver Spring) 2008; 16:714-7. [PMID: 18239585 DOI: 10.1038/oby.2007.119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To document the changes in BMI and the prevalence of overweight and obesity in young women living in poverty in a semi-urban community in Mexico. METHODS AND PROCEDURES Women who had previously participated in a longitudinal research study (1997-2000) were re-assessed in 2005. Anthropometric measurements were obtained using standard procedures, and socio-demographic questionnaires were administered. Total and annual rate of change in BMI and change in the prevalence of overweight and obesity (BMI > or = 25.0 and > or =30.0) were estimated. RESULTS Mean age in 2005 was 30.0 +/- 5.7 years (n = 683) and time between recruitment and follow-up was 6.4 +/- 1.0 years. Mean change in BMI was +3.6 +/- 2.7 (range -8.2 to +14.6). In 2005, 500 (73.2%) women were overweight, up from 263 (38.5%) in the original assessment. The prevalence of obesity tripled over the follow-up period (from 9.8% to 30.3%). The mean annual rate of change in BMI was +0.6 (+/-0.4). After adjustment for age and parity at baseline, an annual rate of change of BMI above the sample median (>0.5) was associated with lower levels of formal education. DISCUSSION The annual increase in the prevalence of overweight and obesity in this sample is double that which was reported at a national level in Mexico. An understanding of the determinants of this rapid increase among the women living in poverty in Mexico is urgently needed.
Collapse
Affiliation(s)
- Lynnette M Neufeld
- Division of Nutri tional Epidemiology, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | | | | | | |
Collapse
|
49
|
Pérez-Martínez I, Ponce-De-León A, Bobadilla M, Villegas-Sepúlveda N, Pérez-García M, Sifuentes-Osornio J, González-y-Merchand JA, Estrada-García T. A novel identification scheme for genus Mycobacterium, M. tuberculosis complex, and seven mycobacteria species of human clinical impact. Eur J Clin Microbiol Infect Dis 2008; 27:451-9. [PMID: 18246375 DOI: 10.1007/s10096-008-0459-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 01/01/2008] [Indexed: 11/24/2022]
Abstract
Recently, the incidence of human mycobacterial infections due to species other than M. tuberculosis has increased worldwide. Since disease control depends on appropriate antimicrobial therapy, the precise identification of these species of clinical importance has become a major public health concern. Identification of mycobacteria has been hampered because of the lack of specific, rapid, and inexpensive methods. Therefore, we aimed at designing and validating a bacterial lysate-based polymerase chain reaction identification scheme. This scheme can classify clinical isolates into: (1) the genus Mycobacterium, (2) the M. tuberculosis complex, (3) the nontuberculous mycobacteria, and (4) the species M. avium, M. intracellulare, M. abscessus, M. chelonae, M. fortuitum and M. bovis of clinical importance, and M. gordonae, the most commonly encountered nonpathogenic species in clinical laboratories. By using M. fortuitum and M. avium lysates as models, the method sensitivity was determined to be 372 pg of DNA. In a blind parallel comparison between our approach and conventional biochemical tests, both assays correctly categorized 75 patient's mycobacterial isolates. However, our approach only required 4-9 h for categorization compared with at least 15 days by conventional tests. Furthermore, our methodology could also detect M. fortuitum and M. avium from liquid cultures, after only 2 and 6 days, respectively, of incubation. Our new identification scheme is therefore sensitive, specific, rapid, and economic. Additionally, it can help to provide proper treatment to patients, to control these diseases, and to improve our knowledge of the epidemiology of mycobacteriosis, all urgently needed, particularly in developing countries.
Collapse
Affiliation(s)
- I Pérez-Martínez
- Department of Molecular Biomedicine, CINVESTAV-IPN, Zacatenco, Mexico City, Mexico
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Villarreal-Molina MT, Flores-Dorantes MT, Arellano-Campos O, Villalobos-Comparan M, Rodríguez-Cruz M, Miliar-García A, Huertas-Vazquez A, Menjivar M, Romero-Hidalgo S, Wacher NH, Tusie-Luna MT, Cruz M, Aguilar-Salinas CA, Canizales-Quinteros S. Association of the ATP-binding cassette transporter A1 R230C variant with early-onset type 2 diabetes in a Mexican population. Diabetes 2008; 57:509-13. [PMID: 18003760 DOI: 10.2337/db07-0484] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The ATP-binding cassette transporter A1 (ABCA1) R230C variant is associated with low HDL cholesterol levels, obesity, and the metabolic syndrome in Mexican-Mestizos. Because a pivotal role for ABCA1 in pancreatic beta-cell function was recently observed in the mouse model, we assessed the association of this variant with type 2 diabetes in this population. RESEARCH DESIGN AND METHODS The initial group included 446 unrelated Mexican individuals: 244 with type 2 diabetes aged 20-69 years (121 with onset </=45 years), and 202 nondiabetic control subjects aged >50 years. An independent study group included 242 type 2 diabetic case subjects and 225 control subjects with similar characteristics. RESULTS R230C/C230C genotypes were significantly more frequent in type 2 diabetic individuals (24.6%) than in control subjects (11.4%) in the initial study group (OR 2.501; P = 0.001). After stratifying by age at diagnosis, the association was significant only in the early-onset group (age at diagnosis </=45 years) (OR 3.776, P = 3.3 x 10(-6)). Both associations remained significant after adjusting for admixture (P = 0.0008 and P = 8.1 x 10(-6), respectively). Similar trends were observed in the independent study group, and the combined analysis of both populations showed a highly significant association of the R230C variant with type 2 diabetes, particularly with that of early onset (P = 7.6 x 10(-6) and 9.4 x 10(-8), respectively). CONCLUSIONS The R230C ABCA1 variant is associated with type 2 diabetes, particularly of early onset, in the Mexican-Mestizo population.
Collapse
Affiliation(s)
- M Teresa Villarreal-Molina
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15 Colonia Sección 16, Tlalpan 14000, México D.F
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|