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Goodman-Palmer D, González-Rivas JP, Jaacks LM, Duran M, Marulanda MI, Ugel E, Chavarro JE, Danaei G, Nieto-Martinez R. The diabetes care continuum in Venezuela: Cross-sectional and longitudinal analyses to evaluate engagement and retention in care. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002763. [PMID: 38232087 PMCID: PMC10793920 DOI: 10.1371/journal.pgph.0002763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024]
Abstract
The impact of the humanitarian crisis in Venezuela on care for noncommunicable diseases (NCDs) such as diabetes is unknown. This study aims to document health system performance for diabetes management in Venezuela during the humanitarian crisis. This longitudinal study on NCDs is nationally representative at baseline (2014-2017) and has follow-up (2018-2020) data on 35% of participants. Separate analyses of the baseline population with diabetes (n = 585) and the longitudinal population with diabetes (n = 210) were conducted. Baseline analyses constructed a weighted care continuum: all diabetes; diagnosed; treated; achieved glycaemic control; achieved blood pressure, cholesterol, and glycaemic control; and achieved aforementioned control plus non-smoking. Weighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and care continuum stage. Longitudinal analyses constructed an unweighted care continuum: all diabetes; diagnosed; treated; and achieved glycaemic control. Unweighted multinomial regression models controlling for region were used to estimate the association between socio-demographic characteristics and changes in care continuum stage. Among 585 participants with diabetes at baseline, 71% were diagnosed, 51% were on treatment, and 32% had achieved glycaemic control. Among 210 participants with diabetes in the longitudinal population, 50 (24%) participants' diabetes management worsened, while 40 (19%) participants improved. Specifically, the proportion of those treated decreased (60% in 2014-2017 to 51% in 2018-2020), while the proportion of participants achieving glycaemic control did not change. Although treatment rates have declined substantially among people with diabetes in Venezuela, management changed less than expected during the crisis.
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Affiliation(s)
- Dina Goodman-Palmer
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Juan P. González-Rivas
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- International Clinical Research Center (ICRC), St. Ann’s University Hospital, Brno, Czech Republic
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
| | - Lindsay M. Jaacks
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Global Academy of Agriculture and Food Systems, The University of Edinburgh, Midlothian, United Kingdom
| | - Maritza Duran
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Venezuelan Society of Internal Medicine, Caracas, Venezuela
| | - María Inés Marulanda
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Venezuelan Society of Internal Medicine, Caracas, Venezuela
- Research Department, Endocrine Associates of Florida, Orlando, Florida, United States of America
| | - Eunice Ugel
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental “Lisandro Alvarado”, Barquisimeto, Venezuela
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Goodarz Danaei
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ramfis Nieto-Martinez
- Department of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Foundation for Clinic, Public Health and Epidemiology Research of Venezuela (FISPEVEN, INC), Caracas, Venezuela
- Precision Care Clinic Corp, Saint Cloud, Florida, United States of America
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Nieto-Martinez R, Barengo NC, Restrepo M, Grinspan A, Assefi A, Mechanick JI. Large scale application of the Finnish diabetes risk score in Latin American and Caribbean populations: a descriptive study. Front Endocrinol (Lausanne) 2023; 14:1188784. [PMID: 37435487 PMCID: PMC10332265 DOI: 10.3389/fendo.2023.1188784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background The prevalence of type 2 diabetes (T2D) continues to increase in the Americas. Identifying people at risk for T2D is critical to the prevention of T2D complications, especially cardiovascular disease. This study gauges the ability to implement large population-based organized screening campaigns in 19 Latin American and Caribbean countries to detect people at risk for T2D using the Finnish Diabetes Risk Score (FINDRISC). Methods This cross-sectional descriptive analysis uses data collected in a sample of men and women 18 years of age or older who completed FINDRISC via eHealth during a Guinness World Record attempt campaign between October 25 and November 1, 2021. FINDRISC is a non-invasive screening tool based on age, body mass index, waist circumference, physical activity, daily intake of fruits and vegetables, history of hyperglycemia, history of antihypertensive drug treatment, and family history of T2D, assigning a score ranging from 0 to 26 points. A cut-off point of ≥ 12 points was considered as high risk for T2D. Results The final sample size consisted of 29,662 women (63%) and 17,605 men (27%). In total, 35% of subjects were at risk of T2D. The highest frequency rates (FINDRISC ≥ 12) were observed in Chile (39%), Central America (36.4%), and Peru (36.1%). Chile also had the highest proportion of people having a FINDRISC ≥15 points (25%), whereas the lowest was observed in Colombia (11.3%). Conclusions FINDRISC can be easily implemented via eHealth technology over social networks in Latin American and Caribbean populations to detect people with high risk for T2D. Primary healthcare strategies are needed to perform T2D organized screening to deliver early, accessible, culturally sensitive, and sustainable interventions to prevent sequelae of T2D, and reduce the clinical and economic burden of cardiometabolic-based chronic disease.
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Affiliation(s)
- Ramfis Nieto-Martinez
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States
- Precision Care Clinic Corp., Saint Cloud, FL, United States
- Foundation for Clinic, Public Health, Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Noël C. Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine & Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
- Faculty of Medicine, Riga Stradiņš University, Riga, Latvia
| | - Manuela Restrepo
- Medical Affairs Latin America, Merck Kommanditgesellschaft auf Aktien (KGaA), Darmstadt, Germany
| | - Augusto Grinspan
- Medical Affairs Latin America, Merck Kommanditgesellschaft auf Aktien (KGaA), Darmstadt, Germany
| | - Aria Assefi
- Medical Affairs Latin America, Merck Kommanditgesellschaft auf Aktien (KGaA), Darmstadt, Germany
| | - Jeffrey I. Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Nieto-Martinez R, Mechanick JI, González-Rivas JP, Ugel E, Iglesias R, Clyne M, Grekin C. Revised Case Finding Protocol for Dysglycemia in Chile: A Call for Action in Other Populations. Endocr Pract 2023:S1530-891X(23)00399-3. [PMID: 37270107 DOI: 10.1016/j.eprac.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Guidelines recommend case finding for dysglycemia (prediabetes and type 2 diabetes [T2D]) in adults or youth older than 10 years with overweight/obesity, but increased adiposity has not been associated with dysglycemia in some Hispanic populations. This study aims to determine the prevalence of dysglycemia in this population using simplified criteria independent of BMI and age to request an oral glucose tolerance test (OGTT). METHODS Cross-sectional retrospective analysis of medical records from a clinical center in Chile (2000-2007). OGTT was obtained from any patient with one cardiometabolic risk factor (CMRF) independent of age and BMI. RESULTS In total, 4,969 adults (mean age ± SD) 45.7 ± 15.9 years and 509 youths 16.6 ± 3.0 years were included. The prevalence (%, 95%CI) of prediabetes doubled that of T2D in youths (14.1%, 1.4-17.4 vs. 6.3%, 4.5-8.7) and tripled it in adults (36.0%, 34.7-37.4 vs. 10.7%, 9.8-11.5). In underweight and normal-weight adults, 22% (12.0-36.7) and 29.2% (26.4-32.1) had prediabetes, whereas 4.9% (1.3-16.1) and 8.8% (7.2-10.7) had T2D, respectively. In normal-weight youths, 10.5% (6.7-15.9) and 2.9% (1.2-6.6) had prediabetes and T2D, respectively. In adults, but not in youths, most dysglycemia categories were related to overweight/obesity. CONCLUSION This study supports a public health policy to identify more people at risk for cardiovascular disease by implementing a revised case-finding protocol for dysglycemia using OGTT in even normal-weight patients over 6 years of age when there is at least one CMRF. Re-analysis of case-finding protocols for cardiometabolic risk in other populations is warranted.
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Affiliation(s)
- Ramfis Nieto-Martinez
- Precision Care Clinic Corp, Saint Cloud, FL, USA; Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Jeffrey I Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P González-Rivas
- Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; International Clinical Research Center, St Anne's University Hospital (ICRC-FNUSA), Brno, Czech Republic
| | - Eunice Ugel
- Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Rocio Iglesias
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Megan Clyne
- Department of Physiology and Biophysics, School of Medicine, Georgetown University, Washington DC, USA
| | - Carlos Grekin
- Nutrition and Diabetes Unit. Clínica Red Salud Vitacura, Santiago, Chile; Nutrition and Diabetes Service. Santiago Military Hospital, Chile; Universidad de Los Andes, Santiago de Chile, Chile.
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Gomez EJ. Institutions, crisis and type 2 diabetes policy in Venezuela. BMJ Glob Health 2022; 7:bmjgh-2021-007174. [PMID: 35798441 PMCID: PMC9263942 DOI: 10.1136/bmjgh-2021-007174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/19/2022] [Indexed: 11/04/2022] Open
Abstract
In a context of economic, political and humanitarian crisis, ensuring effective type 2 diabetes self-care management services in Venezuela has been an ongoing public health challenge. Repeated shortfalls in access to medicine, healthcare workers and food scarcity have hampered the ability of patients with diabetes to effectively manage their condition and receive the healthcare support that they deserve. With respect to methodology, the author relied on qualitative research methods, with a focus on in-depth document analysis. Primary and secondary document data sources were used through a systematic key word search in online search engines and library databases. While one may attribute these challenges in Venezuela to ongoing economic, political and humanitarian crisis, this article combines this perspective with health systems and institutional challenges that appear to have perpetuated and in fact worsened Venezuela's diabetic situation. Specifically, a weakened healthcare system, fragmentation in diabetic primary care services and corruption in a context of ongoing humanitarian crisis have contributed to these ongoing challenges. Within humanitarian and political crisis conditions, future research on type 2 diabetic treatment and self-care management may benefit from combining perspectives in political science institutional theory and public health systems analysis to explain why governments in these settings continue to fall short of providing effective and equitable diabetic care.
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Affiliation(s)
- Eduardo J Gomez
- College of Health, Department Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
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González-Rivas JP, Pavlovska I, Polcrova A, Nieto-Martínez R, Mechanick JI. Transcultural Lifestyle Medicine in Type 2 Diabetes Care: Narrative Review of the Literature. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221095048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Disparities in type 2 diabetes (T2D) care is a global problem across diverse cultures. The Dysglycemia-Based Chronic Disease (DBCD) model promotes early and sustainable interventions along the insulin resistance (stage 1), prediabetes (stage 2), T2D (stage 3), and complications (stage 4) spectrum. In this model, lifestyle medicine is the cornerstone of preventive care to reduce DBCD progression and the socioeconomic/biological burden of disease. A comprehensive literature review, spanning 2000 to 2021, was performed and 55 studies were included examining the effects of lifestyle medicine and their cultural adaptions with different prevention modalities. In stage 1, primordial prevention targets modifiable primary drivers (behavior and environment), unhealthy lifestyles, abnormal adiposity, and insulin resistance with educational and motivational health promotion activities at individual, group, community, and population-based scales. Primary, secondary, and tertiary prevention targets individuals with mild hyperglycemia, severe hyperglycemia, and complications, respectively, using programs that incorporate structured lifestyle interventions. Culturally adapted lifestyle change in primary and secondary prevention improved quality of life and biomarkers, but with a limited impact of tertiary prevention on cardiovascular events. In conclusion, lifestyle medicine with cultural adaptations is an integral part of preventive care in patients with T2D. However, considerable research gaps exist, especially for tertiary prevention.
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Affiliation(s)
- Juan P. González-Rivas
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Iuliia Pavlovska
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anna Polcrova
- International Clinical Research Centre (ICRC), St Anne’s University Hospital Brno (FNUSA), Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Ramfis Nieto-Martínez
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- LifeDoc Health, Memphis, TN, USA
| | - Jeffrey I. Mechanick
- he Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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González-Rivas JP, Infante-García MM, Nieto-Martinez R, Mechanick JI, Danaei G. Feasibility and Effectiveness of a Preventive Care Program during the Compound Humanitarian Crisis and COVID-19 Pandemic in Venezuela. Nutrients 2022; 14:nu14050939. [PMID: 35267915 PMCID: PMC8912706 DOI: 10.3390/nu14050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Effective preventive care programs are urgently needed during humanitarian crises, as has been especially obvious during the COVID-19 pandemic. A pragmatic trial was designed: hybridized intervention (Diabetes Prevention Program [DPP] + medical nutrition therapy + liquid diet [LD]; LD group) vs. DPP only (DPP group). The participants were adults who were overweight/obese and at high risk of type 2 diabetes mellitus (T2DM). The LD consisted of a “homemade” milk- and fruit-juice-based beverage. Pandemic restrictions delayed the program by nine months, tripled the amount of time required for screening, and reduced the total sample to 60%. Eventually, 127 participants were randomized, and 94/127 participants (74.0%) completed the first phase. Participant dropout was influenced by migration, COVID-19 symptoms, education level, and socioeconomic status. In two months, the LD group lost 2.9 kg (p < 0.001) and the DPP group, 2.2 kg (p < 0.001) (between-group p = 0.170), with improvements in their cardiometabolic risk factors. At this stage, the DPP was shown to be feasible and effective, demonstrating weight loss with the improvement of cardiometabolic risk factors in a primary setting in Venezuela, a middle-income country with a chronic humanitarian crisis, during the COVID-19 pandemic.
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Affiliation(s)
- Juan P. González-Rivas
- Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (R.N.-M.); (G.D.)
- International Clinical Research Center (ICRC), St. Anne’s University Hospital (FNUSA) Brno, Pekařská 53, 656 91 Brno, Czech Republic;
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Barquisimeto 3001, Venezuela
- Correspondence: ; Tel.: +420-735190316
| | - María M. Infante-García
- International Clinical Research Center (ICRC), St. Anne’s University Hospital (FNUSA) Brno, Pekařská 53, 656 91 Brno, Czech Republic;
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Barquisimeto 3001, Venezuela
| | - Ramfis Nieto-Martinez
- Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (R.N.-M.); (G.D.)
- Foundation for Clinic, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Barquisimeto 3001, Venezuela
| | - Jeffrey I. Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY 10028, USA;
- Division of Endocrinology, Diabetes and Bone, Icahn School of Medicine at Mount Sinai, New York, NY 10028, USA
| | - Goodarz Danaei
- Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA; (R.N.-M.); (G.D.)
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Noronha JC, Mechanick JI. Is There a Role for Diabetes-Specific Nutrition Formulas as Meal Replacements in Type 2 Diabetes? Front Endocrinol (Lausanne) 2022; 13:874968. [PMID: 35573987 PMCID: PMC9099205 DOI: 10.3389/fendo.2022.874968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/29/2022] [Indexed: 12/13/2022] Open
Abstract
Nutrition therapy plays an integral role in the prevention and management of patients with type 2 diabetes (T2D). A potential strategy is the utilization of diabetes-specific nutrition formulas (DSNFs) as meal replacements. In this article, we distinguish DSNFs from standard nutrition formulas, review the clinical data examining the effectiveness of DSNFs, and propose an evidence-based algorithm for incorporating DSNFs as part of nutrition therapy in T2D. DSNFs contain slowly-digestible carbohydrates, healthy fats (e.g., monounsaturated fatty acids), and specific micronutrients, which provide added benefits over standard nutrition formulas. In short- and long-term clinical trials, DSNFs demonstrate improvements in postprandial glycemic responses translating into sustainable benefits in long-term glycemic control (e.g., hemoglobin A1c and glycemic variability) and various cardiometabolic outcomes. To facilitate the delivery of DSNFs in a clinical setting, the transcultural diabetes nutrition algorithm can be utilized based on body weight (underweight, normal weight, or overweight) and level of glycemic control (controlled or uncontrolled).
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Affiliation(s)
- Jarvis C. Noronha
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON, Canada
- School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Jarvis C. Noronha,
| | - Jeffrey I. Mechanick
- Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Babagoli MA, Nieto-Martínez R, González-Rivas JP, Sivaramakrishnan K, Mechanick JI. Roles for community health workers in diabetes prevention and management in low- and middle-income countries. CAD SAUDE PUBLICA 2021; 37:e00287120. [PMID: 34730688 DOI: 10.1590/0102-311x00287120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/12/2021] [Indexed: 11/22/2022] Open
Abstract
Diabetes prevalence is increasing worldwide, especially in low- and middle-income countries (LMIC), posing the need for improved detection and management strategies. Chronic disease models and lifestyle medicine provide structures for action. Community health workers (CHWs) can significantly contribute to chronic disease care if they are trained and integrated into low-resource health systems. Although most current CHWs worldwide are performing maternal/child health and infectious disease-related tasks, other programs involving CHWs for noncommunicable disease prevention and management are increasing. In this article, we discuss the advantages, challenges, and questions regarding possible roles assigned to CHWs in the prevention and management of diabetes. These roles include performing simple screening tests, implementing lifestyle/behavioral interventions, and connecting patients with alternatives to biomedicine. Specifically, CHWs can aid diabetes epidemiological surveillance by conducting risk score-based screening or capillary glucose testing, and they can facilitate diabetes self-management by delivering interventions described in the transcultural diabetes nutrition algorithm. Furthermore, while this role has not formally been assigned, CHWs can leverage their intimate knowledge of local practices to provide decision-making support to patients in environments with pluralistic health systems. Ethnocultural differences in CHW functions and transcultural adaptations of their roles in diabetes care should also be considered. In summary, CHWs can improve diabetes care by screening high-risk individuals and implementing lifestyle interventions, especially in LMIC.
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Affiliation(s)
- Masih A Babagoli
- Institute for Global Health Sciences, University of California, San Francisco, U.S.A.,Center for the History and Ethics of Public Health, Columbia University, New York, U.S.A
| | - Ramfis Nieto-Martínez
- LifeDoc Health, Memphis, U.S.A.,Harvard TH Chan School of Public Health, Harvard University, Boston, U.S.A
| | - Juan P González-Rivas
- Foundation for the Clinic, Public Health, and Epidemiological Research of Venezuela, Caracas, Venezuela.,International Clinical Research Center, St Anne's University Hospital, Czech Republic
| | | | - Jeffrey I Mechanick
- Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, U.S.A.,Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, U.S.A
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Nieto-Martínez R, González-Rivas JP, Ugel E, Duran M, Dávila E, Constantino R, García A, Mechanick JI, Marulanda MI. Cardiometabolic risk factors in Venezuela. The EVESCAM study: a national cross-sectional survey in adults. Prim Care Diabetes 2021; 15:106-114. [PMID: 32768283 DOI: 10.1016/j.pcd.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/04/2020] [Accepted: 07/16/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND No previous study in Venezuela and few in the Region of the Americas have reported national cardiometabolic health data. OBJECTIVES To determine the prevalence and distribution of cardiometabolic risk factors (CMRF) in adults of Venezuela. METHODS A population-based, cross-sectional, and randomized cluster sampling national study was designed to recruit 4454 adults with 20 years or older from the eight regions of the country from July 2014 to January 2017. Sociodemographic, clinical, physical activity, nutritional, and psychological questionnaires; anthropometrics, blood pressure, and biochemical measurements were obtained. The results were weighted by gender, age, and regions. RESULTS Data from 3414 participants (77% of recruited), 52.2% female, mean age of 41.2 ± 15.8 years, were analyzed. CMRF adjusted-prevalence were: diabetes (12.3%), prediabetes (34.9%), hypertension (34.1%), obesity (24.6%), overweight (34.4%), abdominal obesity (47.6%), underweight (4.4%), hypercholesterolemia (19.8%), hypertriglyceridemia (22.7%), low HDL-cholesterol (63.2%), high LDL-c (20.5%), daily consumption of fruits (20.9%) and vegetables (30.0%), insufficient physical activity (35.2%), anxiety (14.6%) and depression (3.2%) symptoms, current smoker (11.7%), and high (≥ 20%) 10-year fatal cardiovascular risk (14.0%). CMRF prevalence varied according to gender, age and region of residence. CONCLUSIONS Cardiometabolic risk factors are highly prevalent in Venezuelan adults. This situation can be affected by the severe socio-economic crisis in the country. The joint action of different stakeholders to implement public health strategies for the prevention and treatment of these risk factors in Venezuela is urgently needed.
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Affiliation(s)
- Ramfis Nieto-Martínez
- LifeDoc Health, Memphis, TN, USA; Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Barquisimeto, Venezuela; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Juan P González-Rivas
- International Clinical Research Center (ICRC), St Anne's University Hospital (FNUSA) Brno, Czech Republic; Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Eunice Ugel
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Maritza Duran
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Eric Dávila
- Department of Internal Medicine, School of Medicine "Dr. Luis Razetti", Universidad Central de Venezuela (UCV), Caracas, Venezuela
| | - Ramez Constantino
- Department of Internal Medicine, School of Medicine, Universidad de Carabobo, Valencia, Venezuela
| | - Alberto García
- Department of Physiology. School of Medicine "Dr. Luis Razetti", Universidad Central de Venezuela (UCV), Caracas, Venezuela
| | - Jeffrey I Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - María Inés Marulanda
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
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Goodman D, González-Rivas JP, Jaacks LM, Duran M, Marulanda MI, Ugel E, Mattei J, Chavarro JE, Nieto-Martinez R. Dietary intake and cardiometabolic risk factors among Venezuelan adults: a nationally representative analysis. BMC Nutr 2020; 6:61. [PMID: 33088579 PMCID: PMC7566137 DOI: 10.1186/s40795-020-00362-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Increasing trends in global obesity have been attributed to a nutrition transition where healthy foods are replaced by ultra-processed foods. It remains unknown if this nutrition transition has occurred in Venezuela, a country undergoing a socio-political crisis with widespread food shortages. METHODS We described dietary intake of Venezuelans from a nationally representative study conducted between 2014 and 2017. We conducted a cross-sectional analysis of dietary, sociodemographic, and clinical data from Venezuelans ≥20 years of age (n = 3420). Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Standardized clinical and anthropometric measurements estimated obesity, type 2 diabetes, and hypertension. A Dietary Diversity Score (DDS) was calculated using an amended Minimum Dietary Diversity for Women score where the range was 0 to 8 food groups, with 8 being the most diverse. Analyses accounted for complex survey design by estimating weighted frequencies of dietary intake and DDS across sociodemographic and cardiometabolic risk-based subgroups. RESULTS The prevalence of obesity was 24.6% (95% CI: 21.6-27.7), type 2 diabetes was 13.3% (11.2-15.7), and hypertension was 30.8% (27.7-34.0). Western foods were consumed infrequently. Most frequently consumed foods included coffee, arepas (a salted corn flour cake), and cheese. Mean DDS was 2.3 food groups (Range: 0-8, Standard Error: 0.07) and this score did not vary among subgroups. Men, younger individuals, and those with higher socioeconomic status were more likely to consume red meat and soft drinks once or more weekly. Women and those with higher socioeconomic status were more likely to consume vegetables and cheese once or more daily. Participants with obesity, type 2 diabetes, and hypertension had lower daily intake of red meat and arepas compared to participants without these risk factors. CONCLUSIONS Despite high prevalence of cardiometabolic risk factors, adults in Venezuela have not gone through a nutrition transition similar to that observed elsewhere in Latin America. Dietary diversity is low and widely consumed food groups that are considered unhealthy are part of the traditional diet. Future studies are needed in Venezuela using more comprehensive measurements of dietary intake to understand the effect of the socio-political crisis on dietary patterns and cardiometabolic risk factors.
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Affiliation(s)
- Dina Goodman
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Juan P. González-Rivas
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
- International Clinical Research Center (ICRC), St. Ann’s University Hospital, Brno, Czech Republic
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Maritza Duran
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - María Inés Marulanda
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- Endocrine Associates of Florida, Research Department, Orlando, Florida USA
| | - Eunice Ugel
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental “Lisandro Alvarado”, Barquisimeto, Venezuela
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | - Ramfis Nieto-Martinez
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
- LifeDoc Health, Memphis, TN USA
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Nieto-Martínez R, González-Rivas JP, Ugel E, Marulanda MI, Durán M, Mechanick JI, Aschner P. External validation of the Finnish diabetes risk score in Venezuela using a national sample: The EVESCAM. Prim Care Diabetes 2019; 13:574-582. [PMID: 31202539 DOI: 10.1016/j.pcd.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the performance of the Latin American Finnish Diabetes Risk Score (LA-FINDRISC) compared with the original O-FINDRISC in general population. To establish the best cut-off to detect unknown type 2 diabetes (uT2D) and prediabetes. METHODS The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3454 adults from July 2014 to January 2017. Those with self-report of diabetes were excluded; a total of 3061 subjects were analyzed. Waist circumference adapted for Latin America was the difference between the LA-FINDRISC and the O-FINDRISC. The area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS The prevalence of uT2D and prediabetes were 3.3% and 38.5%. The AUC with the LA-FINDRISC vs. the O-FINDRISC were: for uT2D, 0.722 vs. 0.729 in men (p=0.854) and 0.724 vs. 0.732 in women (p=0.896); for prediabetes (impaired fasting glucose [IFG] + impaired glucose tolerance [IGT], 0.590 vs. 0.587 in men (p=0.887) and 0.621 vs. 0.627 in women (p=0.777); for IFG, 0.582 vs. 0.580 in men (p=0.924) and 0.607 vs. 0.617 in women (p=0.690); for IGT, 0.691 vs. 0.692 in men (p=0.971) and 0.672 vs. 0.671 in women (p=0.974). Using the LA-FINDRISC, the best cut-offs to detect uT2D were 9 in men and 10 in women and to detect IGT was 9 in both genders. CONCLUSION LA-FINDRISC has similar performance than O-FINDRISC in Venezuelan adults and showed a good performance to detect uT2D and IGT, but not IFG. The best cut-offs to detect glucose alterations were established.
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Affiliation(s)
- Ramfis Nieto-Martínez
- South Florida Veterans Affairs Foundation for Research & Education and Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA; Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" and Cardio-Metabolic Unit 7, Barquisimeto, Venezuela; Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela.
| | - Juan P González-Rivas
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; The Andes Clinic of Cardio-Metabolic Studies, Mérida, Venezuela
| | - Eunice Ugel
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; Department of Preventive Medicine, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Maria Ines Marulanda
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; Endocrine Associates of Florida, Research Department, Orlando, FL, USA; Internal Medicine Department, Universidad de Carabobo and Guerra Méndez Medical Center, Valencia, Venezuela
| | - Maritza Durán
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; Internal Medicine Department, Avila Clinic, Caracas, Venezuela
| | - Jeffrey I Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pablo Aschner
- Javeriana University, San Ignacio University Hospital, Colombian Diabetes Association, Bogotá, Colombia
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González-Rivas JP, Polonsky W, Infante-García MM, Duran M, Ugel E, Marulanda MI, Mechanick JI, Nieto-Martínez R. Diabetes and depression were not associated in Venezuelan adults: The EVESCAM study, a national cross-sectional sample. Prim Care Diabetes 2019; 13:441-445. [PMID: 30819651 DOI: 10.1016/j.pcd.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence suggests that depression is more common in patients with diabetes than in the general population. However, contradictory results expose controversy in this association. OBJECTIVE To evaluate the relationship between diabetes and depression in a national sample of Venezuelan adults. METHODS The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,454 adults from July 2014 to January 2017 (response rate of 77.3%). Diabetes was defined using fasting blood glucose and a 2-hour oral glucose tolerance test. Depressive symptoms were determined using the Hospital Anxiety and Depression Scale. RESULTS 3255 subjects were assessed. Depressive symptom score was different between genders and among age groups (p<0.001), and similar in those subjects with or without diabetes (p=0.899). Depressive symptoms prevalence was higher in women than in men and increased with age (p<0.05), but was similar in those with and without diabetes (p=0.215). Using a multivariate regression analysis model, the association of depressive symptoms and diabetes remains non-significant after adjusting for age and gender (Odds ratio=0.98; 95% Confidence Intervals 0.95 - 1.02, p=0.504). CONCLUSION Diabetes and depression were not associated in a large sample of Venezuelan adults.
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Affiliation(s)
- Juan Pablo González-Rivas
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela.
| | - William Polonsky
- Department of Psychiatry, University of California, San Diego, California, USA; Behavioral Diabetes Institute, San Diego, California, USA
| | - María María Infante-García
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela
| | - Maritza Duran
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; Internal Medicine Department, Avila Clinic, Caracas, Venezuela
| | - Eunice Ugel
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - María Ines Marulanda
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; Endocrine Associates of Florida, Orlando, Florida, USA
| | - Jeffrey I Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ramfis Nieto-Martínez
- Foundation for Clinical, Public Health, and Epidemiological Research of Venezuela (FISPEVEN), Caracas, Venezuela; Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; South Florida Veterans Affairs Foundation for Research & Education and Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA; Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Barquisimeto, Venezuela
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González-Rivas JP, Mechanick JI, Ugel E, Marulanda MI, Duran M, Nieto-Martínez R. Cardiovascular Health in a National Sample of Venezuelan Subjects Assessed According to the AHA Score: The EVESCAM. Glob Heart 2019; 14:285-293. [PMID: 31327753 DOI: 10.1016/j.gheart.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/18/2019] [Accepted: 06/20/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cardiovascular health status of the Venezuelan population has not been evaluated. The American Heart Association recommends the Cardiovascular Health Score (CHS) to assess cardiovascular health. OBJECTIVES This study sought to determine the prevalence of CHS categories in a nationally representative sample of Venezuelan adults. METHODS EVESCAM (Venezuelan Study of Cardio-Metabolic Health) was a national population-based, cross-sectional, randomized cluster sampling study performed from July 1, 2014 to January 31, 2017, which assessed 3,454 adults, age ≥20 years, with a response rate of 77.3%. The American Heart Association's CHS evaluates 4 behaviors (smoking, body mass index, physical activity, and diet) and 3 risk factors (total cholesterol, blood pressure, and blood glucose), assigning 1 point to those meting an ideal behavior or factor or 0 points if are not. Subjects were categorized as having ideal (5 to 7 points), intermediate (3 to 4), or poor (<3) cardiovascular health. Weighted prevalence by age, sex, and regions are presented. RESULTS A total of 2,992 participants completed the data. Mean age and CHS were 41.4 ± 15.8 years and 4.3 ± 1.1 points, respectively. The prevalence of ideal CHS was 37.9% (95% confidence interval: 35.0 to 40.7); two-thirds presented with intermediate to poor CHS. Ideal CHS was most prevalent in women, in the youngest participants, and in those with higher education degree and living in a rural area. The prevalence of 7 components was 0.13%. Subjects evaluated since mid-2016 had a higher prevalence of ideal CHS (≈47%) than those evaluated before it (≈32%) (p < 0.001). CONCLUSIONS A high prevalence of ideal CHS was observed in Venezuelan adults compared with other reports; however, a large proportion remain with high risk for cardiovascular disease.
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Affiliation(s)
- Juan P González-Rivas
- Foundation for Clinical, Public Health and Epidemiology Research in Venezuela (FISPEVen), Caracas, Venezuela.
| | - Jeffrey I Mechanick
- Divisions of Cardiology Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eunice Ugel
- Foundation for Clinical, Public Health and Epidemiology Research in Venezuela (FISPEVen), Caracas, Venezuela; Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, University Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - María Inés Marulanda
- Foundation for Clinical, Public Health and Epidemiology Research in Venezuela (FISPEVen), Caracas, Venezuela; Endocrine Associates of Florida, Research Department, Orlando, Florida, USA
| | - Maritza Duran
- Foundation for Clinical, Public Health and Epidemiology Research in Venezuela (FISPEVen), Caracas, Venezuela; Internal Medicine Department, Avila Clinic, Caracas, Venezuela
| | - Ramfis Nieto-Martínez
- South Florida Veterans Affairs Foundation for Research & Education and Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA; Department of Global Health and Population. Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" Barquisimeto, Cardio-metabolic Unit 7, Barquisimeto, Venezuela
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14
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Re-Classifying Hypertension in the Venezuelan EVESCAM Database Using 2017 AHA/ACC Criteria: High Prevalence, Poor Control, and Urgent Call for Action. Ann Glob Health 2019; 85. [PMID: 31148436 PMCID: PMC6634473 DOI: 10.5334/aogh.2346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: In 2017 the American Heart Association (AHA)/American College of Cardiology (ACC) changed the criteria to define hypertension (HTN). Objective: To re-analyze Venezuelan data to update HTN prevalence rates and estimate the number of adults with uncontrolled blood pressure (BP) using AHA/ACC criteria. Methods: The EVESCAM was a national population-based, cross-sectional, randomized cluster sampling study, which assessed 3,420 adults from July 2014 to January 2017, with a response rate of 77.3%. The mean of two BP measurements was obtained using a standard oscillometric device protocol. HTN was defined using both 2017 AHA/ACC guideline (BP ≥ 130/80 mmHg) and JNC7 (BP ≥ 140/90 mmHg) criteria. Findings: The crude prevalence of HTN using 2017 AHA/ACC guideline criteria was 60.4%, 13% higher than with the JNC7 criteria. The age-standardized prevalence was 55.4% in men and 49.0% in women (p < 0.001), 17.5% and 12.7% higher, respectively, compared with the JNC7 criteria. In subjects without self-reported HTN, the age-standardized prevalence of HTN was 43.4% in men and 32.3% in women, of whom, 22.9% and 19.2% were between 130–139/80–89 mmHg, respectively. In those with self-reported HTN, the prevalence of uncontrolled BP (≥130/80 mmHg) on antihypertensive medication was 66.8% in men and 65.8% in women. The total estimated number of subjects with HTN in Venezuela increased to 11 million, and only about 1.8 million are controlled. Conclusion: Using the new 2017 AHA/ACC guideline, the prevalence of HTN in Venezuela is approximately half of the adult population and associated with relatively poor BP control.
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Nieto-Martínez R, González-Rivas JP, Infante-García MM. Implementing Medical Nutritional Therapy Through Dietary Patterns in Prevention and Treatment of Diabetes. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0243-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Nieto-Martínez R, Mechanick JI, Brajkovich I, Ugel E, Risques A, Florez H, González-Rivas JP. Prevalence of diabetes in three regions of Venezuela. The VEMSOLS study results. Prim Care Diabetes 2018; 12:126-132. [PMID: 29249672 DOI: 10.1016/j.pcd.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/23/2017] [Accepted: 11/30/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The prevalence of diabetes in multiple regions of Venezuela is unknown. To determine the prevalence of diabetes in five populations from three regions of Venezuela. METHODS During 2006-2010, 1334 subjects ≥20years were selected by multistage stratified random sampling from all households from 3 regions of Venezuela. Anthropometric measurements and biochemical analysis were obtained. Statistical methods were calculated using SPSS 20 software. FINDINGS Mean (SE) age was 44.8 years (0.39) and 68.5% were females. The prevalence of diabetes was 8.3% (95% CI, 6.9%-10.0%), higher in men than women (11.2% and 7.0% respectively; p=0.01). The prevalence adjusted by age and gender was 8.0% (95% CI, 6.9%-9.9%). This figure increased with age, with the lowest prevalence in the 20-29year old group (1.8% [95% CI, 0.6%-4.8%]) and the highest in the oldest group (26.8% [95% CI, 16.2%-40.5%]). Subjects with overweight or obesity had no increased risk of diabetes compared with those with normal weight. However, in women, the presence of abdominal obesity was associated with an increase of the risk of diabetes by 77% (OR 1.77 [95% CI, 1.1%-2.9%]). The prevalence of prediabetes was 14.6% (95% CI, 12.8%-16.7%), and only 48.2% were aware of their diabetes condition. CONCLUSION In this study, 8.3% of the subjects had diabetes and 14.6% prediabetes. Less than half of the subjects with diabetes were aware of their condition. These results point to a major public health problem, requiring the implementation of diabetes prevention programs.
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Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, University Centro-Occidental "Lisandro Alvarado" (UCLA), Barquisimeto, Venezuela; Cardio-Metabolic Unit 7, Barquisimeto, Venezuela; Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, Miami, FL, USA; South Florida Veterans Affairs Foundation for Research & Education, Miami, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Imperia Brajkovich
- Department of Internal Medicine B, School of Medicine "Luis Razetti", University Hospital of Caracas, University Central de Venezuela, Caracas, Venezuela
| | - Eunice Ugel
- Department of Preventive Medicine, School of Medicine, University Centre-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Alejandro Risques
- Department of Social and Preventive Medicine, School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Hermes Florez
- University of Miami Miller School of Medicine and Miami Veterans Affairs Medical Center, Miami, FL, USA
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González-Rivas JP, Nieto-Martínez R, Brajkovich I, Ugel E, Rísquez A. Prevalence of Dyslipidemias in Three Regions in Venezuela: The VEMSOLS Study Results. Arq Bras Cardiol 2018. [PMID: 29538522 PMCID: PMC5831299 DOI: 10.5935/abc.20170180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The prevalence of dyslipidemia in multiple regions of Venezuela is unknown.
The Venezuelan Metabolic Syndrome, Obesity and Lifestyle Study (VEMSOLS) was
undertaken to evaluate cardiometabolic risk factors in Venezuela. Objective To determine the prevalence of dyslipidemia in five populations from three
regions of Venezuela. Methods During the years 2006 to 2010, 1320 subjects aged 20 years or older were
selected by multistage stratified random sampling from all households in
five municipalities from 3 regions of Venezuela: Lara State (Western
region), Merida State (Andean region), and Capital District (Capital
region). Anthropometric measurements and biochemical analysis were obtained
from each participant. Dyslipidemia was defined according to the NCEP/ATPIII
definitions. Results Mean age was 44.8 ± 0.39 years and 68.5% were females. The prevalence
of lipids abnormalities related to the metabolic syndrome (low HDL-c [58.6%;
95% CI 54.9 - 62.1] and elevated triglycerides [39.7%; 36.1 - 43.2]) were
the most prevalent lipid alterations, followed by atherogenic dyslipidemia
(25.9%; 22.7 - 29.1), elevated LDL-c (23.3%; 20.2 - 26.4),
hypercholesterolemia (22.2%; 19.2 - 25.2), and mix dyslipidemia (8.9%; 6.8 -
11.0). Dyslipidemia was more prevalent with increasing body mass index. Conclusion Dyslipidemias are prevalent cardiometabolic risk factors in Venezuela. Among
these, a higher prevalence of low HDL is a condition also consistently
reported in Latin America.
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Affiliation(s)
| | - Ramfis Nieto-Martínez
- Geriatric Research, Education and Clinical Center (GRECC) and South Florida Veterans Affairs Foundation for Research & Education, Miami VA Healthcare System, Miami, FL - USA.,Department of Physiology - School of Medicine - University Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Barquisimeto, Venezuela
| | - Imperia Brajkovich
- Department of Internal Medicine B - School of Medicine "Luis Razetti" - University Hospital of Caracas - Universidad Central de Venezuela
| | - Eunice Ugel
- Department of Preventive Medicine - School of Medicine - Universidad CentroOccidental "Lisandro Alvarado"
| | - Alejandro Rísquez
- Department of Social and Preventive Medicine - School of Medicine, Universidad Central de Venezuela
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Mechanick JI, Leroith D. Synthesis: Deriving a Core Set of Recommendations to Optimize Diabetes Care on a Global Scale. Ann Glob Health 2018; 81:874-83. [PMID: 27108155 DOI: 10.1016/j.aogh.2016.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diabetes afflicts 382 million people worldwide, with increasing prevalence rates and adverse effects on health, well-being, and society in general. There are many drivers for the complex presentation of diabetes, including environmental and genetic/epigenetic factors. OBJECTIVE The aim was to synthesize a core set of recommendations from information from 14 countries that can be used to optimize diabetes care on a global scale. METHODS Information from 14 papers in this special issue of Annals of Global Health was reviewed, analyzed, and sorted to synthesize recommendations. PubMed was searched for relevant studies on diabetes and global health. FINDINGS Key findings are as follows: (1) Population-based transitions distinguish region-specific diabetes care; (2) biological drivers for diabetes differ among various populations and need to be clarified scientifically; (3) principal resource availability determines quality-of-care metrics; and (4) governmental involvement, independent of economic barriers, improves the contextualization of diabetes care. Core recommendations are as follows: (1) Each nation should assess region-specific epidemiology, the scientific evidence base, and population-based transitions to establish risk-stratified guidelines for diagnosis and therapeutic interventions; (2) each nation should establish a public health imperative to provide tools and funding to successfully implement these guidelines; and (3) each nation should commit to education and research to optimize recommendations for a durable effect. CONCLUSIONS Systematic acquisition of information about diabetes care can be analyzed, extrapolated, and then used to provide a core set of actionable recommendations that may be further studied and implemented to improve diabetes care on a global scale.
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Affiliation(s)
- Jeffrey I Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Derek Leroith
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
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Nieto-Martínez R, González-Rivas JP, Aschner P, Barengo NC, Mechanick JI. Transculturalizing Diabetes Prevention in Latin America. Ann Glob Health 2017; 83:432-443. [PMID: 29221516 DOI: 10.1016/j.aogh.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) imposes a heavy burden in developing countries, requiring effective primary prevention policies. Randomized clinical trials have identified successful strategies in T2D prevention. However, translating these results to real-life scenarios and adapting to ethnocultural differences is a major challenge. Transculturalization allows incorporating cultural factors to diabetes prevention strategies to optimize implementation of clinical trials results. The purpose of this paper is to review the transcultural adaptations developed for T2D prevention in Latin America (LA). METHODS A comprehensive literature review spanning 1960-2016 was performed, using "Diabetes," "Latin America," "Prevention," "Screening," and "Tools" as key words. RESULTS Two major tasks are underway in LA: adaptation of screening tools for high-risk individuals, and implementation of diabetes prevention programs. The Finnish Diabetes Risk Score (FINDRISC) is the most widely used screening tool to detect new cases of T2D and people with prediabetes, and it has been adapted (LA-FINDRISC) to include the waist circumference cutoff values appropriate for LA population (≥94 cm for men and ≥90 cm for women). The validation of the LA-FINDRISC performance depends on the local characteristics. A LA-FINDRISC score >10 may be the best cutoff to identify individuals with impaired glucose regulation in population-based studies, but a higher score (>12-14) might be more appropriate in a clinical setting. A shorter version of the FINDRISC using only the 4 variables with highest impact has been developed and validated in Colombia (ColDRISC). The translation of the Diabetes Prevention Program study in a Latino population in Venezuela found a significant improvement in cardiometabolic risk factors. An adaptation of the Diabetes Prevention Study in the DEMOJUAN study in Barranquilla, Colombia, reduced 2-hour postload glucose. CONCLUSION Successful transculturalization strategies have been implemented in screening tools and prevention programs in LA.
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Affiliation(s)
- Ramfis Nieto-Martínez
- Geriatric Research, Education, and Clinical Center (GRECC), Miami VA Healthcare System, South Florida Veterans Affairs Foundation for Research & Education, Miami, FL; Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Barquisimeto, Venezuela.
| | | | - Pablo Aschner
- Javeriana University, San Ignacio University Hospital, Colombian Diabetes Association, Bogotá, Colombia
| | - Noël C Barengo
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL; Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY
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Ponte-Negretti CI, Isea-Perez JE, Lorenzatti AJ, Lopez-Jaramillo P, Wyss-Q FS, Pintó X, Lanas F, Medina J, Machado-H LT, Acevedo M, Varleta P, Bryce A, Carrera C, Peñaherrera CE, Gómez-M JR, Lozada A, Merchan-V A, Piskorz D, Morales E, Paniagua M, Medina-Palomin F, Villar-M RA, Cobos L, Gómez-Alvares E, Alonso R, Colan J, Chirinos J, Lara J, Ullauri V, Arocha I. Atherogenic Dyslipidemia in Latin America: Prevalence, causes and treatment: Expert's position paper made by The Latin American Academy for the Study of Lipids (ALALIP) Endorsed by the Inter-American Society of Cardiology (IASC), the South American Society of Cardiology (SSC), the Pan-American College of Endothelium (PACE), and the International Atherosclerosis Society (IAS). Int J Cardiol 2017; 243:516-522. [PMID: 28552520 DOI: 10.1016/j.ijcard.2017.05.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
This is an executive summary made by a group of experts named Latin American Academy for the study of Lipids (ALALIP). In the current clinical guidelines, atherogenic dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named (ALALIP) to generate a document in order to analyze their prevalence and to offer practical recommendations. METHODOLOGY using the Delphi methodology, we conducted a comprehensive literature review with emphasis on those publications related to LA. Subsequently, we developed key questions for discussion. As a convention, those recommendations that had a 100% of acceptance were considered unanimous, those with >80% were consensual, and those with <80% were in disagreement. RESULTS a systematic analysis of national health surveys and regional cohort studies showed a consistently high prevalence of the lipid abnormalities that define AD: low levels of high-density lipoprotein cholesterol (HDL-C) range from 34.1% to 53.3% and elevated triglycerides (TG) range from 25.5% to 31.2%. These abnormalities could be related to high consumption of food with a high caloric density, cholesterol and trans fats, a sedentary lifestyle and perhaps epigenetic changes CONCLUSIONS: lipid abnormalities that define AD have a high prevalence in LA. The interaction between an unfavorable lifestyle, inheritance and epigenetic changes is probably their cause. It is important to design a global study of risk factors in LA to know its true prevalence in the region, its consequences and to derive from its treatment strategies.
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Nieto-Martínez R, González-Rivas JP, Florez H, Mechanick JI. Transcultural Endocrinology: Adapting Type-2 Diabetes Guidelines on a Global Scale. Endocrinol Metab Clin North Am 2016; 45:967-1009. [PMID: 27823615 DOI: 10.1016/j.ecl.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Type-2 diabetes (T2D) needs to be prevented and treated effectively to reduce its burden and consequences. White papers, such as evidence-based clinical practice guidelines (CPG) and their more portable versions, clinical practice algorithms and clinical checklists, may improve clinical decision-making and diabetes outcomes. However, CPG are underused and poorly validated. Protocols that translate and implement these CPG are needed. This review presents the global dimension of T2D, details the importance of white papers in the transculturalization process, compares relevant international CPG, analyzes cultural variables, and summarizes translation strategies that can improve care. Specific protocols and algorithmic tools are provided.
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Affiliation(s)
- Ramfis Nieto-Martínez
- Department of Physiology, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado" and Cardio-metabolic Unit 7, Av. Andrés Bello con Av. Libertador, Apartado 516, Barquisimeto, Venezuela; Department of Physiology, School of Medicine, University of Panamá, Vía Transísmica, Apartado 0824, Estafeta Universitaria, Panamá, República de Panamá.
| | - Juan P González-Rivas
- The Andes Clinic of Cardio-Metabolic Studies, Av. Miranda entre calles Bermúdez y Arismendi, Apartado 3112, Timotes, Venezuela
| | - Hermes Florez
- Miami Veterans Affairs Medical Center, University of Miami Miller School of Medicine, 1201 Northwest 16th Street, CLC 207, Miami, FL 33125, USA
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, 1192 Park Avenue, New York, NY 10128, USA
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Nieto-Martínez R, González-Rivas JP, Lima-Martínez M, Stepenka V, Rísquez A, Mechanick JI. Diabetes Care in Venezuela. Ann Glob Health 2016; 81:776-91. [DOI: 10.1016/j.aogh.2015.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Transcultural Applications to Lifestyle Medicine. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Transcultural Diabetes Nutrition Algorithm: Brazilian Application. Nutrients 2015; 7:7358-80. [PMID: 26340638 PMCID: PMC4586537 DOI: 10.3390/nu7095342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/16/2015] [Accepted: 07/17/2015] [Indexed: 12/17/2022] Open
Abstract
The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D) is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy) and regular physical activity (structured exercise) represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA) is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.
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