High prevalence of cholelithiasis in a low income mexican population: An ultrasonographic syrvey

The authors present the result of a population based survey of cholelititasis carried out in a low income area of Mexico city using high resolution gallbladder ultrasound. The purpose of the study was to estimate the prevalence and selected associated risk factors of cholelithiasis (CL). The population of the studied area was 15,532 subjects, of whom 3,505 (22.6 percent) were eligible for the baseline survey (men and non-pregnant women between 35-64 years of age). Of this group, 1,735 (76.03 percent, 702 men and 1,033 women) were located for a follow-up study. Ultrasonography was performed on all except for 100 subjects who had undergone previous cholecystectomy. Crude prevalence of CL was 14.1 percent (95 percent CI 12.5-15.5). The prevalence was 5.8 percent (95 percent CI 4.1-7.5) in men and 19.7 percent (95 percent CI 17-3-22.1) in women. Presence of gallstones was associated with age, sex (men p<0.006, women p<0.001), and multiparity (p<0.002). Centrality index in men and body mass index in women were positive and significantly associated with CL when compared with subjects without CL. High levels of fasting and post glucose load insulin in women and men respectively were associated with CL. The authors conclude that the population of this study has a high prevalence of CL and confirm some know risk factors such as age, sex, BMI and multiparity. Proper assessment of the magnitude problem and characterization of potentially modifiable risk factors will play a major role in preventing this pathology

A diabetic retinopathy screening program as a strategy for blindness prevention

The most frequent cause of preventable blindness in adults, in the developed world, is diabetic retinopathy (DR). the early treatable phase of this complication is clinically silent. In order to institute effectiv elaser photocoagulation and prevention of blindness, timely detection is crucial. Consequently there is a nedd for periodic funduscopic examinations of all diabetics. Due to the high prevalence of DM in Mexico most of the primary care facilities are limited. We present the results of a DR screening program (DRSP) using a mobile unit equipped with a fundus photography camera, parked outside of a clinic. We report the prevalence of the various stages of DR and clinical characteristics observed in this population as well as our experience working in such an environment. Th estudy period was from september 1 to december 22, 1995. All the diabetics that presented for care to the clinica were identified and all other persons were invited to participate. A total of 231 participants were invited (112 men, 119 women). Non- stereo fundus photos of two retinal fields (macula and optic disk centered) were taken with techique and classification according to international standards. Response rate to the invitation was 95.3 percent. Mean age was 62.4 ñ 13 years and 63.5 ñ 10 years and duration of diabetes was 12.3 ñ 10.1 years and 11.0 ñ 7.5 years for men and women, respectively. DR was detected in 38 percent of the caes, of these only 5.6 percent have received treatment. DR was uncovered in 84.5 percent of the cases and was associated with duration of diabetes (p<0.001 in men and p=0.04 in women) and hyperglycemia (in men p<005, only). DR has a high prevalence in this population and can be detected through a screening program which rveals undiagnosed hig risk DR in an efficient, and standardized manner

Undiagnosed hypercholesterolemia: a serious health challenge: the Mexico City Diabetes Study

In this report we present the results of a population based survey designed to characterize the prevalence of hypercholesterolemia (HCL: total cholesterol > or = 240 mg/dl) in a low income urban area of Mexico City (The Mexico City Diabetes Study). In an area of 15,532 inhabitants, 3505 (22.57 per cent) were found to be study eligible (all 35 -64 year-old men and nonpregnant women residing in the area permanently). A home interview was obtained in 2813 (80.26 per cent) subjects. A physical exam and oral glucose tolerance test was performed on 2282 (81.2 per cent of the individuals that gave the interview and 65.1 per cent of all study eligibles, 941 men and 1341 women). The crude prevalence of HCL for men in this group was 12.3 per cent and for women 12.5 per cent. Severe HCL (total cholesterol > or = 260 mg/dl) was found in 6.6 per cent of men and 6.5 per cent of women. In the older age group (55 - 64 years) prevalence in women reached 21.1 per cent. Of the individuals with HCL this abnormality was previously diagnosed in only 15.9 per cent of men and in 7.8 per cent of women. Despite having been diagnosed, the abnormality remained untreated in all cases. HCL was associated with higher mena systolic blood pressure (in women), higher mean diastolic blood pressure (in men) and higher mean fasting and 2 h post-glucose load glycemia as weel as post-challenge insulinemia in both sexes. Mean TG was found high in both groups (with and without HCL), but in subjects with HCL the values were significantly higher. We conclude that HCL is very common in this population. The majority of the cases remained undiagnosed and of the small fraction of subjects that have been diagnosed, virtually none is under medical care. It is necessary to design and implement a national program to reduce the impact of this serious health problem

Prevalence of gallbladder disease and associated clinical variables in a low income population of Mexico City

We present the results of a population-bases syrvery carried out in a low income area of Mexico City. The aim of this study is to characterize the prevalence of clinically significant gallbladder disease (CSGD) using the self-reported history of cholecystectomy (CG) or cholelithiasis (CL) demonstrated by cholecystography and/or ultrasonography. The population of the studied area was 15,532 ihabitants, of whom 3505 (22.6 percent) were age elegible (35 - 64 year-old men and non-pregnant women). Home interview were obtained in 2810 (80.2 percent). A physical and laboratory examination was performed in 2282 individuals (65.1 percent; 941 men and 1341 women). The prevalence of CSGD in men was 2.0 percent (95 percent confidence intervals 1.1 - 2.9 percent) and 9.2 percent in women (95 percent confidence intervals 7.7 - 10.7 percent). Patients with CSGD were older, emn (p <0.003) and women (p <0.001). Women with CSGD had higher waist to hip circumference ratio (p <0.06), higher fasting glucose (p <0.03) as well as 2 h post challenge glycemia (p <0.04) and insulinemia (p <0.03) In the multiple logistic regression model only age (p <0.001) and sex (p <0.001) remained significantly associated. We conclude that CSGD is quite prevalent in this population. Is is associated with age in both genders and in women, higher glucose and insulin levels. The prospective follow-up of this cohort is important since it copuld generate the information needed to implement a preventive program to diminish the impact of this condition

Nephropathy in low income diabetics: the Mexico City diabetes study

Among the most serious complications associated with diabetes mellitus (DM) is nephropathy (DN). In Mexico, there is little information on the frequency and clinical characteristics of DN in the Mexican population. We present results of a population-based survey designed to estimate the prevalence of DN. The low income population consisted of 15,532 inhabitants. All 35- to 64-year-old males and non-pregnant women residing in the survey area were identified as eligible for the study (3505; 22.6 percent). A home interview was obtained in 2810 (80.2 percent). A physical exam with oral glucose tolerance test wasobtained in 2282 (81.2 percent of those interviewed). DM was diagnosed in 304 (crude rate 13.3 percent). Mean age for men and women with DM was 51.6 ñ 8.4 and 52.2 ñ 7.5, respectively. Duration of DM in men was 9.2 ñ 8.1 and in women, 7.3 ñ 6.7 years. Hypertension was diagnosed in 19.8 percent of men and 18.1 percent of women. Diabetic retinopathy of any level was found in 55.4 percent of men and 45.7 percent of women. Mean glycohemoglobin in men was 9.6 ñ 2.1 and in women 9.5 ñ 2.2 percent (normal 4 - 8 percent). At baseline, proteinuria (1+ or more, by dipstick) was found in 24.7 percent of men and 9.6 percent of women, microalbuminuria (MA) in 84.4 percent of men and 63.8 percent of women. Quantitative albuminuria was abnormally high in 54.7 percent of men and 40.3 percent or women. In the 203 diabetic studied with 24 h urine collection from creatinine clearance, normal renal function was found in 69.1 percent of men and 47.5 percent of women, reduced renal function was found in 26 percent of men and 50 percent of women, ranl insufficiency was diagnosed in 4.9 percent of men and 1.6 percent of women. One patient was on dialysis and in a subsequent follow up, we found that 2.3 percent of the patients had died of renal failure, six men (46 -63 years) and a woman of 62 years. We concluded that DN is a very serious threat to this population. The high case fatality rate associatd with this condition maintains a low prevalence. It is important to develop a program to diminish the frequency of this condition

Diabetic retinopathy in Mexico: prevalence and clinical characteristics

We present the result of a population based study designed to estimate the prevalence of diabetic retinopathy in a series of 284 type 2 diabetics residing in low income areas of Mexico city. These patients were identified in a survey performed between february 1990 and october 1992 (The Mexico City Diabetes study). We located 214 (75.35 per cent) of the original 284 patients and invited them to attend a clinic where they were interviewed and had a complete opthalmologic examination. All participant had, in addition to the retinal examination by a certified opthalmologist, seven fields stereo fundus photographs taken with a Topcon 50X retinal camera. Photos were taken using ASA 100 Kodak film and processed in their laboratory. All photographs were read and graded for quality and level of diabetic retinopathy (DR) in the Reading Center of the Department of Ophthalmology of the University of Winsconsin. A total of 37 (43.5 per cent) men and 69 (53.5 per cent) women had no evidence of DR. In 16 (18.8 per cent) men and 21 (16.3 per cent) women there was background DR. In 25 (29.4 per cent) men and 30 (23.3 per cent) women there was preproliferative DR. In 5 (5.9 per cent) men and in 7 (5.4 per cent) women there was proliferative DR. Macular edema was diagnosed in 7(8.2 per cent) men and 6 (4.7 per cent) women, of these in 3 (3.5 per cent) men and in 5 (3.9 per cent) women the macular edema was central. There was an association of duration of DM, level of fasting hyuperglycemia and microalbuminuria with the presence of DR. In 5 (7.5 per cent) men and in 7 (10.5 per cent) women with sight threatening DR, the microvascular complication had been previously undiagnosed and untreated. We conclude that DR is very common in Mexican diabetic. This complication is associated with duration of diabetes, chronic poor metabolic control and microalbuminuria. A very significant proportion of cases with sight threatening DR remains undiagnosed and untreated. Consequently there is a significant number of cases developing into blindness that could have been prevented

Prevalence and detection of hypertension in Mexico

The aim of this study was to characterize the prevalence and detection of systemic hypertension in a low income urban area of Mexico City. The population of the studied area was 15,532 inhabitants, of whom 3505 (22.6 per cent) were eligible for study (men aged 35 - 64 years and non-pregnant women). Home interviews were obtained on 2810 (80.2 per cent) and physical and laboratory examination was performed on 2282 individuals (941 men, 1341 women, 81.2 per cent of those interviewed and 65.1 per cent of all the eligibles). Blood pressure (BP) was measured using a randomzero sphygmomanometer (Hawksley, London). Three measurements were made on the right arm after a 5 min rest, with the patient seated. The average of the last two determinations was taken as the patient's BP. High blood pressure (HBP) was defined as systolic BP > or = 160 and/or diastolic BP > or = 95 mmHg, or if the patinet was taking antihypertensive therapy regardless of the blood pressure value. A total of 216 subjects (77 men, 139 women) met criteria for HBP. In the 35.44 age group, prevalence for men was 4.16 per cent and for women 3.06 per cent. In the 44 - 55 age groups the prevalence for men was 7.81 per cent and for women 12.55 per cent. In the 55 - 64 year group the prevalence for men was 16.51 per cent and for women 22.2 per cent. Obesity was associated with HBP (body mass index in men with HBP was 28.9 kg/m² vs. without 26.9 kg/m², p < 0.001; women with HBP, 30.8 kg/m² vs. without 28.5 kg/m², p < 0.001. Fat distribution was upper body in patients with HBP (waist/hip circumferences in men with HBP (body mass index in men with HBP was 28.9 kg/m² vs. without 26.9 kg/m², p<0.001; women with HBP, 30.8 kg/m² vs. without 28.5 kg/m², p<0.001. Fat distribution was upper body in patients with HBP (waist/hip circumferences in men with HBP was 1.02 vs. men without HBP, 0.97, p<0.001, women with HBP, 1.0 vs. without 0.97, p<0.001). In both sexes patients with HBP showed a tendency to higher glucose and insuline values. Women with HBP exihited higher total and LDL cholesterol as well as higher triglicerides when compared to women without HBP. In 14.7 per cent of hypertensive individuals (35 subjects, 21 men and 14 women) HBP was newly diagnosed. The clinical characteristics of this group were not different than in the patients with previously diagnosed HBP. We conclude that the prevalence of HBP is significant in the Mexican population, increases with age, is associated with obesity.

The level of metabolic control in low income Mexico City diabetics. The Mexico City diabetes study

The importance of good metabolic control in the treatment of diabetes mellitus (DM) is unquestionable. Measurements of the level control (LC) are available such as glycohemoglobin (GH) and fructosamine (FA). The aims of this study are: to estimate LC in a population based case series of type II DM patients, to assess the effect of clinical, metabolic and sociodemographic variables usually associated with the LC and to estimate the clinical impact of the LC on vascular complications of DM. A low income area of Mexico City was enumerated. All males and non-pregnant females between 35-64 years of age were considered eligible. Home interview was obtained in 2813 and a medical exam incluiding an oral glucose tolerance test was performed in 2282 (65.1 per cent). Three hundred and four subjects met the criteria (WHO) for DM. Three years later, 213 (70.1 per cent) were located for GH and FA measurements. Cases were divided according to the level of GH: Group I, good LC (GH < o = 8.6 per cent, n = 66); and group II poor LC (GH > o = 8.7 per cent, n = 147). A significant difference was observed in the mean vallue of FA between groups (Grop I 255 ñ 52.3 µmol/dl. Group II 306.4 ñ 51.1; p < 0.001). In compariso with subjects with good LC, patients with poor LC had higher values of duration of DM (p < 0.01), waist/hip ratio (p < 0.04), fasting glucose (p < 0.001) and lower values of fassting insulin (p < 0.07), LDL cholesterol (p < 0.006) and VLDL cholesterol (p < 0.09). Patinets with good LC had less diabetic retinophaty (p < 0.03). Around 48-69 per cent of type II urban Mexican diabetic population have poor LC. Variables usuallyt thougth to affect or be associated with LC do not influence th eend result. New therapeutic strategies in the management of DM are needed to reduce the long-term complications associated with DM