Índices antropométricos predicen riesgo cardiometabólico: Estudio de cohorte prospectivo en una población de empleados de hospitales públicos / Anthropometric Indexes Predicting Cardiometabolic Risk: Prospective Cohort Study in a Population of Employees of Public Hospitals

En las últimas décadas se observa un notable incremento de las enfermedades crónicas no trasmisibles asociadas a estilos de vida no saludables, donde la obesidad es en sí misma una enfermedad crónica y a la vez un reconocido factor de riesgo de muchas otras. Los objetivos del presente trabajo son evaluar el valor predictivo del Índice de Masa Corporal (IMC), perímetro de cintura e índice cintura/altura para el desarrollo de hipertensión arterial (HTA), hipercolesterolemia y diabetes tipo 2 (DM2) en una cohorte de empleados públicos hospitalario de Posadas, Misiones, seguidos desde el año 2002 al 2012. La población total estuvo constituida por 989 empleados públicos, de los cuales fueron seleccionados 259 trabajadores que eran normotensos, no hipercolesterolémicos y no diabéticos al inicio del estudio. Se realizaron encuestas personales, mediciones antropométricas, de presión arterial y extracción sanguínea con ayuno de 12 horas. Para el análisis de eventos se utilizó el modelo de riesgos proporcionales de Cox, calculando los correspondientes Hazard Ratio (HR) corregidos por edad y sexo. El IMC predijo de forma significativa la presentación de HTA (HR: 1,100; IC: 1,054-1,148; p < 0,001) y DM2 (HR: 1,253; IC: 1,122-1,40; p < 0,001). El perímetro de cintura se asoció en forma significativa con HTA (HR: 2,273; IC: 1,465-3,826; p<0,001) y DM2 (HR: 5,578; IC: 1,247-24,92; p: 0,024). El índice cintura/altura predijo de forma significativa la presentación de HTA (HR: 2,173; IC: 1,438-3,283; p < 0,001) y DM2 (HR: 5,875; IC: 1,140-30,28; p: 0,034). Ninguno de los indicadores de obesidad evaluados se asoció de forma significativa con la presentación de hipercolesterolemia. Se concluye que el IMC, el perímetro de cintura y el índice cintura/altura predijeron el desarrollo de HTA y diabetes tipo 2. Se resalta así la utilidad de estos indicadores en la vigilancia de las entidades consideradas a través de mediciones antropométricas tradicionales. Rev Argent Endocrinol Metab 51:185-191, 2014 Los autores declaran no poseer conflictos de interés.

In recent decades, a significant increase has been observed in noncommunicable chronic diseases associated with unhealthy lifestyles, with obesity being a chronic disease in itself and at the same time a recognized risk factor for many other conditions. The aim of this study is to assess the predictive value of body mass index (BMI), waist circumference and waist index / height for the development of high blood pressure (hypertension), high cholesterol and type 2 diabetes (DM2) in a cohort of public hospital employees from Posadas, Misiones, who were followed up from 2002 to 2012. Of the total population of 989 public employees, we selected 259 subjects with normal blood pressure, no hypercholesterolemia and no diabetes at baseline. Personal interviews, anthropometric and blood pressure measurements were performed and blood samples were collected after a 12-hour fast. For the event analysis, the Cox proportional hazards model was used, calculating the corresponding Hazard Ratio (HR) adjusted for age and sex. BMI significantly predicted the development of hypertension (HR: 1.100, CI: 1.054 to 1.148, p < 0.001) and DM2 (HR: 1.253, CI: 1.122 to 1.40, P < 0.001). The waist circumference was associated with hypertension (HR: 2.273, CI: 1.465 to 3.826, p < 0.001) and DM2 (HR: 5.578, CI: 1.247 to 24.92, p = 0.024). The waist / height ratio significantly predicted the development of hypertension (HR: 2.173, CI: 1.438 to 3.283, p < 0.001) and DM2 (HR: 5.875, CI: 1.140 to 30.28, p = 0.034). None of the indicators of obesity evaluated was significantly associated with the development of hypercholesterolemia. We conclude that BMI, waist circumference and waist / height ratio predicted the development of hypertension and type 2 diabetes. This underlines the usefulness of these indicators for monitoring the above-referred conditions by traditional anthropometric measurements. Rev Argent Endocrinol Metab 51:185-191, 2014 No financial conflicts of interest exist.

Prevalencia de Insulinorresistencia en adolescentes de la ciudad de Posadas: criterios diagnósticos recomendados / Prevalence of Insulin Resistance in adolescents in the city of Posadas: recommended diagnostic criteria

Existe un creciente reconocimiento del importante papel de la insulinorresistencia (IR) en la patogénesis de la diabetes tipo 2 en niños y adolescentes. Nos propusimos obtener los percentilos de referencia y la prevalencia de insulinemia en ayunas e índices de IR, HOMA y QUICKI en adolescentes escolarizados de la ciudad de Posadas-Misiones. Se realizó un estudio descriptivo transversal en 420 estudiantes de nivel secundario. Se evaluaron parámetros antropométricos, circunferencia de cintura y presión arterial. Se realizó una extracción sanguínea con 12 horas de ayuno para las determinaciones bioquímicas: glucemia, perfil lipídico e insulina. Las muestras fueron procesadas con control de calidad interno y externo. Se encontró que el percentilo 95 de Insulina fue ≥ 12 mU/lt y de HOMA ≥ 2,5 y percentilo 5 para QUICKI ≤ 0.33. De la comparación entre sexos, no se halló diferencias significativas en los valores de los índices HOMA y QUICKI (U = 3077, p = 0,058), pero con Insulina se observaron diferencias significativas, mujeres = 8,59 ± 2,93 mU/l vs. varones = 6,50 ± 2,55 mU/l (U = 2929; p = 0,019). Sin embargo, al aplicar la prueba z y el 1,5 del DE, no sería necesario el cálculo para grupos separados por sexo (z calculado = 2,63; z crítico = 2,47; 1,5 DE = 3,82 mU/l). 11,7 % presentó Hiperinsulinemia y la prevalencia de IR según HOMA fue 10,5 % y 9,8 %, por QUICKI, sin diferencias estadísticas según sexo y grupo de edad. Insulinemia y ambos índices de IR estaban significativamente más elevados en los adolescentes con sobrepeso u obesos. Estos valores podrán ser utilizados como guía en el algoritmo diagnóstico de IR por parte de la comunidad médica.

Introduction: There is a growing recognition of the important role of insulin resistance (IR) in the pathogenesis of type 2 diabetes in children and adolescents. The aim of this study was to obtain the reference percentiles and the prevalence of fasting insulin and index of IR, HOMA and QUICKI, in adolescents in the city of Posadas, Misiones. Materials and Methods: A descriptive study of 420 high-school students was performed. Anthropometric parameters, waist circumference and blood pressure were evaluated. Blood samples were taken after 12 hours fasting for biochemical measurements: fasting glucose, lipid profile and insulin. The samples were processed in-house and external quality control. Results: Percentile 95 of Insulin ≥ 12 mU/lt, HOMA ≥ 2.5 and percentile 5 for QUICKI was ≤ 0.33. Comparison between genders showed no significant differences in HOMA and QUICKI values (U = 3077, p = 0.058), but significant differences were found for insulin: females = 8.59 ± 2.93 mU/l, males = 6.50 ± 2.55 mU/l (U = 2929, P = 0.019), However, when applying the z test and 1.5 of SD, calculation for groups separated by gender would not be necessary (calculated z = 2.63, critical z = 2.47, 1.5 SD = 3.82 mU/l). 11.7 % were hyperinsulinemic and the prevalence of IR by HOMA was 10.5 % and 9.8 % for QUICKI, with no statistical differences by sex and age group. Insulin and two indexes of IR were significantly higher in overweight or obese adolescents. Conclusions: These values may be used as a guide in the diagnostic algorithm of IR by the medical community.

Insulinorresistencia y su relación con medidas antropométricas y presión arterial en un grupo de empleados hospitalarios, aparentemente sanos / Insulin resistance and its relation to anthropometric measurements and blood pressure in a group of apparently healthy hospital employees

La resistencia insulínica es una disminución de la función biológica de la insulina caracterizada por requerir un alto nivel de insulina plasmática para mantener la homeostasis metabólica. Su presencia está asociada con mayor riesgo de enfermedad cardiovascular. Nos propusimos conocer la frecuencia de hiperinsulinemia e insulinorresistencia en empleados del hospital Dr. Ramón Madariaga, correlacionar la insulinorresistencia a través del índice HOMA con edad, presión arterial, obesidad y obesidad abdominal y evaluar su relación con sexo, presión arterial, obesidad y obesidad abdominal. Se estudiaron 170 sujetos de ambos sexos que tenían entre 27 y 74 años de edad, de los cuales 134 fueron de sexo femenino y 36 de sexo masculino. Se obtuvieron datos antropométricos y presión arterial. Se realizó una extracción sanguínea con un ayuno de 12 horas para las determinaciones bioquímicas. Todos los análisis estadísticos se realizaron utilizando el programa Epi-info 2000, con un nivel de confianza del 95 % y un nivel de significación <0.05. Las frecuencias de in-sulinorresistencia e hiperinsulinemia que se obtuvieron fueron de 7.1 % y 8.2 % respectivamente. El índice HOMA mostró una correlación altamente significativa (p<0.001) para circunferencia de cintura (obesidad abdominal), índice de masa corporal y presión arterial. Cuando evaluamos el comportamiento del índice HOMA entre las diferentes categorías de presión arterial, IMC y circunferencia de cintura, encontramos diferencia significativa (p<0.001), para todos ellos. La valoración de la insulinorresistencia demostró la clara relación existente entre obesidad, obesidad abdominal e hipertensión. Esto permitirá identificar a los individuos con mayor riesgo para las enfermedades cardiovasculares y así poder implementar medidas terapéuticas (dieta, actividad física y/o farmacológicas) para poder retrasarlas o impedirlas, dando a nuestros pacientes una mejor calidad de vida. Los autores declaran no poseer conflictos de interés.

According to 2008 data from the Ministry of Public Health of the Province of Misiones, cardiovascular disease is the main cause of mortality in that province, with a proportional mortality ratio of 28.3 %, and with a process known as arteriosclerosis as the main responsible factor. Arteriosclerosis is a chronic inflammatory process where endothelial dysfunction plays a major role. Insulin resistance (IR), described as a condition in which there is a decrease in the biological function of insulin and high plasma levels of insulin are required to maintain metabolic homeostasis, promotes atherosclerotic development and its presence is associated with an increased risk of cardiovascular disease. Our aim was to determine the frequency of hyperinsulinemia and IR in a group of employees at the Public Provincial Hospital Dr. Ramón Madariaga, to correlate IR with age, blood pressure, general and abdominal obesity and to evalúate our subjects' performance using the HOMA Índex. One-hundred and seventy subjects of both genders (134 females and 36 males) with an age range between 27 and 74 years oíd were studied. Participation in the trial was voluntary and written consent was obtained using an authorization model based on the Declaration of Helsinki. Weight, height and waist circumference data were recorded under WHO standards. Subjects were classified as normal, overweight and obese depending on their Body Mass índex. Blood pressure was measured with a mercury sphygmomanometer and following the American Heart Association recommendations. Blood samples were collected after 8 hours of fasting and glucose was measured by enzymatic colorimetric methods (CV = 2.38 %). Insulin was measured by radioimmunoanalysis (CV=8 %). The Internal Quality Control was performed with a serum pool prepared in the laboratory, and the External Quality Control was carried out with controls provided by the Argentine Biochemical Foundation. All the statistical analyses were performed using the Epiinfo 2000 program, with a confidence interval of 95 % and a significance level <0.05. The frequencies of IR and hyperinsulinemia obtained were 7.1 % and 8.2 %, respectively The HOMA Índex showed a highly significant correlation (p<0.001) for waist circumference (abdominal obesity), body mass Índex (obesity) and blood pressure. When assessing the HOMA Índex performance, it was found that individuáis with abdominal obesity had a higher IR (p<0.001). In addition, the IR Índex mean valué increased with body mass Índex (p<0.001). Subjects with prehypertension and hypertension showed higher HOMA valúes as compared to subjects with normal blood pressure (p<0.001), when the evaluation was performed according to the different blood pressure categories. The assessment of insulin resistance showed a clear relationship between obesity, abdominal obesity and hypertension. This assessment will make it possible to identify individuáis at increased risk for cardiovascular disease so as to implement treatment measures (diet, physical activity and / or pharmacological treatment) to delay or prevent the occurrence of disease, offering our patients an improved quality of life. No competing financial interests exist.

Prevalencia de obesidad y síndrome metabólico en adolescentes de la ciudad de Posadas, Misiones / Prevalence of obesity and metabolic syndrome in adolescents from Posadas, Misiones, Argentina

Los objetivos del presente trabajo fueron: estimar la prevalencia de síndrome metabólico (SM) y obesidad, su distribución por edad y sexo. Además evaluar el riesgo del SM según el grado de obesidad y correlacionar esta última con los componentes del SM en adolescentes de la ciudad de Posadas, provincia de Misiones. Se realizó un muestreo por conglomerados en el año 2005, tomando una muestra representativa de 532 alumnos (NC=95 %) con edades comprendidas entre 11 y 20 años. El SM fue definido según el Adult Treatment Panel III y modificado para edad según Cook. El 4,5 % presentó SM y evidenciaron mayor riesgo los varones, el grupo comprendido entre 15 y 20 años y los que presentaban obesidad y sobrepeso. El 11,7 % presentó sobrepeso y el 3,4 % obesidad. El 44,7 % tenía algún componente del SM, siendo el orden de frecuencia triglicéridos aumentados, colesterol HDL disminuido, presión arterial elevada y circunferencia de cintura aumentada. Según estimaciones poblacionales, 1.400 alumnos, de la ciudad de Posadas, serían portadores del síndrome metabólico, con la probabilidad de persistir sus componentes en la edad adulta y el riesgo consiguiente de desarrollar diabetes tipo 2 y enfermedad cardiovascular. La modificación de hábitos alimentarios y el incremento de la actividad física a través de programas conjuntos entre estado y comunidad podrían revertir esta situación.

The Metabolic Syndrome (MS) results from an association of metabolic abnormalities that could lead to DBT 2 and Cardiovascular Disease (CVD). Atherosclerosis begins during childhood and progresses into adolescence depending on cardiovascular risk factors (1-5). The aim of this study was: 1) Estimation of metabolic syndrome and obesity prevalence according to age and sex. 2) Assessment of metabolic risk linked to obesity. 3) Correlation of obesity with MS parameters in adolescents of Posadas, capital city of Misiones province. Subjects: the population studied was a representative sampling of 532 students recruited during the year of 2005 (NC=95 %), aged from 11 to 20 years old (mean=15 years)- 60 % of them were women. MS was defined following the Adult Treatment Panel III criteria and age-modified according to Cook. Participation in the trial was optional and written consent was obtained from parents or tutors. Authorization model was based on Helsinki(24). Methods: weight, height and waist perimeter (WP) data were recorded under WHO standards. Blood pressure was evaluated regarding American Health Organization recommendations(20). Cole et al. tables(23) were used to classify subjects as normal, overweighed and obese depending on their BMI. Own reference data were registered for WP in 2861 further students in the same schools previously chosen, with the calculation of the 90th percentile in normal teen-agers for age and sex. Blood samples with 12-hours of fasting were collected and glucose, triglyceride and HDL-cholesterol were measured by enzymatic colorimetric methods, with internal control from a pool serum prepared at the laboratory, and an external control provided by the Argentine Biochemical Foundation. Statistical analysis was performed with SPSS 11.S program, and chi square or Mann Whitney Statistical tests when needed, with a significance level >/= 95 % (p<0.05); for risk calculation Odds Ratio (OR) 95 % of confidence interval. Results: 4,5 % showed MS (table 1). They were male subjects aged from 15 to 20 years old with obesity and overweight. 44.7 % had at least one of MS compounds (Table 1). Triglyceride was the most frequent raised analyte, followed by HDL diminished, high blood pressure and high waist perimeter (Table 2). 11.7 % showed overweight and 3,4 were obese (Tables 2 and 3), No significant difference was found for age and sex. Risk for MS increased related to obesity grade (OR overweight= 39.71, CI 10,93-144,18), (OR obese = 119,73 CI 27,6-519,41). BMI correlated significantly to all MS parameters (Table 4). Conclusions: About 1400 students from Posadas should have MS, with its high risk for DBT 2 and /or CVD. School and Community programs to change nutritional habits and increase physical activity should be necessary to face this concerning situation.

Colesterol-IDL y parámetros lipídicos en diabéticos tipo 2 / IDL-cholesterol and lipidic parameters in diabetic patients type 2

La diabetes mellitus ocupa el sexto lugar de las defunciones por causas definidas en la provincia de Misiones. Nos propusimos establecer si existen diferencias significativas para Colesterol Total (CT), Triglicéridos (TG), Colesterol-HDL(CHDL), Colesterol-LDL(CLDL), Colesterol-IDL(CIDL), Colesterol no-HDL y los índices CT/CHDL y TG/CHDL entre diabéticos tipo 2 y un grupo control y comparar los valores de CIDL entre ambos grupos según fenotipo de dislipidemia. Se estudiaron 70 diabéticos tipo 2 (DM 2) y 57 controles. CT, TG, CHDL y CLDL se determinaron por métodos enzimáticos colorimétricos y CIDL por método de Wikinski. Los resultados obtenidos en DM 2 vs. controles fueron: CT 214±49 vs. 205±34 mg/dl (p=0.488); TG 194±119 vs. 128±65 mg/dl (p<0.001); CHDL 43±11 vs. 50±13 mg/dl (p=0.001); CLDL 135±43 vs. 132±32 mg/dl (p=0.934); CIDL 13.8±8.7 vs. 7.2±3.5 mg/dl (p<0.001); CT/CHDL 5.26±1.54 vs. 4.40±1.33 (p=0.001); TG/CHDL 5.01±3.95 vs. 2.97±2.24 (p<0.001) y Col no-HDL 172±48 vs. 155±35 mg/dl (p=0.07); a igual patrón electroforético tanto normolipémico (p=0.043), fenotipo II (p=0.006) o fenotipo IV (p=0.001) el CIDL fue más elevado en el primer grupo. La cuantificación del CIDL mejora la valoración del riesgo aterogénico en DM 2 principalmente en los normolipémicos.

Diabetes Mellitus is in the sixth death cause in the province of Misiones. Majority of patients die in relation with atherosclerosis, being dislipidemias one of the mechanism that explain this increased risk. We aimed to establish if there are significant differences for total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDLC), LDL-Cholesterol (LDLC), IDL-Cholesterol (IDLC), no-HDL Cholesterol and the index TC/HDLC and TG/HDLC between diabetic patients type 2 and a control group, as well as comparing the IDLC amount between both groups according to the dislipidemia phenotype. We studied 70 diabetic patients type 2 and 57 controls, with similar distribution in age, sex and body mass index. TC, TG, HDLC and LDLC were tested by enzymatic colorimetric methods with internal and external quality controls and the IDLC by Wikinski method. The results obtained in diabetic patients vs controls were (table N°1): TC 214 ±49 vs 205± 34 mg/dl (p=0.488); TG 194±119 vs 128±65 mg/dl (p<0.001); HDLC 43±11 vs 50±13 mg/dl(p=0.001); LDLC 135±43 vs 132± 32 mg/dl (p=0.934); IDLC 13.8± 8.7 vs 7.2±3.5 mg/dl (p<0.001) (figure N°1); TC/HDLC 5.26 ±1.54 vs 4.40± 1.33 (p=0.001); TG/HDLC 5.01±3.95 vs 2.97±2.24 (p<0.001) y no-HDL cholesterol 172±48 vs 155±35 mg/dl (p=0.07); at a same electrophoretic pattern ( normolipemic (p=0.043), phenotype II (p=0.006) or phenotype IV (p=0.001)),the IDLC was higher in the first group (figure N°2). The diabetic patients show a more atherogenic lipoprotein profile than the control group. The quantification of IDLC improvement the assessment of atherogenic risk in type 2 diabetic patients, specially normolipemics.