Intervención educativa para la prevención de complicaciones en pacientes con dislipidemia / Educational intervention for the prevention of complications in patients with dyslipidemia

RESUMEN Introducción: actualmente, la enfermedad ateroesclerótica está entre las principales causas de muerte, incapacidad y demencia en adultos mayores. Su causalidad es multifactorial, pero es indiscutible la relación de la dislipidemia con los riesgos de eventos cardiovasculares. Objetivo: dotar de información necesaria a pacientes, para modificar estilos de vida y lograr un impacto positivo en la reducción de la morbimortalidad, producida por enfermedades ateroescleróticas. Materiales y métodos: se aplicó un proyecto de intervención a través de acciones educativas a un grupo de pacientes adultos (n=234) con dislipidemia. Atendidos en la Unidad de Salud Oziel Montecristo, por el equipo I (blanco) del municipio de Campinas, Departamento de São Paulo. Entre enero a julio del 2016. Los participantes fueron sometidos a una encuesta antes y después de recibir la información. Resultados: el grupo etáreo que predominó fue entre 20-50 años con 55,5 %. La escolaridad primaria fue más significativa en el 41 %. Otros factores de riesgo reportados fue obesidad, 46,5 %; fumadores, 9,4 %; con etilismo crónico, 8,5 % y sedentarismo 71,7 %. Las enfermedades crónicas presentes fueron: hipertensión arterial, 53,4 %; diabetes mellitus, 40,5 %; cardiopatía isquémica y enfermedad renal crónica el 20,9 % y 9,4 %, respectivamente. Se lograron resultados positivos en el auditorio, un número importante de pacientes continuaron en los grupos terapéuticos. Conclusiones: los pacientes se apropiaron de conocimientos importantes sobre la dislipidemia, para practicar estilos de vida saludables, que disminuyan el riesgo de eventos cardiovasculares (AU).

ABSTRACT Introduction: currently, atherosclerotic disease is among the main causes of death, disability and dementia in elder people. It is caused by multiple factors, but it is indisputable the relation of dyslipidemia with the risk of cardiovascular events. Objective: to provide the necessary information to patients for them to modify life styles and achieving a positive impact in the reduction of the morbidity and mortality caused by atherosclerotic diseases. Materials and methods: an intervention project was applied through educative actions in a group of adult patients (n=234) with dyslipidemia, treated in the Health Unit ¨Oziel Montecristo¨, by the team I (white), of the municipality Campinas, São Paulo Department, from January to July 2016. The participants answered an inquiry before and after receiving the information. Results: the predominant age group was the 20-50 years one, with 55.5 %. Primary scholarship was the most significant (41 %). Other reported factors were obesity, 46.5 %; smoking, 9.4 %; chronic alcoholism, 8.5 %; and sedentary life style, 71.7 %. The chronic diseases found were: arterial hypertension, 53.4 %; diabetes mellitus, 40.5 %; ischemic heart disease, 20.9 %; and chronic renal disease, 9.4 %. Positive results were achieved in the audience; an important number of patients continued in therapeutic groups. Conclusions: the patients assimilated important knowledge on dyslipidemia, to practice healthy life styles decreasing the risk of cardiovascular events (AU).

Non-alcoholic fatty pancreatic disease and insulin resistance: overlooked complication of obstructive sleep apnea and hypopnea syndrome - signaling pathway diagram / Doença pancreática gordurosa não alcoólica e resistência insulínica: complicação negligenciada da síndrome de apneia e hipopneia obstrutiva do sono

Objective: To demonstrate the interaction between obstructive sleep apnea/hypopnea syndrome, insulin resistance, and non-alcoholic fatty pancreatic disease through the signaling pathway diagram. Methods: To investigate the involvement of metabolic signaling pathway, a search was performed using the Kyoto Encyclopedia of Genes and Genomes. The signaling pathway mapping was performed using the automatic annotation server of this encyclopedia. The Modeller 9.19 package was used to predict 3-dimensional structures based on the homology modeling protocol. The signaling pathway map was performed using PathVisio software, which is a free available signaling pathway drawing software. Based on the 3-dimensional structures, we have designed several peptide activators of the signaling pathway of non-alcoholic fatty pancreatic disease. Results: The contigs were taken from the Kyoto Encyclopedia of Genes and Genomes database and their mapped transcription represented the signaling pathway of the main biomolecules that triggered non-alcoholic fatty pancreatic disease. The interaction between obstructive sleep apnea/hypopnea syndrome, insulin resistance, and inflammatory factors contributes to the possible development of fatty infiltration of pancreas, leading to the loss of function of the pancreatic ß-cells, and even to the development of other metabolic diseases. Conclusion: The interaction between obstructive sleep apnea/hypopnea syndrome and insulin resistance demonstrated through the signaling pathway contributes to the possible development of non-alcoholic fatty pancreatic disease. (AU)

Objetivo: Demonstrar a interação entre a síndrome de apneia/ hipopneia obstrutiva do sono, a resistência à insulina e a doença pancreática gordurosa não alcoólica considerando o desenho de uma via de sinalização. Métodos: Para avaliar o envolvimento da via de sinalização metabólica, realizou-se uma pesquisa usando a Enciclopédia de Genes e Genomas de Kyoto. O mapeamento da via de sinalização foi realizado com o servidor de anotação automático desta enciclopédia. O software MODELLER 9.19 foi usado para prever estruturas tridimensionais, com base no protocolo de modelagem por homologia. O desenho da via de sinalização foi realizado por meio do programa PathVisio, um software de domínio público para desenho de via de sinalização. Com base nas estruturas tridimensionais, desenhamos os vários ativadores peptídicos da via de sinalização da esteatose pancreática. Resultados: Os contigs foram retirados do banco de dados da Enciclopédia de Genes e Genomas de Kyoto, e sua transcrição mapeada representou a via de sinalização das principais biomoléculas que desencadearam doença pancreática gordurosa não alcoólica. A interação entre síndrome de apneia/hipopneia obstrutiva do sono, resistência à insulina e fatores inflamatórios contribuiu para o possível desenvolvimento de infiltração gordurosa do pâncreas, levando à perda de função das células beta pancreáticas e até mesmo ao desenvolvimento de outras doenças metabólicas. Conclusão: A interação entre síndrome de apneia/hipopneia obstrutiva do sono e resistência à insulina demonstrada pela via de sinalização contribui para o possível desenvolvimento de doença pancreática gordurosa não alcoólica. (AU)

Prevalencia de la enfermedad renal oculta en adultos mayores con diabetes mellitus tipo 2 / Prevalence of the Hidden Renal Disease in elder people with diabetes mellitus type 2

RESUMEN Introducción: la Organización Mundial de la Salud, estima que la enfermedad renal crónica estará incluida dentro de las principales causas de discapacidad para el 2020. La prevalencia en países desarrollados es aproximadamente de 500 a 1400 pacientes por millón de habitantes y la incidencia anual se encuentra alrededor de 350 pacientes por millón de población. Objetivo: determinar la prevalencia de la enfermedad renal oculta e identificar algunos factores de riesgos predisponentes en adultos mayores con diabetes mellitus tipo 2 pertenecientes al Policlínico Universitario "Jimmy Hirzel", Bayamo, Granma, en el período comprendido entre junio 2016 - junio 2017. Materiales y métodos: se realizó estudio observacional descriptivo, de corte transversal en el que se incluyeron 180 gerontes con diabetes mellitus tipo 2. Resultados: se estableció el diagnóstico de enfermedad renal oculta en 167 individuos de 180 sujetos estudiados, el grupo de 70 - 79 años de edad fue el más afectado por la nefropatía crónica, mientras que el sexo femenino y la raza blanca fueron los de mayor prevalencia. Los principales factores de riesgo predisponentes de enfermedad renal oculta fueron: cardiopatía isquémica crónica, dislipemias e hipertensión arterial. Conclusiones: existe una alta morbilidad de enfermedad renal oculta en los senescentes estudiados.

ABSTRACT Introduction: the World Health Organization (WHO) estimates that chronic hidden renal disease (ERC) will be included within the principal causes of disability by 2020. The prevalence in developed countries is around 500 to 1400 patients per million inhabitants, and the yearly incidence is around 350 patients per million people. Objective: to determine the prevalence of the hidden renal disease and to identify some predisposing risk factors in elder people with type II diabetes mellitus belonging to the University Policlinic "Jimmy Hirzel", Bayamo, Gramma, in the period between June 2016 and June 2017. Material and methods: an observational descriptive, cross-sectional study was carried out in 180 elder people with type 2 diabetes mellitus. Results: the chronic hidden renal disease was diagnosed in 167 individuals from the 180 studied subjects; the 70-79 years-old-group was the most affected one by chronic renal disease, while the female sex and white race showed the highest prevalence. The main risk factors predisposing to chronic hidden renal disease were: chronic ischemic heart disease, dyslipidemia and arterial hypertension. Conclusions: there is a high morbidity due to hidden renal disease in the studied senescent people.

Metabolic and hormonal assessment of adolescent and young adult women with prior premature adrenarche

OBJECTIVE: Follow-up studies of girls with premature adrenarche have reported the development of polycystic ovary syndrome, insulin resistance, and dyslipidemia and a propensity to cardiovascular disease. The aim of this study was to analyze the presence of these conditions in patients previously treated at the Universidade Federal do Triângulo Mineiro. METHODS: A total of 130 medical records reported premature adrenarche. One hundred and twenty-two patients were invited to participate, of whom 54 accepted; 34 patients were selected, as they had reached their final height. Anthropometric, blood glucose, insulin, and lipid and hormonal profile (LH, FSH, estradiol, 17α-OH-progesterone, androstenedione, dehydroepiandrosterone sulfate, testosterone) data were obtained, the HOMA-IR index was calculated, and pelvic ultrasonography was performed. To characterize polycystic ovary syndrome and metabolic syndrome, the Rotterdam and International Diabetes Federation criteria, respectively, were used. Data were analyzed according to measures of dispersion, frequency and correlations of interest. RESULTS: The age of the participants ranged from 15.2 to 28.2 years/months; 23.5% of the patients were overweight, 11.8% were obese, 29.4% had a large waist circumference, and 8.8% were hypertensive. None of the patients had altered glucose levels, and insulin levels and HOMA-IR were elevated in 29.4% and 38.2% of the participants, respectively; 14.7% of the patients exhibited acanthosis nigricans. The lipid profiles of the participants were variable, and one patient (2.9%) had metabolic syndrome. Polycystic ovary syndrome was found in 41.2% of patients. CONCLUSION: The percentage of patients with polycystic ovary syndrome who also had overweight, obesity and insulin resistance corroborates the literature data about the need for follow-up aiming at interventions, especially for conditions associated with cardiometabolic risk.

Risk factors for new-onset diabetes mellitus after kidney transplantation (NODAT): a Brazilian single center study

ABSTRACT Objectives: This study aims to verify the new-onset diabetes after kidney transplant (NODAT) incidence in recipients within 1 year after kidney transplantation from a single center in Southern Brazil and to assess the associated conditions. Subjects and methods: A retrospective study of 258 post-renal transplant patients was performed. Demographic (gender, age, ethnic background) and clinical (origin of graft, associated infections, body mass index (BMI) at transplant time and 6 and 12 months after, causes of renal failure, and comorbidities) data were analyzed. All patients were on tacrolimus, mycophenolate mofetil, and prednisone treatment. Patients with and without NODAT were compared. Results: A NODAT incidence of 31.2% was noted 1 year post transplantation. In the univariate analysis, patients with NODAT were older (p = 0.001), mostly had African-American ethnic background (p = 0.02), and had renal failure secondary to high blood pressure (HBP) (p = 0.001). The group of patients with NODAT also had more incidence of post-transplant HBP (p = 0.01), heart failure (p = 0.02), and dyslipidemia (p = 0.001). Logistic regression showed that African-American ethnic background, post-transplant HBP, and dyslipidemia were independently associated with NODAT. Conclusion: This study shows a NODAT incidence that is greater in patients with African-American ethnic background and that is associated with HBP and dyslipidemia.

Efeito do estilo de vida e comorbidades nas internações por doenças do aparelho circulatório / Effect of lifestyle and comorbidities in hospitalizations by diseases of the circulatory system / Efecto del estilo de vida y comorbilidad en las internaciones por enfermedades del aparato circulatório

Objetivo: determinar a relação entre o estilo de vida, presença de hipertensão, diabetes e dislipidemia com a taxa de internação hospitalar (IH) por doenças do aparelho circulatório (DC) nos estados brasileiros. Método: foi realizado um estudo de caráter ecológico utilizando a base de dados DATASUS referente ao estilo de vida e comorbidades nos estados brasileiros. Os dados foram analisados por meio de regressão linear bivariada e multivariada, tendo como desfecho a IH por DC. Resultados: a prevalência de IH média mensal no Brasil foi de 43,9/100.000 habitantes, com maior índice no Paraná com 67,4/100.000 habitantes enquanto a menor foi no Amazonas, apresentando 17,6/100.000 habitantes. Na análise por correlação bivariada com à IH por DC foram os observados os seguintes valores: % Insuficientemente ativos (r=0,224, p=0,252), % Consumo regular doces...(AU)

Objective: to determine the relationship between lifestyle, presence of high blood pressure, diabetes and dyslipidemia with hospital admission rate (HA) due to diseases of the circulatory system (CD) in brazilian states. Method: an ecological study was conducted using the DATASUS database on lifestyle and comorbidities in the brazilian states. The data were analyzed by bivariate and multivariate linear regression, with HA by CD Results: the prevalence of monthly HA in Brazil was 43.9/100,000 inhabitants, with a higher index in Paraná with 67.4/100,000 inhabitants while the lowest was in Amazonas, presenting 17.6/100,000 inhabitants. In the analysis by bivariate correlation with HA by CD, the following values were observed% insufficiently active (r = 0.224, p = 0.252), % sweet regular consumption…(AU)

Objetivo: determinar la relación entre el estilo de vida, presencia de hipertensión, diabetes y dislipidemia con la tasa de internación hospitalaria (IH) por enfermedades del aparato circulatorio (DC) en los estados brasileños . Método: se realizó un estudio de carácter ecológico utilizando la base de datos DATASUS referente al estilo de vida y comorbilidades en los estados brasileños. Los datos fueron analizados por medio de regresión lineal bivariada y multivariada, teniendo como resultado la IH por DC. Resultados: la prevalencia de IH media mensual en Brasil fue de 43,9/100.000 habitantes, con mayor índice en Paraná con 67,4/100.000 habitantes mientras que la menor fue en el Amazonas, presentando 17,6/100.000 habitantes. En el análisis por correlación bivariada con la IH por DC se observaron los siguientes valores: % insuficientemente activos (IA) (r=0,224, p=0,252), % consumo regular dulces…(AU)

Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents / Correlação dos escores-z de IMC com os perfis glicêmico e lipídico entre crianças e adolescentes com sobrepeso e obesidade

Abstract Objective To evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between body mass index Z-scores and indicators of comorbidities related to both profiles. Methods This was a multicenter cross-sectional study conducted at two outpatient clinics. The study included all 417 comers for the first visit from 2008 to 2012, aged between 7 and 18 years, with BMI above the Z-score +1. Anthropometry and blood sampling were obtained. The prevalence of dyslipidemias, hyperglycemia, and insulin resistance were evaluated, together with the correlations of these variables with the increase of Z-BMI. Results Dyslipidemia was observed in 43.4% of the boys and 66.1% of the girls, with no difference between genders. High glucose levels were detected in 6.2% of the individuals. Insulin resistance was present in 32.3% and 41.7% of the cases, with no statistical significance between boys and girls. Correlations between the Z-BMI were noted for triglycerides in the entire group and among girls; for HDL-c, only among girls; for glucose, a correlation was observed for the entire group, but not when stratified by gender. The indicators of insulin resistance were all correlated with Z-BMI, even when corrected for age. Conclusions Overweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance. BMI Z-scores showed a weak positive correlation with glucose and triglyceride, and negative with HDL-c. In turn, the strongest positive correlation was found with insulin resistance indicators.

Resumo Objetivo Avaliar a prevalência de anormalidades nos perfis lipídico e glicêmico entre crianças e adolescentes com sobrepeso e obesidade e também verificar se existe correlação entre os escores-z de índice de massa corporal (z-IMC) e indicadores de comorbidades ligados a esses perfis. Métodos Estudo de corte transversal multicêntrico, incluiu 417 pacientes entre 7 e 18 anos e IMC acima do escore-z > + 1 que fizeram a consulta de caso novo entre 2008 e 2012. Antropometria e coleta de sangue foram realizadas. As prevalências de dislipidemia, hiperglicemia e resistência insulínica foram avaliadas, juntamente com as correlações entre essas variáveis e o z-IMC. Resultados Dislipidemia foi encontrada em 43,4% dos meninos e 66,1% das meninas, sem diferença entre os sexos. Hiperglicemia foi encontrada em 6,2% dos indivíduos. Resistência insulínica esteve presente entre 32,3 e 41,7% dos casos, sem diferença estatística entre os sexos. Foi observada correlação com z-IMC para triglicerídeos quando considerado o grupo todo e entre as meninas; e para HDL-c apenas entre as meninas. A glicemia apresentou correlação quando considerado o grupo todo, mas não quando separados por sexo. Os indicadores de resistência insulínica estiveram todos correlacionados com IMC, mesmo quando se executou correção para a idade. Conclusões Sobrepeso e obesidade levam a prevalências elevadas de dislipidemia e resistência insulínica. Os escores-z de IMC mostraram discreta correlação positiva com glicose e triglicerídeos e negativa com HDL-c. Por outro lado, correlação positiva mais forte foi observada com os indicadores de resistência insulínica.

Frecuencia de componentes del síndrome metabólico en familiares de mujeres con síndrome de ovario poliquístico / Frequency of metabolic syndrome´s components in relatives of women with polycystic ovary syndrome

Introducción: se conoce que la mujer con síndrome de ovario poliquístico tiene mayor riesgo de desarrollar complicaciones cardiometabólicas, pero también existen evidencias de que sus familiares son más propensos a estas. Objetivo: identificar la frecuencia de componentes del síndrome metabólico en familiares de mujeres con síndrome de ovario poliquístico. Métodos: se realizó un estudio descriptivo transversal en el Instituto Nacional de Endocrinología durante el periodo de 2012 al 2014, que incluyó 25 mujeres con síndrome de ovario poliquístico y 36 de sus familiares (casos), y 50 mujeres sin síndrome de ovario poliquístico y 65 de sus familiares (controles). En los familiares se indagó sobre antecedentes de hipertensión arterial, diabetes mellitus, dislipidemia, se tomó la tensión arterial, el peso y talla. Se realizó prueba de tolerancia a la glucosa oral midiendo glucemia e insulinemia (exceptuando a los que padecían diabetes mellitus), colesterol y triglicéridos. Se determinaron frecuencias y se empleó chi2 para las comparaciones. Resultados: el 76,0 por ciento de las mujeres con síndrome de ovario poliquístico refirió un familiar con diabetes mellitus, el 80,0 por ciento con hipertensión arterial y el 20,0 por ciento con algún trastorno lipídico. En las mujeres sanas el 28,0 por ciento tuvo algún familiar con diabetes mellitus, el 36,0 por ciento con hipertensión arterial y con dislipidemia el 12,0 por ciento. Según la prueba de tolerancia a la glucosa oral, se diagnosticó glucemia alterada en ayunas en 16,7 por ciento de los familiares de las mujeres con síndrome de ovario poliquístico y 12,3 por ciento de los familiares de las sanas, con tolerancia a la glucosa alterada hubo 19,4 por ciento de los familiares de los casos y 3,1 por ciento de los de las controles; con diabetes mellitus hubo 5,6 por ciento de los parientes de las mujeres con síndrome de ovario poliquístico y 1,5 por ciento de los de las sanas. En el 47,2 por ciento de los familiares de mujeres con síndrome de ovario poliquístico y el 21,5 por ciento de los de las sanas se detectó hipertrigliceridemia. Conclusiones: la frecuencia de los componentes del síndrome metabólico en familiares de mujeres con síndrome de ovario poliquístico, es mayor al compararlo con el de los familiares de mujeres que no lo presentan(AU)

Introduction: it is known that women with polycystic ovary syndrome have a higher risk of developing cardiometabolic complications, but there is also evidence that their relatives are more prone to those too. Objective: to identify the frequency of components of the metabolic syndrome in relatives of women with polycystic ovary syndrome. Methods: a cross-sectional, descriptive study was conducted in the National Institute of Endocrinology from 2012 to 2014, which included 25 women with polycystic ovary syndrome and 36 of their relatives (cases); and 50 women without polycystic ovary syndrome and 65 of their relatives (controls). The relatives were inquired about a history of hypertension, diabetes mellitus, dyslipidemia; and blood pressure, weight and height were measured. An oral glucose tolerance test was carried out for measuring glycaemia and insulinaemia (excepting those suffering from diabetes mellitus), and cholesterol and triglycerides. Frequencies were determined and chi2 was used for comparisons. Results: 76.0 percent of women with polycystic ovary syndrome reported a relative with diabetes mellitus, 80.0 percent a relative with arterial hypertension, and 20.0 percent a relative with a lipid disorder. In healthy women, 28.0 percent of them had a family member with diabetes mellitus, 36.0 percent a relative with arterial hypertension, and 12.0 percent a relative with dyslipidemia. According to the oral glucose tolerance´s test, impaired glucose in fasting was diagnosed in 16.7 percent of the relatives of women with polycystic ovary syndrome, and in 12.3 percent of the relatives of healthy women. There were 19.4 percent of the relatives of the cases with impaired glucose tolerance, and 3.1 percent of the controls. There were 5.6 percent of the relatives of the women with polycystic ovary syndrome with diabetes mellitus and 1.5 percent of those of the healthy ones. In 47.2 percent of the relatives of women with polycystic ovary syndrome and 21.5 percent of those of healthy women, hypertriglyceridemia was detected. Conclusions: the frequency of metabolic syndrome components in family members of women with polycystic ovary syndrome is higher when compared to the relatives of women who do not have it(AU)

Riesgo vascular en personas con diabetes mellitus tipo 2 y dislipidemia / Vascular risk in people with type 2 diabetes mellitus and dyslipidemia

Introducción: la dislipidemia constituye un factor de riesgo vascular frecuente en la diabetes tipo 2. Objetivo: identificar la relación entre las alteraciones lipídicas y el riesgo vascular en la diabetes tipo 2. Métodos: estudio transversal y correlacional de 111 personas con diabetes tipo 2 y dislipidemia (41 con primaria y 70 con secundaria), atendidas en el Centro de Atención al Diabético del Instituto Nacional de Endocrinología, durante 2014-2015. Se analizaron las variables: edad, sexo, tabaquismo, índice de masa corporal, circunferencia de cintura, índices cintura-cadera y cintura-talla, presión arterial sistólica y de pulso, colesteroles total, lipoproteínas de baja densidad y las lipoproteínas de alta densidad, triglicéridos, apoproteínas A y B, hemoglobina glucosilada, complejo íntima-media carotídeo y riesgo cardiovascular por tablas de la OMS y Gaziano. Para comparar variables cualitativas (porcentaje), se utilizó prueba de Fisher y para cuantitativas ( ± DE), U de Mann-Whitney. Para todos los análisis, se asumió una p< 0,05. Resultados: la disminución de lipoproteínas de alta densidad-colesterol fue la alteración de fracción lipídica que más se relacionó con alteración de variables clínicas y bioquímicas, para ambas dislipidemias. La dislipidemia primaria se asoció con mayor riesgo cardiovascular según tablas de la OMS (p= 0,015). Conclusiones: la dislipidemia primaria y la disminución de lipoproteínas de alta densidad-colesterol se relacionaron con mayor riesgo vascular(AU)

Introduction: dyslipidemia is a frequent vascular risk factor in type 2 diabetes. Objective: to identify the relation between lipid alterations and vascular risk in type 2 diabetes. Methods: cross-sectional and correlational study of 111 people with type 2 diabetes and dyslipidemia (41 of them with primary and 70 with secondary) attended at the Diabetics Care Center of the National Institute of Endocrinology during 2014-2015. The variables analyzed were: age, sex, smoking habit, body mass index, waist circumference, waist-hip and waist-height indexes, systolic and pulse blood pressure, total cholesterol, low density lipoproteins and high density lipoproteins, triglycerides, apoproteins A and B, glycosylated hemoglobin, carotid intima-media complex; and cardiovascular risk by WHO and Gaziano tables. To compare qualitative variables (percentage), Fisher's test was used, and for quantitative ( ± DE), Mann-Whitney U. For all analyzes, a p< 0.05 was assumed. Results: the decrease of high density-cholesterol´s lipoproteins was the alteration of lipid fraction that was more related to the alteration of clinical and biochemical variables, for both dyslipidemias. Primary dyslipidemia was associated with a higher cardiovascular risk according to WHO tables (p= 0.015). Conclusions: primary dyslipidemia and the decrease of high density-cholesterol´s lipoproteins were associated with a higher vascular risk(AU)

La hipertensión arterial en Venezuela y sus factores determinantes / Arterial hypertension and determinants in Venezuela

RESUMEN Objetivo Determinar la prevalência y los factores determinantes fundamentales de la hipertensión arterial, en la población venezolana. Métodos Se realizó una revisión sistemática de la literatura en las bases de datos PubMed y LILACS. Los criterios de inclusión fueron: HTA, Venezuela y riesgos. Se escogieron artículos publicados en cualquier idioma, sin límite de tiempo. Resultados Se encontraron 90 artículos de los cuales 20 cumplieron con los criterios. La mayoría de la data proviene de estudios realizados en la región central del país. La prevalencia del HTA encontrada en la zona rural es de 33 %; en la zona urbana oscila entre 24 y 31 %; en niños 2,5 %. Los trabajos evidenciaron que los factores determinantes modificables son la obesidad y las dislipidemias. En cuanto a los no modificables se encuentran los antecedentes familiares, la raza y la edad. Conclusiones No hay datos suficientes para establecer la prevalencia de la enfermedad en Venezuela, ni conocer cuáles son sus factores determinantes de manera global. Se recomienda incentivar estudios multicéntricos de prevalencia que comprendan la totalidad del país. Los estudios deben ser regulares en el tiempo (estudios longitudinales) para describir el aumento o no de la prevalencia.(AU)

ABSTRACT Objective To determine the prevalence and determinants of arterial hypertension in the Venezuelan population. Methods A systematic review of the literature was performed in the PubMed and LILACS databases. The inclusion criteria were hypertension, Venezuela and risks. Articles published in any language were chosen, with no time limit. Results Out of 90 articles found during the search, only 20 met the inclusion criteria. Most of the data come from studies conducted in the central region of the country. The prevalence of hypertension found in the rural area is 33 %, while it oscillates between 24 and 31 % in the urban area, and 2.5 % in children. The studies showed that modifiable determining factors include obesity and dyslipidemias. In turn, non-modifiable factors include family history, race and age. Conclusions Data are insufficient to establish the prevalence of the disease in Venezuela and its determinants. It is recommended to encourage multicenter prevalence studies that cover the entire country. Studies should be regularly done over time (longitudinal studies) to describe the increase or not in prevalence.(AU)

La deficiencia de vitamina D y la resistencia a la insulina como factores de riesgo de dislipidemia en niños obesos / Vitamin D deficiency and insulin resistance as risk factors for dyslipidemia in obese children

Introducción. La dislipidemia es una de las mayores complicaciones de la obesidad; la deficiencia de vitamina D y la resistencia a la insulina son complicaciones metabólicas que se presentan en niños obesos con dislipidemia. Objetivo. Determinar si la deficiencia de vitamina D y la resistencia a la insulina son factores de riesgo de dislipidemia en niños obesos. Materiales y métodos. Este estudio se llevó a cabo en el Departamento de Pediatría del Hospital Universitario y de Investigación Bagcilar en Estambul, Turquía, entre 2014 y 2015. Se incluyeron en el estudio pacientes obesos de 8 a 14 años de edad. Se midió la concentración sérica de triglicéridos, colesterol total, colesterol de las LDL, colesterol de las HDL, glucemia en ayunas, insulina, alanina aminotransferasa y vitamina D; también se hicieron ecografías hepáticas. La resistencia a la insulina se calculó utilizando el índice de la evaluación del modelo homeostático (HOMA-IR). Resultados. Se incluyeron en el estudio 108 niños obesos, de los cuales 39 (36,11%) padecían dislipidemia. Los valores promedio de glucemia en ayunas (88,74 ± 7,58 frente a 95,31 ± 6,82; p= 0,0001), insulina (14,71 ± 12,44 frente a 24,39 ± 15,02; p= 0,0001) y alanina aminotransferasa (23,45 ± 11,18 frente a 30,4 ± 18,95; p= 0,018) fueron significativamente más altos en los niños con dislipidemia. En los niños obesos con dislipidemia, la tasa promedio de esteatosis hepática y el índice HOMA-IR fueron más altos: 28 niños (71,9%) tuvieron esteatosis hepática y 37 (94,87%), presentaron resistencia a la insulina; las concentraciones de vitamina D fueron <20 ng/ml en el 69,3% de los niños. La deficiencia de vitamina D fue notablemente más frecuente (p= 0,033). El análisis de regresión multivariante confirmó que el aumento del índice HOMA-IR (p= 0,015) y el bajo nivel de vitamina D (p= 0,04) fueron factores importantes de riesgo de dislipidemia. Conclusión. En los niños obesos de nuestra región se observanbajas concentraciones de vitamina D y aumento del índice HOMA-IR, ambos factores de riesgo significativos para la dislipidemia.

Introduction. Dyslipidemia is one of the major complications of obesity; vitamin D deficiency and insulin resistance are attending metabolic complications in dyslipidemic obese children. Objective. To determine if vitamin D deficiency and insulin resistance are risk factors for dyslipidemia in obese children. Materials and Methods. This study was conducted in the Department of Pediatrics at Bagcilar Training and Research Hospital in Istanbul, Turkey between 2014 and 2015. Obese patients whose age range was 8-14 were included in the study. The serum triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting glucose, insulin, alanine aminotransferase, vitamin D levels were measured; a liver ultrasonography was performed. Homeostatic model assessment (HOMA-IR), was used to calculate insulin resistance. Results. 108 obese children were included; 39 (36.11%) had dyslipidemia. The average fasting blood glucose (88.74 ± 7.58 vs. 95.31 ± 6.82; p= 0.0001), insulin level (14.71 ± 12.44 vs. 24.39 ± 15.02; p= 0.0001) and alanine aminotransferase level (23.45 ± 11.18 vs. 30.4 ± 18.95; p= 0.018) were significantly higher in the children with dyslipidemia. In the dyslipidemic obese children, the average hepatosteatosis rate and HOMA-IR level were higher; 28 (71.9%) had hepatosteatosis, 37 (94.87%) had insulin resistance; the vitamin D levels were <20 ng/ml in 69.3%. Vitamin D deficiency was significantly more common (p= 0.033). The multivariate regression analysis confirmed that the increase in the HOMA-IR level (p= 0.015) and the low vitamin D level (p= 0.04) were important risk factors for dyslipidemia. Conclusion. Obese children in our region exhibit low vitamin D and increased HOMA-IR levels, which are efficient risk factors of dyslipidemia.

Indicadores antropométricos de obesidade e perfil lipídico de indivíduos de uma clínica escola de Nutrição / Anthropometric indicators of obesity and lipid profile of individuals of a clinical school of Nutrition

Introdução: Estudos evidenciam a existência de associação entre indicadores antropométricos de obesidade com o risco de desenvolvimento de dislipidemia, o que sugere considerável relevância da avaliação antropométrica para a determinação desse risco. Método: Estudo transversal com indivíduos sem diagnóstico prévio de dislipidemia, atendidos no ambulatório de uma clínica escola de Nutrição no ano de 2009, sendo estudadas as variáveis: índice de massa corporal (IMC), circunferência da cintura (CC), relação cintura-quadril (RCQ), colesterol total e suas frações (LDL e HDL), e o triglicerídeo. As análises foram realizadas no SPSS, com utilização dos testes do Qui-quadrado e da correlação de Pearson, considerando p<0,05 como significativo. Resultados: Foram estudados 60 indivíduos, com idade entre 20 e 67 anos, a maioria era do sexo feminino (85%) e na faixa etária adulta (81,7%). Da amostra estudada, 43,3% eram obesos segundo o IMC; 81,7% apresentavam obesidade abdominal de acordo com a CC e 63,3% apresentavam RCQ elevada. Somado a isso, 45% apresentavam colesterol total elevado; 36,7% LDL-c elevado; 30,0% HDL-c baixo; 30% triglicerídeo acima dos valores recomendados, sem associação significativa entre obesidade e perfil lipídico alterado dos indivíduos estudados. Conclusão: Apesar de não ter havido associação entre os parâmetros avaliados, sabe-se que ambos são fatores de risco para o desenvolvimento de doenças cardiovasculares e precisam ser controlados, visto a grande frequência de indivíduos estudados com estas características.(AU)

Introduction: Studies have shown the existence of an association between anthropometric indicators of obesity with the risk of dyslipidemia development, suggesting considerable relevance of anthropometric measurements to determine this risk. Methods: Cross-sectional study with patients without prior diagnosis of dyslipidemia treated at the outpatient of a Nutrition clinic school in 2009, the variables being studied were: body mass index (BMI), waist circumference (WC), waisthip ratio (WHR), total cholesterol and its fractions (LDL and HDL), and triglycerides. The analyzes were performed with SPSS, using chi-square test and Pearson correlation, considering p<0.05 as significant. Results: We studied 60 subjects, aged between 20 and 67 years, most were female (85%) and in the adult age group (81.7%). The sample studied, 43.3% were obese according to BMI; 81.7% had abdominal obesity according to CC and 63.3% had high WHR. Added to this, 45% had high total cholesterol; 36.7% high LDL-c; 30.0% low HDL-c; 30% above the recommended triglyceride values, no significant association between obesity and altered lipid profile of subjects studied. Conclusion: Although there was no association between the evaluated parameters, it is known that both are risk factors for developing cardiovascular disease and need to be controlled, because the high frequency of subjects studied with these characteristics.(AU)

Association of rotating night shift with lipid profile among nurses in an Egyptian tertiary university hospital

The main objective was to identify whether night shift nurses are more prone to dyslipidaemia than day shift nurses. One hundred and fifty female nurses aged 20-49 years were recruited from Ain Shams University Hospitals, Egypt, from January to March 2016: 64 day shift and 86 night shift. Diet type was assessed by interview questionnaire and job satisfaction was assessed using the job satisfaction survey. Triglyceride [TG], low-density lipoprotein [LDL] and high-density lipoprotein [HDL] were measured in all nurses. The predictors of high TG level were ages 30-39 and >/= 40 years and night shift. The only predictor of high LDL level [> 130 mg/dl] was age >/= 40 years. An unhealthy diet and night shift were predictors of risky HDL levels. Seventy nurses were unsatisfied with their jobs, and 137 ate a semi-healthy diet. The findings emphasize that night shift nurses are at risk of abnormal lipid profile, therefore an occupational programme to help nurses cope with their employment conditions is necessary

Alta frecuencia de dislipidemias en niños y adolescentes con Síndrome de Down / High frequency of dyslipidemia in children and adolescents with Down Syndrome

El síndrome de Down (SD) presenta mayor riesgo de desarrollar enfermedades crónicas asociadas a mayor morbimortalidad por enfermedad cardiovascular. Algunos estudios han mostrado un peor perfil lipídico en niños con SD, sin embargo, hasta el momento no existen recomendaciones de tamizaje para dislipidemia en estos pacientes. Objetivo: Describir la frecuencia de dislipidemia en una población chilena de niños y adolescentes con SD. Pacientes y Método: Estudio retrospectivo, que incluyó pacientes con SD entre 2 y 18 años, participantes de un programa de salud para personas con SD en la Red de Salud UC CHRISTUS, entre los años 2007 y 2015. Se incluyeron pacientes que tuvieran perfil lipídico tomado entre sus exámenes de rutina. Se registraron características clínicas, comorbilidades relevantes, malformaciones, medicamentos, estado nutricional y estado puberal. El diagnóstico de dislipidemias se realizó de acuerdo a los criterios de la NHLBI 2011. Resultados: Se revisaron las fichas clínicas de 218 niños con SD, 58,3% tenía algún tipo de dislipidemia. Las más frecuentes fueron colesterol HDL bajo (15,1%) e hipertrigliceridemia (12,8%). La dislipidemia aterogénica (C-HDL bajo más hipertrigliceridemia) fue la dislipidemia combinada más frecuente (13,3%), la cual no se asoció a sobrepeso u obesidad. Conclusiones: Se encontró una alta frecuencia de dislipidemia en niños y adolescentes chilenos con SD. Nuestros resultados nos hacen sugerir la realización de un perfil lipídico de forma temprana a todos los pacientes con SD, independiente de la presencia de factores de riesgo de dislipidemia.

Down Syndrome (DS) shows an increased risk of chronic diseases, associated to higher morbidity and mortality for cardiovascular disease. Some studies have shown a worse lipid profile in children with DS, however, until now there is no recommendation for screening for dyslipidemia in these subjects. Objective: To describe the frequency of dyslipidemia in a population of Chilean children and adolescents with DS. Patients and Method: Retrospective study, including patients with DS, aged 2 to 18 years, who participated in a special health care program for people with DS in Health Net UC CHRISTUS, between 2007 and 2015. Patients who had a lipid profile between their routine laboratory tests were included. Clinical characteristics, relevant comorbidities, malformations, medications, nutritional status and pubertal development were obtained from medical records. Diagnosis of dyslipidemia was considered according to the criteria of the NHLBI 2011. Results: The medical records of 218 children with DS were revised, 58,3% had some type of dyslipidemia. The most frequent single dyslipidemias were low HDL Chol (15,1%) and hypertriglyceridemia (12,8%). Atherogenic dyslipidemia (low HDL plus hypertriglyceridemia) was the most frequent combined dyslipidemia (13,3%). The occurrence of atherogenic dyslipidemia was not associated with overnutrition and obesity. Conclusions: A high frequency of dyslipidemia was found in Chilean children and adolescents with DS. Our results make us suggest that lipid profile should be performed early in all patients with DS, independent of the presence of risk factors for dyslipidemia.

Predictores clínicos y funcionales del riesgo de cáncer pulmonar en el seguimiento de una cohorte de adultos fumadores / Risk factors for the development of lung cancer in a cohort of adult smokers

Background: Identifying risk factors for lung cancer in the population could improve the cost-effectiveness of early detection programs using thoracic computed tomography (CT). Aim: To examine the risk factors of lung cancer in a cohort of adult smokers. Patients and Methods: An annual clinical and respiratory functional assessment, chest computed tomography for three years and clinical follow up for five years was carried out in 270 patients aged 65 ± 9 years, 55% males, active or former smokers of 10 or more pack-years. Results: Thirty seven percent of patients were active smokers, consuming 37 ± 26 packs/year, 85% had comorbidities, especially chronic obstructive pulmonary disease (COPD) (66%), hypertension (48%), diabetes (22%) and dyslipidemia (42%). Thirteen percent of patients had family history of lung cancer. Twenty-one cases of lung cancer were detected in the five years follow up, especially squamous cell carcinoma and adenocarcinoma. In the univariate analysis, the main risk factors for lung cancer identified were an age older than 60 years, history of COPD, family history of lung cancer, active smoking, tobacco consumption more than 30 pack/year and lung hyperinflation. In multivariate analysis, the three independent risk factors for lung cancer were a family history of lung cancer, active smoking and the number of packs per year of tobacco consumption. Conclusions: The identification of risk groups probably will improve the performance of programs for early detection of lung cancer.

Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients

ABSTRACT Objective The oral glucose tolerance test (OGTT) is used in the screening of gestational diabetes, in diagnosis of type 2 diabetes in conjunction with fasting blood glucose and glycated hemoglobin. The aim of this study was to examine the incidence and risk factors of adverse effects of OGTT in patients who underwent bariatric surgery, in addition to proposing standardization for ordering the OGTT in these patients. Subjects and methods This study assessed the incidence of adverse effects in 128 post-bariatric surgery patients who underwent the OGTT. Descriptive and logistic regression analysis were performed, the dependent variables were defined as the presence of signs (tremor, profuse sweating, tachycardia), symptoms (nausea, diarrhea, dizziness, weakness), and hypoglycemia (blood glucose ≤ 50 mg/dL). Results One hundred and seventeen participants (91.4%) were female; 38 (29.7%) participants were pregnant. High incidence (64.8%) of adverse effects was observed: nausea (38.4%), dizziness (30.5%), weakness (25.8%), diarrhea (23.4%), hypoglycemia (14.8%), tachycardia (14.1%), tremor (13.3%), profuse sweating (12.5%) and one case of severe hypoglycemia (24 mg/dL). The presence of signs was associated with hypoglycemia (OR = 8.1, CI 95% 2.6-25.1). The arterial hypertension persisted as a risk factor for the incidence of signs (OR = 3.6, CI 95% 1.2-11.3). Fasting glucose below 75 mg/dL increased the risk of hypoglycemia during the test (OR = 9.5, CI 95% 2.6-35.1). Conclusion In this study, high incidence of adverse effects during the OGTT was observed in post-bariatric surgery patients. If these results are confirmed by further studies, the indication and regulation of the OGTT procedure must be reviewed for these patients.

Fuentes naturales de fitoesteroles y factores de producción que lo modifican / Natural sources of phytosterols and production factors that modify them

Actualmente los fitoesteroles son adicionados a los alimentos industrializados, lo que aumenta su costo y por lo tanto limita su consumo. Este manuscrito tiene como objetivo identificar alimentos que son una fuente natural de fitoesteroles, así como también analizar cómo el ambiente y el manejo productivo modifican su contenido, relacionando estos aspectos con la salud. Los fitoesteroles son compuestos presentes en las plantas con propiedades hipocolesterolémicas, que pueden contribuir a prevenir las enfermedades cardiovasculares. La ingesta diaria estimada de fitoesteroles varía entre 160 y 500 mg/día, sin embargo su acción beneficiosa se logra con consumos de 1500 mg a 2400 mg diarios. Las semillas de oleaginosas y de cereales son las mayores fuentes naturales de fitoesteroles. El amaranto es considerado un pseudocereal y entre los cereales tiene la mayor concentración de fitoesteroles con 178 mg/100 g, valor 5 veces superior al de la harina de trigo. El ambiente modifica el contenido de fitoesteroles de los alimentos, la sequía y temperaturas altas duplican su contenido en las semillas; la fertilización nitrogenada y la fecha de siembra pueden provocar cambios, pero se requieren más estudios al respecto. La selección de genotipos con mayor contenido de fitoesteroles y el estudio de la interacción genotipo ambiente, permitirá la identificación de aquellos genotipos con adaptación local para este carácter. El manejo productivo podrá aumentar la oferta de alimentos naturales ricos en fitoesteroles, contribuyendo a una mayor oferta de alimentos protectores de la salud(AU)

Currently phytosterols are added to processed foods, which increase their cost and therefore limits its use. This manuscript aims to identify foods that are a natural source of phytosterols, as well as analyze how the environment and production management modify its content, linking these aspects with health. Phytosterols are compounds found in plants with hypocholesterolemic properties, which may help prevent cardiovascular diseases. The estimated daily intake of phytosterols varies between 160 and 500 mg/day, but its beneficial effect is achieved with 1,500 to 2,400 mg daily consumption. Oil and cereal seeds are the largest natural sources of phytosterols. Amaranth is considered a pseudocereal and among the cereals has the highest concentration of phytosterols with 178 mg/100 g, value 5 times higher than wheat flour. Environment modifies phytosterol content in food, drought and high temperatures can double their content in seeds; nitrogen fertilization and planting date can cause changes, but more studies are needed. The selection of genotypes with higher phytosterol content and studying the genotype x environment interaction, allow the identification of those genotypes with local adaptation for this character. The production management will increase the supply of natural foods rich in phytosterols, contributing to a greater supply of health protective foods(AU)

Nutritional status and cardiovascular risks in children of two schools in Bogotá, Colombia

This is a cross-sectional observational study. Children's weight, height, blood pressure, serum levels of total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol and non-HDL cholesterol were objectively measured from participants. Statistical analysis was performed using the ANOVA technique for parametric data and the Kruskal-Wallis test for nonparametric data. Study was conducted on 157 children aged 7-9 from two educational institutions located in low-income areas in Bogotá, Colombia. Weight excess (overweight and obesity) was observed in 46 subjects, of which 97.8% had a high or very high waist circumference. The lipid profile was altered in 45.2% of the subjects; 22.3% presented high levels of triglycerides. Metabolic syndrome was identified in 32.6% of the subjects with excess weight, thus being the most frequent component of high or very high waist circumference. Finally this study confirmed the high prevalence of malnutrition by excess weightand, also excess weight associated with high triglyceride and low HDL levels. The results of this study suggest the need for early and thorough interventions aimed at improving the lifestyles and quality of life of children(AU)

Este es un estudio observacional transversal. Se realizó valoración antropométrica, bioquímica y de presión arterial en 157 niños y niñas con edades de 7 a 9 años de dos instituciones educativas, localizadas en sectores con recursos económicos limitados de Bogotá. Se determinó niveles séricos de colesterol total, triglicéridos, colesterol HDL, colesterol LDL y colesterol no-HDL. Se realizó análisis estadístico mediante la técnica de ANOVA para datos paramétricos y la prueba de Kruskal-Wallis para datos no paramétricos. Se observó exceso de peso (sobrepeso y obesidad) en 46 sujetos de los cuales el 97.8 % presentó circunferencia de cintura alta. El perfil lipídico se encontró alterado en el 45.2 % de los sujetos; el 22.3% presentaron triglicéridos elevados. El síndrome metabólico se identificó en el 32,6% de los sujetos con exceso de peso, siendo el componente más frecuente la circunferencia de cintura alta. En este estudio se pudo confirmar la alta prevalencia de malnutrición por exceso y también el exceso de peso asociado a valores altos de triglicéridos y niveles bajo de HDL. Este estudio sugiere la necesidad de intervenciones tempranas e integrales enfocadas a mejorar los estilos y calidad de vida de los niños y niñas(AU)