Evaluación del déficit de vitamina d en mujeres adultas

RESUMEN La deficiencia de vitamina D en la población general se considera un importante problema en salud pública. Esta vitamina tiene un papel central en el metabolismo cálcico, por lo que el aporte adecuado, a través de la dieta o por síntesis cutánea, es esencial para la salud. Nos propusimos analizar el comportamiento de la vitamina D en mujeres adultas que concurren a la Clínica Tajy de Encamación, Paraguay. Además, determinar la prevalencia de hipovitaminosis, su relación con el metabolismo fosfocálcico y su asociación con factores de riesgo cardiovascular. Se estudiaron 120 mujeres, 61 pre-menopaúsicas y 59 pos-menopaúsicas, que asistieron al Laboratorio Tajy de Encarnación Paraguay desde enero del 2.015 hasta marzo del 2.016. Se tomaron muestras de sangre y datos de peso, talla, circunferencia de cintura y presión arterial. Fueron excluidas mujeres embarazadas, con diabetes, hipertensión, nefropatías, neoplasias, patologías tiroideas, procesos inflamatorios o infecciosos, que se encontraban bajo tratamiento o suplemento de cualquier tipo. El 72% de estas mujeres presentaron hipovitaminosis D (< 30 ng/ml), un 38% eran pre menopáusicas, destacando que dentro de esta población se halló el mayor porcentaje de mujeres con deficiencia severa, y un 39% eran pos-menopáusicas. Se encontró diferencia significativa (p<0,001) entre pre y post menopáusicas en edad, presión arterial sistólica, circunferencia de cintura, glucemia, colesterol-HDL, triglicéridos e índice TG/col-HDL, y concentración de calcio y fosforo (p< 0,001). La concentración de vitamina se correlacionó significativamente con circunferencia de cintura, concentración de calcio y fósforo (p<0.001). 67 mujeres con obesidad abdominal tuvieron hipovitaminosis D, presentando 15 veces más riesgo que aquellas con circunferencia <88 cm. El 72% de las mujeres estudiadas presentaron hipovitaminosis D, un 38% eran mujeres pre menopáusicas y 39% pos-menopáusicas. Esta hipovitaminosis D presentó correlación significativa con las concentraciones de calcio y fosforo, edad, presión arterial sistólica, glucemia y col-HDL y asociación significativa con obesidad abdominal.

ABSTRACT in adult women who attend the Tajy Clinic in Encarnación, Republic of Paraguay. To determine the prevalence of hypovitaminosis and the relationship that exists with phosphocalcic metabolism, as well as to evaluate the association of cardiovascular risk factors to hypovitaminosis D in this population of women. 120 women were studied, 61 pre-menopausal and 59 in post-menopause. With median and 25 and 75 percentiles for age 48 (35-62), who attended the Tajy Laboratory in Encamación Paraguay from January 2015 to March 2016. Blood samples were taken and a survey was carried out in order to collect information on those covariates that may influence the variables of interest and where all have signed a consent. Pregnant women, women with diabetes, with hypertension, nephropathies, neoplastic diseases, thyroid diseases, inflammatory or infectious processes, who are under treatment or supplement of any kind were excluded. We obtained data on weight, height, waist circumference and blood pressure. A blood extraction with fasting of 12 hours was performed for biochemical determinations. All samples were processed with internal and external quality control. It was found that 72% of these women had hypovitaminosis D (< 30 ng/ml) , where 38% were pre-menopausal, highlighting that within this population the highest percentage of women with severe vitamin D deficiency was found and 39% were post-menopausal. A statistically significant difference was found (p <0.001) with age, systolic blood pressure, waist circumference, glycemia, HDL-cholesterol concentration, triglyceride concentration and TG / HDL-col index, as well as calcium and phosphorus (p <0.001). It was found that the concentration of vitamin D had a significant correlation with the measurement of waist circumference, calcium and phosphorus concentration (p <0.001). It was found that 67 women with abdominal obesity had low vitamin D levels (<20 ng / ml), those with abdominal obesity had 15 times more risk of hypovitaminosis D than those with a waist circumference of <88 cm. Through this research, and analyzing the behavior of vitamin D concentration in pre and post menopausal women, we found that 72% of them presented hypovitaminosis D, in which 38% were pre-menopausal women and 39% were menopausal This hypovitaminosis D has a significant correlation with calcium and phosphorus concentrations, as well as with other variables such as age, systolic blood pressure, glycemia and HDL cholesterol concentration. Vitamin D deficiency has a significant association with abdominal obesity in this population of women.

Obesidad, hipertensión, síndrome metabólico y diabetes mellitus tipo 2 en dadores de sangre, individuos presuntamente sanos, del banco de sangre, tejidos y biológicos, de la ciudad de Posadas / Obesity, hypertension, metabolic syndrome and type 2 diabetes mellitus in blood donors, presumably healthy individuals, from the blood, tissue and biological bank of the city of Posadas

Resumen La enfermedad cardiovascular ocupa uno de los primeros puestos como causa de muerte en el mundo. Durante el primer año del proyecto, nos propusimos hallar la prevalencia y su distribución por sexo de hipertensión, obesidad general y abdominal en donantes de sangre. Establecer la frecuencia y su distribución por sexo de Síndrome Metabólico y hallar la incidencia de diabetes mellitus tipo 2; en el segundo año nos centramos en re-evaluar y valorar el impacto de la intervención en cada individuo. En una población de dadores de sangre presuntamente sanos del Banco de Sangre, Tejidos y Biológicos de la Provincia de Misiones. Se obtuvieron datos antropométricos y presión arterial. Se realizó una extracción sanguínea con ayuno de 12 horas para las determinaciones bioquímicas, consulta médica y tratamiento para quienes lo necesitaron. Se realizó una encuesta abierta cualitativa. Se obtuvieron datos de 141 donantes voluntarios de sangre, 47 mujeres y 94 varones. El 38,1% tenía presión arterial elevada. El 29,5% presento obesidad. El 59 % obesidad abdominal. 41,7 % de los donantes presentaba SM. Se halló una incidencia de diabetes mellitus tipo 2 de 8,6 % (n=12). El 39,6 % (n=55) de los individuos presentó Glucemia Alterada en Ayunas. Todos los individuos que presentaron algún factor de riesgo, concurrieron a la consulta médica. Al año se los recito para su control. De los 30 individuos que estaban en tratamiento solo 9 continuaron haciendolo, impidiendo esto una correcta evaluación clínica global y medición del impacto de las intervenciones que se realizaron. De toda la poblacion de estudio, solo en 4 individuos se ha notado un cambio significativo transcurrido un año. Casi la totalidad de la población de donantes presentó al menos un factor de riesgo para enfermedad cardiovascular, todos ellos modificables, destacando de ello la corta edad de la población. Ninguno de los individuos del estudio tenía conocimiento de su estado.

ABSTRACT Cardiovascular disease occupies one of the first places as a cause of death in the world. During the first year of the project, we set out to find the prevalence and its distribution by sex of hypertension, general and abdominal obesity in blood donors. Establish the frequency and distribution by sex of Metabolic Syndrome (MS) and find the incidence of type 2 diabetes mellitus; while in the second year we focused on re-evaluating and assessing the impact of the intervention on each individual. In a population of presumably healthy blood donors of the Blood, Tissue and Biological Bank of the Province of Misiones. Volunteer donors between 20 and 50 years were evaluated, 2014-2015 period. Anthropometric data and blood pressure were obtained. A blood extraction with fasting of 12 hours was performed for biochemical determinations, medical consultation and treatment for those who needed it. Period 2015-2016, a qualitative open survey and biochemical-clinical evaluation of individuals was conducted. Data were obtained from 141 voluntary blood donors, 47 women and 94 men. 38.1% of the total population had high blood pressure, 29.5% obesity, 59% of the study population had abdominal obesity and 41.7% of donors had MS. An incidence of type 2 diabetes mellitus of 8.6% (n = 12) and 39.6% (n = 55) of the individuals had altered fasting blood glucose. All the individuals who presented some risk factor attended the medical consultation. At the end of one year they are re-scheduled for re-evaluation. Although, the majority agreed on the importance of carrying out health checks, of the 30 individuals who were in treatment only 9 continued to do so, preventing this a correct global clinical evaluation and measuring the impact of the interventions that were performed. Of all the study population, only 4 individuals have noticed a significant change after one year, improving all their risk factors. The parameter that showed the greatest change, in a year, was the fasting blood glucose. Everyone was aware of the significance of cardiovascular risk factors and what their consequences were. Almost all of the donor population had at least one risk factor for cardiovascular disease, all of them modifiable, highlighting the short age of the population. None of the individuals in the study was aware of their condition. Only 9 individuals completed the treatment scheme indicated according to their pathology.

Adiponectina, índice TG/c-HDL y PCRUS: Predictores de insulinorresistencia / Adiponectin, TG/HDL chol index and CRPhs: Predictors of Insulin resistance

El disturbio inicial de la insulinorresistencia (IR) parece centrarse en el tejido adiposo que es un órgano dinámico involucrado en muchos procesos fisiológicos y metabólicos. Expresa y secreta una gran variedad de péptidos activos, adipocitoquinas. En el presente estudio se propuso determinar la relación entre el índice TG/col-HDL, marcadores del metabolismo del tejido adiposo (Adiponectina) y de inflamación (PCRus) con la IR en una población urbana del interior del país. Se evaluaron 176 empleados de los 2 hospitales públicos de Posadas-Misiones, 117 mujeres y 59 hombres, con edades 49,01 ± 9,33 años. Se excluyeron los individuos que presentaban diabetes, hipotiroidismo o hipertiroidismo, enfermedad infecciosa, renal, hepática o neoplasias y embarazadas. Se les realizó una extracción sanguínea con 12 h de ayuno. Se determinó: Glucemia y triglicéridos (método enzimático colorimétrico final según Trinder), c-HDL (método homogéneo), Insulina (ensayo inmunométrico quimioluminiscente en fase sólida en un equipo Immulite 2000-Siemmens), Adiponectina (anticuerpos monoclonales ALPCO immunoassays) y PCRhs (ensayo inmunométrico quimioluminiscente en fase sólida en un equipo Immulite 2000 Siemmens). Todas las muestras se procesaron con calibradores, controles comerciales normal y patológico y control de calidad interno y externo. Se utilizó para el análisis de los datos el programa Epi Info 6.04d. El 17,2 % fue IR y el 45,7 % de la población presentó un descenso de adiponectina. La IR se asoció de forma significativa con Adiponectina (p < 0.001), PCRus (p = 0.02) y TG/colHDL (p = 0,02). Pero el parámetro que mejor se relacionó con la IR fue la concentración de Adiponectina en suero. Podríamos concluir entonces que la medición de esta hormona puede ser una herramienta útil para mejorar las estimaciones de riesgo actuales.

The initial disturbance of insulin resistance appears to focus on adipose tissue which is a dynamic organ involved in many physiological and metabolic processes. Expresses and secretes a variety of active peptides, adipocytokines. The aim of this study was in urban population of the countryside, represented by employees of two public hospitals in the province of Misiones, to determinate the relationship between circulating levels of TG/HDL-c index, adipose tissue metabolism (adiponectin) and inflammatory markers (hsCRP) with insulin resistance metabolism. We evaluated 176 employees of 2 public hospitals in Posadas, Misiones, 117 women and 59 men, aged 49.01 ± 9.33 years. The exclusion criteria were subjects with diabetes, hypothyroidism or hyperthyroidism, infectious disease, renal or hepatic neoplasms and pregnant women. They performed a blood sample with 12 hours of fasting. Blood glucose (cv = 2.43 %) and triglycerides (cv = 2.45 %): were measured by enzymatic colorimetric method according to Trinder. HDL-c (cv = 3.41 %) by homogeneous method. Insulin (cv = 4,2 %) and the high-sensitivity C-reactive protein (hsCRP) (cv = 2,1 %) were determined by a chemiluminescent immunometric assay on a solid phase Immulite 2000-Siemmens. Adiponectin with monoclonal antibodies (ALPCO immunoassays). All samples were processed with calibrators, trade controls normal and pathological and control of internal and external quality. Statistic analysis was made by Epi Info 6.04d, with a 95 % confidence level and a significance level of < 0.05. 17.2 % of sample were IR and 45.7 % had decreased concentrations of adiponectin. We found that IR was associated with the Adiponectin (p < 0.001), hsCRP (p = 0.02) and TG/HDL-c index (p = 0.02). The parameter that best explained the event IR was serum adiponectin concentration. We can conclude that hormone‘s determination may improve a new opportunity current risk estimates.

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.