Análisis clínicos en pediatría: la necesidad de minimizar las horas de ayuno / Clinical analysis in pediatrics: the need to minimize fasting hours

Los informes de laboratorio tienen impacto en las decisiones médicas. El ayuno es un factor preanalítico "controlable" que influye en los distintos parámetros bioquímicos. El objetivo del presente trabajo es poner en discusión la realización en pediatría de análisis clínicos con la indicación de un ayuno fisiológico , analizando resultados obtenidos por diferentes autores y evaluando las diferencias clínicas encontradas según los criterios de calidad establecidos por el laboratorio de Química Clínica. La mayoría de los individuos durante el día se encuentran en estado postprandial. Los resultados del perfil lipídico en ayunas no representan las concentraciones reales promedios de los lípidos plasmáticos de un paciente. El ayuno no sería crítico en la etapa de pesquisa , pero puede ser relevante para establecer un diagnóstico certero o inicio de tratamiento. En el caso de la glucemia si se indica en el control rutinario del paciente, y no hay sospecha de alteraciones en el metabolismo de los hidratos de carbono la glucemia sin ayuno puede ser solicitada comparando la misma con valores de corte adecuado. Las diferentes guías nacionales e internacionales recomiendan que la elección de la métrica para la evaluación, control y seguimiento de pacientes con diagnóstico de diabetes se realicen según el objetivo terapéutico. En los trabajos analizados, observamos que varios parámetros bioquímicos presentaron diferencias estadísticas, aunque las diferencias clínicas no fueron relevantes y permanecieron dentro de los intervalos de referencia. El factor limitante para evaluar parámetros bioquímicos sin ayuno es la falta de valores de referencia adecuados. Hay evidencia suficiente para que tanto el perfil lipídico, la glucemia como el resto de los parámetros bioquímicos del laboratorio de química clínica, sean solicitados con la indicación de un ayuno fisiológico de 2, 4 o 6 horas, dependiendo siempre del motivo de consulta y/o la edad del paciente. Es esencial extender la evaluación a otros analitos en población pediátrica, así como evaluar nuevos puntos de corte para parámetros bioquímicos sin ayuno (AU)

Laboratory reports have an impact on medical decision-making. Fasting is a "controllable" preanalytical factor that influences the different biochemical parameters. The aim of this study is to discuss the performance of clinical analyses in pediatrics with the indication of physiological fasting, analyzing results obtained in different disciplines, and evaluating the clinical differences found according to the quality criteria established by the clinical chemistry laboratory. During the day, most patients are in a postprandial state. Fasting lipid profile results do not represent the actual average plasma lipid concentrations of a patient. Fasting would not be critical in the screening stage, but it may be relevant to establish an accurate diagnosis or initiate treatment. Regarding glycemia, if it is indicated in the routine control of the patient and there is no suspicion of alterations in carbohydrate metabolism, non-fasting glycemia can be requested, comparing it with adequate cut-off values. Different national and international guidelines recommend that the choice of metrics for the evaluation, control, and follow-up of patients with diabetes should be made according to the therapeutic objective. In the studies analyzed, we found that several biochemical parameters presented statistical differences, although the clinical differences were not relevant and remained within the reference range. The limiting factor in the evaluation of biochemical parameters without fasting is the lack of adequate reference values. There is sufficient evidence that the lipid profile, glycemia, and the remaining biochemical parameters of the clinical chemistry laboratory should be requested with the indication of a physiological fast of 2, 4, or 6 hours, always depending on the reason for consultation and/or the patient's age. It is essential to extend the evaluation to other analytes in the pediatric population, as well as to evaluate new cut-off points for biochemical parameters without fasting (AU)

Effects of Disease Detection on Changes in Smoking Behavior

PURPOSE: This study was conducted to investigate the effect that detection of chronic disease via health screening programs has on health behaviors, particularly smoking. MATERIALS AND METHODS: We analyzed national health insurance data from 2007 and 2009. Subjects who were 40 years of age in 2007 and eligible for the life cycle-based national health screening program were included. The total study population comprised 153518 individuals who participated in the screening program in 2007 and follow-up screening in 2009. Multiple logistic regression analyses were conducted by sex, with adjustment for health insurance type, socioeconomic status, body mass index, diabetes, hypertension, hyperlipidemia, and family history of cardiovascular and/or neurovascular disease. RESULTS: Among men with smoking behavior changes, those newly diagnosed with hyperlipidemia were more likely to show a positive health behavior change, such as smoking cessation, and were less likely to have a negative behavior change (e.g., smoking initiation). Additionally, men newly diagnosed with diabetes showed lower rates of negative health behavior changes compared to those without disease. Body mass index (BMI)> or =25, compared to BMI<23, showed higher rates of positive health behavior changes and lower rates of negative health behavior changes. Newly diagnosed chronic disease did not influence smoking behavior in women. CONCLUSION: Smoking behavior changes were only detected in men who participated in health screening programs. In particular, those newly diagnosed with hyperlipidemia were more likely to stop smoking and less likely to start smoking.

Optimal Range of Triglyceride Values to Estimate Serum Low Density Lipoprotein Cholesterol Concentration in Korean Adults: the Korea National Health and Nutrition Examination Survey, 2009

The aims of this study were to investigate the validity of Friedewald's formula and to propose a range of triglyceride values over which the formula can be used without significant error. This was a cross-sectional analysis of 1,929 subjects (946 males and 983 females) aged 20 yr and older using data of the Korea National Health and Nutrition Examination Survey in 2009. Estimated total number was considered to be 10,633,655 (5,846,384 males and 4,787,271 females). Calculated and directly-measured low density lipoprotein cholesterol (LDL-C) values were highly correlated (r = 0.96); however, significant differences were observed between the directly-measured and calculated LDL-C concentrations. Subjects in the underestimated group (10.5%) had higher dysmetabolic profiles than those in the overestimated group (11.4%). Although serum triglyceride level showed the greatest independent association with differences between the calculated and directly-measured LDL-C concentrations, no statistically significant differences were noted when triglyceride concentration was between 36 and 298 mg/dL (93.2%). In conclusion, Friedewald's formula accurately estimates directly-measured serum LDL-C concentration in Korean adults. However, the formula can be applied to subjects with serum triglyceride concentrations from 36 to 298 mg/dL without significant error.

Hyperlipidaemia in patients with sleep-related breathing disorders: Prevalence & risk factors.

Background & objectives: several studies have shown a close relationship between obstructive sleep apnoea (OSA) and dyslipidaemia. This study was designed to clarify the relationship of metabolic dysfunctions in sleep related-breathing disorders (SRBD), including OSA and simple snoring. The end point was to determine the prevalence of hyperlipidaemia and hyperuricaemia in SRBD. Factors contributing to hyperlipidaemia and hyperuricaemia in SRBD were also evaluated. Methods: Outpatients >20 yr old with complaint of habitual snoring were prospectively enrolled. All patients underwent an overnight polysomnography (PSG) in a sleep laboratory and blood assay after overnight fasting. The factors of gender, age, body mass index (BMI), apnoea-hypopnoea index (AHI), and desaturation index (DI) were recorded in the PSG report. A logistic regression analysis was conducted to investigate the relationship between metabolic dysfunctions and these factors. Results: Of the 275 patients (88.4% male), 236 (85.8%) were diagnosed with OSA (AHI>5/h). The mean (± SD) of age, BMI, AHI, and DI were 44.2 ± 11.4 yr, 27.4 ± 4.0 kg/m2, 37.9 ± 30.6/h, and 21.2 ± 23.2/h, respectively. The overall prevalence of hypercholesterolaemia, hypertriglyceridaemia, and hyperuricaemia in this study was 61.1, 55.3, and 25.8 per cent, respectively. Logistic regression analysis revealed that DI was a significant independent factors contributing to hypercholesterolaemia [odds ratio (OR)=1.016, P=0.010, 95% confidence interval (CI)=1.004-1.028] and hypertriglyceridaemia (OR=1.021, P=0.002, 95% CI=1.008-1.034). Interpretation & conclusions: The data of the present study support a high prevalence of hyperlipidaemia in SRBD. DI may be a determining factor contributing to hyperlipidaemia in SRDB. Underdiagnosis of hyperlipidaemia in SRBD is a critical problem.

Niveles plasmáticos de adiponectina en sujetos diabéticos tipo 2 y su relación con el perfil de lípidos y la hiperglicemia / Adiponectin levels in men with type 2 diabetes and relationship between profile lipids and hyperglycemia

Los pacientes con Diabetes tipo 2 tienen un mayor riesgo de aterosclerosis. El riesgo de infarto coronario entre los sujetos diabéticos es comparable con el observado en aquellos individuos con antecedentes previos de infarto al miocardio. Este aumento del riesgo ha sido atribuido principalmente a la hiperglicemia, dislipidemia y a mecanismos inflamatorios. La diponectina, que es sintetizada exclusivamente en el tejido adiposo, parece jugar un rol importante en todo este mecanismo. El objetivo de este estudio fue investigar la asociación entre los niveles de adiponectina y la HbA1c, los lípidos y la glucosa plasmática en hombres con diabetes tipo 2. Estudiamos 110 hombres diabéticos con edad entre 39 y 85 años. Se determinó glucosa plasmática en ayunas, colesterol sérico, colesterol HDL, triglicéridos, colesterol de LDL, adiponectina y HbA1c. Los resultados muestran que en los sujetos diabéticos tipo 2 los niveles plasmáticos elevados de adiponectina se correlacionaron positivamente con el colesterol de HDL e inversamente con la HbA1c, los triglicéridos y la hiperglicemia. Estas asociaciones fueron independientes de la edad. En conclusión, este estudio sustenta la hipótesis de que el aumento en los niveles de adiponectina puede estar asociado con una menor hiperglicemia y dislipidemia en sujetos diabéticos.

Obesidad en pacientes prepúberes: detección temprana de sindrome metabólico / Obesity in pre pubertal patients: early detection of a metabolic syndrome

El síndrome metabólico (SM) constituye una constelación de anormalidades metabólicas asociadas con resistencia insulínica y obesidad habiéndose demostrado que los individuos con síndrome de resistencia insulínica están en riesgo de desarrollar diabetes tipo 2 y enfermedad cardiovascular. De allí la importancia de detectar en forma precoz los individuos en riesgo e función de prevención. Nuesto objetivo fue estimar la prevalencia de los componentes del SM en una población de niños obesos prepúberes . Se estudiaron 197 niños obesos prepúberes, sin patología asociada, asistidos en el Servicio de Nutrición del Hospital Garrahan. El sin-drome metabólico se definió según los críterios propuestos por Organización Mundial de la Salud (OMS) adaptados a la edad pediátrica. La evaluación comprendió antropometría, examen físico, determinación de TA y estudios bioquímicos. Se realizó prueba de sobrecarga a la glucosa. Se midió glucemias e insulina plasmática basales y a lo 30-60-90-120 minutos postcarga de glucosa y perfil lipidico en la muestra de ayuno. Se determinó el IMC (peso/talla). Se definó obesidad (OB): como IMC > Pc95 para edad y sexo (CDC 2000), según el score z de IMC definimos: OB moderada: Score Z IMC > 2.0 y <2. y 2.5; OB grave: Score: Z IMC entre >_ a 2.5 y < 3.0; OB extrema: score Z IMC >_ 3.0. Resultados: 50% de la población presentó sindrome metabólico que se asoció significativamente a menor sensibilidad y mayor resistencia la insulina. y a mayor IMC. 65% presentó algún tipo de dislipidemia y el 64-% hiperinsulinemia. Obesidad sin ningún factor de riesgo estuvo presente en el 13%. La obesidad extrema que presento el 15% de los niños se asoció a obesidad parental.

Risk factors for coronary heart disease in Indians: a case-control study from Eastern India.

We conducted a hospital-based case-control investigation (150 cases and 176 controls) to examine the putative role of conventional risk factors in subjects with and without coronary heart disease from Eastern India. Multivariate binary logistic regression revealed the following as significant risk factors for coronary heart disease: male sex (OR = 4.6, p = 0.001), elevated total cholesterol/high-density lipoprotein ratio (OR = 4.0, p = 0.001), systolic blood pressure (OR = 3.0, p = 0.004), diastolic blood pressure (OR = 3.6, p = 0.002), fasting plasma glucose (OR = 3.0, p = 0.05), post-pondrial plasma glucose (OR = 3.2, p = 0.005), Impaired fasting glucose (OR = 3.7, p = 0.002), elevated triglyceride (OR = 3.1, p = 0.018), increased total cholesterol (OR = 3.0, p = 0.029), low-density lipoprotein (OR = 3.1, p = 0.001), low-density lipoprotein/high-density lipoprotein ratio (OR = 3.4, p = 0.004), central obesity (OR = 3.0, p = 0.006), smoking (OR = 3.7, p = 0.001) and urban residence (OR = 3.1, p = 0.003). In this study, the discriminant analysis showed that 77.2% of all entry for cases and 72.6% of all entry for controls were correctly classified using conventional risk factors and warrant early intervention for conventional risk factors.

Familial chylomicronemia syndrome.

Familial chylomicronemia syndrome is a group of rare genetic disorders characterized by deficient activity of an enzyme lipoprotein lipase or apo-protein C-II deficiency. Incidence is 1 out of 1,000,000. Alternative names to this syndrome are Type I hyper lipoproteinemia and familial lipoprotein lipase deficiency.

Frecuencia de dislipidemia en una población de adultos jóvenes / Frequency of dislipidemia in a population young-adult

Analizar la frecuencia de dislipidemias en una población hospitalaria y ambulatoria sin enfermedad predisponente. La muestra estuvo conformada por 200 pacientes, 100 hospitalizados y 100 ambulatorios en los Servicios de Medicina Interna del Hospital Universitario de Caracas de 15 a 45 años. Se determinaron los valores de lípidos en sangre de dichas poblaciones y se realizó una encuesta conformada por antecedentes, hábitos y examén físico que incluyó la evolución de los parámetros del síndrome metabólico. De 200 pacientes estudiados (121 mujeres y 79 hombres 30,19 años, la dislipidemia prevalente fue el HDL colesterol bajo (41 por ciento) predominantemente en los masculinos. El 21,5 por ciento de la muestra fue diagnósticada como síndrome metabólico. El 47,5 por ciento resultó con sobrepeso y al 14,5 por ciento con algún grado de obesidad. No se encontró relación entre los resultados obtenidos con los antecedentes familiares. Se encontró relación entre sedentarismo y hábito tabáquico con colesterol total elevado, LDL colesterol elevado y dislipidemia mixta. La pesquisa de dislipidemia en la población joven asintóm tica es de gran utilidad para realizar prevención. La frecuencia encontrada en este grupo fue elevada en comparación con la obtenida en otros trabajos. Se sugiere continuar el estudio de prevalencia en todo el país.

Dislipidemia en el anciano / Dyslipidemia in the Elderly

La edad es un factor de riesgo independiente e inmodificable para enfermedad coronaria. En México, alrededor del 50% de las muertes que ocurren después de los 65 años de edad son debidas a cardiopatía isquémica. La senectud produce importantes diferencias en la presentación, en el diagnóstico, en el pronóstico y en la respuesta a la terapia. La meta fundamental en el tratamiento de la enfermedad arterial coronaria es la prolongación de la vida y la mejoría en la calidad de la misma. En el grupo de ancianos, lo más importante será elevar su calidad de vida con el objetivo primordial de favorecer la autosuficiencia. La disminución en los niveles de lípidos séricos se asocia con una reducción en la incidencia de cardiopatía isquémica independiente de la edad. El tratamiento deberá inicialmente constar de una prescripción dietética individualizada y modificación del estilo de vida. Cuando esto es insuficiente para lograr los niveles deseados de lípidos, el tratamiento de elección es la administración de estatinas. Cuando los triglicéridos están elevados y el C-HDL es bajo, la indicación será para fibratos. El beneficio absoluto es mayor en los enfermos de edades más avanzadas, reduciendo el riesgo de eventos cardiovasculares que puedan afectar su independencia y su calidad de vida.

Age is an independent and unmodifiable risk factor for coronary atherosclerosis. In Mexico, coronary heart disease is responsible for 50 % of the deaths for those older than 65 years of age. Aging produces major differences in the presentation, diagnosis, prognosis, and response to therapy in coronary heart disease. The goal of treatment is the prolongation of survival and the improvement of the quality of life. However, in the elderly, the aim of therapy should focus on attaining a meaningful quality of life thus allowing them to be functionally independent. Clinical trials demonstrate conclusively that lowering serum cholesterol levels will reduce the incidence of coronary heart disease irrespective of age. Dietary advise and lifestyle modifications are the first-line approach in the elderly. When these measures are insufficient to achieve target lipid reductions, statins are the drug of choice. Fibrates may be indicated if triglycerides are high and C-HDL is low. Given the grater coronary risk of older population, the absolute benefit will be greater in the elderly.

Tratamiento actual de las dislipemias / Current therapies of dislipemias

El abordaje del paciente dislipémico se debe realizar en el contexto del riesgo CV global. La estratificación de riesgo permite clasificar cada nivel de riesgo. Este es el que determina los objetivos y la estrategia del tratamiento. Se cuentan con dos grandes armas terapéuticas: 1) higiénico-dietéticas. Comprenden la modificación de hábitos de vida centrado en el ejercicio, la alimentación y el abandono del tabaquismo. 2) los fármacos (estatinas, fibratos, ac. nicotínico, inhibidores selectivos de la absorción de colesterol, resinas). Hasta el momento, las estatinas han revolucionado el tratamiento de las dislipemias. La evidencia señala el beneficio de la utilización de las mismas particularmente pacientes de muy alto riesgo CV con independencia de los valores lipídicos. No se ha establecido aún un umbral por debajo del cual la utilización de estos fármacos no es beneficiosa, proponiéndose en pacientes de muy alto riesgo vascular descenso de los objetivos terapéuticos. Una vez instaurados los fármacos, se deben monitorear los efectos adversos, especialmente en situaciones de mayor riesgo. A nivel internacional,se propone la asociación de drogas hipolipemiantes, en situaciones de riesgo, con el objetivo de mayores modificaciones de las fracciones lipídicas con menores efectos secundarios.

Association of major modifiable risk factors among patients with coronary artery disease--a retrospective analysis.

BACKGROUND: The relative importance of various risk factors varies in different regions of India. This was a retrospective study of patients with recently diagnosed coronary artery disease to assess four major risk factors: dyslipidemia, hypertension, smoking and diabetes. MATERIAL AND METHODS: A total of 5748 patients (4952 males, 796 females) with recently diagnosed coronary artery disease were analysed from the records of Heart Hospital along with 8103 controls (6092 males and 2011 females). Absolute lipid levels as well as prevalence of dyslipidemia using the ATP III guidelines were assessed. They were classified into two major groups premature CAD (males < 45 years females < 55 years) and CAD at usual age (males > or = 45 years, females > or = 55 years). RESULTS: The most common pattern of CAD was chronic stable angina (n=2773, 48.24%). Mean total cholesterol (TC), LDL cholesterol and TC/HDL ratio were significantly higher in subjects with CAD compared to subjects without CAD controls. The mean HDL cholesterol and triglyceride levels were similar in both groups. Elevated LDL cholesterol, decreased HDL cholesterol, elevated total cholesterol and abnormal TC/HDL ratios were more common in CAD patients as compared to controls (38.8% vs. 33.14%, 29.3% vs 18.2%, 36.9% vs 32.5% and 59.05% vs 44.3% respectively). However lipid abnormalities were not significantly different in females > or = 55 in CAD vs non-CAD group. Smoking was significantly more common in subjects with CAD groups (30.97% vs. 12.72%) as compared to subjects without CAD (P < 0.0001). It was most common in males with premature CAD (44.1 % P < 0.0001). Hypertension was found in 1036 patients (18.02%) and diabetes in 763 (13.28%) as compared to 1126 (13.9%) hypertensives in non-CAD group and 639 diabetics (7.89%) (P = 0.001), both were more common in males > or = 45 and females > or = 55 as compared to those with premature CAD (p < 0.01). CONCLUSION: Among the risk factors assessed, dyslipidemia (particularly abnormal TC/HDL ratio and elevated LDL cholesterol), smoking hypertension and diabetes were associated with coronary artery disease in decreasing order of prevalence. In premature CAD, dyslipidemia and (in males) smoking are of particular importance.

Dyslipidemia in Asian Indians: determinants and significance.

Data suggest that lipid fractions other than total cholesterol, i.e. serum triglycerides (TG) and high-density lipoprotein (HDL) cholesterol are important for the pathogenesis of atherosclerosis. A combination of hypertriglyceridemia, low levels of HDL-cholesterol and high levels of small dense low-density lipoprotein, termed as "atherogenic dyslipidemia', is particularly seen in Asian Indians. Although precise reason for such dyslipidemia is unknown, genetic predisposition and characteristic body composition (excess truncal subcutaneous fat and intraabdominal fat) may be important contributors. A common interface between such body composition and dyslipidemia in Asian Indians is high tendency to develop insulin resistance, more than the other ethnic groups. The general guidelines for the management of dyslipidemia in Asian Indians should be according to National Cholesterol Education Program, Adult Treatment Panel III. However, optimal management requires consideration of ethnic-specific dietary, lifestyle and management factors to formulate individual treatment guidelines.

Waist-to-height ratio is a better obesity index than body mass index and waist-to-hip ratio for predicting diabetes, hypertension and lipidemia.

Body mass index (BMI, kg/m.sq) and waist-to-hip ratio (WHR) are widely used as obesity indices for diabetes and cardiovascular risks. Lower adult height was related to diabetes and stroke. Waist-girth was proved important for visceral obesity. Incorporating waist-girth and height as waist-to-height ratio (WHtR), we reported earlier--"Waist-to-height ratio is an important predictor of hypertension and diabetes". We readdressed this index in a larger sample with two-sample OGTT and lipid profiles. In a cluster sampling of 16,818 rural inhabitants, considering age > or = 20 y, 5713 subjects were found eligible. Of them, 4923 (M/F=2321/2602) volunteered for height, weight, blood pressure, waist-girth and hip-girth. Fasting venous blood (5 ml) was drawn for plasma glucose, total cholesterol (T-chol), Triglycerides (TG) and high-density lipoprotien (HDL-c). Overall, 1565 participants were undertaken for OGTT. The mean (SD) values of BMI, WHR and WHtR for subjects with diabetes and hypertension were significantly higher in either sex. The level significance was highest for WHtR. The prevalence of diabetes and hypertension increased significantly with higher quintiles of BMI, WHR and WHtR (chi sq values were largest in WHtR for both events). Partial correlation coefficients, controlling for age and sex, showed that BMI, WHR and WHtR significantly correlated with systolic and diastolic BP, FBG, T-chol and TG. In the entire correlation matrix, the 'r' values were the highest for WHtR. Taking diabetes and hypertension as dependent variables, logistic regression also showed the highest odds ratio in higher WHtR than BMI and WHR. We conclude that WHtR was proved again a valuable obesity index for predicting diabetes, hypertension and lipidemia.

Investigação dos níveis lípidicos em crianças e adolescentes / Assessment of blood lipids in childrin and adolescents

A investigação laboratorial dos níveis lípidicos tem sido recomendada para crianças e adolescentes com história familial positiva de hiperlipidemia e/ou doença coronariana de ocorrência prematura e para crianças e adolescentes com obesidade, pancreatite ou xantomatose. Na interpretação dos resultados das dosagens lipídicas, devem ser levadas em conta as variações fisiológicas relacionadas com idade, sexo e gravidez e variações secundárias a situações como uso de alguns medicamentos, estados infecciosos, diabetes mellitus, hipotireoidismo, algumas doenças renais e hepáticas. Neste artigo são descritos aspectos relacionados ao diagnóstico e tratamento de pacientes com dislipidemia. Para a prevenção da aterosclerose e da doença coronariana do adulto, a prevenção realizada a partir da infância é uma das medidas de maior importância.

It is widely recommended that children and adolescents with familiar history of hyperlipidemia and/or premature coronary heart disease be submitted to a laboratory investigation. This also holds for patients with obesity, pancreatitis and xantomatosis. However, in the analysis of blood lipid levels it is necessary, to take into account the physiological variations which are related to age, sex, pregnancy and variations secondary to drug therapy, infectious states, diabetes mellitus, hypothyroidism and some renal and liver diseases. Some aspects relatecl to diagnosis and management of dislipidemia are pointed out. Nevertheless, the prevention of atherosclerosis and adult coronary disease in childhood is one of the best strategies.

Corneal arcus associated with dyslipidemia.

A cross sectional study based on 243 subjects with an age range of 20-63 years, was conducted to assess the prevalence of corneal arcus and the association between corneal arcus and dyslipidemia which is a coronary heart disease risk factor. The presence of corneal arcus was determined by hand-held slitlamp, serum lipids and serum plasma glucose collected on the same day as corneal arcus detection. Total cholesterol (CHOL), triglyceride (TG) and high density lipoprotein (HDL) were measured by enzymatic procedure, and low density lipoprotein (LDL) was estimated by the Friedewald formula. The prevalence of corneal arcus was divided into 3 age groups, 20-29 years (0%), 30-49 years (male 41.5%, female 26.13%) and 50-69 years (male 86.2%, female 59.1%) In the 30-49 year, female group, those with corneal arcus had higher serum LDL and total cholesterol concentration than those without corneal arcus. The mean difference of LDL was 22.21 mg/dl (p=0.001) and total cholesterol was 30.95 mg/dl (p=0.000). In the 30-49 year, male group people with corneal arcus had a lower serum HDL concentration than those without corneal arcus and the mean difference of the HDL was 8.6 mg/dl (p=0.014). There was no difference for corneal arcus and serum lipid in the 50-69 years group in both sexes. No association between corneal arcus and fasting plasma glucose was found in all ages and both sexes. It is concluded that while corneal arcus is primarily an aged-related change, if present in people under 50 years it should be considered for dyslipidemia which is one of the risk factors for coronary heart disease.

Obesity. Effective and safe management.

Rapidly rising prevalence of weight in Indians in cities and upper strata of society in villages and towns is a problem of health in India. It also adds substantially to future morbidity and mortality and will increase the health costs. It is a public health problem. In other countries it is a national problem. It increase cost of treatment of the nation. It is individual matter in India. Hence the treatment of chronic diseases like hypertension diabetes, hyperlipidemia is not being effectively carried out in India due to burden of cost of treatment on individual. Lack of education and funds prevent continuous treatment. It is problem of education of public and a support from authorities. Those who are aware should not neglect their own health. Prevention of obesity should be the goal in life.

Diagnóstico y tratamiento de la dislipidemia diabética: un enfoque actualizado

Los trastornos lipídicos son responsables, en parte, d ela prevalencia incrementada de enfermedad arterial coronaria (EAC) asociada con diabetes mellitus (DM). El déficit de insulina o la resistencia a la misma son causa primaria. Concentraciones elevadas de triglicéridos y bajas de cHDL asociadas, a menudo, con cLDL densas y pequeñas se encuentran más comunmente en la población con diabetes que en aquella sin diabetes. Además, ciertas anomalías composicionales incrementan la aterogenicidad de las lipoproteínas. Estas anomalías composicionales incrementan la aterogenicidad de las lipoproteínas. Estas anomalías pueden ser ampliamente revertidas por la administración de altas dosis de insulina en el tipo 1 de DM...