Consumo de huevo y diabetes mellitus tipo 2: Una revisión de la literatura científica / Egg intake and diabetes mellitus type 2: A review of the scientific literature

RESUMEN El huevo es un alimento altamente nutritivo con potenciales beneficios para la salud. Sin embargo, debido a su elevado contenido de colesterol, su consumo ha sido restringido en la población general. El objetivo de esta revisión es difundir en la comunidad científica la evidencia más reciente sobre los efectos del consumo de huevo específicamente en sujetos con diabetes mellitus. Estudios observacionales muestran que el consumo de hasta un huevo al día no se asocia a una mayor prevalencia de enfermedad cardiovascular en la población general, pero podría aumentar el riesgo entre los diabéticos. Asimismo, algunos de estos estudios han mostrado que un elevado consumo de huevo se asocia a un aumento en la incidencia de diabetes en la población general. Por otro lado, estudios de intervención a corto plazo en este subgrupo muestra que el consumo de huevo no afecta negativamente los factores de riesgo cardiovascular ni control glicémico en estos pacientes. Además, su consumo podría aumentar el impacto del uso de dietas hipocalóricas en la disminución de peso corporal, una importante herramienta en el manejo médico de la diabetes.

ABSTRACT Eggs are a highly nutritious food with potential health benefits. However, because of its high cholesterol content, physicians have recommended consumption restrictions in the general population. The aim of this review is to update the scientific community on the latest research about the impact of egg consumption in subjects with diabetes mellitus. Although several observational studies show that an intake of one egg a day does not increase cardiovascular risk in the general population, however risk may increase among diabetics. Additionally, some prospective cohorts have associated associated higher egg intake with an increased diabetes incidence in the general population. On the other hand, short-term intervention studies have not shown any adverse outcome in terms of cardiovascular risk or glycemic control with egg intake. Moreover, there are studies that suggest a beneficial effect of egg consumption in weight reduction, an important therapeutic tool in diabetes management.

Asociación entre diabetes mellitus y patología cardiovascular en la población adulta de Chile: estudio de la Encuesta Nacional de Salud 2009-2010 / Association between diabetes mellitus and cardiovascular disease in Chilean adults: Analysis of the national health survey 2009-2010

Background: Diabetes mellitus (DM) is a recognized atherosclerotic cardiovascular disease (ACVD) risk factor. This association has yet to be quantified in the Chilean population. Aim: To compare the frequency of ACVD between diabetic and non-diabetic Chilean subjects. Material and Methods: Data was extracted from the Chile National Health Survey (ENS) performed in 2009-2010. DM diagnosis was made with fasting glucose. ACVD (coronary, cerebral and peripheral vascular disease) was established by self-report. Major cardiovascular risk factors were identified by clinical and laboratory assessment. Results: A total of 5,416 adults (2,200 men and 3,216 women) were surveyed in ENS 2009-2010. Of these, 508 were diabetic and 375 reported ACVD. ACVD frequency was 16.1% and 6.1% in diabetic and non-diabetic subjects, respectively. In diabetic men, the frequency of ACVD steadily increased with age, from 5.1% to 22.1%. In diabetic women, the highest frequency of ACVD (17.4%) was found in ages ranging from 45 to 54 years. In people younger than 54 years, the odds ratio for ACVD in diabetic compared to non-diabetic subjects, was 3.59 in men (χ2 = 4.03 p < 0.03) and 5.26 in women (χ2 = 7.7 p < 0.007). Cardiovascular risk factors and metabolic syndrome were significantly more common in diabetic subjects with reported ACVD. Conclusions: DM is associated with an increased frequency of ACVD and cardiovascular risk factors in Chilean adults. In line with international reports, our findings suggest that DM is also a cardiovascular risk factor in Chile, particularly relevant for women.

Rememorando la contribución de Goldstein y Brown al estudio del metabolismo del colesterol: a un cuarto de siglo del Premio Nobel de Medicina / The contribution of Goldstein and Brown to the study of cholesterol metabolism

Background: In December 1985, the Nobel Prize of Medicine was awarded to Drs. Joseph L. Goldstein and Michael S. Brown for their fundamental scientific work on the regulation of cholesterol metabolism mediated by the low density lipoprotein receptor pathway. This article briefly reviews the academic and research accomplishments of Drs. Brown and Goldstein as a tribute to these physician-scientists for their well-deserved award and enormous contribution to biomedical science worldwide.

Inhibición de la proteína de transferencia de ésteres de colesterol para el manejo de la enfermedad cardiovascular ateroesclerótica: el segundo acto "Una esperanza que renace" / Cholesteryl ester transfer protein inhibition in the management of atherosclerotic cardiovascular disease: second act "A rebirth of hope"

Despite the clinical use of statins to reduce serum levels of LDL cholesterol and treat atherosclerotic cardiovascular disease, a high proportion of patients remain at significant residual cardiovascular risk. In this context, low HDL cholesterol levels are an additional risk factor and intervention studies suggest that a fraction of the cardiovascular protection achieved with pharmacotherapy is explained specifically by the increase in serum levels of HDL cholesterol. Pharmacological inhibitors of the cholesteryl ester transfer protein (CETP) can induce a significant elevation in HDL cholesterol and, potentially, lead to better control of residual cardiovascular risk beyond the benefit demonstrated by statins. While the use of torcetrapib had unexpected side effects, dalcetrapib and anacetrapib are new CETP inhibitors with a better safety profile and are currently under study to evaluate their effects on vascular lesions and clinical events in patients at high cardiovascular risk. If these studies show positive findings, we will witness a new biomedical advance as significant as was the clinical.

Actividad física y su asociación con factores de riesgo cardiovascular: Un estudio en adultos jóvenes / Physical activity and cardiovascular risk factors among Chilean young men and women

Background: Physical activity (PA) has a protective role in cardiovascular diseases. Aim: To quantify PA in young adults and to correlate it with cardiovascular risk factors. Material and Methods: A cross-sectional study was performed employing the international physical activity questionnaire (IPAQ), to measure the PA of 983 randomly selected young adults from Valparaiso region born between 1974 and 1978. Its results were associated with levels of obesity, insulin resistance and cardiovascular risk factors defined by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP- ATP III) Results: Mean physical activity among men and women was 3731 ± 3923 and 1360 ± 2303 METs-minutes/week, respectively (p < 0.001). Fifty percent of women and 21.5 percent of men had an insuffcient level of physical activity (p < 0.001). Sixty percent of men and 23.4 percent of women had an intense level of physical activity (p < 0.001). There was an inverse association of physical activity and insulin resistance. A high physical activity was protective, specially among men, against a low HDL cholesterol level and high triglyceride levels with Odds Ratios of 0.59 (confdence interval (CI): 0,35-0.98) and 0.49 (CI: 0,27-0,87) respectively, after adjusting for body mass index and age. Conclusions: In this sample, men had higher levels of physical activity, that was protective against insulin resistance and the presence of cardiovascular risk factors.

El síndrome metabólico: De factor agravante a principal factor de riesgo patogénico en diversas enfermedades crónicas / The metabolic syndrome: From an aggravating condition to a pathogenic risk factor for chronic diseases

In recent years, a rapidly increasing number of studies have focused on the association between metabolic syndrome and several chronic diseases. However, it is difficult to determine a well defined pathogenic relationship, due to the etiological heterogeneity and comorbidities of these diseases. Research efforts are aiming to identify the convergent biological mechanisms that mediate the effects of hyperinsulinemia, hyperglycemia, dyslipidemia, and hypertension. All these conditions define the metabolic syndrome, that increases the risk for several diseases. The knowledge of these biological mechanisms associated with this syndrome will elucidate the pathogenic association between a variety of chronic diseases, including its pathogenic link with cardiovascular diseases and the most common forms of dementia. The development of new therapeutic and preventive strategies for these diseases will be a corollary of this research.

Prevalencia de síndrome metabólico en población adulta Chilena: Datos de la Encuesta Nacional de Salud 2003 / Prevalence of Metabolic Syndrome among Chilean adults

Background: There are several diagnostic criteria for Metabolic Syndrome (MS) defnition. Aim: To study their application in the Chilean general adult population. Material and Methods: We analyzed data from a random sub sample of 1.833 adults aged 17 years and older surveyed during the First Chilean National Health Survey conducted in 2003. The prevalence of MS was estimated using the update Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF 2005) criteria. The distribution of MS was analyzed according to age, gender, educational level, geographic area, obesity and sedentary lifestyle. Results: The overall prevalence of MS was 31.6 percent (95 percent CI 28.5-34.9) and 36.8 percent (95 percent CI 33.5-40.3), according to update ATPIII-NCEP and IDF criteria respectively. Both criteria had a 90 percent concordance. Demographic and socioeconomic distribution was similar for both criteria. The prevalence of high blood pressure, high fasting glucose, and low HDL cholesterol (MS components) were: 46, 22 and 53 percent respectively. The prevalence of abnormal waist circumference was 30 and 59 percent according to update ATPIII-NCEP and IDF criteria, respectively. Using update ATPIII-NCEP criteria, the gender, age and educational level adjusted odds ratio (OR) for having MS was 9.59 (95 percent IC 6.8- 13.6) for obese subjects compared with normal weight subjects and 2.14 (95 percent IC 1.3-3.7) for sedentary subjects compared with non sedentary. Conclusions: There was a 90 percent agreement between update ATPIII-NCEP and IDF criteria for the diagnosis of MS. The overall prevalence of MS in this population was 32 percent usuing update ATPIII-NCEP criteria, with higher prevalence among obese and sedentary subjects.

Características clínicas y metabólicas de los estados de intolerancia a la glucosa y glicemia de ayuno alteradas / Clinical and metabolic features of subjects with glucose intolerance and high fasting glucose levels

Background: Subjects with glucose intolerance or high fasting glucose levels have a higher cardiovascular risk and frequently become diabetic. Aim: Toassess clinical and metabolic characteristics of patients with glucose intolerance or high fasting glucose levels. Material and methods: Fasting and post glucose load serum glucoseand insulin levels were measured in 1404 people, aged 42,0 ± 14,2 years (81% women) with high diabetic risk. We categorized subjects in different alterations of blood glucose, accordingto 2006 American Diabetes Association categories. Insulin resistance (RI), insulin secretion (ß %) and insulin disposition (ID), were calculated using fasting blood glucose and insulin levels, using the homeostasis model assessment (HOMA I and II). Results: Sixty percent of studied subjects had first grade relatives with diabetes mellitus and 1097 (78%) were categorized as normal (N), 45 (3%) as Diabetes Mellitus (DM), 161 (11%) as high fasting glucose levels (GAA) and 103 (7%) as glucose intolerant (ITG). Fifty three of the 106 subjects with GAA (50%), were also glucose intolerant. Subjects with GAA had similar insulinsensitivity and lower ß cell function than N (insulin disposition 58 ± 12 and 111 ± 32%, respectively, p <0.01). ITG had less insulin sensitivity than N (HOMA-IR 2.6 ± 1.50 ± and 2.0 ± 1.30, respectively) and only a mild decrease in ß cell function (insulin disposition 96 ± 26 and 111 ± 32% respectively, p < 0.01). Patients GAA plus ITG had similar alterations than those with DM (HOMA-IR 3.8 ± 2.2 and 4.4 ± 3.7 respectively; insulin disposition 57 ± 10 and 56.0 ± 26% respectively. Conclusions: Patients with higher fasting glucose levels behavedifferently from those with glucose intolerance. High fasting glucose levels are highly prevalent in subjects with high risk of DM and must be considered as risk indicator in preventive programs for diabetes mellitus.

Association between proinsulin, insulin, proinsulin/insulin ratio, and insulin resistance status with the metabolic syndrome

The Metabolic Syndrome (MS) constitutes an independent risk factor of cardiovascular disease. There is evidence that proinsulin blood levels and the proinsulin/insulin ratio are associated to the MS. The purpose of this study was to compare proinsulin and insulin, insulin resistance index, and the proinsulin/insulin ratio as predictors of MS. This is a cross-sectional study involving 440 men and 556 women with a mean age of 24 years. Diagnosis of MS was made according to the National Cholesterol Education Program Adult Treatment Panel III. Blood levels of insulin and proinsulin were measured, and the insulin resistance status was estimated using the homeostatic model assessment (HOMA-IR). The prevalence of MS was 10.1 percent. HOMA-IR was the best MS risk factor for both women and men (OR = 2.04; 95 percent CI: 1.68-2.48 and 1.09; 95 percent CI: 1.05-1.13, respectively). HOMA-IR presented the best positive predictive value for MS: 22 percent and 36 percent for men and women, respectively, and was the best MS indicator. The proinsulin/insulin ratio did not show significant association with MS. HOMA-IR, proinsulin, and insulin presented good negative predictive values for both genders that could be used to identify an at-risk population.

A síndrome metabólica (SM) constitui um fator de risco independente para doenças cardiovasculares. Existem evidências de que níveis sangüíneos de proinsulina e o índice proinsulina/insulina estão associados com a presença da SM. O objetivo deste trabalho foi comparar proinsulina e insulina, índice de resistência insulínica e o fator proinsulina/insulina para predizer a presença da SM. Este é um estudo transversal envolvendo 440 homens e 556 mulheres com média de 24 anos de idade. O diagnóstico da SM foi feito de acordo com o Painel III do programa de tratamento nacional educacional de colesterol para adultos. Níveis sangüíneos de insulina e proinsulina foram medidos, o índice de resistência insulínica foi estimado através do modelo de avaliação hemostático (HOMA-IR). A prevalência da SM foi de 10 por cento. HOMA-IR demonstrou ser o melhor fator de risco da SM em homens e mulheres (OR = 2,04; 95 por cento CI: 1,68-2,48 e 1,09; 95 por cento CI: 1,05-1,13, respectivamente). HOMA-IR apresentou o melhor valor preditivo positivo para SM: 22 por cento e 36 por cento para homens e mulheres, respectivamente, e foi o melhor indicador da SM. O índice proinsulina/insulina não apresentou associação significativa com SM. HOMA-IR, proinsulina e insulina apresentaram bons valores preditivos negativos para ambos sexos, o que poderia ser usado para identificar uma população de risco.

Lípidos séricos como factor de riesgo coronario: influencia de la dieta en 358 hombres sanos / Serum lipids and coronary risk: diet influence in 358 healthy men

La dieta puede ser un condicionante de riesgo de cardiopatía coronaria si modifica en forma desfavorable los niveles séricos de colesterol total (CT), colesterol de HDL (CH) y la relación entre ellos (CT/CH). En 358 hombres sanos, se estimó la ingesta mediante encuesta alimentaria por registro de 3 días. Se realizaron correlaciones univariadas y multivariadas para establecer la influencia de la dieta, edad e índice de masa corporal (IMC) sobre el CT, CH y CT/CH. Los sujetos consumieron un promedio de 2.388 Kcals/día distribuídas en un 30% como lípidos, un 49,6% como carbohidratos (H de C), un 14,1% como proteínas y 6,3% como alcohol. La ingesta de colesterol promedio ñ DS fue de 287 ñ 143 mg/día y la relación ácidos grasos poliinstaurados/saturados (IP/S), de 0,88. Los H de C fueron los únicos nutrientes que influyeron significativamente sobre los lípidos séricos, demostrándose una asociación inversa entre el consumo de carbohidratos y los niveles de CT y de CH, pero sin inducir cambios en la relación CT/CH. El índice de masa corporal en cambio se asoció positivamente con la razón CT/CH, modificando un 7% de la varianza de este indicador. Se concluye que en esta población la composición de la dieta no constituye un factor de mayor riesgo coronario. La obesidad, evaluada por IMC, incrementa la relación CT/CH elevando así el riesgo de enfermedad coronaria

Formulación, elaboración y evaluación de galletas de masa corta, laminadas y cortadas, para diabéticos / Formulation, preparation and evaluation of shortening, laminated and cut biscuits, for diabetic patients

Se proporciona una nueva alternativa de consumo constituida por galletas laminadas y cortadas. stas son elaboradas con edulcorantes sustitutos de la sacarosa que se metabolizan en forma diferenciada y/o más lenta que ésta. En base a datos de la literatura, a la oferta del mercado y debido a las limitaciones tecnológicas y económicas que presenta el uso de edulcorantes puros, se utilizaron cuatro mezclas de edulcorantes alternativos en reemplazo de la sacarosa, como sigue... Con estas mezclas se prepararon galletas, optimizàndose las variables de las diferentes etapas del proceso: temperatura, tiempo y velocidad de mezcla, laminado, temperatura y tiempo de horneo

Nutrición parenteral central en diabéticos / Total parenteral nutrition in diabetic patients

Se analiza la evolución metabólica, durante la Nutrición Parenteral Total Central (NPTC), de 10 pacientes diabéticos insulino no dependientes. Un primer grupo, constituido por 4 pacientes recibió un aporte calórico predominante como hidratos de carbono (HdeC) (75%% del aporte calórico diario total); mientras que en el segundo grupo, de 6 pacientes, la fuente energética fue mixta, a base de HdeC y de emulsiones de lípidos diarias (50% y 25% del aporte calórico total respectivamente). El grupo que recibió emulsiones de lípidos diariamente, requirió menos dosis de insulina cristalina para mantener las cifras de glicemia estables, presentó menor número de episodios de hiperglicemias e hipoglicemias (p < 0,005) mientras se mantuvo en NPTC. Ninguno de los 2 grupos registró ocurrencia de cetoacidosis o coma hiperosmolar no cetócico durante la NPTC

Obesidad y riesgo obstétrico en una población chilena / Obesity and obstetric risk in chilean women

Se comparó las características evolutivas del embarazo, parto y recién nacido entre un grupo de 163 embarazadas obesas (índice peso para la talla mayor de 120%) y 163 controles (índice peso para la talla entre 94 y 106%) pareadas por edad y paridad. Las embarazadas obesas presentaron una significativa mayor frecuencia de hipertensión arterial (p<0,005), de preeclamsia (p<0,05), de cesáreas (p<0,027) y de infección puerperal (p<0,01) que el grupo control. No se encontró diferencia en la incidencia de diabetes gestacional y hemorragias postparto. El peso de nacimiento fue significativamente superior en los hijos de madres obesas (p<0,004), al igual que la incidencia de niños grandes para la edad gestacional (p<0,037). No se observaron diferencias en la morbilidad neonatal ni en las características de la lactancia al mes de edad entre ambos grupos. Se concluye que la obesidad durante el embarazo, aún de intensidad moderada, constituye un importante riesgo obstétrico