Interrelación de índices de resistencia y sensibilidad a la insulina con variables antropométricas y metabólicas de mujeres del tercer trimestre de embarazo y recién nacido a término / Relationship between insulin resistance and sensibility indexes with anthropometrics and metabolic parameters in third trimester of pregnant women and normal term newborns

Objetivo: Evaluar la interrelación de índices de resistencia y sensibilidad a la insulina con variables antropométricas y metabólicas de mujeres del tercer trimestre de embarazo y RN a término. Métodos: Este estudio transversal evaluó 52 mujeres sanas en el tercer trimestre del embarazo y 52 reciénnacidos (RN) a término. Se evaluaron peso corporal pregestacional y ganancia durante el embarazo (Δpeso). Se estimó el peso fetal (PFE), circunferencia abdominal fetal (CAF) y grosor placentario por ultrasonido. Se registró peso, talla y circunferencia abdominal (CA) del RN y peso placentario. Se realizó lipidograma, glucosa e insulina en ayunas en el suero de la madre y cordón umbilical. Se calcularon los índices lipídicos y de resistencia y sensibilidad a la insulina. Resultados: El Δpeso materno se correlacionó positivamente con PFE y peso del RN (r=0,32, p<0,02; r=0,32, p<0,05). El HOMA-R del RN se relacionó positivamente con CT (r=0,46; p<0,01) y TG (r=0,52; p<0,0001). El índice TG/C-HDL del RN se correlacionó positivamente con índices HOMA-R y TG/C-HDLmat (r=0,31, p=0,03; r=0,35, p=0,01). El peso pregestacional, materno final, placentario y TG maternos fueron significativamente más altos en los RN de mayor peso. Los índices TG/C-HDLmat y HOMA-Rmat se relacionaron inversamente con los índices QUICKImat y HOMA-Smat (p<0,01). Conclusiones: La cuantificación de los índices TG/C-HDL, HOMA-R, HOMA-S y QUICKI en el tercer trimestre del embarazo, puede tener utilidad potencial para identificar mujeres con riesgo alto para desarrollar complicaciones metabólicas en el embarazo.

Objective: To evaluate the relationship between insulin resistance and sensibility indexes with anthropometrics and metabolic parameters in third trimester of pregnant women and normal term newborns. Methods: In this cross-sectional study, 52 normal pregnant women in third trimester and 52 term born were assessed. Pre-gestational body weight, blood pressure and pregnancy weight gain (Δ-weight) were registered. Estimated fetal weight (EFW) and abdominal circumference (AFC) and placental gross were evaluated by ultrasound. Placental and newborn body weight, height and abdominal circumference were registered. Serum lipids, glucose and insulin concentrations were measured in fasting women and cord blood. Placental weight was registered. Lipids and insulin resistance and sensibility indexes were calculated. Results: Δ-weight was significant and positively correlated with EFW and newborn body weight (r=0,32, p<0,02; r=0,32; p<0,05). Newborn HOMA-R was positively correlated with total cholesterol (TC) (r=0,46; p<0,01) and triglycerides serum concentration (r=0,52; p<0,0001). TG/C-HDL index was positively correlated with HOMA-R and maternal TG/C-HDL(r=0,31, p=0,03; r=0,35, p=0,01). Pre-gestational weight, term weight, placental and serum maternal triglycerides were significantly higher in newborns with higher body weight group. Maternal TG/C-HDL and HOMA-R were negatively related with maternal QUICKI and HOMA-S (p<0,01). Conclusions: The quantification of TG/C-HDL, HOMA-R, HOMA-S QUICKI indexes in pregnant women during third trimester could be potentially useful to identify pregnant women at high risk of developing metabolic complications during pregnancy.

Síndrome metabólico en escolares y adolescentes de la ciudad de Mérida-Venezuela: comparación de resultados utilizando valores de referencia locales e internacionales (estudio CREDEFAR) / Metabolic syndrome in children and adolescents from Mérida city, Venezuela: Comparison of results using local and international reference values (CREDEFAR study)

OBJETIVO: Obtener valores de referencia local de lípidos sanguíneos y presión arterial (PA), y determinar la prevalencia de síndrome metabólico (SM) en escolares y adolescentes de la ciudad de Mérida, Venezuela, y comparar resultados usando puntos de corte propios e internacionales. MATERIALES Y MÉTODOS: Participaron 916 estudiantes de 9 a 18 años de edad, de ambos sexos, provenientes de instituciones educativas. Se obtuvieron datos demográficos, antropométricos y de PA. Se cuantificaron glucemia en ayunas y perfil lipídico. Los valores de los lípidos y la PA se distribuyeron por percentiles (pc), según grupos de edad y sexo. Para el diagnóstico de SM se consideraron 2 clasificaciones, la del NCEP-ATP III-modificada por Cook et al. y la de la Federación Internacional de Diabetes, usando los pc de Mérida y de EE. UU. como puntos de corte. La concordancia entre ambas clasificaciones se estimó con el índice kappa (Κ). RESULTADOS: La prevalencia de SM fue del 2,2% por Cook-pc Mérida, frente al 1,8% por Cook-pc EE. UU., concordancia moderada (Κ =0,54). La concordancia entre Cook et al. e IDF, usando pc Mérida, fue débil (Κ =0,28). Usando los pc Mérida hubo mayor frecuencia de obesidad abdominal, hipertrigliceridemia y PA elevada, y menos de cHDL bajo. El riesgo (odds ratio) de presentar SM es mayor si la obesidad abdominal está presente (OR: 98,63; IC: 22,45-433,35; p = 0,0001). El SM fue significativamente más frecuente en los obesos (18,3%; p = 0,0001). CONCLUSIONES: La prevalencia de SM en esta muestra de niños y adolescentes fue del 2,2%. Los valores de lípidos y de PA fueron más bajos que los norteamericanos, europeos y asiáticos, y similares a los latinoamericanos. Se justifica la obtención de valores propios de referencia para diagnóstico certero de SM, así como un consenso mundial sobre sus criterios diagnósticos

OBJECTIVE: To ascertain the prevalence of obesity and overweight recording in primary care (PC) clinical records. DESIGN: A descriptive, cross-sectional study. SETTING: The study was conducted in three urban, primary care centers in Gipuzkoa. PARTICIPANTS: 620 computerized clinical records randomly selected from a population of 63,820. Patient age older than 14 years was the only inclusion criterion. MAIN MEASUREMENTS: Recording of the clinical episode referring to obesity and/or overweight. Other variables included age, sex, body mass index (BMI), waist circumference, comorbidity (diabetes, hypertension, heart failure, among others), and variability of the record made by healthcare professionals at each center. Statistical analysis included a Chi-square test or a Fisher's test for low frequencies. A value of P<.05 was considered significant. Analysis was performed using SPSS® V.21 software. RESULTS: Prevalence of recorded obesity was 6%, and 78.4% of those with recorded obesity were women. Overweight was recorded in 3% of subjects, of which 33.2% were women. BMI was recorded in 170 cases (27%). At least one comorbidity was found in 241 subjects (39%). Association of BMI with presence of comorbidity was statistically significant (P=.0001). Recording of obesity was associated to presence of comorbidity (P =.0002). CONCLUSIONS: This study confirmed that prevalence of obesity is underestimated, mainly because it is inadequately recorded in clinical histories; that prevalence increases in the presence of other risk factors; and that there is a significant variability in data collection between healthcare professionals

Metabolic syndrome in children and adolescents from Mérida city, Venezuela: Comparison of results using local and international reference values (CREDEFAR study).

OBJECTIVE: To obtain local reference values for blood lipids and blood pressure (BP), and to determine the prevalence of metabolic syndrome (MS) in children and adolescents from Mérida, Venezuela, and to compare results using local and international cut-off values. MATERIALS AND METHODS: The study enrolled 916 participants of both sexes aged 9-18 years of age from educational institutions. Demographic, anthropometric, and BP data were collected. Fasting blood glucose and lipid profile were measured. Percentile distribution of lipid and BP values was done by age group and sex. Prevalence of MS was estimated based on the NCEP-ATPIII classification (as modified by Cook et al.) and the classification of the International Diabetes Federation, using percentiles of Mérida and the USA as cut-off points. Agreement between both classifications was estimated using the kappa test (κ). RESULTS: Prevalence of MS was 2.2% by Cook-Merida percentiles, as compared to 1.8% by Cook-USA percentiles, a moderate agreement (κ=0.54). Agreement between Cook et al. and IDF using Merida percentiles was weak (κ=0.28). There was a higher frequency of abdominal obesity, hypertriglyceridemia and hypertension, and a lower frequency of low HDL-C using Mérida percentiles. The risk (odds ratio) of having MS is greater if abdominal obesity exists (OR: 98.63, CI: 22.45-433.35, p=0.0001). MS was significantly more common in obese subjects (18.3%, p=0.0001). CONCLUSIONS: Prevalence of MS in this sample of children and adolescents was 2.2%. Lipid and BP values were lower in Venezuelan as compared to US, European, and Asian children and adolescents, and similar to those in Latin-American references. Own reference values are required for accurate diagnosis of MS, as well as a worldwide consensus on its diagnostic criteria.

Índice trigliceridos/cHDL en el embarazo: Interrelación con índices de resistencia a la insulina y antropometría fetal

Objetivo: Determinar la interrelación entre el índice triglicéridos/colesterol de la lipoproteína de alta densidad (TG/cHDL) y los índices HOMA homeostasis model assessment (HOMA IR) y QUICKI (Quantitative Insulin Sensitivity Index) y antropometría fetal, en mujeres embarazadas sanas. Métodos: Este estudio transversal evaluó 91 mujeres embarazadas sanas en edad de 18-41 años; de acuerdo a la edad gestacional se categorizaron en 3 grupos: primer trimestre (TI, n= 29); segundo trimestre (TII, n=32) y tercer trimestre (TIII, n =30). Se realizó una prueba de tolerancia a la glucosa oral (75g). Se cuantificaron glucosa, insulina, triglicéridos (TG), colesterol total (CT) y colesterol de alta densidad (cHDL). Se calculó el colesterol no-HDL y los índices TG/cHDL, HOMA IR y QUICKI. Se registró el peso del recién nacido y la altura uterina (AU); por ultrasonido se determinaron la circunferencia abdominal fetal (CAF) y el peso estimado fetal (PEF). Resultados: La concentración plasmática de TG, colesterol, cLDL, colesterol no-HDL, e índices TG/cHDL, HOMA IR y QUICKI fueron significativamente más altos en el segundo y tercer trimestre respecto al primer trimestre. En el total de la muestra, tanto el índice TG/cHDL como el colesterol no-HDL mostraron una correlación positiva con el IMC pre-gestacional (r = 0.30, p<0,01; r = 0,26. P<0,05 respectivamente), CAF (r=0,38, p<0,05; r = 0,50, p<0,01 respectivamente), PEF (r = 0,39, p<0,01; r = 0,50, p<0,01 respectivamente) y AU (r= 0,485, p<0,001). Conclusión: Se confirma la dislipidemia del embarazo y se demuestra que el aumento en el índice TG/cHDL y del colesterol no-HDL está relacionado con el peso pre gestacional y la antropometría fetal.

Objective: to determine the relationship between triglycerides/high density lipoprotein cholesterol (TG/HDLc) index and indexes HOMAIR (Homeostasis Model assessment) y QUICKI (Quantitative Insulin Sensitivity Check Index) and fetal anthropometrics in healthy pregnant women. Methods: This cross-sectional study evaluated 91 healthy pregnant women aged 16-41 yr, categorized by gestational age: first trimester (TI, n = 29); second trimester (TII, n = 32); third trimester (TIII, n = 30). Oral glucose tolerance test (75g) was performed. Plasma concentrations of glucose, insulin, triglyceride (TG), total cholesterol (TC) and HDLc were measured. Low density lipoprotein cholesterol (LDLc), no-HDLc, TG/HDLc index, HOMA IR and QUICKI were calculated. Fetal abdominal circumference (FAC) and estimated fetal body weight (EFBW) were evaluated by abdominal ultrasound; uterine height (UH), blood pressure and birth weight were registered. Results: Mean plasma TG, total cholesterol, LDLc, no-HDLc and TG/HDLc, HOMA IR and QUICKI indexes were significantly higher in TII and TIII compared to TI. In all women analysis, both TG/HDLc and no-HDLc showed a significant correlation with pregestational body mass index (BMI) (r = 0.30, p<0,01; r = 0,26, p<0,05 respectively), FAC (r= 0,38, p<0,05; r = 0,50,, p<0,01 respectively), EFBW (r = 0,39, p<0,01; r = 0,50, p<0,05 respectively) and UH (r= 0,485, p<0,001). Conclusions: our results confirm dislipidemia in pregnancy; the increased values of TG/HDLc and no-HDLc, are related with pre-gestational BMI and fetal anthropometrics.

Cardiac autonomic control mechanisms in the pathogenesis of chagas' heart disease.

Primary abnormalities of the autonomic nervous system had been postulated as the pathogenic mechanisms of myocardial damage, in patients with Chagas disease. However, recent investigations indicate that these abnormalities are secondary and amenable to treatment with beta-adrenergic blockers. Moreover, muscarinic cardiac autoantibodies appear to enhance parasympathetic activity on the sinus node. Therefore, the purpose of this paper is to analyze how knowledge on Chagas' disease evolved from being initially considered as a primary cardioneuromyopathy to the current status of a congestive cardiomyopathy of parasitic origin.

Efecto de la combinación fija de Vildagliptina/Metformina o Sitagliptina/Metformina sobre la lipemia postprandial en pacientes con diabetes tipo 2

Objetivo: evaluar el efecto de la combinación fija de vildagliptina o sitagliptina con metformina sobre la lipemia postprandial (PP) en pacientes con diabetes tipo 2 (DM2) previamente tratados solo con metformina. Métodos: cincuenta y siete pacientes con DM2 tratados con metformina y dieta, con valores de HbA1c entre 6,5-8,5% participaron en estudio aleatorizado, doble ciego de 8 semanas. Los participantes recibieron una carga oral de grasa antes y después de 8 semanas de la administración aleatorizada de combinación fija vildagliptina/metformina(grupo 1; n=29) o sitagliptina/metformina (grupo2; n = 28). Muestras de sangre se tomaron basalmente y a intervalos de 2 horas durante 8 horas después de la ingestión de la carga grasa. Resultados: la respuesta PP integrada de triglicéridos (AUC-TG) disminuyó en el 76% de los pacientes del grupo 1 y en el 64% del grupo 2. El perfil lipídico en ayunas no mostró cambios significativos post tratamiento. La glucosa en ayunas y 2h PP y la HbA1c disminuyeron significativamente en ambos grupos (p<0,01) acompañado de una disminución del IMC y la presión arterial (p<0,01). No se observaron efectos adversos. Conclusiones: además de mejorar el control glucémico, el tratamiento con combinación fija de vildagliptina/metformina o sitagliptina/metformina tiene un efecto beneficioso similar sobre la lipemia PP, lo cual es importante para mejorar el riesgo cardiometabólico de los pacientes con DM2.

Objective: to assess the effect of fixed combination of vildagiptin/metformin and sitagliptina/ metformin on postprandiallipemia (PP) in patients with type 2 diabetes mellitus (DM2). Methods: fifty-seven patients with DM2 previously treated with metformin and diet and HbA1c between 6,5-8,5% participated in a 8 weeks randomized, double blind study. An oral fat load was performed at baseline and 8 weeks after treatment with fixed combination of vildagliptin/metformin (grupo 1; n=29) or sitagliptin/metformin (group 2; n=28) twice a day. Blood samples were taken at baseline and at 2 hours interval during 8 hours after oral fat load. Results: integrated postprandial triglyceride response (AUC-TG) decreased in 76% of patients of group 1 and 64% of group 2. Fasting lipoprotein profile did not show significant changes post treatment. Both fasting and 2h postprandial glucose and HbA1c showed a significant decrease in both groups, in association with a decrease of body mass index and blood pressure (p<0,001). No adverse effects were observed. Conclusions: besides improving glucose control, fixed combination of vildagliptin/metformina or sitagliptina/metformin treatment has a beneficial effect postprandial lipemia which is important to improve the cardiometabolic risk of type 2 patients.

Hígado graso no alcohólico y su asociación con variables clínicas y bioquímicas en niños y adolescentes obesos: efecto de un año de intervención en el estilo de vida / Non-alcoholic fatty liver disease and its association with clinical and biochemical variables in obese children and adolescents: effect of a one-year intervention on lifestyle

Objetivo Estudiar la frecuencia de hígado graso no alcohólico (HGNA), su relación con variables clínicas y bioquímicas, y el efecto de la intervención durante 12 meses en el estilo de vida en niños y adolescentes obesos. Métodos Se seleccionaron 36 pacientes obesos entre 7 y 18 años, 42% femeninos y 58% masculinos, 72,2% prepuberales y 27,8% puberales. Antes y 12 meses después de intervención sobre dieta y actividad física, se tomaron medidas antropométricas y se cuantificaron glucosa e insulina (basal y poscarga de glucosa), perfil lipídico, proteína C reactiva y aminotransferasas. Se realizó ecografía hepática para determinar presencia de HGNA. Resultados El 66,7% (n=24) presentó HGNA, 30,6% de grado leve, 27,8% moderado y 8,3% grave. Aquellos con HGNA tenían índice de masa corporal (IMC; p=0,007), circunferencia abdominal (p=0,005), área grasa (p=0,002), insulina basal (p=0,01) y HOMA-IR (p=0,008) más altos, y QUICKI (p=0,02) más bajo, que aquellos sin HGNA. Con la intervención, la actividad física aumentó (p=0,0001) y la ingesta calórica se mantuvo igual; el HGNA desapareció en 9 pacientes (37,5%; p=0,02) y en 3 mejoró el grado de alteración (12,5%). Además, el Z-Score del IMC (p=0,005), el área grasa (p=0,0001), la insulina basal (p<0,05), la resistencia a la insulina (p<0,005), el perfil lipídico (p<0,03) y las transaminasas disminuyeron. La disminución de peso fue la principal variable explicativa de la mejoría del HGNA. Conclusión En este grupo de niños y adolescentes obesos se observó una alta frecuencia de HGNA. La intervención en estilo de vida con reducción de peso es efectiva en el tratamiento del HGNA (AU)

Objective To study the frequency of non-alcoholic fatty liver disease (NAFLD), its relationship to clinical and biochemical variables, and the effect 12-month's lifestyle intervention in obese children and adolescents. Methods Thirty-six obese patients aged 7 to 18 years, 42% female and 58% male, 72.2% prepubertal and 27.8% pubertal, were selected. Anthropometric measurements and glucose, insulin (baseline and after a glucose load), lipid profile, C-reactive protein, and aminotransferase tests were performed before and 12 months after dietary and physical activity intervention. Liver ultrasound was performed to determine the presence of NAFLD. Results NAFLD was found in 66.7% (n=24), and was mild in 30.6%, moderate in 27.8%, and severe in 8.3%. Subjects with NAFLD had higher body mass index (BMI, p=0.007), waist (p=0.005), fat area (p=0.002), basal insulin (p=0.01), and HOMA-IR (p=0.008) values and lower QUICKI (p=0.02) values than those with no NAFLD. After intervention, physical activity increased (p=0.0001) and calorie intake remained unchanged. NAFLD disappeared in 9 patients (37.5%, p=0.02) and disease severity decreased in 3 patients (12.5%). In addition, BMI Z-score (p=0.005), fat area (p=0.0001), basal insulin (p<0.05), insulin resistance (p<0.005), lipid profile (p<0.03), and transaminases decreased. Weight loss was the main variable accounting for NAFLD improvement. Conclusion This group of obese children and adolescents showed a high frequency of NAFLD. The lifestyle intervention with weight reduction is effective for the treatment of NAFLD (AU)

[Non-alcoholic fatty liver disease and its association with clinical and biochemical variables in obese children and adolescents: effect of a one-year intervention on lifestyle]. / Hígado graso no alcohólico y su asociación con variables clínicas y bioquímicas en niños y adolescentes obesos: efecto de un año de intervención en el estilo de vida.

OBJECTIVE: To study the frequency of non-alcoholic fatty liver disease (NAFLD), its relationship to clinical and biochemical variables, and the effect 12-month's lifestyle intervention in obese children and adolescents. METHODS: Thirty-six obese patients aged 7 to 18 years, 42% female and 58% male, 72.2% prepubertal and 27.8% pubertal, were selected. Anthropometric measurements and glucose, insulin (baseline and after a glucose load), lipid profile, C-reactive protein, and aminotransferase tests were performed before and 12 months after dietary and physical activity intervention. Liver ultrasound was performed to determine the presence of NAFLD. RESULTS: NAFLD was found in 66.7% (n=24), and was mild in 30.6%, moderate in 27.8%, and severe in 8.3%. Subjects with NAFLD had higher body mass index (BMI, p=0.007), waist (p=0.005), fat area (p=0.002), basal insulin (p=0.01), and HOMA-IR (p=0.008) values and lower QUICKI (p=0.02) values than those with no NAFLD. After intervention, physical activity increased (p=0.0001) and calorie intake remained unchanged. NAFLD disappeared in 9 patients (37.5%, p=0.02) and disease severity decreased in 3 patients (12.5%). In addition, BMI Z-score (p=0.005), fat area (p=0.0001), basal insulin (p<0.05), insulin resistance (p<0.005), lipid profile (p<0.03), and transaminases decreased. Weight loss was the main variable accounting for NAFLD improvement. CONCLUSION: This group of obese children and adolescents showed a high frequency of NAFLD. The lifestyle intervention with weight reduction is effective for the treatment of NAFLD.

Marcadores inflamatorios en diabetes mellitus Tipo 1: Relación con perfil lipídico, control metabólico y duración de la enfermedad

Objetivos: Determinar los niveles de marcadores inflamatorios en pacientes con DM1, en comparación con controles sin DM1, y su relación con el perfil lipídico, el control metabólico y la duración de la diabetes. Métodos: Se seleccionaron 38 pacientes con DM1, sin complicaciones crónicas de la diabetes, 13 del Servicio de Endocrinología del I.A.H.U.L.A de Mérida y 25 de consultas Endocrinológicas del Táchira. Grupo control: 40 sujetos sin DM, ajustados por edad y sexo. Se obtuvieron datos demográficos y se realizó examen físico. Se calculó el índice de masa corporal (IMC). La glicemia, triglicéridos (Tg), colesterol total (Ct) y C-HDL se cuantificaron por métodos enzimáticos, la Hb A1c por turbidimetría, la proteína C reactiva (PCR) ultrasensible por quimioluminiscencia y el factor de necrosis tumoral alfa (TNFα) por inmunoensayo Resultados: La tensión arterial sistólica (TAS) estuvo más elevada en el grupo de estudio (DM1; p=0,017). El CHDL mostró niveles significativamente mayores en el grupo de diabéticos (p=0,0001) y no se observaron diferencias significativas en el resto de los lípidos. La PCR no fue diferente entre los grupos pero mostró una correlación significativa y positiva con los marcadores de adiposidad (IMC y cintura) (p=0,0001), las cifras de tensión arterial (p=0,002) y la duración de la diabetes (p=0,02). El FNTα se encontró significativamente más alto en los pacientes diabéticos tipo 1 y presentó una fuerte correlación positiva con la glicemia (p=0,0001) y débil con la TAS (p=0,01). Conclusiones: El nivel aumentado de FTNα en los niños diabéticos y las correlaciones positivas de este factor con la glicemia, así como de la PCR con la adiposidad, la tensión arterial y la duración de la DM1, sugieren una posible relación entre marcadores inflamatorios y DM1, sin embargo, se requieren estudios de seguimiento para determinar su importancia.

Objective: To determine the levels of inflammatory markers in patients with DM1 compared to controls without DM1, and their relationship with lipid profile, metabolic control and duration of diabetes. Materials and Methods: We selected 38 patients from the Endocrinology Service of IAHULA, Mérida (n = 13) and Táchira endocrinologist consultations (n = 25) with DM1 without chronic complications of diabetes (Study Group). We selected 40 patients without diabetes mellitus, adjusted for age and sex to patients, who formed the control group. We used a questionnaire covering demographic data and physical examination. Then we calculated the body mass index and laboratory tests in serum were performed: glucose, triglycerides, total cholesterol, LDL-C, HDL-C, HbA1c, C-reactive protein (CRP) and tumour necrosis factor (TNFα). Results: There was no statistical difference between study and control groups regarding age, weight, height and body mass index (BMI). Systolic blood pressure (SBP) was higher in the study group (DM1; p=0.017). HDLC levels were significantly higher in the group of diabetic children (p=0.0001) and there were no significant differences in the other lipid. Levels CRP was not different between groups but showed a significant positive correlation with markers of adiposity (BMI and waist circumference) (p=0.0001), arterial blood pressure (p=0.002) and duration of diabetes (p=0.02). The FNTα was significantly higher in type 1 diabetic patients and showed a strong positive correlation with hyperglycemia (p=0.0001) and weak with SBP (p=0.01). Conclusions: FTNα increased levels in diabetic children and the positive correlations of this factor with glycemia, as well as PCR with adiposity, blood pressure and duration of DM1, suggest a possible relationship between inflammatory markers and DM1, however, follow-up studies are needed to determine its importance.

Frecuencia de criptorquidia y factores asociados en recién nacidos

Objetivos: Determinar la frecuencia de las anormalidades del descenso testicular y los factores asociados en recién nacidos (RN). Métodos: Se realizó un estudio clínico observacional tipo caso control. Durante el período noviembre 2007- Agosto 2008, se examinaron en el Instituto Autónomo Hospital Universitario de los Andes (IAHULA) todos los RN con criptorquidia, los cuales se compararon con 105 RN sin criptorquidia (grupo control). Datos complementarios fueron obtenidos mediante una encuesta a los padres. Resultados: De un total de 2084 RN, 35 presentaron criptorquidia, lo cual corresponde a una frecuencia del 1,7%. La criptorquidia ocurrió en 10,8% de los RN pre-término y solamente en 0,8 % de los RN de término. La prematuridad y el bajo peso al nacer se asociaron con mayor frecuencia con la criptorquidia (p<0,05). Otros factores como la talla, el índice Apgar y la longitud del pene de los RN, también estuvieron asociados con la presencia de criptorquidia. El riesgo relativo indirecto (Odds ratio) de presentar criptorquidia es 5,27 veces mayor en un RN pre-término comparado con un RN de término. Los RN con malformaciones congénitas tienen un riesgo 7,03 veces mayor de tener criptorquidia que un RN sin malformaciones congénitas. Conclusiones: Se confirma que en nuestros niños la criptorquidia es más frecuente en RN pre-término y que la frecuencia de criptorquidia en RN es del 1,7%. El bajo peso al nacer, la prematuridad, el pene de pequeñas dimensiones junto con la presencia de anomalías congénitas asociadas, son factores que se relacionan con el mal descenso testicular.

Objectives: To establish the frequency of abnormalities of testicular descent and associated factors in newborn (NB) boys. Methods: An observational clinical study, case control type, was performed. All criptorchydic NB were evaluated at the Hospital Universitario de Los Andes, from November 2007 to August 2008. They were compared with 105 NB without cryptorchidism. A survey to obtain data from the patients, and their parents was conducted. Results: Criptorchidism was present in thirty five out of 2084 male newborns, representing 1.7% of the sample. In preterm NB, the frecuency of criptory was 10.8%, compared to 0.8% frequency observed in at term male newborns. Prematurity and low birth weight were associated with increased frequency of chryptorchidism (p<0,05). Newborns height, Apgar index, and the lenght of their penis, were also associated with increased presence of chryptorchidism. The calculated odds ratio risk for criptorchidism is 5.27 times higher in pre-term NB compared to term boys at birth. The risk for chriptorchidism in a newborns with morphological developmental abnormalities, is 7.03 times higher than in a NB without such abnormalities. Conclusions: We have verified that criptorchidism in our children is more frequent in pre-term newborns, and that 1.7% is the frequency of criptorchidism in this sample. Low birth weight, prematurity, and the small penis dimensions, together with associated morphological developmental abnormalities, are risk factors related to abnormal testicular descent.

Prevalencia del síndrome metabólico en la población urbana de Mucuchíes, Mérida-Venezuela

Objetivos: evaluar la prevalencia del síndrome metabólico (SM) en una muestra representativa de la población urbana de Mucuchíes, Estado Mérida. Métodos: Se estudiaron 109 sujetos mestizos, de ambos sexos, con edad entre 20 y 65 años. La prevalencia de SM fue definida de acuerdo a los criterios del National Cholesterol Education Program (NECP)/Adult Treatment Panel III (ATP III) y de la International Diabetes Federation (IDF). Resultados: la prevalencia del SM fue del 38% y 43% según los criterios ATP III e IDF respectivamente. El 80% de la población mostró anormalidad en el peso corporal y más del 50% tenía valores anormales de la circunferencia abdominal (CA). La dislipidemia fue muy frecuente, con una alta frecuencia de hipertrigliceridemia (56%) y valores bajos de cHDL (76%). La hipertensión arterial fue significativamente más alta (p<0,05) en los hombres y la glucosa alterada en ayunas sólo se observó en el 6% de la población sin variaciones significativas entre el sexo. La frecuencia del SM fue del 24% en los individuos con normopeso y aumentó significativamente en función del IMC, con una frecuencia máxima de 73% en los sujetos obesos. La circunferencia abdominal, la presión arterial sistólica y el índice TG/c-HDL fueron los factores de riesgo que se asociaron mas fuertemente con el diagnóstico de SM. Conclusiones: La prevalencia del SM en la población urbana de Mucuchíes-Venezuela, es de 38% y 43%, según criterios NCEP-ATPIII e IDF respectivamente. El patrón de SM predominante se caracterizó por dislipidemia, obesidad visceral y baja frecuencia de glucosa en ayunas alterada.

Objective: to estimate the prevalence of metabolic syndrome (MS) in the urban population of Mucuchíes, Estado Mérida, Venezuela. Methods: a representative sample of 109 Hispanic men and women subjects, aged 20-65 yr was studied. MS was defined according to National Cholesterol Education Program (NECP)/Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. Results: the prevalence of MS was 38% and 43% according to ATPIII and IDF criteria respectively. Eighty percent of population had abnormal body mass index and more than 50% showed abnormal waist circumference (WC). Dyslipidemia showed a high frequency of hypertriglyceridemia (56%) and low levels of HDL-C (76%). Hypertension was significantly higher in men (p<0,05). Impaired fasting glucose was observed in 6% of population, no significant difference related to gender was observed. Metabolic syndrome frequency in nonobese subjects was 24% and increased significantly as a function of body mass index showing a maximal frequency of 73% in obese subjects. Waist circumference, systolic blood pressure and triglyceride/HDL-C ratio were the main risk factors related with MS diagnosis. Conclusions: the prevalence of MS in the urban population of Mucuchíes, Estado Mérida, Venezuela is 38% y 43% according to NCEP-ATPIII and IDF criteria respectively. The predominant pattern of MS was characterized by dyslipidemia, abdominal obesity and a low frequency of impaired fasting glucose.

[Relationship between the triglyceride/high-density lipoprotein-cholesterol ratio, insulin resistance index and cardiometabolic risk factors in women with polycystic ovary syndrome]. / Relación entre el cociente triglicéridos/cHDL, índices de resistencia a la insulina y factores de riesgo cardiometabólico en mujeres con síndrome del ovario poliquístico.

OBJECTIVE: To evaluate the relationship between the triglyceride/high density lipoprotein cholesterol (TG/HDL-c) ratio, insulin resistance index and cardiometabolic risk factors in women with polycystic ovary syndrome (PCOS). PATIENTS AND METHOD: The present crosssectional study analyzed 62 women with PCOS and 48 healthy women (control group) aged 17- 35 years old. Body mass index (BMI), waist circumference (WC) and blood pressure were registered. Plasma concentrations of glucose, insulin, triglycerides, total cholesterol and HDL-c were measured. TheTG/HDL-c ratio, homeostasis model assessment for insulin resistance (HOMA(IR)) and quantitative insulin sensitivity check index (QUICKI) were calculated. RESULTS: Women with PCOS showed significantly higher values of the TG/HDL-c ratio and HOMA(IR), and a significantly lower QUICKI value. These differences were related to BMI and WC, with the highest values being observed in obese patients. The 50th percentile for the TG/HDL-c ratio was 3.64; the TG/cHDL ratio was positively correlated with BMI, WC and HOMA(IR) (r=0.48, p<0.001; r=0.58, p<0.001; r=0.43, p<0.001 respectively) and was negatively correlated with the QUICKI (r=-0.51; p<0.001). Women with PCOS showed a higher frequency of fasting glucose > 100 mg/dl (10% vs 3%; p<0.05), triglycerides>150 mg/dl (55% vs 20%; p<0.05) and WC>80 cm (82.3% vs 43.8%; p<0.001). Metabolic syndrome was also more frequent in women with PCOS than in controls (31% vs 10%). The independent variable with the strongest influence on TG/HDL-c was WC (p<0.001). CONCLUSIONS: This cross-sectional study demonstrates that women with PCOS show significantly higher values of the TG/HDL-c ratio, which is closely related to WC and insulin resistance and sensitivity indexes (HOMA(IR), QUICKI). The TG/HDL-c ratio could be considered as a useful and practical method to identify an increased risk of cardiovascular disease in patients with PCOS.

[Obesity in schoolchildren from Merida, Venezuela: association with cardiovascular risk factors]. / Obesidad en escolares de Mérida, Venezuela: asociación con factores de riesgo cardiovascular.

OBJECTIVE: To investigate the prevalence of obesity and associated cardiovascular risk factors in schoolchildren in our city, given the influence of these factors on the development of atherosclerosis. METHODS: We studied a representative sample of second grade students composed of 370 children aged 7.82+/-0.62 years (47.8% girls and 52.2% boys); 52.4% were from public schools and 47.6% were from private schools. Surveys were performed and anthropometric measurements, blood pressure (BP) values and glucose and lipid profiles in capillary blood were determined. RESULTS: A total of 9.7% (36 schoolchildren) were obese and 13.8% were overweight. There were no differences according to sex or school system. Abdominal obesity was observed in 69.4% (p<0.0001), normal-high BP (90-97th percentile) in 27.8% (p<0.0001), dyslipidemia in 66.7% (p<0.05) and metabolic syndrome in 38.9% (p<0.0001) of the obese children compared with 1.3%, 5.1%, 48.9% and 0.4% of the children with normal weight, respectively. No association was found between fasting hyperglycemia and obesity. There were no cases of hypertension or diabetes mellitus. The risk (odds ratio) for normal-high BP, dyslipidemia, abdominal obesity and metabolic syndrome was 6.3, 2.2, 60.9, and 70.2 times higher in obese children than in non-obese children, respectively. A positive and significant correlation was found between waist circumference and body mass index with BP and the atherogenic indexes triglycerides/high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C and low-density lipoprotein cholesterol/HDL-C (p=0.0001). CONCLUSIONS: Compared with cities in other countries, the city of Mérida, Venezuela, has an intermediate prevalence of overweight and obesity in schoolchildren. The high frequency of cardiovascular risk factors in the obese and its positive correlation with adiposity highlights the need to implement population-based strategies for its prevention in childhood.

Obesidad en escolares de Mérida, Venezuela: asociación con factores de riesgo cardiovascular / Obesity in schoolchildren in Merida, Venezuela: association with cardiovascular risk factors

Objetivo: Investigar la frecuencia de obesidad y factores de riesgo cardiovascular asociados a ella en escolares de nuestra ciudad, dada su influencia en el desarrollo de arteriosclerosis. Métodos: Se estudió una muestra representativa de escolares cursantes del segundo grado, conformada por 370 niños, de 7,82 ± 0,62 años (el 47,8% mujeres y el 52,2% varones; el 52,4% proveniente de institutos públicos y el 47,6%, de privados). Se aplicaron encuestas y se realizaron las medidas antropométricas, la toma de presión arterial (PA) y la determinación de la glucemia y el lipidograma en sangre capilar. Resultados: El 9,7% (36 escolares) presentó obesidad y el 13,8%, sobrepeso. No hubo diferencias en cuanto a sexo o plantel educativo. Se observó obesidad abdominal en el 69,4% (p < 0,0001), PA normal-alta (percentil 90-97) en el 27,8% (p < 0,0001), dislipemia en el 66,7% (p < 0,05) y síndrome metabólico (SM) en el 38,9% (p < 0,0001) de los niños obesos, frente al 1,3, el 5,1, el 48,9 y el 0,4% de los niños en normopeso, respectivamente. La hiperglucemia en ayunas no se encontró asociada a la obesidad. No hubo casos de hipertensión arterial ni de diabetes mellitus. La probabilidad de presentar PA normal-alta en el obeso fue 6,3 veces mayor que en el no obeso (riesgo relativo indirecto u odds ratio); la de dislipemia fue 2,2 veces mayor; la de obesidad abdominal, 60,9 veces mayor y la de SM, 70,2 veces mayor. Hubo correlación positiva y significativa entre la circunferencia abdominal y el índice de masa corporal con la PA y con los índices aterogénicos triglicéridos/colesterol de las lipoproteínas de alta densidad (cHDL), colesterol total/cHDL y colesterol de las lipoproteínas de baja densidad/cHDL (p = 0,0001) Conclusiones:En la ciudad de Mérida, Venezuela, respecto a ciudades de otros países, hay una prevalencia intermedia de sobrepeso y obesidad en escolares. La alta frecuencia de factores de riesgo cardiovascular en los obesos y su correlación positiva con la adiposidad enfatizan la necesidad de implementar estrategias poblacionales para su prevención en la edad infantil(AU)

Objective: To investigate the prevalence of obesity and associated cardiovascular risk factors in schoolchildren in our city, given the influence of these factors on the development of atherosclerosis. Methods: We studied a representative sample of second grade students composed of 370 children aged 7.82 ± 0.62 years (47.8% girls and 52.2% boys); 52.4% were from public schools and 47.6% were from private schools. Surveys were performed and anthropometric measurements, blood pressure (BP) values and glucose and lipid profiles in capillary blood were determined. Results A total of 9.7% (36 schoolchildren) were obese and 13.8% were overweight. There were no differences according to sex or school system. Abdominal obesity was observed in 69.4% (p < 0.0001), normal-high BP (90-97th percentile) in 27.8% (p < 0.0001), dyslipidemia in 66.7% (p < 0.05) and metabolic syndrome in 38.9% (p < 0.0001) of the obese children compared with 1.3%, 5.1%, 48.9% and 0.4% of the children with normal weight, respectively. No association was found between fasting hyperglycemia and obesity. There were no cases of hypertension or diabetes mellitus. The risk (odds ratio) for normal-high BP, dyslipidemia, abdominal obesity and metabolic syndrome was 6.3, 2.2, 60.9, and 70.2 times higher in obese children than in non-obese children, respectively. A positive and significant correlation was found between waist circumference and body mass index with BP and the atherogenic indexes triglycerides/high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C and low-density lipoprotein cholesterol/HDL-C (p = 0.0001). Conclusions: Compared with cities in other countries, the city of Mérida, Venezuela, has an intermediate prevalence of overweight and obesity in schoolchildren. The high frequency of cardiovascular risk factors in the obese and its positive correlation with adiposity highlights the need to implement population-based strategies for its prevention in childhood (AU)

Relación entre el cociente triglicéridos/cHDL, índices de resistencia a la insulina y factores de riesgo cardiometabólico en mujeres con síndrome del ovario poliquístico / Relationship between the triglyceride/high-density lipoprotein-cholesterol ratio, insulin resistance index and cardiometabolic risk factors in women with polycystic ovary syndrome

Objetivo: Determinar la interrelación entre el cociente triglicéridos/colesterol de las lipoproteínas de alta densidad (TG/cHDL), índices de resistencia a la insulina y factores de riesgo cardiometabólico en pacientes con síndrome de ovario poliquístico (SOPQ). Pacientes y método: En este estudio transversal se estudió a 62 mujeres con SOPQ y 48 mujeres sanas (grupo control), con edades de 17-35 años. Se registró el índice de masa corporal (IMC), el perímetro de cintura y la presión arterial. Se cuantificó la glucemia, la insulinemia, los triglicéridos, colesterol total y cHDL. Se calcularon los índices de resistencia HOMAIR (homeostasis model assessment), y sensibilidad a la insulina QUICKI (quantitative insulin sensitivity check index) y el cociente TG/cHDL. Resultados: Las pacientes con SOPQ mostraron valores significativamente más altos del HOMAIR y del cociente TG/cHDL, y un valor significativamente más bajo del índice QUICKI, los cuales se relacionaron con el IMC y el perímetro de cintura, con valores máximos en las mujeres obesas. El percentil 50 del cociente TG/cHDL fue 3,64. El cociente TG/cHDL se correlacionó positivamente con el IMC, el perímetro de cintura y el HOMAIR (r = 0,48; p < 0,001; r = 0,58, p < 0,001; r = 0,43; p < 0,001 respectivamente) e inversamente con el QUICKI (r = ¿0,51; p < 0,001). El grupo con SOPQ mostró una mayor frecuencia de glucosa en ayunas > 100 mg/dl (el 10 frente al 3%; p < 0,05), y triglicéridos > 150 mg/dl (el 55 frente al 20%; p < 0,05) y perímetro de cintura > 80 cm (el 82,3 frente al 43,8%; p < 0,001). La frecuencia de síndrome metabólico fue más alta en el grupo con SOPQ (el 31 frente al 10%). El perímetro de cintura fue la principal variable independiente que influyó en el valor del TG/cHDL (p < 0,001) Conclusiones: Este estudio demuestra que las mujeres con SOPQ presentan valores significativamente más altos del cociente TG/cHDL, lo cual está estrechamente relacionado con el perímetro de la cintura y los índices de resistencia y sensibilidad a la insulina (HOMAIR, QUICKI). El cociente TG/cHDL se podría considerar como un método útil y práctico para identificar un riesgo cardiovascular aumentado en las pacientes con SOPQ (AU)

Objective:To evaluate the relationship between the triglyceride/high density lipoprotein cholesterol (TG/HDL-c) ratio, insulin resistance index and cardiometabolic risk factors in women with polycystic ovary syndrome (PCOS). Patients and method: The present cross-sectional study analyzed 62 women with PCOS and 48 healthy women (control group) aged 1735 years old. Body mass index (BMI), waist circumference (WC) and blood pressure were registered. Plasma concentrations of glucose, insulin, triglycerides, total cholesterol and HDL-c were measured. The TG/HDL-c ratio, homeostasis model assessment for insulin resistance (HOMAIR) and quantitative insulin sensitivity check index (QUICKI) were calculated. Results: Women with PCOS showed significantly higher values of the TG/HDL-c ratio and HOMAIR, and a significantly lower QUICKI value. These differences were related to BMI and WC, with the highest values being observed in obese patients. The 50th percentile for the TG/HDL-c ratio was 3.64; the TG/cHDL ratio was positively correlated with BMI, WC and HOMAIR (r = 0.48, p < 0.001; r = 0.58, p < 0.001; r = 0.43, p < 0.001 respectively) and was negatively correlated with the QUICKI (r = ¿0.51; p < 0.001). Women with PCOS showed a higher frequency of fasting glucose > 100 mg/dl (10% vs 3%; p < 0.05), triglycerides > 150 mg/dl (55% vs 20%; p < 0.05) and WC > 80 cm (82.3% vs 43.8%; p < 0.001). Metabolic syndrome was also more frequent in women with PCOS than in controls (31% vs 10%). The independent variable with the strongest influence on TG/HDL-c was WC (p < 0.001). Conclusions: This cross-sectional study demonstrates that women with PCOS show significantly higher values of the TG/HDL-c ratio, which is closely related to WC and insulin resistance and sensitivity indexes (HOMAIR, QUICKI). The TG/HDL-c ratio could be considered as a useful and practical method to identify an increased risk of cardiovascular disease in patients with PCOS(AU)