The effect of successful kidney transplantation on ventricular dysfunction and pulmonary hypertension.

BACKGROUND: Heart disease is a frequent complication of chronic kidney disease and the major cause of death in patients on renal replacement therapy. The purpose of this study was to evaluate the impact of successful kidney transplantation on systolic and diastolic ventricular dysfunction and pulmonary arterial hypertension in patients with chronic kidney disease (CKD). METHODS: The study included 35 patients >18 years of age with CKD who had successful kidney transplantations. Ventricular function and pulmonary arterial pressure were evaluated by echocardiography before and 1 year after transplant. RESULTS: The mean age of subjects was 40 ± 14 years, and 63% were men. Mean left ventricular ejection fraction (LVEF) was 52 ± 16%. Before transplant, 28 (80%) of the patients had ventricular dysfunction (34.3% diastolic and 45.7% systolic). Pulmonary arterial hypertension was found in 48.6%. Ventricular dysfunction was associated with dialysis of >2 years duration before transplant. The LVEF of the entire group increased from 52% to 64% (P < .001) by 12 months after kidney transplant. Left ventricular diameters, wall thickness, and pulmonary arterial systolic pressure decreased significantly after transplantation Echocardiograms became normal 1 year after transplant in 8 (66.7%) of the patients with diastolic dysfunction and 9 (56.2%) with systolic dysfunction, and diastolic dysfunction persisted in 5 (31.2%). CONCLUSIONS: Because kidney transplantation led to considerable improvement in left ventricular systolic and diastolic function as well as pulmonary arterial pressure of patients with CKD, optimal treatment for dysfunction and transplant as soon as possible is recommended.

Outcomes of a school-based intervention (RESCATE) to improve physical activity patterns in Mexican children aged 8-10 years.

The aim of this study was to evaluate the impact of an intervention program on the patterns of physical activity in 8- to 10-year-old Mexican children from lower socioeconomic status. This study performed a randomized controlled field trial in 498 children aged 8-10 years from 10 public schools of low socioeconomic status in Mexico City. Schools were randomly assigned to intervention (n = 5) or control (n = 5) groups and followed up during 12 months. Physical and sedentary activities were assessed at the beginning of the program and after 6 and 12 months. At the end of follow-up, there was a significant increase in the performance of moderate physical activity (MPA) among children in intervention group who had not performed MPA at baseline any day of the week (40%, P = 0.04) but not in the control group (8%, P = not significant). The intervention group also showed a significant reduction in the proportion of children who spent more than 3 hours a day playing video games (from 23 to 13%, P = 0.01), while control group did not show significant changes. Given these findings, we conclude that intervention was able to modify positively physical activity and reduce time spent on such sedentary activities as video games among those at highest risk studied children.

Effect of malnutrition during the first year of life on adult plasma insulin and glucose tolerance.

There is evidence linking intrauterine growth retardation with increased cardiovascular risk and diabetes mellitus (DM) later in life. However, little is known about the association between malnutrition during the first year of life and metabolic abnormalities in adulthood. The objective of this study was to assess the effect of documented malnutrition during the first year of life on glucose tolerance, plasma insulin, lipid profile, and blood pressure in early adulthood, as well as to assess the interaction between body mass index (BMI) and malnutrition on these variables. A study group of young men with a documented history of malnutrition during their first year of life was recruited from 4 pediatric hospitals in Mexico City and compared with a control group. Subjects included were 52 men, aged 20.2 +/- 3.6 years, with a mean birth weight of 3.0 +/- 0.7 kg and documented malnutrition in their first year of life; controls were 50 men, aged 23.3 +/- 1.8 years, with a mean birth weight of 3.2 +/- 0.5 kg. Insulin and glucose concentrations, fasting and in response to an oral glucose load, plasma lipids, blood pressure, and an insulin sensitivity index (ISI) were measured. The areas under the curves of glucose (AUCG) and insulin (AUCI) were significantly higher in cases (P =.012 and <.002, respectively), independent of birth weight, BMI, or age. BMI was significantly associated with fasting plasma insulin (FPI), AUCI, ISI, triglyceride, and high-density lipoprotein (HDL)-cholesterol concentrations in cases, but not in controls. These data suggest that early malnutrition in extrauterine life, independently of birth weight, has an adverse effect on insulin metabolism and glucose tolerance in young men, and it worsens as body mass increases even within the normal range of BMI. Therefore, it is advisable to prevent obesity in individuals exposed to early malnutrition.

Insulin resistance and abdominal adiposity in young men with documented malnutrition during the first year of life.

OBJECTIVE: The main objective of the study was to examine the effect of early life malnutrition on the relation between insulin sensitivity and abdominal adiposity in adulthood. It was hypothesised that participants with early life malnutrition would display a more pronounced deterioration of insulin sensitivity in association with a gain in abdominal fat. DESIGN: As a first attempt to investigate this issue, we studied the effect of body fat gains in a cross-sectional context. SUBJECTS: A total of 26 young adult men with evidence of malnutrition during the first year of life and 27 control subjects were recruited for this study. Malnutrition status was determined from medical files of paediatric hospitals in the Mexico City metropolitan area. MEASUREMENTS: Insulin sensitivity was measured by hyperinsulinaemic euglycaemic clamp, and body composition was measured by anthropometrics, bioelectrical impedance and computed tomography. RESULTS: There was a negative correlation between total abdominal adipose tissue area and insulin sensitivity in the previously malnourished and control groups (r(2)=0.65 and 0.35, P<0.01, respectively). When matched for low amounts of abdominal fat (114 cm(2)), participants with and without early life malnutrition had similar insulin sensitivity (9.03 vs 8.88 mg kg(-1) x min(-1)). However, when matched for high amounts of abdominal fat (310 cm(2)) participants who were malnourished during the first year of life had lower insulin sensitivity (4.74 vs 6.85 mg kg(-1) x min(-1), P<0.05). CONCLUSION: Higher levels of abdominal adipose tissue are more detrimental to insulin sensitivity in previously malnourished individuals.

[Reproducibility and sensitivity of a questionnaire on physical activity in a Mexican population]. / Reproducibilidad y sensibilidad de un cuestionario de actividad física en población mexicana.

OBJECTIVE: To assess the reproducibility and sensitivity of a physical activity questionnaire (PAQ) developed at Laval University, to detect differences in lean and obese individuals. MATERIAL AND METHODS: A cross-sectional study was conducted at Mexico's National Institute of Medical Sciences and Nutrition, between January and May 1999. The PAQ was translated into Spanish and adjusted to the Mexican setting. The test-retest method was used to measure reliability, allowing a four-week interval between tests (n = 30 overweight subjects). To assess the questionnaire's sensitivity a group of young cadets (n = 18) was compared to a group of young civilians (n = 32). Concordance was measured through the intraclass correlation coefficient; test-retest was analyzed using the paired or unpaired Student's t test, as necessary. RESULTS: The intraclass correlation coefficient was 0.86. The PAQ was able to show differences of more than 400 kcal/day (1674 kJ/day) and more than 4 kcal/kg/day (17 kJ/kg/day), among young people with high physical activity (t-test). CONCLUSIONS: The PAQ is a sensitive and reliable instrument that can be used in the Mexican population. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[An anthropometric study of a group of elderly men and women of Mexico City]. / Estudio antropométrico en un grupo de hombres y mujeres de la tercera edad en la Ciudad de México.

OBJECTIVE: The aim of the present study was to estimate basic anthropometric measurements in a group of elderly men and women from Mexico City. MATERIAL AND METHODS: A cross-sectional study was carried out among senior citizens registered in the National Institute of the Elderly and National Institute of Social security in Mexico City. Standardized protocols were used to measure the anthropometric characteristics of the study group. The analysis included Student t tests to detect differences in average values between men and women in general and in each age subgroup formed. In addition, Pearson correlation analysis of the body mass index (BMI) with anthropometric variables was performed; p < 0.05 was taken as the level of significance. RESULTS: A total of 508 people aged 60 or older participated in the study; 230 were males and 278 were females. The average age was 66.9-years-old in the male group and 67.3-years-old in the female group. Among men the average weight was 70.7 kg, standard deviation (SD 9.9), height was 164 cm (SD 6.5) and BMI was 26.4 (SD 3.7). Among women the average weight was 60.8 kg (SD 9.9), height was 150 cm (SD 5.9) and BMI was 27.1 (SD 4.0). The distribution of the BMI showed that 50.9% of men and 54% of women were between 25.0 and 29.9. A correlation coefficient over r 0.70 (p < 0.001) was found between BMI and waist and hip circumferences. CONCLUSIONS: Based on the BMI about three-quarters of the population was overweight or obese. It is possible that the assessment of being overweight and of obesity in elderly people needs to be adjusted considering revised normality values.