Alta prevalencia de osteoporosis en mujeres mapuches postmenopáusicas asintomáticas / High prevalence of osteoporosis in asymptomatic postmenopausal Mapuche women

BACKGROUND: Genetic and environmental factors are responsible for variations in the frequency of osteoporosis. Prevalence of osteoporosis in Mapuche women (native Chileans) is unknown. AIM: To assess the prevalence and risk factors for osteoporosis in Mapuche women. MATERIAL AND METHOD: A random sample of 95 asymptomatic postmenopausal Mapuche females, stratified by age, was studied. Women with diseases or medications that could interfere with calcium metabolism were excluded. Spine and femoral neck bone mass density was determined using a Lunar DPX Alpha densitometer. RESULTS: Seventeen percent of women had normal bone mineral density in both spine and femoral neck. In the spine, 25.3 per cent had a normal bone mineral density, 17.9 per cent had osteopenia and 56.8 per cent had osteoporosis. In the femoral neck, 34.7 per cent had a normal bone mineral density, 57.9 per cent had osteopenia, and 7.4 per cent had osteoporosis. There was a positive correlation between bone mineral density and body mass index. Women with more than one hour per day of physical activity, had a significantly lower proportion of osteopenia or osteoporosis. No association between bone mineral density and parity or calcium intake, was observed. CONCLUSIONS: There is a high prevalence of osteopenia and osteoporosis among Mapuche women. Osteoporosis was associated with low body mass index.

Prevalence of type 2 diabetes and obesity in rural Mapuche population from Chile.

The aim of this study was to estimate the prevalence of Type 2 diabetes, impaired glucose tolerance (IGT), and obesity in the Mapuche natives from rural areas in Chile. This cross-sectional study involved men (n = 95) and women (n = 224) older than 20 y from an aboriginal ethnic group (Mapuches), residing in rural communities from the south of Chile. Prevalence of Type 2 diabetes and IGT was calculated according to the World Health Organization criteria. Data on age, degree of ancestral purity, obesity, and hypertension were also obtained. The prevalence of Type 2 diabetes in rural Mapuche natives was estimated as 3.2% (95% CI: 0.7--9.0) in men and 4.5% (95% CI: 2.2--8.1) in women. The overall prevalence of obesity was 56.1% (95% CI: 50.5--61.6): 40.0% (95% CI: 30.1--40.8) in men and 62.9% (95% CI: 56.3--69.3) in women (P value < 0.001). These data suggest that the prevalence of obesity and Type 2 diabetes has been increasing during recent years in the Mapuche communities. The prevalence estimated in this study is higher than that reported 15 y ago. This suggests an important role of lifestyle changes as a possible explanation for epidemiologic transition.

[Seeds germination of Caesalpinia paraguariensis (Fabaceae): scarificator agents and cattle effects]. / Germinación de semillas de Caesalpinia paraguariensis (Fabaceae): agentes escarificadores y efecto del ganado.

The tree Caesalpinia paraguariensis grows in the Chaco region, Argentina. Fruits are indehiscent with many seeds. This species is an important source of wood and the fruits are consumed by cattle in Salta province. We studied seed germination under chemical, mechanical and biological scarification. Seeds from controls (without scarification) and those with biological scarification had a smaller (and similar) germination rate. The non-germinated seeds from biological treatments were mechanically scarified and their germination rate was similar to others under the mechanical treatment. Passage by digestive tracts would not enhance germination because viable seeds are still dormant due to their hard coats.

[Serum lipids and blood pressure levels in the +Mapuche population living in the Chilean region of Araucanía]. / Niveles de lípidos y de presión arterial en población Mapuche de la Región de la Araucanía, en Chile.

BACKGROUND: Chilean aboriginal populations (Mapuche) predominantly live in the region of Araucanía, in the southern part of the country. Their cardiovascular risk factors have not been systematically assessed. AIM: To study the prevalence of cardiovascular risk factors in the Mapuche population. SUBJECTS AND METHODS: Blood pressure, weight, height, dietary habits, fasting serum total cholesterol, HDL cholesterol and triglycerides were measured in 1.948 adults living in 28 Mapuche communities. RESULTS: Thirteen percent of males and 16% of females had high blood pressure. Body mass index was 25.5 kg/m2 in males and 28.1 kg/m2 in females. Forty five percent of women and 24% of men were classified as obese. Mean serum total cholesterol was 186.7 +/- 9.6 mg/dl, HDL cholesterol was 58.7 +/- 30.7 mg/dl, total cholesterol/HDL cholesterol was 3.4 +/- 2 and triglycerides were 155.2 +/- 91.2 mg/dl. Twenty eight percent of males and 9.6% of females smoked. CONCLUSIONS: Mapuche individuals have higher levels of HDL cholesterol a better total cholesterol/HDL cholesterol ratio and lower frequency of smoking than non aboriginal Chileans subjects.

[Clinical experience with an alpha glucosidase inhibitor (acarbose) in the treatment of non-insulin-dependent diabetes. Multicenter study]. / Experiencia clínica con un inhibidor de la alfa glucosidasa (acarbosa) en el tratamiento de la diabetes no insulinodependiente. Estudio multicéntrico.

BACKGROUND: Acarbose, an alpha glucosidase inhibitor is a drug used in the treatment of non insulin dependent diabetes mellitus, that interferes with the intestinal absorption of monosaccharides. AIM: To study the effect of acarbose in non insulin dependent diabetic patients that had an inadequate metabolic control with diet and sulphonylureas. PATIENTS AND METHODS: Diabetic patients received acarbose, 150 mg/day during four weeks and this dose was increased to 300 mg/day during 3 months. Afterwards, patients were followed for a period of 12 weeks without acarbose. Fasting and post-prandial blood glucose and glycosilated hemoglobin were measured sequentially during the study. RESULTS: Eighty five patients were recruited for the study but 64 complied with the treatment protocol. The age of these patients was 56 +/- 8.8 years old, their diabetes duration was 7.8 +/- 8.8 years and their body mass index was 27.6 +/- 3.6 kg/m2. During acarbose treatment, glycosilated hemoglobin decreased from 8.36 +/- 1.33 to 7.71+ 1.7% (p < 0.001), fasting blood glucose decreased from 173 +/- 48 to 159 +/- 59 mg/dl (p < 0.03) and post-prandial blood glucose decreased from 254 +/- 80 to 241 +/- 80 mg/dl (NS). After discontinuing acarbose glycosilated hemoglobin and blood glucose levels returned to basal levels. Body weight and blood pressure did not change during the treatment period. Fifty nine patients had gastrointestinal symptoms (meteorism, flatulence and abdominal distention) that were mild in 59% and moderate in 39%. Episodes of hypoglycemia were not observed. CONCLUSIONS: Acarbose, associated to sulphonylureas is an effective drug to reduce blood glucose and glycosilated hemoglobin levels in patients with non insulin dependent diabetes.

Incidence of insulin-dependent diabetes mellitus in the IX region of Chile: ethnic differences.

We studied the incidence of insulin-dependent diabetes mellitus (IDDM) among children up to 15 years old of Caucasian and Mapuche origin, in the IX Region of Chile between 1980 and 1993. The Mapuche, or native Chileans, have their own culture, language an distinctive ethnic characteristics. Data were collected according to the methods recommended by the Diabetes Epidemiology Research International Group. We diagnosed IDDM in 47 children, 22 boys and 25 girls. The average annual incidence was 1.27/100,000 inhabitants (95% confidence intervals (C.I.) 0.83-1.71/100,000). The highest incidence along this period was during winter and spring. There was significant difference (P < 0.0016) in the IDDM incidence in Caucasians (1.58/100,000, 95% C.I. 1.11-2.04) compared with Mapuche (0.42/100,000, 95% C.I. 0-0.95). These results show that Mapuche children have less chance of developing diabetes.

[Chemical, sensory and clinical characterization of lupin marmalades]. / Caracterización química, sensorial y clínica de mermelada de lupino.

Legumes are characterized as showing interesting hypoglicemic properties. Their presence in the diet is very useful in controlling the level of blood glucose in diabetic people. Taking in mind this property different formulations of prune marmalades were developed using 5, -7.5, 10 and 15% of full fat sweet lupin flour (FFLF). These samples were submitted to chemical, physical, sensory and clinical analysis. The protein content increased from 0.6 to 5.2% in direct proportion to lupin flour concentration. Energy content remained relatively constant in all formulations. The incorporation of FFLF did not affect the natural dark red prune color and pH, acidity and soluble solids values remained under the limits of Chilean food regulation laws. The samples were analyzed by a Rank preference test. Reported data showed a significative preference for the prune marmalade with 10% HEL (p < 0.05). A facial Hedonic test was used to compare the degree of acceptability between this formula and a control marmalade with fructose as edulcorant. Statistical analysis using the student test did not show significant difference (p < 0.05) between them. The hypoglycemic effect of the lupin flour was tested in seven adult non insulin dependent diabetic patients using the glucose tolerance test. Postprandial blood glucose concentration data was lower in individuals after a test meal of lupin marmalade compared to fructose marmalade. This result would allow diabetic people to eat foods such as marmalades which are known to contain a large amount of carbohydrates.

[Genetic predisposition to develop insulin-dependent diabetes mellitus. A population study in Santiago and Temuco, Chile]. / Predisposición genética para desarrollar diabetes mellitus insulino-dependiente. Estudio en población de Santiago y Temuco, Chile.

Insulin-dependent diabetes mellitus (IDDM) is strongly associated with particular HLA-DQ alpha/beta markers in white population. The heterodimers conformation composed of a DQ alpha chain with an arginine at residue 52 (Arg52) combined to a DQ beta chain lacking an aspartic acid at residue 57 (non Asp57) increase markedly the risk to develop IDDM. To confirm this association, 63 IDDM patients from Santiago de Chile registry, 20 IDDM patients from Temuco registry and 74 unrelated healthy non diabetic control subjects were studied. With polymerase chain reaction (PCR) and sequence specific oligonucleotide probes the individuals were typed for their HLA-DQA1 and DQB1 alleles, their DQA1/DQB1 genotype and heterodimers conformation were compared. In diabetic population both markers Arg52 homocygote and non Asp57 homocygote were markedly increased regard to control subjects (R/R: 0.76 and 0.85 vs 0.33; ND/ND: 0.78 and 0.75 vs 0.50, p < 0.05). A high relative risk (RR) was determined for both homocygote markers in IDDM groups. Arg52 DQ alpha (R)/non Asp57 DQ beta (ND) heterodimers were strongly associated with susceptibility to IDDM. A high RR was observed in patients with four susceptibility DQ heterodimers (RR1: 13.7 in IDDM-Santiago and RR2: 18.6 in IDDM-Temuco, p < 0.00003). The HLA-DQ alpha/beta markers and their risk heterodimers are increased in our diabetic population and could be considered as susceptibility markers to develop IDDM.

[Primary hyperparathyroidism caused by a mediastinal adenoma with intermittent hypercalcemia and severe bone disease]. / Hiperparatiroidismo primario por adenoma mediastínico, con hipercalcemia intermitente y enfermedad ósea acentuada.

We report the case of a 33-year-old woman who was operated on with the diagnosis of primary hyperparathyroidism (PHP) in 1986. She had bone disease and slight hypercalcemia. Two parathyroid glands were removed with a lack of clinical improvement. Subsequently, the serum calcium levels were normal with occasional slight increases. Depressed phosphorus values and elevated alkaline phosphatases and PTH levels were also present, associated with severe bone involvement and muscular weakness. A second cervical exploration performed in 1989 disclosed only a normal parathyroid gland, which was not removed. In 1990, a thoracic CT scan showed the presence of a 1 cm mediastinal nodule close to the great vessels. A thoracotomy was performed to remove this nodule, which proved to be a parathyroid adenoma. After surgery, the patient presented with a "hungry bone" syndrome, characterized by very low levels of calcium, phosphorus and magnesium, which required enteral and parenteral calcium and magnesium supplements, plus dihydroxyvitamin D. The association of normocalcemia and intermittent hypercalcemia with severe bone disease is very rare, as is the presence of a mediastinal adenoma. This could explain the difficulty in the diagnosis in this case.