Nutritional status of highland and lowland children in Ecuador.

UNLABELLED: We assessed the nutritional status of children in Ecuador using anthropometric measurements and body composition. OBJECTIVES: To determine whether living in the highlands in Quito was a predisposing factor to poor nutrition in children. METHOD: We compared the children in highlands at 2772 m above sea level with their costal (605 m above sea level) counterparts at Santo Domingo de Los Colorados. By using the WHO standard reference 2007, we distinguished malnourished children from healthy children using Z-score of -2 as a cut-off point. RESULTS: Mean Z-score indices for both height-for-age (HFA) and weight-for-age (WFA) were found to be significantly lower among urban children than for rural children (p < 0.001). Urban children were also four times more likely of becoming mildly stunted (OR = 3.95%, 95% confidence interval (CI): 1.818-8.448) and three times more likely of being mildly underweight (OR = 3.95%, 95% CI: 1.241-7.551). CONCLUSION: Living in highland urban areas of Ecuador is a predisposing factor for poor nutrition among children.

The En Balance Spanish diabetes education program improves apolipoproteins, serum glucose and body composition in Hispanic diabetics.

OBJECTIVE: We evaluated the changes in apolipoproteins, glycemic status, and body composition after 3 months using a culturally sensitive diabetes education program, En Balance, in diabetic Hispanics. METHODS: Thirty-four (9 males, 25 females) Hispanic diabetics participated in the En Balance program over three months. Body composition was determined by dual energy X-ray absorptiometry (DXA), fasting plasma glucose (FPG), A1c, and apolipoproteins (Apo) measured after 3 months participation. Differences were analyzed using paired t testing and relationships between changes in Apo, A1c, total cholesterol, body mass index and body composition by Spearman correlations. RESULTS: Completion of En Balance resulted in a significant reduction in weight (80.31 +/- 1.97 kg vs 81.25 +/- 17.97 kg, P = .015), FPG (143.21 +/- 57.8 mg/dL vs 166.41 +/- 65.9 mg/dL P = .003), and A1c (7.08 +/- 1.6% vs 7.87 +/- 2.0%, P = < .001). DXA demonstrated reduction in total fat (29.54 +/- 10.0 kg vs 30.24 +/- 11.80 kg, P = < .001) and trunk fat (15.09 +/- 5.6 kg vs 16.87 +/- 5.4 kg, P = .001). High density lipoprotein significantly increased (48.85 +/- 11.4 vs 44.65 +/- 8.8, P = .002) and total serum cholesterol/high density lipoprotein ratio decreased (3.87 +/- .98 vs 4.35 +/- 1.0, P = .001). There were significant correlations at three months between changes in Apo A1 and A2 (r = .559, P < .001), Apo E and total cholesterol (r = .746, P < .001), between A1c and FPG (r = .563, P = .001) and BMI and body weight (r = .732, P < .001). CONCLUSIONS: The En Balance program improved body composition, A1c, FPG, total cholesterol/HDL ratio and HDL. If these trends can be sustained, En Balance may serve as a unique educational paradigm for improving type 2 diabetes in Hispanics.

Impacting obesity and glycemic control using a culturally-sensitive diabetes education program in Hispanic patients with type 2 diabetes.

OBJECTIVES: Diabetes mellitus and obesity are prevalent in the Hispanic community. This group has not benefited greatly from diabetes interventions due to cultural, language and financial constraints. We designed a prospective cohort study to determine the clinical impact on adiposity and glycemic control in Hispanics with type 2 diabetes. RESEARCH DESIGN AND METHODS: The program conducted in Spanish by a multidisciplinary team of health care providers focused on improving glycemic control and complications through cultural lifestyle changes. Outcomes were changes in glycemic control by fasting insulin, glucose and HbA1c, body composition and selected adipokines, adiponectin, leptin and ghrelin. Body composition was measured by dual energy x-ray absorptiometry. Changes from baseline at three months were compared using paired t-tests and with Spearman's correlations. RESULTS: Glycemic control improved by HbA1c (7.9% ± 2.0% vs 7.1% ± 1.7%; P = <0.001), and fasting glucose (166.4 ± 66.0 mg/dl vs 143.2 ± 57.9 mg/dl; P = 0.003). Body weight (81.3 ± 17.9 kg vs 80.3 ± 18.0 kg; P = 0.002), waist circumference (101.6 ± 13.4 cm vs 99.1 ± 12.7 cm; P = 0.015), and truncal fat (16.5 ± 5.7 kg vs 15.9 ± 5.6 kg; P = 0.001) decreased. Only leptin (19.6 ± 15.0 ng/ml vs 16.3 ± 12.7 ng/ml; P = 0.002) was reduced and related to change in body weight (r = 0.392; P = 0.022). CONCLUSIONS: Our program significantly improved glycemic control and decreased obesity in diabetic Hispanic subjects. The early benefits on glycemic control may be related to reductions in leptin through loss of adipose tissue. Success in impacting diabetes and related complications can occur in a culturally focused and multidisciplinary context.

Improved clinical outcomes using a culturally sensitive diabetes education program in a Hispanic population.

PURPOSE: The purpose of this study was to evaluate the effects of a culturally sensitive diabetes education program for Hispanics with type 2 diabetes. METHODS: This study is a prospective cohort study to test the impact of a comprehensive diabetes education program on blood glucose control on Hispanics with type 2 diabetes. The educational program focused on maintaining glycemic control and general aspects of managing diabetes and complications. The study participants were recruited by flyers placed in Hispanic markets and in ambulatory care clinics. A total of 34 Hispanic male and female subjects with type 2 diabetes participated in the study. The concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein (HDL) cholesterol were analyzed at baseline and at 3 months. RESULTS: A significant mean change was observed for HbA1c, fasting plasma glucose, cholesterol/HDL ratio, and HDL after 3 months of education compared with baseline. There were significant reductions in weight, total fat, percent fat, trunk fat, and waist-to-hip ratio compared with baseline. After 3 months, subjects showed a significant positive correlation between changes in body mass index and insulin and weight, total fat, trunk fat, and fat free mass and insulin. CONCLUSIONS: A culturally sensitive program conducted in Spanish had a significant impact on important clinical parameters in Hispanic subjects with diabetes in a relatively short time period. The study demonstrates the importance of designing education intervention studies that are sensitive to cultural diversity, particularly in at-risk diabetic subjects.

Beneficial effects of weight loss on plasma apolipoproteins in postmenopausal women.

A total of 39 postmenopausal women 40-70 years of age and undergoing hormone replacement therapy participated in a 6-month weight reduction program, which consisted of a low calorie diet (5040 KJ/day) and phentermine hydrochloride therapy. Subjects had an average body mass index of 35.95+/-5.32 kg/m(2) and 42.20+/-11.0 kg of total fat. Body mass index, plasma lipids, total and trunk fat, and plasma apoproteins were measured at baseline and after 3 and 6 months of the weight reduction program. Subjects experienced an overall 10% weight loss during the treatment period (P<0.001). Plasma LDL cholesterol and triglycerides were reduced by 18% and 15% (P<0.01) respectively, whereas HDL cholesterol was increased by 9% (P<0.01) over the 6-month period. Plasma apoproteins were significantly affected by weight loss. Plasma apolipoprotein (apo) B concentrations were reduced 6.5% (P<0.01), and apo C-III and apo E were reduced by 9% over 6 months (P<0.01). The observed decreases in plasma apo B were significantly correlated with the observed changes in plasma cholesterol (r=0.356, P<0.01) over 3 months. In addition, changes in plasma triglycerides were correlated with changes in both apo C-III (r=0.436) and apo E (r=0.354) over 6 months. These results suggest that weight loss may have multifactorial effects on lipoprotein metabolism, resulting in better plasma lipid and apoprotein profiles.

Reproducibility of DXA in obese women.

Dual-energy X-ray absorptiometry (DXA) measurements were analyzed using two versions of software (Hologic V8.1a and V8.21) to compare the short- and long-term precisions of the measurements. Software V8.21 was designed by the manufacturer to better address magnification effects on estimations of soft tissue lean mass. Twenty weight-stable, obese postmenopausal Caucasian women aged 40-70 yr participated in the study. Total and regional body composition measurements were obtained at baseline and after 3 mo, using a fan beam Hologic QDR 4500A absorptiometer. For the estimation of precision, duplicate scans obtained on the same day for nine women were analyzed using both versions of the software. The correlations between duplicate scans ranged from 0.886 to 0.998 and were similar between software versions. The CVs for fat and lean weights and bone mineral content (BMC) were 1.2%, 1.1%, and 1.7%, respectively, for software V8.21 compared to 1.3%, 1.3%, and 2.1%, respectively, for V8.1a. Systematic differences were found between software versions with higher values for fat and lean weights for software version V8.21. The 3-mo, long-term reproducibility of body composition estimates from DXA was only slightly less than short-term reproducibility for both software versions (coefficient of variation [CV] range from 1.3% for BMC weight to 11.0% for arm fat). Software V8.21 yielded smaller percentage mean differences between scale and DXA-estimated weights (-2.4% and -7.2% at baseline and -2.9% and -7.6% at 3 mo, respectively) and higher fat and lean weights (49.12 and 47.1 kg and 49.6 and 44.6 kg, respectively) than V8.1a. Reproducibility of all variables was comparable between software versions.