Diabetes is associated with a higher risk of mortality among women in a middle-income country: Results form the Mexican Teacher's cohort study.

AIMS: In Mexico City, the mortality rate among patients with diabetes appears to be four times that of people without diabetes. Our study aimed to refine analyses of the impact of diabetes on mortality in a large cohort of women from different areas in Mexico with healthcare insurance. METHODS: Our study followed 111,299 women with comprehensive healthcare coverage from the Mexican Teachers' Cohort. After a median follow-up of 7.8years, 5514 (5%) prevalent self-reported diabetes cases and 4023 incident cases were identified, while deaths were identified through employers' databases and next-of-kin reports, with dates and causes of death for 1121 women obtained from mortality databases. Hazard ratios (HRs) for total and cause-specific mortality were estimated by Cox regression models, using follow-up time as the time scale and allowing for time-variable diabetes status after adjusting for age, socioeconomic status, use of health services, and anthropometric and lifestyle variables. RESULTS: In multivariable-adjusted models, the HR for all-cause mortality was 3.28 (95% CI: 2.86-3.75) in women with vs. without diabetes. The impact of diabetes on mortality was higher in rural vs. urban areas (HR: 4.72 vs. 2.98, respectively). HRs were 1.57 and 23.44 for cancer and renal disease mortality, respectively. CONCLUSION: In women with healthcare coverage in Mexico, the magnitude of the association between diabetes and all-cause mortality was higher than that observed in high-income countries, but less than what has previously been reported for Mexico. Such elevated mortality suggests a lack of adequate access to quality diabetes care in the population despite comprehensive healthcare coverage.

Associations between surrogate measures of insulin resistance and waist circumference, cardiovascular risk and the metabolic syndrome across Hispanic and non-Hispanic white populations.

AIMS: We evaluated the relations between surrogate indices of insulin resistance and waist circumference, metabolic syndrome and coronary heart disease risk across Hispanic and non-Hispanic white populations. METHODS: The study was a cross-sectional analysis of participants without diabetes in the San Antonio Heart Study, Mexico City Diabetes Study and Spanish Insulin Resistance Study. We evaluated commonly used indices of insulin resistance, including homeostasis model assessment, McAuley's index, Gutt's insulin sensitivity index, Avignon's insulin sensitivity index and the Stumvoll index with and without demographics, the modified Matsuda index and the product of the triglycerides and glucose index. The metabolic syndrome was defined by American Heart Association/National Heart, Lung, and Blood Institute criteria and coronary heart disease risk by Framingham risk scores. RESULTS: The Stumvoll index with demographics and the Avignon's insulin sensitivity index had the strongest correlations with waist circumference across populations. The triglycerides and glucose and McAuley's indices had the most robust correlations with Framingham risk score. The triglycerides and glucose index had the greatest ability to detect individuals with the metabolic syndrome and ≥ 10% coronary heart disease risk. Some indices display significant variability in the strength of the relationship with adiposity and coronary heart disease risk across populations. CONCLUSIONS: There are significant differences between insulin resistance indices regarding the ability to detect the metabolic syndrome and coronary heart disease risk across populations. Studies may need to consider the index of insulin resistance that best suits the objectives.

Was the historic contribution of Spain to the Mexican gene pool partially responsible for the higher prevalence of type 2 diabetes in mexican-origin populations? The Spanish Insulin Resistance Study Group, the San Antonio Heart Study, and the Mexico City Diabetes Study.

OBJECTIVE: Mexican-American populations in San Antonio, Texas (SA-MA) and Mexico have a higher prevalence of type 2 diabetes than non-Hispanic whites in San Antonio (SA-NHW). However, the higher prevalence of type 2 diabetes in Mexican-origin populations might be related, in part, not to Native American genetic admixture but to Spanish genetic admixture. RESEARCH DESIGN AND METHODS: Four population-based epidemiological surveys conducted with Mexican-origin and European-origin samples provided data relevant to this question. In all four surveys, type 2 diabetes was defined as fasting plasma glucose > or =7.0 mmol/l or 2-h glucose > or =11.1 mmol/l or use of antidiabetic agents. RESULTS: A comparison of the two Mexican-origin populations showed that the age- and sex-adjusted prevalence of type 2 diabetes was lower in Mexico than in SA-MA (15.1 vs. 17.9%, P = 0.032). Between the two European-origin populations, the prevalence of type 2 diabetes was lower in SA-NHW than in Spain (6.2 vs. 9.1%, P < 0.0001), but differences were attenuated by adjustment for BMI or after stratification by education. In logistic regression analyses, type 2 diabetes was associated with Mexican ethnic origin after adjusting for age, education, BMI, and waist-to-hip ratio. CONCLUSIONS: The prevalence of type 2 diabetes in Spain was intermediate between that in Mexican-origin populations and SA-NHW. Although the higher degree of Native American admixture is a major contributor to the higher rates of type 2 diabetes, we cannot completely rule out a partial contribution of Spanish admixture to diabetes susceptibility among Mexican- origin populations.

Weight, physical activity, and smoking as determinants of insulinemia in adolescents.

BACKGROUND: It is known that insulinemia is the result of the interaction among several factors, such as weight, body fat pattern distribution, and physical activity as well as ethnicity. There is little information regarding this question among Mexican adolescents. The association among fasting insulin levels, weight, fat distribution, physical activity, and cigarette smoking was studied in Mexican adolescents. METHODS: Cross-sectional data were collected from 352 Mexican adolescents aged 14-19 years (response rate 41.5%). Fasting insulin levels were measured by microparticle enzyme immunoassay; body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) were determined using standardized techniques, while physical activity was determined by 7-day Stanford physical activity inventory. Cigarette smoking was defined as number of cigarettes/year. RESULTS: Increased BMI and waist circumference, low physical activity, younger age, and non-smoking were associated with high insulin levels. Non-smokers had higher fasting insulin levels compared to smokers (57.8 pmol +/- 1.84 vs. 49.7 pmol/L +/- 2.8; p = 0.034). However, adjusted odds ratio (OR) between insulin and smoking status was not significant. Multivariate analysis showed the following: insulin increased 1.06 pmol/L for each unit of change in BMI; increased 1.02 pmol/L for each unit of change in waist circumference; increased 1.16 pmol/L for non-smoking, and decreased 1.07 pmol/L for each 250 kcal/day of energy expenditure. CONCLUSIONS: Our results support the concept that Mexican adolescents who are overweight have abdominal fat distribution and physical inactivity, and significant hyperinsulinemia. The relationship between smoking and lower insulinemia found in this research warrants further study.

[Incidence and progression of diabetic retinopathy in low income population of Mexico City]. / Incidencia y progresión de la retinopatía diabética en población de nivel socioeconómico bajo de la Ciudad de México.

Diabetic retinopathy is one of the leading causes of preventable blindness in working age population. Diabetes mellitus and this microvascular complication affects frequently Mexican population and presents itself in severe clinical forms. There are no incidence studies of diabetic retinopathy in Mexico. The four year incidence and progression of diabetic retinopathy were investigated in low income diabetic patients of Mexico City. In the follow up phase we studied 164 patients, 76.6% of the patients studied at baseline, 63 were men and 101 women. All participants had a complete ophthalmological exam and seven field stereo photographs. All photographs were graded using internationally accepted criteria in the reading center of our institution. The four year incidence of any level of retinopathy was 22.5%. Worsening of retinopathy occurred in 20.6% and the proliferative diabetic retinopathy stage was reached in 4.5%. Incidence of diabetic retinopathy was associated to age at diagnosis of diabetes mellitus of less than 45 years and progression was associated to duration of disease of more than ten years. The four year incidence of macular edema was 8.8%. These data are important to plan strategies for prevention of blindness and the implementation of optimal care of diabetic patients in our country.

Prevalence of hypertension in a Mexican population according to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.

BACKGROUND: Hypertension in Mexico represents a challenging public health problem. The National Survey on Chronic Diseases published in 1993 reported that hypertension affects more than 10 million Mexicans. No information has been published regarding the prevalence of hypertension in Mexico using the new diagnostic criteria established by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). METHODS: The Mexico City Diabetes Study is a prospective study designed to estimate the prevalence and incidence of cardiovascular risk factors in a low-income area. The survey included 941 men and 1341 non-pregnant women aged 35-64 years. Blood pressure measurements were performed using a random zero sphygmomanometer. The diagnostic criteria for hypertension were those recommended by the JNC VI. RESULTS: The crude prevalence of hypertension was 17.2% and 18.1% in men and women, respectively. We found significant associations between hypertension and obesity, body fat distribution, very-low-density lipoprotein cholesterol, fasting and 2-h post-glucose in both sexes, and between hypertension and total cholesterol, low-density lipoprotein cholesterol and triglycerides levels in women. In 40% of hypertensive men and 23% of women, hypertension was undiagnosed and untreated. Of the previously diagnosed hypertensive individuals, 38% of men and 30% of women reported not taking antihypertensive medicine. The prevalence++ of associated risk factors in this population is 12.3% for tobacco consumption, 22.4% for diabetes, 49.8% for hypertriglyceridemia and 40.9% for hypercholesterolemia. CONCLUSIONS: Hypertension occurs in 18% of this population. There is a high prevalence of undiagnosed and untreated cases. Associated cardiovascular risk factors are highly prevalent.

Moderate-to-severe diabetic retinopathy is more prevalent in Mexico City than in San Antonio, Texas.

OBJECTIVE: To compare the prevalence of diabetic retinopathy (DR) between low-income Mexicans from Mexico City and Mexican-Americans from San Antonio, Texas. RESEARCH DESIGN AND METHODS: We designed a cross-sectional population-based study in low-income neighborhoods of Mexico City and San Antonio. The men and non-pregnant women included in the study had NIDDM and were between 35 and 64 years of age. Ophthalmologic evaluation was performed in 414 patients, 204 in San Antonio and 210 in Mexico City. Seven field standard stereophotographs of each eye were obtained, adapting the Early Treatment Diabetic Retinopathy Study protocol, and graded at the Fundus Photograph Reading Center of the University of Wisconsin. RESULTS: Early nonproliferative DR occurred in 37 (17.6%) and 39 (19.1%) patients in Mexico City and San Antonio, respectively. Moderate-to-severe nonproliferative DR occurred in 55 (26.2%) and 37 (18.1%) patients in Mexico City and San Antonio, respectively, and proliferative DR occurred in 12 (5.7%) and 7 (3.4%) patients in Mexico City and San Antonio, respectively. Using univariate and multivariate logistic regression analysis with DR as the dependent variable, age, duration of disease, and fasting glucose concentration were positively and significantly associated with retinopathy, whereas city, systolic blood pressure, and other selected metabolic variables were not. We defined moderate-to-severe DR to include the categories of moderate-to-severe nonproliferative and proliferative DR. For this combined category, Mexico City patients with diabetes had a significantly higher prevalence (P < 0.01) than those from San Antonio when analyzed by multiple logistic regression analysis (odds ratio for Mexico City/San Antonio, 1.72; 95% CI 1.10-2.70). CONCLUSIONS: Overall prevalence of DR is similar in both cities. However, moderate-to-severe DR is significantly higher in Mexico City.

A diabetic retinopathy screening program as a strategy for blindness prevention.

The most frequent cause of preventable blindness in adults, in the developed world, is diabetic retinopathy (DR). The early treatable phase of this complication is clinically silent. In order to institute effective laser photocoagulation and prevention of blindness, timely detection is crucial. Consequently there is a need for periodic funduscopic examinations of all diabetics. Due to the high prevalence of DM in Mexico most of the primary care facilities are limited. We present the results of a DR screening program (DRSP) using a mobile unit equipped with a fundus photography camera, parked outside of a clinic. We report the prevalence of the various stages of DR and clinical characteristics observed in this population as well as our experience working in such an environment. The study period was from September 1 to December 22, 1995. All the diabetics that presented for care to the clinic were identified and all other persons were invited to participate. A total of 231 participants were invited (112 men, 119 women). Non-stereo fundus photos of two retinal fields (macula and optic disk centered) were taken with technique and classification according to international standards. Response rate to the invitation was 95.3%. Mean age was 62.4 +/- 13 years and 63.5 +/- 10 years and duration of diabetes was 12.3 +/- 10.1 years and 11.0 +/- 7.5 years for men and women, respectively. DR was detected in 38% of the cases, of these only 5.6% have received treatment. DR was uncovered in 84.5% of the cases and was associated with duration of diabetes (p < 0.001 in men and p = 0.04 in women) and hyperglycemia (in men p < 0.005, only). DR has a high prevalence in this population and can be detected through a screening program which reveals undiagnosed high risk DR in an efficient, and standardized manner.

High prevalence of cholelithiasis in a low income Mexican population: an ultrasonographic survey.

The authors present the results of a population-based survey of cholelithiasis carried out in a low-income area of Mexico City using high-resolution gallbladder ultrasound. The purpose of the study was to estimate the prevalence and selected associated risk factors of cholelithiasis (CL). The population of the studied area was 15,532 subjects, of whom 3,505 (22.6%) were eligible for the baseline survey (men and non-pregnant women between 35-64 years of age). Of this group, 1,735 (76.03%, 702 men and 1,033 women) were located for a follow-up study. Ultrasonography was performed on all except for 100 subjects who had undergone previous cholecystectomy. Crude prevalence of CL was 14.1% (95% CI 12.5-15.5). The prevalence was 5.8% (95% CI 4.1-7.5) in men and 19.7% (95% CI 17.3-22.1) in women. Presence of gallstones was associated with age, sex (men p<0.006, women p<0.001), and multiparity (p<0.002). Centrality index in men and body mass index in women were positive and significantly associated with CL when compared with subjects without CL. High levels of fasting and post-glucose load insulin in women and men respectively were associated with CL. The authors conclude that the population of this study has a high prevalence of CL and confirm some known risk factors such as age, sex, BMI and multiparity. Proper assessment of the magnitude problem and characterization of potentially modifiable risk factors will play a major role in preventing this pathology.

Genetic basis of variation in carotid artery wall thickness.

BACKGROUND AND PURPOSE: Other than the documented associations of risk factors and carotid artery wall thickness, the genetic basis of variation in carotid artery intimal-medial thickness (IMT) is unknown. The purpose of this study was to examine the extent to which variation in common carotid artery (CCA) IMT and internal carotid artery (ICA) IMT are under genetic control. METHODS: The sibship data used for this analysis were part of an epidemiological survey in Mexico City. The CCA and ICA analyses were based on 46 and 44 sibships of various sizes, respectively. The CCA and ICA IMTs were measured with carotid ultrasonography. Using a robust variance decomposition method, we performed genetic analyses of CCA IMT and ICA IMT measurements with models incorporating several cardiovascular risk factors (eg, lipids, diabetes, blood pressure, and smoking) as covariates. RESULTS: After accounting for the effects of covariates, we detected high heritabilities for CCA IMT (h2 = 0.92 +/- 0.05, P = .001) and ICA IMT (h2 = 0.86 +/- 0.13, P = .029). Genes accounted for 66.0% of the total variation in CCA IMT, whereas 27.7% of variation was attributable to covariates. For ICA IMT, genes explained a high proportion (74.9%) of total phenotypic variation. The covariates accounted for 11.5% of variation in ICA IMT. CONCLUSIONS: Our results suggest that substantial proportions of phenotypic variance in CCA IMT and ICA IMT are attributable to shared genetic factors.

Undiagnosed hypercholesterolemia: a serious health challenge. The Mexico City Diabetes Study.

In this report we present the results of a population based survey designed to characterize the prevalence of hypercholesterolemia (HCL: total cholesterol > or = 240 mg/dl) in a low income urban area of Mexico City (The Mexico City Diabetes Study). In an area of 15,532 inhabitants, 3505 (22.57%) were found to be study eligible (all 35-64 year-old men and nonpregnant women residing in the area permanently). A home interview was obtained in 2813 (80.26%) subjects. A physical exam and oral glucose tolerance test was performed on 2282 (81.2% of the individuals that gave the interview and 65.1% of all study eligibles, 941 men and 1341 women). The crude prevalence of HCL for men in this group was 12.3% and for women 12.5%. Severe HCL (total cholesterol > or = 260 mg/dl) was found in 6.6% of men and 6.5% of women. In the older age group (55-64 years) prevalence in women reached 21.1%. Of the individuals with HCL this abnormality was previously diagnosed in only 15.9% of men and in 7.8% of women. Despite having been diagnosed, the abnormality remained untreated in all cases. HCL was associated with higher mean systolic blood pressure (in women), higher mean diastolic blood pressure (in men) and higher mean fasting and 2 h post-glucose load glycemia as well as post-challenge insulinemia in both sexes. Mean TG was found high in both groups (with and without HCL), but in subjects with HCL the values were significantly higher. We conclude that HCL is very common in this population. The majority of the cases remained undiagnosed and of the small fraction of subjects that have been diagnosed, virtually none is under medical care. It is necessary to design and implement a national program to reduce the impact of this serious health problem.

Nephropathy in low income diabetics: the Mexico City Diabetes Study.

Among the most serious complications associated with diabetes mellitus (DM) is nephropathy (DN). In Mexico, there is little information on the frequency and clinical characteristics of DN in the Mexican population. We present results of a population-based survey designed to estimate the prevalence of DN. The low income population consisted of 15,532 inhabitants. All 35- to 64-year-old males and non-pregnant women residing in the survey area were identified as eligible for the study (3505; 22.6%). A home interview was obtained in 2810 (80.2%). A physical exam with oral glucose tolerance test was obtained in 2282 (81.2% of those interviewed). DM was diagnosed in 304 (crude rate 13.3%). Mean age for men and women with DM was 51.6 +/- 8.4 and 52.2 +/- 7.5, respectively. Duration of DM in men was 9.2 +/- 8.1 and in women, 7.3 +/- 6.7 years. Hypertension was diagnosed in 19.8% of men and 18.1% of women. Diabetic retinopathy of any level was found in 55.4% of men and 45.7% of women. Mean glycohemoglobin in men was 9.6 +/- 2.1 and in women 9.5 +/- 2.2% (normal 4-8%). At baseline, proteinuria (1+ or more, by dipstick) was found in 24.7% of men and 9.6% of women, microalbuminuria (MA) in 84.4% of men and 63.8% of women. Quantitative albuminuria was abnormally high in 54.7% of men and 40.3% of women. In the 203 diabetics studied with 24 h urine collection for creatinine clearance, normal renal function was found in 69.1% of men and 47.5% of women, reduced renal function was found in 26% of men and 50% of women, renal insufficiency was diagnosed in 4.9% of men and 1.6% of women. One patient was on dialysis and in a subsequent follow up, we found that 2.3% of the patients had died of renal failure, six men (46-63 years) and a woman of 62 years. We conclude that DN is a very serious threat to this population. The high case fatality rate associated with this condition maintains a low prevalence. It is important to develop a program to diminish the frequency of this condition.

Prevalence of gallbladder disease and associated clinical variables in a low income population of Mexico City.

We present the results of a population-based survey carried out in a low income area of Mexico City. The aim of this study is to characterize the prevalence of clinically significant gallbladder disease (CSGD) using the self-reported history of cholecystectomy (CG) or cholelithiasis (CL) demonstrated by cholecystography and/or ultrasonography. The population of the studied area was 15,532 inhabitants, of whom 3505 (22.6%) were age eligible (35-64 year-old men and non-pregnant women). Home interviews were obtained in 2810 (80.2%). A physical and laboratory examination was performed in 2282 individuals (65.1%; 941 men and 1341 women). The prevalence of CSGD in men was 2.0% (95% confidence intervals 1.1-2.9%) and 9.2% in women (95% confidence intervals 7.7-10.7%). Patients with CSGD were older, men (p < 0.003) and women (p < 0.001). Women with CSGD had higher waist to hip circumference ratio (p < 0.06), higher fasting glucose (p < 0.03) as well as 2 h post challenge glycemia (p < 0.04) and insulinemia (p < 0.03). In the multiple logistic regression model only age (p < 0.001) and sex (p < 0.001) remained significantly associated. We conclude that CSGD is quite prevalent in this population. It is associated with age in both genders and in women, higher glucose and insulin levels. The prospective follow-up of this cohort is important since it could generate the information needed to implement a preventive program to diminish the impact of this condition.

Differential impact of obesity in related populations.

To search for genetic and environmental determinants of obesity, we compared the prevalences and the impact of obesity in three populations from two cities: Mexican Americans (n = 820) and non-Hispanic whites (n = 1112) from San Antonio, Texas, and Mexicans from Mexico City (n = 1878). In the age range examined, 35-64 years, only Mexican men and women showed a significant increase in the prevalence of obesity with age. On the other hand, genetic ancestry, especially in women, made significant differences in the rates of obesity. Mexican Americans showed relatively high, and non-Hispanic whites low, rates of obesity. To discriminate between genetic and environmental influences mediating the impact of obesity on a set of hemodynamic and metabolic variables, we compared this impact between Mexican Americans and both non-Hispanic whites (same macro-environment, different gene pools), and Mexicans (same gene pool, different environments). We found that obesity always worsens the hemodynamic and metabolic profiles of individuals, but the magnitude of the effects may be variable. We showed that the levels of insulin concentrations for a given level of obesity were similar in Mexicans and Mexican Americans, suggesting that genetic influences predominate in determining insulin levels; the levels of triglycerides and HDL for a given level of obesity were similar in Mexican Americans and non-Hispanic whites, suggesting predominant environmental influences on lipid levels. On the other hand, the levels of glucose and systolic blood pressure for a given level of obesity were usually different between Mexican Americans and either of the other two populations, suggesting that these levels may result from genotype-by-environment interactions.

Myocardial infarction and cardiovascular risk factors in Mexico City and San Antonio, Texas.

Because the epidemiology of cardiovascular disease in Mexico is largely unknown, we examined the prevalence of cardiovascular risk factors and myocardial infarction (MI) in adults from low-income colonias in Mexico City. Data were collected as part of the Mexico City Diabetes Study, a population-based survey of diabetes and cardiovascular disease conducted between 1987 and 1992. Results were compared with those obtained from a comparable survey conducted previously among low-income Mexican Americans in San Antonio, Tex. A total of 2271 individuals between the ages of 35 and 64 years from Mexico City and 1143 adults of the same age range from San Antonio were studied. Despite being leaner and having lower levels of total cholesterol, Mexicans in Mexico City had markedly higher levels of triglycerides (P < .001) and lower levels of HDL cholesterol (P < .001) than Mexican Americans in San Antonio. MI was assessed by Minnesota-coded electrocardiograms and by a self-reported history of physician-diagnosed heart attack. In men, the prevalence of self-reported heart attack was significantly higher in San Antonio than in Mexico City (odds ratio, 5.85; P < .001), and in women, the prevalence of electrocardiogram-documented MI was significantly higher in San Antonio than Mexico City (odds ratio, 2.51; P < .001). The apparent excess of MI in San Antonio relative to Mexico City could be due to higher case-fatality in Mexico City or to a higher incidence in San Antonio.

Relationships between physical activity, insulin levels and lipids in non-diabetic low income residents of Mexico City: the Mexico City Diabetes Study.

The epidemiologic data supporting an association between physical activity and lipoprotein profile is controversial. We hypothesized that physical activity is positively associated with triglyceride levels and negatively associated with high density lipoprotein (HDL) cholesterol levels, and that these associations are mediated by insulin activity. We tested these hypotheses in 819 male and 1159 female healthy non-diabetic Mexicans, aged 35-64 years, residing in Mexico City. Physical activity was assessed using a modified Stanford 7-day Physical Activity Recall. Serum glucose and insulin were evaluated in the fasting state and 2 h following a glucose challenge. Crude analysis indicated that physical activity was not associated with HDL cholesterol in males, but was associated with HDL cholesterol in females (r = 0.06; p = 0.025). Physical activity was not associated with triglyceride concentration in males or females. Multivariate results showed that the positive association between HDL cholesterol and physical activity in women remained after controlling for age, estrogen status, body mass index, and smoking. Furthermore, there was a significant interaction between physical activity, HDL cholesterol and an index of insulin sensitivity. Women with higher levels of insulin sensitivity had higher levels of HDL cholesterol. However, among women at lower levels of insulin sensitivity, those with greater physical activity were significantly more likely to have higher HDL cholesterol values.

The insulin resistance syndrome in Mexico. Prevalence and clinical characteristics: a population based study.

The insulin resistance syndrome (IRS) is recognized as a harbinger of serious morbidity and high mortality. No published data on the prevalence of the IRS in the Mexican population exist. We estimated the prevalence of the IRS in an area that had 15,532 inhabitants, 3505 (22.6%) of whom were eligible (35-64 years of age, men and non-pregnant women). Interviews were obtained on 2810 (80.2%), a physical and laboratory examination with oral glucose tolerance test, insulin determinations and lipid profile was performed on 2282 individuals, 81.2% of those interviewed, 65.1% of eligibles. The IRS was defined as the coexistence of the triad: hypertension, glucose intolerance (diabetes or impaired glucose tolerance) and dyslipidemia (triglycerides > or = 200 mg/dl and HDL < 35 mg/dl). Using this diagnostic criteria the prevalence of IRS in the general population was 2.97% for men and 3.21% for women. In subjects with impaired glucose tolerance (IGT), the IRS was identified in 11.7%. In diabetics, IRS occurred in 13.7%. Subjects with IRS (IGT and diabetics) were significantly more obese (BMI 30 +/- 4.3 vs. 28.4 +/- 4.2 kg/m2 p < 0.001), had central upper body fat pattern distribution (sub/tri skinfolds 1.66 +/- 1.1 vs. 1.5 +/- 0.7 p < 0.02), (waist/hip circumferences 1 +/- 0.07 vs. 0.97 +/- 0.07 p < 0.001) and hyperinsulinemia fasting and post glucose load (25 +/- 17 vs. 15 +/- 13 p < 0.001, 157 +/- 92 vs. 85 +/- 72 p < 0.001, respectively). We conclude that the prevalence of IRS is high, individuals with IRS in Mexico have an anthropometric profile characterized by central, upper body obesity. A significant proportion of the patients with IGT and DM are at the highest cardiovascular risk.

Carotid artery atherosclerosis in a Mexico City population with high carbohydrate intake.

We present the results of a population based survey designed to estimate the prevalence and clinical characteristics of carotid artery atherosclerosis (CAS) diagnosed using vascular ultrasonography (VUS) in a low income area of Mexico City encompassing six neighborhoods that we previously studied. We attempted to locate all the non-diabetic participants of the first two neighborhoods (n = 834) and all diabetics from the six neighborhoods (n = 304). We located 1078 (94.7%) participants and examined 770 (71.4%). All study subjects were men and non-pregnant women between 35-64 years of age and had standardized VUS protocol. In men, the prevalence of CAS was 16.29%, in women the prevalence was 12.3%. CAS was significantly associated in both sexes to age (p < 0.001) and systolic blood pressure (p < 0.001). The ratio of the subscapular to triceps skinfolds was significantly higher in men with CAS (p < 0.04). In women, fasting glucose was higher in subjects with CAS (p < 0.04). The lipid profile was similar in men with and without CAS. However, women with CAS had significantly higher total cholesterol (p < 0.001), LDL cholesterol (p < 0.002), VLDL cholesterol (p < 0.092) and mean TG (p < 0.033). The percent of patients with hypertension, tobacco use, myocardial infarction and diabetic retinopathy of any degree was significantly higher in the subjects with CAS. CAS of any degree was observed in 12.4% of the non-diabetic population and 18.13% of the diabetics.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of hypertension in Mexico City and San Antonio, Texas.

BACKGROUND: Few data are available on the prevalence of hypertension in Mexico. METHODS AND RESULTS: We compared the prevalence of mild hypertension (systolic blood pressure > or = 140 mm Hg and/or diastolic blood pressure > or = 90 mm Hg and/or use of antihypertensive medications) in 1500 low-income Mexican Americans who participated in the San Antonio Heart Study and 2280 low-income Mexicans who participated in the Mexico City Diabetes Study. The crude prevalence of mild hypertension was 17.1% in Mexican men versus 24.4% in Mexican American men (P = .001) and 17.4% in Mexican women versus 22.0% in Mexican American women (P = .005). After adjustment for age, body mass index (BMI), waist-to-hip ratio (WHR), non-insulin dependent diabetes mellitus (NIDDM), educational attainment, and percent native American genetic admixture (Caucasian and native American), the odds ratio (Mexico City/San Antonio) was 0.55 (95% CI, 0.39, 0.77; P < .001) in men and 0.81 (CI, 0.54, 1.12; P = .201) in women. In a pooled model including both men and women, the odds ratio was 0.67 (95%, CI, 0.53, 0.84; P < .001). In the pooled model, city, age, female sex, NIDDM, BMI, WHR, and low educational attainment were significantly related to the prevalence of hypertension. CONCLUSIONS: The causes for these differences in hypertension prevalence are not known but may reflect a less modernized lifestyle in Mexico City, including greater physical activity, less obesity, and the consumption of a high-carbohydrate, low-fat diet.

[The use of hospital services by diabetic patients: study in an open population]. / Utilización de servicios hospitalarios por pacientes diabéticos: estudio en poblacion abierta.

The results of a population based survey, carried on in a low income area of Mexico City, with a total population of 15,532 inhabitants, are presented. From these, 3,505 individuals were considered eligible (35-64 years of age and non pregnant women). A home interview was performed in 2,810 households (80.17%). Physical exam with oral glucose tolerance test was performed in 2,282 (65.10%) participants. A total of 340 patients were identified as type II diabetics (WHO criteria); 140 of them were males and 200 females. Impaired glucose tolerance (IG) was diagnosed in 376 subjects, 120 (12.78%) of whom were males and 256 (19.06%) females. Approximately three years after the first exam, an attempt was made to recontact all the participants. A home or telephone interview was obtained in 2,139 subjects; they were asked if they had been hospitalized in the past three years, their length of stay and the cause. Due to incomplete data 194 subjects were excluded from the analyses presented in this report. A total of 101 participants that had normal glucose tolerance were hospitalized (6.4%). Of the ones diagnosed as IG, 15 (5.45%) were hospitalized. Of the patients diagnosed as diabetics 31 (12.5%) were hospitalized. At least 30 per cent of this excess demand is potentially preventable, since it is related directly to decompensation of DM control. We identified the need to implement a mechanism for guaranteeing entrance of all patients diagnosed with IG to health facilities.(ABSTRACT TRUNCATED AT 250 WORDS)