[Not Available]. / Threshold values of sagittal abdominal diameter for the detection of cardio-metabolic risk factors in Northeastern Mexico: a cross-sectional study.

BACKGROUND: The use of sagittal abdominal diameter (SAD) has been proposed for screening cardio-metabolic risk factors; however, its accuracy can be influenced by the choice of thresholds values. AIM: To determine the SAD threshold values for cardio-metabolic risk factors in Mexican adults; to assess whether parallel and serial SAD testing can improve waist circumference (WC) sensitivity and specificity; and to analyze the effect of considering SAD along with WC and body mass index (BMI) in detecting cardio-metabolic risk. METHODS: This cross-sectional study was conducted during 2012-2014 in Northeast Mexico (n = 269). Data on anthropometric, clinical, and biochemical measurements were collected. Sex-adjusted receiver-operating characteristic curves (ROC) were obtained using hypertension, dysglycemia, dyslipidemia and insulin resistance as individual outcomes and metabolic syndrome as a composite outcome. Age-adjusted odds ratios and 95% confidence intervals (CI) were estimated using logistic regression. RESULTS: The threshold value for SAD with acceptable combination of sensitivity and specificity was 24.6 cm in men and 22.5 cm in women. Parallel SAD testing improved WC sensitivity and serial testing improved WC specificity. The co-occurrence of high WC/high SAD increased the risk for insulin resistance by 2.4-fold (95% CI: 1.1-5.3), high BMI/high SAD by 4.3-fold (95% CI: 1.7-11.9) and SAD alone by 2.2-fold (95% CI: 1.2.-4.2). CONCLUSIONS: The use of SAD together with traditional obesity indices such as WC and BMI has advantages over using either of these indices alone. SAD may be a powerful screening tool for interventions for high-risk individuals.

Threshold values of sagittal abdominal diameter for the detection of cardio-metabolic risk factors in Northeastern Mexico: a cross-sectional study / Valores de corte del diámetro sagital del abdomen para la detección de factores de riesgo cardiovascular en el noreste mexicano: estudio transversal

Background: The use of sagittal abdominal diameter (SAD) has been proposed for screening cardio-metabolic risk factors; however, its accuracy can be influenced by the choice of thresholds values. Aim: To determine the SAD threshold values for cardio-metabolic risk factors in Mexican adults; to assess whether parallel and serial SAD testing can improve waist circumference (WC) sensitivity and specificity; and to analyze the effect of considering SAD along with WC and body mass index (BMI) in detecting cardio-metabolic risk. Methods: This cross-sectional study was conducted during 2012-2014 in Northeast Mexico (n = 269). Data on anthropometric, clinical, and biochemical measurements were collected. Sex-adjusted receiver-operating characteristic curves (ROC) were obtained using hypertension, dysglycemia, dyslipidemia and insulin resistance as individual outcomes and metabolic syndrome as a composite outcome. Age-adjusted odds ratios and 95% confidence intervals (CI) were estimated using logistic regression. Results: The threshold value for SAD with acceptable combination of sensitivity and specificity was 24.6 cm in men and 22.5 cm in women. Parallel SAD testing improved WC sensitivity and serial testing improved WC specificity. The co-occurrence of high WC/high SAD increased the risk for insulin resistance by 2.4-fold (95% CI: 1.1-5.3), high BMI/high SAD by 4.3-fold (95% CI: 1.7-11.9) and SAD alone by 2.2-fold (95% CI: 1.2.-4.2). Conclusions: The use of SAD together with traditional obesity indices such as WC and BMI has advantages over using either of these indices alone. SAD may be a powerful screening tool for interventions for high-risk individuals (AU)

Introducción: el diámetro sagital del abdomen (SAD) se ha usado para detectar factores de riesgo cardiometabólicos; su precisión se ve afectada por los valores de corte. Objetivo: determinar valores de corte para factores de riesgo cardiometabólicos en mexicanos adultos; evaluar la sensibilidad y especificidad cuando se utiliza en serie o en paralelo con la circunferencia de la cintura (WC); y analizar el uso del SAD individualmente o junto a WC o el índice de masa corporal (IMC) para detectar factores de riesgo cardiometabólicos. Métodos: en forma transversal, de 2012 a 2014 se estudiaron 209 sujetos provenientes del noreste mexicano. Se recopilaron datos antropométricos, clínicos y bioquímicos. Se construyeron curvas ROC ajustadas por sexo utilizando como resultado individual hipertensión, disglicemia y resistencia a la insulina y como resultado compuesto, el síndrome metabólico. Se calcularon razón de momios e intervalos de confianza (IC 95%) mediante regresión logística. Resultados: los valores de corte fueron 24,6 cm en hombres y 22,5 cm en mujeres. El SAD en paralelo con la WC mejoró sensibilidad y en forma seriada, la especificidad de WC. La coocurrencia de WC y SAD por encima de los rangos incrementó el riesgo para resistencia a la insulina 2,4 veces (95% CI: 1,1-5,3); BMI y SAD elevados, 4,3 veces (95% CI: 1,7-11,9) y SAD individualmente, 2,2 veces (95% CI: 1,2-4,2). Conclusiones: utilizar el SAD junto a índices tradicionales de obesidad (WC y BMI) tiene ventajas sobre su uso individual. El SAD puede ser una poderosa herramienta de tamizaje para intervenciones en individuos de alto riesgo (AU)

Clinical coaching in primary care: Capable of improving control in patients with type 2 diabetes mellitus?

AIMS: Few clinical coaching studies are both endorsed by real cases and focused on reducing suboptimal diabetes control. We evaluated the effectiveness of coaching on improving type 2 diabetes goals after 3 years of implementation in primary care. METHODS: A cross-sectional study with follow up was conducted during 2008-2011. Coaching consisted of guiding family doctors to improve their clinical abilities, and it was conducted by a medical doctor trained in skill building, experiential learning, and goal setting. Effectiveness was assessed by means of fasting plasma glucose and glycosylated hemoglobin outcomes. The main analysis consisted of 1×3 and 2×3 repeated measures ANOVAs. RESULTS: A significant coaching×time interaction was observed, indicating that the difference in glucose between primary care units with and without coaching increased over time (Wilks' lambda multivariate test, P<0.0001). Coaching increased 1.4 times (95%CI 1.3, 1.5) the possibility of reaching the fasting glucose goal after controlling for baseline values. There was also a significant improvement in glycosylated hemoglobin (Bonferroni-corrected p-value for pairwise comparisons, P<0.0001). CONCLUSIONS: A correctible and even preventable contributing component in diabetes care corresponds to physicians' performance. After 3 years of implementation, coaching was found to be worth the effort to improve type 2 diabetes control in primary care.

Prediabetes, diabetes, and risk of breast cancer: a case-control study.

BACKGROUND AND AIMS: Although underlying mechanisms have been described to account for the association between prediabetes and diabetes with breast cancer, reported results have been inconsistent. We undertook this study to determine whether prediabetes and diabetes are risk factors for breast cancer in Mexican women with no family history of breast cancer in the mother, daughters, or sisters. METHODS: A case-control study was carried out during 2011-2013. "Case" referred to patients with a histopathological diagnosis of breast cancer (incident and primary cases) (n = 240); "controls" were those with a BI-RADS 1 or 2 mammography result (n = 406). Categorization of prediabetes and diabetes was based on self-reporting or fasting glucose and glycated hemoglobin blood sampling results. Reproductive and sociodemographic data were collected by interview. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated using multivariate unconditional binary logistic regression analysis. RESULTS: Prediabetes increased the risk of breast cancer in postmenopausal women (adjusted OR 2.08, 95% CI 1.10-3.96) as did diabetes (adjusted OR 2.85, 95% CI 1.55-5.26). A history of diabetes preceding breast cancer by ≥7 years and <7 years were both associated with an increased risk for breast cancer (adjusted OR 2.80, 95% CI 1.40-5.60 and 3.00, 95% CI 1.50-5.90, respectively). CONCLUSIONS: This is the first study in Mexico evaluating prediabetes and diabetes as breast cancer risk factors in women with no first-degree relatives with breast cancer. Our findings suggest that women with prediabetes and diabetes should be considered a more vulnerable population for early breast cancer detection.

[Estimation of overweight and obesity in preschoolers according to national and international normativity]. / Estimación de sobrepeso y obesidad en preescolares. Normatividad nacional e internacional.

BACKGROUND: Prevalence of overweight and obesity in children under 5 years can be affected by type of anthropometric indicator and selected threshold values. We assessed variation on estimates according to national and international regulations (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 and GPC-IMSS-029-08; WHO-2006, CDC-2000 and IOTF, respectively). METHODS: Cross-sectional study in all the daycare centers (100 %) affiliated to Instituto Mexicano del Seguro Social-Nuevo León during June-December, 2010 (n = 11 141 children). Overweight and obesity were defined on the basis of each regulation, and total and stratified prevalences by age and sex were estimated. RESULTS: According to national regulation, overweight/obesity estimates varied from 12 to 22 %, and to international normativity, from 3 to 14 %. The highest prevalence was given by NOM-008-SSA3-2010 and GPC-SSA-025-08; and the lowest by WHO-2006. There were no differences by sex, but they existed by age; the highest discrepancy occurred in the 3.0-3.9 age group with 28 %. CONCLUSION: Health personnel and health policy makers should be aware of variation on estimates according to the definition employed. We recommend to standardize national regulation for pointing out overweight/obesity in preschoolers.

INTRODUCCIÓN: la prevalencia de sobrepeso/obesidad en menores de 5 años se puede ver afectada por tipo de indicador antropométrico y punto de corte aplicado. Se evaluó la variación en las estimaciones según la normatividad nacional (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 y GPC-IMSS-029-08) y la internacional (OMS-2006, CDC-2000 e IOTF). MÉTODOS: estudio transversal en 100 % de guarderías afiliadas al Instituto Mexicano del Seguro Social-Nuevo León durante junio-diciembre de 2010 (n = 11 141 infantes). Se definió sobrepeso y obesidad con base en cada normatividad y se estimaron las prevalencias totales y estratificadas por edad y sexo. RESULTADOS: de acuerdo con la normatividad nacional, el sobrepeso/obesidad varió entre 12 y 22 %; y con la normatividad internacional, entre 3 y 14 %. La mayor prevalencia fue con la NOM-008-SSA3-2010 y GPC-SSA-025-08; y la menor, con OMS-2006. No hubo diferencias por sexo, pero sÍ por edad; la mayor discrepancia ocurrió en niños entre 3.0 y 3.9 años, con 28 puntos porcentuales. CONCLUSIÓN: el personal y las personas relacionadas con la generación de políticas de salud tienen que estar conscientes de la variación de las estimaciones según la definición utilizada. Se recomienda estandarizar la normatividad nacional para señalar sobrepeso/obesidad en preescolares.

[Prevalence of overweight and obesity in children from Monterrey, Nuevo León]. / Prevalencia de sobrepeso y obesidad en niños de Monterrey, Nuevo León.

BACKGROUND: Pediatric obesity is a major health problem around the globe. It has increased in the last decades up to 30 % (in 2010). The aim of this study was to establish the prevalence of overweight and obesity in children from zero to 14 years from three family medicine units and one school. METHODS: A prospective study of prevalence, which included children of both sexes who assisted to three family medicine units and a junior high school. We assessed the somatometry and compared it in accordance to the World Health Organization 2006-2007 references and standards. RESULTS: The overall overweight and obesity prevalence in 1624 children was 45.5 % (15.5 % of overweight and 29.9 % of obesity, respectively). A total of 354 of 840 women (42.1 %) and 385 of 784 men (49 %) had overweight and obesity (p < 0.05). In both sexes, we did not observed a difference in overweight (15.7, women; 15.4, men). However, with regards to obesity, women showed 26.4 versus 33.6 of men (p < 0.05). We observed only one family unit with major obesity prevalence, which probably had an initial overestimation. CONCLUSIONS: We found one of the highest prevalences of overweight and obesity in children at a national level: up to 45 % in a state of Mexican northwestern. Obesity doubled overweight, and it was almost 10 % higher in men than in women.

INTRODUCCIÓN: la obesidad infantil es un problema de salud pública mundial y se ha incrementado en forma alarmante en las últimas décadas hasta en 30 % en el 2010. El objetivo de este estudio fue establecer la prevalencia de sobrepeso y obesidad en niños de cero a 14 años de tres unidades de medicina familiar (UMF). MÉTODOS: estudio prospectivo, de prevalencia, que incluyó a niños de ambos sexos que acudieron a tres UMF y una escuela primaria. Se evaluó la somatometría y se comparó de acuerdo con estándares y referencias de crecimiento de la Organización Mundial de la Salud (OMS) 2006-2007. RESULTADOS: la prevalencia de sobrepeso y obesidad en todo el grupo fue de 45.5 % en los 1624 niños de 0 a 14 años (15.5 %, sobrepeso; 29.9 %, obesidad). Un total de 354 de 840 mujeres (42.1 %) y 385 de 784 hombres (49 %) tuvieron sobrepeso u obesidad (p < 0.05). En las mujeres no se observó diferencia en cuanto a sobrepeso en relación con los hombres (15.7 frente a 15.4 %), pero sí en relación con la obesidad: 26.4 frente a 33.6 % (p < 0.05). Solo se observó una de las UMF con mayor prevalencia de obesidad, lo que probablemente se relacione con un sesgo de sobrerregistro. Conclusiones: se encontró una de las prevalencias de sobrepeso y obesidad infantiles más altas reportadas a nivel nacional, hasta en 45 %, en un estado del noreste mexicano. La obesidad fue dos a uno mayor al sobrepeso y casi 10 % mayor en hombres que en mujeres.

Obesidad central única y combinada con sobrepeso/obesidad en preescolares mexicanos

La circunferencia de cintura (CC) constituye una herramienta útil para identificar niños con mayor riesgo de complicaciones relacionadas con grasa abdominal. Se determinó la magnitud de obesidad central, única y combinada con sobrepeso/obesidad en infantes 1-5 años de edad. También se identificaron valores percentilares suavizados de CC específicos para edad y sexo, y se compararon con datos disponibles de otros países. Se realizó un estudio transversal en niños de 8 guarderías en Monterrey, México (n=903; 431 niños y 472 niñas). Debido a que el riesgo por obesidad abdominal inicia con CC en percentil 75, se consideraron dos puntos de corte, percentil 75 y 90. Se definió sobrepeso con base en índice de masa corporal para edad y sexo en percentil 85-94; y obesidad, en percentil ≥95. El análisis consistió de prevalencias puntuales e intervalos de confianza de 95%. El software LMS Chart Maker Light se utilizó para suavizar los valores percentilares de CC. La media de edad de la población fue 2,7±1,0 años. Los mexicanos registraron diferencias de 1 cm de CC más que los afro-americanos; y hasta 4 cm menos que los méxico-norteamericanos. La combinación de obesidad central con CC percentil ≥75 con sobrepeso/obesidad, fue 25,1% (IC95% 22,3-28,0) y única 15,4% (IC95% 13,0-17,8). La prevalencia de obesidad abdominal única con CC percentil ≥90, fue de 4.4% (IC95% 3.0, 5.8). Las estancias infantiles representan una oportunidad para desafiar la obesidad central. La CC puede ser utilizada desde edad temprana para tamizaje y atención a niños con mayor riesgo cardiovascular.

Central: single and combined with overweight/ obesity in preeschool Mexican children. Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n=903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile ≥75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile ≥95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7±1.0 years. Mexican children’s WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95%CI 22.3-28.0) and single, 15.4% (95CI% 13.0- 17.8). Prevalence of single abdominal obesity with WC at percentile ≥90 was 4.4% (IC95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.

[Single central obesity and combined with overweight/obesity in preeschool Mexican children]. / Obesidad central única y combinada con sobrepesolobesidad en preescolares mexicanos.

Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n = 903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile > or = 75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile > or = 95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7 +/- 1.0 years. Mexican children's WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95% CI 22.3-28.0) and single, 15.4% (95 CI% 13.0-17.8). Prevalence of single abdominal obesity with WC at percentile > or = 90 was 4.4% (IC 95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.