High adiponectin concentrations are associated with the metabolically healthy obese phenotype.

CONTEXT: In the ob/ob mice, keeping adiponectin concentrations in the physiological range (through overexpression of this gene in the adipose tissue) results in expansion of fat mass and protection against metabolic co-morbidities. OBJECTIVE: The aim of the study was to test in humans whether plasma adiponectin levels, similar to those found in lean subjects, are associated with the metabolically healthy obese phenotype. DESIGN AND SETTING: A cross-sectional analysis was performed of a cohort of obese and nonobese subjects aged 18-70 yr. A medical history was taken, and glucose, plasma lipids, and total adiponectin were measured. PARTICIPANTS: We studied 189 men and 527 women. The majority were obese (n = 470, 65.6%). The metabolically healthy obese phenotype was found in 38 men and 133 women. This is defined as a body mass index (BMI) above 30 kg/m(2) plus high-density lipoprotein cholesterol of at least 40 mg/dl in the absence of type 2 diabetes and arterial hypertension. RESULTS: Twenty percent of the cases with a BMI above 40 kg/m(2) had adiponectin concentrations above the median value of normal BMI subjects. Adiponectin levels above 12.49 mg/liter in obese women (odds ratio, 3.02; 95% confidence interval, 1.95-4.67; P < 0.001) and above 8.07 mg/liter in obese men (odds ratio, 2.14; 95% confidence interval, 1.1-4.06; P = 0.01) increased the probability of being metabolically healthy. The association remained significant (beta, 0.673 +/- 0.205, P < 0.001) in a logistic regression model (r(2) = 0.25, P < 0.001) after controlling for the confounding effect of age, insulin, and waist circumference. CONCLUSIONS: Certain obese individuals have adiponectin levels similar to those found in normal BMI subjects; this is associated with the metabolically healthy obese phenotype.

The ATP-binding cassette transporter A1 R230C variant affects HDL cholesterol levels and BMI in the Mexican population: association with obesity and obesity-related comorbidities.

Although ATP-binding cassette transporter A1 (ABCA1) is well known for its role in cholesterol efflux and HDL formation, it is expressed in various tissues, where it may have different functions. Because hypoalphalipoproteinemia is highly prevalent in Mexico, we screened the ABCA1 coding sequence in Mexican individuals with low and high HDL cholesterol levels to seek functional variants. A highly frequent nonsynonymous variant (R230C) was identified in low-HDL cholesterol but not in high-HDL cholesterol individuals (P = 0.00006). We thus assessed its frequency in the Mexican-Mestizo general population, seeking possible associations with several metabolic traits. R230C was screened in 429 Mexican Mestizos using Taqman assays, and it was found in 20.1% of these individuals. The variant was significantly associated not only with decreased HDL cholesterol and apolipoprotein A-I levels but also with obesity (odds ratio 2.527, P = 0.005), the metabolic syndrome (1.893, P = 0.0007), and type 2 diabetes (4.527, P = 0.003). All of these associations remained significant after adjusting for admixture (P = 0.011, P = 0.001, and P = 0.006, respectively). This is the first study reporting the association of an ABCA1 variant with obesity and obesity-related comorbidities as being epidemiologically relevant in the Mexican population.

[Fecal incontinence in the elderly]. / Incontinencia fecal en adultos mayores.

UNLABELLED: Fecal incontinence (FI) is a devastating condition that affects quality of life. Age and gender are related with the prevalence of FI. In adults, prevalence varies from 2% to 7%. It is more frequent in women than in men (3:1) and is more prevalent in elderly patients. There are no studies in Mexico that evaluate the frequency of FI in adults older than 60 years. AIM: To investigate the FI frequency, severity and associated factors in patients > or = 60 years. PATIENTS AND METHODS: Three groups of patients were included: a) Group I: consecutive outpatients patients from the Gastroenterology and Geriatrics Clinics of the INCMNSZ; b) Group II: INCMNSZ inpatients admitted due to a non-related condition with FI; c) Group III: Reyna Sofia nursing home residents (NHR) in Mexico City. A structured questionnaire was used to obtain demographic data, comorbidity and associated factors with FI. Grade of FI was assessed with the Wexner scale. RESULTS: 159 patients were included, 89 (56%) were women. Mean age was 75 years (range 59-98). There were 54 patients in group I, 50 in group II and 55 in group III. Overall frequency of FI was 33% (n = 53). Frequency of FI was 26% in group 1, 20% in group II and 53% in group III. Sixty six percent (n = 35) of the FI cases were female. Neuropsychiatric disorders were associated to FI in 29 patients (54%) and diabetes mellitus in 17 (32%). Eighty percent of patients wore disposable pads for FI. Urinary incontinence was associated to FI in 31 (58%). Thirteen (24%) patients had mild FI, 20 (38%) moderate, and 20 (38%) severe FI. The severity score for FI was lower in groups I and II (8.1 y 9.7) than in group III (18, p = 0.001). Age in patients with mild FI was significantly lower (73 years) than in patients with severe FI (83y, p = 0.01). CONCLUSIONS: FI in patients older than 60 years old is a very common condition. FI was more frequent and severe in women, in NHR and in those with neuropsychiatric disorders. Urinary incontinence was associated in half of patients with FI.

Incontinencia fecal en adultos mayores / Fecal incontinence in the elderly

Fecal incontinence (FI) is a devastating condition that affects quality of life. Age and gender are related with the prevalence of FI. In adults, prevalence varies from 2% to 7%. It is more frequent in women than in men (3:1) and is more prevalent in elderly patients. There are no studies in Mexico that evaluate the frequency of FI in adults older than 60 years. Aim. To investigate the FI frequency, severity and associated factors in patients ≥ 60 years. Patients and methods. Three groups of patients were included: a) Group I: consecutive outpatients patients from the Gastroenterology and Geriatrics Clinics of the INCMNSZ; b) Group II: INCMNSZ inpatients admitted due to a non-related condition with FI; c) Group III: Reyna Sofia nursing home residents (NHR) in Mexico City. A structured questionnaire was used to obtain demographic data, comorbidity and associated factors with FI. Grade of FI was assessed with the Wexner scale. Results. 159 patients were included, 89 (56%) were women. Mean age was 75 years (range 59-98). There were 54 patients in group I, 50 in group II and 55 in group III. Overall frequency of FI was 33% (n = 53). Frequency of FI was 26% in group I, 20% in group II and 53% in group III. Sixty six percent (n = 35) of the FI cases were female. Neuropsychiatric disorders were associated to FI in 29 patients (54%) and diabetes mellitus in 17 (32%). Eighty percent of patients wore disposable pads for FI. Urinary incontinence was associated to FI in 31 (58%). Thirteen (24%) patients had mild FI, 20 (38%) moderate, and 20 (38%) severe FI. The severity score for FI was lower in groups I and II (8.1 y 9.7) than in group III (18, p = 0.001). Age in patients with mild FI was significantly lower (73 years) than in patients with severe FI (83y, p = 0.01). Conclusions. FI in patients older than 60 years old is a very common condition. FI was more frequent and severe in women, in NHR and in those with neuropsychiatric disorders. Urinary incontinence was associated in half of patients with FI.

La incontinencia fecal (IF) es una condición que afecta la calidad de vida del enfermo. La prevalencia está relacionada con la edad y el género. Afecta de 2 a 7% de los adultos y es tres veces más frecuente en mujeres que hombres. En personas mayores de 65 años la frecuencia de IF se incrementa y varía según la población estudiada. En México no existen estudios que evalúen la frecuencia de IF en los adultos mayores. Objetivo. Investigar la frecuencia, gravedad y factores asociados a la IF en tres poblaciones de pacientes adultos mayores de 60 años. Pacientes y métodos. Se realizó un estudio descriptivo en el cual se evaluaron tres poblaciones de pacientes adultos > de 60 años: a) Grupo I, pacientes consecutivos que acudieron a la consulta externa de Gastroenterología y Geriatría del INCMNSZ; b) Grupo II, pacientes hospitalizados en el INCMNSZ por motivos diferentes a la IF; y c) Grupo III, pacientes residentes del asilo Reina Sofía de la Ciudad de México. Mediante un cuestionario estructurado se investigaron datos demográficos, tiempo de evolución, comorbilidad y factores asociados a la IF. El grado de IF se evaluó mediante la escala de Wexner modificada por Kamm. Resultados. Se evaluaron 159 pacientes, 89 (56%) mujeres. La edad promedio fue de 75 años (rango 59-98). Hubo 54 pacientes en el grupo I, 50 en el grupo II y 55 en el grupo III. Cincuenta y tres pacientes (33%) presentaron IF. La frecuencia de IF fue de 26% en el grupo I, de 20% en el grupo II y de 53% en el grupo III. De los casos con IF, 66% (n = 35) fueron mujeres. Veintinueve pacientes (54%) tuvieron trastornos neuropsiquiátricos asociados y 17 (32%) diabetes mellitus. De los pacientes, 80% utilizaron pañal. La incontinencia urinaria estuvo presente en 31 (58%) pacientes. De acuerdo con la escala de gravedad, 13 (24%) pacientes tuvieron IF leve, 20 (38%) moderada y 20 (38%) tuvieron IF grave. Los pacientes de los grupos I y II tuvieron puntuaciones menores en la escala de gravedad (8.1 y 9.7) que los pacientes del grupo III (18, p = 0.001). Los pacientes con IF leve tuvieron un promedio de edad menor (73 años) que los pacientes con IF grave (83 años, p = 0.01). Conclusiones. La frecuencia de IF en pacientes adultos mayores es elevada y afecta a la mitad de los pacientes residentes de un asilo. El grado de IF es más grave en las mujeres, en los pacientes residentes de un asilo y con trastornos neuropsiquiátricos. La incontinencia urinaria se asoció a IF en más de la mitad de los pacientes.