[show abstract][hide abstract] ABSTRACT: It is well known that infections in patients with diabetes mellitus are more severe, although there is controversy for increased susceptibility to them. Non-specific immune response mechanisms could be related to defense and/or susceptibility to pathogens. The aim of this study was to investigate the activity of several enzymes involved in the primary host defense mechanisms in non-insulin dependent diabetes mellitus (NIDDM). Twenty NIDDM females with a mean HbA(1c) level of 8.19% were included. No patient had clinical evidence of infection. As controls 20 healthy females were studied. The enzymes tested were dipeptidyl-peptidase I (DPP-I), cathepsin B and D, NADPH oxidase and superoxide dismutase (oxidative burst) and collagenase. Isolated leukocytes were incubated with the specific substrates in pyrogen free conditions. The intracellular enzyme activity was analyzed by flow cytometry. Collagenase enzymatic activity was similar in the three leukocyte subpopulations studied. Oxidative burst induction in monocytes was comparable between both groups. Enzyme activity of cathepsin B and D in all cell subsets, oxidative burst in PMN cells, and DPP-I in lymphocytes and monocytes from patients, was higher than those from healthy females (P<0.05). Overall, our findings demonstrate an enhanced functional status of several intracellular leukocyte enzymes in NIDDM. Furthermore, the increased oxidative burst induction and the consequent production of free radicals, may contribute to vascular complications. Other mechanisms - either from the non-specific or specific immune response - deserve investigation to establish if diabetic patients are more susceptible to infectious diseases.
[show abstract][hide abstract] ABSTRACT: Urinalysis is one of the most common studies performed on the diabetic patient at every visit. The presence of leukocyturia is relatively common but it is not clear what the attitude of the physician toward this particular finding should be. The main objective of the present study was to investigate the clinical significance of leukocyturia in diabetic women.
Ninety-eight diabetic women (84.7% type 2) aged 57 +/- 13 years who were being seen at the diabetic out-patient clinic were randomly selected. All patients underwent a clinical and gynecologic examination and a urinalysis. A Papanicolaou smear and a urine culture were also obtained.
The overall prevalence of leukocyturia (>5 cells/high power field (hpf)) was 46.5%. Patients with urinary tract infections (UTI) were 7.5 times more likely to have leukocyturia, while a leukocyte count <5cells/hpf predicted the absence of UTI in 96% of the women. In the comparison of patients with and without leukocyturia, we found that proteinuria (p = 0.06) and bacteriuria (p <0.002) were more common in the women with leukocyturia. A significant association with leukorrhea was not demonstrated. The empirical use of antibiotics was 12 times more frequent in the patients with leukocyturia.
A urinary culture should be requested in all diabetic patients with leukocyturia. The possibility of a UTI is remote when leukocyturia is absent.
Archives of Medical Research 01/2000; 31(2):210-5. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the prevalence of obesity and its association to different variables in urban and rural older Mexican populations.
A cross-sectional study of three different Mexican communities. A total of 121 men and 223 women 60 years and older and 93 men and 180 women aged 35 to 59 years old were selected randomly for inclusion in the survey. A personal interview assessed demographic information, personal medical history and functional status and a 24-hour diet recall was obtained. The physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin and glucose.
Obesity was highly prevalent in women, in individuals from the urban communities and diminished with advancing age. A BMI > or =30 kg/m2 was observed in 23.6% younger vs. 15.6% older adult men (p=0.21) and 28.4% younger vs. 19.7% older adult women (p = 0.06). The association of obesity with other variables was estimated using a stepwise multivariate logistic regression, increased insulin levels [Odds Ratio (OR) 1.68, p=0.006] and living in an urban area (OR 5.90, p<0.007) were variables independently associated to obesity in adult older individuals. In the younger adults, obesity was associated with hypertension (OR 2.74, p<0.0009), higher insulin levels (OR 1.31, p<0.03) and central adiposity (OR 2.97, p = 0.05), these relationship were not observed with gender, distribution of food or alcohol intake or other coronary risk factors.
The present survey confirms the high prevalence of obesity in the Mexican urban population that declines with advanced age. Studies in elderly population must consider the bias produced by increased early mortality in those individuals with a more unfavorable risk profile.
Obesity research 08/1999; 7(4):402-6. · 4.95 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate the relationship between fasting insulin concentrations and several metabolic and anthropometric variables in the Mexico City population.
Cross-sectional, randomized, stratified by age, sex and economically active and inactive.
700 healthy adults, older than 20 years, 396 males and 304 females.
Body mass index, waist to hip ratio, systolic and diastolic blood pressure, insulin, glucose, triglycerides, total, HDL and LDL cholesterol and lipoprotein(a).
Means for age were 39 +/- 13 years for men and 41 +/- 12 for women (p < 0.05). In males, the mean values of body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, triglycerides, glucose and LDL-cholesterol : HDL-cholesterol increased significantly with higher insulin levels. A significant inverse tendency was observed for the mean concentrations of HDL-cholesterol and lipoprotein(a). Age, total cholesterol and LDL-cholesterol were not related to the insulin levels. A similar pattern was observed in women, significance, however, was only obtained for the body mass index, triglycerides, glucose, HDL-cholesterol and lipoprotein(a). Age-adjusted multiple regression analysis showed that insulin was directly and independently associated to triglyceride levels and inversely with lipoprotein(a) concentrations for both sexes, and with HDL-C, only in males.
The prevalence of insulin resistance related metabolic disorders was high in a random sample of the Mexico City population. Increased cardiovascular risk factors associated with the insulin resistance syndrome were observed with higher insulin levels, and lipoprotein(a) was inversely and significantly related to insulin. Preventive strategies are urgently needed to avoid the already increased incidence of morbidity and mortality associated to atherosclerotic disease.
International Journal of Obesity 04/1996; 20(4):311-8. · 5.22 Impact Factor
[show abstract][hide abstract] ABSTRACT: In Mexico, the incidence and prevalence of coronary heart disease (CHD) has increased over the past three decades and has become the leading cause of death in the country. Hypercholesterolemia is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to determine the mean total cholesterol values and the prevalence of hypercholesterolemia, an epidemiologic survey was carried out in a representative national population sample that included men and women aged 1 to 98 years. In this report, we present the findings in all individuals older than 20 years (n = 33,558). Considering the country as a whole, the mean serum total cholesterol (TC) was 4.80 +/- 1.16 mmol/l, the prevalence of borderline hypercholesterolemia (TC between 5.17 and 6.20 mmol/l) was 22.8% and the prevalence of high risk hypercholesterolemia (TC > or = 6.20 mmol/l) was 10.6%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 4.43 +/- 1.05 mmol/l in the south to 5.48 +/- 1.36 mmol/l in the north. The prevalence of high risk hypercholesterolemia was as high as 24.8% in Baja California Norte and as low as 4.0% in the state of Guerrero. These large differences in mean TC values are probably diet related and reinforce the need to carry out prospective and intervention trials related to CHD and its risk factors.
[show abstract][hide abstract] ABSTRACT: To determine the prevalence of diabetes and associated coronary risk factors in the Mexico City population.
A sample of 805 adults was selected from Mexico City. The participants, 20-90 years of age and living in the city, were selected by the method of multistage cluster sampling with proportional allocation. Diabetes was diagnosed by previous history or if fasting blood glucose was > or = 7.8 mmol/l ( > or = 7.8 mmol/l ( > or = 140 mg/dl).
The crude rate prevalence of NIDDM was 8.7%, with an age-adjusted rate of 10.6% for women and 6.0% for men. Age strongly influenced diabetes prevalence, with a chi 2 of risk tendency of 39.1 (P < 0.00005). A significant proportion (5.9%) of younger individuals (35-44 years of age) was affected by the disease. Diabetes was associated with advanced age, had a greater impact in the low-income group, and showed increased odds ratio for hypertension, dyslipidemias, and myocardial infarction in men and women and for obesity only in women.
There is a high prevalence of NIDDM in Mexico City that also strikes a significant group of younger individuals. Associated coronary risk factors are also common and more prevalent in diabetic individuals. Current epidemiological data in Mexico and Mexican-Americans in the U.S. suggest that we may be on the ascending limb for diabetes and cardiovascular disease. There is a critical need for resources to be allocated to programs for primary and secondary prevention, which must be well structured and organized so that proper standards of care are followed to prevent progression of the disease.
Diabetes Care 12/1994; 17(12):1441-8. · 7.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the effects of two controlled diets, one rich in oleic acid obtained from avocado and olive oil and the other rich in complex carbohydrates, on fasting and postprandial serum lipids and glycemic control in 12 women with NIDDM.
A randomized crossover study was designed. During a 4-week baseline period, all patients received the isocaloric diets recommended by the American Diabetes Association. After this period the patients were randomly assigned to receive the two study diets alternatively during two 4-week periods. One diet was high in monounsaturated fatty acids (HMUFA) and the other was high in complex carbohydrates (high-CHO). There also was a 4-week washout period in between the two 4-week periods during which the patients followed the American Diabetes Association's isocaloric diet. Blood samples were obtained before and after each dietary period.
Both diets had a minor hypocholesterolemic effect with no major changes in high-density lipoprotein cholesterol. The HMUFA diet was associated with a greater decrement in plasma triglycerides (20 vs. 7% in the high-CHO diet). Glycemic control was similar with both diets.
Partial replacement of complex digestible carbohydrates with monounsaturated fatty acids (avocado as one of its main sources) in the diet of patients with non-insulin-dependent diabetes mellitus improves the lipid profile favorably, maintains an adequate glycemic control, and offers a good management alternative.
Diabetes Care 05/1994; 17(4):311-5. · 7.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: In Mexico, the incidence and prevalence of coronary heart disease has increased over the past three decades and has become the leading cause of death in some areas of the country. Hypercholesterolemia (HC) is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to learn the mean total cholesterol values and the prevalence of HC, an epidemiologic survey was carried out in a representative population sample that included men and women aged 1 to 98 years, across the nation. In this report, we present the findings in children and teenagers of both sexes (n = 34369). Considering the country as a whole, the mean serum TC was 147 +/- 35 mg/dl, the prevalence of borderline hypercholesterolemia (TC between 170 and 199 mg/dl) was 14.7% and the prevalence of high risk hypercholesterolemia (TC > or = 200 mg/dl) was 6.7%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 133 mg/dl in the south to 164 mg/dl in the north. The prevalences of high risk hypercholesterolemia was as high as 18.2% in Baja California Norte and as low as 2.5% in the state of Morelos. These geographic differences in total cholesterol and prevalence of hypercholesterolemia were already present at one year of age and persisted throughout childhood and adolescence.
[show abstract][hide abstract] ABSTRACT: HbA1c is considered the gold standard of long-term glycemic control and is recommended as a routine test for every diabetic patient. However, its common use in clinical practice has some problems related to lack of standardization and its relative cost. Recent studies have suggested, that postprandial blood glucose could be better than a fasting sample, as a marker of diabetes control. The objective of the present study was to evaluate the relative value of plasma glucose samples at different times of the day, and easy and accessible programs for home blood and urinary glucose measurements compared with HbA1c in assessing the mean glycemic control of type 2 diabetic patients.
Sixty type 2 diabetic patients were instructed to do home blood and urine glucose monitoring for two months, at the end, plasma glucose profiles were obtained.
The mean of all the capillary BG measurements had the best correlation with the HbA1c (r = 0.84, p < 0.001), followed by the mean of the capillary BG measurements before breakfast and supper (r = 0.82, p < 0.001), and the 2 hr. postbreakfast plasma glucose (r = 0.79 p < 0.001). The fasting PG had a low correlation (r = 0.65, p < 0.001), but a good sensitivity to predict a fair or a poor metabolic control. Diabetes duration and type of treatment explained 17% and 28% of variance in HbA1c levels.
A bimonthly fasting PG correlated well with the glycosylated hemoglobin and is the easiest and cheapest way of monitoring glycemic control in type 2 diabetic patients with some preserved insulin reserve (diabetes for less than 10 years and on treatment with only one hypoglycemic agent). A sample of capillary BG, fasting, once per week correlates better with the HbA1c than a fasting PG every 2-3 months. The 2 hr and 5 hr postbreakfast PG have a good correlation with the HbA1c, but are not a substitute for doing BG monitoring. Glycosuria may be a useful parameter to rule out a fair or poor metabolic control in some patients.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 53(6):518-25. · 0.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Atherosclerosis is more common and severe in DM. The purpose of this study was to compare the blood lipids profile and the prevalence of different coronary risk factors (CRF) in a mexican population with CHD (coronary heart disease) and DM compared with non DM patients. All had a history of myocardial infarction. Patients with nephropathy or other secondary causes of dyslipidema were excluded. There were two groups of 45 patients, 32 males, 13 females; age was 60 +/- 1 (SEM), body mass index (BMI) 26 +/- 6. Diabetes duration was 10 +/- 1 years. Diabetic individuals referred smoking in 58%, high blood pressure 55%, obesity (IQ greater than 27) 42%. There were no statistical differences with the non DM group. The mean values of total cholesterol, LDL cholesterol and triglycerides were similar in diabetics and non diabetics. HDL cholesterol was significantly lower in diabetic females (p less than 0.01). Hypoalphalipoproteinemia (HDL-C less than or equal to 30 mg/dL) was the most common abnormality in both groups (52% DM vs 38% nonDM) (p less than 0.01) Type IV phenotype was present in 40 vs 29% (NS). Lipid values were not related to BMI, metabolic control or diabetes type of treatment. To conclude, non insulin dependent diabetic patients with CHD have a high prevalence of CRF. Lipid abnormalities, particularly hypoalphalipoproteinemia and hypertriglyceridemia, could be a cause for the increased atherogenic risk, particularly in females.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 42(4):257-64. · 0.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: To assess the effect of the new American Diabetes Association (ADA) diagnostic criteria for diabetes in the Mexico City survey.
The data available from the Mexico City study were included. This cross-sectional survey was conducted from January 1991 to March 1992 and involved 805 adults (20 years of age or older; mean age, 41 years). Survey procedures and results were previously published. Of the residents with diabetes, 74.2% had a previous diagnosis, and 25.8% were diagnosed on the basis of fasting plasma glucose (FPG) levels obtained during the survey. For the current report, these data were reanalyzed on the basis of the new ADA diagnostic criteria.
The prevalence of newly diagnosed diabetes with use of the old and the new criteria was 23.1% versus 32.3% in men (P = 0.31) and 27.5% versus 36.3% in women (P = 0.32), respectively. The crude prevalence rate of diabetes increased from 8.7% to 9.3% (P = 0.42), and the age-adjusted rate increased from 10.6% to 11.2% for women (P = 0.64) and from 6.0% to 6.5% for men (P = 0.49). The prevalence of impaired FPG was 4.8%. Those patients with impaired FPG or newly diagnosed diabetes with FPG levels between 126 and 140 mg/dL had a more atherogenic risk profile than did those with normal carbohydrate metabolism.
On the basis of the 1990 population census in Mexico City, the new ADA criteria will add 28,331 patients with diabetes (6.9%) to an already insufficient medical system. For those patients with impaired FPG or newly diagnosed diabetes on the basis of the new criteria, management should be focused on the control of the diverse and highly prevalent coronary risk factors.
Endocrine Practice 5(4):179-83. · 2.49 Impact Factor
[show abstract][hide abstract] ABSTRACT: Reactive hypoglycemia is a common medical problem whose pathophysiology is not completely understood. The objective of this study was to investigate the prevalence of autonomic nervous system abnormalities in patients with reactive hypoglycemia compared with controls.
Six women, mean age 31 +/- 5 years, with reactive hypoglycemia, and 5 healthy controls women aged 24 +/- 4 years were studied. We investigated the heart rate variability and blood pressure changes after an upright tilt with and without an isoproterenol infusion. A positive result was defined as syncope or presyncope associated with bradycardia, hypotension or both.
In response to the orthostatic stress alone or in conjunction with a 4 micrograms isoproterenol infusion, 5 of 6 patients had a positive test as did one of the five control subjects. Patients had a baseline hyperadrenergic tone, with a sympathetic to parasympathetic ratio of 2.3 +/- 0.8 under basal conditions and 10.1 +/- 4.1 during the isoproterenol infusion, compared to 0.7 +/- 0.3 (p = 0.06) and 0.5 +/- 0.1 (p < 0.01) respectively, in the control group.
Patients with reactive hypoglycemia may be at the extreme end of a spectrum of normal biologic variability, they may have an hyperadrenergic tone and, after a provocative stimulus, sympathetic nerve firing and or synaptic release of NE may not be sufficient to maintain an adequate vascular tone. Alternatively, the vascular response to NE may be impaired. An excessive and paradoxic vasovagal or parasympathetic response was not observed.
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 52(6):603-10. · 0.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: This 16-week, double-blind study compared the efficacy and safety of pravastatin, a new HMG-CoA reductase inhibitor, with probucol in the treatment of hyperlipidemia in 26 patients at the Instituto Nacional de Cardiología "Ignacio Chávez" in Mexico City. Patients had to have a low-density lipoprotein-cholesterol (LDL-C) level in the 75th (or greater) percentile for age and sex greater than 150 mg/ on 2 occasions, and a triglyceride level less than 350 mg/dl. The patients, aged 21 to 75 years, were randomly assigned to receive either pravastatin, 40 mg once daily at bedtime (n = 15), or probucol, 500 mg twice daily (n = 11). Complete lipid profiles were obtained at 4-week intervals. By the end of the study, mean changes in total cholesterol (CT) and LDL-C in the pravastatin group were -28% and -37%, respectively, p less than 0.001 vs baseline. In the pravastatin group, there was a mean increment in HDL-cholesterol (HDL-C) of 9% and consequently a significant reduction in the LDL-C/HDL-C ratio. However, in the probucol group HDL-C levels dropped -21%, p less than 0.01, and no significant change in the LDL-C/HDL-C ratio was observed, accounting for the significant difference in LDL-C/HDL-C ratios between the 2 groups. Both drugs were well tolerated. One pravastatin patient discontinued because of adverse effects (nausea/vomiting and mild muscle pain). These results suggest that once daily administration of pravastatin is an effective therapy for hypercholesterolemia and that it produces a more favorable response in LDL-C/HDL-C ratio than probucol.
Archivos del Instituto de Cardiología de México 61(4):365-73.
[show abstract][hide abstract] ABSTRACT: The National Seroepidemiologic survey was carried out by the General Directorate of Epidemiology of the Ministry of Health from March 1987 to May 1988. One of the objectives of this survey was to know the mean cholesterol levels in the whole country and in each of the different states of the Mexican Republic by sex and in the different age groups. Of the 68,257 individuals studied, 39,990 (58.6%) were females and 28,267 (41.1%) males. The blood samples were processed at the Lipid Laboratory in the Endocrinology Department of the National Institute of Cardiology "Ignacio Chávez". The mean serum cholesterol levels were for the entire country 184 and 185 mg/dl in adult males and females, respectively, and 145 in males and 149 mg/dl in females in the age group below 20 years old. The northern states and two states in the southeast (Yucatan and Campeche) had the highest mean values of the country, and were found to be very similar to those observed in the United States population. When the values seen during childhood were compared with those attained on adult age, an increment of around 33 percent in the mean cholesterol levels was disclosed. This finding was similar in the different regions of Mexico as well as in the USA population. Also, the states with the highest mean cholesterol values in the young population had the highest values during adulthood (R2 = 0.90 and 0.91, for males and females). This information can be of great value for developing public health strategies to diminish the incidence of coronary heart disease.
Salud publica de Mexico 34(2):157-67. · 0.94 Impact Factor