Concordance between Different Criteria for Metabolic Syndrome in Peruvian Adults Undergoing Bariatric Surgery

Background: Metabolic Syndrome (MetS) is a clinical entity that has been linked to several non-communicable diseases. There are various consensuses to determine its presence, such as the IDF, ALAD, Harmonized, AHA/NHLBI, NCEP-ATP III or AACE criteria. However, there is currently no standardization to properly identify it. Objective: To assess the diagnostic concordance between different criteria for MetS in Peruvian adults undergoing bariatric surgery. Methods: We conducted a secondary analysis of the institutional database of a bariatric clinic located in Lima, Peru. We obtained data from adults between 18–59 years who underwent bariatric surgery (Roux-en-Y Gastric Bypass or Sleeve Gastrectomy). According to the Kappa coefficient, a heatplot was designed to analyze the concordance of the criteria. Results: An almost perfect concordance was found between all criteria except AACE. The highest kappa coefficient (κ = 0.980) was recorded between the IDF and ALAD criteria using all the sample. Similar results were obtained when we stratified by sex. Conclusions: This study shows that, excluding the AACE, different criteria for metabolic syndrome could be used in Latino adults undergoing bariatric surgery with similar results. Given the postoperative implications, we believe that IDF and ALAD would be the best options in our population.Revisión por pare

Prevalence of Metabolic Syndrome Components in an Urban Mexican Sample: Comparison between Two Classifications

Background. The aim of this study was to examine the prevalence of metabolic syndrome (MS) components in an urban Mexican sample. Methods. A total of 854 subjects were included. Anthropometric, blood pressure measurements, clinical data, and overnight fasting blood samples were obtained from all subjects. Results. In accordance with definitions by the American Heart Association/ National Heart, Lung, and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF), the prevalence of MS among participants was 59.7 and 68.7%, respectively. The prevalence of MS was higher in women and in individuals older than 45 years of age. More than 40% of the subjects fulfilled four criterions of MS according to both definitions. Conclusions. There was a high prevalence of MS components in an urban Mexican sample. Therefore, strong strategies had to be developed for early detection of MS and its components to prevent DMT2 and atherothrombotic complications in these patients

Prevalence of the Metabolic Syndrome in Latin America and its association with sub-clinical carotid atherosclerosis: the CARMELA cross sectional study

<p>Abstract</p> <p>Background</p> <p>Metabolic syndrome increases cardiovascular risk. Limited information on its prevalence in Latin America is available. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study included assessment of metabolic syndrome in 7 urban Latin American populations.</p> <p>Methods</p> <p>CARMELA was a cross-sectional, population-based, observational study conducted in Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. The prevalence of metabolic syndrome, defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and associated carotid atherosclerosis were investigated in 11,502 participants aged 25 to 64 years.</p> <p>Results</p> <p>Across CARMELA cities, metabolic syndrome was most prevalent in Mexico City (27%) and Barquisimeto (26%), followed by Santiago (21%), Bogota (20%), Lima (18%), Buenos Aires (17%), and Quito (14%). In nondiabetic participants, prevalence was slightly lower but followed a comparable ranking. Overall, 59%, 59%, and 73% of women with high triglycerides, hypertension, or glucose abnormalities, respectively, and 64%, 48% and 71% of men with abdominal obesity, hypertension, or glucose abnormalities, respectively, had the full metabolic syndrome. Prevalence of metabolic syndrome increased with age, markedly so in women. Mean common carotid artery intima-media thickness (CCAIMT) and prevalence of carotid plaque increased steeply with increasing numbers of metabolic syndrome components; mean CCAIMT was higher and plaque more prevalent in participants with metabolic syndrome than without.</p> <p>Conclusion</p> <p>The prevalence of metabolic syndrome and its components by NCEP ATP III criteria was substantial across cities, ranging from 14% to 27%. CARMELA findings, including evidence of the association of metabolic syndrome and carotid atherosclerosis, should inform appropriate clinical and public health interventions.</p

Changes in insulin sensitivity over time and associated factors in HIV-infected adolescents

OBJECTIVE: To compare prevalence of insulin resistance between perinatally HIV-infected (PHIV+) and perinatally HIV-exposed, but uninfected adolescents (PHEU), determine incidence of and contributory factors to new and resolved cases of insulin resistance in PHIV+, and evaluate glucose metabolism. DESIGN: Cross-sectional design for comparison of prevalence among PHIV+ and PHEU. Longitudinal design for incidence and resolution of insulin resistance among PHIV+ at risk for these outcomes. METHODS: The source population was adolescents from pediatric HIV clinics in the United States and Puerto Rico participating in the Pediatric HIV/AIDS Cohort Study, an ongoing prospective cohort study designed to evaluate impact of HIV infection and its treatment on multiple domains in preadolescents and adolescents. Insulin resistance was assessed by homeostatic model assessment of insulin resistance. Those with incident insulin resistance underwent 2-h oral glucose tolerance test and HbA1c. Baseline demographic, metabolic, and HIV-specific variables were evaluated for association with incident or resolved insulin resistance. RESULTS: Unadjusted prevalence of insulin resistance in PHIV+ was 27.3 versus 34.1% in PHEU. After adjustment for Tanner stage, age, sex, and race/ethnicity, there was no significant difference between groups. Factors positively associated with developing insulin resistance included female sex, higher BMI z score, and higher waist circumference; those associated with resolving insulin resistance included male sex and lower BMI z score. CONCLUSION: Prevalence of insulin resistance in PHIV+ and PHEU was substantially higher than that reported in HIV-uninfected nonoverweight youth, but similar to that in HIV-uninfected obese youth. Factors associated with incident or resolved insulin resistance among PHIV+ were similar to those reported in HIV-negative obese youth. However, a contributory role of HIV infection and/or its treatment to the incident risk of insulin resistance cannot be excluded

Evaluation of metabolic syndrome in adults of Talca city, Chile

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Metabolic features of women with polycystic ovary syndrome in Latin America : a systematic review

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder that commonly affects women of childbearing age and has been associated with metabolic and reproductive abnormalities. Only a few studies have investigated metabolic traits in women with PCOS in Latin America. Therefore, we conducted a systematic review to provide an overview of the available evidence on the metabolic profile of Latin American women with PCOS. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, and Embase databases for cross-sectional, case-control, or cohort studies focusing on populations of countries in South and Central America and Mexico, published until October 31, 2019. We selected studies that reported the diagnostic criteria for PCOS. In the absence of a control group, we included studies if they reported relevant metabolic data. Results: The initial search yielded 4878 records, of which 41 studies were included in the systematic review. Sample sizes ranged from 10 to 288 in PCOS groups and from 10 to 1500 in control groups. The prevalence of phenotypes A and B (classic PCOS) ranged from 65.8% to 87.5% as reported in studies from Argentina, Brazil, and Chile. Metabolic syndrome ranged from 33.3% to 44.0% for phenotype A, from 15.0% to 58.0% for phenotype B, from 11.9% to 36.0% for phenotype C, and from 14.2% to 66.0% for phenotype D. Women with PCOS had higher body mass index, waist circumference, blood pressure, glucose, and homeostasis model assessment index as well as a more adverse lipid profile than those without PCOS. Conclusions: Evidence from the present systematic review suggests that anthropometric and metabolic profiles are worse in women with PCOS who live in different Latin American countries than in women without PCOS living in the same region. Additional studies assessing metabolic comorbidities, such as diabetes, and distinct PCOS phenotypes in different Latin American countries are warranted and may produce invaluable information for primary and secondary prevention of PCOS in the region

The UP AMIGOS project: Testing the predictive validity of the 2007 Pediatric Expert Committee Recommendations in Latinos

Background. Mexicans are disproportionately affected by cardiovascular disease and there is mounting evidence that Mexicans may be genetically prone to the development of cardiovascular disease (CVD) risk factors. Objective. There were three aims of study. The first aim was to identify the prevalence of three CVD risk factors in Mexican young adults: (1) non-alcoholic fatty liver disease (NAFLD), (2) dyslipidemia, and (2) impaired fasting glucose. The second aim was to test the sensitivity and specificity of the Pediatric Expert Committee Recommendations (PECR) in identifying Mexicans with these three cardiovascular disease risk factors. Finally, the third aim was to explore ways to improve the clinical screening algorithm. Methods. In this cross-sectional study, data for UP AMIGOS were collected from 9,974 participants (age 18- to 21-years-old) living in Central Mexico. Participants underwent a health screen that included: a questionnaire, anthropometric measurements (i.e. height, weight, waist circumference, blood pressure), a physician-conducted history and physical, and venipuncture for blood biomarkers. Analysis. In order to determine prevalence of CVD risk factors, descriptive statistics were run making comparisons in prevalence by sex and weight category: normal weight, overweight, or obese. The value of the PECR was measured with sensitivity, specificity, and positive predictive value, with additional tests for significant associations. Alternative algorithms were explored using classification and regression tree analysis. Results. NALFD (17.1 to 45.5%) and dyslipidemia (44.8%) were fairly prevalent. In contrast, impaired fasting glucose (IFG) was rare (4.0%). Each CVD risk factor increased with increasing levels of adiposity. The PECR provided a reasonable clinical screen for NALFD, but was fairly insensitive in detecting those with dyslipidemia or IFG. Multiple exploratory analyses revealed more sensitive screening solutions for each individual CVD disease risk factor, but at the cost of having a less parsimonious clinical screen. Significance. Mexican adolescents and young adults already have a high prevalence of CVD risk factors. These risk factors may go unnoticed and eventually convert to irreversible disease, unless a valid, predictive screening protocol is established. Based on this analysis, screening recommendations are three-fold: (1) Universal screening for dyslipidemia is recommended for Mexican young adults, (2) IFG screening is not recommended in adolescents or young adults, (3) the PECR may be a reasonable clinical screen for NALFD, but more data is needed

Specific issues concerning the management of patients on the waiting list and after liver transplantation

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system

Latin American Consensus: Children Born Small for Gestational Age

72-87Cuatrimestra

Prevalence and components of metabolic syndrome in HIV-infected patients at the Tiko Central Clinic and Cottage Hospital in Cameroon

Background: HAART and HIV related metabolic syndrome (MS) is associated with increased cardiovascular risk in aging HIV patients. This study was aimed at comparing the prevalence of MS between HIV-infected patients on HAART and apparently healthy HIV-uninfected individuals and identifying key MS components in these groups of subjects.Methods: This was a hospital-based case-control study. The cases were HIV sero-positive individuals on HAART for at least 6 months and controls were HIV sero-negative individuals.Results: 74/135 (54.8%) participants were females amongst which 53/75 (70.7%) and 21/60 (35%) were in the test and control groups respectively. The prevalence of MS was insignificantly higher in HIV-infected patients on HAART than in control subjects according to the IDF (22.7% versus 20%, p=0.834) and NCEP ATP III criteria (18.7% versus 18.3%, p=1.000) respectively. The most prevalent components of MS in HIV-infected patients on HAART were low HDL-c (100%), abdominal obesity (IDF: 68%, ATP III: 32%), and hypertension (28%). Multivariate analysis of MS components in HIV-infected patients on HAART revealed that hypertension (OR: 15.996, 95% CI: 3.385-75.585; p≤0.001) and high blood glucose (OR: 10.760, 95% CI: 1.642-70.505; p=0.013) were associated with MS. Significantly more HIV-infected females were seen with abdominal obesity than HIV-infected males (86.8% versus 4.5%, p≤0.001).Conclusions: Abdominal obesity is a driving component of MS in HIV-infected patients particularly among females and hypertension is a prevalent and predictor component of MS among HIV patients