Percentiles de presión arterial de niños y adolescentes de Santiago de Cali-Colombia

RESUMEN  Objetivo: Determinar los valores percentiles de presión arterial de niños y adolescentes de 10 a 16 años de Santiago de Cali-Colombia. Materiales y Métodos: Estudio descriptivo de corte transversal en 1773 niños y adolescentes de ambos géneros (n=865 hombres y n=908 mujeres) pertenecientes al estudio IFRECNTEC (Identificación de Factores de Riesgo de Enfermedades Crónicas No Transmisibles del Adulto en la Población Escolarizada de 6 a 18 años en el municipio de Cali, Colombia). Se calcularon los valores percentiles a partir de la regresión de los mínimos cuadrados (Least Mean Squares) según edad y sexo p5, p25, p50, p75, p90 y p95 de la presión arterial. Resultados: La presión arterial por sexo fue similar en la infancia, aumentando progresivamente con la edad y con mayor rapidez durante la pubertad. La presión sistólica y diastólica fue mayor en los adolescentes hombres que en las mujeres. Discusión y Conclusiones: La presentación de valores percentiles permite clasificar la presión arterial de niños y adolescentes de Cali-Colombia y comparar con sus contemporáneos. La presión arterial alta para la edad debería definirse en percentiles por encima del p95 y la presión arterial alta y normal podría definirse entre el p90 y p95. (MED.UIS. 2010;23(2):94-8).  Palabras clave: presión arterial. Niños. Adolescentes. Colombia. SUMMARYBlood pressure centiles for Santiago de Cali-Colombian children and adolescents Aim. To determine age- and sex- specific centile values of Blood pressure for urban Santiago de Cali-Colombia children and adolescents aged 10–16 years. Material and Methods. The sample (n=1773) consisted of 865 boys and 908 girls from the cross-sectional population survey, IFRECNTEC Study (Identificación de Factores de Riesgo de Enfermedades Crónicas No Transmisibles del Adulto en la Población Escolarizada de 6 a 18 años en el Municipio de Cali, Colombia) for whom the data for Blood pressure was recorded. Smoothed age- and sex- specific 5th, 25th, 50th, 75th, 90th and 95th Centile values where derived using Least Mean Squares regression. Results. Blood pressure in both sexes was similar in childhood, rising progressively with age and more rapidly during puberty. Systolic and Diastolic pressure rose faster and was appreciably higher in men than in adolescents women. Discussion and Conclusion. These centiles increase our knowledge of blood pressure data in contemporary Colombian children and young people. High blood pressure for age should be defined as blood pressure above the 95th centile, and high-normal blood pressure for age as blood pressure between the 90th and 95th centiles. (MÉD.UIS. 2010;23(2):94-8) . Key words: Blood pressure. Adolescents. Children. Colombia

Potential effect of physical exercise and consumption of micronutrients during pregnancy on the placental and maternal factors associated with chronic non-communicable diseases in adult

Introducción: En la actualidad casi todos los esfuerzos para prevenir las enfermedades crónicas no transmisibles (ECNT) a nivel poblacional, se han centrado en promover comportamientos saludables como el ejercicio, la actividad física, el consumo de frutas y verduras, y el desestimular el consumo de tabaco y alcohol en la población adulta, pero los resultados han sido poco alentadores. En los últimos años, múltiples estudios han señalado la relación entre alteraciones del crecimiento fetal y el desarrollo de ECNT en la edad adulta. Más recientemente, se ha propuesto que factores maternos (función endotelial, estrés oxidativo y alteraciones en adipoquinas) y placentarios (disfunción mitocondrial) pueden ser mecanismos precursores de alteraciones metabólicas fetales y del desarrollo posterior de ECNT y que intervenciones como el ejercicio físico y la complementación con micronutrientes durante la gestación podrían regular dichos factores maternos y placentarios. Objetivo: Realizar una revisión de la literatura para verificar el papel del ejercicio físico y los micronutrientes durante la gestación sobre factores maternos y placentarios relacionados con ECNT del adulto. Metododología: Se utilizaron las siguientes bases de datos: Medline, Scielo, EMBASE, Science Direct, Cochrane Central Register of Controlled Trials y The Cochrane Libraryp Pregnancy, fetal development, oxidative stress, vascular endothelium, mitochondrial, adipokines, micronutrients, exercise. Resultados: El estrés oxidativo, como mecanismo central de otros eventos fisiopatológicos (alteración en los niveles de adipoquinas, disfunción endotelial y mitocondrial), tiene un papel importante en la programación fetal de ECNT, factores como la complementación con micronutrientes y el ejercicio físico, durante la gestación, podrían modular este estado y contribuir posiblemente a la prevención temprana de ECNT. Conclusión: Se debe establecer si los mecanismos moleculares y fisiológicos propuestos están relacionados con alteraciones metabólicas fetales y si la complementación durante la gestación con micronutrientes y/o el ejercicio físico los pueden regular. Introduction: Currently, most efforts to prevent nontransmissible chronic diseases at population level have centered on promoting healthy behaviors like physical activity, consumption of fruits and vegetables, and discouraging from the consumption of tobacco and alcohol in the adult population, but the results have been less than hopeful. During recent years, a number of studies have indicated the relation between metabolic alterations and fetal growth with the development of nontransmissible chronic diseases in adult age. More recently, it has been proposed that maternal factors (endothelial function, oxidative stress, and alterations in adipokynes) and placental factors (mitochondrial dysfunction) are the precursory mechanisms of fetal metabolic alterations and of the later development of nontransmissible chronic diseases. Also, it has been suggested that possibly supplementation with micronutrients and physical exercise during gestation could regulate these maternal and placental factors. Aim: To conduct a literature review to verify the role of physical exercise and micronutrients during pregnancy on placental and maternal factors related to nontransmissible chronic diseases in adults. Methods: Medline, SciELO, Embase, Science Direct, Cochrane Central Register of Controlled Trials, and the Cochrane Library were used in the last 10 years (1998-2008). The following topics were reviewed: pregnancy, fetal development, oxidative stress, vascular endothelium, mitochondrial dysfunction, adipokines, micronutrients, and exercise. Results: Oxidative stress, as the central pathophysiological event, such as changes in levels of adipokynes, mitochondrial and endothelial dysfunction, plays an important role in fetal programming of chronic diseases and factors such as micronutrient supplementation and physical exercise during pregnancy could modulate this state in a charity institution aiding in the early prevention of chronic diseases. Conclusion: To clarify whether the proposed molecular and physiological mechanism items are related to metabolic abnormalities and fetal complementation with micronutrients during pregnancy and/or regular physical exercise

Un ensayo controlado aleatorio factorial para evaluar el efecto de la suplementación con micronutrientes y el ejercicio aeróbico regular sobre la vasodilatación dependiente del endotelio materno y el estrés oxidativo del recién nacido

Background Many studies have suggested a relationship between metabolic abnormalities and impaired fetal growth with the development of non-transmissible chronic diseases in the adulthood. Moreover, it has been proposed that maternal factors such as endothelial function and oxidative stress are key mechanisms of both fetal metabolic alterations and subsequent development of non-transmissible chronic diseases. The objective of this project is to evaluate the effect of micronutrient supplementation and regular aerobic exercise on endothelium-dependent vasodilation maternal and stress oxidative of the newborn. Methods and design 320 pregnant women attending to usual prenatal care in Cali, Colombia will be included in a factorial randomized controlled trial. Women will be assigned to the following intervention groups: 1. Control group: usual prenatal care (PC) and placebo (maltodextrine). 2. Exercise group: PC, placebo and aerobic physical exercise. 3. Micronutrients group: PC and a micronutrients capsule consisting of zinc (30 mg), selenium (70 ?g), vitamin A (400 ?g), alphatocopherol (30 mg), vitamin C (200 mg), and niacin (100 mg). 4. Combined interventions Group: PC, supplementation of micronutrients, and aerobic physical exercise. Anthropometric measures will be taken at the start and at the end of the interventions. Discussion Since in previous studies has been showed that the maternal endothelial function and oxidative stress are related to oxidative stress of the newborn, this study proposes that complementation with micronutrients during pregnancy and/or regular physical exercise can be an early and innovative alternative to strengthen the prevention of chronic diseases in the population

A factorial randomized controlled trial to evaluate the effect of micronutrients supplementation and regular aerobic exercise on maternal endothelium-dependent vasodilatation and oxidative stress of the newborn

<p>Abstract</p> <p>Background</p> <p>Many studies have suggested a relationship between metabolic abnormalities and impaired fetal growth with the development of non-transmissible chronic diseases in the adulthood. Moreover, it has been proposed that maternal factors such as endothelial function and oxidative stress are key mechanisms of both fetal metabolic alterations and subsequent development of non-transmissible chronic diseases. The objective of this project is to evaluate the effect of micronutrient supplementation and regular aerobic exercise on endothelium-dependent vasodilation maternal and stress oxidative of the newborn.</p> <p>Methods and design</p> <p>320 pregnant women attending to usual prenatal care in Cali, Colombia will be included in a factorial randomized controlled trial. Women will be assigned to the following intervention groups: <it>1. Control group: </it>usual prenatal care (PC) and placebo (maltodextrine). <it>2. Exercise group: </it>PC, placebo and aerobic physical exercise. <it>3. Micronutrients group: </it>PC and a micronutrients capsule consisting of zinc (30 mg), selenium (70 μg), vitamin A (400 μg), alphatocopherol (30 mg), vitamin C (200 mg), and niacin (100 mg)<it>. 4. Combined interventions Group: </it>PC, supplementation of micronutrients, and aerobic physical exercise. Anthropometric measures will be taken at the start and at the end of the interventions.</p> <p>Discussion</p> <p>Since in previous studies has been showed that the maternal endothelial function and oxidative stress are related to oxidative stress of the newborn, this study proposes that complementation with micronutrients during pregnancy and/or regular physical exercise can be an early and innovative alternative to strengthen the prevention of chronic diseases in the population.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00872365">NCT00872365</a>.</p

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Association between adiposity and cardiovascular risk factors in prepubertal children Association between adiposity and cardiovascular risk factors in prepubertal infants

Introducción y objetivos Examinar las relaciones entre cuatro medidas de adiposidad, a saber, circunferencia de cintura (WC), índice de masa corporal (IMC) y pliegues subescapulares y abdominales, con diferentes factores de riesgo cardiovascular en niños prepúberes. Métodos Cuatrocientos noventa y cuatro niños prepúberes de 6 a 10 años participaron en este estudio transversal. Los pliegues cutáneos subescapulares y abdominales, el WC y el IMC se midieron para evaluar la adiposidad, y los factores de riesgo cardiovascular (FRCV) se evaluaron midiendo la presión sanguínea sistólica (PAS) y diastólica (PAD), glucosa, triglicéridos (TG) y alta densidad ( HDL-C) y colesterol de lipoproteínas de baja densidad (LDL-C). Las variables dicotómicas se crearon en función de si los sujetos estaban o no en el cuartil superior (Q4) para las variables WC, IMC y pliegues cutáneos. Resultados No se encontró CVRF en el 52.8% de los niños, el 33.4% tenía un factor, y el 10.9% y el 2.8% tenían 2 y 3 factores respectivamente. Un análisis de regresión logística ajustado mostró que estar en Q4 de variables antropométricas y FRCV estaba asociado a niveles de TG ? 100 mg / dL. Los niveles de glucosa ?96 mg / dL se asociaron con Q4 y el pliegue abdominal. La presencia de 2 o más CVRF se asoció significativamente con Q4 en todas las variables antropométricas a pesar del ajuste por edad, sexo y consumo de calorías. El pliegue cutáneo subescapular fue el marcador de adiposidad asociado al mayor riesgo. Conclusiones Los niños con un perfil de adiposidad más desfavorable tienden a tener un mayor riesgo cardiovascular en la etapa prepuberal.Introduction and objectives To examine the relationships between of four measures of adiposity, namely waist circumference (WC), body mass index (BMI), and subscapular and abdominal skinfolds, with different cardiovascular risk factors in prepubertal children. Methods Four hundred and ninety-four prepubertal children aged 6–10 years participated in this cross-sectional study. The subscapular and abdominal skinfolds, WC, and BMI were measured to assess adiposity, and cardiovascular risk factors (CVRFs) were assessed by measuring systolic (SBP) and diastolic blood pressures (DBP), glucose, triglycerides (TG), and high density (HDL-C) and low density lipoprotein cholesterol (LDL-C). Dichotomous variables were created based on whether or not the subjects were in the upper quartile (Q4) for the WC, BMI, and skinfold variables. Results No CVRF was found in 52.8% of children, 33.4% had one factor, and 10.9% and 2.8% had 2 and 3 factors respectively. An adjusted logistic regression analysis showed that being in Q4 of anthropometric variables and CVRFs was associated to TG levels ? 100 mg/dL. Glucose levels ?96 mg/dL were associated to Q4 and abdominal fold. Presence of 2 or more CVRFs was significantly associated to Q4 in all anthropometric variables despite adjustment for age, gender, and calorie intake. The subscapular skinfold was the adiposity marker associated to the highest risk. Conclusions Children with a more unfavorable adiposity profile tend to have a greater cardiovascular risk in the prepubertal stage

El Centinela de lípidos séricos en adolescentes de Colombia

Objetivo Determinar los valores por edad y sexo de los lípidos séricos colesterol total (CT), triglicéridos (TG), y colesterol de lipoproteínas de alta densidad (c-HDL) de niños y adolescentes de 10 a 17 años de Colombia. Material y métodos Estudio descriptivo de corte transversal en 1.773 niños y adolescentes. A cada participante se le realizó una medición en ayunas para cuantificar los niveles de CT, c-HDL y TG utilizando métodos enzimático-colorimétricos. Se calcularon centiles a partir de la regresión LMS por edad y sexo p5, p25, p50, p75, p90 y p95 con el método de los Least Mean squares (LMS, ‘mínimos cuadrados’) por curvas centiles que representan la asimetría, la mediana y la variabilidad utilizando el paquete estadístico Growth Analyzer. Resultados En general, los hombres presentan menores valores de CT y TG séricos que las mujeres. El p95 de los TG y CT en los hombres de las edades de 10 a 14 años fue mayor que en las mujeres, mientras que los niveles de c-HDL fueron similares en ambos sexos y edades. Conclusiones La obtención de valores centiles ayudará a clasificar los niños y adolescentes con respecto a otras poblaciones en función de este indicador de salud.Objective To assess age- and sex-specific percentile baseline data for total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) in Colombian children and adolescents aged 10 to 17 years. Patients and Methods A cross-sectional, descriptive study was conducted on 1,773 children and adolescents. Each participant underwent a fasting measurement to quantify TC, HDL-C, and TG levels using enzymatic-colorimetric methods. Smoothed age- and sex-specific 5th, 25th, 50th, 75th, 90th and 95th percentile values where derived using LMS regression (Least Mean Square) using the statistical package Growth Analyzer. Results Overall, males had lower serum TC and TG levels as compared to females. P95 of TG and TC was higher in males aged 10 to 14 years as compared to females, while HDL-C levels were similar in both sexes. Conclusions Percentile values will help classify children and adolescents as compared to other populations based on this health indicator

Los niveles de ferritina y los marcadores de riesgo cardiovascular se correlacionan con mayor tiempo sedentario auto-reportado en hombres aparentemente sanos

Evaluar la correlación entre las concentraciones séricas de ferritina y los marcadores de riesgo cardiovascular con el tiempo de actividad física y sedentarismo auto-reportados en hombres aparentemente sanos. MÉTODOS: se incluyeron 69 hombres pertenecientes a tres empresas de servicio privado y público del área metropolitana de Cali, Colombia, con edades entre 25 y 64 años. Se aplicó la versión corta del International Physical Activity Questionnaire (IPAQ) y se agruparon cuatro categorías de actividad física: 1. Minutos actividad física intensa (AFI)/semana. 2. Minutos actividad física moderada (AFM)/semana. 3. Minutos caminata/semana. 4. Minutos sentado/día. Los marcadores de riesgo cardiovascular se definieron con base en los criterios del ATP-III y la Federación Internacional de Diabetes. RESULTADOS: se encontraron correlaciones positivas en los sujetos que auto-reportaban mayor tiempo en actividades sedentarias según la categoría del IPAQ (minutos promedio sentado/día) en los indicadores antropométricos: porcentaje de grasa corporal (rho=0,249, p<0,05), índice de masa (rho=0,268, p<0,05) y circunferencia de cintura (rho=0,266, p<0,05). Este mismo comportamiento se observó en las variables bioquímicas: ferritina (rho=0,247, p<0,05), triglicéridos (rho=0,258, p<0,05), insulina (rho=0,284, p<0,05) e índice HOMA (rho=0,261). Asimismo, se evidenciaron menores niveles de c-HDL a menores niveles de actividad física (rho=-0,279; p<0,05). CONCLUSIONES: el tiempo sedentario (minutos sentado/semana) reportado por los sujetos, se correlacionó de manera positiva con los niveles de ferritina así como con la resistencia a la insulina y los marcadores de riesgo cardiovascular. Los depósitos de hierro corporales estimados como ferritina sérica, al relacionarse con parámetros de sedentarismo, se comportan como un potencial marcador de riesgo cardiovascularto evaluate the correlation between serum ferritin and cardiovascular risk markers with the time of self-reported physical activity and sedentary life style in apparently healthy men. METHODS: we included 69 men from three private and public companies in the metropolitan area of Cali, Colombia, aged between 25 and 64. The short version of the International Physical Activity Questionnaire (IPAQ) was applied, and were grouped in four categories of physical activity: 1. Minutes of intense physical activity (IFA)/week. 2. Minutes of moderate physical activity (MFA)/week. 3. Minutes of walk/week. 4. Minutes of sitting/day. Cardiovascular risk markers were defined based on the criteria of the ATP-III and the International Diabetes Federation. RESULTS: positive correlations were found in subjects who self-reported more time in sedentary activities according to the IPAQ category (average minutes sitting/day) in anthropometric indicators: percentage of body fat (rho = 0.249, p <0.05), mass index (rho = 0.268, p <0.05) and waist circumference (rho = 0.266, p <0.05). This same behavior was observed in biochemical variables: ferritin (rho = 0.247, p <0.05), triglycerides (rho = 0.258, p <0.05), insulin (rho = 0.284, p <0.05) and HOMA index (rho = 0.261). Also, lower levels of HDL-C were evidenced with lower levels of physical activity (rho =- 0.279, P <0.05). CONCLUSIONS: sedentary time (minutes sitting/week) reported by the subjects correlated positively with ferritin levels as well as with insulin resistance and cardiovascular risk markers. The body iron deposits estimated as serum ferritin, when related to sedentary lifestyle parameters, behave as a potential marker of cardiovascular ris