Scores de riesgo libres de sangre y pruebas de evaluación de neuropatía para detectar diabetes tipo 2 en el Perú

La prevalencia de la diabetes mellitus tipo 2 está aumentando, especialmente en países de ingresos bajos y medios, donde la situación empeora porque aproximadamente la mitad de los casos desconocen la enfermedad. El examen universal que utiliza marcadores de sangre puede ser un desafío en entornos con recursos limitados. La identificación de estos individuos puede abordarse potencialmente utilizando puntajes de riesgo y herramientas de evaluación de neuropatía. Este estudio tuvo como objetivo evaluar la precisión diagnóstica del FINDRISC, un puntaje de riesgo libre de sangre, tres herramientas de evaluación de neuropatía (EZSCAN, pupilómetro y biotesiómetro), solo y en combinación. Se realizó un estudio basado en la población que incluyó una muestra aleatoria estratificada por sexo de participantes de Tumbes, un área semiurbana en el norte de Perú. La DM2 no diagnosticada fue el resultado, definido utilizando los umbrales OGTT de la OMS. La precisión diagnóstica de las herramientas FINDRISC y neuropatía se evaluó utilizando el área bajo la curva ROC (aROC) y los respectivos intervalos de confianza del 95% (IC 95%). Se analizaron los datos de 1609 participantes, edad media 48,2 (DE: 10,6) años, 810 (50,3%) mujeres. Un total de 176 (10.9%) individuos tenían DM2, y solo 71 (4.7%) tenían DM2 no diagnosticada. La precisión diagnóstica del FINDRISC fue de aROC = 0,69 (IC del 95%: 0,64 a 0,74), con una sensibilidad del 69% y una especificidad del 67%. Entre los dispositivos, el EZSCAN (aROC = 0,59; IC del 95%: 0,53-0,66; sensibilidad del 59% y especificidad del 54%) y biothesiómetro en la cabeza del tercer metatarsiano (aROC = 0,60; IC del 95%: 0,53-0,67; sensibilidad de 31% y especificidad del 85%) tuvieron el mejor rendimiento. Una combinación del FINDRISC y el biotesiómetro tuvo la mejor precisión diagnóstica, con un aROC similar de FINDRISC solo (AROC = 0,69; IC del 95%: 0. 68-0,78), con una sensibilidad del 79% y una especificidad del 59%. Nuestros resultados confirman que la combinación del FINDRISC y el biotesiómetro puede mejorar la precisión diagnóstica del FINDRISC y el biotesiómetro solo, aumentando la sensibilidad sin afectar la especificidad o el área bajo la curva ROC.The prevalence of type 2 diabetes mellitus is rising, especially in low- and middle-income countries, where the situation is worsened because around half of cases are unaware of the disease. Universal screening utilizing blood markers can be challenging in resource-constrained settings. The identification of these individuals can be potentially addressed using risk scores and neuropathy assessment tools. This study aimed to assess the diagnostic accuracy of the FINDRISC, a blood-free risk score, three neuropathy assessment tools (EZSCAN, pupillometer, and biothesiometer), alone and in combination. A population-based study was conducted enrolling a sex-stratified random sample of participants from Tumbes, a semiurban area in the north of Peru. Undiagnosed T2DM was the outcome, defined using WHO OGTT thresholds. Diagnostic accuracy of the FINDRISC and neuropathy tools was evaluated using the area under the ROC curve (aROC) and respective 95% confidence intervals (95%CI). Data from 1609 participants were analysed, mean age 48.2 (SD: 10.6) years, 810 (50.3%) females. A total of 176 (10.9%) individuals had T2DM, and only 71 (4.7%) had undiagnosed T2DM. The diagnostic accuracy of the FINDRISC was aROC = 0.69 (95% CI: 0.64–0.74), with a sensitivity of 69% and specificity of 67%. Among devices, the EZSCAN (aROC = 0.59; 95%CI: 0.53–0.66; sensitivity of 59% and specificity of 54%) and biothesiometer in the third metatarsal head (aROC = 0.60; 95%CI: 0.53–0.67; sensitivity of 31% and specificity of 85%) performed best. A combination of the FINDRISC and the biothesiometer had the best diagnostic accuracy, with a similar aROC of FINDRISC alone (AROC = 0.69; 95%CI: 0.68–0.78), with a sensitivity of 79% and a specificity of 59%. Our results confirm that combination of the FINDRISC and biothesiometer can improve diagnostic accuracy of the FINDRISC and biothesiometer alone, increasing sensitivity without affecting specificity or the area under the ROC curve.Wellcome Trust : Research Training Fellowship in Public Health and Tropical Medicine - Grant number: 103994/Z/14/Z))Tesi

Associação entre participação em programa de assistência alimentar e sobrepeso

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.OBJETIVO Investigar associação entre participação no programa de assistência alimentar e sobrepeso/obesidade, segundo nível de pobreza. MÉTODOS Estudo transversal com dados sobre 46.217 mulheres não gestantes e não lactantes, de Lima, Peru, obtidos de pesquisas, com representatividade nacional, nos anos de 2003, 2004, 2006 e 2008-2010. A variável dependente foi o sobrepeso/obesidade e a independente foi a participação no programa de assistência alimentar. Utilizou-se regressão de Poisson; os modelos foram estratificados por nível socioeconômico familiar para todo o país, por área de residência (Lima versus o resto do país; urbano versus residência rural) e anos de estudo (2003-2006 versus 2008-2010). Os modelos foram ajustados por idade, nível acadêmico, urbanização e ano de estudo. RESULTADOS Participar do programa de assistência alimentar associou-se com risco aumentado de sobrepeso/obesidade para as mulheres que viviam em domicílios sem indicadores de pobreza (PR = 1,29; IC95% 1,06;1,57). Quando estratificados por área de residência, foram observadas associações similares para as mulheres que vivem em Lima e em áreas urbanas; não foram encontradas associações entre a participação no programa de assistência alimentar e sobrepeso/obesidade entre as mulheres que vivem fora de Lima ou em áreas rurais, independentemente de sua condição de pobreza. CONCLUSÕES Participar do programa de assistência alimentar associou-se com sobrepeso/obesidade para mulheres não pobres. Estudos adicionais serão necessários em países que enfrentam ambas as faces da má nutrição

Associação entre participação em programa de assistência alimentar e sobrepeso

OBJETIVO Investigar associação entre participação no programa de assistência alimentar e sobrepeso/obesidade, segundo nível de pobreza. MÉTODOS Estudo transversal com dados sobre 46.217 mulheres não gestantes e não lactantes, de Lima, Peru, obtidos de pesquisas, com representatividade nacional, nos anos de 2003, 2004, 2006 e 2008-2010. A variável dependente foi o sobrepeso/obesidade e a independente foi a participação no programa de assistência alimentar. Utilizou-se regressão de Poisson; os modelos foram estratificados por nível socioeconômico familiar para todo o país, por área de residência (Lima versus o resto do país; urbano versus residência rural) e anos de estudo (2003-2006 versus 2008-2010). Os modelos foram ajustados por idade, nível acadêmico, urbanização e ano de estudo. RESULTADOS Participar do programa de assistência alimentar associou-se com risco aumentado de sobrepeso/obesidade para as mulheres que viviam em domicílios sem indicadores de pobreza (PR = 1,29; IC95% 1,06;1,57). Quando estratificados por área de residência, foram observadas associações similares para as mulheres que vivem em Lima e em áreas urbanas; não foram encontradas associações entre a participação no programa de assistência alimentar e sobrepeso/obesidade entre as mulheres que vivem fora de Lima ou em áreas rurais, independentemente de sua condição de pobreza. CONCLUSÕES Participar do programa de assistência alimentar associou-se com sobrepeso/obesidade para mulheres não pobres. Estudos adicionais serão necessários em países que enfrentam ambas as faces da má nutriçã[email protected] The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.Revisión por pare

Bioimpedance markers and tuberculosis outcome among HIV-infected patients

ackground: The changes in body composition markers (weight, fat mass, lean mass, and BMI) over time can be associated with TB treatment outcome among HIV-infected patients. The aim of this study was to investigate whether changes in fat mass and lean mass were associated with the treatment response among patients with HIV infection and pulmonary tuberculosis. Materials and Methods: This was a prospective cohort study. Data from HIV-infected patients commencing TB therapy were analyzed. This included body weight measurement using bioimpedance equipment at baseline, one month, and two months after starting TB treatment. Results: The study was conducted in 125 patients, 17 patients (13.6%) died during treatment, of which 5 died during the first month of treatment, 4 during the second month and 8 after the second month. The group of patients with good response, increased their weight by 1.3 kg (p <0.001) at the end of the first month of TB treatment and 2.6 kg in the second month (p <0.001), and body fat increase was 1.2 Kg (p <0.001) and 2.3 kg (p <0.001), the first and second month respectively. The group of patients who died had lost 2.1 kg fat mass after the first month (p <0.001) and 3.7 kg in the second month (p <0.001). Conclusions: Our results show that the weight change during TB treatment (increased fat mass) helps us predict therapeutic response. Weight loss during the first month of starting therapy should be evaluated thoroughly to identify the probable cause of treatment failure.Revisión por pare

Diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM in Peruvian population.

AIMS: To assess the diagnostic accuracy of the Finnish Diabetes Risk Score (FINDRISC) for undiagnosed T2DM and to compare its performance with the Latin-American FINDRISC (LA-FINDRISC) and the Peruvian Risk Score. MATERIALS AND METHODS: A population-based study was conducted. T2DM and undiagnosed T2DM were defined using oral glucose tolerance test (OGTT). Risk scores assessed were FINDRISC, LA-FINDRISC and Peruvian Risk Score. Diagnostic accuracy of risk scores was estimated using the c-statistic and the area under the ROC curve (aROC). A simplified version of FINDRISC was also derived. RESULTS: Data from 1609 individuals, mean age 48.2 (SD: 10.6), 810 (50.3%) women, were collected. A total of 176 (11.0%; 95%CI: 9.4%-12.5%) were classified as having T2DM, and 71 (4.7%; 95%CI: 3.7%-5.8%) were classified as having undiagnosed T2DM. Diagnostic accuracy of the FINDRISC (aROC=0.69), LA-FINDRISC (aROC=0.68), and Peruvian Risk Score (aROC=0.64) was similar (p=0.15). The simplified FINDRISC, with 4 variables, had a slightly better performance (aROC=0.71) than the other scores. CONCLUSION: The performance of FINDRISC, LA-FINDRISC and Peruvian Risk Score for undiagnosed T2DM was similar. A simplified FINDRISC can perform as well or better for undiagnosed T2DM. The FINDRISC may be useful to detect cases of undiagnosed T2DM in resource-constrained settings

EFFECT OF Cr AND Pb ON THE ACTIVITY OF ANTIOXIDANT ENZYMES IN A CELL SUSPENSION CULTURE OF Jatropha curcas

Jatropha curcas is a tolerant and accumulator plant of heavy metals (HMs). Little is known about the mechanisms behind this ability. It is suggested that antioxidant enzymes might participate; however, there are no studies reporting the relationship between the activities of antioxidant enzymes and the presence of HMs in an in vitro cell suspension culture of J. curcas. The aim of this study was to determine the effect of chromium (Cr) or lead (Pb) at 0.0 to 3.0 mM on the activity of three antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and peroxidase (POX) through the growthofcellsuspensioncultures(CSC)ofJ.curcas. Theactivitydisplayedbythoseenzymeswasstatisticallysignificant (P≤0.05) when Cr or Pb was used. The greatest enzymatic activity was noted at the first hour of culture for SOD and at five h for POX and CAT. After 192 h, the activity of these three enzymes decreased, which coincided with the exponential growth phase of the cell culture. The results indicated that there is a close relationship between the presence of Cr and Pb and SOD, CAT, and POX activities in a cell suspension culture of J. curcas, which can explain the plant’s capability for tolerating and accumulating high concentrations of Cr and P

Impact of Food Assistance Programs on Obesity in Mothers and Children: A Prospective Cohort Study in Peru.

Objectives. To assess obesity risk among mothers participating in Community Kitchens and children participating in Glass of Milk (Peru food assistance programs). Methods. We analyzed prospective data from the Young Lives study. The exposure consisted in varying degrees of benefit from any of the programs (no participation in any of the programs, program participation for some months, or program participation nearly every month) at baseline (2006–2007). The outcome was overweight and obesity in mothers and children at follow-up (2009–2010). Results. Prevalence of childhood overweight and obesity was 15.5% and 5.1%, respectively; the corresponding figures for mothers were 40.5% and 14.6%. Children exposed nearly every month to the Glass of Milk program had a 65% lower risk of becoming obese compared with children not participating in the program (relative risk [RR] = 0.35; 95% confidence interval [CI] = 0.18, 0.66). Mothers participating frequently in the Community Kitchens program had almost twice the risk of becoming obese compared with those who did not participate (RR = 1.93; 95% CI = 1.18, 3.15). Conclusions. Participating in food assistance programs in Peru was associated with a lower risk of obesity in children and greater risk of obesity in mothers.Revisión por pare

Fruits and vegetables consumption and depressive symptoms: A population-based study in Peru.

OBJECTIVES: Among different factors, diet patterns seem to be related to depression. The aim of this study was to evaluate the association between the consumption of fruits and/or vegetables and depressive symptoms. METHODOLOGY/PRINCIPAL FINDINGS: A secondary data analysis was conducted using information from a population-based survey from 25 regions from Peru. The outcome was the presence of depressive symptoms according to the Patient Health Questionnaire (cutoff ≥15 to define major depressive syndrome); whereas the exposure was the self-reported consumption of fruits and/or vegetables (in tertiles and using WHO recommendation ≥5 servings/day). The association of interest was evaluated using Poisson regression models controlling for the complex-sample survey design and potential confounders. Data from 25,901 participants were analyzed, mean age 44.2 (SD: 17.7) and 13,944 (54.0%) women. Only 910 (3.8%; 95%CI: 3.5%-4.2%) individuals reported consuming ≥5 servings of fruits and/or vegetables/day; whereas 819 (2.8%; 95%CI: 2.5%-3.1%) had depressive symptoms. Those in the lowest tertile of fruits and/or vegetables consumption had greater prevalence of depressive symptoms (PR = 1.88; 95%CI: 1.39-2.55) than those in the highest tertile. This association was stronger with fruits (PR = 1.92; 95%CI: 1.46-2.53) than vegetables (PR = 1.42; 95%CI: 1.05-1.93) alone. CONCLUSIONS: An inverse relationship between consumption of fruits and/or vegetables and depressive symptoms is reported. Less than 5% of subjects reported consuming the amount of fruits and vegetables recommended by the WHO. There is a need to implement strategies to promote better diet patterns with potential impact on mental health

Association between perceived social support and induced abortion: A study in maternal health centers in Lima, Peru.

OBJECTIVES: This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated. METHODS/PRINCIPAL FINDINGS: A cross-sectional study enrolling women aged 18-25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%-49.3%), and 17.4% (95%CI: 13.1%- 21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81-3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14-3.30) after controlling for confounders. CONCLUSIONS: There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed