Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

Background. Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods. An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved). Conclusions. Most of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.Centro de Endocrinología Experimental y Aplicada (CENEXA

The importance of the cellular stress response in the pathogenesis and treatment of type 2 diabetes

Organisms have evolved to survive rigorous environments and are not prepared to thrive in a world of caloric excess and sedentary behavior. A realization that physical exercise (or lack of it) plays a pivotal role in both the pathogenesis and therapy of type 2 diabetes mellitus (t2DM) has led to the provocative concept of therapeutic exercise mimetics. A decade ago, we attempted to simulate the beneficial effects of exercise by treating t2DM patients with 3 weeks of daily hyperthermia, induced by hot tub immersion. The short-term intervention had remarkable success, with a 1 % drop in HbA1, a trend toward weight loss, and improvement in diabetic neuropathic symptoms. An explanation for the beneficial effects of exercise and hyperthermia centers upon their ability to induce the cellular stress response (the heat shock response) and restore cellular homeostasis. Impaired stress response precedes major metabolic defects associated with t2DM and may be a near seminal event in the pathogenesis of the disease, tipping the balance from health into disease. Heat shock protein inducers share metabolic pathways associated with exercise with activation of AMPK, PGC1-a, and sirtuins. Diabetic therapies that induce the stress response, whether via heat, bioactive compounds, or genetic manipulation, improve or prevent all of the morbidities and comorbidities associated with the disease. The agents reduce insulin resistance, inflammatory cytokines, visceral adiposity, and body weight while increasing mitochondrial activity, normalizing membrane structure and lipid composition, and preserving organ function. Therapies restoring the stress response can re-tip the balance from disease into health and address the multifaceted defects associated with the disease

Extruded Flaxseed Meal Enhances the Nutritional Quality of Cereal-based Products

Human consumption of flaxseed is increasing due to its health benefit properties and extrusion processes can enhance its nutritional quality. Extruded flaxseed meal (EFM) obtained in a pilot plant was characterized and incorporated in flour mixes and cereal-based bars to demonstrate its nutritious usefulness. Amino acid content was not affected by extrusion and, despite lysine was the limitating amino acid, the chemical score (CS) was 83 %. Thiamin and riboflavin decreased slightly as consequence of extrusion, phytic acid did not change and trypsin inhibitor activity was undetectable. Proximate composition and nutritional quality determined by biological and chemical indexes were compared among EFM, flour mixes (FM) and cereal bars (CB). They presented high protein levels (26, 20 and 17 %, respectively), good biological value (BV) (80, 79 and 65, respectively), acceptable true protein digestibility (TD) (73, 79 and 78, respectively), and high dietary fiber (33, 20.5 and 18 %, respectively). The ratio of ω6:ω3 for CB was within the WHO/FAO recommendations. These results open a new venue for the usefulsess of nutritious/healthy extruded flaxseed flours into ready-to-eat cereal-based products with improved nutritional quality. © 2013 Springer Science+Business Media New York.This research has been funded by Buenos Aires University 01/1171 project and the Spanish Commission of Science and Technology AGL2010-16310 project. We thank INTI, Argentine, for providing industrial facilities. E.P. is indebted to CSIC and FSE-EU for a JAE-post grant.Peer Reviewe

Assessment of the nutritional quality of raw and extruded Pisum sativum L. var. laguna seeds

Pea (Pisum sativum L. var. Laguna) seeds were submitted to extrusion process at 129, 135 and 142 °C and modifications on the proximate composition and nutritional parameters were evaluated. Peas were a good source of protein (24 g/100 g), amino acids (sulphur amino acids were the limiting ones), dietary fibre (18 g/100 g), carbohydrates (53 g/100 g), energy (330 kcal/100 g), riboflavin and thiamine (0.1-0.2 mg/100 g). Pea seeds also contained non-nutritive compounds such as α-galactosides (4 g/100 g), phytic acid (0.4 g/100 g) and trypsin inhibitor activity (2 TIU/mg). Extrusion cooking caused a slight increase of protein and fat content, whilst it reduced dietary fibre, thiamine and α-galactosides, and led to negligible trypsin inhibitor activity (TIA) levels. The protein quality of pea measured by biological indexes (net protein utilisation, net protein ratio, relative net protein ratio, true protein digestibility and biological value) was not affected by extrusion treatments. Protein quality measured by chemical indexes (chemical score and protein digestibility corrected amino acid score) decreased in processed peas. Among extruded peas, those processed at 135 °C presented the highest chemical indexes. Therefore, the aforementioned condition could be considered adequate for the manufacture of novel pea-derived products with high nutritive value. © 2011 Elsevier Ltd.This work has been funded by the Spanish Commission of Science and Technology AGL2010-16310 project, Buenos Aires University B426 project and Cereal and Oilseeds Centre of National Institute of Industrial Technology (INTI).Peer Reviewe

How Do Usage and Payment Behavior Interact in Rent-to-Own Business Models? Evidence from Developing Economies

The diffusion of technological innovations in developing economies has been facilitated by the use of rent-to-own business models, which give flexibility to customers by allowing them to make incremental payments over time. Understanding the implications of this flexibility is a fundamental problem for an increasing number of firms operating in these markets. In this study, we empirically analyze how consumer usage and payment behaviors interact in an application of rent-to-own to the distribution of solar lamps in developing countries. By exploiting the longitudinal variation in the data—and hence accounting for intrinsic differences between customers—the analysis led to three main insights. First, higher usage rates lowered the probability of late payments by customers. Our characterization of this engagement effect enhances existing knowledge of the drivers of payment behavior in these environments. Second, customers often “bundled” payments, making advance payments for future product access. We showed that bundling the initial payment led to lower usage rates (bundling effect), suggesting that firms may not benefit from advance payments upfront, and that they should closely track usage patterns from these customers. Finally, we showed that first-period usage information can improve the accuracy of predictive models of default and that observing usage rates in subsequent periods does not lead to further improvements. Overall, the analysis highlights the importance for firms of jointly tracking and analyzing payment and usage behavior by customers, particularly in initial stages of the adoption process

Effect of extrusion on the nutritional and non-nutritive compounds of Pisum sativum L.

Trabajo presentado al EuroFoodChem XV: Food for the future, celebrado del 5 al 8 de julio de 2009 en Copenhague (Dinamarca).Peer reviewe

Estudio de la calidad nutricional de arveja (Pisum sativum L.) sometida a procesos de extrusión

Trabajo presentado al XV Congreso Latinoamericano de Nutrición, celebrado en Chile en noviembre de 2009.Peer reviewe

Glucosinolate-rich broccoli sprouts protect against oxidative stress and improve adaptations to intense exercise training.

Oxidative stress plays a vital role for the adaptive responses to physical training. However, excessive oxidative stress can precipitate cellular damage, necessitating protective mechanisms to mitigate this effect. Glucosinolates, found predominantly in cruciferous vegetables, can be converted into isothiocyanates, known for their antioxidative properties. These compounds activate crucial antioxidant defence pathways and support mitochondrial function and protein integrity under oxidative stress, in both Nrf2-dependent and independent manners. We here administered glucosinolate-rich broccoli sprouts (GRS), in a randomized double-blinded cross-over fashion to 9 healthy subjects in combination with daily intense exercise training for 7 days. We found that exercise in combination with GRS significantly decreased the levels of carbonylated proteins in skeletal muscle and the release of myeloperoxidase into blood. Moreover, it lowered lactate accumulation during submaximal exercise, and attenuated the severe nocturnal hypoglycaemic episodes seen during the placebo condition. Furthermore, GRS in combination with exercise improved physical performance, which was unchanged in the placebo condition