Prevalence of metabolic syndrome and prediabetes in an urban population of Guayaquil, Ecuador

Sarcopenia Definition and Outcomes Consortium 2020 Definition: Association and Discriminatory Accuracy of Sarcopenia With Disability in the Canadian Longitudinal Study on Aging

BACKGROUND

Previous sarcopenia definitions have poor discriminatory accuracy for identifying people with/without relevant health outcomes, and poor agreement between methods of operationalizing sarcopenia criterion. The 2020 Sarcopenia Definitions and Outcomes Consortium (SDOC) definition recommends grip strength (absolute, or standardized to body mass index, total body fat, lean arm mass, or weight), and gait speed. The agreement between methods of operationalizing grip strength and discriminatory accuracy of the SDOC definition for health outcomes such as activities of daily living (ADL) disability is unknown.

METHODS

Cross-sectional analyses of 27 924 Canadian Longitudinal Study on Aging participants aged 45-85 at baseline (2012-2015) stratified by sex. The associations of the SDOC definitions with ADL disability were assessed using logistic regression. Area under the curve (AUC) analyses were conducted to assess discriminatory accuracy. Agreement between methods of operationalizing grip strength was measured using Cohen's kappa.

RESULTS

Sarcopenia was associated with 1.60 (1.42-1.80) to 5.80 (4.89-6.88) greater odds of ADL disability with AUC values between 0.60 and 0.81. Agreement between methods of operationalizing grip strength was between 0.10-0.80 for grip strength alone and 0.45-0.91 when combined with gait speed.

CONCLUSIONS

The SDOC-suggested criteria of grip strength and gait speed are significantly associated with ADL disability and have high discriminatory accuracy. However, the agreement between methods of operationalizing grip strength tended to be modest, and AUC, sensitivity, and specificity differed depending on the definition. We suggest a single measure of grip strength be considered and age-stratified cutoff values to improve AUC values.

Predictors of Prediabetes Among Communities Without a Family History of Type 2 Diabetes Mellitus: A Case-Control Study

Background Prediabetes is the golden period to promote, prevent, or delay diabetes mellitus (DM) conversion. This study aims to assess the risk predictors associated with prediabetes among communities without a family history of type 2 DM (T2DM). Methodology This case-control study involved 570 participants (265 prediabetes cases and the same number of age-matched controls) in Palembang, Indonesia. Each participant is willing to take fasting blood glucose, lipid profile tests, and physical examinations. Results Multivariate analysis of this study revealed that significant risk predictors identified were occupation in the informal sector (aOR = 3.28; 95% CI = 1.64-6.58; p-value = 0.001), diastolic blood pressure of 80-89 mmHg (aOR = 2.18; 95% CI = 1.35-3.52; p-value = 0.001), diastolic blood pressure of 90-99 mmHg (aOR = 2.09; 95% CI= 1.15-3.82; p-value = 0.016), with an aOR = 5.80 (95% CI= 3.71-9.05; p-value <0.001). triglyceride-glucose index was the dominant risk predictor for prediabetes. Conclusions Knowing who is most vulnerable can guide the efficient allocation of promotion and prevention resources. This finding proves essential consideration for health promoters emphasizing a healthy diet and lifestyle by maintaining diastolic pressure and triglyceride glucose (TyG) index while considering the occupation in populations without a family history of T2DM.

Prevalence of Prediabetes and Related Modifiable Cardiovascular Risk Factors Among Employees of Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia

BACKGROUND

Prediabetes is considered an important risk factor for type 2 diabetes and related cardiovascular problems. However, evidence shows that both prediabetes and its associated cardiovascular risk factors could be mitigated through lifestyle modification. This study aims at determining the magnitude of prediabetes and related modifiable cardiovascular risk factors as an initial step towards undertaking such mitigation measures.

METHODS

A cross-sectional study was conducted on employees of a tertiary care hospital from March to June/2019. Socio-demographic data were collected using a self-administered questionnaire. Anthropometric and blood pressure measurements were performed following WHO guidelines. Biochemical parameters were assayed following standard operating procedures. Categorical variables are summarized using frequencies and percentages. Normality test was performed ahead of describing the numeric data and log transformations were carried out when appropriate. International Diabetes Federation (IDF) and American Diabetes Association (ADA) criteria were used to classify glycemic status. Likewise, IDF and revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) were employed for the diagnosis of metabolic syndrome.

RESULTS

In this study, we engaged a total of 265 employees. About 35.1% were males and 64.9% were females. The median age was 29 (9) years. About 5.7% and 18.1% had prediabetes based on IDF and ADA criteria, respectively. Equally, 3.4% had FBS levels that meet the criteria for overt diabetes on IDF and ADA. Besides, 55.1% had a metabolic risk as implied by the elevated waist-to-height ratio (WhtR), 24.2% had hypertriglyceridemia, 27.9% had above optimal LDL and 57% had low HDL. Overall, 17.9% and 21.9% of the participants had metabolic syndrome according to IDF and revised NCEP ATP III criteria, respectively.

CONCLUSION

The prevalence of prediabetes and metabolic syndrome observed in hospital employees is comparable with the general population.

A pilot of a modified diabetes prevention program in Quito, Ecuador

CONTEXT

Diabetes has become a global noninfectious pandemic with rates rapidly rising around the globe. The major drivers of this increase in type 2 diabetes are obesity, an increase in processed foods, and a decrease in physical activity. In the United States, the National Diabetes Prevention Program (NDPP) has proven to be an effective lifestyle intervention to delay or prevent new-onset type 2 diabetes. However, there is limited evidence that such a lifestyle program will work in a South American community.

OBJECTIVES

This pilot program aims to determine if a modified version of the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) would be feasible in an Ecuadorian population. The goals of this pilot program were a 7% weight loss, >150 min of physical activity per week, and a reduction of fat calories to yield a reduced risk of type 2 diabetes. This program was led by family medicine physicians and was offered to people with prediabetes in Quito, Ecuador.

METHODS

The program was modified to include only the first half of the DPP curriculum, which included a schedule of 16 classes in the first 6 months. Further, the program was provided in Spanish and modified to be more culturally specific to this population. Participants were recruited from the faculty and staff of Pontifical Catholic University of Ecuador (Pontificia Universidad Católica del Ecuador [PUCE]) in Quito. Outcomes measured included A1c reduction, weight loss, increase in physical activity minutes, and progression to type 2 diabetes mellitus (T2DM).

RESULTS

The sample included 33 people with prediabetes. The mean age of the participants was 52 years (range, 41-66 years), the mean body mass index (BMI) was 27.6 kg/m² (range, 21.0-40.3 kg/m²), and the mean HbA1C was 6.2% (range, 5.7-6.4%). The attendance was 97.8% at 6 months. The mean weight loss was 3.4 kg per participant (range, 1.5 kg weight gain to 8.3 kg weight loss); in percentage points, this was a mean weight loss of 3.6% (range, 2.3% gain to 11.8% weight loss). Three-fourths of the participants lost weight (78.3%). The majority of participants (75.8%) met the target physical activity level of 150 min per week, and all participants increased their physical activity levels from baseline. No participants progressed to type 2 diabetes during this study.

CONCLUSIONS

The DPP 6 month pilot was effective in this population with prediabetes in Ecuador. The largest changes were made in physical activity time. Holding the program at worksites and providing lunch were key factors in the very high retention rate in this study.

The burden of hypertension in Ecuador: a systematic review and meta-analysis

Hypertension is a major risk factor of cardiovascular diseases, which occurrence has increased consistently worldwide. With this in mind, this review was designed to evaluate the prevalence of hypertension in Ecuador. We systematically searched publications in Medline, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database, and Ibero-America electronic databases for articles published through September 2019 and reporting the prevalence of hypertension in Ecuador. Selected data were subjected to meta-analysis, and pooled prevalence and their 95% (95% CI) were calculated. Seventeen articles have been selected according to the inclusion/exclusion criteria of the study. The overall estimate of the pooled prevalence of hypertension was 35.8% (CI: 31.3-38.4). Most importantly, the prevalence of hypertension increased markedly with age and obesity. Pooled estimates for the four age subdivisions (<30 years), (≥30 and ≤50 years), (>50 and ≤60 years) and (>60 years) were 9.4% (CI: 7.3-11.5), 22.0% (CI: 19.0-25.0), 26.1% (22.2-30.0) and 48.7% (CI: 45.4-52.0), respectively. Moreover, the pooled estimate of subjects with BMI ≥ 30 kg/m² (57.7%, CIs: 45.6-69.8) was markedly higher than those with BMI < 30 kg/m² (30.4%, CI: 23.3-38.4). Although limited, available data reported higher rates of hypertension in Afro-Ecuadorians than other ethnicities. This study underlines a high prevalence of hypertension in adults nationwide, but mostly in elderly and obese individuals. The magnitude of this burden emphasizes the need for robust and targeted interventions to control hypertension, and ultimately reverse the trend of cardiovascular diseases.

Assessment of Arterial Stiffness in Metabolic Syndrome Related to Insulin Resistance in Apparently Healthy Men

BACKGROUND

Assessment of subclinical atherosclerosis in metabolic syndrome is one of the global health targets' priorities. This study aimed to evaluate the subclinical atherosclerosis in metabolic syndrome related to insulin resistance in healthy and physically active men.

METHODS

A consecutive group of 68 healthy men, 30-55 years of age, was studied. Anthropometric parameters, proinflammatory factors, and insulin level were measured, and pulse wave analysis (PWA) was performed by applanation tonometry and then processed with dedicated software (SphygmoCor^®). The metabolic syndrome was defined according to International Diabetes Federation (IDF) and metabolic health as ≤1 component of metabolic syndrome according to the Joint Interim Statement criteria.

RESULTS

The odds ratio of insulin resistance for metabolic syndrome was 5.16 (95% confidence interval: 1.44-18.5), P = 0.008. In PWA, metabolically healthy subjects had lower aortic systolic and diastolic, and cardiac end-systolic pressures (103.5 ± 9.9 vs. 108.8 ± 11.0), P = 0.03, (76.2 ± 8.8 vs. 80.6 ± 7.8), P = 0.04, and (96.5 ± 9.2 vs. 101 ± 10.1), P = 0.05, respectively. Furthermore, metabolic syndrome was accompanied by higher ejection duration% (38.8 ± 3.5 vs. 36.9 ± 2.8), P = 0.04, and lower subendocardial viability ratio (SEVR) (139.8 ± 17.7 vs. 150.9 ± 17.6), P = 0.05. Insulin resistance was associated with higher cardiac end-systolic pressure (103.0 ± 6.9 vs. 96.7 ± 10.4), P = 0.015.

CONCLUSION

Metabolic risk factors had incremental correlations with central arterial pressures and cardiac end-systolic pressure. Furthermore, the composite of metabolic syndrome components imposed additional load on cardiac muscle by higher cardiac ejection duration and impairment in perfusion with lower Buckberg SEVR. Likewise, insulin resistance could be an early marker of arterial stiffness in healthy and active young to middle-age men.

Metabolic syndrome is associated with hearing disturbance

BACKGROUND

Although metabolic syndrome (MetS) has been associated with various diseases, few studies to date have addressed the association between MetS and hearing loss.

AIMS/OBJECTIVES

This cross-sectional review of health examination center data sought to determine the association between MetS and hearing disturbance.

MATERIAL AND METHODS

This study involved 28,866 subjects. Height, weight, waist circumference, and blood pressure were measured, and basic blood tests and pure-tone audiometry (PTA) were performed. Other factors analyzed included body mass index, hypertension, diabetes mellitus, and hyperlipidemia.

RESULTS

Age and gender did not differ between subjects with and without MetS. PTA was slightly higher in subjects with than without MetS, but the difference was not statistically significant (p = .47). The incidence of hearing loss was no higher in subjects who met three of the five diagnostic criteria of MetS than in those who met 0-2 criteria, but was significantly higher in subjects who met four (p = .04) and five (p < .01) criteria.

CONCLUSIONS AND SIGNIFICANCE

MetS may be associated with hearing loss, especially in subjects who meet four or five of the diagnostic criteria for MetS.

Prevalence of prediabetes and diabetes among older adults in Ecuador: Analysis of the SABE survey

AIMS

To examine the prevalence of prediabetes and diabetes among subjects aged 60 years and older in Ecuador.

MATERIALS AND METHODS

The present study used data from the National Survey of Health, Wellbeing, and Aging to describe the prevalence of prediabetes and diabetes among older adults. Logistic regression models were assembled to examine the association between certain demographic and health characteristics of participants and prediabetes and diabetes prevalence rates.

RESULTS

Of 2298 participants, the prevalence of prediabetes and diabetes was 36.9% (95% CI: 34.2%-39.6%) and 16.7% (95% CI: 14.9%-18.7%) among older adults in Ecuador, respectively. Notably, higher diabetes prevalence rates were seen among women, black subjects, residents in the urban coastal region, and obese participants than those without. In general, the prevalence of diabetes widely varied across provinces of the country, with higher rates seen in provinces along the coastal region of the country. After adjustment for age, gender, and BMI, residents in the urban coast, subjects with greater number of comorbidities, and those classified as having hypertension, and hypertriglyceridemia had significantly higher odds of having diabetes than those without.

CONCLUSIONS

Prediabetes and diabetes are prevalent among older adults in Ecuador. The increased prevalence of these metabolic disorders was particularly associated with obesity. Thus, the present findings may assist health care authorities to implement healthy lifestyle interventions among older Ecuadorians at risk for diabetes.

Prevalence of abdominal obesity and its association with cardio metabolic risk factors among older adults in Ecuador

AIMS

To describe the prevalence of abdominal obesity and its association with cardio metabolic risk factors among older adults in Ecuador.

MATERIALS AND METHODS

The present study used data from the National Survey of Health, Wellbeing, and Aging survey to examine the prevalence of abdominal obesity according to certain demographic, behavioral, and health characteristics of the participants. Logistic regression models adjusted for potential confounders were used to evaluate the association of abdominal obesity with cardio metabolic risk factors.

RESULTS

Of 2053 participants aged 60 years and older, the prevalence of abdominal obesity was 65.9% (95% CI; 62.2%, 69.4%) in women and 16.3% (95% CI; 13.8%, 19.2%) in men. Notably, a higher prevalence of abdominal obesity was seen among residents in the urban areas of the country, those who reported their race as black or mulatto, individuals with sedentary lifestyle and obesity, and older adults with greater number of comorbidities. Moreover, after adjustment for potential confounders, women with abdominal obesity were 2.0, 2.8, and 1.6 times more likely to have diabetes, the metabolic syndrome, and hypertriglyceridemia as compared with those without, respectively. Likewise, men with abdominal obesity had 51% and 22% higher rates of hypertension and diabetes than their non-obese counterparts, respectively.

CONCLUSIONS

the prevalence of abdominal obesity is high among older adults in Ecuador. Moreover, abdominal obesity is significantly associated with cardio metabolic risk factors. Therefore, further research is needed to evaluate sociodemographic and nutritional determinants of this emerging public health burden among older Ecuadorians.

The prevalence of metabolic syndrome among older adults in Ecuador: Results of the SABE survey

AIMS

To describe the prevalence of metabolic syndrome among older adults in Ecuador. A secondary objective was to examine the relationship between metabolic syndrome and its components and insulin resistance among non-diabetic participants.

MATERIALS AND METHODS

The National Survey of Health, Wellbeing, and Aging survey was used to examine the prevalence of metabolic syndrome according to demographic, behavioral, and health characteristics of the participants. Logistic regression models adjusted for covariates were used to examine the independent association of metabolic syndrome and its components and insulin resistance in non-diabetic older adults.

RESULTS

Of 2298 participants with a mean age of 71.6 (SD 8.1) years, the prevalence of metabolic syndrome was 66.0% (95% CI, 62.6%, 69.3%) in women and 47.1% (95% CI, 43.2%, 50.9) in men. However, even higher prevalence rates were seen among literate individuals, residents from urban areas of the coastal and Andes Mountains region, obese subjects, those diagnosed with diabetes, and participants with≥2 comorbidities. Overall, abdominal obesity followed by elevated blood pressure were the metabolic syndrome components more prevalent and associated with insulin resistance among older Ecuadorians. Moreover, after adjustment for covariates, older adults defined as having metabolic syndrome had a 3-fold higher odds of having insulin resistance as compared with those without.

CONCLUSIONS

The prevalence of metabolic syndrome is high among older adults in Ecuador. The present findings may assist public health authorities to implement programs of lifestyle and behavioral modification targeting older adults at increased risk for this cardio metabolic disorder.

Assessment of arterial stiffness in patients with metabolic syndrome in Ecuador: A cross-sectional study

BACKGROUND

Metabolic syndrome increases cardiovascular risk, and causes damage to the vascular wall. Through this mechanism, it might increase arterial rigidity, leading to further complications and heart strain. The use of a device that measures arterial rigidity can help determine if metabolic syndrome is related to a higher vascular stiffness and changes in estimated arterial age.

METHODOLOGY

Cross-sectional study at Luis Vernaza hospital of Guayaquil, Ecuador. Inpatients and outpatients from the Department of Cardiology with a full blood panel and echocardiogram were included. We used the IDF criteria to diagnose metabolic syndrome and measured arterial rigidity parameters in all of them, including augmentation indexes, central blood pressure, pulse wave velocity and arterial age.

RESULTS

95 patients were included for analysis, 44.2% were females and 55.8% were males. Mean age was 61.7 years (±13.1). Metabolic syndrome was diagnosed in 49.5% of our patients and it was significantly more prevalent in women. We found significant differences in PWV, augmentation indexes, and peripheral and central blood pressure between metabolic and non-metabolic syndrome patients. There was a non-significant relationship between estimated arterial age and metabolic syndrome (p=0.32).

CONCLUSION

Patients with metabolic syndrome have an increased arterial rigidity. This, added to the high prevalence of the disease we found in our sample, shows the high cardiovascular risk these patients are at. A multidisciplinary approach to management is needed, along with patient collaboration. The introduction of these devices to measure arterial stiffness in developing countries can improve diagnosis and therapy of patients with cardio-metabolic conditions.