Diego Urrunaga-Pastor

Is free triiodothyronine important in the development of insulin resistance in healthy people

OBJECTIVE To determine the association between thyroid hormones and insulin resistance in a population of healthy individuals. MATERIALS AND METHODS We conducted an analytical cross-sectional study in adults who attended a private clinic from 2012 to 2014. We excluded those participants with fasting glucose values ​​compatible with diabetes mellitus, abnormal thyroid hormone values, chronic use of corticosteroids, and incomplete medical records. Participants were divided into tertiles (low, intermediate and high) according to their free triiodothyronine and free thyroxine values. We defined Insulin resistance as a Homeostasis Model Assessment (HOMA-IR) value greater than 3.8. We conducted a univariate and multivariate Poisson regression model to assess the association between thyroid hormones and insulin resistance. The association measure reported was the prevalence ratio (PR) with their confidence interval (CI) at 95%. RESULTS We evaluated 600 participants. The mean age was 36.8±14.2years and 33% were male. The frequency of insulin resistance was 29.5%. In the univariate regression, we found association between free triiodothyronine tertiles and insulin resistance. In the multivariate regression adjusted for age, sex, body mass index and thyroid stimulating hormone, the association between free triiodothyronine tertiles and insulin resistance remained; intermediate tertile (PR=1.54; CI95%: 1.10-2.15) and high tertile (PR=1.70; CI95%: 1.21-2.39). We found no association between T4 and insulin resistance. CONCLUSIONS High levels of free triiodothyronine are associated with insulin resistance. The use of free trioodothyronine to assess insulin resistance in healthy patients should be considered.

Disrespect and abuse during childbirth in fourteen hospitals in nine cities of Peru

To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru.

High serum ferritin levels are associated with insulin resistance but not with impaired glucose tolerance in a healthy people population

AIM To assess the association between elevated serum ferritin levels and the presence of insulin resistance (IR) or impaired glucose tolerance (IGT) in a population of individuals with no endocrine or metabolic disorders background. METHODS Analytical cross-sectional study, carried out in adults of both sexes with no medical history of type 2 diabetes mellitus (T2DM) or other metabolic or endocrine disorder, who attended the outpatient service of a private clinic in Lima-Peru during 2012-2014 period. Impaired serum ferritin levels were defined as serum ferritin values >300μg/L in men and >200μg/L in women. IR was defined as a Homeostasis Model Assessment (HOMA-IR) value ≥3.8 and IGT was defined as an oral glucose tolerance test (OGTT) value between 126mg/dL and 199mg/dL. The reported association measure was the prevalence ratio (PR) with their respective 95% confidence intervals (95% CI). RESULTS We analyzed 213 participants, the average age was 35.8±11.1years and 35.7% were males. The prevalence of impaired serum ferritin levels, IR and IGT in the population was 12.7%, 33.3% and 9.9% respectively. In the adjusted Poisson regression models, the prevalence of IR was higher among the group with impaired serum ferritin levels (PR=1.74; 95%CI:1.18-2.56); however, we found no association between impaired serum ferritin levels and IGT (PR=1.42; 95%CI:0.47-4.30). CONCLUSIONS Impaired levels of serum ferritin are associated with IR, nevertheless, not with IGT in a metabolically healthy population. Serum ferritin could be considered as an early marker of IR prior to the onset of glycaemia disorders.

High triglycerides to HDL-cholesterol ratio is associated with insulin resistance in normal-weight healthy adults

AIM To evaluate the association between high triglyceride/HDL-cholesterol (TG/HDL-C) ratio and insulin resistance (IR) or hyperinsulinemia after oral glucose tolerance test (OGTT) in normal-weight healthy adults. METHODS We carried out an analytical cross-sectional study in euthyroid non-diabetic adults, who attended the outpatient service of a private clinic in Lima-Peru from 2012 to 2016. Participants were divided in two groups according to the presence or absence of high TG/HDL-C ratio, IR or hyperinsulinemia after OGTT. TG/HDL-C ratio values ≥ 3 were considered as high. IR was defined as a Homeostasis Model Assessment (HOMA-IR) value ≥ 2.28 and hyperinsulinemia after OGTT as a serum insulin value ≥ 80μU/mL after 120 min of 75-g glucose intake. We elaborated crude and adjusted Poisson generalized linear models to evaluate the association between high TG/HDL-C ratio and IR or hyperinsulinemia after OGTT and reported the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI). RESULTS We analyzed the data of 118 individuals. Prevalence of high TG/HDL-C ratio was 17.8% (n = 21) while the prevalence of IR and hyperinsulinemia after OGTT was 24.6% (n = 29) and 17.0% (n = 20), respectively. TG/HDL-C-ratio values were positively correlated with HOMA-IR (r = 0.498; p < 0.01) and serum insulin after OGTT (r = 0.326; p < 0.001). In the adjusted model, high TG/HDL-C ratio was associated with both IR (aPR = 3.16; 95%CI: 1.80-5.77) and hyperinsulinemia after OGTT (aPR = 2.36; 95%CI: 1.20-4.63). CONCLUSIONS High TG/HDL-C ratio was associated with both IR markers used in our study, appearing to be a clinically useful tool to assess IR in euthyroid normal-weight adults without type 2 diabetes mellitus.

Triglycerides and glucose index as an insulin resistance marker in a sample of healthy adults

AIM To assess the association between elevated triglycerides/glucose index (TGI) and insulin resistance (IR) or hyperinsulinemia after oral glucose tolerance test (OGTT) in a sample of healthy adults. METHODS We conducted an analytical cross-sectional study in euthyroid non-diabetic adults, who attended the outpatient service of a private clinic in Lima-Peru during the 2012-2016 period. Participants were categorized in two groups according to the presence or absence of elevated TGI, IR or hyperinsulinemia after OGTT. A TGI value ≥ 8.65 was considered as elevated. We defined IR as a Homeostasis Model Assessment (HOMA-IR) value ≥ 2.28 and hyperinsulinemia after OGTT as a serum insulin value ≥ 80μU/mL after 120 min of 75-g glucose intake. We elaborated crude and adjusted Poisson regression models to assess the association between elevated TGI and IR or hyperinsulinemia after OGTT. The reported association measure was the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI). RESULTS We analyzed 118 individuals, the average age was 37.5 ± 11.3 years, 21 (17.8%) were males and the median BMI was 22.7 ± 1.6 kg/m2. The prevalence of elevated TGI was 25.4% (n=30) while the prevalence of IR and hyperinsulinemia after OGTT was 24.6% (n=29) and 17.0% (n=20) respectively. In the adjusted model, elevated TGI was associated with both IR (aPR=6.36; 95%CI: 3.41-11.86) and hyperinsulinemia after OGTT (aPR=4.19; 95%CI: 1.81-9.70). CONCLUSIONS We found that elevated TGI was associated with both IR markers in a sample of euthyroid adults without T2DM and with a normal BMI. The simplicity of the TGI calculation makes it the first-choice alternative when the hyperinsulinemic-euglycemic clamp or HOMA-IR are not available.

Association between free thyroid hormones values and the lipid profile in middle-aged women with chronic symptoms

AIMS To determine the association between the thyroid hormones(FT3, FT4 and TSH) and the lipid profile markers(HDL-c, LDL-c and triglycerides) values in middle-aged women with no metabolic disorders and recurrent chronic symptomatology. MATERIALS AND METHODS We carried out an analytical cross-sectional study in euthyroid women with recurrent chronic symptoms of at least six months with no apparent diagnosis who attended the endocrinological gynaecology outpatient service of a private clinic in Lima-Peru during 2012-2014. Participants who met the eligibility criteria were evaluated according to their thyroid hormones(FT3, FT4 and TSH) and lipid profile markers(HDL-c, LDL-c and triglycerides) values. We elaborated univariate/multivariate linear regression models to evaluate the association between the thyroid markers and the lipid profile levels. The reported association measure was the beta coefficient(β) with its respective p-value. RESULTS We analyzed 211 participants, the average age was 44.9 ± 14.0(SD) years, the FT3 and FT4 mean levels were 3.2 ± 0.4 pg/mL and 1.2 ± 0.2 ng/dL respectively, while the TSH median was 2.8(IQR:1.9-4.0) μU/mL. The mean or median levels of LDL-c, HDL-c and triglycerides were of 137.5 ± 37.9 mg/dL, 54.0 ± 15.0 mg/dL and 118.5(IQR:79.5-169.5) mg/dL respectively. In the multivariate linear regression model between the FT3 and LDL-c levels, we found that for each increase in a FT3 unit, the LDL-c values decreased on average 30.85 mg/dL(p < 0.01). We found no statistically significant associations in the other multivariate models of linear regression, among the other thyroid hormones and lipid markers. CONCLUSION We found an inverse association between the FT3 and LDL-c values in women with chronic gynaecological symptoms.

Factors associated with poor balance ability in older adults of nine high-altitude communities

INTRODUCTION Poor balance ability in older adults result in multiple complications. Poor balance ability has not been studied among older adults living at high altitudes. In this study, we analysed factors associated with poor balance ability by using the Functional Reach (FR) among older adults living in nine high-altitude communities. MATERIAL AND METHODS Analytical cross-sectional study, carried out in inhabitants aged 60 or over from nine high-altitude Andean communities of Peru during 2013-2016. FR was divided according to the cut-off point of 8 inches (20.32 cm) and two groups were generated: poor balance ability (FR less or equal than 20.32 cm) and good balance ability (greater than 20.32 cm). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor balance ability. Prevalence ratio (PR) with 95% confidence intervals (95CI%) are presented. RESULTS A total of 365 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60-91 years), and 180 (49.3%) participants had poor balance ability. In the adjusted Poisson regression analysis, the factors associated with poor balance ability were: alcohol consumption (PR = 1.35; 95%CI: 1.05-1.73), exhaustion (PR = 2.22; 95%CI: 1.49-3.31), gait speed (PR = 0.67; 95%CI: 0.50-0.90), having had at least one fall in the last year (PR = 2.03; 95%CI: 1.19-3.46), having at least one comorbidity (PR = 1.60; 95%CI: 1.10-2.35) and having two or more comorbidities (PR = 1.61; 95%CI: 1.07-2.42) compared to none. CONCLUSIONS Approximately a half of the older adults from these high-altitude communities had poor balance ability. Interventions need to be designed to target these balance issues and prevent adverse events from concurring to these individuals.

Factores asociados a la no utilización de los servicios formales de prestación en salud en la población peruana: análisis de la Encuesta Nacional de Hogares (ENAHO) 2015

The aim of the study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors using the National Household Survey (ENAHO 2015). The participants were defined as NUHS if they have presented any symptoms, discomfort, illness, relapse of chronic illness or accident during the last month and did not go to the health services. 35036 participants were analyzed; the prevalence of NUHS was 53,9%. NUHS was higher in the coastal region (adjusted Prevalence Ratio [aPR]=1.24;95%CI:1.17-1.31), highlands (aPR=1.38; 95%CI: 1.31-1.46) and jungle (aPR=1.25,95%CI:1.18-1.33) compared to Lima. Likewise, there were a higher prevalence of NUHS in participants without health insurance (aPR=1.59;95%CI:1.52-1.66) and those affiliated to Ministry of Health insurance (aPR=1.16;95%CI:1.11-1.22) compared to those affiliated to Social Security. More than half of the participants suffered from NUHS, which was associated with geographical and health system conditions. It is required evidenced-informed public policies to improve this situation.

Cursos masivos abiertos en línea de psicoterapia

Sr. Editor Los desordenes mentales son un problema prioritario de salud publica, de manera que su prevalencia mundial se calcula en 17,6% (1), y se estima que el 22,9% de anos vividos con discapacidad a nivel mundial se deben a desordenes mentales y abuso de sustancias (2). Para afrontar esta situacion, resulta necesario que los sistemas de salud dispongan de personal capacitado en el diagnostico y manejo de estas condiciones, que incluye el manejo de psicoterapiabasica. De esta manera, un metaanalisis refiere que el entrenamiento en psicoterapia del personal de salud no especializado es efectivo en el primer nivel de atencion, reduciendo los desordenes mentales perinatales en mujeres (3) y el riesgo de padecer depresion en adultos hasta en 60%, siendo potencialmente efectivo para otros desordenes mentales (4). Coherentemente, la normativa peruana refiere que los encargados de realizar el diagnostico y manejo en el primer nivel de atencion son los medicos y todo personal asistencial que brinde servicio de salud,previamente capacitado (5). Sin embargo, lograr esta capacitacion es dificil, en especial en paises con escasos recursos destinados a salud. Leer mas...

High free triiodothyronine and free-triiodothyronine-to-free-thyroxine ratio levels are associated with metabolic syndrome in a euthyroid population

AIMS To determine the association between free triiodothyronine (FT3), free thyroxine (FT4) and free-triiodothyronine-to-free-thyroxine ratio (FT3/FT4) levels and Metabolic Syndrome (MetS). MATERIALS AND METHODS We carried out an analytical cross-sectional study in euthyroid adults of both sexes, who attended the outpatient service of a private clinic in Lima-Peru during the 2014-2016 period. Participants were divided into tertiles (low, intermediate and high) according to their FT3, FT4, and FT3/FT4 ratio values. MetS was defined when three or more metabolic criteria were met by the participants. ROC curves were constructed, and Youdens Index were used to identify the optimal cut-points of each thyroid marker. We elaborated crude/adjusted Poisson regression models to evaluate the association between the thyroid markers and the presence of MetS. The reported association measure was the prevalence ratio (PR) with their respective 95% confidence intervals (95% CI). RESULTS We analyzed 245 participants, the average age was 38.5 ± 10.3 years, 29.8% were males, and the prevalence of MetS was 31%. In the adjusted Poisson regression models, the prevalence of MetS was higher among the high FT3 tertile compared to the low tertile (aPR = 2.01; 95% CI: 1.22-3.34). The prevalence of MetS was higher among the intermediate FT3/FT4 ratio tertile and the high FT3/FT4 ratio tertile compared to the low tertile, (aPR = 1.78; 95% CI: 1.02-3.10) and (aPR = 2.80; 95% CI: 1.67-4.72); respectively. The highest areas under the curve (AUC) were found for FT3 and FT3/FT4 ratio with areas of 0.654 (95% CI: 0.58-0.73) and 0.649 (95% CI: 0.57-0.72); respectively. CONCLUSION Elevated levels of FT3 and FT3/FT4 ratio were associated with MetS in a euthyroid population.