Elena Carrasco P

Prevalencia de diabetes tipo 2 y obesidad en dos poblaciones aborígenes de Chile en ambiente urbano

Background: The prevalence of cardiovascular risk factors is increasing in aboriginal populations in Chile. Aim: To study the prevalence of obesity, type 2 diabetes and serum lipids in two aboriginal populations, Mapuche and Aymara, that were transferred from a rural to a urban environment. Subjects and Methods: Two groups of subjects over 20 years were analyzed, Mapuche and Aymara. The Mapuche group was formed by 42 men and 105 women, living in four urban communities of Santiago, and an Aymara group formed by 42 men and 118 women, living in Arica, in Northern Chile. Anthropometric measurements, blood pressure, lipid profile, oral glucose tolerance test, fasting insulin and serum leptin were determined. Results: The prevalence of type 2 diabetes was 6.9% in Aymara and 8.2% in Mapuche subjects. The frequency of glucose intolerance was similar in both groups, but greater among men. A total blood cholesterol over 200 mg/dl was observed in 43.1% of Aymara and 27.9% of Mapuche subjects (p <0.008). Serum triglycerides over 150 mg/dl were observed in 16.9 and 23.1% of Aymara and Mapuche individuals, respectively (p= NS). Conclusions: The prevalence of type 2 diabetes and dyslipidemia in urban aboriginal populations is higher than that of their rural counterparts. A possible explanation for these results are changes in lifestyles that come along with urbanization, characterized by a high consumption of saturated fat and refined sugars and a low level of physical activity (Rev Med Chile 2004; 132: 1189-97). (Key Words: Diabetes Mellitus, type II; Hypercholesterolemia; Hyperlipidemia; Indians, South American)

Incidencia de diabetes gestacional y su relación con obesidad en embarazadas chilenas

BACKGROUND Gestational diabetes (GDM) is associated to a worse outcome of pregnancy. This justifies efforts for finding possible causes of GDM that would allow implementing preventive interventions. AIM To study incidence of GDM and its relation with obesity and other traditional risk factors. MATERIAL AND METHODS A retrospective study was performed in 234 women who had delivered a singleton during the last 12 months, attended in an outpatient clinic in Santiago, Chile. Familiar and personal history, body mass index (BMI), obstetrical-related pathology and data about the labor and the newborn were analyzed. RESULTS GDM was diagnosed in 11.2% of the women. BMI before pregnancy was 26.6 +/- 4.4 kg/m2 (mean +/- SD) and it was 25 or over in 37.8% of women. Women who developed GDM had significantly higher BMI in the pre-pregnancy stage and in the second and third trimester of pregnancy (p < 0.001). The average age was greater in the GDM group (31 +/- 0.2 yr versus 26 +/- 0.41 yr). Incidence of GDM was 14.4% among women 25 years old or older and increased to 21.4% when they had, in addition, a BMI of 25 or over. Age, BMI, and family history of diabetes were all independently correlated with the development of GDM. Elective caesarean sections were more common in GDM than in non-GDM women (p < or = 0.01) and complications were present in 3/23 of newborns of women with GDM and 2/199 among women without GDM (p < 0.01) CONCLUSIONS GDM and obesity are highly prevalent in Chilean pregnant women. BMI, first degree relative with DM and age are independent risk factors for the development of GDM.

Prevalencia de obesidad , hipertensión arterial y dislipidemia en grupos aborígenes rurales de Chile

Background: Chilean aboriginal ethnic groups (mapuche and aymaras) have a very low prevalence rate of type 2 diabetes. The investigation of a possible relationship between this low prevalence of diabetes and obesity, hypertension and serum lipid profiles in both groups is worthwhile. Aim: To study the prevalence of obesity, hypertension and lipid profile in two Chilean aboriginal communities. Subjects and Methods: The prevalence of obesity, hypertension, fasting serum total cholesterol, HDL cholesterol, triglycerides, glucose, insulin, leptin and oral glucose tolerance test were measured in 345 mapuche (106 male) and 247 aymara (100 male) individuals. Results: Sixty three percent of mapuche women, 37.9% of mapuche men, 39.7% of the aymara women and 27.0% of aymara men had a body mass index over 27 kg/m2. Twenty percent of mapuche men, 18.0% of mapuche women, 9.0% of aymara men and 4.8% of the aymara women had high blood pressure values. Serum HDL cholesterol was below 35 mg/dl in 16% of mapuche women, 14% of mapuche men, 25% of the aymara women and 27% of aymara men. No differences in total cholesterol levels were observed between mapuches and aymaras. Conclusion: Mapuche women have higher prevalence of obesity and high blood pressure than aymara women. Low serum HDL cholesterol has a higher prevalence among aymara individuals.

Niveles plasmáticos de citoquinas IL-1ß, IL2 e IL-4 en niños diabéticos tipo 1 de diagnóstico reciente y su asociación con anticuerpos ß pancreáticos

9.1 pg/ml respectively, p=0,01). No differences in serum IL-4 were observed between diabetics and con-trol. Diabetic children with one or two positive autoantibodies (IA-2 and/or GAD65) had significantly higherlevels of IL-1s and IL-2 and lower levels of IL-4 than diabetic children without positive autoantibodies. Highconcentrations of IL-1s were associated with an early onset of the disease.

Polimorfismos del gen del receptor de muerte celular programada 1 (PDCD1) y diabetes tipo 1 en población Chilena

BACKGROUND Programmed cell death 1 (PDCD-1) immune-receptor is a key element in the negative regulation of peripheral tolerance in T cells. Several polymorphisms of this gene have been described and it is linked with susceptibility to autoimmune diseases like Lupus and Multiple Sclerosis. AIM To analyze four gene polymorphisms of PDCD-1 gene and explore its possible contribution as a susceptibility gene for type 1 diabetes (T1D). PATIENTS AND METHODS We analyzed 160 cases with T1D of recent diagnosis aged 9.5 +/- 3.3 years and 160 control children aged 10.7 +/- 3.1 years. Four genetic variants of PDCD-1 gene were studied (PD1.2; PD1.5; PD1.6 and PD1.9) by polymerase chain reaction and restriction enzymes. Autoantibodies GAD65 and anti-IA-2 were also measured in all studied children. The comparison of allelic and genotypic frequency and consistency with respect to Hardy-Weinberg equilibrium test were analyzed using Chi-square and Fisher exact test. RESULTS No differences between cases and controls were observed for PDCD1.2; PDCD1.5 and PDCD1.9 polymorphisms. PDCD1.6 polymorphism (carriers of allele A) had a higher frequency in the control group (0.794 versus 0.644, p < 0.017). There was no particular association of these polymorphisms with anti- GAD65 and anti-IA-2 antibodies among patients with T1D. CONCLUSIONS Only PDCD1.6 polymorphism showed differences between T1D cases and controls. Possibly, none of these genetic variants of PDCD1 has a relevant role as a marker for T1D in the Chilean population.

Incidencia de diabetes mellitus tipo 1 en Santiago de Chile: análisis por comunas de la Región Metropolitana en el período 2000-2004

BACKGROUND There are great geographical differences in the incidence of type I diabetes mellitus. AIM To determine the incidence rate of type 1 diabetes mellitus (DM1) in the Metropolitan Region of Santiago, Chile from January 1, 2000 to December 31, 2004 and to observe the distribution of cases in the different counties of Santiago. MATERIAL AND METHODS All the cases diagnosed with DM1 in the Metropolitan Region who fulfilled the following requirements were included in the study: age of onset <15 years, insulin treatment from onset, permanent residency in the area, and a diagnosis made between January, 2000 and December, 2004. RESULTS The incidence of DM1 was 6.58/100,000 inhabitants/year, and showed a significant increase from 2001 to 2004 (5.44 and 8.33 inhabitants/year, respectively, p <0.04). The incidence of DM1 also increased significantly in children younger than 4 years old. The incidence by counties exhibited large differences, ranging from 1.5 to 26.6/100,000 inhabitants. Counties with higher income, urbanization and low aborigine component showed a high incidence rate of type 1 diabetes. CONCLUSIONS In the Metropolitan Region of Santiago, an increase of the incidence of DM1 has occurred in the period 2000-2004, especially in children younger than 4 years old. Large differences among counties were observed.

Estudio temporal de diabetes mellitus tipo 1 en Chile: asociación con factores ambientales durante el período 2000-2007

BACKGROUND Pollution and viral infections could be associated with the incidence of type 1 diabetes mellitus. AIM To look for associations between the temporal patterns of Type 1 Diabetes Mellitus (T1D) in infants younger than the age of 15 years, and environmental factors, such as air pollution and viruses. MATERIAL AND METHODS Data registries from hospitals, emergency services, and the Infantile Diabetes Foundation were reviewed, corresponding to children aged less than 15 years, who received their first insulin injection between 2000 and 2007. The incidence of type 1 diabetes was computed for each epidemiological week. Environmental ozone and particulate matter rates for each week were obtained from Environmental services. Rates of influenza and respiratory syncytial virus infections were obtained from the epidemiological department of the Ministry of Health. An ecological Bayesian Poisson regression model was fitted, introducing the covariates, lagged covariates and errors, to estimate the incidence by epidemiological week. RESULTS Three factors were significant by the proposed model: particulate matter PPM 2.5 (relative risk (RR): 1.003) lagged by two weeks, influenza (RR: 0.1808) and RSV (RR: 1.021). Trends and seasonality were clearly controlled by these covariates, considering the epidemiological week as a counting period. CONCLUSIONS These results show that environmental factors could be related to peaks of type 1 diabetes incidence.Background: Pollution and viral infections could be associated with the incidence of type 1 diabetes mellitus. Aim: To look for associations between the temporal patterns of Type 1 Diabetes Mellitus (T1D) in infants younger than the age of 15years, and environmental factors, such as air pollution and viruses. Material and Methods: Data registries from hospitals, emergency services, and the Infantile Diabetes Foundation were reviewed, corresponding to children aged less than 15years, who received their first insulin injection between 2000 and 2007. The incidence of type 1 diabetes was computed for each epidemiological week. Environmental ozone and particulate matter rates for each week were obtained from Environmental services. Rates of influenza and respiratory syncytial virus infections were obtained from the epidemiological department of the Ministry of Health. An ecological Bayesian Poisson regression model was fitted, introducing the covariates, lagged covariates and errors, to estimate the incidence by epidemiological week. Results: Three factors were significant by the proposed model: particulate matter PPM 2.5 (relative risk (RR): 1.003) lagged by two weeks, influenza (RR: 0.1808) and RSV (RR: 1.021). Trends and seasonality were clearly controlled by these covariates, considering the epidemiological week as a counting period. Conclusions: These results show that environmental factors could be related to peaks of type 1 diabetes incidence.

Polimorfismo +49 A/G del gen del antígeno 4 del linfocito T citotóxico (CTLA-4) en la diabetes tipo 1: Asociación con el perfil de anticuerpos y citoquinas

Cytotoxic T lymphocyte associated antigen 4 (CTLA-4)has been one of the non HLA genes more commonly studied in type 1 diabetes mellitus (TID). CTLA-4 isa co-stimulation protein that has a key role in the negative regulation of T cells and is related with afunctional cytokine imbalance, generating a T helper (Th) 1 over Th2 dominance.

Asociación obesidad y leptina en tres poblaciones aborígenes de Chile

Background: Although there is a clear relationship between body mass index and leptin levels, few authors have addressed the possible influence of ethnic factors on these levels. Aim: To measure serum leptin in three different Chilean aboriginal populations. Subjects and methods: Fasting serum leptin and insulin levels were measured by radioimmunoassay in 345 rural mapuche individuals, 247 rural aymara subjects and 162 urban mapuche subjects. A body mass index of 27.5 kg/m2 was used as cutoff point to classify study subjects. Results: Among the three ethnic groups, women had serum leptin levels three times higher than men. In all three ethnic groups, there was a significant association between leptin levels, body mass index and gender (r2= 0.32 and 0.5 p <0.001, in rural mapuche, r2= 0.32 and 0.5 p <0.001, in aymara and r2= 0.24 and 0.49, p <0.001 in urban mapuche populations). No differences in leptin levels were observed for the interaction between age and insulin. The increments per quartile in leptin levels were lower among mapuche than aymara individuals. Conclusions: Rural mapuche individuals have a high frequency of obesity. However their leptin levels are lower than those of aymara or urban mapuche populations. The higher leptin levels observed in urban mapuche subjects could be due to environmental influences. (Rev Med Chile 2000; 128: 45-52)

High glucose concentration in T1D patients modulates apoptotic protein expression: Down regulation of BAX and FAS and up regulation of XIAP

UNLABELLED Type 1 diabetes mellitus (T1D) is an autoimmune disease characterized by a progressive destruction of pancreatic β cells. It has been reported that patients with autoimmune diseases exhibit decreased expression of caspase 3 and other pro-apoptotic markers in peripheral blood mononuclear cells (PBMC). AIM To estimate the expression of apoptosis markers in PBMC from T1D patients cultured with high glucose concentration. RESULTS At 11 mM of glucose, the pro-apoptotic gene fas showed a 7-fold decreased expression in the T1D group compared to controls, while bax showed a 50-fold decreased expression (medians 0.14 and 0.02, respectively, considering patients as 1). At 44 mM of glucose, there is a decreased expression of the same genes, but less abrupt (medians 0.75 and 0.47). Only the anti-apoptotic gene xiap showed a 2-fold increased expression at 11 mM of glucose (median 2.3). Regarding the clinical history, no relationships were observed with age of diagnosis, ketoacidosis, glucose at debut or GAD-65 and IA-2 titles. CONCLUSION We can conclude that the apoptotic mechanisms in PBMC of T1D patients under high glucose conditions are altered, and this is proved by the decreased expression of the pro-apoptotic genes fas and bax and by the increased expression of the anti-apoptotic gene xiap.