Esperanza de la Cruz Mendoza

Family History of Hypertension and Cardiovascular Risk Factors in Prepubertal Children

BACKGROUND To determine the relationship between family history of hypertension (FHH) and cardiovascular risk factors (CVRF) in healthy prepubertal children. METHODS DESIGN Cross-sectional, population-based study. SETTING Elementary schools from San Luis Potosi and Durango, cities in middle and northern Mexico. PARTICIPANTS A total of 358 randomly enrolled, healthy boys and girls aged 6-10 years in Tanner stage 1, with and without FHH. OUTCOME MEASURES Odds ratio (OR) that estimates the relationship between FHH and CVRF. RESULTS FHH was identified in 72 (20.1%) children; 212 (59.2%) children had at least one CVRF, where low high-density lipoprotein (HDL)-cholesterol (36.3%), elevated waist circumference (WC) (29.3%), and hypertriglyceridemia (28.8%) were the most frequent; high-blood pressure (HBP) and hyperglycemia were recognized in 10 (3.3%) and 1 (0.3%) children. Metabolic syndrome and hyperinsulinemia were identified in 36 (10.0%) and 48 (13.4%) children. In all subjects, hyperinsulinemia (OR 2.0; 95% confidence interval (CI) 1.2-8.4), but not other CVRF was significantly associated with FHH. Subsequent analysis stratified by WC showed that FHH was not associated with CVRF in children with elevated WC. Among children with nonelevated WC, FHH in the maternal branch, but not in the paternal branch, was associated with hyperinsulinemia (OR 1.5; 95% CI 1.1-5.5), HBP (OR 4.0; 95% CI 1.3-30.1), hypertriglyceridemia (OR 1.6; 95% CI 1.1-7.2), and low HDL-cholesterol (OR 1.3; 95% CI 1.1-3.0). CONCLUSION Results show that FHH in the maternal branch is associated with CVRF in children with nonelevated WC.

Obesity and family history of diabetes as risk factors of impaired fasting glucose: implications for the early detection of prediabetes

Rodríguez‐Moran M, Guerrero‐Romero F, Aradillas‐García R, Simental‐Mendia LE, Monreal‐Escalante E, de la Cruz Mendoza E. Obesity and family history of diabetes as risk factors of impaired fasting glucose: implications for the early detection of prediabetes.

Atherogenic indices and prehypertension in obese and non-obese children

We evaluate the relationship between different lipoproteins and atherogenic indices with pre-hypertension in 297 obese and 942 non-obese children with Tanner stage 1 enrolled in a multicentre, community-based cross-sectional study. Height, weight, fasting glucose and insulin levels, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), non-HDL-c, LDL/HDL-c, triglycerides/cholesterol and total cholesterol/HDL-c ratios were measured. Mean age was 8.4 ± 1.2 years; pre-hypertension was identified in 104 (8.4%) participants, 46 (15.5%) obese and 58 (6.1%) non-obese children. The pre-hypertensive non-obese children show a high proportion of family history of hypertension (41.6 and 24.7%, p = 0.002) and elevation of insulin at a relatively low body mass index. The triglycerides:HDL-c ratio, but not other lipoproteins or atherogenic indices, was associated with pre-hypertension in obese (1.15, 95% confidence intervals 1.06–1.26) and non-obese children (1.38 95% confidence intervals 1.22–1.57). The triglycerides:HDL-c ratio is related to pre-hypertension in children; the family history of hypertension seems to be a risk factor in developing pre-hypertension.

Biochemical Characteristics and Risk Factors for Insulin Resistance at Different Levels of Obesity

OBJECTIVE: To establish the biochemical characteristics of nonobese, overweight, and obese children as well as to determine the risk factors associated with insulin resistance in nonobese children and with non–insulin resistance in obese children in the age strata of 6 to 11 years. METHODS: A total of 3512 healthy children were enrolled in a cross-sectional study. In the absence of obesity, fasting hyperinsulinemia and hypertriglyceridemia defined nonobese, insulin-resistant (NO-IR) children. In the absence of metabolic abnormalities of fasting insulin and triglycerides levels, obese children were defined as obese, not insulin-resistant (O-NIR) children. RESULTS: The gender- and age-adjusted prevalence of NO-IR and O-NIR was 6.6% and 21.3%, respectively. In the age-, gender-, and birth weight–adjusted analysis, family history of hypertension (FHH) in both maternal and paternal branches (odds ratio [OR]: 1.514; 95% confidence interval [CI]: 1.2–3.9; P = .04) was associated with NO-IR children. In the analysis adjusted by gender, age, waist circumference (WC), BMI, FHH, and family history of diabetes, high birth weight was associated with NO-IR children (OR: 1.319; 95% CI: 1.2–2.1; P = .04). Finally, in the gender-, age-, family history–, and birth weight–adjusted analysis, a WC lower than the 95th percentile was associated with a lower odds of insulin resistance among obese children (OR: 0.96; 95% CI: 0.91–0.98; P < .0005). CONCLUSIONS: FHH and high birth weight are associated with NO-IR children, and a low WC is associated with lower odds of O-IR children.

Obesity is the main determinant of insulin resistance more than the circulating pro-inflammatory cytokines levels in rheumatoid arthritis patients

BACKGROUND Systemic blockade of TNF-α in Rheumatoid arthritis with insulin resistance seems to produce more improvement in insulin sensitivity in normal weight patients with Rheumatoid arthritis than in obese patients with Rheumatoid arthritis, suggesting that systemic-inflammation and obesity are independent risk factors for insulin resistance in Rheumatoid arthritis patients. OBJECTIVES To evaluate the insulin resistance in: normal weight patients with Rheumatoid arthritis, overweight patients with Rheumatoid arthritis, obese Rheumatoid arthritis patients, and matched control subjects with normal weight and obesity; and its association with major cytokines involved in the pathogenesis of the disease. METHODS Assessments included: body mass index, insulin resistance by Homeostasis Model Assessment, ELISA method, and enzymatic colorimetric assay. RESULTS Outstanding results from these studies include: (1) In Rheumatoid arthritis patients, insulin resistance was well correlated with body mass index, but not with levels of serum cytokines. In fact, levels of cytokines were similar in all Rheumatoid arthritis patients, regardless of being obese, overweight or normal weight (2) Insulin resistance was significantly higher in Rheumatoid arthritis with normal weight than in normal weight (3) No significant difference was observed between insulin resistances of Rheumatoid arthritis with obesity and obesity (4) As expected, levels of circulating cytokines were significantly higher in Rheumatoid arthritis patients than in obesity. CONCLUSIONS Obesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA.