Maritza Pérez

Using waist circumference as a screening tool to identify colombian subjects at cardiovascular risk

Objective A cut-off value for waist circumference (WC) of 94 cm associated with cardiovascular risk factors (CVRF) has been recommended in Caucasian populations. However, it is unclear if recommendations derived from Western studies should be extrapolated to populations from developing countries. The present study evaluated a group of Colombian subjects to determine and evaluate the level of WC capable of identifying subjects with CVRF. Research design and methods (Study 1) A cross-sectional study in 145 healthy men, to determine the level of WC associated with the following lipid profile (triglycerides 2.25mmol/L and total-cholesterol/HDL-cholesterol ratio >5) was performed. (Study 2) Two hundred and thirty-eight unrelated male adults were recruited to test whether the new WC cut-off point would identify subjects with CVRF. Results (Study 1) A WC cut-off point of 88 cm identified subjects with the pre-established lipid profile with a sensitivity of 80.6% and specificity of 80.1%, while the WC of 94 cm had a low sensitivity (48.3%) and a high specificity (93.3%). Additionally, the values of C-reactive protein, fasting glucose and insulin levels in subjects with a WC 88cm were significantly higher compared to subjects with WC <88cm. (Study 2) The diagnostic accuracy of the new WC cut-off point (88 cm) to identify subjects with two or more CVRF remained acceptable in the new sample studied (sensitivity: 83.7% and specificity: 84.8%); while the WC value of 94 cm suggested in Caucasians showed a very low sensitivity (43.2%) and a high specificity (93.9%). Conclusion This study demonstrates a higher prevalence of CVRF in our population at lower levels of WC than those suggested previously in Caucasians, suggesting that ethnic background should be taken into account when using WC as a screener for CVRF. Eur J Cardiovasc Prevention Rehab 10:328-335

Nonalcoholic fatty liver disease is associated with insulin resistance in a young Hispanic population

OBJECTIVE To investigate whether nonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) in a young Hispanic population. METHODS A cross-sectional study was performed in Bogotá, Colombia, during 2006 in 263 males from the Colombian Air Force (age range 29-54 years). Anthropometric measurements and biochemical determinations (glycemia, lipid profile, insulin, and HOMA-IR) were obtained in order to determine the presence of metabolic syndrome (MS) criteria and insulin resistance in this population. In addition, ultrasound studies were performed to evaluate the presence of NAFLD. RESULTS NAFLD was detected in 26.6% (n=70) of the subjects. Thirty four individuals had complete MS criteria (48.5%). The presence of NAFLD was associated with higher insulin levels (11.0±5.1 vs. 6.6±3.6, p=0.001), and its prevalence increased from 11% (n=8), to 24% (n=17) to 64% (n=45) from the lowest to the highest HOMA-IR tertile. Body mass index, triglycerides and subcutaneous and visceral fat were found to be independent predictors of NAFLD. CONCLUSIONS These results suggest that NAFLD is associated with insulin resistance and extrahepatic adiposity in nondiabetic young Hispanic population.

Social disparities explain differences in hypertension prevalence, detection and control in Colombia.

Objective: Hypertension is the principal risk factor for cardiovascular diseases. The global Prospective Urban Rural Epidemiology study showed that the levels of awareness, treatment and control of this condition are very low worldwide and show large regional variations related to a countrys income index. The aim of the present analysis was to identify associations between sociodemographic, geographic, anthropometric, behavioral and clinical factors and the awareness, treatment and control of hypertension within Colombia – a high-middle income country which participated in the global Prospective Urban Rural Epidemiology study. Methods and results: The sample comprised 7485 individuals aged 35–70 years (mean age 50.8 years, 64% women). Mean SBP and DBP were 129.12 ± 21.23 and 80.39 ± 11.81 mmHg, respectively. The overall prevalence of hypertension was 37.5% and was substantially higher amongst participants with the lowest educational level, who had a 25% higher prevalence (<0.001). Hypertension awareness, treatment amongst those aware, and control amongst those treated were 51.9, 77.5 and 37.1%, respectively. The prevalence of hypertension was higher amongst those with a higher BMI (<0.001) or larger waist–hip ratio (<0.001). Being male, younger, a rural resident and having a low level of education was associated with significantly lower hypertension awareness, treatment and control. The use of combination therapy was very low (27.5%) and was significantly lower in rural areas and amongst those with a low income. Conclusion: Overall Colombia has a high prevalence of hypertension in combination with very low levels of awareness, treatment and control; however, we found large variations within the country that appear to be associated with sociodemographic disparities.