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Objetivo. Determinar la asociación entre apoyo familiar (AF) y apego al tratamiento de la hipertensión arterial esencial (HAS). Material y métodos. Estudio de casos y controles al que se integraron 80 sujetos con diagnóstico establecido de HAS, con 40 pacientes en cada grupo. Se consideró como casos a los pacientes con apego y como controles a los pacientes sin apego al tratamiento. El estudio se realizó de mayo a diciembre de 1999, en el Hospital Regional del IMSS, en la ciudad de Durango, Durango, México. La edad, género, duración de la HAS, escolaridad y estado civil fueron criterios de pareamiento. Las diferencias se establecieron con las pruebas ji cuadrada y t de student. Se calculó la razón de momios para estimar la fuerza de asociación. El diagnóstico de hipertensión arterial secundaria, o de otras enfermedades crónicas fueron criterios de exclusión. Resultados. No hubo diferencias entre los grupos respecto a las variables sociodemográficas, modalidad de tratamiento ni conocimiento que el enfermo tenía sobre su enfermedad. Tenían control de la presión arterial 31 (77.5%) pacientes con apego y 11 (27.5%) sin apego, p= 0.003. El AF se asoció de manera independiente con apego al tratamiento, RM 6.9, IC 95% 2.3-21.1. Conclusiones. El apego se vincula de forma significativa con el apoyo que los familiares otorgan al enfermo. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

Objetivo. Determinar cuáles son las alteraciones del ritmo y la conducción cardiaca más frecuentes en pacientes con diabetes tipo 2 sin cardiopatía previa y establecer su asociación con los factores de riesgo cardiovascular. Material y métodos. Se incluyeron pacientes con diabetes tipo 2 sin presencia o antecedentes de cardiopatía. Se determinaron los factores de riesgo cardiovascular, el índice de masa corporal y los niveles séricos de glucosa, colesterol y triglicéridos. Se registró electrocardiograma convencional en reposo. La asociación de las variables en estudio con la ocurrencia de arritmias se calculó con un modelo de análisis multivariado ajustado por sexo. Resultados. Se integraron 199 pacientes: 113 mujeres (56.8%) y 86 hombres (43.2%), y se identificó algún tipo de alteración electrocardiográfica en 29.1% de los sujetos. El hemibloqueo fascicular anterior (HFA) y el bloqueo completo de rama derecha del Haz de His (BRDHH), constituyeron 75.9% de las alteraciones identificadas. Los pacientes con trastornos del ritmo y la conducción tienen niveles más elevados de colesterol y triglicéridos. La aparición de arritmias se relaciona directamente con el incremento de la edad (r= 0.75, p= 0.01). En el análisis multivariado ajustado por sexo la hipercolesterolemia y la edad se asociaron significativamente con las alteraciones del ritmo y la conducción: RM 1.5, IC95% 1.1-4.6, p< 0.05 y RM 1.3, IC95% 1.0-5.2, p< 0.05, respectivamente. Conclusiones. Las alteraciones del ritmo y la conducción cardiaca más frecuentes en la diabetes tipo 2 son el HFA y el BRDHH; la hipercolesterolemia y la edad son los factores asociados a su presencia.

Objetivo. Valorar la asociación de la deficiencia de folatos y otros factores de riesgo con la ocurrencia de defectos de cierre del tubo neural (DCTN), en la población rural del norte de México (Chihuahua, Durango y Zacatecas). Material y métodos. Se hizo un estudio multicéntrico de casos y controles. Se consideraron como casos a los recién nacidos vivos (RNV) y a los muertos con DCTN, y como controles, a los RNV sanos, no malformados. Se determinó la exposición a factores de riesgo conocidos, estableciendo su asociación con los DCTN, con un modelo de análisis múltiple de regresión logística. Resultados. Los factores de riesgo asociados a DCTN fueron: la deficiencia de folatos (RM 11.1; IC95% 1.2-106.2, p= 0.04); el antecedente, en embarazos previos, de productos con DCTN (RM 3.3; IC95% 1.1-18.8, p= 0.05), y óbitos (RM 7.1; IC95% 1.1-46.3, p= 0.04). Conclusiones. La deficiencia de folatos constituye uno de los principales factores de riesgo asociado a los DCTN en la población rural del norte de México. Es necesario llevar a cabo más investigaciones para determinar la contribución de otros factores de riesgo y establecer las medidas preventivas adecuadas.

Objetivo. Determinar la prevalencia y los factores asociados a la hipertensión arterial sistémica (HAS) en la población rural marginada de Durango, México. Material y métodos. Se realizó un estudio transversal comparativo en 627 comunidades rurales, de las que aproximadamente 90% tiene 250 o menos habitantes. Se determinaron las cifras de presión arterial y las variables sociodemográficas. Resultados. Se estudiaron 5 802 sujetos, es decir, 4 452 mujeres (76.7%) y 1 350 hombres (23.3%). Se identificó HAS en 1 271 individuos (21.9%; IC95% 20.8-23.0), de los cuales 1 011 eran mujeres (22.71%; IC95% 21.5-23.9), y 260, hombres (19.26%; IC95% 17.2-21.4). Del total de la población blanco, 3 018 personas (52.0%) viven en comunidades con menos de 250 habitantes, 2 080 (60.9%) mujeres y 938 (31.1%) hombres; en ésta se identificó HAS en 445 casos (14.74%; IC95% 13.5-16.0), de los cuales 326 son mujeres (15.7%; IC95% 14.1-17.3), y 119, hombres (12.7%; IC95% 10.6-14.9). Los principales factores de riesgo relacionados con la HAS fueron la obesidad, el diagnóstico de diabetes tipo 2 y el consumo de alcohol y tabaco. Conclusiones. Al parecer la prevalencia de HAS en la población rural marginada se relaciona con el grado de desarrollo de las comunidades.

Objetivo. Determinar la frecuencia de cardiopatía isquémica (CI) y su asociación con los niveles séricos de colesterol (NSC), en pacientes con diabetes mellitus no insulinodependiente (DMNID) en el primer nivel de atención médica. Material y métodos. Se estudiaron 411 pacientes y se determinaron indicadores sociodemográficos, NSC y glucemia. Se registró electrocardiograma de 12 derivaciones. Se consideró como CI la presencia, en dos o más derivaciones, de desnivel ST, T isquémica u ondas Q patológicas; se excluyeron los pacientes con antecedentes de CI. Resultados. Predominó el sexo femenino con una proporción de 1.5:1. Se identificó CI en 90 pacientes (22%), con predominio ligeramente mayor en el hombre (0.85:1, mujeres: hombres). En el análisis estratificado, la CI fue más prevalente cuando los NSC fueron ³ 200 mg/dl. La frecuencia de CI en pacientes con NSC de 200-239 mg/dl fue de 24.6% (oportunidad relativa [OR] 2.04; IC 95% 1.03-4.07, p= 0.04) y de 24.2% (OR 1.99; IC 95% 1.02-3.96, p= 0.04) en los pacientes con NSC de 240-300 mg/dl; cuando los NSC fueron >300 mg/dl la CI se incrementó a 38.7% (OR 3.95; IC 95% 1.52-10.30, p= 0.002). Conclusiones. En pacientes con DMNID la CI es más prevalente cuando los NSC son > o = 200 mg/dl, por lo que deberían de considerarse como de alto riesgo para la enfermedad coronaria.

Objetivo. Determinar la importancia del apoyo familiar en el control de la glucemia en diabéticos no insulino dependientes. Material y métodos. Se diseñó un estudio de casos y controles, considerando como casos a los pacientes con glucemia o = 140 mg/dl. El apoyo familiar se determinó con el cuestionario Environmental Barriers to Adherence Scales, que estima el apoyo otorgado para que el paciente siga las indicaciones terapéuticas. Se incluyeron 32 casos y 50 controles. Resultados. El apoyo familiar que recibe el paciente se asocia significativamente a la presencia de glucemia

Abstract Background Recent studies have demonstrated that low and high birth-weight at birth are risk factors of developing diabetes. The aim of this study was to determine if the abnormal birth-weight is related with hyperinsulinemia and elevated index of the Homeostasis Model assessment for Insulin Resistance (HOMA-IR) at birth, in at term newborns. Methods Newborns with gestational age between 38 and 41 weeks, products of normal pregnancies of healthy mothers aged 18 to 39 years, were eligible to participate. Small-for-gestational age (SGA) and large-for-gestational age (LGA) newborns were compared with appropriate-for-gestational (AGA) age newborns. Incomplete or unclear data about mother’s health status, diabetes, gestational diabetes, history of gestational diabetes, hypertension, pre-eclampsia, eclampsia, and other conditions that affect glucose metabolism were exclusion criteria. Hyperinsulinemia was defined by serum insulin levels ≥13.0 μU/mL and IR by HOMA-IR ≥2.60. Multiple logistic regression analysis was used to determine the odds ratio (OR) that computes the association between birth-weight (independent variable) with hyperinsulinemia and HOMA-IR index (dependent variables). Results A total of 107 newborns were enrolled; 13, 22, and 72 with SGA, LGA, and AGA, respectively. Hyperinsulinemia was identified in 2 (15.4%), 6 (27.3%), and 5 (6.9%) with SGA, LGA, and AGA (p=0.03), whereas IR in 3 (23.1%), 8 (36.4%), and 10 (13.9%) newborns with SGA, LGA and AGA (p=0.06). The LGA showed a strong association with hyperinsulinemia (OR 5.02; CI 95%, 1.15-22.3; p=0.01) and HOMA-IR (OR 3.54; CI 95%, 1.03-12.16; p=0.02); although without statistical significance, the SGA showed a tendency of association with hyperinsulinemia (OR 2.43; CI 95%, 0.43-17.3 p=0.29) and HOMA-IR (OR 1.86; CI 95%, 0.33-9.37; p=0.41). Conclusions Our results suggest that LGA is associated with hyperinsulinemia and elevated HOMA-IR at birth whereas the SGA show a tendency of association.

OBJECTIVE: Our goal was to determine the relationship between family history of type 2 diabetes and fasting hyperinsulinemia in healthy children and adolescents. METHODS: A total of 317 children and adolescents, 10 to 14 years of age with Tanner stage 1 or 2, were randomly selected from elementary and middle schools in Durango, northern Mexico, to participate in a cross-sectional, community-based study. Family history was ascertained by a direct, detailed medical examination that included anthropometric and laboratory measurements from both parents. We determined the prevalence of family history of type 2 diabetes, high blood pressure, obesity, hyperinsulinemia, and the adjusted odds ratio that computes the relationship between hyperinsulinemia and family history of type 2 diabetes. RESULTS: Family history of type 2 diabetes, high blood pressure, and obesity was recognized in 30 (9.2%), 61 (18.7%), and 74 (22.7%) children and adolescents, respectively. Children and adolescents with positive family history showed higher systolic and diastolic blood pressure, were more obese, and exhibited significantly higher fasting insulin and triglycerides levels, as well as a higher homeostasis model analysis insulin resistance index, than children with negative family history. A total of 48 (15.1%) children and adolescents exhibited hyperinsulinemia, 35 (72.9%) with and 13 (27.1%) without family history. The odds ratio adjusted by gender, fat mass (kilograms and percent), waist circumference, BMI, and Tanner stage showed that family history of diabetes, but not high blood pressure and obesity, was independently related with hyperinsulinemia. CONCLUSIONS: Among children and adolescents, family history of diabetes, but not high blood pressure and obesity, is independently associated with hyperinsulinemia. [ABSTRACT FROM AUTHOR]

Individuals with long-COVID exhibit a higher frequency of hypomagnesemia, vitamin D deficiency, and depression. Objective. To evaluate the efficacy and safety of oral supplementation with magnesium chloride plus vitamin D in alleviating depressive symptoms related to long-COVID. A total of 60 subjects, aged 52.8±12.6 years, with a diagnosis of hypomagnesemia, vitamin D deficiency, and mild-to-moderate depression (MMD) related to long-COVID, were enrolled in an open-label randomized, controlled clinical trial. Participants were randomly allocated into an intervention group (n=30) that received magnesium chloride (1300 mg) plus vitamin D (4000 IU), or a control group (n=30) that received vitamin D (4000 IU), for four months. Using the Beck Depression Inventory (BDI), diagnosis of MMD was established based on a score of ≥11<30. The primary trial endpoint was improvement in depressive symptoms (BDI <11). Mild adverse events that did not require withdrawal from intervention were documented in six (20.0%) and three (10%) individuals of the intervention and control group, respectively. By comparing baseline vs. final measurements, the BDI score was significantly reduced in individuals in the intervention (28.8±3.7 to 9.2±7.5, p<0.01) and control (28.4±3.8 to 21.6±9.1, p<0.05) group. A total of 22 (73.2%) subjects in the intervention group and 10 (34.5%) in the control group reached a BDI <11, p=0.006. Our results show that, among patients with hypomagnesemia and vitamin D deficiency, combined oral supplementation with magnesium plus vitamin D is effective and safe in alleviating MMD related to long-COVID.

Clinical manifestations related to hypomagnesemia and/or deficiency of vitamin D are frequent in patients with an extended course of coronavirus disease-2019 (long COVID). To evaluate hypomagnesemia and hydroxyvitamin D deficiency in patients with long COVID. A total of 125 adults with a diagnosis of long COVID were enrolled in a cross-sectional study. Participants were allocated into a risk (hypomagnesemia and hydroxyvitamin D deficiency) or control (serum magnesium and hydroxyvitamin D within normal ranges) group. Hypomagnesemia and 25-hydroxyvitamin D deficiency were defined based on serum level ≤1.8 mg/dL and <30 ng/mL, respectively. The number of clinical manifestations of long COVID were significantly higher in the risk compared to the control group. Fatigue, memory loss, attention disorders, joint pain, anxiety, sleep disorders, myalgia, and depression, all of which are related to hypomagnesemia and/or 25-hydroxyvitamin D deficiency, were among the 10 most frequent manifestations in the risk group. The adjusted odds ratio for the association between hypomagnesemia and hydroxyvitamin D deficiency during long COVID was 3.1; 95% CI 2.3-12.4, p=0.005. Our results show that patients suffering with long COVID had a deficiency in magnesium and 25-hydroxyvitamin D which correlated with the number of associated clinical manifestations.

A large amount of published research points to the interesting concept (hypothesis) that magnesium (Mg) status may have relevance for the outcome of COVID-19 and that Mg could be protective during the COVID disease course. As an essential element, Mg plays basic biochemical, cellular, and physiological roles required for cardiovascular, immunological, respiratory, and neurological functions. Both low serum and dietary Mg have been associated with the severity of COVID-19 outcomes, including mortality; both are also associated with COVID-19 risk factors such as older age, obesity, type 2 diabetes, kidney disease, cardiovascular disease, hypertension, and asthma. In addition, populations with high rates of COVID-19 mortality and hospitalization tend to consume diets high in modern processed foods, which are generally low in Mg. In this review, we review the research to describe and consider the possible impact of Mg and Mg status on COVID-19 showing that (1) serum Mg between 2.19 and 2.26 mg/dL and dietary Mg intakes > 329 mg/day could be protective during the disease course and (2) inhaled Mg may improve oxygenation of hypoxic COVID-19 patients. In spite of such promise, oral Mg for COVID-19 has thus far been studied only in combination with other nutrients. Mg deficiency is involved in the occurrence and aggravation of neuropsychiatric complications of COVID-19, including memory loss, cognition, loss of taste and smell, ataxia, confusion, dizziness, and headache. Potential of zinc and/or Mg as useful for increasing drug therapy effectiveness or reducing adverse effect of anti-COVID-19 drugs is reviewed. Oral Mg trials of patients with COVID-19 are warranted.

We thank Dr. Scarpati and Dr. Piazza for their interest and comments [...].

Background: The SLC38A4 gene encodes for the SNAT4 protein, which has been related to glucose metabolic alterations in human newborns. This study aimed to determine whether the 1304 G > A and 292 C > T polymorphisms of the SLC38A4 gene are associated with the presence of glucose levels > 95 mg/dL in normal weight full-term healthy newborns., Methods: We conducted a case-control study and analyzed 50 normal weight full-term healthy newborns. Groups were defined based on glucose levels: > 95 mg/dL (cases; n = 13) and < 95 mg/dL (controls; n = 37). The 1304 G > A and 292 C > T polymorphisms of the SLC38A4 gene were determined through quantitative polymerase chain reaction using placental DNA. The association between polymorphism and glucose levels > 95 mg/dL was established using multivariate logistic regression analysis., Results: No significant differences were observed either for gestational age or body weight at birth between groups. In the case group, newborns showed significantly higher homeostatic model assessment for insulin resistance than those in the control group (p < 0.0005). The odds ratio (OR) between the SLC38A4 gene 292 C > T single-nucleotide polymorphism (SNP) and glucose levels > 95 mg/dL was 7.78 (p = 0.024), whereas no significant association was found for the 1304 G > A SNP (OR 1.46; p = 0.77)., Conclusions: Our results suggest that the SLC38A4 gene 292 C > T SNP is associated with glucose levels > 95 mg/dL in normal weight full-term healthy newborns.

Objective: To evaluate whether the Fat-to-Lean Mass (FyM) ratio is associated to hyperinsulinemia in healthy adolescents. Methods: Apparently healthy adolescents aged 10 to 15 years that according to sex, age, and percentiles of body fat percent, were included and allocated into the groups with elevated (body fat percent ≥85 percentile) and normal total body fat (body fat percent <85 percentile). The FyM ratio was calculated as total lean mass (kg)/total body fat (kg) and hyperinsulinemia was defined by fasting insulin levels ≥20 µUI/mL. Results: A total of 1,299 adolescents, 665 (51.9%) girls and 634 (48.1%) boys, were enrolled and allocated into the groups with high (n = 439) and normal (n = 860) body fat. The FyM index remained significantly associated with hyperinsulinemia (OR 5.58; 95% CI: 1.54-28.10) after logistic regression analysis adjusted by sex, age, body-weight, body mass index, and waist circumference. Conclusion: The FyM index is highly associated to the presence of hyperinsulinemia in adolescents, emerging as a useful tool from anthropometric measurements for identify insulin abnormalities.

It has been suggested that the triglyceride and glucose (TyG) index is an early indicator for type 2 diabetes (T2D) in adults. Thus, the aim of this study was to evaluate whether the TyG index is useful in the screening of glucose disorders (GD) in apparently healthy children and adolescents. Eligible participants were apparently healthy children and adolescents. Individuals with new diagnosis of GD were allocated into the study groups with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and T2D. Participants with normal glucose tolerance (NGT) were the control group. In total, 1872 children and adolescents were enrolled and allocated into the study groups. Diagnosis of NGT, IFG, IGT, and T2D was established in 1541 (82.3%), 256 (13.7%), 66 (3.5%), and 9 (0.4%) children, respectively. In girls, the best cutoff points of the TyG index for identifying IFG, IGT, and T2D were 4.51 (sensitivity 59.8%, specificity 59.8%), 4.55 (sensitivity 63.0%, specificity 64.3%), and 4.63 (sensitivity 75.0%, specificity 74.6%), respectively; and in boys were 4.52 (sensitivity 62.8%, specificity 64.2%), 4.54 (sensitivity 71.8%, specificity 65.1%), and 4.82 (sensitivity 91.0%, specificity 990.6%), respectively.Conclusion: Our results suggest that the TyG index may be a useful tool for screening GD in healthy children and adolescents.What is Known:• Prevalence of prediabetes and type 2 diabetes is increasing worldwide among young adults and adolescents.• Elevated fasting glucose and triglyceride concentrations have been recognized as independent risk factors for type 2 diabetes.What is New:• The TyG index exhibited highest sensitivity and specificity to detect impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes.• The TyG index may be a useful tool for the screening of glucose disorders in apparently healthy children and adolescents.

Prevalence of elevated blood pressure in pediatric population has been increasing worldwide. Thus, the aim of this study was to examine whether the triglycerides and glucose (TyG) index is associated with the presence of prehypertension or hypertension in children and adolescents. Apparently healthy children aged 6 to 15 years were enrolled in a population-based cross-sectional study. Participants were allocated into groups with normal blood pressure (NBP), prehypertension, and hypertension. Smoking, alcohol intake, pregnancy, previous diagnosis of diabetes, kidney, hepatic, or endocrine diseases were exclusion criteria. NBP was defined by systolic and/or diastolic blood pressure < 90th percentile, prehypertension by systolic and/or diastolic blood pressure ≥ 90th < 95th percentile, and hypertension by systolic and/or diastolic blood pressure ≥ 95th percentile, according to age, sex, and height percentiles. A total of 3589 children were enrolled, 1748 (49%) girls and 1841 (51%) boys, and allocated into groups with NBP (n = 2874), prehypertension (n = 271), and hypertension (n = 444). The multiple logistic regression analysis stratified by age and adjusted by the Z-score/SDS of body mass index and waist circumference showed that elevated TyG index was significantly associated with prehypertension (OR = 1.48; 95% CI: 1.08-2.05) and hypertension (OR = 1.63; 95% CI: 1.26-2.11).Conclusion: The results of the present study shows that the elevated TyG index is significantly associated with the presence of prehypertension and hypertension in children and adolescents. What is Known: • Prevalence of elevated blood pressure in children and adolescents has been increasing worldwide. • Insulin resistance plays a key role in the pathogenesis of hypertension. What is New: • The elevated TyG index is significantly associated with the presence of prehypertension in children aged 6-9 years and adolescents aged 10-15 years. • The elevated TyG index is significantly associated with the presence of hypertension in children aged 6-9 years and adolescents aged 10-15 years.

Background: To analyse whether the weight ratio of potassium-to-magnesium intake is associated with incident high blood pressure, in otherwise healthy individuals., Materials and Methods: A total of 529 healthy individuals were enrolled in a cross-sectional study and allocated into following groups: group 1) potassium and magnesium intake within Recommended Dietary Allowance; group 2) magnesium intake as recommended and potassium intake below of recommended dietary allowance; group 3) potassium intake as recommended and magnesium intake below of recommended dietary allowance; and group 4) magnesium and potassium intake below recommended dietary allowance. Groups in study were matched by sodium and calcium intake. A "24 hours recall" questionnaire was used to register all intakes of food and drinks for two consecutive days. Multiple logistic regression analysis adjusted by sex, waist circumference, and triglycerides levels was used to compute the odds ratio between intakes of magnesium and potassium with the high blood pressure., Results: High blood pressure was identified in 155 (29.3%) individuals. There were no statistical significant differences by obesity and overweight between the groups. As compared with individuals in the group 1, the potassium-to-magnesium ratio (odds ratio 0.88; 95%CI 0.85-0.93) but not the isolated magnesium and potassium intake per se, was inversely associated to high blood pressure in the subjects of group 4; individuals in the groups 2 and 3 showed no association., Conclusions: Our results suggest that, in healthy individuals with magnesium and potassium intake below recommended dietary allowance, the high potassium-to-magnesium ratio is inversely associated with incident high blood pressure., (© 2019 Stichting European Society for Clinical Investigation Journal Foundation.)