Obesity: Aguilar-Salinas CA

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00019. · Instituto Nacional de Salud Pública, Cuemrnavaca, Morelos, México. · Gac Med Mex. · Pubmed #19043956 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Ministry of Health with the aim of drafting evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has documented that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages in six categories. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage. Ranges included healthier (level 1) to least healthy (level 6) options as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category together with healthy consumption patterns for men and women.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC, Anonymous00004. · Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. · Salud Publica Mex. · Pubmed #18372998 links to  free full text

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Aguilar-Salinas CA, Canizales-Quinteros S, Rojas-Martínez R, Mehta R, Villarreal-Molina MT, Arellano-Campos O, Riba L, Gómez-Pérez FJ, Tusié-Luna MT. · Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, Mexico. · Curr Opin Lipidol. · Pubmed #19280764 No free full text.

Abstract: PURPOSE OF THIS REVIEW: Our aim is to review the environmental and genetic factors associated with hypoalphalipoproteinemia in populations of Native American ancestry. We examine the strength of the association and outline the population-specific genetic factors that lead to a higher susceptibilty for this condition. RECENT FINDINGS: Low HDL is the most common lipid abnormality in populations of Native American ancestry. Population-based surveys carried out in Latin America and in Mexican Americans shows that 40-60% of adults have hypoalphalipoproteinemia. The contribution of this trait to the metabolic syndrome is greater in individuals with Native American ancestry than in other ethnic groups. Several environmental factors have contributed to this phenomenon (i.e. high dietary content of carbohydrates and fat due to cultural factors and a growing incidence of obesity). In addition, results from recent genetic studies show that certain hypoalphalipoproteinemia susceptibility alleles are ethnic specific for Native Americans. The variant R230C of the ATP-binding cassette transporter subfamily A member 1 gene (ABC-A1) is common among mestizos (10.9% in Mexican mestizos) and its presence has a significant negative effect on HDL cholesterol levels (-4.2%). An additional noteworthy finding is that the R230C variant appears to be specific for the Amerindian populations. Its allele frequency is 0.28 in Mayans, 0.214 in Purepechas, 0.203 in Yaquis and 0.179 among Teenek. In contrast, the C230 allele has not been found in African, European, Chinese or South Asian populations. SUMMARY: The assessment of the genetic and environmental determinants of hypoalphalipoproteinemia in populations of Native American origin provides an opportunity to assess the population-specific interactions between genes and the environment

Córdova-Villalobos JA, Barriguete-Meléndez JA, Lara-Esqueda A, Barquera S, Rosas-Peralta M, Hernández-Avila M, de León-May ME, Aguilar-Salinas CA. · Secretaría de Salud, México. · Salud Publica Mex. · Pubmed #18852939 links to  free full text

Abstract: The federal government has implemented several strategies to reduce mortality caused by chronic non-communicable diseases (CNTD). One example is the development of medical units specialized in the care of CNTD (i.e. overweight, obesity, cardiovascular risk and diabetes), named UNEMES (from its Spanish initials). These units--consisting of an ad-hoc, trained, multi-disciplinary team--will provide patient education, help in the resolution of obstacles limiting treatment adherence, and involve the family in patient care. Treatment will be provided using standardized protocols. The efficacy of the intervention will be regularly measured using pre-specified outcomes. We expect that these UNEMES will result in significant savings. In summary, our health care system is developing better treatment strategies for CNTD. Evaluating the performance of the UNEMES will generate valuable information for the design of future preventive actions.

Aguilar-Salinas CA, Mehta R, Rojas R, Gómez-Pérez FJ, Olaiz G, Rull JA. · Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México. · Curr Diabetes Rev. · Pubmed #18220590 No free full text.

Abstract: The metabolic syndrome is known to increase cardiovascular morbidity and precede the development of type 2 diabetes. Even before the appearance of hyperglycemia, the components of the metabolic syndrome play a crucial role in the pathogenesis of the macrovascular complications. Thus, the recognition and treatment of the metabolic syndrome may be a strategy to prevent the most likely cause of death (i.e. cardiovascular events) in cases that eventually develop type 2 diabetes. In this review, controversial issues regarding the treatment of the two main components of the metabolic syndrome (i.e dyslipidemia and arterial hypertension) are discussed. Several disparities in the current NCEP-ATPIII recommendations, when applied to patients with the metabolic syndrome, are pointed out. In population-based studies, the number of individuals with the metabolic syndrome who would need LDL cholesterol lowering treatment following these guidelines is remarkably low compared to subjects belonging to the same risk strata (10 year risk 10-20%). Subjects with the metabolic syndrome do not fall into the same risk category, resulting in differing LDL-C targets. Also, the Framingham tables underestimate the cardiovascular risk associated with the metabolic syndrome; hence fewer cases qualify for drug therapy. In addition, LDL-C underestimates the number of atherogenic particles and is therefore not the ideal target for these patients. The selection of antihypertensive medication in the metabolic syndrome is also controversial. Thus, there is sufficient evidence for a review of the current management of the metabolic syndrome as part of a strategy to prevent the macrovascular complications in type 2 diabetes.

Aguilar-Salinas CA, Rojas R, Gómez-Pérez FJ, Mehta R, Franco A, Olaiz G, Rull JA. · Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Arch Med Res. · Pubmed #15925012 No free full text.

Abstract: The metabolic syndrome integrates, in a single diagnosis, the manifestations of insulin resistance that may lead to increased cardiovascular morbidity and precedes type 2 diabetes. Here we discuss the strengths and limitations of the definitions of the metabolic syndrome and the epidemiology of the syndrome including information from non-Caucasian populations. The definitions proposed by the World Health Organization (WHO) and the National Cholesterol Education Program (NCEP) are the most frequently used. The relative risk of having long-term complications is greater for the WHO definition; this is explained by the inclusion of the insulin resistance criteria. The cut-off points used in these definitions should be, but are not, adjusted for ethnicity; as a result, in non-Caucasian subjects, there is lack of agreement among these criteria. In a Mexican population-based survey the prevalence was 13.61% using the WHO definition and 26.6% using the NCEP-III criteria. Cases identified by the WHO criteria had a more severe form of the disease. We propose that the metabolic syndrome should be viewed as a progressive long-term process that leads to major complications. Its definition should reflect the continuous nature of the disease; the categorical approach of the current criteria oversimplifies the complexity of the syndrome. The threshold for defining abnormality should be based on the associated risk of the identified phenotype. Refinement of the definition of both affected and nonaffected subjects is required. The available definitions include, in each of these categories, heterogeneous groups with a broad range of risk of future complications.

Rull JA, Aguilar-Salinas CA, Rojas R, Rios-Torres JM, Gómez-Pérez FJ, Olaiz G. · Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Arch Med Res. · Pubmed #15925009 No free full text.

Abstract: The epidemiology of diabetes in Mexico is reviewed. In less than four decades, diabetes has become the main health problem in Mexico. It is the principal cause of death in women and the second among men since the year 2000. It is the primary cause of premature retirement, blindness, and kidney failure. By the year 2025, close to 11.7 million Mexicans are expected to be diagnosed with diabetes. In the year 2000, diabetes was the 11th most frequent cause of hospitalization but the second most common cause of hospital mortality. The number of cases reported in children has also increased since 1995. The results of population-based, nationwide surveys have detected a 25% increment over a 7-year period. Fourteen percent of people with diabetes are <40 years of age, and a large proportion of patients have other conditions that determine the appearance of macrovascular complications and kidney failure. In addition, many cases do not reach treatment goals. In conclusion, the growing number of cases and the significant health burden imposed on affected subjects makes diabetes a disease that needs to be prevented. Well-planned strategies are urgently needed to modify the lifestyle of the population and to increase their physical activity. In addition, an enormous effort will be required to educate the population and physicians to improve the diagnosis and treatment of patients with diabetes.

González-Barranco J, Ríos-Torres JM, Castillo-Martínez L, López-Alvarenga JC, Aguilar-Salinas CA, Bouchard C, Deprès JP, Tremblay A. · National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico. · Metabolism. · Pubmed #12898465 No free full text.

Abstract: There is evidence linking intrauterine growth retardation with increased cardiovascular risk and diabetes mellitus (DM) later in life. However, little is known about the association between malnutrition during the first year of life and metabolic abnormalities in adulthood. The objective of this study was to assess the effect of documented malnutrition during the first year of life on glucose tolerance, plasma insulin, lipid profile, and blood pressure in early adulthood, as well as to assess the interaction between body mass index (BMI) and malnutrition on these variables. A study group of young men with a documented history of malnutrition during their first year of life was recruited from 4 pediatric hospitals in Mexico City and compared with a control group. Subjects included were 52 men, aged 20.2 +/- 3.6 years, with a mean birth weight of 3.0 +/- 0.7 kg and documented malnutrition in their first year of life; controls were 50 men, aged 23.3 +/- 1.8 years, with a mean birth weight of 3.2 +/- 0.5 kg. Insulin and glucose concentrations, fasting and in response to an oral glucose load, plasma lipids, blood pressure, and an insulin sensitivity index (ISI) were measured. The areas under the curves of glucose (AUCG) and insulin (AUCI) were significantly higher in cases (P =.012 and <.002, respectively), independent of birth weight, BMI, or age. BMI was significantly associated with fasting plasma insulin (FPI), AUCI, ISI, triglyceride, and high-density lipoprotein (HDL)-cholesterol concentrations in cases, but not in controls. These data suggest that early malnutrition in extrauterine life, independently of birth weight, has an adverse effect on insulin metabolism and glucose tolerance in young men, and it worsens as body mass increases even within the normal range of BMI. Therefore, it is advisable to prevent obesity in individuals exposed to early malnutrition.

Almeda-Valdés P, Cuevas-Ramos D, Aguilar-Salinas CA. · Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City. · Ann Hepatol. · Pubmed #19381120 No free full text.

Abstract: The development of nonalcoholic fatty liver disease (NAFLD) is strongly associated with the metabolic syndrome as reflected by the fact that approximately 90% of the patients with NAFLD have more than one feature of metabolic syndrome and about 33% have three or more criteria. The physiopathology, epidemiology and therapeutic considerations of the disease are reviewed here. Lipotoxicity plays a predominant role in the pathophysiology of both entities. It leads to accumulation of triglycerides in the liver as a result of an imbalance among the uptake, synthesis, export, and oxidation of fatty acids. Both conditions are very common in Mexico. Using the Adult Treatment Panel diagnostic criteria, the 1994 prevalence of the metabolic syndrome was 26.6%.Although the prevalence of NAFLD is not known, but it can be estimated from the prevalence of obesity (30%). Since NAFLD is found in over two thirds of the obese subjects, this condition may exist in 20% of the adult population. The treatment of both conditions should be based in an integral approach, including the adoption of a healthy lifestyle, weight loss and may be pharmacotherapy. In summary, NAFLD is the hepatic expression of the metabolic syndrome. The study and treatment of these disorders could not be viewed as separate issues.

Villalobos-Comparán M, Teresa Flores-Dorantes M, Teresa Villarreal-Molina M, Rodríguez-Cruz M, García-Ulloa AC, Robles L, Huertas-Vázquez A, Saucedo-Villarreal N, López-Alarcón M, Sánchez-Muñoz F, Domínguez-López A, Gutiérrez-Aguilar R, Menjivar M, Coral-Vázquez R, Hernández-Stengele G, Vital-Reyes VS, Acuña-Alonzo V, Romero-Hidalgo S, Ruiz-Gómez DG, Riaño-Barros D, Herrera MF, Gómez-Pérez FJ, Froguel P, García-García E, Teresa Tusié-Luna M, Aguilar-Salinas CA, Canizales-Quinteros S. · Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Instituto de Investigaciones Biomédicas de la Universidad Nacional Autónoma de México, Mexico City, Mexico. · Obesity (Silver Spring). · Pubmed #18719664 No free full text.

Abstract: Common polymorphisms in the fat mass and obesity-associated gene (FTO) have shown strong association with obesity in several populations. In the present study, we explored the association of FTO gene polymorphisms with obesity and other biochemical parameters in the Mexican population. We also assessed FTO gene expression levels in adipose tissue of obese and nonobese individuals. The study comprised 788 unrelated Mexican-Mestizo individuals and 31 subcutaneous fat tissue biopsies from lean and obese women. FTO single-nucleotide polymorphisms (SNPs) rs9939609, rs1421085, and rs17817449 were associated with obesity, particularly with class III obesity, under both additive and dominant models (P = 0.0000004 and 0.000008, respectively). These associations remained significant after adjusting for admixture (P = 0.000003 and 0.00009, respectively). Moreover, risk alleles showed a nominal association with lower insulin levels and homeostasis model assessment of B-cell function (HOMA-B), and with higher homeostasis model assessment of insulin sensitivity (HOMA-S) only in nonobese individuals (P (dom) = 0.031, 0.023, and 0.049, respectively). FTO mRNA levels were significantly higher in subcutaneous fat tissue of class III obese individuals than in lean individuals (P = 0.043). Risk alleles were significantly associated with higher FTO expression in the class III obesity group (P = 0.047). In conclusion, FTO is a major risk factor for obesity (particularly class III) in the Mexican-Mestizo population, and is upregulated in subcutaneous fat tissue of obese individuals.

Aguilar-Salinas CA, García EG, Robles L, Riaño D, Ruiz-Gomez DG, García-Ulloa AC, Melgarejo MA, Zamora M, Guillen-Pineda LE, Mehta R, Canizales-Quinteros S, Tusie Luna MT, Gómez-Pérez FJ. · Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico D.F. 14000, México. · J Clin Endocrinol Metab. · Pubmed #18682512 No free full text.

Abstract: CONTEXT: In the ob/ob mice, keeping adiponectin concentrations in the physiological range (through overexpression of this gene in the adipose tissue) results in expansion of fat mass and protection against metabolic co-morbidities. OBJECTIVE: The aim of the study was to test in humans whether plasma adiponectin levels, similar to those found in lean subjects, are associated with the metabolically healthy obese phenotype. DESIGN AND SETTING: A cross-sectional analysis was performed of a cohort of obese and nonobese subjects aged 18-70 yr. A medical history was taken, and glucose, plasma lipids, and total adiponectin were measured. PARTICIPANTS: We studied 189 men and 527 women. The majority were obese (n = 470, 65.6%). The metabolically healthy obese phenotype was found in 38 men and 133 women. This is defined as a body mass index (BMI) above 30 kg/m(2) plus high-density lipoprotein cholesterol of at least 40 mg/dl in the absence of type 2 diabetes and arterial hypertension. RESULTS: Twenty percent of the cases with a BMI above 40 kg/m(2) had adiponectin concentrations above the median value of normal BMI subjects. Adiponectin levels above 12.49 mg/liter in obese women (odds ratio, 3.02; 95% confidence interval, 1.95-4.67; P < 0.001) and above 8.07 mg/liter in obese men (odds ratio, 2.14; 95% confidence interval, 1.1-4.06; P = 0.01) increased the probability of being metabolically healthy. The association remained significant (beta, 0.673 +/- 0.205, P < 0.001) in a logistic regression model (r(2) = 0.25, P < 0.001) after controlling for the confounding effect of age, insulin, and waist circumference. CONCLUSIONS: Certain obese individuals have adiponectin levels similar to those found in normal BMI subjects; this is associated with the metabolically healthy obese phenotype.

Rivera JA, Muñoz-Hernández O, Rosas-Peralta M, Aguilar-Salinas CA, Popkin BM, Willett WC. · Instituto Nacional de Salud Pública, Cuernavaca, Mor. · Rev Invest Clin. · Pubmed #18637573 No free full text.

Abstract: The Expert Committee in charge of developing the Beverage Consumption Recommendations for the Mexican Population was convened by the Secretary of Health for the purpose of developing evidence-based guidelines for consumers, health professionals, and government officials. The prevalence of overweight, obesity and diabetes have dramatically increased in Mexico; beverages contribute a fifth of all calories consumed by Mexicans. Extensive research has found that caloric beverages increase the risk of obesity. Taking into consideration multiple factors, including the health benefits, risks, and nutritional implications associated with beverage consumption, as well as consumption patterns in Mexico, the committee classified beverages into six levels. Classifications were made based on caloric content, nutritional value, and health risks associated with the consumption of each type of beverage and range from the healthier (level 1) to least healthy (level 6) options, as follows: Level 1: water; Level 2: skim or low fat (1%) milk and sugar free soy beverages; Level 3: coffee and tea without sugar; Level 4: non-caloric beverages with artificial sweeteners; Level 5: beverages with high caloric content and limited health benefits (fruit juices, whole milk, and fruit smoothies with sugar or honey; alcoholic and sports drinks), and Level 6: beverages high in sugar and with low nutritional value (soft drinks and other beverages with significant amounts of added sugar like juices, flavored waters, coffee and tea). The committee recommends the consumption of water as a first choice, followed by no or low-calorie drinks, and skim milk. These beverages should be favored over beverages with high caloric value or sweetened beverages, including those containing artificial sweeteners. Portion size recommendations are included for each beverage category and healthy consumption patterns for men and women are illustrated.

Aguilar-Salinas CA, Canizales-Quinteros S, Rojas-Martínez R, García-García E, Olaiz-Fernández G, Gómez-Pérez FJ, Tusié-Luna MT. · Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México. · Gac Med Mex. · Pubmed #18246928 No free full text.

Abstract: OBJECTIVE: To describe the contributions ofthree Mexican institutions (Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Universidad Nacional Autónoma de México and the Centro de Encuestas Nacionales de Salud of the Instituto Nacional de Salud Pública) in the study, of chronic degenerative disorders. RESULTS: The most relevant group contributions include: the identification of a risk allele for metabolic syndrome and diabetes, specific for the Mexican population (the R230C variant of the ABC-A1 transporter); the design and validation of a population-based definition of metabolic syndrome which is useful to predict the risk of incident diabetes; the description of the molecular epidemiology of familial hypercholesterolemia in Mexico and the identification of several loci associated with familial combined hyperlipidemia. In addition, members of these institutions have participated in the description of the epidemiology of diabetes, metabolic syndrome and lipid abnormalities. CONCLUSIONS: The complementary approach of these research groups has facilitated successful collaborations. Our results will be useful for the future development of diagnostic tests and preventive programs.

Villarreal-Molina MT, Flores-Dorantes MT, Arellano-Campos O, Villalobos-Comparan M, Rodríguez-Cruz M, Miliar-García A, Huertas-Vazquez A, Menjivar M, Romero-Hidalgo S, Wacher NH, Tusie-Luna MT, Cruz M, Aguilar-Salinas CA, Canizales-Quinteros S, Anonymous00273. · Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15 Colonia Sección 16, Tlalpan 14000, México D.F. · Diabetes. · Pubmed #18003760 links to  free full text

Abstract: OBJECTIVE: The ATP-binding cassette transporter A1 (ABCA1) R230C variant is associated with low HDL cholesterol levels, obesity, and the metabolic syndrome in Mexican-Mestizos. Because a pivotal role for ABCA1 in pancreatic beta-cell function was recently observed in the mouse model, we assessed the association of this variant with type 2 diabetes in this population. RESEARCH DESIGN AND METHODS: The initial group included 446 unrelated Mexican individuals: 244 with type 2 diabetes aged 20-69 years (121 with onset </=45 years), and 202 nondiabetic control subjects aged >50 years. An independent study group included 242 type 2 diabetic case subjects and 225 control subjects with similar characteristics. RESULTS: R230C/C230C genotypes were significantly more frequent in type 2 diabetic individuals (24.6%) than in control subjects (11.4%) in the initial study group (OR 2.501; P = 0.001). After stratifying by age at diagnosis, the association was significant only in the early-onset group (age at diagnosis </=45 years) (OR 3.776, P = 3.3 x 10(-6)). Both associations remained significant after adjusting for admixture (P = 0.0008 and P = 8.1 x 10(-6), respectively). Similar trends were observed in the independent study group, and the combined analysis of both populations showed a highly significant association of the R230C variant with type 2 diabetes, particularly with that of early onset (P = 7.6 x 10(-6) and 9.4 x 10(-8), respectively). CONCLUSIONS: The R230C ABCA1 variant is associated with type 2 diabetes, particularly of early onset, in the Mexican-Mestizo population.

Canizales-Quinteros S, Aguilar-Salinas CA, Ortiz-López MG, Rodríguez-Cruz M, Villarreal-Molina MT, Coral-Vázquez R, Huertas-Vázquez A, Hernández-Caballero A, López-Alarcón M, Brito-Zurita OR, Domínguez-Banda A, Martinez-Sánchez LR, Canto-de Cetina T, Vilchis-Dorantes G, Rosas-Vargas H, Granados-Silvestre MA, Medeiros-Domingo A, Menjivar M, Tusié-Luna MT. · Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Hum Biol. · Pubmed #17985660 No free full text.

Abstract: Previous studies have sought to associate the Pro12Ala variant of the peroxisome proliferator-activated receptor gamma2 (PPARG2) gene with type 2 diabetes, insulin resistance, and obesity, with controversial results. We have determined the Pro12Ala variant frequency in 370 nondiabetic Mexican Mestizo subjects and in five Mexican Amerindian groups and have investigated its possible association with lipid metabolism, insulin serum levels, and obesity in three of these populations. Two independent case-control studies were conducted in 239 nondiabetic individuals: 135 case subjects (BMI > or = 25 kg/m2) and 104 control subjects (BMI < 25 kg/m2). The PPARG2 Ala12 allele frequency was higher in most Amerindian populations (0.17 in Yaquis, 0.16 in Mazahuas, 0.16 in Mayans, and 0.20 in Triquis) than in Asians, African Americans, and Caucasians. The Pro12Ala and Ala12Ala (X12Ala) genotypes were significantly associated with greater BMI in Mexican Mestizos and in two Amerindian groups. X12Ala individuals had a higher risk of overweight or obesity than noncarriers in Mestizos (OR = 3.67; 95% CI, 1.42-9.48; p = 0.007) and in Yaquis plus Mazahuas (OR = 3.21; 95% CI, 1.27-8.11; p = 0.013). Our results provide further support of the association between the PPARG2 Ala12 allele and risk of overweight or obesity in Mestizos and two Amerindian populations from Mexico.

Villarreal-Molina MT, Aguilar-Salinas CA, Rodríguez-Cruz M, Riaño D, Villalobos-Comparan M, Coral-Vazquez R, Menjivar M, Yescas-Gomez P, Königsoerg-Fainstein M, Romero-Hidalgo S, Tusie-Luna MT, Canizales-Quinteros S, Anonymous00050. · Unit of Molecular Biology and Genomic Medicine, Salvador Zubiran National Institute of Medical Sciences and Nutrition (INCMNSZ), National Autonomous University of Mexico, Mexico City, Mexico. · Diabetes. · Pubmed #17287470 links to  free full text

Abstract: Although ATP-binding cassette transporter A1 (ABCA1) is well known for its role in cholesterol efflux and HDL formation, it is expressed in various tissues, where it may have different functions. Because hypoalphalipoproteinemia is highly prevalent in Mexico, we screened the ABCA1 coding sequence in Mexican individuals with low and high HDL cholesterol levels to seek functional variants. A highly frequent nonsynonymous variant (R230C) was identified in low-HDL cholesterol but not in high-HDL cholesterol individuals (P = 0.00006). We thus assessed its frequency in the Mexican-Mestizo general population, seeking possible associations with several metabolic traits. R230C was screened in 429 Mexican Mestizos using Taqman assays, and it was found in 20.1% of these individuals. The variant was significantly associated not only with decreased HDL cholesterol and apolipoprotein A-I levels but also with obesity (odds ratio 2.527, P = 0.005), the metabolic syndrome (1.893, P = 0.0007), and type 2 diabetes (4.527, P = 0.003). All of these associations remained significant after adjusting for admixture (P = 0.011, P = 0.001, and P = 0.006, respectively). This is the first study reporting the association of an ABCA1 variant with obesity and obesity-related comorbidities as being epidemiologically relevant in the Mexican population.

Gómez-Díaz RA, Martínez-Hernández AJ, Aguilar-Salinas CA, Violante R, Alarcón ML, Villarruel MJ, Rodarte NW, Solórzano-Santos F. · Servicio de Endocrinología Pediátrica del Hospital de Pediatría, Mexico City, México. · Diabetes Obes Metab. · Pubmed #16219015 No free full text.

Abstract: AIM: The aim of this study is to describe the percentile distribution of the waist circumference in Mexican pre-pubertal children living in an urban, middle-income area. METHODS: Children, aged 6-10, from a primary school, located in a middle-income area in Mexico City were included (n=833). Anthropometric measurements were made in the case of all children by using standardized procedures. RESULTs: The prevalence of obesity and overweight was greater among boys (p<0.001). Of them, 30 were obese (7.2%) and 47 were overweight (11.4%). Girls had a prevalence of obesity of 2.8% and of overweight of 8.8%. Boys had greater waist circumference than girls (p<0.001). This observation was independent from differences in age or body mass index (BMI). The distribution of the waist circumference was shifted towards higher values among boys. The values corresponding to the 85th percentile ranged, in boys aged 6-10, between 62.9 and 85.9 cm. By contrast, for girls, those values were 66.8 and 72.08 cm, respectively. A receiver-operator curve was constructed in order to identify the waist circumference most likely to be associated with a BMI of > 85th percentile. We found that age- and sex-specific cut-off points are required for the detection of central adiposity in children aged 6-10. CONCLUSIONS: The percentile distribution of the waist circumference in Mexican pre-pubertal children living in urban, middle-income areas is described in this study. Moreover, included are the cut-off points most likely to be associated with increased adiposity. This information can be used for defining abdominal obesity in paediatric populations.

Tovar AR, Torre-Villalvazo I, Ochoa M, Elías AL, Ortíz V, Aguilar-Salinas CA, Torres N. · Department of Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF, México. · J Lipid Res. · Pubmed #15995177 links to  free full text

Abstract: Hepatic steatosis is commonly present during the development of insulin resistance, and it is a clear sign of lipotoxicity attributable in part to an accelerated lipogenesis. There is evidence that a soy protein diet prevents the overexpression of hepatic sterol-regulatory element binding protein-1 (SREBP-1), decreasing lipid accumulation. Therefore, the aim of the present work was to study whether a soy protein diet may prevent the development of fatty liver through the regulation of transcription factors involved in lipid metabolism in hyperinsulinemic and hyperleptinemic Zucker obese fa/fa rats. Serum and hepatic cholesterol and triglyceride levels, as well as VLDL-triglyceride and LDL-cholesterol, were significantly lower in rats fed soy protein than in rats fed a casein diet for 160 days. The reduction in hepatic cholesterol was associated with a low expression of liver X receptor-alpha and its target genes, 7-alpha hydroxylase and ABCA1. Soy protein also decreased the expression of SREBP-1 and several of its target genes, FAS, stearoyl-CoA desaturase-1, and delta5 and delta6 desaturases, decreasing lipogenesis even in the presence of hyperinsulinemia. Reduction in SREBP-1 was not associated with the presence of soy isoflavones. Finally, soy protein reduced SREBP-1 expression in adipocytes, preventing hypertrophy, which also helps prevent the development of hepatic lipotoxicity.

Lara-Esqueda A, Aguilar-Salinas CA, Velazquez-Monroy O, Gómez-Pérez FJ, Rosas-Peralta M, Mehta R, Tapia-Conyer R. · Mexican Health Ministry, México City, Mexico. · Int J Obes Relat Metab Disord. · Pubmed #15356661 No free full text.

Abstract: OBJECTIVE: To assess the ability of the body mass index (BMI) to detect obesity-associated morbidity in subjects with a normal or short stature. METHODS: Information was obtained on 119 975 subjects from a cardiovascular risk factors detection program. Standardized questionnaires were used. Capillary glucose and cholesterol concentrations were measured. Diabetes, arterial hypertension and hypercholesterolemia were selected as end points. Sensitivity, specificity and the likelihood ratio for several BMI thresholds were calculated. ROC curves were constructed to identify the BMI cutoff points with best diagnostic performance. The area under the curve (AUC) was used to assess the proficiency of BMI. RESULTS: Short stature (height </=150 cm for women or </=160 cm for men) was found in 24 854 subjects (20.7%). These cases had a higher prevalence of type II diabetes and arterial hypertension even after adjusting for confounding variables. In addition, the frequency of the abnormalities was higher even at the lowest BMI values; the prevalence increased in direct proportion with the BMI, but at a lower rate compared to cases with normal stature. The AUC for every co-morbidity was smaller in short stature subjects. The likelihood ratio for detecting co-morbidities increased at the same BMI value in subjects with or without short stature. CONCLUSIONS: The prevalence of obesity-associated co-morbidities is higher in subjects with short stature compared to those without it. The proficiency of BMI as a diagnostic tool is poor in short stature subjects. This problem is not resolved by decreasing BMI thresholds used to define overweight.

Gómez-Díaz R, Aguilar-Salinas CA, Morán-Villota S, Barradas-González R, Herrera-Márquez R, Cruz López M, Kumate J, Wacher NH. · Servicio de Endocrinología Pediátrica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, D.F., México. · Diabetes Care. · Pubmed #15333489 links to  free full text

Abstract: OBJECTIVE: The aim of this study was to describe the agreement between impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in children with excess body weight using the original and the revised definitions of IFG. RESEARCH DESIGN AND METHODS: Obese and overweight children aged 4-17 years were included (n = 533). Anthropometric parameters and biochemical tests (fasting and 2-h glucose tests after an oral glucose load [1.75 g/kg]) were performed. Case subjects with a fasting plasma glucose >/=126 mg/dl were excluded. The diagnostic parameters of the original and the revised definitions of IFG for detecting IGT were estimated. The analysis of agreement between these categories was made using the kappa test. RESULTS: The prevalence of IFG increased from 6.2 to 13.3% using the new criteria. The prevalence of IFG became closer to the prevalence of IGT (14.8%). The revised criteria increased the sensitivity from 26.6 to 36.7%. However, the new IFG definition was not useful for identifying IGT cases. Of the 71 case subjects with IFG, only 29 (40.8%) had IGT. In addition, 50 case subjects with IGT (9.4%) and 13 with diabetes (2.4%) had a fasting glycemia <100 mg/dl. A poor agreement was found between the 2003 IFG definition and abnormal 2-h postchallenge plasma glucose (kappa = 0.359). The proportion of false-positive cases increased (36.3-59.1%) under the new definition. CONCLUSIONS: The new definition modestly increases the sensitivity of IFG for detecting IGT in children with excess body weight. Despite this, more than one-half of these cases are not detected. In addition, the false-positive rate was increased by 61%.

Aguilar-Salinas CA, Velazquez Monroy O, Gómez-Pérez FJ, Gonzalez Chávez A, Esqueda AL, Molina Cuevas V, Rull-Rodrigo JA, Tapia Conyer R, Anonymous00362. · Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico. · Diabetes Care. · Pubmed #12832306 links to  free full text

Abstract: OBJECTIVE: To describe the clinical characteristics of the diabetic population that formed part of a population-based survey conducted in México. RESEARCH DESIGN AND METHODS: In 2000, information was obtained from 42,886 subjects aged > or =20 years using a multistage sampling procedure. Standardized questionnaires were used. Anthropometric measurements, blood pressure, and capillary glucose concentrations were taken. RESULTS: Type 2 diabetes was found in 3,597 subjects (age-adjusted prevalence 8.18%), of which 2,878 (80%) had previously been diagnosed. The average age of the diabetic participants was 55.2 +/- 13.5 years; 13% were <40 years of age. Nine percent had been diagnosed for >10 years. The average BMI was 29.2 +/- 5.7 kg/m(2); three-quarters of the cases had BMI >25 kg/m(2). The average waist circumference was 102 +/- 13.4 cm, and increased waist circumference was more common among women. Arterial hypertension was found in half of the cases and, of those on treatment, only one-third had a blood pressure <140/90 mmHg. Smoking was reported in 34% of the diabetic group, a higher rate than in the nondiabetic subjects. There was at least one modifiable coronary risk factor in 67.6% of the cases. Very few followed an exercise or dietary regimen and a small percentage used insulin. CONCLUSIONS: Diabetes affects a large proportion of Mexican adults (8.18%). This figure may be underestimated. The majority of the subjects had modifiable risk factors for the chronic complications of diabetes. Only a few achieved adequate blood pressure control and other treatment goals.

Boulé NG, Tremblay A, Gonzalez-Barranco J, Aguilar-Salinas CA, Lopez-Alvarenga JC, Després JP, Bouchard C, Gomez-Perez FJ, Castillo-Martinez L, Rios-Torres JM. · Division of kinesiology, Laval University, Ste-Foy, Québec, Canada. · Int J Obes Relat Metab Disord. · Pubmed #12704409 No free full text.

Abstract: OBJECTIVE: The main objective of the study was to examine the effect of early life malnutrition on the relation between insulin sensitivity and abdominal adiposity in adulthood. It was hypothesised that participants with early life malnutrition would display a more pronounced deterioration of insulin sensitivity in association with a gain in abdominal fat. DESIGN: As a first attempt to investigate this issue, we studied the effect of body fat gains in a cross-sectional context. SUBJECTS: A total of 26 young adult men with evidence of malnutrition during the first year of life and 27 control subjects were recruited for this study. Malnutrition status was determined from medical files of paediatric hospitals in the Mexico City metropolitan area. MEASUREMENTS: Insulin sensitivity was measured by hyperinsulinaemic euglycaemic clamp, and body composition was measured by anthropometrics, bioelectrical impedance and computed tomography. RESULTS: There was a negative correlation between total abdominal adipose tissue area and insulin sensitivity in the previously malnourished and control groups (r(2)=0.65 and 0.35, P<0.01, respectively). When matched for low amounts of abdominal fat (114 cm(2)), participants with and without early life malnutrition had similar insulin sensitivity (9.03 vs 8.88 mg kg(-1) x min(-1)). However, when matched for high amounts of abdominal fat (310 cm(2)) participants who were malnourished during the first year of life had lower insulin sensitivity (4.74 vs 6.85 mg kg(-1) x min(-1), P<0.05). CONCLUSION: Higher levels of abdominal adipose tissue are more detrimental to insulin sensitivity in previously malnourished individuals.

Aguilar-Salinas CA, Rojas R, Gómez-Pérez FJ, García E, Valles V, Ríos-Torres JM, Franco A, Olaiz G, Sepúlveda J, Rull JA. · Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Mexico City 14000, Mexico. · Am J Med. · Pubmed #12459403 No free full text.

Abstract: OBJECTIVE: To investigate the prevalence and characteristics of patients with type 2 diabetes diagnosed before the age of 40 years (early-onset disease) in a nationwide, population-based study. METHODS: Using a multistage sampling procedure, we enrolled a representative sample of Mexican urban adults aged 20 to 69 years. Weight, height, blood pressure, and plasma levels of glucose, insulin, and other metabolic parameters were measured in all subjects. RESULTS: We identified 993 subjects with type 2 diabetes, including 143 subjects aged 20 to 39 years (14% of those with diabetes). Subjects with early-onset diabetes had a greater prevalence of obesity and higher plasma insulin and lipid levels than did age-matched controls, and a greater prevalence of high-density lipoprotein cholesterol levels <35 mg/dL and severe hypertriglyceridemia than did older subjects with diabetes. Those (n = 32) with a normal body mass index (20 to 25 kg/m(2)) tended to have insulin deficiency as the main abnormality, whereas the "metabolic syndrome" characterized the remaining 111 subjects with early-onset diabetes. CONCLUSION: Most patients with early-onset type 2 diabetes in Mexico are obese or overweight, suggesting that obesity treatment and prevention programs may be effective in reducing the prevalence of this disease.

Aguilar-Salinas CA, Arellano SA, Villanueva-Sanchez O, Magos GA, Guillén-Pineda LE, Rodriguez R, Gómez-Pérez FJ. · Departamento de Endocrinologia y Metabolismo, Unidad de Investigación Experimental, Instituto Nacional de la Nutrición, México City, México. · Blood Press. · Pubmed #11688764 No free full text.

Abstract: OBJECTIVE: To assess the effects of omapatrilat, fosinopril and placebo on blood pressure, plasma insulin, glucose and triglycerides concentrations in Zucker rats, a model for insulin resistance. DESIGN: Double blind, parallel, prospective trial. METHODS: Forty-two male obese Zucker (falfa) rats (aged 13-18 week) initially weighing 400-600 g were used for the experiments. Omapatrilat (n = 14), placebo (n = 14) or fosinopril (n = 14) were administrated once daily at 10 micromol/kg oral for 15 days. At baseline and at the end of the study, a tail-cuff blood pressure measurement was performed; an oral glucose tolerance test was done at the end of the study. RESULTS: Omapatrilat and fosinopril resulted in significant lower systolic blood pressure compared to the placebo group (p < 0.001). This parameter was significantly lower in the omapatrilat group compared with fosinopril-treated rats (116+/-9 vs 125+/-4 mmHg, p < 0.05). After an overnight fast, there was no difference in the fasting glucose concentrations among treatment groups. The basal and post-glucose challenge insulin concentrations were lower in the omapatrilat group compared to the placebo group. No difference was observed in the fasting triglycerides concentrations between the treatment groups. CONCLUSIONS: Compared to placebo and fosinopril treatment, omapatrilat results in lower arterial blood pressure in an animal model of insulin resistance. The results suggest that omapatrilat may have a positive effect on insulin sensitivity.

Aguilar-Salinas CA, Vázquez-Chávez C, Gamboa-Marrufo R, García-Soto N, de Jesús Ríos-González J, Holguín R, Vela S, Ruiz-Alvarez F, Mayagoitia S. · Departamento de Endocrinología y Metabolismo de Lípidos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. · Arch Med Res. · Pubmed #11578762 No free full text.

Abstract: BACKGROUND: The aim of this study was to describe the prevalence of some of the main coronary risk factors in an open Mexican adult population. METHODS: This is a cross-sectional study that includes individuals from eight different cities. Except for Mexico City, all centers were located in medium-sized cities ranging from 1 to 5 million inhabitants. Eligible subjects were adults 20 years of age or older. Exclusion criteria included subjects seeking medical attention due to an acute illness or individuals unable to provide the requested information or written consent to participate in the study. Men (n = 567) and women (n = 1,018) were included. A previously validated interview was conducted. A questionnaire assessed demographic and lifestyle factors. Capillary glucose concentration and blood pressure were obtained. Remarkably, 40% of the population had a body mass index (BMI) between 25 and 29.9 kg/m(2); an additional 28% had a BMI >30 kg/m(2). A large proportion of the individuals had abdominal fat distribution (62% of men and 81% of women). At the time of the evaluation, 30% of men and 18% of women were regular smokers. RESULTS: Blood pressure >140/90 mmHg was found in 29.4% of the population. Less than one half of the subjects had a previous measurement of plasma cholesterol (47%) or triglycerides (42%). The prevalence of diabetes was 9.02%. A significant percentage of these subjects were <40 years of age (18.8% of the diabetic population). CONCLUSIONS: The prevalence of obesity, diabetes, and hypertension in the population reported here is among the highest reported in Mexican populations.