Examinando por Materia "Metabolic syndrome"
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- PublicaciónRestringidoAged garlic extract improves adiponectin levels in subjects with metabolic syndrome : A double-blind, placebo-controlled, randomized, crossover study(2013-01) Gómez Arbeláez, Diego; Lahera, Vicente; Oubiña, Maria del Pilar; Valero Muñoz, Maria; De las Heras, Natalia; Rodríguez, Yudy; García, Ronald G.; Camacho López, Paul Anthony; Lopez-Jaramillo, PatricioBackground. Garlic (Allium sativum) has been shown to have important benefits in individuals at high cardiovascular risk. The aim of the present study was to evaluate the effects of the administration of aged garlic extract (AGE) on the risk factors that constitute the cluster of metabolic syndrome (MS). Methods and Design. Double-blind, crossover, randomized, placebo-controlled clinical trial to assess the effect of 1.2 g/day of AGE (Kyolic), for 24 weeks of treatment (12 weeks of AGE and 12 weeks of placebo), on subjects with MS. Results. The administration of AGE increased the plasma levels of adiponectin (𝑃 = 0.027). No serious side effects associated with the intervention were reported. Conclusion. The present results have shown for the first time that the administration of AGE for 12 weeks increased plasma adiponectin levels in patients with MS. This suggests that AGE might be a useful, novel, nonpharmacological therapeutic intervention to increase adiponectin and to prevent cardiovascular (CV) complications in individuals with MS.
- PublicaciónAcceso abiertoAre nutrition-induced epigenetic changes the link between socioeconomic pathology and cardiovascular diseases?(2008-07) Lopez-Jaramillo, Patricio; Silva, Sandra Y.; Rodríguez Salamanca, Narella; Durán Hernández, Álvaro-Hernán; Mosquera, Walter; Castillo, Victor R.The prevalence of cardiovascular diseases (CVD) and diabetes mellitus type 2 (DM 2) is decreasing in developed countries despite the increase in the percentage of subjects with obesity and other wellrecognized cardiovascular risk factors. In contrast, the recent transition of the economic model experienced by developing countries, characterized by the adoption of a Western lifestyle, that we have named ‘‘socioeconomic pathology,’’ has led to an increase in the burden of CVD. It has been demonstrated that conventional cardiovascular risk factors in developed and developing countries are the same. Why then does the population of developing countries currently have a higher incidence of CVD than that of developed countries if they share the same risk factors? We have proposed the existence of a higher susceptibility to the development of systemic inflammation at low levels of abdominal obesity in the population of developing countries and the consequent endothelial dysfunction, insulin resistance, DM 2, and CVD. In contrast, an important percentage of obese people living in developed countries have a healthy phenotype and low risk of developing CVD and DM 2. Human epidemiologic studies and experimental dietary interventions in animal models have provided considerable evidence to suggest that nutritional imbalance and metabolic disturbances early in life may later have a persistent effect on an adult’s health that may even be transmitted to the next generations. Epigenetic changes dependent on nutrition could be key in this evolutionary health behavior, acting as a buffering system, permitting the adaptation to environmental conditions by silencing or increasing the expression of certain genes.
- PublicaciónAcceso abiertoConsenso Latino-Americano de hipertensão em pacientes com diabetes tipo 2 e síndrome metabólica(2014-03) Lopez-Jaramillo, Patricio; Sánchez, Ramiro A.; Diaz, Margarita; Cobos, Leonardo; Bryce, Alfonso; Parra Carrillo, Jose Z.; Lizcano, Fernando; Lanas, Fernando; Sinay, Isaac; Sierra, Iván D.; Peñaherrera, Ernesto; Bendersky, Mario; Schmid, Helena; Botero, Rodrigo; Urina, Manuel; Lara, Joffre; Foss, Milton C.; Márquez, Gustavo; Harrap, Stephen; Ramírez, Agustín J.; Zanchetti, AlbertoO presente documento foi preparado por um grupo de especialistas, membros das Sociedades de Cardiologia, Endocrinologia, Medicina Interna, Nefrologia e Diabetes dos países da América Latina, para que sirva de diretriz para médicos que cuidam de pacientes com diabetes, hipertensão e fatores de risco concomitantes ou complicações de ambas as condições. Embora o conceito de síndrome metabólica seja atualmente muito discutido, a alta prevalência na América Latina do conjunto de alterações metabólicas que a compõem sugere que a síndrome metabólica é uma entidade nosográfica útil no contexto da medicina latino-americana. Devido a isso, no presente documento presta-se especial atenção a essa síndrome com a finalidade de alertar aos médicos sobre uma população particularmente de alto risco, que, por ser subestimada, não é tratada de forma adequada para os fatores de risco que constituem a síndrome metabólica. As recomendações deste documento são o resultado de apresentações e debates que ocorreram durante um encontro de dois dias em Bucaramanga (Colômbia), em outubro de 2012. Todos os participantes aprovaram as decisões finais. Os autores reconhecem que a publicação e difusão das diretrizes não serão suficientes para alcançar as mudanças recomendadas tanto em estratégias diagnósticas como terapêuticas, por isso programaram intervenções que permitirão identificar as barreiras do conhecimento, asatitudes e comportamento, o que permitirá tanto aos médicos como aos pacientes uma adequada adesão às recomendações sugeridas nestas diretrizes.
- PublicaciónAcceso abiertoConsenso Latinoamericano de Hipertensión en pacientes con diabetes tipo 2 y Síndrome Metabólico(2013) Lopez-Jaramillo, Patricio; Sánchez, Ramiro A.; Díaz, Margarita; Cobos, Leonardo; Bryce, Alfonso; Parra Carrillo, Jose Z.; Lizcano, Fernando; Lanas, Fernando; Sinay, Isaac; Sierra, Iván D.; Peñaherrera, Ernesto; Bendersky, Mario; Schmid, Helena; Botero, Rodrigo; Urina, Manuel; Lara, Joffre; Foos, Milton C.; Márquez, Gustavo; Harrap, Stephen; Ramírez, Agustín J.; Zanchetti, Alberto; Grupo de Expertos de LatinoaméricaThe present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of 'metabolic syndrome' is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that 'metabolic syndrome' is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
- PublicaciónAcceso abiertoEstudio piloto de la prevalencia de síndrome metabólico en estudiantes de la institución universitaria Colegio Mayor de Antioquia en Medellín y la Universidad de Santander. Cúcuta, Colombia(Revista Latinoamericana de Hipertensión, 2019-03-01) Gómez Rave, Lyz Jenny; Sierra-Castrillo, Jhoalmis; Bermúdez Pirela, Valmore; Román Marín, Laura-Melisa; Rojas, JoselynAntecedentes: El síndrome metabólico (SM) es una condición que predispone al individuo al desarrollo de enfermedades cardiovasculares, diabetes mellitus tipo 2 y sus complicaciones. Debido a que su prevalencia se encuentra en aumento, se ha convertido en un problema de salud mundial que debe manejarse desde la prevención temprana y la promoción de hábitos saludables. Objetivo: Determinar la prevalencia de SM en un grupo de jóvenes universitarios de la Institución Universitaria Colegio Mayor de Antioquia y la Universidad de Santander. Diseño y método: la investigación es de tipo descriptivo y transversal con una muestra conformada por 80 estudiantes (16 hombres y 64 mujeres), entre los 17 y 32 años, aparentemente sanos. Utilizando la definición de la IDF para el SM, se midieron variables como circunferencia de cintura (CC), presión arterial sistólica y diastólica (PS, PD), glucosa en ayunas (GA), colesterol HDL (HDLc) y triglicéridos (TG). Para el análisis estadístico, la comparación entre grupos se realizó con la medida no paramétrica prueba U de Mann-Whitney, con un nivel de significaticancia p<0,005 y mediante el uso del programa estadístico SPSS versión 24. Resultados: se encontró una prevalencia de SM de 5 %, y en el análisis individual de sus componentes o factores de riesgo asociados se evidenció una mayor prevalencia para CC y GA elevada (38,89% en cada una), seguida de la disminución del HDLc (27,78%). Conclusiones: estos hallazgos concuerdan con estudios previos donde se estima que el SM está presente en adultos jóvenes de acuerdo con criterios de la IDF. A partir de esto se recomienda adoptar medidas institucionales que promuevan la actividad física y la alimentación saludable.
- PublicaciónAcceso abiertoLatin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome(2013-02) Lopez-Jaramillo, Patricio; Sánchez, Ramiro A.; Diaz, Margarita; Cobos, Leonardo; Bryce, Alfonso; Parra Carrillo, Jose Z.; Lizcano, Fernando; Lanas, Fernando; Sinay, Isaac; Sierra, Iván D.; Peñaherrera, Ernesto; Bendersky, Mario; Schmid, Helena; Botero, Rodrigo; Urina, Manuel; Lara, Joffre; Foss, Milton C.; Márquez, Gustavo; Harrap, Stephen; Ramírez, Agustín J.; Zanchetti, Alberto; The Latin America Expert GroupThe present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of ‘metabolic syndrome’ is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that ‘metabolic syndrome’ is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
- PublicaciónRestringidoLatin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome(2019-06) Lopez-Jaramillo, Patricio; Barbosa, Eduardo; Molina, Dora I.; Sánchez, Ramiro; Diaz, Margarita; Camacho López, Paul Anthony; Lanas, Fernando; Pasquel, Miguel; Accini, Jose Luis; Ponte Negretti, Carlos I.; Alcocer, Luis; Cobos, Leonardo; Wyss, Fernando; Sebba-Barroso, Weimar; Coca, Antonio; Zanchetti, AlbertoThe prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.
- PublicaciónAcceso abiertoNeck circumference as a predictor of metabolic syndrome, insulin resistance and low-grade systemic inflammation in children : The ACFIES study(2016-03-08) Gómez Arbeláez, Diego; Camacho López, Paul Anthony; Cohen, Daniel Dylan; Saavedra Cortes, Sandra; López López, Cristina; Lopez-Jaramillo, PatricioBackground: The current study aims to evaluate the association between neck circumference (NC) and several cardio-metabolic risk factors, to compare it with well-established anthropometric indices, and to determine the cut-off point value of NC for predicting children at increased risk of metabolic syndrome, insulin resistance and low-grade systemic inflammation. Methods: A total of 669 school children, aged 8–14, were recruited. Demographic, clinical, anthropometric and biochemical data from all patients were collected. Correlations between cardio-metabolic risk factors and NC and other anthropometric variables were evaluated using the Spearman’s correlation coefficient. Multiple linear regression analysis was applied to further examine these associations. We then determined by receiver operating characteristic (ROC) analyses the optimal cut-off for NC for identifying children with elevated cardio-metabolic risk. Results: NC was positively associated with fasting plasma glucose and triglycerides (p = 0.001 for all), and systolic and diastolic blood pressure, C-reactive protein, insulin and HOMA-IR (p < 0.001 for all), and negatively with HDL-C (p = 0.001). Whereas, other anthropometric indices were associated with fewer risk factors. Conclusions: NC could be used as clinically relevant and easy to implement indicator of cardio-metabolic risk in children.
- PublicaciónAcceso abiertoNonalcoholic fatty liver disease is associated with insulin resistance in a young Hispanic population(2011-02) Pérez, M.; Gonzáles, L.; Olarte, R.; Rodríguez, N.I.; Tabares, M.; Salazar, J.P.; Jaimes, S.; García, Ronald G.; Lopez-Jaramillo, PatricioObjective 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.
- PublicaciónRestringidoLa obesidad central es el componente clave en la asociación del síndrome metabólico con el deterioro del strain longitudinal global del ventrículo izquierdo(2018-07) Cañón Montañez, Wilson; Santos, Angela B.S.; Nunes, Lisandra A.; Pires, Julio C.G.; Freire, Claudia M.V.; Ribeiro, Antonio L.P.; Mill, José G.; Bessel, Marina; Duncan, Bruce B.; Schmidt, Maria Inês; Foppa, MuriloIntroduction and objectives: Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MSand impaired leftventricularglobal longitudinalstrain(GLS)andtheroleofeachMScriteria inthisassociation. Methods: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSABrasil) after excluding participants with prevalent heart disease. Results: Among the 1055 participants fulfilling the inclusion criteria (53% women; 52 9 years), 444 (42%) had MS. Those with MS had worse GLS (–18.0% 2.5%) than those without (–19.0% 2.4%; P < .0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference = 0.86%; P < .0001), even after inclusion of body mass index. Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS –16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS –14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS –13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values. Conclusions: Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function.
- PublicaciónRestringidoPatología socioeconómica como causa de las diferencias regionales en las prevalencias de síndrome metabólico e hipertensión inducida por el embarazo(2007-02) Lopez-Jaramillo, Patricio; Pradilla, Lina P.; Castillo, Victor R.; Lahera, VicenteLa epidemia de enfermedades cardiovasculares que están experimentando los países del tercer mundo ha suscitado controversias acerca de la posible presencia de diferencias regionales en su etiofisiopatología, las cuales estarían asociadas a factores socioeconómicos. La demostración de estas diferencias es importante, pues significaría la necesidad de realizar distintos enfoques en la prevención, el diagnóstico y el tratamiento. Algunos datos indican que hay diferencias en los mecanismos etiofisiopatológicos de la hipertensión inducida por el embarazo y del síndrome metabólico en poblaciones de países desarrollados y en vía de desarrollo, así como en el peso específico de los factores de riesgo que determinan la presentación de estas enfermedades. Varias observaciones realizadas en nuestra población indican que el tiempo de exposición a los cambios de hábitos de vida ocasionados por la sociedad consumista (sedentarismo, dieta hipergrasa, hipercalórica) determina una respuesta biológica normal (obesidad, síndrome metabólico, diabetes), la cual aumenta el riesgo de enfermedades cardiovasculares. Proponemos utilizar el nombre de «patología socioeconómica» para los cambios determinados por la sociedad moderna, con el fin de diferenciarlos de la consideración aislada de «factores socioeconómicos» y «factores de riesgo», pues consideramos que la interacción entre ellos es la causa más importante del aumento acelerado en la incidencia de enfermedades cardiovasculares observado en los últimos años en los países en vías de desarrollo.
- PublicaciónRestringidoThe role of adiponectin in cardiometabolic diseases : Effects of nutritional interventions(2016-02) Lopez-Jaramillo, PatricioAdiponectin is an adipocyte-derived hormone abundantly present in plasma that exerts its effects through the activation of 3 receptors. Its concentrations are negatively regulated by the accumulation of visceral fat, and clinical studies implicate hypoadiponectinemia in the pathogenesis of diabetes mellitus type 2, coronary artery disease, hypertension, and left ventricular hypertrophy. In contrast, high concentrations of adiponectin are associated with a decreased risk of coronary artery disease, with an improvement in the differentiation of preadipocytes into adipocytes, and with increased endothelial nitric oxide production. Therefore, adiponectin appears to be an important molecule involved in limiting the pathogenesis of obesity-linked disorders, and it may have potential benefits in the treatment and prevention of cardiovascular disease. Caloric restriction, moderate alcohol consumption, and consuming a Mediterranean diet increase adiponectin concentrations, and current evidence suggests a positive, dose-dependent relation between v-3 (n–3) fatty acid intake and circulating concentrations of adiponectin. Recently, it was reported that the administration of aged garlic extract and a single food intervention with pistachios can increase adiponectin concentrations in individuals with metabolic syndrome. Moreover, the Mediterranean diet is associated with higher adiponectin concentrations. Additional studies are needed to evaluate the potential benefits of increasing adiponectin by nutritional interventions in the treatment and prevention of cardiometabolic diseases.
- PublicaciónAcceso abiertoThe role of leptin/adiponectin ratio in metabolic syndrome and diabetes(2014-04-18) Lopez-Jaramillo, Patricio; Gómez Arbeláez, Diego; López López, Jose; López López, Cristina; Martínez-Ortega, Javier; Gomez Rodriguez, Andrea; Triana Cubillos, StefanyThe metabolic syndrome comprises a cluster of cardiometabolic risk factors, with insulin resistance and adiposity as its central features. Identifying individuals with metabolic syndrome is important due to its association with an increased risk of coronary heart disease and type 2 diabetes mellitus. Attention has focused on the visceral adipose tissue production of cytokines (adipokines) in metabolic syndrome and type 2 diabetes mellitus, as the levels of the anti-inflammatory adipokine adiponectin are decreased, while proinflammatory cytokines are elevated, creating a proinflammatory state associated with insulin resistance and endothelial dysfunction. In this review, we will give special attention to the role of the leptin/adiponectin ratio. We have previously demonstrated that in individuals with severe coronary artery disease, abdominal obesity was uniquely related to decreased plasma concentrations of adiponectin and increased leptin levels. Leptin/adiponectin imbalance was associated with increased waist circumference and a decreased vascular response to acetylcholine and increased vasoconstriction due to angiotensin II. Leptin and adiponectin have opposite effects on subclinical inflammation and insulin resistance. Leptin upregulates proinflammatory cytokines such as tumor necrosis factor-α and interleukin-6; these are associated with insulin resistance and type 2 diabetes mellitus. In contrast, adiponectin has anti-inflammatory properties and downregulates the expression and release of a number of proinflammatory immune mediators. Therefore, it appears that interactions between angiotensin II and leptin/adiponectin imbalance may be important mediators of the elevated risk of developing type 2 diabetes mellitus and cardiovascular diseases associated with abdominal obesity.
- PublicaciónAcceso abiertoRole of the autonomic nervous system in the endothelial dysfunction of the metabolic syndrome(2011) Lopez-Jaramillo, Patricio; Molina, Dora I.; Aguillon, Alba; Gómez Arbeláez, Diego; Sotomayor Rubio, Aristides; López López, JoseIn the last decade there has been an accelerated growth in the prevalence of metabolic syndrome (MS), especially in Latin American countries, which has led an increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2). Recently has been raised the relationship between the autonomic nervous system (ANS), endothelial dysfunction (ED) and the appearance of MS. In the present article we review the evidence that support the proposal that abdominal obesity (AO) produce adypokines that result in insulin resistance and low degree inflammation, which increase the activity of ANS, causing vasoconstriction, hypertension, decreased peripheral glucose uptake, and decreased secretion of insulin, leading to hyperglycemia and increased lipolysis and hypertriglyceridemia. All these factors cause ED, explaining the higher risk of the patients with MS of developing DM2 and CVD.