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      Estado nutricional, síndrome metabólico e inflamación en pacientes con enfermedad de Chagas Translated title: Nutritional condition, metabolic syndrome and inflammation in patients with Chagas disease

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          Abstract

          Resumen El propósito de este estudio fue describir la asociación entre el estado nutricional, la presencia de síndrome metabólico (SM), y el estado inflamatorio, en pacientes con Enfermedad de Chagas (ECh), atendidos en la consulta externa del Instituto de Medicina Tropical en Caracas. El estudio fue de tipo transversal y correlacional, en el cual se seleccionaron 34 pacientes a los cuales se les realizó un diagnóstico parasitológico, inmunológico y molecular de la ECh. Se evaluaron variables antropométricas, clínicas y bioquímicas, así como el SM el cual fue determinado por los criterios del III Panel estadounidense para el Tratamiento de Adultos del Programa Nacional de Educación sobre el Colesterol (ATP-III, por sus siglas en inglés). Se encontró que la mayoría de los pacientes presentaron sobrepeso u obesidad (73,5%), un porcentaje de grasa corporal (% GC) alto o muy alto (82,3%), y obesidad abdominal (61,8 %). La frecuencia de SM fue de 29,4% y más del 90% mostraron valores elevados de Proteína C Reactiva ultrasensible (PCRus). Valores más elevados del IMC se asociaron con un estadio más avanzado de la ECh. Los sujetos con presencia de ADN de Tripanosoma cruzi (T. cruzi) circulante en sangre, presentaron mayor % GC, y en su mayoría, fueron diagnosticados con SM. En conclusión, los pacientes evaluados mostraron un exceso de adiposidad, que puede favorecer el estado inflamatorio, el desarrollo de SM y la progresión de la ECh.

          Translated abstract

          Abstract The purpose of the study was to describe the association between nutritional and inflammatory status and the presence of metabolic syndrome (MS) on patients with Chagas disease (CD) treated at the Outpatient Services of the Tropical Medicine Institute in Caracas, Venezuela. The study was cross-sectional and correlational. Thirty-four (34) patients were selected and a molecular, immunological, and parasitological diagnostic test was ran for Chagas disease. Anthropometric, clinic, and biochemical variables were evaluated, and the MS was determined using National Cholesterol Education Program Expert/Adult Treatment Panel III (ATP-III) criteria. The results showed a high percentage of patients overweight or presenting obesity (73.5%), a high and very high percentage of body fat (82.3%), and abdominal obesity (61.8%). The prevalence of MS was 29,4% and more than 90% of patients showed elevated values of high sensitivity C-reactive protein (hsCRP). Higher body-mass index values were associated with advanced stages of the CD. Subjects in the presence of T. cruzi DNA in the blood showed a greater percentage of body fat and, most of them, were diagnosed with MS. In conclusion, the evaluated patients showed an excess of adiposity which may favor an inflammatory status, the development of the MS, and the progress of the CD.

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            Use of metabolic markers to identify overweight individuals who are insulin resistant.

            Insulin resistance is more common in overweight individuals and is associated with increased risk for type 2 diabetes mellitus and cardiovascular disease. Given the current epidemic of obesity and the fact that lifestyle interventions, such as weight loss and exercise, decrease insulin resistance, a relatively simple means to identify overweight individuals who are insulin resistant would be clinically useful. To evaluate the ability of metabolic markers associated with insulin resistance and increased risk for cardiovascular disease to identify the subset of overweight individuals who are insulin resistant. Cross-sectional study. General clinical research center. 258 nondiabetic, overweight volunteers. Body mass index; fasting glucose, insulin, lipid and lipoprotein concentrations; and insulin-mediated glucose disposal as quantified by the steady-state plasma glucose concentration during the insulin suppression test. Overweight was defined as body mass index of 25 kg/m2 or greater, and insulin resistance was defined as being in the top tertile of steady-state plasma glucose concentrations. Receiver-operating characteristic curve analysis was used to identify the best markers of insulin resistance; optimal cut-points were identified and analyzed for predictive power. Plasma triglyceride concentration, ratio of triglyceride to high-density lipoprotein cholesterol concentrations, and insulin concentration were the most useful metabolic markers in identifying insulin-resistant individuals. The optimal cut-points were 1.47 mmol/L (130 mg/dL) for triglyceride, 1.8 in SI units (3.0 in traditional units) for the triglyceride-high-density lipoprotein cholesterol ratio, and 109 pmol/L for insulin. Respective sensitivity and specificity for these cut-points were 67%, 64%, and 57% and 71%, 68%, and 85%. Their ability to identify insulin-resistant individuals was similar to the ability of the criteria proposed by the Adult Treatment Panel III to diagnose the metabolic syndrome (sensitivity, 52%, and specificity, 85%). Three relatively simple metabolic markers can help identify overweight individuals who are sufficiently insulin resistant to be at increased risk for various adverse outcomes. In the absence of a standardized insulin assay, we suggest that the most practical approach to identify overweight individuals who are insulin resistant is to use the cut-points for either triglyceride concentration or the triglyceride-high-density lipoprotein cholesterol concentration ratio.
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                Author and article information

                Journal
                alan
                Archivos Latinoamericanos de Nutrición
                ALAN
                Sociedad Latinoamericana de Nutrición (Caracas, DF, Venezuela )
                0004-0622
                2309-5806
                June 2020
                : 70
                : 2
                : 101-114
                Affiliations
                [2] Caracas Districto Capital orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Escuela de Nutrición y Dietética Venezuela
                [3] Caracas Districto Capital orgnameUniversidad Simón Bolívar orgdiv1Departamento de Tecnología de Procesos Biológicos y Bioquímicos Venezuela
                [1] Caracas Districto Capital orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Escuela de Nutrición y Dietética Venezuela
                [5] Caracas Districto Capital orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Escuela de Nutrición y Dietética Venezuela
                [4] orgnameUniversidad de Carabobo orgdiv1Facultad de Ciencias de la Salud orgdiv2Instituto de Investigaciones en Nutrición Venezuela
                Article
                S0004-06222020000200101 S0004-0622(20)07000200101
                10.37527/2020.70.2.003
                4e33bb3c-0c98-4f4a-8577-272d2455d34a

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 21 September 2020
                : 27 May 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 60, Pages: 14
                Product

                SciELO Venezuela

                Categories
                Artículo Original

                síndrome metabólico,Chagas disease,nutritional status,inflammatory status,metabolic syndrome,T. cruzi,Enfermedad de Chagas,estado nutricional,inflamación

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