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Background: Hypertension and type 2 diabetes (T2D) are the most prevalent noncommunicable diseases in Mexico and worldwide. According to international practice management guidelines, the principal chronic management therapy is daily oral medication. Aim: We aim to describe the trends of antihypertensive, antidiabetic, and nonsteroidal anti-inflammatory (NSAID) drugs use among the Mexican adult population from 2004-2018. Methods: We analyzed data from the Health Workers Cohort Study (HWCS) for males and females aged >18 years. We calculated the prevalence of chronic diseases and utilization for every kind of antihypertensive, antidiabetic, and NSAIDs (measured by self-reported utilization) at baseline and two follow-ups (2004, 2010, and 2017). Trends were analyzed using Fisher's exact test. Results: Hypertension prevalence increased from 19.8 to 30.3%, higher than T2D prevalence from 7.0 to 12.8% through fourteen years of follow-up. Like the self-reported dual therapy, the proportion of patients using beta-blockers and angiotensin II receptor blockers increased. Regarding T2D, the prevalence of metformin utilization increased to 83.9%. The utilization of common NSAIDs, mainly for muscular pain, remained around 13 to 16%. Conclusions: Our findings showed a changing prevalence of drug utilization for hypertension and T2D between 2004 and 2018 and consistent use of NSAIDs in the adult Mexican population.
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BACKGROUND: Experimental evidence suggests that p,p'-DDE might be involved in the development of diabetes and hypertension (HTN); however, the evidence in humans is inconclusive. OBJECTIVE: To summarize the epidemiological evidence for the association of p,p'-DDT exposure and its breakdown products with the risk of diabetes and HTN from prospective studies. METHODS: We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies (prospective) were search in PubMed, Web of Science, EBSCO, and SciELO databases (July 11, 2020). Different search algorithms were used for diabetes and HTN. Pooled odds ratios (ORs) were estimated from meta-analysis with random effects for each exposure and outcome. RESULTS: A total of 23 prospective studies were included in this review, 16 assessed diabetes and seven HTN; very few measured p,p'-DDT. Exposure to p,p'-DDE was associated with a slightly increased risk of type 2 diabetes (T2D) (pooled OR = 1.44; 95%CI: 1.00, 2.07; p = 0.049) and HTN (pooled OR = 1.21; 95%CI: 1.07, 1.38). Dose-response meta-analysis suggested a non-linear relation between p,p'-DDE and T2D. Exposure to p,p'-DDE was not associated with gestational diabetes (pooled OR = 1.01; 95%CI: 0.94, 1.09); similarly, p,p'-DDT was not associated with T2D (pooled OR = 1.03; 95%CI: 0.79, 1.35). CONCLUSIONS: Evidence from prospective studies suggests that exposure to p,p'-DDE, the main breakdown product of p,p'-DDT, might increase the risk of developing T2D; such increase may be apparent only at low levels. Exposure to p,p'-DDE may also increase the risk of having HTN; however, further evidence is required.
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Diabetes Mellitus Tipo 2 , Hipertensão , Praguicidas , DDT , Diabetes Mellitus Tipo 2/epidemiologia , Diclorodifenil Dicloroetileno , Humanos , Hipertensão/epidemiologia , Estudos ProspectivosRESUMO
Objetivo. Resumir la evidencia científica sobre las altera-ciones renales asociadas con la infección por SARS-CoV-2. Material y métodos. Se realizó una revisión rápida con la metodología Cochrane. Resultados. La enfermedad renal crónica (ERC) preexistente en pacientes con SARS-CoV-2 varió de 1 a 38% y la lesión renal aguda (LRA), de 2.9 a 86.4%. El pronóstico de la infección fue peor en pacientes con ERC y en aquellos con reserva renal remanente (RRR) intacta que desarrollaron LRA. El riesgo de muerte fue mayor (riesgo relativo combinado = 1.49; IC95%: 1.09-2.04) en pacientes infectados por SARS-CoV-2 con ERC preexistente. Los mar-cadores de RRR mostraron alteraciones en pacientes con SARS-CoV-2 graves y fatales; el marcador más utilizado fue la creatinina sérica. Conclusiones. La evidencia científica muestra la relevancia de la evaluación y monitoreo perma-nente de la RRR en pacientes hospitalizados por SARS-CoV-2 para mejorar el pronóstico de aquellos con ERC preexistente, así como de aquellos sin ERC que desarrollan LRA.
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COVID-19/fisiopatologia , Rim/fisiopatologia , HumanosRESUMO
OBJECTIVE: To assess the effect of intimate partner violence on the risk of depression and depressive symptoms among adult women. METHOD: We analyzed data from the Mexican Health Workers' Cohort study (n=470). Type and severity of intimate partner violence was ascertained between 2004 and 2011. Self-reported medical diagnosis of depression (2011) was the main outcome; depressive symptoms ascertained with the Centre for Epidemiologic Studies-Depression (CES-D) scale was the secondary outcome. Random-effects regressions were run to model the risk of depression (logistic) and depressive symptoms (linear) in relation to intimate partner violence. RESULTS: 41.9% women experienced intimate partner violence at baseline. The incidence of depression was 7.2%. The risk of depression increased with any type of IPV (adjusted odds ratio [aOR]=2.9; 95% confidence interval [95%CI]: 1.4-6.2) and with physical (aOR=4.3; 95%CI: 1.8-10.1), psychological (aOR=3.1; 95%CI: 1.4-6.6) and sexual (aOR=3.1; 95%CI: 1.2-8.2) violence. Depressive symptoms (CES-D) increased slightly with physical and sexual intimate partner violence. CONCLUSIONS: Intimate partner violence was associated with a higher risk of depression in this sample of women working in a Mexican health facility. Our results indicate the need to develop infrastructure, to implement strategies of attention and counselling, and to provide a safe environment in the workplace for women who experience intimate partner violence.
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Depressão , Violência por Parceiro Íntimo , Adulto , Estudos de Coortes , Estudos Transversais , Depressão/epidemiologia , Feminino , Instalações de Saúde , Humanos , Masculino , México/epidemiologia , Prevalência , Fatores de RiscoRESUMO
Resumen Objetivo: Resumir la evidencia científica sobre las alteraciones renales asociadas con la infección por SARS-CoV-2. Material y métodos: Se realizó una revisión rápida con la metodología Cochrane. Resultados: La enfermedad renal crónica (ERC) preexistente en pacientes con SARS-CoV-2 varió de 1 a 38% y la lesión renal aguda (LRA), de 2.9 a 86.4%. El pronóstico de la infección fue peor en pacientes con ERC y en aquellos con reserva renal remanente (RRR) intacta que desarrollaron LRA. El riesgo de muerte fue mayor (riesgo relativo combinado = 1.49; IC95%: 1.09-2.04) en pacientes infectados por SARS-CoV-2 con ERC preexistente. Los marcadores de RRR mostraron alteraciones en pacientes con SARS-CoV-2 graves y fatales; el marcador más utilizado fue la creatinina sérica. Conclusiones: La evidencia científica muestra la relevancia de la evaluación y monitoreo permanente de la RRR en pacientes hospitalizados por SARS-CoV-2 para mejorar el pronóstico de aquellos con ERC preexistente, así como de aquellos sin ERC que desarrollan LRA.
Abstract: Objective: To summarize the scientific literature on kidney abnormalities associated with SARS-CoV-2 infection. Materials and methods: It was conducted a rapid review using the Cochrane methodology. Results: Pre-existing chronic kidney disease (CKD) in SARS-CoV-2 infected patients ranged from 1-38% and acute kidney injury (AKI) ranged from 2.9-86.4%. The prognosis of patients with SARS-CoV-2 infection was worse among those with CKD and those with normal remnant kidney function (RKF) that developed AKI. The risk of death was higher (pooled risk ratio =1.49; 95%CI: 1.09-2.04) among SARS-CoV-2 infected patients with pre-existing CKD. The RKF markers showed alterations among severe and non-surviving SARS-CoV-2 patients; the most common marker was serum creatinine. Conclusions: The scientific evidence shows the relevance of the evaluation and permanent monitoring of the RKF in SARS-CoV-2 hospitalized patients to improve the prognosis of those with pre-existing CKD as well as the prognosis of those without CKD who develop AKI.
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OBJECTIVE: Our aim was to examine prospectively predictors of subclinical renal alterations among adults without chronic kidney disease. MATERIALS AND METHODS: We analyzed data from a cohort of Mexican adults (n=757). Kidney function (2010) was assessed with the estimated glomerular filtration rate (eGFR-Cr), serum creatinine and uric acid. Predictors of each kidney function marker (2004) were identified with linear and logistic regression models. RESULTS: 33% had an eGFR-Cr 40 years old and users of antihypertensive medication; and higher among those with a high protein intake. Serum creatinine predictors were similar to those observed for eGFR-Cr. Uric acid decreased in men, among those with obesity, hypertension and high cholesterol. CONCLUSIONS: Conventional kidney function biomarkers are useful to identify subclinical alterations. Some predictors of kidney function are potentially modifiable, therefore susceptible for intervention among high-risk groups.
OBJETIVO: Examinar prospectivamente los predictores de alteraciones subclínicas de la función renal en adultos sin diagnóstico previo de enfermedad renal crónica. MATERIAL Y MÉTODOS: Se analizaron datos de una cohorte de adultos mexicanos (n=757). La función renal (2010) se midió mediante la tasa de filtración glomerular estimada (TFGECr), creatinina y ácido úrico séricos. Los predictores (2004) se identificaron con modelos de regresión lineal y logística. RESULTADOS: Se clasificó 33% con TFGE-Cr disminuida.La TFGE-Cr fue menor en hombres, en >40 años y en usuarios de antihipertensivos; y fue mayor en aquellos con consumo proteico alto. Los predictores de la creatinina fueron similares a los de la TFGE-Cr. El ácido úrico disminuyó en participantes hombres, con obesidad, hipertensión e hipercolesterolemia. CONCLUSIONES: Los biomarcadores séricos convencionales son útiles para identificar alteraciones subclínicas de la función renal. Algunos predictores de la función renal son potencialmente modificables, por tanto susceptibles de intervención.
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Rim/fisiologia , Adulto , Estudos de Coortes , Taxa de Filtração Glomerular , Humanos , Masculino , México , Ácido Úrico/urinaRESUMO
Resumen: Objetivo: Examinar prospectivamente los predictores de alteraciones subclínicas de la función renal en adultos sin diagnóstico previo de enfermedad renal crónica. Material y métodos: Se analizaron datos de una cohorte de adultos mexicanos (n=757). La función renal (2010) se midió mediante la tasa de filtración glomerular estimada (TFGE-Cr), creatinina y ácido úrico séricos. Los predictores (2004) se identificaron con modelos de regresión lineal y logística. Resultados: Se clasificó 33% con TFGE-Cr disminuida. La TFGE-Cr fue menor en hombres, en >40 años y en usuarios de antihipertensivos; y fue mayor en aquellos con consumo proteico alto. Los predictores de la creatinina fueron similares a los de la TFGE-Cr. El ácido úrico disminuyó en participantes hombres, con obesidad, hipertensión e hipercolesterolemia. Conclusión. Los biomarcadores séricos convencionales son útiles para identificar alteraciones subclínicas de la función renal. Algunos predictores de la función renal son potencialmente modificables, por tanto susceptibles de intervención.
Abstract: Objectives: Our aim was to examine prospectively predictors of subclinical renal alterations among adults without chronic kidney disease. Materials and methods: We analyzed data from a cohort of Mexican adults (n=757). Kidney function (2010) was assessed with the estimated glomerular filtration rate (eGFR-Cr), serum creatinine and uric acid. Predictors of each kidney function marker (2004) were identified with linear and logistic regression models. Results: 33% had an eGFR-Cr <90 ml/min/1.73 m2. eGFR-Cr was lower among men, those >40 years old and users of antihypertensive medication; and higher among those with a high protein intake. Serum creatinine predictors were similar to those observed for eGFR-Cr. Uric acid decreased in men, among those with obesity, hypertension and high cholesterol. Conclusion: Conventional kidney function biomarkers are useful to identify subclinical alterations. Some predictors of kidney function are potentially modifiable, therefore susceptible for intervention among high-risk groups.
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Adulto , Humanos , Masculino , Rim/fisiologia , Ácido Úrico/urina , Estudos de Coortes , Taxa de Filtração Glomerular , MéxicoRESUMO
CHD is becoming an increasing priority worldwide, as it is one of the main causes of death in low- and middle-income countries lately. This study aims to evaluate the association between beverage consumption patterns and the risk of CHD among Mexican adult population. We performed a cross-sectional analysis using data from 6640 adults participating in the Health Workers' Cohort Study. Factor analysis was performed to identify beverage patterns using sex-specific Framingham prediction algorithms to estimate CHD risk. The prevalence of moderate to high CHD risk was 17·8 %. We identified four major beverage consumption patterns, which were categorised as alcohol, coffee/tea, soft drinks and low-fat milk. We observed a lower risk of CHD (OR=0·61; 95 % CI 0·46, 0·80; and OR=0·58; 95 % CI 0·43, 0·79, respectively) among participants in the upper quintile of alcohol or low-fat milk consumption compared with those in the bottom quintile. In contrast, a higher consumption of soft drinks was positively associated with CHD risk (OR=1·64; 95 % CI 1·21, 2·20) when compared with other extreme quintiles. Finally, coffee/tea consumption was not significantly associated with CHD risk. Our findings suggest that a beverage pattern characterised by a higher intake of sugar-sweetened beverages may be associated with an increased risk of CHD among the Mexican adult population, whereas patterns of moderate alcohol intake and low-fat milk may be associated with a reduced risk.
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Bebidas , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Dieta , Medição de Risco , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas , Algoritmos , Animais , Antropometria , Bebidas Gaseificadas , Café , Estudos de Coortes , Estudos Transversais , Ingestão de Energia , Feminino , Humanos , Estilo de Vida , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Leite , Saúde Pública , Adulto JovemRESUMO
OBJECTIVE: To prospectively examine the extent to which mealtime habits influences the risk of weight gain and obesity in Mexican adults. DESIGN: We performed a prospective cohort study. The Mealtime Habits Quality (MHQ) scale was used for assessing participants' MHQ; the outcomes of interest were gain ≥5 % of body weight, developing overweight/obesity and abdominal obesity, after 7 years of follow-up. In order to estimate the independent effect of MHQ on anthropometric indicators, generalized linear models were computed to obtain adjusted relative risks (95 % CI). SETTING: The state of Morelos, Mexico. SUBJECTS: Mexican adults (n 837) aged 18-70 years participating in a cohort study. RESULTS: Compared with participants classified in the higher MHQ category, individuals in the middle and lower MHQ groups had a 4·1 (2·5, 6·7) and 6·2 (3·9, 9·7) fold greater risk of gain ≥5 % of body weight, respectively; 6·6 (2·8, 15·5) and 8·6 (3·7, 19·8) fold greater risk of becoming overweight/obese, respectively; and 3·8 (2·0, 7·3) and 5·3 (2·8, 9·8) fold greater risk of developing abdominal obesity, respectively. CONCLUSIONS: This study provides evidence about the influence of a set of mealtime habits on obesity indicators, showing that greater adherence to unadvisable mealtime habits increases the risk of developing unhealthy anthropometric indicators. Since the meal is one of the most important sources of food intake, and consequently weight status, the MHQ scale can be a useful population tool to predict weight gain and obesity.
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Comportamento Alimentar , Refeições , Obesidade/etiologia , Sobrepeso/etiologia , Aumento de Peso , Adolescente , Adulto , Idoso , Antropometria/métodos , Peso Corporal , Inquéritos sobre Dietas/métodos , Feminino , Humanos , Modelos Lineares , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Risco , Adulto JovemRESUMO
Abstract: Objective: To examine different health outcomes that are associated with specific lifestyle and genetic factors. Materials and methods: From March 2004 to April 2006, a sample of employees from three different health and academic institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013), participants completed a self-administered questionnaire, a physical examination, and provided blood samples. Results: A total of 10 729 participants aged 6 to 94 years were recruited at baseline. Of these, 70% were females, and 50% were from the Mexican Social Security Institute. Nearly 42% of the adults in the sample were overweight, while 20% were obese. Conclusion: Our study can offer new insights into disease mechanisms and prevention through the analysis of risk factor information in a large sample of Mexicans.
Resumen: Objetivo: Examinar diferentes desenlaces en salud y su asociación con factores genéticos y del estilo de vida. Material y métodos: De marzo de 2004 a abril de 2006, una muestra de empleados de tres diferentes instituciones de salud y académicas, así como miembros de sus familias, fueron enrolados en el estudio, previa firma de consentimiento informado. Durante la medición basal y el seguimiento (2010-2013) los participantes completaron un cuestionario autoaplicado, exámenes físicos y proporcionaron muestras sanguíneas. Resultados: Fueron incluidos participantes (10 729) de entre 6 y 94 años en la medición basal. De estos, 70% fueron mujeres y 50% del Instituto Mexicano del Seguro Social. Aproximadamente 42% de los adultos tuvieron sobrepeso y 20% obesidad. Conclusión: Este estudio puede ofrecer conocimientos sobre los mecanismos de la enfermedad a través del análisis de factores de riesgo en una muestra de mexicanos.