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PURPOSE: A variable number of tandem repeats (VNTR) in the insulin gene (INS) control region may be involved in type 2 diabetes (T2D). The TH01 microsatellite is near INS and may regulate it. We investigated whether the TH01 microsatellite and INS VNTR, assessed via the surrogate marker single nucleotide polymorphism rs689, are associated with T2D and serum insulin levels in a Mexican population. METHODS: We analyzed a main case-control study (n = 1986) that used univariate and multivariate logistic regression models to calculate the risk conferred by TH01 and rs689 loci for T2D development; rs689 results were replicated in other case-control (n = 1188) and cross-sectional (n = 1914) studies. RESULTS: TH01 alleles 6, 8, 9, and 9.3 and allele A of rs689 were independently associated with T2D, with differences between sex and age at diagnosis. TH01 alleles with ≥ 8 repeats conferred an increased risk for T2D in males compared with ≤ 7 repeats (odds ratio, ≥ 1.46; 95% confidence interval, 1.1-1.95). In females, larger alleles conferred a 1.5-fold higher risk for T2D when diagnosed ≥ 46 years but conferred protection when diagnosed ≤ 45 years. Similarly, rs689 allele A was associated with T2D in these groups. In males, larger TH01 alleles and the rs689 A allele were associated with a significant decrease in median fasting plasma insulin concentration with age in T2D cases; the reverse occurred in controls. CONCLUSION: Larger TH01 alleles and rs689 A allele may potentiate insulin synthesis in males without T2D, a process disabled in those with T2D.

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BACKGROUND: Atherosclerotic ischaemic heart disease is the second leading cause of general mortality in Mexico due to the growing prevalence of atherosclerotic risk factors in our society. The data of the FRIMEX study (Factores de Riesgo en México, Risk Factors in Mexico), considered together with those of other contemporary epidemiological surveys, will aid in our comprehension of the current state of cardiovascular epidemics in Mexico. METHODS: Frequencies of obesity, hypertension and smoking, and total cholesterol and glucose in capillary blood were estimated in a non-probabilistic sample comprised of 140017 individuals (aged 44+/-13 years; 42% men and 58% women), from six Mexican cities (Mexico City, Guadalajara, Monterrey, Puebla, Leon and Tijuana). RESULTS: Obesity or overweight status was found in 71.9% of participants. Hypertension was found in 26.5%, and the proportions of awareness, treatment and control for this disease were 49.3, 73 and 36%, respectively. Prevalence of hypertension increased with age; while it was higher in men under 60 years of age, in the more aged individuals it was higher in women. Hypercholesterolaemia was found in 40% of the individuals and cholesterolaemia > or =240 mg/dl was significantly higher in women. Thirty-five and a half percent of men and 18.1% of women were smokers. Type 2 diabetes mellitus was found in 10.4% of participants. There was significant Pearson's correlation between body mass index and blood pressure, between hypertension and glucose levels, and between hypertension and total cholesterol concentrations. CONCLUSIONS: We conclude that this population has a high cardiovascular risk profile and a high probability of the occurrence of metabolic syndrome.

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OBJECTIVE: To elaborate Mexican growth charts based on international methodology. DESIGN: Data were obtained from the Mexican National Health Survey. The survey was stratified and probabilistic representative of all the country. SETTING: Nationwide open population living in urban and rural areas. SUBJECTS: Boys (8545) and girls (9983) from 10 to 18 years participating in the survey. METHODS: Age, weight and height were recorded. Empirical percentiles were calculated and smoothed. Smoothed curves were approximated using least-mean square estimation. RESULTS: Tables and figures for percentile values of weight, height and body mass index (BMI) for age, as well as percentile values of weight and BMI for height for both genders are presented. Regarding 50th BMI for age percentiles, Mexicans had higher levels than the Americans in the Centers for Disease Control and Prevention growth charts; Mexicans were lower but had similar weights than the Americans. Owing to the high BMI, the percentile corresponding to an overweight level (25 kg/m(2)) at 18 years was 74.5 in boys and 72.5 in girls, whereas obesity level (30 kg/m(2)) at 18 years was 97.3 and 97.4 in boys and girls, respectively. CONCLUSIONS: The present growth charts are snapshots of a Mexican population. Because of the high median BMI compared to US and World Health Organization standards, we must be cautious in establishing an upper normal cutoff for clinical normality, not merely selecting the 85th and 95th percentiles as equivalents of overweight and obesity, respectively. Therefore, we proposed percentiles 74.5 in boys and 72.5 in girls as the action points of overweight as they are the percentiles corresponding to BMI 25 kg/m(2) at 18 years. SPONSORSHIP: The survey was supported by the Mexican Minister of Health. Statistical analyses were sponsored by Dr Del-Rio-Navarro.

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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

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To generate timely and reliable information for decision making in local health centers, Mexico's National Epidemiological Surveillance System (SINAVE) was evaluated and reformed. The reform was achieved by consensus through national meetings of epidemiologists, using a conceptual model of requirements, leadership, participation, and motivation. The new SINAVE is run by committees that use data from 16 468 local health centers that generate homogeneous information from all health institutions. Indicators, flowcharts, and standardized instruments were created. The reforms modernized SINAVE and strengthened epidemiologists' leadership, consolidated local decision making, and assessed control actions needed to improve the health of the Mexican population.

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Smoking is one of the main preventable causes of disease and death worldwide; 3.5 million smokers die annually. This essay shows the progress made against this epidemic in our country and points out the relevance of implementing a comprehensive program to control smoking. Results from three national surveys conducted in Mexico in 1988, 1993, and 1998 are analyzed and compared. On the one hand, the strategies should include preventive actions, protection of non-smokers, smoking cessation, banning of smoking advertisement, and tax increases; on the other hand, controlling smoking and its consequences on health depend on all of us.

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OBJECTIVE: 1. To estimate the prevalence of pre-obesity and obesity in a 1992 to 1993 national survey of the Mexican urban adult population. 2. To compare our findings with other national surveys and with data for Mexican Americans. RESEARCH METHODS AND PROCEDURES: The national representative sample of the Mexican urban adult population included 8462 women and 5929 men aged 20 to 69 years from 417 towns of >2500 people. Body mass index (BMI), calculated from measured weight and height, was classified using the World Health Organization categories of underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5 to 24.9 kg/m2), pre-obesity (PreOB = BMI 25 to 29.9 kg/m2) and obesity (OB = BMI 30+ kg/m2). Estimates for Mexican Americans were calculated from U.S. survey data. RESULTS: Overall, 38% of the Mexican urban adult population were classified as pre-obese and 21% as obese. Men had a higher prevalence of pre-obesity than women did at all ages, but women had higher values of obesity. Both pre-obesity and obesity increased with age up to the age range brackets of 40 to 49 or 50 to 59 years for both men and women. Both pre-obesity and obesity prevalence estimates were remarkably similar to data for Mexican Americans from 1982 through 1984. Comparison with other large surveys showed that countries differed more in the prevalence of obesity than of pre-obesity, leading to differences in the PreOB/OB ratio, and that countries also differed in the gender ratio (female/male) for both pre-obesity and obesity. DISCUSSION: Pre-obesity and obesity were high in our population and increased with age. Our approach of characterizing large surveys by PreOB/OB and gender ratios appeared promising.

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BACKGROUND: Drug resistance threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Mexico. OBJECTIVE: To obtain population-based data on Mycobacterium tuberculosis drug resistance in Mexico. METHODS: To obtain drug resistance data, we conducted a population-based study of TB cases in the states of Baja California, Sinaloa, and Oaxaca, Mexico. We performed cultures and drug susceptibility testing on M tuberculosis isolates from patients with newly diagnosed, smear-positive TB from April 1 to October 31, 1997. RESULTS: Mycobacterium tuberculosis was isolated from 460 (75%) of the 614 patients. Levels of resistance in new and retreatment TB cases to 1 or more of the 3 current first-line drugs used in Mexico (isoniazid, rifampin, and pyrazinamide) were 12.9% and 50.5%, respectively; the corresponding levels of multi-drug-resistant TB were 2.4% and 22.4%. Retreatment cases were significantly more likely than new cases to have isolates resistant to 1 or more of the 3 first-line drugs (relative risk [RR], 3.9; 95% confidence interval [CI], 2.8-5.5), to have isoniazid resistance (RR, 3.6; 95% CI, 2.5-5.2), and to have multi-drug-resistant TB (RR, 9.4; 95% CI, 4.3-20.2). CONCLUSIONS: This population-based study of M tuberculosis demonstrates moderately high levels of drug resistance. Important issues to consider in the national strategy to prevent M tuberculosis resistance in Mexico include consideration of the most appropriate initial therapy in patients with TB, the treatment of patients with multiple drug resistance, and surveillance or periodic surveys of resistance among new TB patients to monitor drug resistance trends.

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