The double burden of malnutrition is the coexistence of two different conditions, mainly reflected as excess or deficit in weight. Anemia is a specific nutritional deficit not always included in the double burden assessment. We reviewed overweight and/or obesity (OW/OB) and anemia studies from Latin-American Children over the last ten years up to 2019. Two authors evaluated the MEDLINE, SCOPUS, and LILACS databases. A scale of ten questions was used to assess the risk of bias in prevalence studies. Fourteen studies were selected. The population studies' size ranged from 147 to 20,342 children with different socioeconomic backgrounds, such as urban, peri-urban and rural settings, socioeconomic status, schooling, population (ethnic minorities and indigenous), and environmental differences (sea level or high altitude). The prevalence of OW/OB ranged from 4.9% to 42%. The prevalence of anemia was from 3.4% to 67%. The double burden, including OW/OB and anemia, ranged from 0.7% to 67%. A higher prevalence of excess weight and anemia was found in rural and high altitude above sea level environments, extreme poverty, low education level, and indigenous communities. These heterogeneous data, before the 2020 (COVID-19 pandemic), reflect the vast inequities between countries and within each country. Food insecurity linked to poverty and the induced change in eating habits and lifestyles threaten optimal child nutrition in ongoing and future scenarios. The existence of OW/OB and anemia and their simultaneous coexistence in the community, home, and individual levels, indicates that interventions should be comprehensive to face the double burden of malnutrition.
Objective: To collect information of prediabetes in the Peruvian context. Methods: 9 national experts were summoned and a scoring questionnaire was prepared for screening dimensions as diagnosis, tools to determine the risk of progression to DM2, risk factors and management of prediabetes for the prevention of DM2. The consensus was made in three rounds, being the third one, face-to-face. Findings: Fasting plasma glucose is the best test for prediabetes screening. The best cut-off point is the one recommended by the American Diabetes Association (100 mg/dl to 125 mg/dl or 5.6-6.9 mmol/L). Every patient with altered fasting plasma glucose should undergo an oral glucose tolerance test with 75 g of anhydrous glucose. PERUDIAB study is the best population analysis that estimated an impaired fasting glucose prevalence of 22.4%. The options are: lifestyle change or this one but with metformin. Conclusion: This document is essential to establish pre-diabetes prevention policies, identifying risk populations and screening tools.
Backrgound: To estimate the accuracy of metabolic syndrome definitions for detecting Carotid Intima-Media thickness (CIMT) in Peruvian type 2 diabetes mellitus (T2DM) subjects without cardiovascular events.Methods: We performed a cross-sectional evaluation of T2DM subjects from the endocrinology service of two reference health centers without stroke or coronary disease. . Bilateral carotid intima-media thickness was measure by B mode ultrasound one only operator. We performed four definitions of Metabolic Syndrome; 1. Cholesterol Education Program Adult Treatment Panel III (ATP III), 2. Harmonized criteria; 3. Gurka's Metabolic syndrome severity score (MSSS) formula. 4. Non-glucose modified MSSS. We calculated the area under the receiver operator curve (AUROC) for detecting increased CIMT (≥ 0.86 mm) between metabolic syndrome definitions. Results: We included 184 subjects with T2DM, 29% were men with a mean age of 61.5 ± 10.5 years old. Median diabetes time was 10.8 years (IQR 4.8 to 19.4), and 26.8% achieved HbA1c goals. Non-glucose modified MSSS was the only definition significantly correlated with elevated CIMT (r = 0.19; p<0.01), and it showed the best accuracy for predicting elevated CIMT (AUC: 0.61, CI95%: 0.52-0.70). Adjusting for age, sex, and HbA1c, each point increase in the non-glucose MSSS Z score, the risk of altered CIMT increases by 59% RP 1.59 (CI 95% 1.09 - 2.35; p=0.017). Conclusions: Non-glucose modified MSSS had a weak accuracy for elevated CIMT and was the best compared to ATP III, harmonized, and original MSSS. Further research on no MS-factors is required to predict better elevated CIMT.
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