Objective: To investigate the association between dietary patterns and risk of a first nonfatal acute myocardial infarction (MI) in Costa Rican adults. Design: Population-based case-control study. Subjects: A total of 496 incident MI cases and 518 population-based randomly selected controls matched to the cases by age (75 years), gender, and county of residence. Subjects were interviewed with a validated food frequency questionnaire. Dietary patterns were identified by factor analysis. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using multivariate conditional logistic regression adjusted for several recognized risk factors for MI. Results: Two diet patterns were identified, 'vegetable' characterized by increased intake of vegetables and fruits, and 'staple', characterized by an increased use of palm oil for cooking, and intake of refined grains (mostly white rice and white bread), legumes, coffee, added sugar, and red meat. Compared to the lowest quintile of the staple diet pattern, the highest quintile was associated with an increased risk of MI (OR: 3.70, 95% CI: 2.30-5.97). Adjusting for potential confounders did not change the results (OR: 3.53, 95% CI: 1.98-6.31). Consistently, an increasing staple pattern score was associated with lower HDL cholesterol (P for trend o0.02) and a-linolenic acid in adipose tissue (P for trend o0.0001). The vegetable pattern was not associated with MI. Conclusions: The staple dietary pattern of Costa Rican adults is associated with low plasma HDL cholesterol, low a-linolenic acid in adipose tissue, and increased risk of MI.
Se presenta el caso de una mujer de 52 años sedentaria y con sobrepeso (índice de masa corporal= 28.3), que tiene, según ATP-III, las 5 características del síndrome metabólico: diabetes tipo 2 (glicemia en ayunas = 294 mg/dL), triacilglicerol = 162 mg/dL, HDL-colesterol = 44 mg/dL y obesidad central (perímetro de la cintura = 90 cm). La diabetes tipo 2 le fue diagnosticada hace 17 años, recibe medicamento para la hipertensión desde hace 7 años y presenta hipercolesterolemia (colesterol total = 283 mg/dL), para lo que no recibe tratamiento farmacológico. A pesar de su condición, la paciente se considera saludable lo cual le impide modificar su estilo de vida y mejorar la calidad de vida lo que aumenta el costo de su tratamiento médico para el sistema de seguridad social.
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