Publications by authors named "Patricia Medina Bravo"

27 Publications

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Protein-conformational diseases in childhood: Naturally-occurring hIAPP amyloid-oligomers and early ő≤-cell damage in obesity and diabetes.

PLoS One 2020 24;15(8):e0237667. Epub 2020 Aug 24.

Unidad de Investigación en Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.

Background And Aims: This is the first time that obesity and diabetes mellitus (DM) as protein conformational diseases (PCD) are reported in children and they are typically diagnosed too late, when ő≤-cell damage is evident. Here we wanted to investigate the level of naturally-ocurring or real (not synthetic) oligomeric aggregates of the human islet amyloid polypeptide (hIAPP) that we called RIAO in sera of pediatric patients with obesity and diabetes. We aimed to reduce the gap between basic biomedical research, clinical practice-health decision making and to explore whether RIAO work as a potential biomarker of early ő≤-cell damage.

Materials And Methods: We performed a multicentric collaborative, cross-sectional, analytical, ambispective and blinded study; the RIAO from pretreated samples (PTS) of sera of 146 pediatric patients with obesity or DM and 16 healthy children, were isolated, measured by sound indirect ELISA with novel anti-hIAPP cytotoxic oligomers polyclonal antibody (MEX1). We carried out morphological and functional studied and cluster-clinical data driven analysis.

Results: We demonstrated by western blot, Transmission Electron Microscopy and cell viability experiments that RIAO circulate in the blood and can be measured by ELISA; are elevated in serum of childhood obesity and diabetes; are neurotoxics and works as biomarkers of early ő≤-cell failure. We explored the range of evidence-based medicine clusters that included the RIAO level, which allowed us to classify and stratify the obesity patients with high cardiometabolic risk.

Conclusions: RIAO level increases as the number of complications rises; RIAOs > 3.35 őľg/ml is a predictor of changes in the current indicators of ő≤-cell damage. We proposed a novel physio-pathological pathway and shows that PCD affect not only elderly patients but also children. Here we reduced the gap between basic biomedical research, clinical practice and health decision making.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237667PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446879PMC
October 2020

Effects of fatty liver on the size and composition of high-density lipoprotein cholesterol subpopulations in adolescents with type 2 diabetes mellitus.

Pediatr Diabetes 2020 Nov 18;21(7):1140-1149. Epub 2020 Sep 18.

Endocrinology Department, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.

Background: Type 2 diabetes mellitus (T2DM) is an emerging disease in the pediatric population. The association between T2DM and non-alcoholic fatty liver disease (NAFLD) has been described. Recent evidence suggests that sizes and composition of high-density lipoprotein (HDL) may be more important that HDL-C levels in predicting coronary heart disease. There is not data regarding the HDL subclasses distribution and composition in T2DM youths with NAFLD.

Methods: This cross-sectional study included 47 adolescents with T2DM and 23 non-diabetic controls of both sexes aged 10 to 18‚ÄČyears. The presence of NAFLD was determined estimated proton density fat fraction (PDFF) by magnetic resonance by spectroscopy. We compared the HDL subclasses distribution (HDL2b, HDL2a, HDL3a HDL3b and HDL3c) and the HDL chemical composition (total protein, triglyceride, phospholipid, cholesteryl esters, and free cholesterol) between the groups of adolescents with T2DM and the control group.

Results: Patients with T2DM and NAFLD had a significantly lower proportion HDL2b (P = .040) and a higher proportion of HDL3c (P = .035); higher proportion of TG (P = .032) and a lower CE (P = .002) and FC (P‚ÄČ<‚ÄČ.001). A negative association was observed between PDFF and the percentages of HDL2b (r = -0.341, P = .004) and the average particle size (r = -0.327, P = .05), and a positive association with HDL3c subpopulations (r = 0.327, P = .015); about composition inside HDL particle, a positive association with PDFF and the TG (r = 0.299, P = .013) and negative with CE (r = -0.265, P = .030).

Conclusions: In adolescents diagnosed with T2DM, the presence of NAFLD is associated with abnormalities in the distribution of HDL subpopulations and the lipid composition of HDL particles.
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http://dx.doi.org/10.1111/pedi.13103DOI Listing
November 2020

Growth hormone ameliorates high glucose-induced steatosis on in vitro cultured human HepG2 hepatocytes by inhibiting de novo lipogenesis via ChREBP and FAS suppression.

Growth Horm IGF Res 2020 Aug - Oct;53-54:101332. Epub 2020 Jul 15.

Laboratory for Proteomics and Metabolomics, Research Division, General Hospital of Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico.. Electronic address:

Objective: Growth hormone (GH) deficiency has been associated with increased steatosis but the molecular mechanism has not been fully elucidated. We investigated the effect of GH on lipid accumulation of HepG2 cells cultured on an in vitro steatosis model and examined the potential involvement of insulin-like growth factor 1 (IGF-1) as well as lipogenic and lipolytic molecules.

Methods: Control and steatosis conditions were induced by culturing HepG2 cells with 5.5 or 25 mmol/l glucose for 24 h, respectively. Afterward, cells were exposed to 0, 5, 10 or 20 ng/ml GH for another 24 h. Lipid content was quantified as well as mRNA and protein levels of IGF-1, carbohydrate responsive element-binding protein (ChREBP), sterol regulatory element-binding protein 1c (SREBP1c), fatty acid synthase (FAS), carnitine palmitoyltransferase 1A (CPT1A), and peroxisome proliferator-activated receptor alpha (PPAR-alpha) by qPCR and western blot, respectively. Data were analyzed by one-way ANOVA and the Games-Howell post-hoc test.

Results: In the steatosis model, HepG2 hepatocytes showed a significant 2-fold increase in lipid amount as compared to control cells. IGF-1 mRNA and protein levels were significantly increased in control cells exposed to 10 ng/ml GH, whereas high glucose abolished this effect. High glucose also significantly increased both mRNA and protein of ChREBP and FAS without having effect on SREBP1c, CPT1A and PPAR-alpha. However, GH inhibited ChREBP and FAS production, even in HepG2 hepatocytes cultured under steatosis conditions.

Conclusions: Growth hormone ameliorates high glucose-induced steatosis in HepG2 cells by suppressing de novo lipogenesis via ChREBP and FAS down-regulation.
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http://dx.doi.org/10.1016/j.ghir.2020.101332DOI Listing
July 2020

Monitoring during the treatment of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty.

Bol Med Hosp Infant Mex 2020 ;77(Supl 1):29-34

Hospital Infantil de México Federico Gómez, Ciudad de México. México.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the monitorization of the treatment and follow-up of patients with central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based, can be consulted in this same supplement.
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http://dx.doi.org/10.24875/BMHIM.20000086DOI Listing
January 2020

Synthesis of the evidence: Clinical guideline for the diagnosis and treatment of precocious puberty.

Bol Med Hosp Infant Mex 2020 ;77(Supl 1):35-40

Hospital de Pediatría Centro Médico Nacional Siglo XXI, Ciudad de México. México.

Three systematic reviews were conducted to formulate the recommendations on diagnosis, treatment and follow-up of patients with precocious puberty: interventions for the treatment of precocious puberty that included the outcomes of final or near-final height, mental health, metabolic health, health bone, or blockade success; comparative observational studies evaluating long-term outcomes in subjects with a history of precocious puberty; and diagnostic test accuracy studies for puberty.
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http://dx.doi.org/10.24875/BMHIM.20000087DOI Listing
January 2020

Adjuvant interventions in the treatment of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty.

Bol Med Hosp Infant Mex 2020 ;77(Supl 1):26-28

Hospital Infantil de México Federico Gómez, Ciudad de México. México.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the complementary interventions for the treatment of precocious puberty besides puberty blockade. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based, can be consulted in this same supplement.
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http://dx.doi.org/10.24875/BMHIM.20000090DOI Listing
January 2020

Diagnosis of secondary causes of precocious puberty: Clinical guideline for the diagnosis and treatment of precocious puberty.

Bol Med Hosp Infant Mex 2020 ;77(Supl 1):15-18

Sociedad Mexicana de Endocrinología Pediátrica, Ciudad de México. México.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of secondary causes of central PP. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.
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http://dx.doi.org/10.24875/BMHIM.20000084DOI Listing
January 2020

Methodology for the development of the Clinical guideline for the diagnosis and treatment of precocious puberty.

Bol Med Hosp Infant Mex 2020 ;77(Supl 1):1-6

Hospital Infantil de México Federico Gómez, Ciudad de México.

Background: The Mexican Society of Pediatric Endocrinology presents recommendations for the diagnosis and treatment of precocious puberty (PP), a condition defined as the development of sexual characteristics due to an increase in pituitary gonadotropin secretion before 8 or 9 years of age in girls and boys, respectively.

Methods: Three systematic reviews were conducted: controlled clinical trials on interventions for PP treatment, diagnostic tests, and observational studies on the long-term effects of PP. The quality evaluation and data extraction from the studies were conducted by two independent reviewers. The Scottish Intercollegiate Guidelines Network and the Oxford Center for Evidence-Based Medicine systems were used for grading the quality of evidence for recommendations on intervention and diagnosis, respectively. Recommendations were submitted to a consensus by a Delphi method and were validated by another 143 certified pediatric endocrinologists through an online questionnaire.

Results: The group generated 12 recommendations on the diagnosis of PP, seven on the diagnosis of secondary causes of PP, eight on interventions for inhibition of puberty, five on other interventions for PP treatment, and 14 for the monitoring and follow-up of these patients. The online questionnaires submitted to certified pediatric endocrinologists showed more than 90% of approval for each one of the recommendations.

Conclusions: Although a high degree of consensus for the recommendations for diagnosis, treatment, and monitoring of PP among pediatric endocrinologists was achieved, most of these recommendations showed a low level of evidence.
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http://dx.doi.org/10.24875/BMHIM.20000083DOI Listing
January 2020

Diagnosis of precocious puberty: clinical guideline for the diagnosis and treatment of precocious puberty.

Bol Med Hosp Infant Mex 2020 ;77(Supl 1):7-14

Hospital Infantil de México Federico Gómez, Ciudad de México. México.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the diagnosis of precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be accessed in this same supplement.
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http://dx.doi.org/10.24875/BMHIM.20000075DOI Listing
January 2020

Puberty blockade: Clinical guideline for the diagnosis and treatment of precocious puberty.

Bol Med Hosp Infant Mex 2020 ;77(Supl 1):19-25

Hospital Infantil de México Federico Gómez, Ciudad de México. México.

The Mexican Society of Pediatric Endocrinology developed a clinical practice guide for the diagnosis and treatment of precocious puberty. This document presents recommendations related to the interventions for the inhibition of central precocious puberty. The detailed description of the methodology for the development of this guide and the grading system, as well as the synthesis of the evidence on which it is based can be consulted in this same supplement.
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http://dx.doi.org/10.24875/BMHIM.20000085DOI Listing
January 2020

Positive health beliefs are associated with improvement of glycated hemoglobin and lipid profiles in Mexican patients with type 2 diabetes mellitus: a cross-sectional study.

BMC Public Health 2020 May 24;20(1):761. Epub 2020 May 24.

Clinical Epidemiology Research Unit, "Carlos Mac Gregor S√°nchez Navarro" Hospital, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Mexico City, Mexico.

Background: Health beliefs are relevant to consider in patients with type 2 diabetes since disease control depends mainly on the patient's behaviour. The aim of this study was to assess the association between health beliefs and glycated hemoglobin levels in Mexican patients with type 2 diabetes.

Methods: An analytical cross-sectional study was conducted, and 336 patients were included. Fasting blood levels of glycated hemoglobin, glucose, cholesterol; triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were measured. Body fat percentage, weight, height; waist circumference, and systolic and diastolic blood pressures were also obtained. A previously validated self-administered questionnaire was used to assess the health beliefs with regards to non-pharmacological treatment. Health beliefs were classified as positive, neutral, and negative.

Results: The average age of patients was 54.7‚ÄȬĪ‚ÄČ8.5‚ÄČyears, with a higher proportion of females (69%). The questionnaire had a good internal consistency with a Cronbach's alpha score of 0.83. More than 90% of patients attributed a health benefit to diet and exercise, 30 to 40% experienced barriers, and more than 80% had a perception of complications associated to uncontrolled diabetes. Patients with positive health beliefs had lower HbA1c levels (8.2‚ÄȬĪ‚ÄČ1.7%) compared to those with neutral (9.0‚ÄȬĪ‚ÄČ2.3%), or negative (8.8‚ÄȬĪ‚ÄČ1.8%; p¬†=‚ÄČ0.042). The LDL-c levels were lower (p¬†=‚ÄČ0.03), and HDL-c levels were higher (0.002) in patients with positive heath beliefs.

Conclusions: Positive health beliefs are associated with better metabolic control indicators in patients with type 2 diabetes.
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http://dx.doi.org/10.1186/s12889-020-08866-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245761PMC
May 2020

Ontogeny of the facial phenotypic variability in Mexican patients with 22q11.2 deletion syndrome.

Head Face Med 2019 Dec 11;15(1):29. Epub 2019 Dec 11.

Escuela Superior de Medicina del Instituto Politécnico Nacional, Ciudad de México, Mexico.

Background: 22q11.2 deletion syndrome is a medical condition that results from genomic loss at chromosome 22. Affected patients exhibit large variability that ranges from a severe condition to mild symptoms. In addition, the spectrum of clinical features differs among populations and even within family members. The facial features related to this syndrome are not an exception, and although part of its variation arises through development, few studies address this topic in order to understand the intra and inter-population heterogeneities. Here, we analyze the ontogenetic dynamics of facial morphology of Mexican patients with del22q11.2 syndrome.

Methods: Frontal facial photographs of 37 patients (mean age‚ÄČ=‚ÄČ7.65‚ÄȬĪ‚ÄČ4.21 SE) with del22q11.2DS and 200 control subjects (mean age‚ÄČ=‚ÄČ7.69‚ÄȬĪ‚ÄČ4.26 SE) were analyzed using geometric morphometric methods. Overall mean shape and size differences between patients and controls were analyzed, as well as differences in ontogenetic trajectories (i.e. development, growth, and allometry).

Results: We found that Mexican patients show typical traits that have been reported for the Caucasian population. Additionally, there were significant differences between groups in the facial shape and size when all the ontogenetic stages were considered together and, along ontogeny. The developmental and allometric trajectories of patients and controls were similar, but they differed in allometric scaling. Finally, patients and controls showed different growth trajectories.

Conclusion: The results suggest that the typical face of patients with del22q11.2DS is established prenatally; nonetheless, the postnatal ontogeny could influence the dysmorphology and its variability through size-related changes.
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http://dx.doi.org/10.1186/s13005-019-0213-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905036PMC
December 2019

Education with a multimedia web platform improves knowledge and HbA1c of Mexican patients with type 2 diabetes. Open clinical trial.

Endocrinol Diabetes Nutr 2020 Oct 2;67(8):530-539. Epub 2019 Nov 2.

Unidad de Investigación en Epidemiología Clínica, Hospital Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México. Electronic address:

Introduction: The patient with diabetes mellitus type requires to receive education about the disease aimed at improving knowledge and skills for their control. The objective of this study is to evaluate the efficacy of nutritional therapy and education through a multimedia site on the level of knowledge and metabolic control in patients with type 2 diabetes.

Patients And Methods: Open-label clinical trial of 12 months of follow-up in 161 patients with type 2 diabetes. A total of 101 patients were assigned to the intervention group with nutrition therapy (TN) + Nutriluv (multimedia site in diabetes), 80 patients to the TN control group. The glycosylated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL and HDL cholesterol were measured at the beginning and end. Weight, waist circumference, percentage of fat, systolic blood pressure and diastolic blood pressure were recorded. The level of knowledge was measured with the Diabetes Knowledge Questionnaire (DKQ24).

Results: The knowledge in diabetes improved in the group with TN+Nutriluv compared with the TN group (P<0.05). HbA1c, HDL, diastolic blood pressure and waist circumference, improved in the group with TN+Nutriluv (P<0.05). In the group with TN, cholesterol HDL, diastolic blood pressure, waist circumference and the fat percentage was increased (P<0.05). They had a higher risk of having an HbA1c>7% who had more years of diagnosis of diabetes.

Conclusions: The use of a multimedia site with education in diabetes, improves knowledge, HbA1c, and other indicators of cardiovascular risk in diabetes type 2 patients.
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http://dx.doi.org/10.1016/j.endinu.2019.07.011DOI Listing
October 2020

Diabetes and obesity during pregnancy are associated with oxidative stress genotoxicity in newborns.

J Perinat Med 2019 Apr;47(3):347-353

Materno-Fetal Medicine Unit, Obstetrics and Gynecology Department, Hospital General de México Eduardo Liceaga O.D., Mexico City, Mexico.

Objective To compare the level of oxidative deoxyribonucleic acid (DNA) damage (genotoxicity) between the offspring of mothers with and without diabetes diagnosed during pregnancy and its association with maternal body mass index (BMI). Methods We measured 8-hydroxy-deoxyguanosine (8-OH-dG), a marker of DNA oxidative damage, in venous umbilical cord plasma from newborns of mothers with (n=34) and without (n=56) diabetes diagnoses obtained during pregnancy. Two markers of oxidative stress - namely, nitric oxide degradation products (NOx) and total glutathione (GSH) - were quantified in both mothers and newborns. The effects of BMI, glycated hemoglobin (HbA1c), age and delivery mode were also analyzed. Results Newborns of mothers with diabetes during pregnancy exhibited higher levels of 8-OH-dG than those of mothers without diabetes (P<0.001). The other markers of oxidative stress were also higher in both mothers with diabetes and their newborns, with the exception of NOx in the mothers. The association of diabetes with 8-OH-dG was independent of other analyzed factors. Conclusion The offspring of mothers with diabetes during pregnancy are born with increased genotoxicity than the offspring of mothers without diabetes. BMI and HbA1c display an independent association with 8-OH-dG, particularly in the offspring of mothers not diagnosed with diabetes.
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http://dx.doi.org/10.1515/jpm-2018-0201DOI Listing
April 2019

Resistin levels are not associated with obesity in central precocious puberty.

Peptides 2018 11 29;109:9-13. Epub 2018 Sep 29.

Unit of Medical Research in Clinical Epidemiology, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, Mexico. Electronic address:

Objective: To compare serum resistin concentrations between prepubertal girls with a BMI > 85th percentile and girls with precocious puberty (CPP) who have and have not undergone GnRH analog treatment.

Patients And Methods: This is a cross-sectional study in girls with a BMI > 85th percentile and a median age of 8 years. We included 31 girls with CPP who did not receive treatment (CPPoT), 23 girls with CPP who were treated with leuprolide (CPPT), 22 prepubertal girls and 24 pubertal girls. Anthropometric data and the fasting plasma concentrations of lipids, glucose, insulin, and resistin were measured.

Results: The z-BMI scores were similar among the groups (p‚ÄČ=‚ÄČ0.344), and body fat percentage (BF%) was similar among CPPT, CPPoT and prepubertal girls (p‚ÄČ=‚ÄČ0.151). Resistin and insulin levels were lower in girls with CPP (CPPT and CPPoT) than in prepubertal and pubertal girls (median resistin level: CPPT 11.8‚ÄČpg/ml vs CPPoT 11‚ÄČpg/ml vs prepubertal 16‚ÄČpg/ml vs pubertal 16‚ÄČpg/ml, p‚ÄČ=‚ÄČ0.001; median insulin level: CPPT 10.7 őľUI/mL vs CPPoT 10.2 őľUI/mL vs prepubertal 14.4 őľUI/mL vs pubertal 32 őľUI/mL p‚ÄČ=‚ÄČ0.02). ANCOVA analysis, after adjustments for pubertal stage, BF% and z-BMI, showed that CPP modifies resistin levels (F‚ÄČ=‚ÄČ31.4; p‚ÄČ=‚ÄČ0.0001) independently of these parameters (p‚ÄČ<‚ÄČ0.05).

Conclusions: In the group of girls with overweight or obesity, the resistin level was lower in girls with CPP than in prepubertal and pubertal girls. More studies are needed to understand the role of resistin in CPP patients.
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http://dx.doi.org/10.1016/j.peptides.2018.09.009DOI Listing
November 2018

Cardiometabolic Risk Indicators for Kidney Disease in Mexican Patients with Type 2 Diabetes.

Arch Med Res 2018 04 16;49(3):191-197. Epub 2018 Aug 16.

Unidad de Investigación en Epidemiología Clínica, Hospital Carlos Mac Gregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Ciudad de México, México.

Introduction: Kidney disease is one of the main complications in the diabetic patient. Risk factors such as obesity, dyslipidemia, and hyperglycemia have been associated with increased urinary albumin excretion (UAE) and decreased glomerular filtration rates (GFR). However, the data are inconsistent. The objective of this study was to identify the primary risk factors associated with kidney disease in Mexican patients with type 2 diabetes.

Methods: A cross-sectional study was done in 395 patients with type 2 diabetes from four primary-care clinics. From fasting venous blood samples, the serum creatinine, glucose, glycated hemoglobin (HbA1c), and lipid profiles were measured. The diagnosis of diabetic kidney disease (DKD) was made by measuring GFR with the CKD-EPI equation, and the UAE from the first morning urination, according to the KDIGO 2012 Guidelines. Weight and waist circumference (WC), as well as body composition through the method of bioimpedance, were measured.

Results: Fourteen percent of the study population was diagnosed with DKD. Higher age and higher triglyceride levels were associated with a greater risk of DKD (p <0.05). In a multivariate analysis, higher age (OR = 1.06, 95% CI 1.02-1.11), triglyceride level (OR = 2.4, 95% CI 1.18-4.92), WC (OR = 1.09, 95% CI 1.03-1.15), and smoking (OR 2.6, 95% CI 1.07-6.49) were associated to DKD.

Conclusion: Higher triglyceride levels, greater WC, and smoking are risk factors associated to DKD. An early diagnosis and opportune treatment for several cardiometabolic risk factors associated to DKD and cardiovascular disease should be identified and treated.
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http://dx.doi.org/10.1016/j.arcmed.2018.08.003DOI Listing
April 2018

Multimedia education program and nutrition therapy improves HbA1c, weight, and lipid profile of patients with type 2 diabetes: a randomized clinical trial.

Endocrine 2017 Nov 18;58(2):236-245. Epub 2017 Sep 18.

Unidad de Investigación en Epidemiología Clínica, Hospital "Carlos Mac Gregor Sánchez Navarro", Instituto Mexicano del Seguro Social (IMSS), México City, Mexico.

Purpose: To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes.

Research Question: What is the effect of a multimedia education program and nutritional therapy on metabolic control in type 2 diabetes?

Patients And Methods: A randomized clinical trial was conducted in 351 patients randomly assigned to either an experimental group receiving a multimedia diabetes education program (MDE) and nutrition therapy (NT) (NT‚ÄČ+‚ÄČMDE: n‚ÄČ=‚ÄČ173), or to a control group who received nutrition therapy only (NT: n‚ÄČ=‚ÄČ178). At baseline, 7, 14, and 21 months, the glycated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded.

Results: Glycated hemoglobin decreased in both groups, although the group with NT‚ÄČ+‚ÄČMDE had a greater reduction, with a difference of -0.76% (95%CI -1.33 to -0.19) at 7 months and -0.73% (95%CI -1.37 to -0.09) at 21 months. Only in the NT‚ÄČ+‚ÄČMDE did the glucose decrease at 7 (-41.2‚ÄČmg/dL; 95%CI -52.0 to -30.5), 14 (-27.8‚ÄČmg/dL; 95%CI -32.6 to -23.1), and 21 months (-36.6‚ÄČmg/dL; 95%CI -46.6 to -26.6). Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT‚ÄČ+‚ÄČMDE group did it decrease at 21 months. (p‚ÄČ<‚ÄČ0.05). Weight decreased at 21 months in the NT‚ÄČ+‚ÄČMDE group (-1.23, -2.29 at -0.16; p‚ÄČ<‚ÄČ0.05).

Conclusion: Nutrition therapy and a multimedia diabetes education program have a favorable impact on achieving metabolic control goals in type 2 diabetes.
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http://dx.doi.org/10.1007/s12020-017-1416-0DOI Listing
November 2017

Velocardiofacial syndrome in Mexican patients: Unusually high prevalence of congenital heart disease.

Int J Pediatr Otorhinolaryngol 2015 Nov 8;79(11):1886-91. Epub 2015 Sep 8.

Department of Genetics, Hospital Infantil de México Federico Gómez, Calle Dr. Márquez 162, Colonia Doctores, Delegación Cuauhtémoc, C.P. 06720, Mexico City, Mexico. Electronic address:

Introduction: Velocardiofacial syndrome (VCFS) is the most common microdeletion syndrome with an incidence of 1:4000 live births. Its phenotype is highly variable with facial, velopharyngeal, cardiac, endocrine, immunologic and psychiatric abnormalities. It is caused by a microdeletion in chromosome 22q11.2.

Objectives: We present 7 years of experience evaluating patients with VCFS regarding their main clinical characteristics.

Material And Methods: The patients included were multidisciplinary evaluated and had a positive FISH analysis for del22q11.2.

Results: A total of 62 patients were assessed, a 34 female/28 male ratio was observed with ages ranging from 9 days to 16 years, all but one patient had typical facial features. A diagnosis of congenital heart disease was established in 97% of the patients; other clinical characteristics were identified with different percentages such as cleft palate, and hypocalcaemia. Three cases had a familial presentation.

Discussion: While the clinical findings of this study were in general terms in keeping with the literature, it is interesting the unexpectedly high percentage of congenital heart disease identified in Mexican children with VCFS that also was the main cause for clinical referral.
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http://dx.doi.org/10.1016/j.ijporl.2015.08.038DOI Listing
November 2015

Maternal obesity increases oxidative stress in the newborn.

Obesity (Silver Spring) 2015 Aug;23(8):1650-4

Departamento de Investigación en Salud Comunitaria, Hospital Infantil de México Federico Gomez, México City, México.

Objective: Obesity before pregnancy is associated with a greater risk for the offspring to develop obesity and diabetes in childhood and adulthood. The aim of the present study was to determine the association between maternal overweight or obesity before pregnancy and newborn oxidative stress (OS).

Methods: Seventy-two mother-child pairs were divided according to the pre-gestational body mass index (BMI) of the mothers as follows: eutrophic (n‚ÄČ=‚ÄČ21), overweight (n‚ÄČ=‚ÄČ32), and obese (n‚ÄČ=‚ÄČ19). Malondialdehyde (MDA) and nitric oxide (NO) were measured in the plasma of a blood sample from the newborn's umbilical cord.

Results: The MDA levels of newborns increased with maternal BMI (P‚ÄČ=‚ÄČ0.001), as did the levels of NO (P‚ÄČ=‚ÄČ0.019). There was a direct correlation between MDA and NO levels in each of the three groups (eutrophic: R(2) ‚ÄČ=‚ÄČ0.59, P‚ÄČ<‚ÄČ0.001; overweight: R(2) ‚ÄČ=‚ÄČ0.45, P‚ÄČ<‚ÄČ0.001; and obese: R(2) ‚ÄČ=‚ÄČ0.26, P‚ÄČ=‚ÄČ0.024).

Conclusions: Maternal overweight and obesity before pregnancy are associated with increased OS in the offspring.
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http://dx.doi.org/10.1002/oby.21159DOI Listing
August 2015

Identification of unsuspected Wolfram syndrome cases through clinical assessment and WFS1 gene screening in type 1 diabetes mellitus patients.

Gene 2015 Jul 17;566(1):63-7. Epub 2015 Apr 17.

Department of Genetics-Research Unit, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico; Department of Biochemistry, Faculty of Medicine, UNAM, Mexico City, Mexico. Electronic address:

Objective: Wolfram syndrome (WS) is a severe autosomal recessive pleiotropic disease primarily characterized by the association of juvenile-onset diabetes mellitus and optic atrophy. Earlier reports have shown that a proportion of WS cases may remain unrecognized due to misdiagnosis as type 1 diabetes mellitus (T1DM). The objectives of this work were to estimate the prevalence of patients fulfilling clinical criteria for WS in a cohort of subjects diagnosed as T1DM and to identify causal WFS1 gene mutations in those individuals meeting clinical criteria for the disease.

Methods: A cohort of 131 unrelated Mexican T1DM patients was collected, including 77 females and 54 males. Additional clinical anomalies suggesting WS were identified through review of medical files, detailed physical examination and/or specialized tests. WFS1 gene analysis was performed using exon-by-exon PCR amplification and direct Sanger sequencing on genomic DNA from patients reaching WS clinical criteria.

Results: Clinical criteria for a WS diagnosis were reached in 6 probands, corresponding to a 4.58% frequency of the disease. WFS1 mutations were identified in 4 out of 5 (80%) individuals fulfilling WS clinical criteria, including two homozygous, one compound heterozygous, and one patient with a single allele mutation. No WFS1 mutations were identified in the remaining subject.

Conclusions: In our cohort, approximately 6% of cases diagnosed as T1DM were in fact patients with Wolfram syndrome. WFS1 mutations were identified in 4 out of 5 individuals (80%) fulfilling clinical criteria for WS. Clinical and genetic analyses of large cohorts of T1DM patients from different ethnic origins would help to better estimate the occurrence of WS and will lead to a better management of such patients.
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http://dx.doi.org/10.1016/j.gene.2015.04.040DOI Listing
July 2015

Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity.

BMC Pediatr 2014 Jul 5;14:175. Epub 2014 Jul 5.

Clinical Epidemiology Research Unit, Hospital General Regional No, 1 Carlos Macgregor S√°nchez-Navarro, Instituto Mexicano del Seguro Social, Mexico City, Mexico.

Background: The beneficial effects of the Mediterranean diet have been amply proven in adults with cardiovascular risk factors. The effects of this diet have not been extensively assessed in pediatric populations with obesity, insulin resistance (IR) and metabolic syndrome (MetS). The aim of this study was to assess the efficacy of the Mediterranean style diet (MSD) to decrease cardiovascular risk factors in children and adolescents with obesity.

Methods: Participants were randomly assigned to a MSD rich in polyunsaturated fatty acids, fiber, flavonoids and antioxidants (60% of energy from carbohydrate, 25% from fat, and 15% from protein, (n‚ÄČ=‚ÄČ24); or a standard diet (55% of carbohydrate, 30% from fat and 15% from protein, (n‚ÄČ=‚ÄČ25), the caloric ingest was individualized. At baseline and 16-week of intervention, the glucose, triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C were measured as well as the body composition and anthropometric data. The diet compliance was determined by the 24-hour recalls.Paired Student's t and Macnemar's test were used to compare effects in biochemical, body composition, anthropometric, and dietary variables.

Results: The MSD group had a significantly decrease in BMI, lean mass, fat mass, glucose, TC, TG, HDL-C and LDL-C. (p‚ÄČ<‚ÄČ0.05); the diet compliance increased consumption of omega 9 fatty acids, zinc, vitamin E, selenium, and decreased consumption of saturated fatty acids (p‚ÄČ<‚ÄČ0.05). The standard diet group decrease in glucose levels and frequency of glucose >100 mg/dL (p‚ÄČ<‚ÄČ0.05).

Conclusion: The MSD improves the BMI, glucose and lipid profile in children and adolescents with obesity and any MetS component.
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http://dx.doi.org/10.1186/1471-2431-14-175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102089PMC
July 2014

Glycemic control and high-density lipoprotein characteristics in adolescents with type 1 diabetes.

Pediatr Diabetes 2013 Sep 11;14(6):399-406. Epub 2012 Oct 11.

Department of Endocrinology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.

Background: Recent evidence suggests that high-density lipoprotein (HDL) physicochemical characteristics and functional capacity may be more important that HDL-C levels in predicting coronary heart disease. There is little data regarding HDL subclasses distribution in youth with type 1 diabetes.

Objective: To assess the relationships between glycemic control and HDL subclasses distribution, composition, and function in adolescents with type 1 diabetes.

Methods: This cross-sectional study included 52 adolescents with type 1 diabetes aged 12-16 years and 43 age-matched non-diabetic controls. Patients were divided into two groups: one in fair control [hemoglobin A1c (HbA1c) < 9.6%] and the second group with poor glycemic control (HbA1c ‚Č• 9.6%). In all participants, we determined HDL subclasses distribution, composition, and the ability of plasma and of isolated HDL to promote cellular cholesterol efflux. Levels of soluble adhesion molecules were also measured.

Results: Although both groups of patients and the control group had similar HDL-C levels, linear regression analyses showed that compared with non-diabetic subjects, the poor control group had a lower proportion of HDL2b subclass (p‚ÄČ=‚ÄČ0.029), triglyceride enriched (p‚ÄČ=‚ÄČ0.045), and cholesteryl ester depleted (p‚ÄČ=‚ÄČ0.028) HDL particles. Despite these HDL changes, cholesterol efflux was comparable among the three groups. The poor control group also had significantly higher intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 plasma concentrations.

Conclusions: In adolescents with type 1 diabetes, poor glycemic control is associated with abnormalities in HDL subclasses distribution and HDL lipid composition, however, in spite of these HDL changes, the ability of HDL to promote cholesterol efflux remains comparable to that of healthy subjects.
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http://dx.doi.org/10.1111/j.1399-5448.2012.00924.xDOI Listing
September 2013

Low calorie and carbohydrate diet: to improve the cardiovascular risk indicators in overweight or obese adults with prediabetes.

Endocrine 2013 Jun 1;43(3):593-602. Epub 2012 Sep 1.

Clinical Epidemiology Research Unit, Hospital General de Zona Carlos MacGregor S√°nchez-Navarro, Mexican Social Security Institute, Mexico, DF, Mexico.

Our objective was to evaluate the effects of a moderate calorie and carbohydrate-restricted diet on cardiovascular risk indicators in overweight or obese patients with prediabetes. A clinical trial was conducted in which 86 subjects presenting with overweight or obesity and prediabetes received a personalized diet of 1,200 to 1,700 calories with a distribution of 50 % carbohydrates, 20 % proteins, and 30 % fat. Body weight, fat mass, and lean mass were measured through bioimpedance. Glucose, total cholesterol, high density lipoprotein cholesterol and low density cholesterol, and triglycerides were measured. The measurements were taken at the beginning of, and at, 6 and 12 months during the intervention, and the differences were compared by paired Student's t and Ōá(2) tests. At 12 months, a significant reduction was noticed in body weight in patients with overweight and obesity (72.4 ¬Ī 7.8-69.6 ¬Ī 7.5 kg) (85.7 ¬Ī 14.8-80.2 ¬Ī 12.7 kg) with body mass index (28.2 ¬Ī 0.8-27.2 ¬Ī 2.1 kg/m(2)) (34.3 ¬Ī 3.5-32.1 ¬Ī 3.2 kg/m(2)), systolic (120.9 ¬Ī 14.2-112.4 ¬Ī 11.5 mmHg) (124.1 ¬Ī 11.9-115.7 ¬Ī 14.0 mmHg), diastolic blood pressures (79.0 ¬Ī 9.3-71.8 ¬Ī 8.3 mmHg) (80.4 ¬Ī 9.0-73.7 ¬Ī 13.1 mmHg), glucose (106.0 ¬Ī 8.9-95.9 ¬Ī 7.5 mg/dL) (107.3 ¬Ī 7.0-97.0 ¬Ī 8.2 mg/dL), and significant improvement on lipid profile (p < 0.05). The restrictions in the calorie and carbohydrate diet decrease the cardiovascular risk indicators in overweight or obese adults with prediabetes.
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http://dx.doi.org/10.1007/s12020-012-9775-zDOI Listing
June 2013

Decrease in serum adiponectin levels associated with visceral fat accumulation independent of pubertal stage in children and adolescents.

Arch Med Res 2011 Feb;42(2):115-21

Endocrinology Department, Hospital Infantil de México Federico Gómez, Mexico, D.F., Mexico.

Background And Aims: Childhood obesity is an important risk factor for the development of insulin resistance (IR) and its co-morbidities. However, visceral adipose tissue (VAT) rather than obesity appears to have a determining role in the development of IR. Adiponectin is considered a key molecule for protection against metabolic abnormalities related to IR. Several studies have documented that lower adiponectin concentrations are related to VAT, but the results are still controversial. We undertook this study to assess the association between VAT and adiponectin concentrations with respect to body mass index (BMI) and pubertal stage in children and adolescents.

Methods: Eighty five subjects were studied (46 prepubertal and 39 pubertal) and classified according to BMI into obese and normal weight groups. All participants were given a clinical examination. Glucose, insulin, lipid profile and adiponectin were measured. VAT was estimated using helical computed tomography.

Results: In the prepubertal group, obese children had lower adiponectin concentrations than nonobese subjects (p <0.001) but not in pubertal group (p = 0.67). When the total population was subclassified according to VAT, those with higher VAT had greater systolic and diastolic blood pressure, triglycerides, post-load glucose, insulin and HOMA-IR (p <0.001) compared to those with less VAT. HDL-C and adiponectin values trends to diminish as VAT increased (p = 0.005 and p = 0.015, respectively).

Conclusions: Adiponectin concentrations are inversely associated with VAT in children. The higher amount of VAT is related to metabolic abnormalities including lower values of adiponectin, which could confer a greater risk of developing type 2 diabetes mellitus and cardiovascular disease.
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http://dx.doi.org/10.1016/j.arcmed.2011.03.002DOI Listing
February 2011

Insulin resistance and its association with the components of the metabolic syndrome among obese children and adolescents.

BMC Public Health 2010 Jun 7;10:318. Epub 2010 Jun 7.

Department for Innovation and Quality. Institute for Decentralized Public Health Services, INDESALUD, Campeche State, Mexico.

Background: Insulin resistance is the primary metabolic disorder associated with obesity; yet little is known about its role as a determinant of the metabolic syndrome in obese children. The aim of this study is to assess the association between the degree of insulin resistance and the different components of the metabolic syndrome among obese children and adolescents.

Methods: An analytical, cross-sectional and population-based study was performed in forty-four public primary schools in Campeche City, Mexico. A total of 466 obese children and adolescents between 11-13 years of age were recruited. Fasting glucose and insulin concentrations, high density lipoprotein cholesterol, triglycerides, waist circumference, systolic and diastolic blood pressures were measured; insulin resistance and metabolic syndrome were also evaluated.

Results: Out of the total population studied, 69% presented low values of high density lipoprotein cholesterol, 49% suffered from abdominal obesity, 29% had hypertriglyceridemia, 8% presented high systolic and 13% high diastolic blood pressure, 4% showed impaired fasting glucose, 51% presented insulin resistance and 20% metabolic syndrome. In spite of being obese, 13% of the investigated population did not present any metabolic disorder. For each one of the components of the metabolic syndrome, when insulin resistance increased so did odds ratios as cardiometabolic risk factors.

Conclusions: Regardless of age and gender an increased degree of insulin resistance is associated with a higher prevalence of disorders in each of the components of the metabolic syndrome and with a heightened risk of suffering metabolic syndrome among obese children and adolescents.
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http://dx.doi.org/10.1186/1471-2458-10-318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898826PMC
June 2010

[The impact of nutritional education on metabolic disorders in obese children and adolescents].

Endocrinol Nutr 2009 Dec;56(10):441-6

Unidad de Investigación en Epidemiología Clínica, Hospital Regional Carlos MacGregor Sánchez Navarro, Instituto Mexicano del Seguro Social, Delegación Benito Juárez, México DF, México.

Introduction: Childhood obesity has become a serious public health problem. Nutritional therapy plays an important role in its prevention and treatment.

Patients And Methods: A nonrandomized clinical trial was conducted in 40 obese children and adolescents who underwent a complete medical history and assessment of eating habits through 24-hour food recall and a frequency of food consumption questionnaire. In all patients, body weight, height, skinfold thickness, waist and hip circumferences and fasting glucose, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were measured. The nutritional intervention consisted of identifying the calorie consumption and nutrient intake, and participants were given advice aimed at changing eating habits with a healthy normocaloric diet. After 4 months, biochemical, anthropometric and dietary indicators were measured again.

Results: Significant reductions were observed in body weight (56.0 +/- 16.5 to 54.4 +/- 16.1 kg), body mass index (26.5 +/- 3.7 to 25.1 +/- 3.1), waist circumference (86.4 +/- 11.6 to 81.4 +/- 11.4 cm) and mid-arm circumference (29.0 +/- 5.0 to 26.0 +/- 4.2 mm). Significant reductions were also observed in total cholesterol (167.1 +/- 30.0 to 156.0 +/- 26.5 mg/dl) and LDL-cholesterol (103.0 +/- 21.4 to 84.6 +/- 26.0 mg/dl). A significant increase was found in HDL values (38.0 +/- 7.8 to 43.4 +/- 9.3 mg/dl). In all comparisons, the p-value was < 0.05.

Conclusions: Counseling aimed at changing eating habits is effective in reducing body weight and improves lipid profile in children and adolescents with obesity.
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http://dx.doi.org/10.1016/S1575-0922(09)73311-XDOI Listing
December 2009