Prediabetes is a highly prevalent health problem with a high risk of complications and progression to type 2 diabetes (T2D). The goals of this study were to evaluate the effect of the combination of ...lingaliptin + metformin + lifestyle on glucose tolerance, pancreatic β-cell function and T2D incidence in patients with prediabetes.
A single center parallel double-blind randomized clinical trial with 24 months of follow-up in patients with impaired glucose tolerance plus two T2D risk factors which were randomized to linagliptin 5 mg + metformin 1700 mg daily + lifestyle (LM group) or metformin 1700 mg daily + lifestyle (M group). Primary outcomes were regression to normoglycemia and T2D incidence; glucose levels and pancreatic β-cell function were secondary outcomes.
Subjects were screened for eligibility by OGTT and 144 patients with prediabetes were randomized to LM group (n = 74) or M group (n = 70); 52 and 36 participants in the LM group and 52 and 27 participants in the M group, completed the 12 and 24 months of treatment, respectively; average follow-up was 17 ± 6 and 18 ± 7 months in M and LM group, respectively. Glucose levels during OGTT improved more in LM group. OGTT disposition index (DI) improved significantly better during the first months in LM group, increasing from 1·31 (95% CI: 1·14–1·49) to 2·41 (95% CI: 2.10–2.72) and to 2.07 (95% CI: 1.82–2.31) at 6 and 24 months in LM group vs from 1.21 (95% CI: 0.98–1.34) to 1.56 (95% CI: 1.17–1.95) and to 1.72 (95% CI: 1.45–1.98) at 6 and 24 months in M group (p < .05). T2D incidence was higher in M group in comparison to LM group (HR 4.0, 95% CI: 1.24–13.04, p = .020). The probability of achieving normoglycemia was higher in LM group (OR 3.26 CI 95% 1.55–6.84). No major side effects were observed during the study.
The combination of linagliptin, metformin and lifestyle improved significantly glucose metabolism and pancreatic β-cell function, and reduced T2D incidence in subjects with prediabetes as compared to metformin and lifestyle.
•Linagliptin + metformin plus lifestyle showed a better glucose improvement•Pancreatic β-cell function improved better in the linagliptin + metformin group•There was a 67% risk reduction of T2D in the linagliptin + metformin group•All differences between groups were observed early at 6–12 months of treatment
A one-stop guide for public health students and practitioners learning the applications of classical regression models in epidemiology This book is written for public health professionals and ...students interested in applying regression models in the field of epidemiology. The academic material is usually covered in public health courses including (i) Applied Regression Analysis, (ii) Advanced Epidemiology, and (iii) Statistical Computing. The book is composed of 13 chapters, including an introduction chapter that covers basic concepts of statistics and probability. Among the topics covered are linear regression model, polynomial regression model, weighted least squares, methods for selecting the best regression equation, and generalized linear models and their applications to different epidemiological study designs. An example is provided in each chapter that applies the theoretical aspects presented in that chapter. In addition, exercises are included and the final chapter is devoted to the solutions of these academic exercises with answers in all of the major statistical software packages, including STATA, SAS, SPSS, and R. It is assumed that readers of this book have a basic course in biostatistics, epidemiology, and introductory calculus. The book will be of interest to anyone looking to understand the statistical fundamentals to support quantitative research in public health. In addition, this book: - Is based on the authors' course notes from 20 years teaching regression modeling in public health courses - Provides exercises at the end of each chapter - Contains a solutions chapter with answers in STATA, SAS, SPSS, and R - Provides real-world public health applications of the theoretical aspects contained in the chapters Applications of Regression Models in Epidemiology is a reference for graduate students in public health and public health practitioners. ERICK SUÁREZ is a Professor of the Department of Biostatistics and Epidemiology at the University of Puerto Rico School of Public Health. He received a Ph.D. degree in Medical Statistics from the London School of Hygiene and Tropical Medicine. He has 29 years of experience teaching biostatistics. CYNTHIA M. PÉREZ is a Professor of the Department of Biostatistics and Epidemiology at the University of Puerto Rico School of Public Health. She received an M.S. degree in Statistics and a Ph.D. degree in Epidemiology from Purdue University. She has 22 years of experience teaching epidemiology and biostatistics. ROBERTO RIVERA is an Associate Professor at the College of Business at the University of Puerto Rico at Mayaguez. He received a Ph.D. degree in Statistics from the University of California in Santa Barbara. He has more than five years of experience teaching statistics courses at the undergraduate and graduate levels. MELISSA N. MARTÍNEZ is an Account Supervisor at Havas Media International. She holds an MPH in Biostatistics from the University of Puerto Rico and an MSBA from the National University in San Diego, California. For the past seven years, she has been performing analyses for the biomedical research and media advertising fields.
Randomization has been commonly used to modify the chemical and physical properties of natural fats and oils. In this study, seal blubber oil (SBO) and menhaden oil (MHO) were modified through ...chemical randomization using sodium methoxide, and the effect on positional distribution of fatty acids was investigated using gas chromatography (GC) and 13C nuclear magnetic resonance (NMR) spectroscopy. The effect of randomization on the stability of the original oils and their randomized counterparts was analyzed by comparing conjugated dienes and thiobarbituric acid reactive substances (TBARS) values after accelerated oxidation at 60 °C for 4 days. The omega-3 polyunsaturated fatty acids (PUFA) were distributed more evenly among the terminal sn-1,3 positions and the middle sn-2 position in chemically randomized oils when compared to the starting oils. The effect was more pronounced for SBO with omega-3 PUFA attached preferentially to sn-1,3 positions of triacylglycerols before randomization, and it was less pronounced for MHO, which contained omega-3 PUFA more evenly distributed before randomization. However, different levels of commonly known omega-3 fatty acids, namely, docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), eicosapentaenoic acid (EPA), and stearidonic acid (STA), were obtained in both original and randomized oils from GC and 13C NMR spectroscopy. The stability of the randomized oils was also affected to different degrees, depending on the storage time.
Functional disability continues to be a significant public health problem that increases older adults' vulnerability to experience a diminished quality of life, loss of independence, higher ...healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of functional disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities.
We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico. Functional disability was measured by the PROMIS® Physical Function Short Form-20 T-score. The selected community was reported to have 5980 adult residents ≥65 years, according to the USA Census. The prevalence of functional disability was estimated using the logistic regression model, weighting by the effect of the sampling. Our estimated prevalence was compared between sexes using the prevalence ratio (PR), which was estimated with logistic regression models, controlling for age, income, number of chronic conditions, high and low impact of chronic conditions in functional disabilities, marital status, and sampling design.
We recruited 211 older Hispanics from a randomly selected sample. Their mean age was 74.4 ± 7.1 years, with female predominance (57.3%). The overall estimated prevalence of physical function disability using T-score among females was 2.70 (95% CI: 1.4, 5.1) times the estimated prevalence of physical function disability among males. Women were more likely to report functional disabilities in instrumental activities of daily living, self-care activities, and functional mobility compared to males. However, sex differences were largely explained by the presence of musculoskeletal conditions of high impact in functional disability.
The females in our study bear the greater burden of physical function disability in their adult age. Health policies, as well as future studies, should be targeted at reducing the burden of physical function disabilities in different types of daily activities through gender-sensitive disability self-management programs.
The objectives of this analysis were to compare the ability of fasting plasma glucose (FPG), post oral load plasma glucose (2hPG), and hemoglobin A1c (HbA1c) to identify U.S. Hispanic/Latino ...individuals with prediabetes, and to assess its cardiovascular risk factor correlates.
This is a cross-sectional analysis of baseline data from 15,507 adults without self-reported diabetes mellitus from six Hispanic/Latino heritage groups, enrolled in the Hispanic Community Health Study/Study of Latinos, which takes place in four U.S. communities. The prevalence of prediabetes was determined according to individual or combinations of ADA-defined cut points: FPG=5.6–7.0mmol/L, 2hPG=7.8–11.1mmol/L, and HbA1c=5.7%–6.4% (39–46mmol/mol). The sensitivity of these criteria to detect prediabetes was estimated. The prevalence ratios (PRs) for selected cardiovascular risk factors were compared among alternative categories of prediabetes versus normoglycemia FPG<5.6mmol/L and 2hPG<7.8mmol/L and HbA1c<5.7% (39mmol/mol).
Approximately 36% of individuals met any of the ADA prediabetes criteria. Using 2hPG as the gold standard, the sensitivity of FPG was 40.1%, HbA1c was 45.6%, and that of HbA1c+FPG was 62.2%. The number of significant PRs for cardiovascular risk factors was higher among individuals with isolated 2hPG=7.8–11.1mmol/L, FPG=5.6–7.0mmol/L+HbA1c=5.7%–6.4%, or those who met the three prediabetes criteria.
Assessing FPG, HbA1c, and cardiovascular risk factors in Hispanics/Latinos at risk might enhance the early prevention of diabetes mellitus and cardiovascular complications in this young and growing population, independent of their heritage group.
•Over a third of U.S. Hispanic adults are at increased risk for diabetes mellitus.•A significant percent of individuals younger than age 45 met prediabetes criteria.•FPG plus HbA1c were more sensitive at detecting prediabetes than either test alone.•Cardiovascular risk factors were highly prevalent across prediabetes categories.•Cardiovascular risk factors were highly prevalent in both men and women.
Abstract Objective To assess the prevalence of cervical cancer screening through Papanicolaou (Pap) test utilization and its association with sexual behaviors among a population-based sample of ...Hispanic women in Puerto Rico (PR). Methods This study was a secondary data analysis of the database of a cross-sectional study of HPV infection in PR (2010–2013; n = 554 women). Pap test utilization (past 3 years) was self-reported and sexual risky behavior was defined as an index that considered the following sexual behaviors: early age of sexual debut (≤16 years), 11 or more lifetime sexual partners, and 2 or more sexual partners in the last year. Multivariable logistic regression was used to estimate the magnitude of the association between sexual risk behavior and Pap test utilization, after adjusting for socioeconomic and lifestyles characteristics. Results The overall prevalence of Pap test utilization was 78.0%. Pap test screening varied with sexual behavior, with women with none or one risky sexual behavior having higher odds of Pap test utilization in the past 3 years (odds ratio OR, 1.74; 95% CI, 1.03–2.93) compared with those with two or three risky sexual behaviors. This difference remained marginally significant (p < .10) after adjusting for age, educational attainment, smoking status and STI history (OR, 1.72; 95% CI, 0.96–3.08). Conclusions The prevalence of cervical cancer screening in this population (78%) is still below Healthy People 2020 recommendations (93%). Also, women with risky sexual behaviors are less likely to have been screened. Efforts to promote cervical screening programs should focus on these high-risk women as a method for cervical cancer prevention and control.
Objective To compare the general adiposity index (BMI) with abdominal obesity indices (waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)) in order to examine the ...best predictor of cardiometabolic risk factors among Hispanics living in Puerto Rico. Design Secondary analysis of measurements taken from a representative sample of adults. Logistic regression models (prevalence odds ratios (POR)), partial Pearson's correlations (controlling for age and sex) and receiver-operating characteristic (ROC) curves were calculated between indices of obesity (BMI, WC, WHR and WHtR) and blood pressure, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), total cholesterol (TC):HDL-C, TAG, fasting blood glucose, glycosylated Hb, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and an aggregated measure of cardiometabolic risk. Setting Household study conducted between 2005 and 2007 in the San Juan Metropolitan Area in Puerto Rico. Subjects A representative sample of 858 non-institutionalized adults. Results All four obesity indices significantly correlated with the cardiometabolic risk factors. WHtR had the highest POR for high TC:HDL-C, blood pressure, hs-CRP, fibrinogen and PAI-1; WC had the highest POR for low HDL-C and high LDL-C and fasting blood glucose; WHR had the highest POR for overall cardiometabolic risk, TAG and glycosylated Hb. BMI had the lowest POR for most risk factors and smallest ROC curve for overall cardiometabolic risk. Conclusions The findings of the study suggest that general adiposity and abdominal adiposity are both associated with cardiometabolic risk in this population, although WC, WHR and WHtR appear to be slightly better predictors than BMI.
The aim of this study was to compare the ability of American Diabetes Association (ADA) diagnostic criteria to identify U.S. Hispanics/Latinos from diverse heritage groups with probable diabetes ...mellitus and assess cardiovascular risk factor correlates of those criteria.
Cross-sectional analysis of data from 15,507 adults from 6 Hispanic/Latino heritage groups, enrolled in the Hispanic Community Health Study/Study of Latinos. The prevalence of probable diabetes mellitus was estimated using individual or combinations of ADA-defined cut points. The sensitivity and specificity of these criteria at identifying diabetes mellitus from ADA-defined prediabetes and normoglycemia were evaluated. Prevalence ratios of hypertension, abnormal lipids, and elevated urinary albumin-creatinine ratio for unrecognized diabetes mellitus-versus prediabetes and normoglycemia-were calculated.
Among Hispanics/Latinos (mean age, 43 years) with diabetes mellitus, 39.4% met laboratory test criteria for probable diabetes, and the prevalence varied by heritage group. Using the oral glucose tolerance test as the gold standard, the sensitivity of fasting plasma glucose (FPG) and hemoglobin A1c-alone or in combination-was low (18, 23, and 33%, respectively) at identifying probable diabetes mellitus. Individuals who met any criterion for probable diabetes mellitus had significantly higher (P<.05) prevalence of most cardiovascular risk factors than those with normoglycemia or prediabetes, and this association was not modified by Hispanic/Latino heritage group.
FPG and hemoglobin A1c are not sensitive (but are highly specific) at detecting probable diabetes mellitus among Hispanics/Latinos, independent of heritage group. Assessing cardiovascular risk factors at diagnosis might prompt multitarget interventions and reduce health complications in this young population.
2hPG = 2-hour post-glucose load plasma glucose ADA = American Diabetes Association BMI = body mass index CV = cardiovascular FPG = fasting plasma glucose HbA1c = hemoglobin A1c HCHS/SOL = Hispanic Community Health Study/Study of Latinos HDL-C = high-density-lipoprotein cholesterol NGT = normal glucose tolerance NHANES = National Health and Nutrition Examination Survey OGTT = oral glucose tolerance test TG = triglyceride UACR = urine albumin-creatinine ratio.
The major immunostimulatory principle in the hot aqueous extract of
Chlorella pyrenoidosa has been isolated by a sequence of ethanol precipitation, precipitation with a cationic surfactant (CTAB), ...size exclusion chromatography, and anion exchange chromatography. A series of phosphorylated polysaccharides were obtained having different molecular masses but with similar structures. The higher molecular mass fractions showed considerable activity in the stimulation of mouse peritoneal macrophages to synthesize nitric oxide. The structure of the major polysaccharide was established by sugar analysis, configurational analysis, and 1D and 2D NMR experiments at 500 and 800
MHz on the parent polysaccharide, the de-O-acetylated polysaccharide, and on the components obtained after hydrolysis of the phosphate diesters. It had a β-
d-Gal
p-(1→3)-β-
d-Gal
p-(1→3)-backbone with half of the Gal
p units substituted at O-6 by terminal β-
d-Glc
p units. The remaining Gal
p units were substituted on O-6 by about equal amounts of α-
d-Man
p-1-phosphate and 3-
O-Me-α-Man
p-1-phosphate diesters. The substituents were not located in a regularly alternating fashion on the backbone. The
O-acetyl groups were largely located on O-2 and O-4 of Gal
p and 35% of the Gal
p residues were O-acetylated. This is the second observation of a phosphorylated polysaccharide in an alga and the first where it is present to a significant extent.
The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR).
We identified 9,489 women ...who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer.
A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79).
Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.
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