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The present study was aimed at (1) the differences between current weight v. ideal weight, (2) total energy intake and comparing it with required energy (Rkeer), (3) absolute protein intake in g/kg per d and g/1000 calories, (4) how energy and protein intake relate to the nutritional status of the subjects in terms of overall overweight (OEW) [overweight + obesity] and conservative overweight (CEW) [obesity] and (5) the contribution (%) of protein to total energy intake based on the acceptable macronutrient distribution range (AMDR). A dietary study was carried out in Colombia with 29 259 subjects between 1 and 64 years of age, based on cross-sectional data collected in 2015 by a 24-h dietary recall (24HR) administered as part of the National Nutrition Survey. Energy and protein intake did not differ by nutritional status. In the general population, energy intake was 2117 kcal/d (95 % CI 1969, 2264). The total protein intake was 64⋅3 g/d (95 % CI 61⋅4, 67⋅3). Adequate energy intake ranged from 90 to 100 %, except for the 1–4-year-old group, which ranged from 144 to 155 %. Protein intake was 1⋅64 g/kg per d (95 % CI 1⋅53, 1⋅75). The mean AMDR for protein to total energy intake was 13⋅3 % (95 % CI 12⋅9, 13⋅7). Excess weight began during the first 4 years of age. In conclusion, it is worth reviewing and updating energy and protein intake recommendations and dietary guidelines for the Colombian population and designing and modifying public policy.
The role of anthropometric status on dengue is uncertain. We investigated the relations between anthropometric characteristics (height, body mass index and waist circumference (WC)) and two dengue outcomes, seropositivity and hospitalisation, in a cross-sectional study of 2038 children (aged 2–15 years) and 408 adults (aged 18–72 years) from Bucaramanga, Colombia. Anthropometric variables were standardised by age and sex in children. Seropositivity was determined through immunoglobulin G antibodies; past hospitalisation for dengue was self-reported. We modelled the prevalence of each outcome by levels of anthropometric exposures using generalised estimating equations with restricted cubic splines. In children, dengue seropositivity was 60.8%; 9.9% of seropositive children reported prior hospitalisation for dengue. WC was positively associated with seropositivity in girls (90th vs. 10th percentile adjusted prevalence ratio (APR) = 1.19; 95% confidence interval (CI) 1.03–1.36). Among adults, dengue seropositivity was 95.1%; 8.1% of seropositive adults reported past hospitalisation. Height was inversely associated with seropositivity (APR = 0.90; 95% CI 0.83–0.99) and with hospitalisation history (APR = 0.19; 95% CI 0.04–0.79). WC was inversely associated with seropositivity (APR = 0.89; 95% CI 0.81–0.98). We conclude that anthropometry correlates with a history of dengue, but could not determine causation. Prospective studies are warranted to enhance causal inference on these questions.
Tobacco consumption has been related to the onset of panic attacks (PA), panic disorder (PD) and agoraphobia, to panic symptoms and to features related to PD. The relationship that links tobacco and panic is not clear, and some models have been proposed to explain it (causal, neuroticism as a vulnerability factor).
Our aim was to study the relationship that tobacco consumption before the onset of PD has with some features of the disorder and to clarify the relationship that links tobacco and panic.
A sample of 82 naïve PD patients was included. Patients were extensively evaluated (Mini Neuropsychiatric Interview–MINI-, Panic Disorder Severity Scale–PDSS-, State-Trait Anxiety Inventory–STAI-, Beck Depression Index–BDI-; Anxiety Sensitivity Index–ASI-, Mobility Inventory of Agoraphobia–MIA-, Clinical Global Impression-CGI-, NEO-Five Factor Inventory–NEO-FFI). Tobacco consumption was retrospectively assessed by asking the patients the consumption they had the week before suffering the first panic attack.
The condition of smoker before the onset of PA showed significant relationships with earlier age of onset of PD (p=0.04), less frequency of PA (p=0.04), and higher scores in BDI (p=0.04) and NEO-FFI neuroticism (p=0.02). After analysis with multiple logistic regression, neuroticism did not show considerably influence on any of these associations.
Being a smoker before the onset of PA is related, in the early phases of PD, to higher neuroticism and depressive symptoms, less frequency of PA and PD onset at a younger age.
Although proposed as a common vulnerability factor, neuroticism does not influence the observed associations.
Nocturnal panic attacks are considered in PD patients a severe subtype of the illness. Recent studies failed at identifying more severe psychopathology in these patients. We analyzed this issue in a sample in the earlier phases of PD.
Patients and method:
A sample of 153 patients (107 women and 46 men) with a recent onset of a PD established with the MINI was included. Patients were free of treatment and had never received effective treatment for their disorder. Data were obtained both from the clinical interview and from specific questionnaires concerning severity (PDSS, CGI), agoraphobia (MIA), anxiety (STAI) and depression (BDI). The presence of nocturnal attacks was assessed during the clinical interview.
The median time of evolution of the PD was 8 months. The mean age of the sample was 30 years old. Agoraphobia was diagnosed in 66% of the cases and the mean CGI was 4.22 (moderate). More than half of the patients (52.9%) reported nocturnal panic attacks. A positive relationship was found between rate of panic attacks and nocturnal attacks (PDSS frequency: p=0.002; number of attacks in the last month: p=0.02). A positive relationship appeared with agoraphobia (PDSS agoraphobic avoidance: p=0.05; MIA alone: p=0.02). No relationship appeared regarding CGI and scales concerning psychopathology.
Half of the patients in first stages of PD reports nocturnal panic attacks, which are related both to an increased rate of panic attacks and an increased agoraphobic avoidance. However, nocturnal attacks are not related with the whole clinical severity of PD.
Since 1970, a relationship between cardiovascular morbi-mortality and anxiety disorders has been studied. Endothelial dysfunction is one of the possible mechanisms and has been studied in mental stress. The aim of this study is to compare the levels of two of the best known endothelial damage markers (von Willebrand Factor –vWF- and E-selectin) in patients and controls and its evolution after the treatment.
We recruited a sample of patients with recent onset panic disorder from the Panic Disorder Unit of Cantabria (University Hospital Marques de Valdecilla, Santander, Spain). Data were analyzed with the statistical package SPSS 12.0 and parametric test were used to compare the means (T test for paired and for independent samples).
We obtained measures in 54 cases and 43 age, sex and BMI matched controls. Mean age was 31.3 and 63% were women. Median duration of panic disorder was 7 months. Mean values of the markers were higher in patients than controls (vWF= 78.7 vs. 75.5; p=0.4, and E-selectin= 64.7 vs. 57.8; p=0.3) but did not reach statistical significance. When we analyzed evolution of markers in patients we observed a decrease in both (vWF= 78.7 → 74.6; p=0,058, E-selectin= 62.1 → 57.8; p=0,1) but again without reaching statistical significance.
These results could support our hypothesis of a relationship between the endothelial damage and panic disorder. The lack of statistical significance could be explained because of our small sample; therefore larger samples are needed to confirm our results.
It has been shown the relationship between Panic Disorder (PD) and cardiovascular mortality. Lipoprotein (a) is a well known cardiovascular risk factor. The aim of this study was to establish the relationship between Lp (a) and clinical severity in Panic Disorder patients and changes related to treatment response.
Patients with recent onset Panic Disorder were recruited in the Panic Disorder Unit of Cantabria. All of them were drug naive to minimize potential confounding factors. Thereafter, patients entered in a naturalistic treatment with SSRIs and were evaluated after 8 weeks follow-up.
159 patients were included. The mean score of the CGI was of 4.2 ± 1.0 and the mean of Lp (a) levels was 25.0 ± 26.8 mg/dl. Clinical response occurred in about 80% of the patients.
There was a significant correlation between the CGI scale and the Lp (a) levels (rho: 0.208; d.f.: 147; p=0.011) at intake.
Evaluation of Lp (a) at follow up showed lower levels, without statistical significance. Only in the subgroup of patients without agoraphobia this diminution in Lp (a) was significant (p=0.047).
Patients with higher scores in CGI presented higher levels of Lp (a) with a linear positive correlation between this variables. These findings could implicate Lp (a) in the increased cardiovascular morbidity and mortality in PD.
At follow-up a trend toward decrease in Lp (a) was observed, being this reduction higher in patients without agoraphobia.
Future researches are needed to establish whether Lp (a) modifications occur at longer follow-up evaluations.
The present study aimed to (a) establish the frequency of consumption of red meat and eggs; (b) determine serum ferritin levels (μg/l); and (c) establish the relationship between serum ferritin and the consumption of red meat and eggs. In Colombia during 2014–2018, an analytical study was conducted in 13 243 Colombian children between the ages of 5 and 17 years, based on cross-sectional data compiled by ENSIN-2015 (Encuesta Nacional de la Situación Nutricional en Colombia-2015) on serum ferritin levels and dietary consumption based on a questionnaire of the frequency of consumption. Using simple and multiple linear regression, with the serum ferritin level as the dependent variable and the frequency of consumption as the main explanatory variable, the crude and adjusted partial regression coefficients (β) between serum ferritin levels and consumption were calculated. The frequency of habitual consumption of red meat was 0⋅49 (95 % CI 0⋅47, 0⋅51) times/d. The frequency of habitual egg consumption was 0⋅76 (95 % CI 0⋅74, 0⋅78) times per d. The mean serum ferritin level in men was 41⋅9 (95 % CI 40⋅6, 43⋅1) μg/l and in women, 35⋅7 (95 % CI 34⋅3, 37⋅7) μg/l (P < 0⋅0001). The adjusted β between the consumption of red meat and eggs and serum ferritin levels were β = 3⋅0 (95 % CI 1⋅2, 4⋅7) and β = 2⋅5 (95 % CI 1⋅0, 3⋅9) for red meat and eggs, respectively. In conclusion, red meat and eggs are determinants of serum ferritin levels in Colombia and, therefore, could be considered public policy options to reduce anaemia and Fe deficiency.
Food insecurity (FI) has been associated with the generation of chronic disease and as a barrier in the treatment of cancer. We established at an ecological level the relationship between FI and the incidence rate of colorectal cancer x 100.000 inhabitants (CRACI).
Materials and Methods
An ecological study was carried out with information that measured the level of human, social and economic development in the territory of the 33 geodemographic units that make up Colombia. Using multiple linear regression with the CRACI as the dependent variable, the FI as the main explanatory and other variables of the context, we established the relationship between FI and the CRACI and predictive equations of the CRACI by sex. The goodness of fit in the models was the coefficient of determination (R2) and the Bland and Almant method.
The FI is related in an inverse manner, and the human development Index (HDI) is directly related to the CRACI. Two equations predict the CRACI with high precision; In men, [CRACI = -6.38 + -0.25 * FI + 35.5 * HDI].
In Women, [CRACI = 6.47 + -0.23 * FI + 19.1 * HDI].
The coefficient of determination R2 (%) in men is 88 and in women 72. The average difference between CRACI observed versus the estimated, was -0.00 in men (95% CI: -3.13 to 3.13), and in women of -0.00 (95% CI: -4.08 to 4.08).
We establish that in Colombia, FI is significantly and inversely associated with the CRACI and that it is possible to predict the CRACI at an ecological level with a high degree of precision using two variables that are calculated on a regular basis by Colombian state agencies—FI and the HDI.
FI has previously been identified as a risk factor in the development and treatment of patients with cancer since the associated economic incapacity reduces adherence to treatment and promotes a limited biological response, explained by a limited and poor-quality diet that exposes these patients to greater levels of infection and relapse.
A possible explanation for this is that as greater social and economic development is achieved in the territory, decreasing FI, the diet transitions toward greater consumption of proteins of animal origin, which in turn favours the development of mediators of chronic diseases, such as obesity, hypertension, and cancer. This change is part of the phenomena called nutritional transition and food transition.
The equations presented here constitute a cost-effective method for estimating CRACI in Colombia.
PUFA might modulate inflammatory responses involved in the development of severe dengue. We aimed to examine whether serum PUFA concentrations in patients diagnosed with dengue fever (DF) were related to the risk of progression to dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). A secondary aim was to assess correlations between fatty acids (FA) and inflammatory biomarkers in patients with DF. We conducted a prospective case–control study nested within a cohort of patients who were diagnosed with DF and followed during the acute episode. We compared the distribution of individual FA (% of total FA) at onset of fever between 109 cases who progressed to DHF/DSS and 235 DF non-progressing controls using unconditional logistic regression. We estimated correlations between baseline FA and cytokine concentrations and compared FA concentrations between the acute episode and >1 year post-convalescence in a subgroup. DHA was positively related to progression to DHF/DSS (multivariable adjusted OR (AOR) for DHA in quintile 5 v. 1=5·34, 95 % CI 2·03, 14·1; Ptrend=0·007). Dihomo-γ-linolenic acid (DGLA) was inversely associated with progression (AOR for quintile 5 v. 1=0·30, 95 % CI 0·13, 0·69; Ptrend=0·007). Pentadecanoic acid concentrations were inversely related to DHF/DSS. Correlations of PUFA with cytokines at baseline were low. PUFA were lower during the acute episode than in a disease-free period. In conclusion, serum DHA in patients with DF predicts higher odds of progression to DHF/DSS whereas DGLA and pentadecanoic acid predict lower odds.
Vitamin D could modulate pathways leading to dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). We examined the associations of serum total 25-hydroxy vitamin D [25(OH)D] and vitamin D binding protein (VDBP) concentrations in patients with uncomplicated dengue fever (DF) with risk of progression to DHF/DSS. In a case–control study nested in a cohort of DF patients who were followed during the acute episode in Bucaramanga, Colombia, we compared 25(OH)D and VDBP at onset of fever between 110 cases who progressed to DHF/DSS and 235 DF controls who did not progress. 25(OH)D concentrations were also compared between the acute sample and a sample collected >1 year post-convalescence in a subgroup. Compared with 25(OH)D ⩾75 nmol/l, adjusted odds ratios (95% CI) for progression were 0·44 (0·22–0·88) and 0·13 (0·02–1·05) for 50 to 75 nmol/l (vitamin D insufficiency) and <50 nmol/l (vitamin D deficiency), respectively (P, trend = 0·003). Mean 25(OH)D concentrations were much lower post-convalescence compared with the acute episode, regardless of case status. Compared with controls, mean VDBP was non-significantly lower in cases. We conclude that low serum 25(OH)D concentrations in DF patients predict decreased odds of progression to DHF/DSS.
Intrauterine exposure to the rainy season in the tropics may be accompanied by high rates of infection and nutritional deficiencies. It is unknown whether this exposure is related to the extrauterine timing of development. Our aim was to evaluate the relations of prenatal exposure to the rainy season and altitude of residence with age at menarche. The study included 15,370 girls 10 to <18 years old who participated in Colombia’s 2010 National Nutrition Survey. Primary exposures included the number of days exposed to the rainy season during the 40 weeks preceding birth, and altitude of residence at the time of the survey. We estimated median menarcheal ages and hazard ratios with 95% confidence interval (CI) according to exposure categories using Kaplan–Meier cumulative probabilities and Cox proportional hazards models, respectively. All tests incorporated the complex survey design. Girls in the highest quintile of gestation days exposed to the rainy season had an earlier age at menarche compared with those in the lowest (adjusted hazard ratios (HR)=1.08; 95% CI 1.00–1.18, P-trend=0.03). Girls living at altitudes ⩾2000 m had a later age at menarche compared with those living <1000 m (adjusted HR=0.88; 95% CI 0.82–0.94, P-trend <0.001). The inverse association between gestation days during the rainy season and menarche was most apparent among girls living at altitudes ⩾2000 m (P, interaction=0.04). Gestation days exposed to the rainy season and altitude of residence were associated with the timing of sexual maturation among Colombian girls independent of socioeconomic status and ethnicity.
theorem is an
boundedness criterion by which the question of the global behavior of an operator is reduced to its local behavior, acting on a family of test functions
indexed by the dyadic cubes. We present two versions of such results, in particular, treating square function operators whose kernels do not satisfy the standard Littlewood–Paley pointwise estimates. As an application of one version of the local
theorem, we show how the solvability of the Kato problem (which was implicitly based on local
theory) may be deduced from this general criterion.
Coeliac disease (CD) is an immune-mediated enteropathy resulting from exposure to gluten in genetically predisposed individuals. Gluten proteins are partially digested by human proteases generating immunogenic peptides that cause inflammation in patients carrying HLA-DQ2 and DQ8 genes. Although intestinal dysbiosis has been associated with patients with CD, bacterial metabolism of gluten has not been studied in depth thus far. The aim of this study was to analyse the metabolic activity of intestinal bacteria associated with gluten intake in healthy individuals, CD patients and first-degree relatives of CD patients. Faecal samples belonging to twenty-two untreated CD patients, twenty treated CD patients, sixteen healthy volunteers on normal diet, eleven healthy volunteers on gluten-free diet (GFD), seventy-one relatives of CD patients on normal diet and sixty-nine relatives on GFD were tested for several proteolytic activities, cultivable bacteria involved in gluten metabolism, SCFA and the amount of gluten in faeces. We detected faecal peptidasic activity against the gluten-derived peptide 33-mer. CD patients showed differences in faecal glutenasic activity (FGA), faecal tryptic activity (FTA), SCFA and faecal gluten content with respect to healthy volunteers. Alterations in specific bacterial groups metabolising gluten such as Clostridium or Lactobacillus were reported in CD patients. Relatives showed similar parameters to CD patients (SCFA) and healthy volunteers (FTA and FGA). Our data support the fact that commensal microbial activity is an important factor in the metabolism of gluten proteins and that this activity is altered in CD patients.
We analyze a general R&D-based endogenous growth model with a growth-essential natural resource. The economy comprises two separate sectors, final output and R&D, both directly or indirectly dependent on the natural resource. Because the resource is exhaustible and it is an essential productive input, increasing returns to scale to manmade inputs are compatible with nonexplosive sustained growth. The instability problem usually associated with increasing returns is overcome thanks to the existence of imperfect markets in a decentralized economy. We find an admissible range of values for the elasticity of capital in the R&D sector under which growth is fully endogenous and saddlepath stable, with no need of exogenous population growth.