Lerman I G, Villa A R, Martinez C L, Cervantes Turrubiatez L, Aguilar Salinas C A, Wong B, Gómez Pérez F J, Gutierrez Robledo L M
Departamento de Diabetes y Metabolismo de Lípidos, Instituto Nacional de la Nutrición Salvador Zubirán., Mexico City, Mexico.
J Am Geriatr Soc. 1998 Nov;46(11):1387-95. doi: 10.1111/j.1532-5415.1998.tb06005.x.
To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations.
A cross-sectional study.
Three Mexican communities (urban areas of medium and low income and a rural area).
A total of 121 men and 223 women aged 60 years and older and 93 men and 180 women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study (Cross-Cultural Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community.
A personal interview assessed demographic information, personal medical history, and functional status, and a 24-hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and glucose.
Diabetes prevalence was higher in men than in women for all age groups: 16.7% versus 9.5% in younger adults and 30.8% versus 22.8% in older adults. For all age groups, diabetes was more highly prevalent in urban communities. Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: gender (male sex: OR = 2.1; P < .009); diminished carbohydrate intake in the diet (OR = 0.77; P < .03); central distribution of adiposity (OR = 1.9; P < .03); and functional disability (OR = 2.3; P < .01). This relationship was not observed with living area, income, education, fiber and alcohol intake, body mass index, or age. Individuals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceridemia, and a proportionally higher fat intake.
This survey confirms the high prevalence of diabetes in the older Mexican population - particularly in men and in individuals living in urban areas - associated with an increased prevalence of other coronary risk factors. Diabetes was associated with higher fat, low carbohydrate, low fiber diets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertriglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a survivorship effect must be considered in studies of older individuals. The health situation in the older Mexican population presents a complex problem that needs correct diagnosis and better strategies to benefit those segments of the population at increased risk.
确定墨西哥城乡老年人群中糖尿病的患病率，并研究其与食物摄入量、人体测量和代谢变量以及其他冠心病危险因素之间的关联。
横断面研究。
三个墨西哥社区（中等收入和低收入城市地区以及一个农村地区）。
从欧洲经济共同体推动的CRONOS研究（老年成人营养跨文化研究组）中随机选取了121名60岁及以上男性、223名60岁及以上女性、93名35至59岁男性和180名35至59岁女性纳入调查。
通过个人访谈评估人口统计学信息、个人病史和功能状态，并获取24小时饮食回忆。体格检查包括人体测量和血压测量。采集空腹血样用于测量血脂、胰岛素和血糖。
各年龄组中男性糖尿病患病率均高于女性：年轻人中分别为16.7%和9.5%，老年人中分别为30.8%和22.8%。各年龄组中，城市社区糖尿病患病率更高。采用多变量逐步逻辑回归分析，老年个体中与糖尿病独立相关的变量有：性别（男性：比值比=2.1；P<.009）；饮食中碳水化合物摄入量减少（比值比=0.77；P<.03）；肥胖的中心分布（比值比=1.9；P<.03）；以及功能残疾（比值比=2.3；P<.01）。未观察到糖尿病与居住地区、收入、教育程度、纤维和酒精摄入量、体重指数或年龄之间存在这种关系。80岁及以上个体的致动脉粥样硬化风险状况有所降低。老年人中的糖尿病与高甘油三酯血症、功能状态受损以及缺血性心脏病患病率增加显著相关；年轻人中的糖尿病与低密度脂蛋白（LDL）高胆固醇血症、高甘油三酯血症以及脂肪摄入量成比例增加相关。
本次调查证实墨西哥老年人群中糖尿病患病率较高——尤其是男性和城市居民——且与其他冠心病危险因素患病率增加相关。糖尿病与高脂肪、低碳水化合物、低纤维饮食以及肥胖中心分布患病率增加有关。在老年受试者中，糖尿病与高甘油三酯血症、功能状态受损以及缺血性心脏病患病率增加显著相关。在对老年人的研究中必须考虑早期死亡和生存效应产生的偏差。墨西哥老年人群的健康状况呈现出一个复杂的问题，需要正确诊断并制定更好的策略以使那些风险增加的人群受益。
