Archives of Medical Research 32 (2001) 446–453 ORIGINAL ARTICLE Obesity, Diabetes, Hypertension, and Tobacco Consumption in an Urban Adult Mexican Population Carlos A Aguilar-Salinas,a Cuauhtémoc Vázquez-Chávez,b Rubén Gamboa-Marrufo,c Norma García-Soto,d José de Jesús Ríos-González,e Roberto Holguín,f Sergio Vela,g Fernando Ruiz-Alvarezh and Sonia Mayagoitiai a Departamento de Endocrinología y Metabolismo de Lípidos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico b Departamento de Estudios Metabólicos, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico c Unidad de Cuidados Intensivos, Hospital Benito Juárez, IMSS, Mérida, Yucatán, Mexico d Unidad de Metabolismo, Centro Médico Adolfo Ruiz Cortines, Veracruz, Mexico e Departamento de Endocrinología, Centro Médico de Occidente, IMSS, Guadalajara, Jalisco, Mexico f Departamento de Endocrinología, Hospital Infantil, Hermosillo, Sonora, Mexico g Unidad de Cuidados Intensivos, Centro Médico de León, IMSS, Guanajuato, Mexico h Private practice, Puebla, Mexico i Departamento de Endocrinología, Centro Médico de Chihuahua, IMSS, Ciudad Juárez, Chihuahua, Mexico Received for publication January 19, 2001; accepted April 16, 2001 (01/017) Background The aim of this study was to describe the prevalence of some of the main coronary risk factors in an open Mexican adult population Methods This is a cross-sectional study that includes individuals from eight different cities Except for Mexico City, all centers were located in medium-sized cities ranging from to million inhabitants Eligible subjects were adults 20 years of age or older Exclusion criteria included subjects seeking medical attention due to an acute illness or individuals unable to provide the requested information or written consent to participate in the study Men (n ϭ 567) and women (n ϭ 1,018) were included A previously validated interview was conducted A questionnaire assessed demographic and lifestyle factors Capillary glucose concentration and blood pressure were obtained Remarkably, 40% of the population had a body mass index (BMI) between 25 and 29.9 kg/m2; an additional 28% had a BMI Ͼ30 kg/m2 A large proportion of the individuals had abdominal fat distribution (62% of men and 81% of women) At the time of the evaluation, 30% of men and 18% of women were regular smokers Results Blood pressure Ͼ140/90 mmHg was found in 29.4% of the population Less than one half of the subjects had a previous measurement of plasma cholesterol (47%) or triglycerides (42%) The prevalence of diabetes was 9.02% A significant percentage of these subjects were Ͻ40 years of age (18.8% of the diabetic population) Conclusions The prevalence of obesity, diabetes, and hypertension in the population reported here is among the highest reported in Mexican populations © 2001 IMSS Published by Elsevier Science Inc Key Words: Diabetes, Obesity, Hypertension, Tobacco, Mexico Introduction Address reprint requests to: Carlos Alberto Aguilar-Salinas, M.D., Departamento de Endocrinología y Metabolismo de Lípidos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col Sección XIV, Tlalpan, 14000 México, D.F., México Phone and FAX: (ϩ525) 513-0002; E-mail: caguilarsalinas@yahoo.com Chronic-degenerative disorders have become a growing health problem in Mexico Diabetes and coronary heart disease are two of the most frequent causes of death in Mexican adults, followed by cerebrovascular accident (CVA) a few positions behind the former (1) The earlier age of onset 0188-4409/01 $–see front matter Copyright © 2001 IMSS Published by Elsevier Science Inc PII S0188-4409(01)00 0 - Prevalence of Coronary Risk Factors in Urban Mexico of these disorders observed in the past few decades aggravates the social and economic implications of the problem Interaction among genetic and environmental factors may explain the increasing magnitude of the phenomenon Several authors have demonstrated that the Mexican population has a genetic predisposition for the metabolic syndrome, type diabetes, and several primary forms of dyslipidemias (2–4) High caloric intake, fat, and simple carbohydrates in the diet, together with tobacco and alcohol consumption, as well as sedentary lifestyle are among the recognized environmental factors (5–7) Assessment of Framingham and Multiple Risk Factor Intervention Trial (MRFIT) data showed that approximately 85% of the excess risk for premature coronary heart disease is due to one or more of the following risk factors: advancing age; high serum cholesterol; high LDL-cholesterol concentration; type diabetes mellitus; hypertension; cigarette smoking, and family history of premature coronary artery disease (8) Based on the age distribution of the population, composed mainly of subjects aged 30 years or younger, it is very likely that mortality due to chronic degenerative disorders will be even greater in the next few decades Multiple studies have shown that modification of coronary risk factors is a useful approach to decrease cardiovascular mortality (9) Periodic estimation of the prevalence of the main coronary risk factors will help to predict trends for the coming years and to design preventive strategies to cope with the magnitude of this health problem The objective of this study is to describe the prevalence of some of the main coronary risk factors in an open Mexican adult population The results confirm the high prevalence of diabetes, high blood pressure, and overweight individuals in Mexico Materials and Methods Population sample This is a cross-sectional study that includes individuals from eight different cities Except for Mexico City, all centers were located in medium-sized cities with populations ranging from to million inhabitants The centers were selected to afford a fair representation of the three socioeconomic regions of the country The northern area of the Mexican Republic was represented by two cities (Hermosillo, Sonora (n ϭ 201) and Ciudad Juárez, Chihuahua (n ϭ 148); Mexico City (n ϭ 100) and the cities of Guadalajara (n ϭ 209), Veracruz (n ϭ 264), Puebla (n ϭ 189), and León (n ϭ 199) are located in the center of the country, while Mérida (n ϭ 275) represented the southern area of Mexico Randomly selected cases were detected at small stations located in primary care clinics or factories at which information concerning the Sociedad Mexicana de Nutrición y Endocrinología was presented to the public No medical assistance was offered at the various sites; only information regarding coronary risk factors was presented In 447 factories, some areas were randomly selected and each worker was asked to participate in the study Consecutive subjects not seeking medical attention (spouses or non-related companions) were also included in primary care clinics Eligible subjects were adults 20 years of age or older Exclusion criteria included subjects seeking medical attention due to an acute illness or individuals unable to provide requested information or written consent for participation in the study Institutionalized older people, those with an acute illness, and those with memory problems were excluded Studied population A total of 567 men and 1,018 women was included in the study The study was carried out over a 5-month period (March–August, 1999) Surveyed individuals were able to understand and answer all survey questions independently Age and gender distribution is shown in Table The study was carried out in accordance with the guidelines of the Helsinki Declaration of Human Studies Personal interview A general structured interview was conducted Procedures were previously standardized The same questionnaire was used at every center Prior to the beginning of the study, this instrument was applied to 30 bluecollar workers to validate understanding of questions Instructions were included in each preprinted questionnaire The questionnaire assessed demographic and socioeconomic information, family health history, personal medical history, and lifestyle factors such as smoking At the same visit, anthropometric and blood pressure measurements were obtained Systolic (first-phase) and diastolic (fifthphase) blood pressures were measured to the nearest even digit using a sphygmomanometer with the subject in the supine position after a 5-min rest Participants removed their shoes and upper garments Height was measured to the nearest 0.5 cm Waist circumference was measured with subjects in the standing position at the end of gentle expiration, at a point midway between the lower rib margin and iliac crest Circumference was measured in duplicate to the nearest 0.5 cm Body weight was measured on a daily calibrated balance and recorded to the nearest 0.1 kg Body mass index (BMI) was calculated as weight (kg) divided by height (m2) and was used as an index of overall adiposity Capillary glucose concentration Table Age and gender distribution of the population Age range (years) Ͻ30 30–39 40–49 50–59 60–69 Ն70 Total n % Men (n) Women (n) 370 473 434 203 74 31 1,585 23.3 27.3 29.8 12.8 8.9 1.9 133 175 142 74 30 13 567 (35.8%) 237 298 292 129 44 18 1,018 (64.2%) 448 Aguilar-Salinas et al./ Archives of Medical Research 32 (2001) 446–453 was measured using Accutrend strip reagent and glucometer All equipment, new and calibrated on acquisition, was regularly calibrated using reference samples provided by the manufacturer Measurements were taken by qualified endocrinologists with vast experience in obtaining this type of information deviations (SDs) for continuous variables These values were rounded to the nearest integer or first decimal Prevalence and frequencies are expressed in terms of percentage Significance of differences among subgroups of population was tested by one-way ANOVA using Bonferroni correction Categoric variables were compared by chi square statistics with Yates correction or exact Fisher test when appropriate The sample size did not allow us to make comparisons among the centers All statistical analysis was conducted in Statgraphics 5.0 software: STSC (Statistical Graphics Co., Inc., Rockville, MD, USA) Definitions Overweight was defined as having a BMI 25– 30 kg/m2 for males and females Obesity was defined as BMI Ն30 kg/m2 Based on random measurement of capillary blood glucose and the patient’s medical history, the population was classified as normal, diabetic (capillary glucose Ն200 mg/dL, or fasting glucose value Ն7 mmol/L [126 mg/dL], or previously diagnosed cases), potential diabetics (capillary glucose Ն7mmol/L [126 mg/dL] after fasting for at least h), and potential glucose intolerance (capillary glucose 6.1–7 mmol/L [110–126 mg/dL] after fasting for at least h) Hypertension was diagnosed when systolic pressure was Ն140 mmHg and/or diastolic pressure was Ն90 mmHg and/or current use of antihypertensive medications Smoking was considered present if the subject smoked daily Ischemic heart disease was considered if there was a history of myocardial infarction Results The number of study subjects was 1,585 (567 men and 1,018 women) All evaluations were completed in 1,534 cases (96.7%) Non-acceptance for capillary glucose measurement and incomplete data recollection were reasons for not including the remaining 51 cases Age distribution was similar to that observed in the Mexican adult population according to the 1990 National Survey (Table 1) However, ages Ͻ30 years or Ͼ70 years were underrepresented A greater-than-expected proportion of women was included Statistical analysis The sample size was estimated using the following formula (Eq 1): N = Z (1 – P) ⁄ E P 2 Obesity Mean BMI stratified by age and sex is shown in Table Additionally, the percent of subjects classified as either overweight or obese is shown Remarkably, 40% of the population had a BMI between 25 and 29.9 kg/m2; an additional 28% had a BMI Ͼ30 kg/m2 Percentage of obese individuals was directly related to age, except for individuals Ͼ70 years of age Men had a higher prevalence of being overweight than women (44.7 vs 37.5%), especially in subjects Ͻ40 years of age Obesity was also more common in men as compared to women (31.7 vs 26.7%), especially between the ages of 30 and 49 years; however, the opposite trend was observed between the ages of 50 and 69 years The overweight/obesity ratio is also shown in Table This parameter is nearly in populations with the highest prevalence of obesity in the world (10) In both genders, this ratio was nearly in ages 30 to 60 years (1) where N ϭ sample size, Z ϭ confidence level, P ϭ frequency of the phenomenon to be measured (6%), and E2 ϭ precision (35%) The study had the power to assess the prevalence of any disorder with a prevalence Ͼ6% Each evaluated disorder fulfilled this requirement The total number of cases required was 1,341 (167 cases per city) Supplies were shipped with an excess of 30% to each center Data were codified and digitized under ASCII fixed format The database was validated through recognition of missing values, outliers, and inconsistencies among variables Descriptive analysis included estimation of mean values and standard Table Prevalence of obesity (BMI Ͼ30 kg/m2) and overweight (BMI 25–30 kg/m2) stratified by age and gender Men Age range (years) Ͻ30 30–39 40–49 50–59 60–69 Ն70 Total Women BMI (mean Ϯ SD) Overweight (%) Obesity (%) R Ov/ob BMI (mean Ϯ SD) Overweight (%) Obesity (%) R Ov/ob 26.9 Ϯ 28.7 Ϯ 29.1 Ϯ 4.6 28.4 Ϯ 4.3 27.3 Ϯ 3.5 27.2 Ϯ 3.1 28.3 Ϯ 4.8 43.8 50.7 39.4 36.6 51.4 60 44.7 21.3 29.8 42 36.6 25.7 20 31.7 2.05 1.7 0.93 1.41 24.8 Ϯ 26.8 Ϯ 28.2 Ϯ 5.1 29.5 Ϯ 29.4 Ϯ 3.8 27.3 Ϯ 27.2 Ϯ 5.3 22.9 39.7 41.4 40.7 51.7 60 37.5 23 22.9 32.7 43 34.4 20 26.7 0.99 1.73 1.26 0.94 1.5 1.40 R Ov/ob ϭ ratio overweight/obesity Prevalence of Coronary Risk Factors in Urban Mexico A large proportion of individuals had abdominal fat distribution assessed by an abdominal circumference Ͼ102 cm for men and Ͼ88 cm for women Table shows the percentage of individuals (including lean, overweight, and obese cases) with increased waist circumference stratified by age and sex Prevalence of central adiposity increased in both sexes as subjects grew older This characteristic was more often seen in women; one half or more of women had abdominal fat accumulation after age 50 Among obese individuals, 62% of men and 81% of women had abdominal fat distribution In subjects with a BMI Ͻ25 kg/m2, prevalence was 4.6% in women and 5% in men Tobacco consumption At the time of evaluation, 30% of men and 18% of women were regular smokers Prevalence of active smokers by age and gender subgroups is shown in Table A clear decreasing trend was observed as individuals reached Ͼ50 years of age A total of 40% of the population lives or works close to an active smoker High blood pressure In 90% of the population, blood pressure had been measured at least once previously A total of 467 cases with arterial hypertension (Ն140/90 mmHg) were included (29.46% of the population) The percentage of individuals with blood pressure Ͼ140/90 stratified by age and gender is shown in Table Cases with previously diagnosed arterial hypertension were also taken into account regardless of the study measurement Prevalence of high blood pressure was directly related to age A total of 32% of hypertensive patients was diagnosed during the study (152 cases) Seventeen percent of previously diagnosed hypertensive individuals had systolic pressure Ͼ140 mmHg and 20.8% had diastolic pressure Ͼ90 mmHg Dyslipidemia Less than one half of the subjects had a previous measurement of plasma cholesterol (47%) or triglycerides (42%) These data demonstrate that dyslipidemia is currently underdiagnosed in the majority of the Mexican adult population Table Prevalence of increased abdominal circumference (Ն102 cm for men and Ն88 cm for women) stratified by age and gender Men Age range (years) Ͻ30 30–39 40–49 50–59 60–69 Ն70 Total Table Prevalence of tobacco consumption stratified by age and gender Age range (years) Men Women Regular tobacco consumption (%) Regular tobacco consumption (%) 31.4 33.9 45 16.1 17.3 13 30.6 21.8 20.4 16.8 17.1 13 10.5 18.2 Ͻ30 30–39 40–49 50–59 60–69 Ն70 Total Menopause During the previous year, 237 women were amenorrheic Four were 40 years of age or younger and 42 were 40 to 50 years of age Only 13.2% received hormone replacement therapy Diabetes mellitus Age and sex distribution of diabetic subjects (n ϭ 143) is shown in Table All had type diabetes A significant percentage of these subjects were Ͻ40 years of age (18.8% of the diabetic population) Based on random measurement of capillary blood glucose and the patients’ medical history, the population was classified as follows: normal; diabetic (capillary glucose Ն200 mg/dL or fasting glucose value Ն7 mmol/L [126 mg/dL] or previously diagnosed cases); potential diabetics (capillary glucose Ն7mmol/L [126 mg/dL] after fasting for at least h), and potential glucose intolerance (capillary glucose 6.1–7 mmol/L [110– 126 mg/dL] after fasting for at least h) Individuals who fasted Ͻ2 h were not included in the analysis unless they had a glucose concentration Ͻ200 mg/dL Prevalence of these categories is also shown in Table Prevalence of diabetes was 9.02% If potential diabetics (3.5% of the population) are also included, prevalence increases to 12.5% As shown in Table 7, clear differences were found among these three groups Clinical characteristics of the insulin resistance syndrome were more frequently observed in the potential diabetes and potential glucose intolerance groups compared to normal controls The main difference observed between Table Prevalence of arterial hypertension (Ն140/90 mmHg) stratified by age and gender Women Abdomen circumference (mean Ϯ SD) Increased AC (%) Abdomen circumference (mean Ϯ SD) Increased AC (%) 87 Ϯ 19 91 Ϯ 16 94.6 Ϯ 13 96.7 Ϯ 12 97.8 Ϯ 21 90 Ϯ 20 92 Ϯ 16 19.3 21.7 27.5 35.1 38.4 10 25.2 77 Ϯ 12 83.5 Ϯ 12 85 Ϯ 11 93 Ϯ 14 93.3 Ϯ 95.4 Ϯ 84.3 Ϯ 13 17 28.7 35 57 66 80 32.8 AC ϭ abdominal circumference 449 Systolic hypertension Age range (years) Men (%) Women (%) Both genders (%) Ͻ30 30–39 40–49 50–59 60–69 Ն70 Total 13.5 22.8 40.1 45.9 80 46.1 31.5 9.2 24.1 29.7 55.8 45.4 83.3 28.29 10.8 23.6 33.1 52.2 59.4 67.7 29.46 450 Aguilar-Salinas et al./ Archives of Medical Research 32 (2001) 446–453 Table Prevalence of diabetes and abnormal capillary glucose concentration stratified by age and gender Men Age range (years) Ͻ30 30–39 40–49 50–59 60–69 Ն70 Total Women Both genders Diabetes (%) Pot DM (%) Pot GI (%) Diabetes (%) Pot DM (%) Pot GI (%) Diabetes (%) 1.9 6.5 8.02 17.6 39 40 10.9 0.9 2.9 4.3 11 2.1 13 4.1 2.8 10.7 3.6 2.9 4.3 0.6 5.6 1.4 3.7 9.4 16.4 30.4 21 8.43 0.9 3.0 5.2 2.7 2.1 10 3.3 2.4 3.4 5.9 6.1 4.3 5.2 4.3 1.6 4.7 16.8 34.7 29.4 9.02 Definitions: Diabetic (capillary glucose Ն200 mg/dL and previously diagnosed cases), potential diabetics (Pot DM, capillary glucose Ն126 mg/dL after fasting for at least h), and potential glucose intolerance (Pot GI, capillary glucose 110–126 mg/dL after fasting for at least h) these two groups and patients with diabetes was age: diabetic patients were older These data suggest that potential diabetes and potential glucose intolerance groups had abnormal carbohydrate metabolism and in the future may have increased risk for type diabetes Discussion These data clearly demonstrate that some main coronary risk factors are very common in the adult Mexican population Prevalences reported here are the highest among the previously reported national or regional Mexican studies (11–16) These reports are difficult to compare due to the different characteristics of the study subjects Consequently, methodologic differences among the studies not allow us to firmly establish a growing trend Despite these problems, the data reported here are important because no data were published during the previous years Furthermore, our results provide new information on Mexican urban adults concerning the prevalence of central obesity, passive smoking, and use of hormone replacement therapy in postmenopausal women Early and proper detection of coronary risk factors is a critical step in order to identify the population at risk of a coronary event According to U.S data, reduction in cardiovascular deaths observed over the past few decades is explained 15 to 30% by improvement of preventive actions (17) Unfortunately, our data suggest that coronary risk factors remained underdiagnosed in a large percentage of the studied population The vast majority of subjects had never been tested for cholesterol or triglyceride measurement Less than 50% had previous glucose testing However, all subjects had their blood pressure measured at least once previously, suggesting that high blood pressure preventive programs have been effective for reinforcing early detection of the disease It is critical to extend educational programs, especially among primary physicians, to other cardiovascular risk factors such as dyslipidemias or diabetes Socioeconomic changes occurring in Mexico over the past century resulted in modifications of life habits, food consumption, and physical activity As a result, consumption of calories, protein, fat, and simple carbohydrates has increased in the urban population, leading to a higher prevalence of overweight and obesity In this report, 28% of the population was obese and 40% had a BMI between 25 and 29.9 kg/m2 According to these results, desirable weight has become an uncommon feature in our population Nearly 50% of men and women Ͻ30 years of age had a BMI Ͼ25 kg/m2 This observation suggests that prevalence of metabolic co-morbidities of obesity may increase to an even greater extent over the next 10 years, as currently young obese individuals grow older Prevalences reported here are almost identical to those observed in Mexican-Americans in the NHANES III report Table Clinical characteristics of patients with diabetes or abnormal capillary glucose concentrations Age (years) BMI (kg/m2) Abdominal circumference Systolic BP Diastolic BP Diabetes (n ϭ 143) Pot DM (n ϭ 56) Pot GI (n ϭ 75) Non-diabetics (n ϭ 1,311) ANOVA 51 Ϯ 12a,b,c 28 Ϯ 4.1 94.5 Ϯ 15a,b,c 124 Ϯ 20a,b,c 81.7 Ϯ 12a,b,c 45.4 Ϯ 1b,c 28.6 Ϯ 5.4c 91.3 Ϯ 13b,c 118 Ϯ 14 78 Ϯ 10c 41.5 Ϯ 11 28.9 Ϯ 6.8 89 Ϯ 14c 118 Ϯ 14 78 Ϯ 10 39.2 Ϯ 11 27.3 Ϯ 86.2 Ϯ 14 116 Ϯ 15 76 Ϯ 11 Ͻ0.001 Ͻ0.001 Ͻ0.001 Ͻ0.001 Ͻ0.001 Data expressed as mean Ϯ SD ap Ͻ0.05 vs Pot DM; bp Ͻ0.05 vs Pot GI, cp Ͻ0.05 vs non-diabetics Definitions: Diabetic (capillary glucose Ն11.1 mmol/L [200 mg/dL] and previously diagnosed cases), potential diabetics (Pot DM, capillary glucose Ն7 mmol/L [126 mg/dL] after fasting for at least h), and potential glucose intolerance (Pot GI, capillary glucose Ն6.1–7 mol/L [126 mg/dL] after fasting for at least h) Prevalence of Coronary Risk Factors in Urban Mexico conducted from 1988 to 1994 (38.4% overweight and 28.3% obesity) (18) Interestingly, the prevalence observed in the 1993 National Survey of Chronic Disease effected in Mexico (10) showed nearly the same prevalence as observed in Mexican-Americans in the NHANES II report carried out from 1982 to 1984 (19) These data suggest that environmental changes to which the urban populations in Mexico and Mexican-Americans living in the U.S are exposed are similar; nevertheless, in Mexican-Americans these changes occur to years previous to when they occur in Mexicans living in urban populations in Mexico Compared to other populations (20), the prevalence of obesity reported herein is only lower to that reported in Kuwait in 1994 (36%) and in Samoa in 1991 (59%) The higher prevalence of obesity in males found in this report is unusual Although the same phenomenon has been previously reported in at least one antecedent population (21), the most likely explanation for this finding is a bias in our selection procedure This observation suggests that some subgroups may be over- or underrepresented in this report; however, the size of the sample allows a fair measurement of global rates in urban Mexican adults Our observations confirm that a large percentage of Mexican obese individuals had abdominal fat distribution Among obese individuals, 62% of men and 81% of women had abdominal fat distribution This fat distribution pattern, frequently associated with the metabolic syndrome (22), was found even in lean subjects (5% of men and 4.6% of women) This characteristic was quite common in women Ͼ50 years of age These data imply that many of these subjects may be at high risk for metabolic syndrome and its cardiovascular complications Type diabetes mellitus is one of the major health and socioeconomic problems worldwide In Mexico, according to a 1993 National Survey it was calculated that nearly 1.9 million subjects (7.2% of adults) were affected by type diabetes According to King (23), Mexico is in ninth place among countries with the highest prevalence of type diabetes; the author postulates that Mexico will advance two or more positions by 2025 According to this report, 9.02% of adults Ͼ20 years of age had type diabetes This percentage should be even greater because criteria used for the diagnosis of diabetes in this report are not very sensitive Inclusion of an oral glucose tolerance test would increase the number of cases to approximately 18% (24), situating the estimated prevalence at 10.67% Although we recognize that this is arbitrary, we attempted to overcome this limitation of the study by including in the analysis cases with abnormal (but not diagnosed) capillary glucose concentration As shown in Table 7, individuals considered as potential diabetics (capillary glucose Ն7 mmol/L [126 mg/dL] after fasting for at least h) had clinical characteristics similar to individuals with diabetes; however, the latter individuals were significantly younger If potential diabetics (3.5% of the population) are also included, the prevalence increases 451 to 12.5% These data clearly suggest that prevalence of type diabetes in Mexican urban adults may be in the range of to 12.5% As previously shown in the 1993 National Survey on Chronic Diseases, diabetes affects a significant proportion of individuals Ͻ40 years of age Based on that report, it was estimated that the total number of patients with diabetes diagnosed prior to age 40 years was nearly 300,000 (25) Our data confirm the early onset of diabetes in Mexico Eighteen percent of diabetic patients were Ͻ40 years of age Prevalence of the disease in the 30- to 39-year-old age group (4.7%) is similar to that reported by Laviada in 1968 in urban adults from the southeastern Mexican state of Yucatán (13) The socioeconomic and biologic consequences of the early onset of type diabetes are enormous (26) A large number of temporal or definitive incapacities prior to the age of 50 years is a consequence of this characteristic of the disease Additionally, these subjects frequently exhibit a more aggressive form of the disease, require insulin treatment at a younger age, and suffer from severe chronic complications This report confirms the high prevalence of arterial hypertension in our population (27) The disease affected 29% of the population Prevalence was slightly higher in men than in women (31.5 vs 28.2%, respectively) Furthermore, our data suggest that one of five hypertensive subjects did not achieve the minimal goals of the treatment Previous reports in Mexican populations showed even lower rates of successful treatment [22% according to Arroyo and coworkers (27)], suggesting that large variations in the treatment of high blood pressure must exist in different areas of the country The phenomenon has been previously reported in many populations (28) These data confirm that hypertension in Mexico is an important health problem Its magnitude is similar to that observed in developed nations Our data confirm the high prevalence of tobacco consumption among Mexican adults Prevalence reported here (30.6% for men and 18.2% for women) is very similar to that observed in the last decade (28.5–38% for men and 4.1–20% for women) (29,30) Passive smoking was reported in 40% of the population; the same proportion was reported in the 1993 National Addiction Survey These data suggest that tobacco prevention programs did not reach their goals based on the similar prevalence of tobacco consumption during the past decade Some limitations of our study must be recognized A multistage sampling procedure was not used To overcome this limitation, we were careful to select random populations, and hospitals or reference centers were not included as sampling centers Age distributions of patients are similar to those observed in the 1990 National Census, suggesting that our results may be representative of an unbiased Mexican adult urban population Support for this statement is found in the similar prevalence of tobacco consumption found in this report compared to the recently reported National Survey of Addictions 452 Aguilar-Salinas et al./ Archives of Medical Research 32 (2001) 446–453 The main bias of this report was the inclusion of a smaller number of subjects aged 30 years or less (23.3 vs 36.2%) and a greater number of women (64.2 vs 58.3%) This bias does not invalidate our results; it simply limits its applicability in the underrepresented groups The number of subjects Ͼ60 years of age is not sufficient to draw definitive conclusions in this age group However, these cases were included for use in comparing the younger age groups Although the sample size is sufficient for estimating the prevalence of common disorders such as obesity and diabetes, it is too small to make comparisons among regions or to study other less common disorders In conclusion, our data show that the main determinants for continuous increase of chronic degenerative disorders may still be active in urban Mexico Although it is possible to decrease the cardiovascular mortality rate despite a growing prevalence of obesity, the cost of this approach is unaffordable for many countries because it is based on the systematic use of several hypolipidemic and antihypertensive drugs and expensive detection programs (31–34) We believe that cardiovascular preventive programs in Mexico must consider a decreasing prevalence of obesity as the main goal, followed by proper diagnosis and treatment of the other risk factors An enormous effort for educating the general population and primary-level physicians will be required to achieve these goals On the other hand, it would not be prudent to wait and treat millions of incapacitated subjects, many young and at the height of their productivity Acknowledgments The materials used for this study were provided by an unrestricted educational grant from Roche Metabolism References Dirección 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