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L J Franco

Publications and source records attributed to L J Franco.

33 records · Page 2Linked to original sources
PubMed1996

Diabetes in Japanese-Brazilians--influence of the acculturation process.

Epidemiologic studies of migrant populations provide very promising clues towards understanding the roles of genetics and environmental factors in the etiology of diabetes mellitus. Populations of Japanese ancestry are of particular interest due to marked differences in prevalence rates of non-insulin dependent diabetes (NIDDM) when comparing those living in Japan with those who migrated to western countries. Brazil offers very favorable conditions of the study of diabetes in the Japanese origin population. Presently, Brazil has the largest population of Japanese ancestry outside Japan. A cross-sectional study comparing first (Issei) and second (Nisei) generations of Japanese-Brazilians living in the city of Bauru, in the industrialized state of São Paulo, southeast of Brazil, was carried out between May and November 1993. The study sample consisted of all first generation (127 men and 111 women) and a random sample of second generation (136 men and 156 women) aged 40-79 years. Results show that: 1--The prevalence of diabetes in Japanese Brazilians (12.8 and 16.2% for first and second generations) are higher than the rates reported for Japan at comparable age-groups. 2--Comparing generations, the age-adjusted prevalence of diabetes was higher in the second generation only for men (men: 12.4 vs. 21.7%; women: 11.6 vs. 11.4%). 3--Obesity was more prevalent in the second generation among men (Men: 34.6 vs. 45.7% women, 39.6 vs. 40.8%).

Acculturation↗
PubMed1994

Self-reported prevalence of non-insulin-dependent diabetes mellitus in the 1st (Issei) and 2nd (Nisei) generation of Japanese-Brazilians over 40 years of age.

The immigration of Japanese people to Brazil began in 1908 with two major waves, from 1925 to 1940 and from 1952 to the 1960s. Brazil has the largest population (about 1,288,000) of Japanese origin outside Japan with varying age groups. A mortality study revealed that diabetes as an underlying cause of death was higher in the first-generation Japanese than in Japan (3.4 vs. 1.9 per 100,000 for men, and 7.2 vs. 1.9 for women). The self-reported prevalences of known diabetes in subjects aged 40 years or older were obtained by questionnaires from three sources. In six Japanese cultural associations in Säo Paulo city, the prevalences were 9.7% and 6.9% for the first generation (mean age 61.5 years) and for the second generation (mean age 40.0 years), respectively. Age-adjusted prevalences, according to the Brazilian population in the 1980 national census, were 6.9% and 8.1% for the first and second generations. According to a study carried out as a part of a socioeconomic census of the Japanese population in Brazil, the prevalences of diabetes were 7.4% and 5.2%, and the age-adjusted prevalences were 5.3% and 5.8% in the first and second generations, respectively. Another study carried out for employees of a bank, owned by Japanese-Brazilian community members, revealed crude prevalences of diabetes in the first and second generations of 7.1% and 4.2%, and age-adjusted prevalences of 7.3% and 8.2%, respectively. These data indicate an increased prevalence of diabetes in this population compared to Japan, suggesting the importance of environmental factors in the pathogenesis of diabetes.

Adult↗
PubMed1994

The ROC curve in the evaluation of fasting capillary blood glucose as a screening test for diabetes and IGT.

OBJECTIVE: To assess the performance of different cutoff points of fasting capillary glycemia (FCG) in the diagnosis of diabetes and impaired glucose tolerance (IGT) using the receiver operating characteristics (ROC) curve approach. RESEARCH DESIGN AND METHODS: This study included a sample of 4,019 subjects without a previous history of diabetes who were recruited for a confirmatory 2-h post-glucose challenge capillary glycemia from a larger sample of 21,847 individuals screened with FCG. The sensitivity and the specificity of FCG as a screening test were analyzed in the cutoff range 3.9-8.9 mmol/l, and the corresponding ROC curves were plotted to assess the performance of the test. RESULTS: The screening test performance was better for diabetes than for IGT in the full range of cutoff points studied. Sensitivities ranged between 37.9 and 97.1% for diabetes and 1.8 and 94.4% for IGT; the areas under the ROC curves were 0.91 +/- 0.01 and 0.75 +/- 0.01, respectively. The cutoffs showing the best equilibrium between sensitivity and specificity approached 5.6 and 5.0 mmol/l for diabetes and IGT, respectively. Factors such as age, color, and family history of diabetes can affect the screening test performance. CONCLUSIONS: ROC curves can provide useful information toward improving the usefulness of FCG as a screening test for abnormalities of glucose tolerance.

Adult↗
PubMed1993

Population-based incidence of IDDM in the state of São Paulo, Brazil.

OBJECTIVE: To study the incidence of IDDM among children, infants to 14 yr of age, in the state of São Paulo, Brazil, 1987-1991. RESEARCH DESIGN AND METHODS: A prospective population-based register was established, using physician reports of newly diagnosed IDDM patients < 15 yr of age as the primary source of case identification and school surveys as the main secondary source. Data were collected according to the methods recommended by the Diabetes Epidemiology Research International group. RESULTS: Case ascertainment was estimated at 95.0, 92.8, and 98.8% complete for each of the three cities studied. The average annual IDDM incidence was 7.6/100,000 inhabitants (95% confidence interval, 5.6-9.7). We found a higher incidence rate in girls than boys. CONCLUSIONS: The incidence of childhood IDDM in a tropical region in South America (São Paulo, Brazil) is in the middle incidence range observed in developed countries throughout the world. Increased incidence of IDDM in girls compared with boys will be tested by the ongoing Brazilian incidence study being developed in 18 other centers across the country.

Adolescent↗
PubMed1992

Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30-69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence.

OBJECTIVE: To assess the prevalence of diabetes and IGT in the urban adult Brazilian population. RESEARCH DESIGN AND METHODS: We used a two-stage, multicenter, cross-sectional survey in a random sample of 21,847 individuals aged 30-69 yr from nine large cities. Subjects were first screened by FCG. All positive screenees (FCG > or = 5.6 mM/L) and every sixth consecutive negative screenee were administered a 75 g OGTT and classified as diabetic, IGT, or normal (nondiabetic) according to WHO recommendations. OGTT findings from the negative screenees were extrapolated to all negative screenees after adjustments for potential biases. RESULTS: The overall rates were 7.6 and 7.8% for diabetes and IGT, respectively. Men (7.5%) and women (7.6%) had similar rates of diabetes. Similar rates resulted with whites (7.8%) and nonwhites (7.3%). Diabetes prevalence increased from 2.7% in the 30-39-yr age-group to 17.4% in the 60-69-yr age-group. Diabetes was more prevalent among less educated people, but this difference disappeared after adjusting for age. Family history of diabetes was associated with a twofold increase in diabetes prevalence (12.5 vs. 5.8%); the same increase occurred with obesity (11.6 vs. 5.2%). Undiagnosed diabetes accounted for 46% of the total prevalence. Among previously diagnosed cases, 22.3% were not under treatment, 7.9% were on insulin, 40.7% were on oral agents, and 29.1% were on dietary treatment only. Self-reported diabetes prevalence was 0.1, 3.2, and 11.6% in the age groups < 30, 30-69, and > 70 yr, respectively. CONCLUSIONS: The prevalence of diabetes in Brazil is comparable with that of more developed countries, where it is considered a major health problem.

Adult↗
PubMed1989

Blood pressure in four remote populations in the INTERSALT Study.

Four remote population samples (Yanomamo and Xingu Indians of Brazil and rural populations in Kenya and Papua New Guinea) had the lowest average blood pressures among all 52 populations studied in INTERSALT, an international cooperative investigation of electrolytes and blood pressure. Average systolic blood pressure was 103 versus 120 mm Hg in the remaining INTERSALT centers; diastolic blood pressure in these four population samples averaged 63 versus 74 mm Hg in the 48 other centers. There was little or no upward slope of blood pressure with age; hypertension was present in only 5% of the rural Kenyan sample and virtually absent in the other three centers. Also in marked contrast with the rest of the centers was level of daily salt intake, as estimated by 24-hour urinary sodium excretion. Median salt intake ranged from under 1 g to 3 g daily versus more than 9 g in the rest of INTERSALT populations. Average body weight was also low in these four centers, with no or low average alcohol intake, again unlike the other centers. The association within these four centers between the above variables and blood pressure was low, possibly reflecting their limited variability. While several other INTERSALT centers also had low average body weight or low prevalence of alcohol drinking, when this was accompanied by much higher salt intake (7-12 g salt or 120-210 mmol sodium daily), hypertension prevalence ranged from 8% to 19%. These findings confirm previous reports that in populations with a low salt intake, there is little or no hypertension or rise of blood pressure with age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Evidence of bimodality of two hour plasma glucose concentrations in Mexican Americans: results from the San Antonio Heart study.

Evidence for bimodality in the distribution of two hour post oral glucose challenge plasma glucose concentrations has come previously primarily from native American and Pacific Island populations having high non-insulin dependent diabetes mellitus (NIDDM) prevalence. Because the National Diabetes Data Group (NDDG) criteria for diagnosing NIDDM rely in part upon the assumption of bimodality, it is important to determine the generality of this phenomenon. We looked for bimodality among Mexican Americans in San Antonio, a population having greater than 50% Caucasian admixture. By fitting both a single normal distribution model and a mixture model of two normal distributions, for each age decade, we found that the mixture model was preferred to the single normal model (p less than 0.001) and that this model fit the data well. The proportion in the upper component (hyperglycemics) increased with each successive age decade. The minimum misclassification cutpoints decreased with age, but all were higher than the 200 mg/dl cutpoint recommended by the NDDG. Use of the NDDG cutpoint, however, improved sensitivity with only a minimal deterioration of specificity. Our findings further generalize the bimodality phenomenon and support the NDDG criteria.

Adult↗
PubMed1985

Prevalence, detection, and control of hypertension in a biethnic community. The San Antonio Heart Study.

A survey was carried out on a random sample of 1,288 Mexican Americans and 929 Anglos living in three socially distinct neighborhoods in San Antonio, Texas. Hypertension was defined as diastolic blood pressure greater than or equal to 95 mmHg or currently taking antihypertensive medication. Overall age-adjusted prevalence rates of hypertension were similar for Mexican-American and Anglo men (10.0 and 9.8%, respectively); for women, the Mexican-American rate was slightly lower than that for Anglos (7.8 and 9.7%, respectively). After adjustment for obesity differences, Mexican Americans have a tendency toward lower hypertension rates than Anglos of the same socioeconomic level. Only among women was a decline in the prevalence of hypertension with increasing socioeconomic status observed. Mexican Americans have a higher proportion of newly diagnosed hypertension, and, among previously diagnosed cases, a lower proportion are on antihypertensive medication than Anglos. The rates of hypertension control found in this survey are among the highest reported in the United States at the community level. Despite this, Mexican Americans still lag somewhat behind Anglos of the same socioeconomic level in awareness, treatment, and degree of hypertension control, suggesting the possibility of sociocultural barriers to adequate medical care.

Adult↗
PubMed1985

Coffee consumption, diet, and lipids.

Recent reports suggest that coffee consumption is associated with increased serum cholesterol and triglyceride concentrations. The authors examined the association between serum lipids and coffee consumption and other caffeinated beverages as part of a population-based study of 1,228 women and 923 men, aged 25-64 years, in San Antonio, Texas, studied between October 1979 and November 1982. The study confirmed a positive relationship between coffee consumption and both total and low density lipoprotein cholesterol in both sexes which persisted after adjustment for age, ethnicity, obesity, cigarette smoking, and alcohol consumption. Neither tea nor cola consumption was associated with changes in serum lipids, suggesting that caffeine alone does not exert a direct effect on lipid levels. The possibility was examined that the coffee-cholesterol relationship might be due to a more atherogenic diet consumed by heavy coffee drinkers. In men, per cent calories from both total and saturated fat and dietary cholesterol intake increased with increased coffee consumption. Similar trends were not observed in women, however. The positive relationship between coffee and cholesterol may therefore be due to confounding effects of other aspects of the diet.

Adult↗
PubMed1984

Sex difference in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans. The San Antonio Heart Study.

The authors postulated that as Mexican Americans became more affluent and/or acculturated to "mainstream" United States life-style they would progressively lose their "obesity-related" pattern of cardiovascular risk factors which were defined as: obesity, diabetes, hypertriglyceridemia and low levels of high density lipoprotein cholesterol. This hypothesis was tested in 1979-1982 in the San Antonio Heart Study, a population-based study on 1,288 Mexican Americans and 929 Anglos living in three San Antonio neighborhoods: a low-income barrio, a middle-income transitional neighborhood, and a high-income suburb. The study population comprised 25-65-year-old men and nonpregnant women. In Mexican American women, all of the "obesity-related" risk factors fell sharply with rising socioeconomic status. In Mexican American men, by contrast, diabetes was the only "obesity-related" risk factor which fell with rising socioeconomic status. Moreover, it fell less steeply, there being an approximately twofold difference in diabetes prevalence between the barrio and the suburbs in men compared to a fourfold difference in women. Also, total and low density lipoprotein cholesterol rose with rising socioeconomic status in Mexican American men, but not in Mexican American women. "Obesity-related" risk factors were generally higher in Mexican Americans of both sexes than in their Anglo neighbors who were of similar socioeconomic status. These results suggest that cultural factors exert a stronger influence on diabetes and cardiovascular risk factors in Mexican Americans than do purely socioeconomic factors.

Adult↗
PubMedDate not supplied

Evaluation of three potential screening tests for diabetes mellitus in a biethnic population.

We tested the ability of three potential screening tests for diabetes (fasting plasma glucose value greater than or equal to 140 mg/dl, 1-h postglucose (PG) load value greater than or equal to 200 mg/dl, and 2-h PG value greater than or equal to 200 mg/dl) to detect non-insulin-dependent diabetes in 130 diabetic Mexican Americans (MAs) and 50 diabetic Anglo Americans (AA) using the National Diabetes Data Group criteria as the standard. The sensitivity of the fasting plasma glucose (FPG) cutpoint in detecting diabetes was low in both AAs (36.0%) and MAs (59.3%) and was related to the age-adjusted prevalence rates of diabetes in the two ethnic groups (AAs, 4.9%; MAs, 10.9%). The 2-h PG load cutpoint had good sensitivity (greater than 93%) and specificity (greater than 99%) in both ethnic groups. The ethnic difference in the sensitivity of the FPG cutpoint appeared to be related to the greater hyperglycemia of diabetic MAs compared with diabetic AAs. Nearly 30% of diabetic MAs had FPG values greater than or equal to 200 mg/dl as contrasted with only 10% of diabetic AAs. The difference in severity of hyperglycemia between the ethnic groups appears to be unrelated to ethnic differences in adiposity, pharmacologic treatment, or delay in diagnosis, although longer disease duration in MAs may explain part of the difference.

Adult↗