THE PREVALENCE OF DIABETES AND ASSOCIATED CORONARY RISK-FACTORS IN URBAN AND RURAL OLDER MEXICAN POPULATIONS

OBJECTIVE: To determine the prevalence of diabetes and examine its ass ociation with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populati ons. DESIGN: A cross-sectional study. SETTING: Three Mexican communiti es turban areas of medium and low income and a rural area). PARTICIPAN TS: A total of 121 men and 223 women aged 60 years and older and 93 me n and 180 women aged 35 to 59 years were selected randomly for inclusi on in the survey, which was derived from the CRONOS study (Cross-Cultu ral Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community. MEASUREMENTS: A personal interview as sessed demographic information, personal medical history, and function al status, and a 24-hour diet recall was obtained. A physical examinat ion included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and gl ucose. RESULTS: Diabetes prevalence was higher in men than in women fo r 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 moro highly p revalent 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 ca rbohydrate intake in the diet (OR = 0.77; P < .03); central distributi on of adiposity (OR = 1.9; P < .03; and functional disability (OR = 2. 3; P < .01). This relationship was not observed with living area, inco me, education, fiber and alcohol intake, body mass index, or age. Indi viduals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertrigly ceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceride mia, and a proportionally higher fat intake. CONCLUSION: This survey c onfirms the high prevalence of diabetes in the older Mexican populatio n - particularly in men and in individuals living in urban areas - ass ociated with an increased prevalence of other coronary risk factors. D iabetes was associated with higher fat, low carbohydrate, low fiber di ets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertr iglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a surv ivorship effect must be considered in studies of older individuals. Th e 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.