The UP AMIGOS project: Testing the predictive validity of the 2007 Pediatric Expert Committee Recommendations in Latinos

Flood, Tracy L.

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Description

Title

The UP AMIGOS project: Testing the predictive validity of the 2007 Pediatric Expert Committee Recommendations in Latinos

Author(s)

Flood, Tracy L.

Issue Date

2011-08-25T22:20:04Z

Director of Research (if dissertation) or Advisor (if thesis)

Graber, Kim C.

Doctoral Committee Chair(s)

Graber, Kim C.

Committee Member(s)

• Buchner, David
• Andrade, Flavia
• Motl, Robert W.
• Teran-Garcia, Margarita D.

Department of Study

Kinesiology & Community Health

Discipline

Kinesiology

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• obesity
• child
• childhood
• pediatric
• expert
• committee
• liver
• nonalcoholic fatty liver disease (NAFLD)
• type 2 diabetes mellitus
• glucose
• Aspartate transaminase (AST)
• Alanine aminotransferase (ALT)
• recommendations
• sensitivity
• specificity

Abstract

Background. Mexicans are disproportionately affected by cardiovascular disease and there is mounting evidence that Mexicans may be genetically prone to the development of cardiovascular disease (CVD) risk factors. Objective. There were three aims of study. The first aim was to identify the prevalence of three CVD risk factors in Mexican young adults: (1) non-alcoholic fatty liver disease (NAFLD), (2) dyslipidemia, and (2) impaired fasting glucose. The second aim was to test the sensitivity and specificity of the Pediatric Expert Committee Recommendations (PECR) in identifying Mexicans with these three cardiovascular disease risk factors. Finally, the third aim was to explore ways to improve the clinical screening algorithm. Methods. In this cross-sectional study, data for UP AMIGOS were collected from 9,974 participants (age 18- to 21-years-old) living in Central Mexico. Participants underwent a health screen that included: a questionnaire, anthropometric measurements (i.e. height, weight, waist circumference, blood pressure), a physician-conducted history and physical, and venipuncture for blood biomarkers. Analysis. In order to determine prevalence of CVD risk factors, descriptive statistics were run making comparisons in prevalence by sex and weight category: normal weight, overweight, or obese. The value of the PECR was measured with sensitivity, specificity, and positive predictive value, with additional tests for significant associations. Alternative algorithms were explored using classification and regression tree analysis. Results. NALFD (17.1 to 45.5%) and dyslipidemia (44.8%) were fairly prevalent. In contrast, impaired fasting glucose (IFG) was rare (4.0%). Each CVD risk factor increased with increasing levels of adiposity. The PECR provided a reasonable clinical screen for NALFD, but was fairly insensitive in detecting those with dyslipidemia or IFG. Multiple exploratory analyses revealed more sensitive screening solutions for each individual CVD disease risk factor, but at the cost of having a less parsimonious clinical screen. Significance. Mexican adolescents and young adults already have a high prevalence of CVD risk factors. These risk factors may go unnoticed and eventually convert to irreversible disease, unless a valid, predictive screening protocol is established. Based on this analysis, screening recommendations are three-fold: (1) Universal screening for dyslipidemia is recommended for Mexican young adults, (2) IFG screening is not recommended in adolescents or young adults, (3) the PECR may be a reasonable clinical screen for NALFD, but more data is needed.

Graduation Semester

2011-08

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Copyright 2011 Tracy L. Flood

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