INTRODUCTION It would be useful to have diagnostic indices for obesity phenotypes in pregnant women based on morphological traits and the specific distribution of abdominal adipose tissue. This type of practical resource would allow for the classification of obesity phenotypes in normal-weight women in early pregnancy and would contribute to primary healthcare followup of pregnant women.
OBJECTIVES Validate a new diagnostic index for the metabolically unhealthy obese, normal-weight phenotype, as a determinant for cardiometabolic risk in normal-weight pregnant Cuban women in the first trimester of pregnancy.
METHODS A cross-sectional study of 526 pregnant women at a gestational age of 12 to 14 weeks seen at the ultrasound service of the Chiqui Gómez Lubián Teaching Polyclinic, Santa Clara municipality, Villa Clara province, Cuba, was conducted from January 2016 through July 2020. Subcutaneous, preperitoneal and visceral abdominal fats, as well as anthropometric and blood chemistry variables, were measured. The women were divided into three groups based on metabolic phenotypes, taking into account body mass index in the normal weight range, visceral adiposity index values and the lipid accumulation product starting at the 75th percentile.
The new index, called the abdominal adipose deposit index, was obtained by multiplying the subcutaneous fat thickness by visceral fat thickness, both measured by ultrasound. A cutoff point was established that facilitated discernment of an unhealthy phenotype: normal weight but metabolically obese, a cardiometabolic risk factor.
RESULTS Receiver operating characteristic (ROC) analysis of the abdominal adipose deposit index to distinguish the metabolically unhealthy obese, normal-weight phenotype in normal-weight pregnant women showed an area under the curve of 0.707 (95% CI: 0.62‒0.79, p <0.001), greater than that of the body fat index (0.630; 95% CI: 0.54‒0.72), the fat accumulation index (0.637; 95% CI: 0.55‒0.73) and other established ultrasound indices of abdominal adiposity, with a prevalence of 6.3%.
CONCLUSIONS The abdominal adipose deposit index is better than other traditional indicators at detecting the risk of metabolic obesity in early pregnancy in normal-weight women, facilitating early intervention in clinical practice to prevent or delay progression of cardiometabolic disease in these women.
KEYWORDS Abdominal adipose tissue, abdominal fat, pregnant woman, phenotype, metabolic syndrome, diagnostic ultrasound, Cuba
In the last 20 years obesity has emerged as one of the top causes of preventable deaths worldwide and is a health problem for adult women globally; according to WHO, in 2014, 40% were overweight and 15% obese.[1]
Pregnancy brings risk for excessive weight gain and can result in short-, medium- or long-term postpartum weight retention. In some women, the result is obesity. Excessive weight gain during pregnancy is a powerful risk factor for new and persistent obesity. What’s more, women who have given birth once or twice are three to four times more likely to become obese in the five years following childbirth than women who have had no children during the same period.[2]
INTRODUCTION One reason given by the South African government for establishing a physician training agreement with Cuba is that the ethical, humanistic and solidarity principles promoted in Cuban medical education are difficult to acquire in other settings. However, Cuba’s general medical training program does not provide all skills needed by a general practitioner in South Africa: other competencies are required, such as management of general and gynecological or obstetrical surgical emergencies, administration of anesthesia and nursing procedures. As long as the desired humanistic values were assured, South African authorities have preferred to complement these competencies. Thus, since 2003, the Medical University of Villa Clara has applied a curricular strategy of 12 complementary courses to develop the requested additional skills, but results have not met expectations.
OBJECTIVE Determine why the complementary curricular strategy has not been entirely successful and identify possible courses of action for improvement.
METHODS A document review was conducted of the curricular strategy applied and of minutes of meetings between Cuban and South African counterparts to identify correspondence between requested professional skills and actions to develop them. In addition, South African students were surveyed and Cuban professors were interviewed in depth. Senior university administrators and key informants were also interviewed. Variables assessed were course quality and satisfaction of students and professors.
RESULTS Some actions originally included in the curricular strategy were not implemented and there were structural weaknesses in complementary courses, primarily in objectives, teaching strategy and evaluation. Students reported insufficient practical activities and lack of relationship between content and the health situation in South Africa. Professors were dissatisfied with student levels of motivation and ability to manage their own learning. Other influencing factors were insufficient academic management and professors’ lack of knowledge about the context where these future professionals would eventually practice.
CONCLUSIONS Curricular strategy deficiencies detected are primarily in academic management; overcoming them could facilitate action in specific directions identified to improve the requested skill levels.
KEYWORDS Evaluation, qualitative evaluation, curriculum, competency-based education, professional competence, medical education, clinical skills, international educational exchange, Cuba, South Africa
