Mobility Grant project of Ms Alejandra de Jesús Cantoral-Preciado
In order to strengthen the on-going research of cardio-metabolic diseases in Mexico at the Department of Public Health, University of Copenhagen, relevant for primary health care in Mexico the project coordinator has identified a very strong candidate, Dr. Alejandra de Jesús Catoral Preciado (AJCP), a nutritionist and epidemiologist at the National Institute of Public Health in Mexico; an institution with which the project coordinator would like to initiate scientific collaboration due to its high international standards and reputation. Mexico is among the top 10 countries in the world when it comes to diabetes and the closely related risk factor obesity. Research which tackles these problems is regarded as pivotal and urgently needed. At the overall level, diabetes and related cardio-vascular risk factors/diseases have over the past two decades turned into a major health problem in Mexico and is a growing burden on the health system including primary health care. The Mexican National Health and Nutrition Survey (2016) estimated that the prevalence of diabetes was 9.4%, being more prevalent in women than men (10.3% vs 8.4%). Diabetes is also the first cause of death in women and the leasing cause of Disability Adjusted Life Years in Mexico. Among others, diabetes related to pregnancy outcomes such as gestational diabetes is a problem – for the mother as well as for the off-spring. Furthermore, the long term risk of manifest diabetes in both mother and off-spring increases substantially following gestational diabetes. Foetal growth restriction due to maternal malnutrition may also be a risk factor for diabetes for the off-spring in adulthood.
Physical activity is an important parameter to study in the context of diabetes and pregnancy and/or the off-spring of mothers with adverse pregnancy courses. In Mexico physical activity in pregnant women has not been measured at the national level; however, a survey has shown that 15% of adult, Mexican women do not live up to the recommended minimum of 150 min/week of moderate-to-vigorous physical activity. Physical activity may prevent adverse outcomes in pregnancy by reducing obesity and diabetes in both the mother and off-spring. Thus, physical activity may act as a substitute for or complement reduced intake of medicine and potentially reduce the primary health care costs not only in pregnancy but also during ante-natal health care and into adulthood.
The main objective of this application is for AJCP to work on at least two scientific papers related to diabetes and hypertension, primarily in Mexican populations, based on a thesis handed in by a Mexican MSc Global Health student (supervised by the project coordinator) in 2016 at the Section of Global Health. This project is supposed to analyse and discuss diabetes, hypertension and maternal health in relation to primary health care in the context of the introduction of public health insurance (“Seguro Popular”) in Mexico.
Secondly, AJCP will participate in data collection with partners of the Department of Public Health at the Copenhagen University Hospital (Rigshospitalet). The project title of the study is: “Can exercise training revert and/or minimize the deleterious cardio-metabolic effects of carbohydrate overfeeding in individuals with and without increased risk of type 2 diabetes?” Here, a group of 25 adults born low birth weight (<2,500 g) but within term (wk. 37-41) will participate in a 16 weeks’ exercise and carbohydrate over-feeding intervention compared to an age-matched control group born normal birth weight undergoing a similar intervention. One of several aims is to investigate if carbohydrate overfeeding results in negative metabolic effects in a differential manner in low birth weight individuals and normal birth weight controls.
Thirdly, AJCP will assist in organising a seminar at the Department of Public Health on “Physical activity and cardio-metabolic risk factors in pregnancy: the impact on primary health care” planned for the spring of 2018. AJCP will do a lecture based on the scientific papers she will write on diabetes, hypertension, and maternal health in the context of primary health care. Apart from AJCP, health professionals and academics will be invited as speakers. AJCP will also present her results at a European diabetes epidemiology conference in Helsingør, Denmark in April, 2018.
The different sub-projects are inter-linked in a way so as to improve the professional skills and tools of AJCP, ranging from scientific writing (papers and applications) to data collection in the lab and finally dissemination of scientific results in an academic context. The common denominators are cardio-metabolic diseases, physical activity and maternal health to be applied in the context of primary health care in Mexico.
1) FFU proposal under 4. as given above was succesful, and the 3-year study is about to begin in the spring of 2020.
2) A 4-week medical course for UCPH medical students, ’International Study Exposure - Global Public Health’ has been moved from Krakow, Poland to Cuernavaca (National Institute of Public Health), Mexico in the autumn semester. The move was initiated based on a combination between the collaboration with Alejandra Cantoral and discussions with Mexican health professionals participating in the Danida ’Cardio-Metabolic Health and Disease’ courses at UCPH headed by the undersigned. The public health course for UCPH medical students is planned to continue on an annual basis.
1) Publication “Healthcare coverage and access to healthcare in the context of type 2 diabetes and hypertension in rural Mexico: A systematic literature review” in Public Health, vol. 181 (2020), pp. 8-15
2) Manuscript "Pre-pregnancy overwweight and weight gain during pregnancy increase the risk of gestational anemia" in peer-review in BMC Research Notes