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Objectives: The mechanisms behind the association between retinol-binding protein-4 (RBP4) and insulin resistance are not well understood. An interaction between iron and vitamin A status, of which RBP4 is a surrogate, has long been recognized. We hypothesized that iron-associated insulin resistance could be behind the impaired insulin action caused by RBP4.Research Design and Methods: Serum ferritin and RBP4 concentration and insulin resistance were evaluated in a sample of middle-aged men (n = 132) and in a replication independent study. Serum RBP4 was also studied before and after iron depletion in patients with type 2 diabetes. Finally, the effect of iron on RBP4 release was evaluated in vitro in adipose tissue.Results: A positive correlation between circulating RBP4 and log serum ferritin (r = 0.35 and r = 0.61, respectively; P < 0.0001) was observed in both independent studies. Serum RBP4 concentration was higher in men than women in parallel to increased ferritin levels. On multiple regression analyses to predict serum RBP4, log serum ferritin contributed significantly to RBP4 variance after controlling for BMI, age, and homeostasis model assessment value. Serum RBP4 concentration decreased after iron depletion in type 2 diabetic patients (percent mean difference -13.7 [95% CI -25.4 to -2.04]; P = 0.024). The iron donor lactoferrin led to increased dose-dependent adipose tissue release of RBP4 (2.4-fold, P = 0.005) and increased RBP4 expression, while apotransferrin and deferoxamine led to decreased RBP4 release.Conclusions: The relationship between circulating RBP4 and iron stores, both cross-sectional and after iron depletion, and in vitro findings suggest that iron could play a role in the RBP4-insulin resistance relationship. [ABSTRACT FROM AUTHOR]

Objective: To compare the anthropometric, alimentary, nutritional and lipid profiles and global diet quality of Spanish children according to saturated fat intake.Design: This was a cross-sectional study. Food data were collected using a food-frequency questionnaire.Subjects and Methods: The sample included 1112 children of both sexes, aged between 6 and 7 years, selected by means of random cluster sampling in schools. The plasma lipid profile included measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein A1 (apoA1) and apolipoprotein B (apoB). Global diet quality was evaluated by the Dietary Variety Index (DVI) and the Healthy Eating Index (HEI).Results: Energy intake, DVI and HEI of children from the lower quartile of saturated fat intake (LL) were higher (P<001) than in the remaining children (UL). However, there were no significant differences in average height or weight between groups. The UL children had lower intakes of meat, fish, vegetables, fruits and olive oil and a higher intake of dairy products (P<0.001). The intakes of fibre, vitamins C, D, B6, E and folic acid were higher in the LL children, who had lower intakes of vitamin A and calcium. The ratios LDL-C/HDL-C and apoB/apoA1 were lower (P=0.04) in the LL children (1.87 and 0.52, respectively) than in the UL children (2.02 and 0.54, respectively).Conclusions: The growth rate of children does not seem to be affected by the level of saturated fat intake. Furthermore, at the levels of intake observed in this study, diets with less saturated fat are associated with better alimentary, nutritional and plasma lipid profiles. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although an important secondary prevention trial reported an impressive protection by a Mediterranean dietary pattern on reinfarction and cardiovascular death, scarce direct epidemiologic evidence is currently available regarding the role of the Mediterranean diet in the aetiology of coronary heart disease. AIMS: The aim of the study was to quantify the risk reduction of incident myocardial infarction provided by a Mediterranean dietary pattern. METHODS: We included 342 subjects (171 patients who suffered their first acute myocardial infarction and 171 matched controls) in a case-control study. A validated semi-quantitative food frequency questionnaire (136 items) was used. We defined an a priori Mediterranean dietary pattern. We assessed six food items that we considered protective: 1) olive oil, 2) fiber, 3) fruits, 4)vegetables, 5) fish and 6) alcohol. For each of these six dietary factors, we calculated the distribution according to quintiles within the study and assigned each participant a score of 1 to 5 corresponding to the quintile of intake, with 1 representing the lowest and 5 representing the highest quintile. We also estimated the quintiles of two other elements assumed to be associated with a higher risk: 7) meat/meat products and 8) some items with high glycaemic load (white bread, pasta and rice). For these two elements we inversely ranked the score, with 1 representing the highest and 5 representing the lowest quintile. Finally, we summed up the eight quintile values for each participant.A second score ( post hoc pattern) was built using only a single cut-off point for these eight elements. The cut-off points for each element in this post hoc pattern were decided according to the dose-response relationships between the consumption of each food item and the risk of myocardial infarction observed in the analyses that used quintiles of each food item. RESULTS: For both patterns, we found that the higher the score, the lower the odds ratio of myocardial infarction. A significant linear trend was apparent after adjustment for the main cardiovascular risk factors. For each additional point in the a priori Mediterranean pattern (observed range: 9-38) the odds ratio (95 % confidence intervals) was 0.92 (0.86-0.98). This estimate was 0.55 (0.42-0.73) when we used the post hoc pattern (range: 0-8). CONCLUSIONS: Our data support the hypothesis that a Mediterranean diet (that emphasizes olive oil, fiber, fruits, vegetables, fish and alcohol and reduces meat/meat products) can be an effective measure for reducing the risk of myocardial infarction. However, our results support the exclusion of refined cereals with a high glycaemic load as healthy elements of this pattern. [ABSTRACT FROM AUTHOR]

Presents information on a study which evaluated glycemic control and insulin requirements in diabetic patients who received total parenteral nutrition. Demographic characteristics; Statistical analysis; Results and discussion.

Purpose To report the comparative efficacy of intravitreal bevacizumab and ranibizumab in the treatment of diabetic macular oedema (DME). Methods Interventional, case report series. Two patients who were on treatment for DME by monthly intravitreal ranibizumab in one eye, were started on treatment by intravitreal bevacizumab for DME in the fellow eye. The patients were monthly evaluated by complete ocular examination, best corrected visual acuity (BCVA) performed by certified optometrists and Stratus optical coherence tomography (OCT). Results Eyes treated by intravitreal ranibizumab showed a complete resolution of DME as documented by OCT and significantly improved BCVA. DME recurred after two to three months requiring further injections. The fellow eyes showed a progression of DME and decreased BCVA while untreated. Intravitreal bevacizumab did not induce any significant change in macular thickness or BCVA and did not prevent DME progression. Conclusion Intravitreal ranibizumab seems to improve BCVA and macular thickness in DME though recurrence of the condition makes it necessary to repeat intravitreal injections. Intravitreal bevacizumab does not seem to reduce macular thickness or improve visual function in patients with DME in whom good results had been observed after intravitreal ranibizumab. Commercial interest [ABSTRACT FROM AUTHOR]

Purpose To report the efficacy of photodynamic therapy with Visudyne (PDT) associated with two different concentrations of intravitreal triamcinolone (TA) to treat subfoveal choroidal neovascularization (CNV) secondary to age related macular degeneration (AMD). Methods Prospective, controlled, randomized, multicenter, phase IIIb clinical trial. Fifty five eyes from 55 patients presenting CNV secondary to AMD were randomized to be treated by PDT as monotherapy, PDT associated with 4mg TA or PDT associated with 20mg TA. Primary outcome measure was the average change in visual acuity at one year. Secondary outcome measures were the proportion of patients with severe vision loss (≥15 letters) at one year, the proportion of patients with moderate vision loss (<15 letters) and CNV activity as determined by fluorescein angiography at three month intervals, and the appearance of side effects. Results No statistically significant differences were observed for the average change in visual acuity and for the proportion of patients with severe vision loss at one year. The proportion of patients with moderate vision loss was higher among patients treated by PDT combined with 4mg TA at 3 and 6 months. The most frequent adverse events were increased intraocular pressure and retinal pigment epithelium detachment. Conclusion Combined treatment PDT‐4mg TA may increase the proportion of patients with moderate vision loss at month 3 and 6 compared with PDT monotherapy and combined PDT‐20mg TA. [ABSTRACT FROM AUTHOR]

Background: A major component of disability is related to chronic disease, but the study of self-reported causes of disability could add new aspects in understanding this process. The main objective of this work was to determine the associations between chronic diseases and disability and to describe the pattern of self-reported causes of the disabilities present in older persons.Methods: We carried out a survey in a probabilistic sample of people aged 65 and older of the city of Madrid. The initial sample size was 1001. Subjects were interviewed in their homes. We asked about the presence of 14 chronic conditions. Self-reported difficulty and dependence in 9 noninstrumental activities of daily living (ADLs) were ascertained. Subjects were asked to report the main cause responsible for the disability. Multivariate logistic regression models were constructed to estimate the association of each chronic condition with the probability of having disability.Results: Final sample size was 772 people (overall response rate 77.0%). Interviews answered by proxies were 7.5%. Only 4.5% declared no chronic condition. Osteoarthitis/rheumatism was the most prevalent condition (56.8%). In addition, 63.2% were independent, 21.3% were independent with difficulty (in at least one ADL), and 15.5% were dependent (in at least one ADL). Subjects attributed to osteoarthitis and to aging 41.8% and 17.1% of all disabilities, respectively. Chronic conditions strongly associated with disability were cerebrovascular disease (adjusted odds ratio [OR]: 3.51 [95% confidence interval: 1.44-8.60]), depression/anxiety disorders (OR: 2.72 [1.83-4.05]), and diabetes (OR: 2.18 [1.24-3.83]).Conclusions: Cerebrovascular diseases, depression/anxiety disorders, and diabetes were the conditions more clearly related to disability. On the other hand, a large proportion of subjects attribute their disabilities to osteoarthritis and old age. [ABSTRACT FROM AUTHOR]