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BACKGROUND: Longitudinal data assessing the impact of Iodine deficiency on mortality are scarce. We aimed to study the association between the state of iodine nutrition and the risk of total and cause-specific mortality in a representative sample of the Spanish adult population.; METHODS: We performed a longitudinal observational study to estimate mortality risk according to urinary iodine (UI) concentrations using a sample of 4370 subjects >18 years representative of the Spanish adult population participating in the nation-wide study Di@bet.es (2008-2010). We used Cox regression to assess the association between UI at the start of the study (

Objective: To analyze the reference range of thyroid-stimulating hormone (TSH) in different BMI categories and its impact on the classification of hypothyroidism. Methods: The study included 3,928 individuals free of thyroid disease (without previous thyroid disease, no interfering medications, TSH < 10 mu UI/mL and thyroid peroxidase antibodies [TPO Abs] < 50 IU/mL) who participated in a national, cross-sectional, population-based study and were representative of the adult population of Spain. Data gathered included clinical and demographic characteristics, physical examination, and blood and urine sampling. TSH, free thyroxine, free triiodothyronine, and TPO Ab were analyzed by electrochemiluminescence (E170, Roche Diagnostics, Basel, Switzerland). Results: The reference range (p2.5-97.5) for TSH was estimated as 0.6 to 4.8 mu UI/mL in the underweight category (BMI= 40). By using the reference criteria for the normal-weight population, the prevalence of high TSH levels increased threefold in the morbid obesity category (P < 0.01). Conclusions: Persons with morbid obesity might be inappropriately classified if the standard ranges of normality of TSH for the normal-weight population are applied to them.

Caso clínico Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption. Yes El adenocarcinoma gástrico es una de las causas más frecuentes de mortalidad en el mundo, siendo la cirugía el único tratamiento potencialmente curativo, aunque los efectos adversos digestivos y nutricionales son frecuentes y abundantes. La hipogammaglobulinemia variable común es causa de frecuentes manifestaciones digestivas, derivándose las más importantes en diarrea crónica causada por giardiasis, hiperplasia nodular linfoide o atrofia vellosa, siendo frecuente la malabsorción y la desnutrición. Los déficits nutricionales secundarios a la malabsorción (postgastrectomía y asociada a la atrofia vellosa y la giardiasis por hipogammaglobulinemia variable común) son asimismo frecuentes. Presentamos el caso de un paciente gastrectomizado por adenocarcinoma gástrico y con hipogammaglobulinemia variable común e infestación crónica por giardiasis que presenta una importante diarrea crónica refractaria a tratamiento y malabsorción.

Background: Abdominal obesity (AO) is a common modifiable risk factor for certain non-communicable diseases associated with enhanced oxidative stress (OS). The objective of this work was to investigate whether the interaction between antioxidant vitamin intake and OS-related polymorphisms modulates gene-associated anthropometry in a Spanish population. Methods: A total of 246 subjects with AO, and 492 age and gender matched non-AO subjects were included in the study. Anthropometric, biochemical, and OS parameters, and antioxidant dietary intake data were assessed using validated procedures. DNA from white blood cells was isolated and the genotype of seven polymorphisms from genes involved in OS (pro-oxidant and antioxidant) were analyzed using the SNPlex system. The effects of the c.-793T > C polymorphism on promoter activity and thus thioredoxin (TXN) activity were examined using reporter assays. Results: The AO group had higher 8-Oxo-2'-deoxyguanosine levels and took in less vitamin A and vitamin E compared to the non-AO group. Logistic regression analysis revealed that the rs2301241 polymorphism in TXN and rs740603 in catechol-O-methyltransferase (COMT) were associated with waist circumference (WC) and AO. Moreover, these polymorphisms were more strongly associated with variations in WC in subjects with low vitamin E intakes. A promoter assay revealed that the T to C conversion at c.-793 (rs2301241) induced a more than two fold increase in reporter gene expression. Conclusions: WC is associated both with dietary vitamin E intake and genetic variants of TXN and COMT suggesting that existence of a complex nutrigenetic pathway that involves regulation of AO.

10.1111/eci.12002

Se ha estudiado la flora y vegetación de dos de los afloramientos perido¬títicos del sur de la Península Ibérica, que incluyen la Sierra de Alpujata (71 Km2) y La Robla (7 Km2) en la provincia de Málaga. La flora serpentinícola muestra características diferentes del resto de la flora que vive sobre suelos zonales, debido a las limitaciones causadas por la composición de los suelos serpentínicos. Los resultados muestran una presencia elevada de serpentinófitos (18 de un total de 27) de los cuales 13 son ser¬pentinófitos estrictos aunque ninguno es exclusivo de las sierras estudiadas. En cuanto a la vegetación, casi todas las asociaciones y comunidades son endémicas de sustratos serpentínicos. Se describe una subasociación nueva y se reivindican, invierten y corrigen nombres de sintaxones. El paisaje vegetal está dominado por matorrales edafoxerófilos (Staehelino-Ulicion baetici), formaciones climácicas de pinos (Pinus pinaster) y coscojas (Quercus coccifera) (Pino-Juniperion phoeniceae), comunidades edafohigrófilas de sau¬cedas (Salicion pedicellatae) y juncales (Molinio-Holoschoenion). La Sierra de Alpujata es el tercer afloramiento del sur de la Península en cuanto a riqueza en vegetación ser¬pentinícola, por detrás solo de Sierra Bermeja y Sierra de las Nieves peridotítica (Sierra Parda). La presencia de especies endémicas y protegidas junto a sus hábitats incluidos en la Directiva 92/43CEE hacen de la Sierra de Alpujata una candidata a ser declarada como LIC (Lugar de Inetrés Comunitario). Este trabajo podría ser de gran valor para el seguimiento de la restauración y regeneración de la Sierra de Alpujata tras el incendio sufrido en el verano de 2012. Iberian serpentine flora and vegetation: Alpujata and La Robla mountains (Malaga, Spain). The flora and vegetation of two peridotite outcrops in the south of the Iberian Peninsula have been studied: Sierra de Alpujata (71 Km2) and La Robla (7 Km2) in the province of Malaga. Serpentine flora and vegetation show different characteris¬tics from the rest of the flora that lives on zonal soils, due to the limitations caused by the serpentine soil composition. The results show a high presence of serpentinophytes (18 out of 27) of which 13 are obligate serpentinophytes although none is exclusive from the studied outcrops. In terms of vegetation, almost all associations and com¬munities are endemic to serpentine substrates. A new subassociation is described and some syntaxa names are claimed, reversed or corrected. The landscape is dominated by xerophytic shrublands (Staehelino-Ulicion baetici), climax communities of pine (Pinus pinaster) and shrub oaks (Quercus coccifera) (Pino-Juniperion phoeniceae) and ripar¬ian forests (Salicion pedicellatae) mixed with higrophytic grasslands on wet soils and streams (Molinio-Holoschoenion). Sierra de Alpujata is the third outcrop of the south of the Iberian Peninsula regarding serpentine vegetation richness, after Sierra Bermeja and Sierra de las Nieves (peridotites of Sierra Parda). The presence of endemic and protected species together with their habitats included in the 92/43/EU Directive may drive Sierra de Alpujata to be a candidate to obtain the declaration of SCI (Site of Comunitarian Interest). This work could be of great value to monitor the restoration and regeneration of Sierra de Alpujata after the fire in the summer of 2012.

10.1155/2012/872305 Objective. To evaluate the association between diabetes mellitus and health-related quality of life (HRQOL) controlled for several sociodemographic and anthropometric variables, in a representative sample of the Spanish population. Methods. A population-based, cross-sectional, and cluster sampling study, with the entire Spanish population as the target population. Five thousand and forty-seven participants (2162/2885 men/women) answered the HRQOL short form 12-questionnaire (SF-12). The physical (PCS-12) and the mental component summary (MCS-12) scores were assessed. Subjects were divided into four groups according to carbohydrate metabolism status: normal, prediabetes, unknown diabetes (UNKDM), and known diabetes (KDM). Logistic regression analyses were conducted. Results. Mean PCS-12/MCS-12 values were /, respectively. Men had higher scores than women in both PCS-12 ( versus ; ) and MCS-12 ( versus ; ). Increasing age and obesity were associated with a poorer PCS-12 score. In women lower PCS-12 and MCS-12 scores were associated with a higher level of glucose metabolism abnormality (prediabetes and diabetes), ( for trend), but only the PCS-12 score was associated with altered glucose levels in men ( for trend). The Odds Ratio adjusted for age, body mass index (BMI) and educational level, for a PCS-12 score below the median was 1.62 (CI 95%: 1.2–2.19; ) for men with KDM and 1.75 for women with KDM (CI 95%: 1.26–2.43; ), respectively. Conclusion. Current study indicates that increasing levels of altered carbohydrate metabolism are accompanied by a trend towards decreasing quality of life, mainly in women, in a representative sample of Spanish population.

Summary: The main objective was to evaluate the association between SNPs and haplotypes of the FABP1-4 genes and type 2 diabetes, as well as its interaction with fat intake, in one general Spanish population. The association was replicated in a second population in which HOMA index was also evaluated. Methods: 1217 unrelated individuals were selected from a population-based study [Hortega study: 605 women; mean age 54 y; 7.8% with type 2 diabetes]. The replication population included 805 subjects from Segovia, a neighboring region of Spain (446 females; mean age 52 y; 10.3% with type 2 diabetes). DM2 mellitus was defined in a similar way in both studies. Fifteen SNPs previously associated with metabolic traits or with potential influence in the gene expression within the FABP1- 4 genes were genotyped with SNPlex and tested. Age, sex and BMI were used as covariates in the logistic regression model. Results:One polymorphism (rs2197076) and two haplotypes of the FABP-1 showed a strong association with the risk of DM2 in the original population. This association was further confirmed in the second population as well as in the pooled sample. None of the other analyzed variants in FABP2, FABP3 and FABP4 genes were associated. There was not a formal interaction between rs2197076 and fat intake. A significant association between the rs2197076 and the haplotypes of the FABP1 and HOMA-IR was also present in the replication population. Conclusions: The study supports the role of common variants of the FABP-1 gene in the development of type 2 diabetes in Caucasians.

El adenocarcinoma gástrico es una de las causas más frecuentes de mortalidad en el mundo, siendo la cirugía el único tratamiento potencialmente curativo, aunque los efectos adversos digestivos y nutricionales son frecuentes y abundantes. La hipogammaglobulinemia variable común es causa de frecuentes manifestaciones digestivas, derivándose las más importantes en diarrea crónica causada por giardiasis, hiperplasia nodular linfoide o atrofia vellosa, siendo frecuente la malabsorción y la desnutrición. Los déficits nutricionales secundarios a la malabsorción (postgastrectomía y asociada a la atrofia vellosa y la giardiasis por hipogammaglobulinemia variable común) son asimismo frecuentes. Presentamos el caso de un paciente gastrectomizado por adenocarcinoma gástrico y con hipogammaglobulinemia variable común e infestación crónica por giardiasis que presenta una importante diarrea crónica refractaria a tratamiento y malabsorción. Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers). © 2009 Elsevier B.V.

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers). (C) 2009 Elsevier B.V. All rights reserved.

SEEDO consensus ' 2000 for the evaluation of overweight and obesity and the establishment of criteria for therapeutic intervention. Consenso SEEDO' 2000 para la evaluación del sobrepeso y la obesidad y el establecimiento de criterios de intervención terapéutica.

To find the evolution of consumption of self-analysis material used to control Diabetes (reactive strips of glucose) and the costs involved, in the metropolitan area of Málaga from July 1994 to the first quarter of 1996.Descriptive retrospective study.Metropolitan area of Málaga (580, 586 inhabitants), which is divided in two HEALTH DISTRICTS: Málaga East and West.All diabetics using reactive strips in the metropolitan area of Málaga which are charged to the National Health system.The data base of the health districts of the metropolitan area of Málaga was used for the review of public prescriptions of reactive strips. Consumption in relation to the total population was analysed and the average consumption per diabetic was calculated. The total number of patients for whom reactive strips were prescribed increased considerably over the three years studied.A considerable increase in consumption of glucose reactive strips was observed in recent years in the metropolitan area of Málaga, mainly because of its generalised use among elderly patients. Consumption of urine strips was small and tended to fall.

Recent studies suggest that the biological effects of saturated fatty acids depend on the length of their chain. We compared the effect of diets containing different fatty acids on plasma lipids and lymphocyte proliferation in the presence of lovastatin and with increasing amounts of LDL. Lymphocytes from rats fed with a diet rich in palmitic acid had a greater lymphocyte proliferation capacity than those from rats fed with diets rich in oleic acid, linoleic acid, or fish oil. This effect was maintained when small amounts of polyunsaturatwed fatty acids (PUFA; sunflower oil) were added to the palmitic acid diet. LDL receptor activity, measured by the capacity of lovastatin to revert the inhibition of lymphocyte proliferation with increasing amounts of LDL in the medium, was greater in the rats fed with palmitic acid, and was similar to the other groups when small amounts of PUFA were added. All the groups had similar levels of plasma cholesterol, but the LDL levels were significantly lower in the group fed with palmitic acid plus PUFA. The highest HDL-cholesterol (HDLc) levels were found in the palmitic acid group and the lowest LDL-cholesterol (LDLc)/HDLc ratio in the palmitic acid plus PUFA group. These results suggest that diets rich in palmitic acid do not raise total cholesterol, but reduce LDLc or keep it normal, and raise HDLc levels. This effect may be partly due to an increase in LDL receptor activity. The inclusion of small amounts of PUFA in the diet rich in palmitic acid substantially modified the LDL receptor response in the lymphocytes, suggesting that the proportion of different families of dietary fatty acids may be more important than the individual amount of each in absolute terms to explain their effects on plasma lipids and lipoproteins.

Tendencies in the consumption of antidiabetic agents in Andalusia between 1986-1994 were analysed, with special emphasis on the impact of the introduction of acarbose and mechanized systems for the injection of insulin.The information concerning consumption was obtained from the data bases of the Andalusian Health Service and the Ministry of Health which contain details of the items sold in community chemists and charged to the National Health System. Data are expressed as defined daily doses per 1000 inhabitants per day (DID).Insulin consumption rose from 4.67 DID in 1986 to 9.33 DID en 1994, an increase (delta) of 99.8%. All types of insulins contributed to the increase, with the mixtures rising most (delta 275%). Intermediate insulins were the most used. Prefilled syringes accounted for 25% of all insulin dispensed in 1994. Consumption of oral antidiabetic agents (OAA) rose from 12.75 DID in 1986 to 20.92 DID in 1994 (delta 64%). The most prescribed OAAs during these years were second generation sulphonylureas, representing 83% of those dispensed in 1994, followed by acarbose (11%), biguanides (3.8%), and first generation sulphonylureas (2.1%).There was a notable increase in the consumption of insulins and OAAs. Although the tendency in the consumption differs from that expected according to consensus agreements, qualitative changes were seen, suggesting an improvement in prescription habits. The appearance of mechanized injection systems for insulin and of acarbose have clearly modified prescription habits.

To analyse the prescription of insulin and oral diabetic medication (ODM) in primary health care, and to evaluate which variables, depending on the prescribing doctor, work-place or population attended, explain quality and/or quantity variations in prescription.Crossover, observational study.Málaga-Este Health District, Málaga.21,166 prescriptions issued by 144 doctors in the Málaga-Este Health District during the first quarter of 1997 were analysed.Insulin consumption of 10.63 defined daily doses per 1,000 inhabitants and day (DID) and ODM of 18.51 DID were calculated. No significant differences were observed in insulin or ODM prescription for sex, and few for age, job or doctors' specialty via MIR (intern) training. Working in a centre with MIR teaching and in a reformed centre were significantly associated with a greater use of insulin (p0.0001 and p0.02, respectively). Having a higher allocation of patients drawing pensions meant a greater consumption of insulin (p0.01) and even more of ODM (p0.0001). The population allocated being older was associated with greater consumption of ODM without any changes in insulin prescription.The personal features of doctors working in primary care affect very little the quantity and quality of insulin and ODM prescription. The characteristics of the work-place (reformed centre and centre entitled to teach) and the population attended (older and drawing a pension) are the main factors conditioning the amount of prescription of insulin and ODM, respectively. Nevertheless, in all cases ODM prescription quality is low.

Genome-wide association studies (GWAS) have found few common variants that influence fasting measures of insulin sensitivity. We hypothesized that a GWAS of an integrated assessment of fasting and dynamic measures of insulin sensitivity would detect novel common variants. We performed a GWAS of the modified Stumvoll Insulin Sensitivity Index (ISI) within the Meta-Analyses of Glucose and Insulin-Related Traits Consortium. Discovery for genetic association was performed in 16,753 individuals, and replication was attempted for the 23 most significant novel loci in 13,354 independent individuals. Association with ISI was tested in models adjusted for age, sex, and BMI and in a model analyzing the combined influence of the genotype effect adjusted for BMI and the interaction effect between the genotype and BMI on ISI (model 3). In model 3, three variants reached genome-wide significance: rs13422522 (NYAP2; P = 8.87 × 10−11), rs12454712 (BCL2; P = 2.7 × 10−8), and rs10506418 (FAM19A2; P = 1.9 × 10−8). The association at NYAP2 was eliminated by conditioning on the known IRS1 insulin sensitivity locus; the BCL2 and FAM19A2 associations were independent of known cardiometabolic loci. In conclusion, we identified two novel loci and replicated known variants associated with insulin sensitivity. Further studies are needed to clarify the causal variant and function at the BCL2 and FAM19A2 loci.

Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM; ISCIII Ministerio de Ciencia e Innovacion); Ministerio de Sanidad y Consumo; Spanish Diabetes Society (SED), Brugnara, L., Murillo, S., Novials, A., Rojo-Martínez, G., Soriguer, F., Goday, A., Calle-Pascual, A., Castaño, L., Gaztambide, S., Valdés, S., Franch, J., Castell, C., Vendrell, J., Casamitjana, R., Bosch-Comas, A., Bordiú, E., Carmena, R., Catalá, M., Delgado, E., Girbés, J., López-Alba, A., Martínez-Larrad, M.T., Menéndez, E., Mora-Peces, I., Pascual-Manich, G., Serrano-Ríos, M., Gomis, R., Ortega, E.

Background Abdominal obesity (AO) is a common modifiable risk factor for certain non-communicable diseases associated with enhanced oxidative stress (OS). The objective of this work was to investigate whether the interaction between antioxidant vitamin intake and OS-related polymorphisms modulates gene-associated anthropometry in a Spanish population. Methods A total of 246 subjects with AO, and 492 age and gender matched non-AO subjects were included in the study. Anthropometric, biochemical, and OS parameters, and antioxidant dietary intake data were assessed using validated procedures. DNA from white blood cells was isolated and the genotype of seven polymorphisms from genes involved in OS (pro-oxidant and antioxidant) were analyzed using the SNPlex system. The effects of the c.-793T > C polymorphism on promoter activity and thus thioredoxin (TXN) activity were examined using reporter assays. Results The AO group had higher 8-Oxo-2′-deoxyguanosine levels and took in less vitamin A and vitamin E compared to the non-AO group. Logistic regression analysis revealed that the rs2301241 polymorphism in TXN and rs740603 in catechol-O-methyltransferase (COMT) were associated with waist circumference (WC) and AO. Moreover, these polymorphisms were more strongly associated with variations in WC in subjects with low vitamin E intakes. A promoter assay revealed that the T to C conversion at c.-793 (rs2301241) induced a more than two fold increase in reporter gene expression. Conclusions WC is associated both with dietary vitamin E intake and genetic variants of TXN and COMT suggesting that existence of a complex nutrigenetic pathway that involves regulation of AO. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0652-4) contains supplementary material, which is available to authorized users.

CIBERDEM (Ministerio de Economía, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad-ISCIII, Instituto de Salud Carlos III (PI17/02136, PI20/01322), European Regional Development Fund (ERDF) “A way to build Europe”. Ayudas a la investigación SED 2020., Doulatram-Gamgaram, V., Valdés, S., Maldonado-Araque, C., Lago-Sampedro, A., Badía-Guillén, R., García-Escobar, E., García-Serrano, S., García-Vivanco, M., Garrido, J.L., Theobald, M.R., Gil, V., Martín-Llorente, F., Calle-Pascual, A., Bordiu, E., Castaño, L., Delgado, E., Franch-Nadal, J., Chaves, F.J., Montanya, E., Galán-García, J.L., Aguilera-Venegas, G., Soriguer, F., Rojo-Martínez, G.

Objective. To evaluate the association between diabetes mellitus and health-related quality of life (HRQOL) controlled for several sociodemographic and anthropometric variables, in a representative sample of the Spanish population.Methods. A population-based, cross-sectional, and cluster sampling study, with the entire Spanish population as the target population. Five thousand and forty-seven participants (2162/2885 men/women) answered the HRQOL short form 12-questionnaire (SF-12). The physical (PCS-12) and the mental component summary (MCS-12) scores were assessed. Subjects were divided into four groups according to carbohydrate metabolism status: normal, prediabetes, unknown diabetes (UNKDM), and known diabetes (KDM). Logistic regression analyses were conducted.Results. Mean PCS-12/MCS-12 values were50.9±8.5/47.6±10.2, respectively. Men had higher scores than women in both PCS-12 (51.8±7.2versus50.3±9.2;P<0.001) and MCS-12 (50.2±8.5versus45.5±10.8;P<0.001). Increasing age and obesity were associated with a poorer PCS-12 score. In women lower PCS-12 and MCS-12 scores were associated with a higher level of glucose metabolism abnormality (prediabetes and diabetes), (P<0.0001for trend), but only the PCS-12 score was associated with altered glucose levels in men (P<0.001for trend). The Odds Ratio adjusted for age, body mass index (BMI) and educational level, for a PCS-12 score below the median was 1.62 (CI 95%: 1.2–2.19;P<0.002) for men with KDM and 1.75 for women with KDM (CI 95%: 1.26–2.43;P<0.001), respectively.Conclusion. Current study indicates that increasing levels of altered carbohydrate metabolism are accompanied by a trend towards decreasing quality of life, mainly in women, in a representative sample of Spanish population.

Journal Article; Research Support, Non-U.S. Gov't; SUMMARY The main objective was to evaluate the association between SNPs and haplotypes of the FABP1-4 genes and type 2 diabetes, as well as its interaction with fat intake, in one general Spanish population. The association was replicated in a second population in which HOMA index was also evaluated. METHODS 1217 unrelated individuals were selected from a population-based study [Hortega study: 605 women; mean age 54 y; 7.8% with type 2 diabetes]. The replication population included 805 subjects from Segovia, a neighboring region of Spain (446 females; mean age 52 y; 10.3% with type 2 diabetes). DM2 mellitus was defined in a similar way in both studies. Fifteen SNPs previously associated with metabolic traits or with potential influence in the gene expression within the FABP1-4 genes were genotyped with SNPlex and tested. Age, sex and BMI were used as covariates in the logistic regression model. RESULTS One polymorphism (rs2197076) and two haplotypes of the FABP-1 showed a strong association with the risk of DM2 in the original population. This association was further confirmed in the second population as well as in the pooled sample. None of the other analyzed variants in FABP2, FABP3 and FABP4 genes were associated. There was not a formal interaction between rs2197076 and fat intake. A significant association between the rs2197076 and the haplotypes of the FABP1 and HOMA-IR was also present in the replication population. CONCLUSIONS The study supports the role of common variants of the FABP-1 gene in the development of type 2 diabetes in Caucasians. Yes

Little information is available as to whether doses of iodide similar to those recommended in clinical practice for the prevention of iodine deficiency in pregnant women affect thyroid function. The aim of the present study was to analyse whether doses of iodide can affect thyroid function in adults, and evaluate its effect on plasma markers of oxidative stress, inflammation and acute-phase proteins. A total of thirty healthy volunteers (ten men and twenty women) with normal thyroid function were randomly assigned to three groups (n10). Each group received a daily dose of 100, 200 or 300 μg of iodide in the form of KI for 6 months. Free tetraiodothyronine (FT4) levels at day 60 of the study were higher in the groups treated with 200 and 300 μg (P = 0·01), and correlated with the increase in urinary iodine (r0·50,P = 0·007). This correlation lost its significance after adjustment for the baseline FT4. The baseline urinary iodine and FT4 correlated positively with the baseline glutathione peroxidase. On day 60, urinary iodine correlated with C-reactive protein (r0·461,P = 0·018), and free triiodothyronine correlated with IL-6 (r− 0·429,P = 0·025). On day 60, the changes produced in urinary iodine correlated significantly with the changes produced in α1-antitrypsin (r0·475,P = 0·014) and ceruloplasmin (r0·599,P = 0·001). The changes in thyroid-stimulating hormone correlated significantly with the changes in α1-antitrypsin (r− 0·521,P = 0·005) and ceruloplasmin (r− 0·459,P = 0·016). In conclusion, the administration of an iodide supplement between 100 and 300 μg/d did not modify thyroid function in a population with adequate iodine intake. The results also showed a slight anti-inflammatory and antioxidative action of iodide.

CIBERDEM (Ministerio de Economía, Industria y Competitividad‑ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad‑ISCIII, Instituto de Salud Carlos III (PI17/02136, PI20/01322), Consejería de Salud y familias (PI‑0144‑2018), European Regional Development Fund (ERDF) “A way to build Europe”. GRM belongs to the regional Nicolás Monardes research program of the Consejería de Salud (RC‑0006‑2016; Junta de Andalucía, Spain). CMA is recipient of a “Rio Hortega” research contract (CM19/00186, Instituto de Salud Carlos III). VKDG is recipient of a “Rio Hortega” research contract (CM21/00214, Instituto de Salud Carlos III)., Valdés S., Doulatram-Gamgaram V., Maldonado-Araque C., Lago-Sampedro A., García-Escobar E., García-Serrano S., García-Vivanco M., Garrido Juan L., Theobald M.R., Gil V., Martín-Llorente F., Ocon P., Calle-Pascual A., Castaño L., Delgado E., Menendez E., Franch-Nadal J., Gaztambide S., Girbés J., Chaves F.J., Galán-García J.L., Aguilera-Venegas G., Gutierrez-Repiso C., Fernández-García J.C., Colomo N., Soriguer F., García-Fuentes E., Rojo-Martínez G.

BackgroundThe elongase of long chain fatty acids family 6 (ELOVL6) is an enzyme that specifically catalyzes the elongation of saturated and monounsaturated fatty acids with 12, 14 and 16 carbons. ELOVL6 is expressed in lipogenic tissues and it is regulated by sterol regulatory element binding protein 1 (SREBP-1).ObjectiveWe investigated whether ELOVL6 genetic variation is associated with insulin sensitivity in a population from southern Spain.DesignWe undertook a prospective, population-based study collecting phenotypic, metabolic, nutritional and genetic information. Measurements were made of weight and height and the body mass index (BMI) was calculated. Insulin resistance was measured by homeostasis model assessment. The type of dietary fat was assessed from samples of cooking oil taken from the participants' kitchens and analyzed by gas chromatography. Five SNPs of the ELOVL6 gene were analyzed by SNPlex.ResultsCarriers of the minor alleles of the SNPs rs9997926 and rs6824447 had a lower risk of having high HOMA_IR, whereas carriers of the minor allele rs17041272 had a higher risk of being insulin resistant. An interaction was detected between the rs6824447 polymorphism and the intake of oil in relation with insulin resistance, such that carriers of this minor allele who consumed sunflower oil had lower HOMA_IR than those who did not have this allele (P = 0.001).ConclusionsGenetic variations in the ELOVL6 gene were associated with insulin sensitivity in this population-based study.

Discordances exist in epidemiological studies regarding the association between the intake of nutrients and death and disease. We evaluated the social and health profile of persons who consumed olive oil in a prospective population cohort investigation (Pizarra study) with a 6-year follow-up. A food frequency questionnaire and a 7d quantitative questionnaire were administered to 538 persons. The type of oil used in food preparation was determined by direct measurement of the fatty acids in samples obtained from the kitchens of the participants at baseline and after follow-up for 6 years. The fatty acid composition of the serum phospholipids was used as an endogenous marker of the type of oil consumed. Total fat intake accounted for a mean 40% of the energy (at baseline and after follow-up). The concordance in intake of MUFA over the study period was high. The fatty acid composition of the serum phospholipids was significantly associated with the type of oil consumed and with fish intake. The concentration of polar compounds and polymers, indicative of degradation, was greater in oils from the kitchens where sunflower oil or refined olive oil was used, in oils used for deep frying and in oils that had been reused for frying five times or more. Consumption of olive oil was directly associated with educational level. Part of the discordance found in epidemiological studies between diet and health may be due to the handling of oils during food preparation. The intake of olive oil is associated with other healthy habits. © 2009 The Authors., The present study was supported by Fondo de Investigación Sanitaria (PI041883, PI051307), Junta de Andalucía (0124/2005, P06-CTS-01 684) and Fundación Centro de Excelencia en Investigación sobre Aceite de oliva y Salud (CEAS). CIBERDEM and CIBEROBN are initiatives of Instituto de Salud Carlos III, Spain.

Iodine deficiency is an important clinical and public health problem. Its prevention begins with an adequate intake of iodine during pregnancy. International agencies recommend at least 200 μg iodine per d for pregnant women. We assessed whether iodine concentrations in the amniotic fluid of healthy pregnant women are independent of iodine intake. This cross-sectional, non-interventional study included 365 consecutive women who underwent amniocentesis to determine the fetal karyotype. The amniocentesis was performed with abdominal antisepsis using chlorhexidine. The iodine concentration was measured in urine and amniotic fluid. The study variables were the intake of iodized salt and multivitamin supplements or the prescription of a KI supplement. The mean level of urinary iodine was 139·0 (sd94·5) μg/l and of amniotic fluid 15·81 (sd7·09) μg/l. The women who consumed iodized salt and those who took a KI supplement had significantly higher levels of urinary iodine than those who did not (P = 0·01 andP = 0·004, respectively). The urinary iodine levels were not significantly different in the women who took a multivitamin supplement compared with those who did not take this supplement, independently of iodine concentration or multivitamin supplement. The concentrations of iodine in the amniotic fluid were similar, independent of the dietary iodine intake. Urine and amniotic fluid iodine concentrations were weakly correlated, although the amniotic fluid values were no higher in those women taking a KI supplement. KI prescription at recommended doses increases the iodine levels in the mother without influencing the iodine levels in the amniotic fluid.

Journal Article; Research Support, Non-U.S. Gov't; Oxidative modification of LDL is thought to play an important role in the development of atherosclerosis. Susceptibility of LDL to peroxidation may partly depend on the compositional characteristics of the antioxidant and fatty acid content. The aim of this study was to examine the association between levels of antibodies to oxidized LDL and the various serum fatty acids in women. A total of 465 women aged 18-65 years were selected randomly from the adult population census of Pizarra, a town in southern Spain. Measurement of anti-oxidized-LDL was done by ELISA and the fatty acid composition of serum phospholipids was determined by GC. The levels of anti-oxidized-LDL antibodies were significantly related with age (r - 0.341, P < 0.001), BMI (r - 0.239, P < 0.001), waist:hip ratio (r - 0.285, P < 0.001), glucose (r - 0.208, P < 0.001), cholesterol (r - 0.243, P < 0.001), LDL-cholesterol (r - 0.185, P = 0.002), EPA (r - 0.159, P = 0.003), DHA (r - 0.121, P = 0.026), and the sum of the serum phospholipid n-3 PUFA (r - 0.141, P = 0.009). Multiple regression analysis showed that the variables that explained the behaviour of the levels of anti-oxidized-LDL antibodies were age (P < 0.001) and the serum phospholipid EPA (P < 0.001). This study showed that the fatty acid composition of serum phospholipids, and especially the percentage of EPA, was inversely related with the levels of anti-oxidized-LDL antibodies. Yes

Background: Identifying those parameters that could potentially predict the deterioration of metabolically healthy phenotype is a matter of debate. In this field, epigenetics, in particular DNA methylation deserves special attention. Results: The aim of the present study was to analyze the long-term evolution of methylation patterns in a subset of metabolically healthy subjects in order to search for epigenetic markers that could predict the progression to an unhealthy state. Twenty-six CpG sites were significantly differentially methylated, both at baseline and 11-year follow-up. These sites were related to 19 genes or pseudogenes, a more in-depth analysis of the methylation sites of these genes showed that CYP2E1 had 50% of the collected CpG sites differently methylated between stable metabolically healthy obesity (MHO) and unstable MHO, followed by HLA-DRB1 (33%), ZBTB45 (16%), HOOK3 (14%), PLCZ1 (14%), SLC1A1 (12%), MUC2 (12%), ZFPM2 (12.5%) and HLA-DQB2 (8%). Pathway analysis of the selected 26 CpG sites showed enrichment in pathways linked to th1 and th2 activation, antigen presentation, allograft rejection signals and metabolic processes. Higher methylation levels in the cg20707527 (ZFPM2) could have a protective effect against the progression to unstable MHO (OR: 0.21, 95%CI (0.067–0.667), p &lt, 0.0001), whilst higher methylation levels in cg11445109 (CYP2E1) would increase the progression to MUO, OR: 2.72, 95%CI (1.094–6.796), p &lt, 0.0014, respectively). Conclusions: DNA methylation status is associated with the stability/worsening of MHO phenotype. Two potential biomarkers of the transition to an unhealthy state were identified and deserve further investigation (cg20707527 and cg11445109). Moreover, the described differences in methylation could alter immune system-related pathways, highlighting these pathways as therapeutic targets to prevent metabolic deterioration in MHO patients.

This investigation has been supported by CIBERDEM (Ministerio de Economía, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad-ISCIII, Instituto de Salud Carlos III (research Grants PI18/01165, PI17/02136, PI14/00710, PI14/01104, PI14/00970, PI14/00874, PIE14/00031) and cofunding by the European Regional Development Fund (ERDF) “A way to build Europe”. LifeScan España (Madrid, Spain) kindly donated the glucometers and test strips for capillary glucose measurements. Cristina Maldonado-Araque is a researcher in the ‘Rio Hortega’ program (CM19/00186) financed by the Instituto de Salud Carlos III. Gemma Rojo-Martinez belongs to the Nicolás Monardes research program of the Consejería de Salud (C-0060-2012; Junta de Andalucía, Spain)., García-Escobar E., Valdés S., Soriguer F., Vendrell J., Urrutia-Etxebarria I.M., Maldonado-Araque C., Ortega E., Ocón P., Montanya E., Menéndez E., Lago-Sampedro A., González-Frutos T., Gomis R., Goday A., García-Serrano S., Galán-García J.L., Castell C., Bordiú E., Badía R., Aguilera-Venegas G., Girbés J., Gaztambide S., Delgado E., Chaves F.J., Castaño L., Calle-Pascual A., Rojo-Martínez G., Franch-Nadal J.

Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (Ministerio de Economía, Industria y Competitividad-Instituto de Salud Carlos III), Instituto de Salud Carlos III (PI11-02755), (PI17-02136), Consejería de Salud y familias (PI-0144-2018), European Regional Development Fund ‘‘A way to build Europe.’’, Maldonado-Araque, C., Valdés, S., Badiá-Guillén, R., Lago-Sampedro, A., Colomo, N., Garcia-Fuentes, E., Gutierrez-Repiso, C., Goday, A., Calle-Pascual, A., Castaño, L., Castell, C., Delgado, E., Menendez, E., Franch-Nadal, J., Gaztambide, S., Girbés, J., Chaves, F.J., Soriguer, F., Rojo-Martínez, G.

CIBERDEM (Ministerio de Economia, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad-ISCIII, Instituto de Salud Carlos III [PI14/00710, PI14/01104, PI14/00970, PI14/00874, PIE14/00031], Cuesta, M., Fuentes, M., Rubio, M., Bordiu, E., Barabash, A., Garcia De La Torre, N., Rojo-Martinez, G., Valdes, S., Soriguer, F., Vendrell, J.J., Urrutia, I.M., Ortega, E., Montanya, E., Menendez, E., Lago-Sampedro, A., Gomis, R., Goday, A., Castell, C., Badia-Guillen, R., Girbés, J., Gaztambide, S., Franch-Nadal, J., Delgado Álvarez, E., Chaves, F.J., Castano, L., Calle-Pascual, A.L.

Te study was supported by CIBER in Diabetes and Associated Metabolic Disorders - CIBERDEM (ISCIII - Ministerio de Ciencia e Innovación), Ministerio de Sanidad y Consumo, Spanish Society of Diabetes – SED, Consejería de Salud Junta de Andalucía “Andalucía se mueve con Europa” (0256/2007), Instituto de Salud Carlos III and FEDER “Una manera de hacer Europa” (PI11/02755, PI14/00710, PI14/01104, PI14/00970, PI14/00874 and PI14/00465), Sociedad Andaluza de Endocrinología, Diabetes y Nutrición (Beca SAEDYN)., Maldonado-Araque, C., Valdés, S., Lago-Sampedro, A., Lillo-Muñoz, J.A., Garcia-Fuentes, E., Perez-Valero, V., Gutierrez-Repiso, C., Goday, A., Urrutia, I., Peláez, L., Calle-Pascual, A., Castaño, L., Castell, C., Delgado, E., Menendez, E., Franch-Nadal, J., Gaztambide, S., Girbés, J., Ortega, E., Vendrell, J., Chacón, M.R., Chaves, F.J., Soriguer, F., Rojo-Martínez, G.

Background: Visceral obesity and high body fat percentages are related to metabolic syndrome (MetS) in all ethnic groups. Based on the International Diabetes Federation (IDF) definition of MetS, the aim of the study was to explore thresholds of body fat (BF%) and the visceral fat area (VFA) for the prediction of MetS among Colombian university students. Methods: A cross-sectional study was conducted on 886 volunteers (51.9% women, mean age= 21.4 years). Weight, height, serum lipids indices, blood pressure, fasting plasma glucose, and waist circumference were measured. BF% and VFA were calculated by bioelectrical impedance analysis (BIA). MetS was defined as including ≥ 3 of the metabolic abnormalities according to the IDF definition.Results: The overall prevalence of MetS was found to be 5.9%, higher in men compared to women. BF% and VFA was positively correlated to MetS components (all p < 0.001). The optimal cutoff values for BF% in predicting MetS were 31.9% (sensitivity and specificity of 78.6 and 76.7%) in women and 20.3% in men (sensitivity and specificity of 79.5 and 82.5%). ROC curve for participants showed that VFA ≥ 4.9 mm in women and 4.3 mm in men are an indicator to best predict MetS for prediction in university students from Colombia. Conclusion: Based on the IDF criteria, both indexes were able to predict MetS in our population.

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Introducción Definimos la Diabetes Gestacional(DG) “como cualquier intolerancia hidrocarbonada, de gravedad variable, con comienzo o primer reconocimiento durante el embarazo independientemente del tratamiento y de la evolución”. La incidencia de DG y de Diabetes mellitus tipo 2(DM) está aumentando en todo el mundo. La DG se estima alrededor del 8,8% . El desarrollo de DG en una gestación conlleva complicaciones(materno-fetales y posparto: recurrencia de DG, disglucemias como glucemia basal alterada-GBA, tolerancia alterada a la glucosa-IG o diabetes mellitus preferentemente tipo 2-DM). También son mujeres con posible manifestación del síndrome metabólico. Al año posparto, la Unidad de Diabetes y Embarazo(H.Virgen de La Victoria), comunica un 50% de disglucosis. Debido a la incidencia acumulativa(en los primeros 5 años posparto), nos planteamos detectar precozmente dichas alteraciones, así como otros factores de riesgo modificables(incluidos en el Síndrome Metabólico:SM); valorar estilos de vida y revisar a sus hijos(por tener mayor riesgo de Obesidad infantil). La captación activa es crucial para intervenir en estadíos de pre-diabetes y prevenir(o retrasar) la enfermedad. Conclusiones Observamos ganancia de peso progresiva en las mujeres que han sufrido DG. Inicialmente predomina la GBA y posteriormente la IG. La HbA1c detecta más casos de pre-diabetes con el paso de los años. Es una población con alta prevalencia de SM. La recaptación es muy baja: nos referimos a un 8% de la población inicial y a un 31,17% de la subpoblación revisada al año. Fallan las estrategias de prevención primaria en cuanto a estilos de vida. Los niños tienen una distribución de grasa predominantemente troncular(en los varones hay mayor tendencia al sobrepeso). Quizás intervenir al año posparto sería más eficaz(ya que es cuando más peso ganan). Trabajemos en la comunicación interniveles(tanto en detección de DG como en seguimiento posparto) para evitar diagnósticos tardíos y bajas tasas de recaptación. Puede ser una buena opción diseñar proyectos multidisciplinares en educación en salud, pues el objetivo de mejorar hábitos higiénico-dietéticos es prioritario en esta población. Bibliografía 1. Association AD. 12. Management of Diabetes in Pregnancy. Dia Care [Internet]. 2016 Jan 1 [cited 2016 Jan 9];39(Supplement 1):S94–8. Available from: http://care.diabetesjournals.org/content/39/Supplement_1/S94 2. Bellamy L, Casas JP, Hingorami AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet. 2009; 373: 1773-79. 3. II Plan Integral de Diabetes de Andalucía 2009-2013. Consejería de Salud. 2009. Junta de Andalucía. 4. Metzger BE, Buchanan TA, Counstan DR, et al. Summary and recomendations of the Fith International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007;30(Suppl. 2): S251-S260. 5. Pallardo LF. Evaluación posparto de la diabetes gestacional. Recomendaciones para la prevención de la diabetes tipo 2. Avances en Diabetología. 2006; 22(2): 136-141. 6. Retnakaran R, Qi Y, Sermer M, Connely PW, Hanley AJ, Zinman B. Beta-cell function declines within the first year postpartum in women with recent glucose intolerance in pregnancy. Diabetes Care 2010; 33: 1798-1804. 7. Soriguer F, Goday A, Bosch-Comas A, Bordiú E, Calle-Pascual A, Carmena R, et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@betes.es study. Diabetología. 2012;55:88-93.

Background A recent study using a rat model found significant differences at the time of diabetes onset in the bacterial communities responsible for type 1 diabetes modulation. We hypothesized that type 1 diabetes in humans could also be linked to a specific gut microbiota. Our aim was to quantify and evaluate the difference in the composition of gut microbiota between children with type 1 diabetes and healthy children and to determine the possible relationship of the gut microbiota of children with type 1 diabetes with the glycemic level. Methods A case-control study was carried out with 16 children with type 1 diabetes and 16 healthy children. The fecal bacteria composition was investigated by polymerase chain reaction-denaturing gradient gel electrophoresis and real-time quantitative polymerase chain reaction. Results The mean similarity index was 47.39% for the healthy children and 37.56% for the children with diabetes, whereas the intergroup similarity index was 26.69%. In the children with diabetes, the bacterial number of Actinobacteria and Firmicutes, and the Firmicutes to Bacteroidetes ratio were all significantly decreased, with the quantity of Bacteroidetes significantly increased with respect to healthy children. At the genus level, we found a significant increase in the number of Clostridium, Bacteroides and Veillonella and a significant decrease in the number of Lactobacillus, Bifidobacterium, Blautia coccoides/Eubacterium rectale group and Prevotella in the children with diabetes. We also found that the number of Bifidobacterium and Lactobacillus, and the Firmicutes to Bacteroidetes ratio correlated negatively and significantly with the plasma glucose level while the quantity of Clostridium correlated positively and significantly with the plasma glucose level in the diabetes group. Conclusions This is the first study showing that type 1 diabetes is associated with compositional changes in gut microbiota. The significant differences in the number of Bifidobacterium, Lactobacillus and Clostridium and in the Firmicutes to Bacteroidetes ratio observed between the two groups could be related to the glycemic level in the group with diabetes. Moreover, the quantity of bacteria essential to maintain gut integrity was significantly lower in the children with diabetes than the healthy children. These findings could be useful for developing strategies to control the development of type 1 diabetes by modifying the gut microbiota.

Comprender cuáles son los determinantes de la calidad de vida relacionada con la salud (CVRS) en fibrosis quística (FQ) podría ayudar al desarrollo de intervenciones para mejorarla. Cómo refiera una persona cuál es su CVRS puede estar influido por muchas variables: demográficas, clínicas, psicológicas y sociales. Algunos de estos factores probablemente estén interrelacionados, pero es útil tenerlos en cuenta cuando se diseña, analiza e interpretan estudios que midan la CVRS, ya que pueden influir sobre los hallazgos. La medición de la CVRS en FQ permite valorar la enfermedad desde la perspectiva del paciente, aportando información valiosa tanto para la clínica como para la investigación. Así, aunque algunos parámetros como el volumen espiratorio forzado en el primer segundo (FEV1) o el índice de masa corporal (IMC) tienen valor pronóstico sobre la morbimortalidad, son pobres predictores de la sensación de falta de bienestar. Para cuantificarla son necesarios instrumentos de medida válidos y de confianza. Los cuestionarios genéricos (por ejemplo, el SF-36) no son lo suficientemente sensibles como para discriminar aspectos específicos de la enfermedad (como los posibles beneficios de nuevos tratamientos, el impacto de las reagudizaciones o como marcadores de la progresión de la enfermedad) siendo sus características psicométricas menos sólidas que los datos procedentes de cuestionarios específicos diseñados para personas con FQ. Por otro lado, hay un instrumento específico para la enfermedad respiratoria que se suele utilizar en FQ. Se trata de una escala de síntomas, el St. George RespiratoryQuestionnaire (SGRQ). Este instrumento ha demostrado ser válido, fiable y sensible en una población de pacientes con EPOC, asma y bronquiectasias. En FQ también se ha utilizado para medir la calidad de vida con resultados satisfactorios. No obstante, resulta un poco largo y deja de lado otros aspectos importantes de la FQ, como por ejemplo los síntomas emocionales y los digestivos. Hasta la fecha, se han desarrollado dos instrumentos específicos para medir la CVRS específicos para FQ, el Cystic Fibrosis Questionnaire-Revised (CFQ-R) y el cuestionario Cystic Fibrosis Quality of Life (CFQoL). Ambos instrumentos están considerados como instrumentos válidos con una fiabilidad, validez interna y sensibilidad demostradas. Estos instrumentos, junto con una gran cantidad de instrumentos no específicos para FQ se han utilizado en investigación clínica en FQ. OBJETIVOS El objetivo general de esta investigación es determinar cuál de los tres cuestionarios (SF-36, SGRQ y CFQ-R) tendrá una mayor capacidad para discriminar la gravedad de la enfermedad, es decir, si aquellos sujetos más graves (especialmente aquéllos en lista de espera para trasplante bipulmonar y los que tengan un porcentaje de FEV1 predicho inferior al 40%) obtendrán puntuaciones más bajas que el resto de participantes. Por otro lado, también se pretende comprobar cuál de los tres cuestionarios tiene una mayor capacidad para medir la calidad de vida en sujetos con fibrosis quística. Por último, se pretende llevar a cabo una segunda validación del cuestionario específico CFQ-R en la versión española para población española. METODOLOGÍA Se administraron simultáneamente tres cuestionarios de calidad de vida a 86 pacientes mayores de 14 años con fibrosis quística de la Unidad de Trasplante Pulmonar y Fibrosis Quística del Hospital universitario y Politécnico La Fe entre 2009 y 2012: el Cystic Fibrosis Questionnaire – Revised (CFQ-R), el St. George’sRespiratoryQuestionnaire (SGRQ), y el Short-form-36 healthsurvey (SF-36), 31 de ellos en lista de espera para trasplante pulmonar.De estos pacientes, 31 estaban en lista de espera para recibir un trasplante bipulmonar. Además, se recogieron una serie de variables cínicas y sociodemográficas. Entre las variables clínicas se incluyeron estar en lista de espera para trasplante bipulmonar, el porcentaje del volumen espiratorio forzado en 1 segundo (FEV1) el día de la administración de los cuestionarios, el número de ingresos en el último año, exacerbación pulmonar en el último mes, tratamiento intravenoso (IV) en el último mes, tener insuficiencia pancreática, y si ésta era leve o moderada, tener enfermedad hepática, diabetes mellitus en tratamiento con insulina, colonización bacteriana crónica y colonización fúngica crónica. Entre las variables sociodemográficas, se recogieron el sexo, edad, nivel de estudios, trabajo y estado civil. Se analizaron tanto la fiabilidad como la validez de los tres cuestionarios. En cuanto a la fiabilidad, para el cálculo de la consistencia interna de cada cuestionario se partieron lo cuestionarios en dos mitades para calcular el Alfa de Cronbach de cada una de las mitades y la correlación entre éstas, tanto de la Spearman Brown como la de Guttman. La bipartición de los cuestionarios se hizo por dimensiones. También se calculó la consistencia interna de cada cuestionario calculando el Alfa de Cronbach de cada escala. En lo que respecta a la validez, se analizaron la validez concurrente y la validez predictiva. Con el fin de comprobar si estos tres cuestionarios de medición de la calidad de vida mostraban una relación significativa en sus puntuaciones, se realizaron dos mediciones diferentes. En primer lugar, se calculó la correlación de Spearman de cada cuestionario entre sus escalas. En segundo lugar, se correlacionaron las puntuaciones totales y las escalas de cada cuestionario con las puntuaciones totales y las escalas de los otros dos cuestionaros. Para evaluar la validez predictiva de los cuestionarios, se analizó la capacidad de cada uno de ellos para discriminar entre distintos grados de gravedad de la enfermedad realizando correlaciones con las variables clínicas y sociodemográficas. Por último, se evaluó la validez de constructo de los tres cuestionarios RESULTADOS En lo que respecta a la fiabilidad, las tres escalas mostraron una fiabilidad aceptable. Validez concurrente: Al calcular las correlaciones de las escalas de cada cuestionario entre sí mismas, los tres cuestionarios obtuvieron correlaciones altas y significativas. En el cálculo de las correlaciones entre escalas de un cuestionario con otro, se obtuvieron correlaciones altas y significativas entre aquellas escalas que miden constructos similares. Las escalas más específicas de la enfermedad de la fibrosis quística en el CFQ-R (cuerpo, alimentación, digestivo) correlacionaron pobremente con el resto de escalas de los otros dos cuestionarios, a excepción de la escala respiratorio. Validez predictiva. Variables clínicas: Se encontraron multitud de diferencias significativa entre medias entre el grupo en lista de espera y el grupo que no lo estaba en gran parte de las escalas de cada cuestionario. Sin embargo, en lo que respecta al rol emocional, la salud mental y el impacto emocional del SF-36, las diferencias no fueron significativas, al contrario que ocurrió con la escala social y la de emoción del CFQ-R. Tampoco se encontraron diferencias en las escalas relacionadas con la patología digestiva del CFQ-R. Del mismo modo, se encontraron muchas diferencias significativas entre aquellos sujetos con un porcentaje de FEV1 predicho inferior a 40% y aquéllos con FEV1 superiores. Las diferencias más significativas fueron entre las escalas que miden el funcionamiento físico, las limitaciones físicas, la salud general y la vitalidad. No obstante, en la escala de síntomas respiratorios del CFQ-R no se encontraron diferencias significativas entre grupos. Similares fueron los resultados cuando se evaluó la insuficiencia respiratoria, el ingreso durante el último mes por empeoramiento de la enfermedad basal, o el tratamiento intravenoso en el último mes. No se obtuvieron apenas diferencias significativas al dividir a los sujetos según el grado de insuficiencia pancreática, diabetes mellitus, enfermedad hepática o índice de masa corporal. En cuanto a la supervivencia, ninguno de los cuestionarios mostró ser un buen predictor del evento muerte o trasplante. Variables sociodemográficas: En los tres cuestionarios, las mujeres presentaron peores puntuaciones que los hombres en todas las escalas. No hubo diferencias significativas entre los sujetos según la edad en ninguna de las escalas. En el caso de la actividad laboral o escolar, sí que hay multitud de escalas en las que se encontraron diferencias significativas entre los sujetos que no trabajaban o estudiaban y los que sí lo hacían. No parece haber diferencias significativas entre los sujetos con pareja y los que no la tenían ni según la formación académica. Validez de constructo: el análisis factorial mostró que los cuestionarios tienen una estructura factorial homogénea que mide constructos muy similares en los tres cuestionarios, lo cual añade validez estructural a este análisis. CONCLUSIONES Los tres cuestionarios demostraron ser válidos y fiables para medir la calidad de vida relacionada con la salud en FQ, tanto en este estudio como en otros anteriores, y los tres tienen capacidad para predecir la gravedad de la enfermedad. Sin embargo, el SF36 y el CFQ-R parecen tener una validez predictiva superior al SGRQ. De hecho, el CFQ-R evalúa otras áreas específicas de la enfermedad, como son los síntomas respiratorios y digestivos y las implicaciones directas de éstos sobre la salud. Por este motivo, resulta el más adecuado para administrar a sujetos con fibrosis quística cuando se pretenda tener una medida de su calidad de vida. Es más, aunque se deberían hacer estudios posteriores con una muestra más amplia, puede deducirse que los tres cuestionarios discriminan bien entre los grados de la enfermedad, especialmente el CFQ-R. Esto sugiere que podría utilizarse en la ventana de trasplante pulmonar con el fin de sumar los resultados obtenidos sobre la percepción del paciente de su calidad de vida y estado de salud a las variables clínicas que el equipo médico valora a la hora de incluir a un sujeto en la lista de espera para trasplante. BIBLIOGRAFÍA BÁSICA Uchmanowicz I, Jankowska-Polańska B, Rosińczuk J, Wleklik M. Health-related quality of life of patients suffering from cystic fibrosis. 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Quittner AL, Sweeny S, Watrous M, Munzenberger P, Bearss K, Gibson NA, Fisher LA, Henry B. Translation and linguistic validation of a disease-specific quality of life measure for cystic fibrosis. J PediatrPsychol 2000;25:403–414. Feltrim MI, Rozanski A, Borges AC, Cardoso CA, Caramori ML, Pego-Fernandes P.The quality of life of patients on the lung transplantation waiting list. Transplant Proc. 2008 Apr;40(3):819-21. Padilla A, Olveira G, Olveira C, Dorado A, Plata AJ, Gaspar I, Pérez-Frías J. Validity and reliability of the St George's Respiratory Questionnaire in adults with cystic fibrosis. Arch Bronconeumol. 2007 Apr;43(4):205-11. Spanish Olveira G, Olveira C, Gaspar I, Cruz I, Dorado A, Pérez-Ruiz E, Porras N, Soriguer F. Validation of the Spanish version of the Revised Cystic Fibrosis Quality of Life Questionnaire in adolescents and adults (CFQR 14+ Spain)]. Arch Bronconeumol. 2010 Apr;46(4):165-75. Epub 2010 Mar 20. Spanish. Liou TG, Adler FR, Fitzsimmons SC, Cahill BC, Hibbs JR, Marshall BC. Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol 2001;153:345–352. Abbott J. Health-related quality of life measurement in cystic fibrosis: advances and limitations. ChronRespir Dis. 2009;6:31–41. Gee L, Abbott J, Conway SP, Etherington C, Webb AK. Quality of life in cystic fibrosis: the impact of gender, general health perceptions and disease severity. J Cyst Fibros 2003;2:206–213. Gee L, Abbott J, Hart A, Conway SP, Etherington C, Webb AK. Associations between clinical variables and quality of life in adults with cystic fibrosis.J CystFibros 2005;4:59–66. Libro blanco de atención a la fibrosis quística. Editado por: Federación Española contra la Fibrosis Quística. 2002

Journal Article; Research Support, Non-U.S. Gov't; OBJECTIVE Serum levels of soluble TNF-like weak inducer of apoptosis (sTWEAK) and its scavenger receptor CD163 (sCD163) have been linked to insulin resistance. We analysed the usefulness of these cytokines as biomarkers of type 2 diabetes in a Spanish cohort, together with their relationship to food consumption in the setting of the Di@bet.es study. RESEARCH DESIGN AND METHODS This is a cross-sectional, matched case-control study of 514 type 2 diabetes subjects and 517 controls with a Normal Oral Glucose Tolerance Test (NOGTT), using data from the Di@bet.es study. Study variables included clinical and demographic structured survey, food frequency questionnaire and physical examination. Serum concentrations of sTWEAK and sCD163 were measured by ELISA. Linear regression analysis determined which variables were related to sTWEAK and sCD163 levels. Logistic regression analysis was used to estimate odd ratios of presenting type 2 diabetes. RESULTS sCD163 concentrations and sCD163/sTWEAK ratio were 11.0% and 15.0% higher, respectively, (P

The adipokine resistin is an insulin-antagonizing factor that also plays a regulatory role in inflammation, immunity, food intake, and gonadal function and also regulates growth hormone (GH) secretion in rat adenopituitary cells cultures with the adipokine. Although adipose tissue is the primary source of resistin, it is also expressed in other tissues, including the pituitary. The aim of this study is to investigate the possible action of resistin on the lipid metabolism in the pituitary gland in vivo (rats in two different nutritional status, fed and fast, treated with resistin on acute and a chronic way) and in vitro (adenopituitary cell cultures treated with the adipokine). Here, by a combination of in vivo and in vitro experimental models, we demonstrated that central acute and chronic administration of resistin enhance mRNA levels of the lipid metabolic enzymes which participated on lipolysis and moreover inhibiting mRNA levels of the lipid metabolic enzymes involved in lipogenesis. Taken together, our results demonstrate for the first time that resistin has a regulatory role on lipid metabolism in the pituitary gland providing a novel insight in relation to the mechanism by which this adipokine can participate in the integrated control of lipid metabolism. Sara Borrell Postdoctoral program; BFU 2011 and CIBER Obesidad y Nutricion (Instituto de Salud Carlos Tercero (ISCIII), Ministerio de Ciencia e Innovacion). Juan de la Cierva Program (Ministerio de Educacion y Ciencia) SI

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers)., CIBEROBN is an initiative of ISCIII and CEAS Foundation, Spain.

Journal Article; Research Support, Non-U.S. Gov't; "Comment in: What do we know about iodine supplementation in pregnancy? [J Clin Endocrinol Metab. 2009]" (Nota tomada de PubMed). CONTEXT The association between thyroid function during pregnancy and the later mental and psychomotor development of the child is supported by numerous experimental, clinical, and epidemiological studies. OBJECTIVE The aim of the study was to evaluate the psychological development of infants aged 3 to 18 months whose mothers had received 300 microg of potassium iodide during the first trimester of their pregnancy and compare with infants whose mothers had received no iodine supplements. DESIGN AND STUDY SUBJECTS: The study included 133 women who had received 300 microg of potassium iodine and 61 women who had received no iodine supplements. MAIN OUTCOME MEASURES The neuropsychological status of the children was evaluated with the Bayley Scales of Infant Development, and measurements were made of TSH, free T(3), free T(4), and urinary iodine. RESULTS Those children whose mothers had received an iodine supplement of 300 microg had a more favorable psychometric assessment than those of the other group of mothers. They had higher scores on the Psychomotor Development Index (P = 0.02) and the Behavior Rating Scale. CONCLUSIONS Dietary iodine supplements not only have no harmful effect on the neurodevelopment of the children, they may even be beneficial. Given the possible presence of confounding variables not controlled for in this study, these findings should be considered as preliminary. Yes 2010-09

Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; BACKGROUND. Transsexual persons afford a very suitable model to study the effect of sex steroids on uric acid metabolism. DESIGN. This was a prospective study to evaluate the uric acid levels and fractional excretion of uric acid (FEUA) in a cohort of 69 healthy transsexual persons, 22 male-to-female transsexuals (MFTs) and 47 female-to-male transsexuals (FMTs).The subjects were studied at baseline and 1 and 2 yr after starting cross-sex hormone treatment. RESULTS. The baseline levels of uric acid were higher in the MFT group.Compared with baseline, uric acid levels had fallen significantly after 1 yr of hormone therapy in the MFT group and had risen significantly in the FMT group. The baseline FEUA was greater in the FMT group. After 2 yr of cross-sex hormone therapy, the FEUA had increased in MFTs (P = 0.001) and fallen in FMTs (P = 0.004).In MFTs, the levels of uric acid at 2 yr were lower in those who had received higher doses of estrogens (P = 0.03),and the FEUA was higher (P = 0.04).The FEUA at 2 yr was associated with both the estrogen dose (P = 0.02) and the serum levels of estradiol-17beta (P =0.03).In MFTs, a correlation was found after 2 yr of therapy between the homeostasis model assessment of insulin resistance and the serum uric acid (r = 0.59; P = 0.01). CONCLUSIONS. Serum levels of uric acid and the FEUA are altered in transsexuals as a result of cross-sex hormone therapy.The results concerning the MFT group support the hypothesis that the lower levels of uric acid in women are due to estrogen-induced increases in FEUA. Yes

Background The objective was to investigate the association between BMI and single nucleotide polymorphisms previously identified of obesity-related genes in two Spanish populations. Forty SNPs in 23 obesity-related genes were evaluated in a rural population characterized by a high prevalence of obesity (869 subjects, mean age 46 yr, 62% women, 36% obese) and in an urban population (1425 subjects, mean age 54 yr, 50% women, 19% obese). Genotyping was assessed by using SNPlex and PLINK for the association analysis. Results Polymorphisms of the FTO were significantly associated with BMI, in the rural population (beta 0.87, p-value 2 in Hortega and 2.0 kg/m2 in Pizarra. Overall, the obesity predictive value was low (less than 1%). Conclusion The risk associated with polymorphisms is low and the overall effect on BMI or obesity prediction is minimal. A weighted genetic risk score based on genes mainly acting through central nervous system mechanisms was associated with BMI but it yields minimal clinical prediction for the obesity risk in the general population.

The relative importance of the usual diet in serum phospholipids in subjects with cystic fibrosis (CF) has been poorly studied. To compare the fatty acid profile in serum phospholipids from adult CF subjects with that of healthy subjects, and determine the role of the normal diet in this profile, we studied thirty-seven adult CF subjects with stable pulmonary disease and thirty-seven healthy controls matched for age, sex and nutritional status. A dietary questionnaire was obtained, anthropometric data were recorded, and the fatty acid profile measured by GLC. Compared with the controls, the percentages of myristic, palmitoleic and stearic acids and total MUFA were significantly higher in the CF group, and DHA, linoleic acid, total PUFA and n−6 fatty acids were significantly lower in the CF group. The CF subjects with worse pulmonary function and with pancreatic insufficiency had significantly lower levels of linoleic and n−6 fatty acids. The total energy intake was significantly higher in the CF subjects, although the energy distribution in the CF subjects and the controls was not different for the carbohydrates, lipids and proteins. No differences were detected in fat intake for MUFA (51 (sd 4) v. 52 (sd 4) %) or saturated fatty acids (33·5 (sd 5) v. 31·2 (sd 3·8) %), but the PUFA were slightly lower in the CF subjects (15·4 (sd 4·5) v. 17·4 (sd 4·2) %; P=0·02). The usual dietary intake of fatty acids by adult CF subjects does not appear to explain the difference in the fatty acid profile compared with controls. This suggests an abnormal fatty acid metabolism in CF subjects.