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Objetivo La desnutricion es frecuente en pacientes con fibrosis quistica (FQ) e implica un desequilibrio entre la ingesta y los requerimientos. Nuestro objetivo ha sido calcular el gasto energetico en reposo (GER) mediante calorimetria indirecta en adultos con FQ, compararlo con las formulas estimativas habitualmente empleadas y valorar la influencia de parametros clinicos sobre el GER. Pacientes y metodos Estudiamos a 21 pacientes con FQ que se encontraban estables clinicamente. Se efectuaron medidas de parametros antropometricos, dinamometria de mano, impedanciometria bioelectrica y del GER medido por calorimetria indirecta (CI) . Estudiamos la concordancia entre los valores del GER medidos y estimados por las formulas de la Organizacion Mundial de la Salud (OMS) y de Harris- Benedict (HB) mediante el coeficiente de correlacion intraclase y el metodo de Bland-Altman. Resultados Las ecuaciones infraestimaron el GER en mas del 90% de los casos. La concordancia entre la CI y la estimada por las formulas fue escasa (para OMS, 0,47, y para HB, 0,41). Mediante el metodo de Bland-Altman observamos un sesgo variable entre la CI y las formulas, independiente de los valores del GER. La diferencia entre la CI respecto de la estimada por la formula de la OMS fue significativamente mayor en homocigoticos ΔF508 y en los pacientes con insuficiencia pancreatica exocrina frente al resto. Conclusiones En adultos con FQ, las formulas de la OMS y de HB infraestiman el GER. Hay una baja concordancia entre los valores del GER medidos y estimados. La infraestimacion fue mayor en pacientes con insuficiencia pancreatica exocrina y en homocigoticos ΔF508.

Objective To study self-perceived quality of life in adults with cystic fibrosis (CF), and to assess the validity of the St George's Respiratory Questionnaire (SGRQ) for use in these patients. Patients and methods We studied 37 adults with CF who were in stable condition as indicated by their respiratory and nutritional status. Disease severity was assessed by spirometry used in conjunction with a modified National Institutes of Health (NIH) scoring system and the Bhalla scale. Nutritional status was evaluated by measuring height and weight, calculating body mass index, analyzing bioelectric impedance, and performing various laboratory tests. The patients' quality of life was assessed using the SGRQ. Results SGRQ scores were higher (indicating poorer quality of life) among patients with CF than in the general population or among patients with chronic obstructive pulmonary disease. Internal consistency coefficients indicated the SGRQ had good reliability (Cronbach's alpha, 0.864). Women with CF tended to score higher than men, although this difference was not statistically significantly. A statistically significant relationship was observed between SGRQ score and severity of pulmonary impairment (the more severe the impairment, the worse the patient's quality of life). Statistically significant positive relationships were found between SGRQ domains and age, body mass index, and body fat percentage. Significant negative relationships were found between these domains and the modified NIH score, the Bhalla score, forced expiratory volume in 1 second (expressed as a percentage of predicted), and somatomedin C and zinc levels. Conclusions Self-perceived quality of life is worse among adults with CF than in the general population or among patients with chronic obstructive pulmonary disease. The SGRQ is a valid instrument for analyzing health-related quality of life in adults with CF as it discriminates very well between different degrees of severity of pulmonary impairment and has acceptable internal consistency.

Objetivo Estudiar la percepcion de la calidad de vida (CV) en una poblacion adulta con fibrosis quistica (FQ) y valorar la validez del Cuestionario Respiratorio St. George (SGRQ) en estos pacientes. Pacientes y metodos Hemos estudiado a 37 personas adultas con FQ, estables desde el punto de vista respiratorio y nutricional. Se realizo una valoracion de la gravedad de la enfermedad mediante espirometria y los sistemas NIH (National Institutes of Health) modificado y Bhalla, asi como una valoracion nutricional mediante la medicion del peso, la talla, el indice de masa corporal, impedanciometria bioelectrica y parametros analiticos. Se estimo la percepcion de la CV mediante el SGRQ. Resultados Las personas con FQ tienen mayores puntuaciones (peor CV) que la poblacion general y que los afectados de enfermedad pulmonar obstructiva cronica (EPOC). El coeficiente alfa de Cronbach de la puntuacion total fue de 0,864. Las mujeres con FQ presentan puntuaciones mas altas que los varones, aunque sin alcanzar la significacion estadistica. Se observa una gradacion de las puntuaciones (de forma estadisticamente significativa) en funcion de la gravedad de la afectacion pulmonar (a mayor gravedad, peor CV). Se han encontrado relaciones positivas, estadisticamente significativas, entre las dimensiones del SGRQ y la edad, el indice de masa corporal y el porcentaje de masa grasa, y negativas con el NIH modificado, el Bhalla, el volumen espiratorio forzado en el primer segundo (expresado en porcentaje) y las concentraciones de cinc y somatomedina C. Conclusiones LOS adultos con FQ tienen peor percepcion de la CV que la poblacion general y que los afectados de EPOC. El SGRQ es valido para analizar la CV relacionada con la salud de las personas adultas con FQ, ya que discrimina muy bien entre los distintos grados de gravedad de la funcion pulmonar y presenta una adecuada consistencia interna.

OBJECTIVE Undernutrition, which implies an imbalance between energy intake and energy requirements, is common in patients with cystic fibrosis. The aim of this study was to compare resting energy expenditure determined by indirect calorimetry with that obtained with commonly used predictive equations in adults with cystic fibrosis and to assess the influence of clinical variables on the values obtained. PATIENTS AND METHODS We studied 21 patients with clinically stable cystic fibrosis, obtaining data on anthropometric variables, hand grip dynamometry, electrical bioimpedance, and resting energy expenditure by indirect calorimetry. We used the intraclass correlation coefficient (ICC) and the Bland–Altman method to assess agreement between the values obtained for resting energy expenditure measured by indirect calorimetry and those obtained with the World Health Organization (WHO) and Harris–Benedict prediction equations. RESULTS The prediction equations underestimated resting energy expenditure in more than 90% of cases. The agreement between the value obtained by indirect calorimetry and that calculated with the prediction equations was poor (ICC for comparisons with the WHO and Harris–Benedict equations, −; 0.47 and 0.41, respectively). Bland–Altman analysis revealed a variable bias between the results of indirect calorimetry and those obtained with prediction equations, irrespective of the resting energy expenditure. The difference between the values measured by indirect calorimetry and those obtained with the WHO equation was significantly larger in patients homozygous for the ΔF508 mutation and in those with exocrine pancreatic insufficiency. CONCLUSIONS The WHO and Harris–Benedict prediction equations underestimate resting energy expenditure in adults with cystic fibrosis. There is poor agreement between the values for resting energy expenditure determined by indirect calorimetry and those estimated with prediction equations. Underestimation was greater in patients with exocrine pancreatic insufficiency and patients who were homozygous for Δ F508.

We present a case of severe acute pancreatitis induced by hypertriglyceridemia secondary to lipoprotein lipase (LPL) deficiency in a pregnant patient with gestational diabetes, initially maneged with diet but it was later necessary to carry out artificial nutricional support measures: total parenteral nutrition. LPL deficiency might cause severe hypertriglyceridemia, repetition acute pancreatitis which is an unwieldy and severe situation during pregnancy. Acute familial hypertriglyceridemia pancreatitis accounts for 5% of cases, including LPL deficiency. The goal of treatment is to reach triglycerides levels below 500 mg/dl, being very low fat diet the treatment of choice, drugs or plasmapheresis techniques can also be associated. TPN enriched in ω3 fatty acids and glutamine was safe and effective in our patient with significant decrease in triglyceride levels.Presentamos un caso de pancreatitis aguda severa inducida por hipertrigliceridemia secundaria a déficit de lipoproteín lipasa (LPL) en una paciente gestante con diabetes gestacional, manejada inicialmente con dieta, siendo necesario posteriormente llevar a cabo medidas de soporte nutricional artificial: nutrición parenteral total. El déficit de LPL causa hipertrigliceridemia severa y, frecuentemente, pancreatitis aguda de repetición, situación de difícil manejo y de importante gravedad durante la gestación. La pancreatitis aguda por hipertrigliceridemia familiar supone el 5% de los casos, incluyéndose el déficit de LPL. El objetivo del tratamiento será alcanzar niveles de triglicéridos inferiores a 500 mg/dl, siendo la dieta muy baja en grasa el tratamiento de elección, pudiéndose asociar también fármacos o técnicas de plasmaféresis. La nutrición parenteral total enriquecida en ácidos grasos 3 y glutamina resultó segura y eficaz en la paciente, con un descenso importante de los niveles de triglicéridos.

the evaluation of hospital menus should be performed periodically to suit the needs of patients. Goat cheese may have nutritional benefits, compared to cow cheese.to evaluate patient satisfaction with the hospital menu and with the inclusion of goat cheese, given like dessert in hospital vs menu with cow cheese.a survey of hospital menu satisfaction and dessert (goat cheese (GC) vs cow cheese (CC)) in patients with basal diets was conducted.334 surveys were analyzed. 46.7% were women. The average age was 58.16 ± 15.15 years and the average stay of 11.21 ± 11.53. Acceptance of the hospital menu was rated as "good" in a high percentage of respondents (91% Temperature, presentation 94%, humidity 75% and 84% schedule). Overall satisfaction lunch (1 to 10) was 7.31 ± 2.10 en CC vs 7.39 ± 1.75 GC (ns) and dessert satisfaction was 6.93 ± 2.89 vs 6.88 ± 3.52 (ns) (respectively).the overall satisfaction with the hospital menu is high and the acceptance of new dessert (QC) is equivalent to acceptance obtained with cow cheese, which could be included in the code of diets.Introducción: la valoración de los menús hospitalarios debe realizarse periódicamente para adecuarlos a las necesidades de los pacientes. El queso de cabra podría tener ventajas nutricionales, en comparación con el de vaca. Objetivos: evaluar la satisfacción de los pacientes con el menú hospitalario y con la incorporación del queso de cabra, dado como postre en el menú hospitalario vs queso de vaca. Material y métodos: se realizó una encuesta de satisfacción del menú hospitalario y del postre (queso de cabra (QC) vs queso de vaca (QV)) en pacientes con dietas basales. Resultados: se analizaron 334 encuestas. El 46,7% fueron mujeres. La edad media fue de 58,16 ± 15,15 años y la estancia media de 11,21 ± 11,53. La aceptación del menú hospitalario fue valorado como buena en un alto porcentaje de los encuestados (temperatura 91%, presentación 94%, humedad 75% y horario 84%). La satisfacción global del almuerzo (1 al 10) fue 7,31 ± 2,10 en QV vs 7,39 ± 1,75 QC (ns) y del postre 6,93 ± 2,89 vs 6,88 ± 3,52 (ns) respectivamente. Los pacientes que habitualmente no toman queso de cabra (57%) tampoco tomaron postre en el 50% de los casos, frente a los que sí toman en su domicilio (42,98%), que no ingirieron nada del postre solo en el 8% (p0.01) Conclusiones: la satisfacción global con el menú hospitalario es alta y la aceptación del nuevo postre (QC) es equivalente a la obtenida con el queso de vaca, por lo que podría incluirse en el código de dietas.

Introduction: Pulmonary rehabilitation (PR) has become a basic element in treatment of chronic lung diseases but has not been sufficiently studied in Bronchiectasis (BC); there is little evidence about its effect on exercise capacity. Specific nutritional supplements may improve these results. Aims: To compare the effect of PR for 12 weeks vs PR plus hyperproteic supplement enriched with beta-hydroxy-beta-methylbutyrate (HMB) in non-cystic fibrosis BC on different parameters of cardiopulmonary exercise test. Methods: Prospective randomized study in which a structured PR program for patients with BC was applied for three months. Hyperproteic HMB supplementation (PRHMB) was added to one of the groups. Exercise test with incremental cycle ergometer protocol was performed at baseline, three and six months. Data were analyzed by intention to treat. Results: 30 patients with non-CF BC (15 in each arm) were included, with no differences in clinical and respiratory variables between groups. All 30 patients completed the PR. Both groups significantly increased values of maximum oxygen uptake (VO2max) at 3 and 6 months, as well as METs at 6 moths. PR isolated group significantly increased its heart rate at 3 and 6 months. Conclusions: Pulmonary rehabilitation program improved exercise capacity (VO2max and METs) in patients with BC. Adding a supplement did not improve outcome other than a minor tachycardic response to exercise. Study funded by Consejeria de Salud de la Junta de Andalucia (PI-0239-2013), SEPAR 016/2013 and Neumosur 3/2013.

Aims To investigate the clinical efficacy and safety of insulin glargine compared with NPH insulin as basal insulin for the management of corticosteroid-induced hyperglycemia in hospitalized people with type 2 diabetes (T2DM) and respiratory disease. Materials and methods Randomized, two-arm parallel group, clinical trial undertaken from February 2011 to November 2012 on the pneumology ward of the Hospital Regional Universitario de Malaga (Spain), involving 53 participants with T2DM treated with medium/high doses of intermediate-acting corticosteroids. Participants were randomly assigned to receive one single dose of insulin glargine or NPH insulin in three equally divided doses before each meal as basal insulin within a basal–bolus insulin protocol. The intervention lasted six days or until discharge if earlier. Results No significant differences were seen between groups during the study in mean blood glucose (11.43 ± 3.44 mmol/l in glargine vs. 11.88 ± 2.94 mmol/l in NPH, p = 0.624), and measures of glucose variability (standard deviation 3.27 ± 1.16 mmol/l vs. 3.61 ± 0.99 mmol/l, p = 0.273; coefficient of variation 1.55 ± 0.33 mmol/l vs. 1.72 ± 0.39 mmol/l, p = 0.200). Results from CGM were concordant with those obtained with capillary blood glucose reading. The length of hospital stay was also similar between groups (8.2 ± 2.8 days vs. 9.8 ± 3.4 days, p = 0.166) There was a non significant trend for lower episodes of mild (4 vs. 8, p = 0.351) and severe hypoglycemia (0 vs. 3, p = 0.13) in the glargine group. Conclusions The results of this study showed that insulin glargine and NPH insulin are equally effective in a basal–bolus insulin protocol to treat glucocorticoid-induced hyperglycemia in people with T2DM on a pneumology ward.

In the last years, epigenetic processes have emerged as a promising area of complex diseases research. DNA methylation measured in Long Interspersed Nucleotide Element 1 (LINE-1) sequences has been considered a surrogate marker for global genome methylation. New findings have suggested the potential involvement of epigenetic mechanisms in Type 2 diabetes (T2DM) as a crucial interface between the effects of genetic predisposition and environmental influences. Our study evaluated whether global DNA methylation predicted increased risk from T2DM or other carbohydrate metabolism disorders in a cohort study. We used a prospective cohort intervention study and a control group. We collected phenotypic, anthropometric, biochemical, and nutritional information from all subjects. Global LINE-1 DNA methylation was quantified by pyrosequencing technology. Subjects that did not improve their carbohydrate metabolism status showed lower levels of global LINE-1 DNA methylation (63.9 ± 1.7 vs. 64.7 ± 2.4) and they practiced less intense physical activity (5.8% vs. 21.5%). Logistic regression analyses showed a significant association between LINE-1 DNA methylation and metabolic status after adjustment for sex, age, BMI, and physical activity. Our study showed that lower LINE-1 DNA methylation levels were associated with a higher risk metabolic status worsening, independent of other classic risk factors. This finding highlights the potential role for epigenetic biomarkers as predictors of T2DM risk or other related metabolic disorders.

Activation of the PPAR gamma 2 gene (PPARG2) improves the action of insulin and its lipid metabolism. We examined the association between Pro12Ala polymorphism of PPARG2, type 2 diabetes mellitus (DM2), and peripheral insulin sensitivity in a population with a high intake of oleic acid. A cross-sectional, population-based study was undertaken in Pizarra, a small town in the province of Malaga in southern Spain. A total of 538 subjects, aged 18-65 y, were selected randomly from the municipal census. All subjects underwent a clinical, anthropometrical, and biochemical evaluation, including an oral glucose tolerance test and Pro12Ala polymorphism of PPARG2. Insulin resistance was measured by homeostasis model assessment. Those subjects with the Ala-12 allele had an odds ratio for impaired fasting glucose of 0.55, for impaired glucose tolerance of 0.59, and for DM2 of 0.30. The intake of monounsaturated fatty acids (MUFA) contributed to the variance of the homeostasis model assessment insulin resistance index (HOMA IR) (P = 0.04), with a 2-way interaction between the Ala-12 allele of PPARG2 and the intake of MUFA (P = 0.005). The results suggest the existence of an interaction between Pro12Ala polymorphism of PPARG2 and dietary MUFA, such that obese people with the Ala-12 allele have higher HOMA IR values, especially if their intake of MUFA is low.

El protocolo aqui presentado es el desarrollo de la ponencia del mismo titulo expuesta en la mesa redonda sobre yododeficiencia del congreso de la Sociedad Espanola de Endocrinologia (SEEN) celebrado en Caceres. En el se recogen las experiencias de protocolizacion previas que se han producido en Espana para el estudio de los trastornos por deficit de yodo, que han sido de gran utilidad para sistematizar los estudios realizados en los ultimos anos. Con este protocolo se pretende actualizar la sistematica del estudio de los trastornos por deficit de yodo en el contexto de los nuevos conocimientos y de los importantes cambios sociosanitarios que se han producido en los ultimos anos.

The aim of this study was to assess the relationship between obesity and vitamin D status cross-sectionally, the relationship between obesity and the incidence of hypovitaminosis D prospectively and inversely the relationship between vitamin D status and incidence of obesity in a population-based cohort study in Spain. At baseline (1996-1998), 1226 subjects were evaluated and follow-up assessments were performed in 2002-2004 and 2005-2007, participants undergoing an interview and clinical examination with an oral glucose tolerance test. At the second visit, 25-hydroxyvitamin D and intact parathyroid hormone concentrations were also measured. Prevalence of obesity at the three visits was 28.1, 36.2 and 39.5%, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D ≤ 20 ng/ml (≤ 50 nmol/l)) was 34.7%. Neither obesity at baseline (OR=0.98, 95% CI: 0.69-1.40, P=0.93) nor the development of obesity between baseline and the second evaluation (OR=0.80, 95% CI: 0.48-1.33, P=0.39) were significantly associated with vitamin D status. In subjects who were non-obese (BMI30 kg/m²) at the second evaluation, 25-hydroxyvitamin D values ≤ 17 ng/ml (≤ 42.5 nmol/l) were significantly associated with an increased risk of developing obesity in the next 4 years (OR=2.35, 95% CI: 1.03-5.4, P=0.040 after diverse adjustments). We conclude that vitamin D deficiency is associated with an increased risk of developing obesity.

[Aim]: To evaluate the relation between type of dietary fatty acid and degree of insulin resistance. Design: A cross-sectional study. [Methods]: Anthropometrical data were measured in 538 subjects, aged 18-65 years, selected randomly from the municipal census of Pizarra (Spain). An oral glucose tolerance test (OGTT) was given to all subjects and measurements were made of glycemia, insulinemia and the proportion of fatty acids in plasma phospholipids. Insulin resistance (IR) was estimated by homeostasis model assessment. Samples of cooking oil being used were obtained from the kitchens. The strength of association between variables was measured by calculating the odds ratio (OR) from logistic models, and the relationships were measured by linear correlation coefficients. [Results]: Insulin resistance was significantly less in people who used olive oil compared with those who used sunflower oil or a mixture. Statistical significance remained in the group of people with normal OGTT after adjusting for obesity. In the whole sample, IR correlated negatively with the concentration of oleic acid (r = -0.11; P = 0.02) and positively with that of linoleic acid (r = 0.10; P = 0.02) from the cooking oil. In subjects with normal OGTT, IR correlated negatively with oleic acid from cooking oil (r = -0.17; P = 0.004) and from plasma phospholipids (r = -0.11; P = 0.01) and positively with the concentration of linoleic acid in cooking oil (r = 0.18; P = 0.004) and plasma phospholipids (r = 0.12; P = 0.005). The risk (OR) of having raised IR was significantly lower in people who consumed olive oil, either alone (OR = 0.50) or mixed (OR = 0.52) compared with those who consumed only sunflower oil. [Conclusion]: There is an association between the intake of oleic acid, the composition of oleic acid in plasma phospholipids and peripheral insulin action., This work was supported by grants from the Fondo de Investigación Sanitaria of the Instituto de Salud Carlos III (98/0475 and Red de Centros RCMN C03/08), Junta de Andalucía (6/98), Fondo Europeo de Desarrollo Regional (IFD97/0718) and Asociación Maimónides.

Background. Adrenal insufficiency is a common complication of transsphenoidal surgery (TSS) for pituitary adenoma. It is very important to identify patients requiring glucocorticoid replacement, minimising risks of adrenal insufficiency.Aim: to assess the performance of early ( 3ºday) post-TSS 08:00 a.m. cortisol measurement to detect and exclude secondary adrenal insufficiency.Methods. We selected patients undergoing TSS in our hospital during 12 months and performed a 3º day postoperative 08:00 a.m. cortisol measurement and cortisol+/-Synachten 6 months post-surgery. All patients received perioperative glucocorticoid replacement (First and second days postsurgery) unless basal cortisol was > 10 microg/dl and cortisol after Synachten > 23 microg/dl previous to surgery. We excluded patients with previous diagnosed and treated adrenal insuficiency. In patients with 3º day cortisol lower than 10 microg/dl we maintained glucocorticoid treatment until reevaluation with cortisol/Synachten 6 months post-surgery.In patients with 3º day cortisol higher than 10 microg/dl glucocorticoids were discontinued.Results. Data were reviewed from 20 patients (9 males, mean age 52,8 years), 18 with macroadenomas, 8 patients with cushing disease. Patients with adenomas no cushing: all patients with 3º day cortisol > 15 microg/dl had normal cortisol/Synachten 6 months post-surgery. 2 patients with 3º day cortisol between 10 and 15 microg/dl had adrenal insufficiency 6 months postsurgery.1 patient with 3º day cortisol< 10 microg/dl mantained adrenal insuficiency 6 months postsurgery. Cushing disease: all patients with 3º day cortisol > 10 microg/dl had not adrenal insuficiency 6 months postsurgery, all except one with recurrence. All patients with 3º day cortisol 15 microg/dl is a safe cutt off to discarge adrenal insufficiency. In cushing disease, a level < 10 microg/dl predict a low likelihood of recurrences.

Un edificio no se construye sino ladrillo a ladrillo. Y antes de construir ya hubo quien roturó el terreno y asentó los cimientos. Y cuando la construcción esté terminada otros diseñarán los interiores, la amueblarán y harán que sea no un edificio sino una casa. Una revista científica se parece un poco a una construcción: se trabaja por fases, se precisa la colaboración de muchos, busca ser hogar de todos.Hace un año asumíamos el reto de continuar la tarea de la anterior Dirección de Nutrición Hospitalaria. Bajo la dirección del actual director emérito, el Dr. Jesús Culebras, y del profesor Abelardo García de Lorenzo, la revista primero apareció en los repositorios internacionales de mayor prestigio y luego siguió un crecimiento progresivo hasta el lugar que ocupa hoy. Nuevo equipo directivo, nueva editorial. Muchos de los mimbres que la habían llevado a ocupar un lugar destacado en el mundo de las publicaciones sobre nutrición y dietética humana han continuado siendo su principal activo: el apoyo de las sociedades científicas, en especial de la SENPE, los editores adjuntos y los revisores. El camino, sin embargo, no ha sido fácil. Quedan flecos por pulir, objetivos por alcanzar.

Background Several recent studies have related short sleep duration with different health problems, though the results related with the risk of obesity and type 2 diabetes (T2D) are far from conclusive. The aim of this study was to investigate the association between night-time sleep duration and the incidence of obesity and T2D in a prospective study with a follow-up of 11 years. Material and methods The study comprised 1145 people evaluated in 1997–1998 and re-evaluated after 6 years and 11 years. At the three study points, subjects without known diabetes mellitus (KDM) were given an oral glucose tolerance test (OGTT). Anthropometric and biochemical variables were measured. The subjects were asked about their number of hours of night-time sleep. Results After adjustment, the OR of becoming obese was significantly higher in subjects who slept ≤7 hours per night, at both the 6-year follow-up (OR = 1.99; 95% CI = 1.12–3.55) and the 11-year follow-up (OR = 2.73; 95% CI = 1.47–5.04). The incidence of T2D at the 6-year follow-up in subjects without T2D at baseline was higher in those who slept ≤7 hours per night (OR = 1.96; 95% CI = 1.10–3.50). However, this association was not independent of obesity, weight gain or abnormal glucose regulation at baseline. At the 11-year follow-up however there was no association between night-time sleep duration and the incidence of T2D. Conclusions The incidence of obesity over the 11-year follow-up increased in subjects with fewer hours of night-time sleep. The incidence of T2D according to the hours of night-time sleep depended on obesity and the carbohydrate metabolism phenotype.

Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose70 mg/dL) in hospitalized patients receiving total parenteral nutrition (TPN).This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage.The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia.The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.

The aim of this study was to test the hypothesis of an association between the -30GA polymorphism of the promoter of the glucokinase gene and the prevalence and incidence of obesity. We studied the -30GA polymorphism of the glucokinase gene promoter in 981 persons, of whom 866 were seen again 6 years later. All the persons underwent an oral glucose-tolerance test and the BMI (weight/height(2)) was recorded. The -30GA polymorphism of the glucokinase gene promoter was studied using RFLP-PCR. At the initial study, the probability of having a BMIor =25 in carriers of the A allele was significantly lower than expected by chance (odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.456-0.885). In those persons with a BMIor =30 at the first study, the probability at 6 years of losing weight (reaching a BMI30) was greater in carriers of the A allele (OR = 0.22; 95% CI = 0.087-0.576). The increase in weight over these 6 years, taken as a continuous variable, was significantly less only in those persons who were originally obese (P = 0.018). In conclusion, in a population from southern Spain, carriers of the A allele of the -30GA polymorphism in the promoter of the glucokinase gene had a lower risk for obesity and the likelihood of losing weight was greater in those obese persons who had the A allele (GA or AA).

The aim of the present study is to examine the influence which different concentrations of free fatty acids (FFAs) have on the insulin secretion response of the islets of Langerhans when the culture is prolonged over a week. Animals were killed by decapitation and pancreatic islets of Langerhans isolated. The islets were incubated in enriched RPMI and oleic or linoleic acid was added at concentrations of 0.04, 0.1, 0.375, and 1 mmol/l. The medium without FFAs was used as a control. The culture time was 7 days. For insulin secretion studies, islets were selected after preincubation in batches of six islets in 1 ml of KRB (Krebs-Ringer buffer) containing one of the following: 5.5, 11.1, 16 or 26.7 mmol/l glucose, 10 μ mol/l forskolin or 20 mmol/l arginine. The results showed a significant increase in insulin secretion observed after culture with 1 mmol/l oleic and linoleic acid compared to the other concentrations and the control culture for all the secretagogues used. However, at this same concentrations no increase was observed in insulin secretion as the glucose concentration rose, and this was noticeable with linoleic acid at concentrations of 0.375 mmol/l. In conclusion, culture of islets of Langerhans for a week with high concentrations of unsaturated fatty acids produces a hypersecretion of insulin which is not influenced by secretagogues such as glucose, arginine, or forskolin. The loss of gluco-sensitivity may become greater as the degree of unsaturation of the fatty acid used increases.

Bronchiectasis is a chronic disease, leading to worsening of health-related quality of life. This study evaluated the psychometric properties of a new patient-reported outcome for non-cystic fibrosis bronchiectasis, the Quality of Life Questionnaire Bronchiectasis, translated into Spanish (QOL-B-Sp-V3.0).This prospective study recruited clinically stable patients with non-cystic fibrosis bronchiectasis at 4 Spanish centers. Health status was assessed with multiple indicators (dyspnea, exacerbations, bronchorrhea, etc.), microbiological, radiological, spirometric, and anthropometric parameters plus St-George Respiratory Questionnaire (SGRQ). Psychometric analyses included internal consistency, test-retest reliability, convergent validity, predictive validity, and responsivity to change.The 207 stable patients (mean age 57.2 years) had a Bhalla score of 11.53 ± 7.39 and FEV1% of 68.3 ± 22.2 %. One hundred and sixty-one stable patients repeated the test 2 weeks later, and 80 patients who had an exacerbation within 6 months of the assessment also repeated it. Internal consistency was high across all scales (Cronbach's alpha0.70). Thirty-six of 37 items correlated more strongly with their assigned scale than a competing scale. Test-retest coefficients were strong (intraclass correlations r = 0.68-0.88). All scales, except Treatment Burden, discriminated significantly between patients with mild, moderate, and severe disease according to FEV1% and other respiratory parameters. Strong convergence was found between the QOL-B-Sp-V3.0 and SGRQ. Significant correlations were found between QOL-B-Sp-V3.0 and various clinical, spirometric, radiological, and anthropometric variables. Significant differences were found on all QOL-B-Sp-V3.0 scales, except emotional functioning, between the baseline responses and onset of an exacerbation; robust sensitivity to change was observed on the Respiratory Symptoms scale.The QOL-B-Sp-V3.0 questionnaire demonstrated strong reliability and validity. Scores were reproducible after 2 weeks, and it discriminated between patients who varied in severity and was responsive to changes related to exacerbation.

Objectives: It has been shown that a chronic disease involves a significant risk for developing depression and anxiety symptoms. The impact of anxiety and depression on quality of life is well known in adults but not among adolescents. The aim of the study is to estimate the prevalence of depression and anxiety in adolescents with CF and to describe their health-related quality of life. Methods: 26 patients, age 12 to 17 were recruited. Mean age 15. Participants completed the Hospital Anxiety and Depression Scale (HADS) including 14 items on a Likkert scale (cut off mild = 7, severe = 10) and the Cystic Fibrosis Quality of Life Questionnaire (CFQ-R) (8 sub-domains in proportions of 100%). Results: HADS shows a depression mean of 2 (range 0−15) and an anxiety mean of 4 (range 0−11). The CFQ-R sub-domains means: physical 88% (range 42–100), emotional state 79% (range 46–100), social 78% (range 44–100), body image 82% (range 44–100), eating 86% (range 22–100), treatment burden 63% (range 0−89), respiratory 76% (range 50–100), digestion 74% (range 33–100). Conclusions: Anxiety and depressive symptoms are not very common among CF adolescents at Stockholm CF-center but there are some patients that suffer from both depression and anxiety. The symptoms of anxiety appears to occur to a greater extent than depression. Among the domains of CF quality of life the treatment burden was the most troubling. A routine screening for symptoms of anxiety, depression and health-related quality of life is important in the prevention of mental illness. Those identified with elevated clinical symptoms need appropriate treatment.

Summary Background & aim Recent studies suggest that white rice consumption increases risk of diabetes. Aim: to assess the association between white rice intake and the incidence of diabetes in a population from Southern Spain. Methods A population-based cohort study was undertaken in Pizarra, Spain. At baseline and follow-up, participants underwent an interview and a standardized clinical examination which included an oral glucose tolerance test in those subjects without known diabetes. Incidence and odds ratio (OR) for diabetes were calculated. Multivariate analysis was performed using stepwise logistical regression. Results Thirty eight percent of subjects reported rice consumption 2–3 times a week, 58.5% once or less a week, and 3.6% no rice consumption. In subjects who reported rice intake 2–3 times a week, incidence of diabetes after 6 years follow-up was 12.0%, and in those who reported once or less a week, 20.2% (p = 0.04, non adjusted). Subjects who ate rice frequently had lower risk to develop diabetes 6 years later (OR = 0.43, p = 0.04; adjusted for age, sex, obesity, and presence of impaired fasting glucose and/or impaired glucose tolerance at baseline). Conclusions A negative association was found between white rice intake in the way it is consumed in Southern Spain, and the 6 years incidence of diabetes.

Bronchiectasis causes pulmonary infections and loss of lung function, resulting in chronic respiratory symptoms and worsening health-related quality of life. The aims of this study were to measure symptoms of depression and anxiety in a sample of patients with bronchiectasis and evaluate their relationship to health outcomes and health-related quality of life. This cross-sectional study included adolescents and adults with bronchiectasis. Patients completed the hospital anxiety and depression scale and the St. George respiratory questionnaire. Health outcome data, including clinical, radiological and spirometric values, were recorded from medical charts. Ninety-three participants with bronchiectasis of any aetiology were recruited: 20 % had elevated depression-related scores and 38 % had elevated anxiety-related scores. Increased symptoms of depression and anxiety were significantly associated with age; anxiety was associated with more frequent exacerbations. Regression analyses indicated that after controlling for demographic (gender and age) and clinical variables (exacerbations frequency, daily sputum, aetiology and spirometry), both depression and anxiety symptoms predicted significantly worse health-related quality of life. In comparison with other predictors, psychological symptoms explained the largest amount of variance in health-related quality of life. Symptoms of depression and anxiety were significant predictors of health-related quality of life in patients with bronchiectasis, independently of respiratory involvement, gender, age or other variables.

The Spanish paradox is a phenomenon observed in Spain and some other Mediterranean countries by which the cardiovascular morbidity and mortality levels are dissociated from their cardiovascular risk factors. The Mediterranean diet has been proposed as the main reason for this dissociation, but dietary changes themselves are not enough to explain this situation. It has been recently discovered that Stearoil-CoA desaturase (SCD) is involved in the dissociation between a favourable atherogenic metabolic profile and the risk for arteriosclerosis. We propose a hypothesis that attempts to clarify the Spanish paradox. This hypothesis contemplates the essential role of dietary olive oil and its interaction with different SCD genetic patterns. Confirmation of this hypothesis could provide the basis for the design of clinical and preventive strategies against cardiovascular morbidity and mortality, as well as certain metabolic risk factors.

Summary Background & aims To investigate the relationship between levels of 25-hydroxyvitamin D and the incidence of type 2 diabetes in a Spanish population. Methods We undertook a population-based prospective study in a population from southern Spain. The first phase of the study (1996–1998) included 1226 individuals. Of this original cohort, 988 persons were reassessed in 2002–2004 and 961 in 2005–2007. Measurements were made of 25-hydroxyvitamin D and intact parathyroid hormone in 2002–2004 and an oral glucose tolerance test was done in three time points. Results The incidence of diabetes in subjects with 25-hydroxyvitamin D levels ≤18.5 ng/mL (percentile 25) was 12.4% vs 4.7% in subjects with levels >18.5 ng/mL. The likelihood of having diabetes during the four years of follow-up was significantly lower in the subjects with higher levels of 25-hydroxyvitamin D [OR = 0.17 (0.05–0.61)]. None of the subjects with levels higher than 30 ng/mL developed diabetes. Conclusion In this prospective study, we found a significant inverse association between serum 25-hydroxyvitamin D levels and the risk for type 2 diabetes in a population from the south of Spain.

Recognition of transexuality as a clinical entity for which medical attention should be available is currently a well-established reality, but institutional care has not been uniformly instituted throughout Spain. The aim of the present study was to determine the current situation of healthcare for transexualism in the publicly-funded health service in Spain.A descriptive study based on data provided by the Spanish Society of Endocrinology Group on Identity and Sexual Differentiation was performed. The resources in the regions that have created specific gender units for these disorders are described.Nine autonomous regions (55%) have started to provide various procedures, although only four provide genitoplastic procedures. The first region to include all sex reassignment surgeries was Andalusia (year 1999). At the same time, Madrid and Catalonia also began to provide specialized mental health care and endocrinology but did not include surgical procedures until 2007 and institutional recognition until 2008. Since 2007 other regions have incorporated healthcare for transsexual patients. Overall, 3,303 patients (a male-to female/female-to-male transsexual ratio of 1.9/1) and 864 surgical procedures have been registered in this study. The composition and proportion of working hours of specialists, as well as the kinds of treatments provided, differ widely in each region.The geographical distribution of healthcare to transsexual persons and the services provided vary. Few regions offer genitoplastic procedures. The number of applicants exceeds the number estimated by the national health system.

[Background and aims]: The importance of milk intake to the supply of dietary iodine is not fully known. We therefore undertook a study in Spain of the iodine concentration in cow's milk and the impact of the frequency of milk consumption on urinary iodine concentrations in three study populations. [Methods]: We studied the iodine concentration in 362 samples of milk from 45 commercial brands and compared it with the milk iodine status in studies undertaken 17 years earlier. The epidemiologic studies were performed in three different places in the south of Spain: two in school-age children (N = 757 and N = 1205 children) and one in adults (N = 1051). A milk consumption questionnaire was given and urinary iodine concentrations measured. [Results]: The mean concentration of iodine in the milk rose from 1991 (117 ± 37 μg/L) to 2008 (259 ± 58 μg/L) (P < 0.001). The iodine concentration was greater in skimmed milk (273 ± 52 μg/L) than in semi-skimmed milk (254 ± 57 μg/L) or whole milk (251 ± 61 μg/L) (P < 0.0001). The winter samples had a greater concentration of iodine (270 ± 55 μg/L) than the summer samples (247 ± 58 μg/L) (P < 0.0001), independently of the type of milk. The urinary iodine concentrations in all three epidemiologic studies were significantly associated with the frequency of milk intake. [Conclusions]: The concentration of iodine in cow's milk has risen over recent years, and it is higher in skimmed milk. The results also show that cow's milk is a relevant source of dietary iodine. © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism., This work was supported in part by a grant from the Spanish Society of Endocrinology and Nutrition. CIBER Fisiopatología de la Obesidad y Nutrición (CB06/03) and CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) are ISCIII projects.

International audience; ABSTRACT Background: Vitamin D deficiency is common worldwide. No homogenous reference values have yet been established and no studies of values have been done in Spain involving a large number of participants. Objective: To study the population concentrations of vitamin D in a representative sample of the Spanish population. Subjects/Methods: The study involved two cohorts from Spain. The Asturias Study and the Pizarra Study are two prospective, population-based studies with 2260 participants. In 1262 subjects(age:20-83 years) we studied 25-hydroxyvitamin D, intact parathyroid hormone (PTHi), calcium, phosphorus and creatinine. Results: The median population values of 25-hydroxyvitamin D and PTHi were 22.46 ng/mL and 42.29 pg/mL, respectively. The values of 25-hydroxyvitamin D were significantly higher in summer and correlated with age (beta=-0.050.01, p

Background: Continuous subcutaneous insulin infusion (CSII) may be an alternative to multiple daily injections (MDI) in pregestational diabetes during pregnancy. However, no clear improvement in obstetric and perinatal outcome has so far been established for CSII treatment. Methods: In a case-control study, 35 pregnancies treated with CSII and 64 pregnancies treated with MDI treatment were evaluated. Metabolic control and obstetric and perinatal outcome were compared. Results: Women in the CSII group improved their metabolic control (hemoglobin A1c before CSII, 7.83 ± 0.97%; 3–6 months after, 6.77 ± 0.61%; P

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.

Chronic inflammation plays a major role in lung deterioration in cystic fibrosis (CF) patients and anti-inflammatory strategies have beneficial effects. To study the changes seen after a one-year course of low-dose dietary supplements with a mixture of fatty acids in adult patients with CF in chronic inflammation, pulmonary status (lung function, respiratory exacerbations and antibiotic consumption), quality of life and anthropometric parameters.Seventeen adult subjects with CF received 324 mg of eicosapentaenoic, 216 mg of docosahexaenoic, 480 mg of linoleic and 258 mg of gammalinolenic acid daily. We assessed inflammation markers, spirometry parameters, number and severity of respiratory exacerbations, antibiotic consumption, quality of life (St George's QoL), anthropometric parameters and serum phospholipid fatty acid composition.At the end of the treatment period TNF alpha levels fell significantly and its soluble receptors (60 and 80) rose significantly. Levels of IgG and IgM anti-oxidized LDL antibodies fell significantly. Spirometry improved significantly. Annual respiratory exacerbations and days of antibiotic treatment fell significantly. The improvement in QoL was not significant. Serum levels of docosahexaenoic, total omega-3 and linoleic acid rose significantly and more favourable profiles were seen in monoenoic acids, arachidonic acid and the arachidonic/docosahexaenoic ratio. The fat-free mass and hand grip dynamometry improved significantly.Low-dose supplements of n-3 and gammalinolenic fatty acids over a long period (one year) appears to improve pulmonary status (lung function, respiratory exacerbations and antibiotic consumption), inflammatory and anthropometric parameters in adults with CF.