RESUMEN
Aims: To evaluate (1) the prevalence of diabetic distal symmetrical sensory-motor polyneuropathy (DSPN) and painful DSPN among patients with type 1 diabetes mellitus (DM1) aged over 18 years and (2) the determinant factors of neuropathy and pain in those patients. Materials and Methods: An epidemiological, cross-sectional, observational study was performed; 330,386 people were included, and a total of 444 people were diagnosed with DM1. After exclusion of possible confounders, 360 patients were assessed for painless and painful DSPNs using neurological examination and questionnaires for neuropathy and pain. Odds ratio (OR) and confidence intervals (95% CI) were estimated using multinomial logistic regression models. The analysis was based on a framework with four conceptual levels that consider feasible pathways between several risk factors: (1) socio-demographic factors and diabetes duration, (2) patient habits, (3) co-morbidities, and (4) metabolic factors and disease complications. Results: The prevalence of DSPN and painful DSPN were 42.8 and 18.9%, respectively. Diabetes duration was positively associated with painful (OR = 1.107, 95% CI: 1.107-1.139) and painless DSPN (OR = 1.069, 95% CI: 1.043-1.096). Education level was negatively associated with painful DSPN (OR = 0.889, 95% CI: 0.826-0.957). Sex (female) was positively associated only with painless DSPN (OR = 1.769, 95% CI: 1.007-3.107). Being a current or former smoker was positively associated only with painless DSPN (OR = 1.940, 95% CI: 1.069-3.518). Hypertension was positively associated with painful DSPN (OR = 2.474, 95% CI: 1.110-5.512) and painless DSPN (OR = 2.565, 95% CI: 1.252-5.256). Glycated hemoglobin (HbA1c) was positively associated only with painless DSPN (OR = 1.193, 95% CI: 1.018-1.399). Conclusions: Diabetes duration and hypertension have a direct impact on the development of painful and painless DSPN. However, female sex and HbA1c have a direct effect only on the development of painless DSPN, and education level has an indirect effect on the development of painful DSPN. Therefore, it can be concluded that different etiological factors have different contributions to the development of neuropathy and pain.
RESUMEN
The importance of food in health promotion and disease prevention is well known. The aims of our study were to evaluate the daily energy intake of an adult group; to study the association of a 24 hour recall (R24h) and a Food Frequency Questionnaire (FFQ); to analyse energy intake variation with obesity and to verify if our sample had an ingestion according to DRI's. We studied a convenience sample of Portuguese adult population of 154 office workers (121 women), with a mean of ages of 44.2 +/- 12.1 years. We used a self administered FFQ and a R24h to evaluate food habits. Middle number of meals was 4.8 +/- 1.0 meals (breakfast, lunch and dinner were the most frequent). Middle daily ingestion was 1908 +/- 559 kcal. Men had a superior energy intake at all meals, except at afternoon snack and supper. We did not find any relation between BMI and food intake, BMI is only related with age. We compared our sample ingestion with DRI's and verified that vitamins B1, B2, B12, B6, C, niacin, Fe and P, were totally reached, and the inverse was obtained in Zn, folate, vitamin D and E, pantothenic acid and biotin. We conclude that our sample ingestion of protein is higher than the recommended, carbohydrates is less consume than the recommended and only recommendations of fat and alcohol consumption were in agreement with WHO recommendations.
