Impact of a 'school-based' nutrition intervention on anthropometric parameters and the metabolic syndrome in Spanish adolescents.

BACKGROUND/AIMS: In adolescents, overweight and obesity are associated with an increased cardiovascular risk. The aim of this study was to determine the impact of a school-based nutritional education program (NEP) on lifestyle changes in Spanish adolescents. METHODS: We selected 263 secondary school students (127 males) aged 12-16 years from Granada (Spain), who were followed up throughout 1 school year (2009-2010). At the beginning and end of the school year, data were gathered on the food consumption frequency, and anthropometric and biochemical profile. The NEP comprised a class on nutritional recommendations every 15 days, and administration of a daily breakfast of 275-350 kcal. RESULTS: After the intervention, the prevalence of overweight and obesity decreased among both male and female students (p < 0.001) and there was also a global reduction in the prevalence of the metabolic syndrome (MS) from 32.2 to 19.7% (p < 0.001); in addition, body mass index was significantly decreased in normal weight, overweight and obesity groups (p = 0.001 and p = 0.02, respectively), and high-density-lipoprotein cholesterol and lean body mass was increased in all groups (p = 0.001). CONCLUSION: The NEP achieved a medium-term reduction in the prevalence of overweight and obesity and had a significant and positive effect on MS components in all groups.

Factors associated with microalbuminuria in type 1 diabetes mellitus: a cross-sectional study.

In order to determine the prevalence of microalbuminuria in people with Type 1 diabetes mellitus (Type 1 DM) and identify factors associated with microalbuminuria, we studied 312 Type 1 DM patients attending in three hospitals in two Spanish regions over 6 months. Clinical characteristics, micro- and macro-vascular complications, blood pressure, 24-h urine albumin excretion, lipid profile, HbA1(c) levels, smoking habits, and family history of hypertension and diabetic nephropathy were recorded. Univariate analysis and multiple logistic regression were used to examine associations between these variables and the prevalence of microalbuminuria. We detected microalbuminuria in 29% of the patients. The prevalence of microalbuminuria was high during the second decade of diabetes and declined thereafter. Univariate analysis showed dyslipidaemia (P<0. 002), previously diagnosed hypertension (P<0.001), family history of hypertension (sibling alone P<0.006; mother alone P<0.05), family history of diabetic nephropathy (P<0.001), and laser-treated retinopathy (P<0.03) to be factors associated with the presence of microalbuminuria. Multiple logistic regression revealed an association between microalbuminuria and family history of nephropathy (OR 7.6, 3.6-16). In conclusion, in our sample the frequency of microalbuminuria seems to be related to the presence of dyslipidaemia, hypertension, and to a family history of hypertension or nephropathy.

Thyroid function during pregnancy and the postpartum period: iodine metabolism and disease states.

OBJECTIVE: To review various aspects of thyroid function during and early after pregnancy. METHODS: We discuss biochemical and potential pathologic changes in the thyroid associated with the gestational and postpartum periods. RESULTS: Urinary iodine excretion during the last trimester of gestation in healthy euthyroid women shows that, in areas with mild iodine intake, iodine supplementation is necessary during pregnancy and the postpartum period. This measure should be considered in iodine-sufficient areas as well. Thyroglobulin is the main biochemical marker of persistent thyroidal stimulation. Alterations in thyroid volume during pregnancy can persist after delivery, especially in breast-feeding mothers. In most patients, the goitrogenic stimulus of pregnancy can be suppressed with iodine supplementation. Autoimmune thyroid disease during pregnancy and the postpartum period is reflected by monitoring of thyroid peroxidase antibodies (TPO-Ab). Women with positive test results for TPO-Ab early in gestation showed a highly significant decrease in free thyroxine and increased thyroid-stimulating hormone levels late in gestation. The main marker of Graves' disease during pregnancy is thyroid-stimulating antibodies. Nonautoimmune gestational hyperthyroidism differs from Graves' disease in that thyroid-stimulating antibodies are not detectable. CONCLUSION: Clinicians should be alert to the fact that pregnancy can induce thyroidal pathologic conditions.

[Long-term evolution of immunologic and thyroid function in Graves disease according different therapeutic options]. / Evolución inmunológica y de la función tiroidea a largo plazo en la enfermedad de Graves según distintas opciones terapéuticas.

BACKGROUND: A prospective study was carried out to compare the evolution of thyroid hormones, thyroglobulin (Tg) and immunoglobulins inhibiting the binding of thyrotropin to its receptor (TBII) in patients with Graves disease treated with antithyroid drugs, radioactive iodine and subtotal thyroidectomy. METHODS: Ninety-five patients with Graves disease were studied, being distributed according to clinical criteria: Group I (n = 35) patients treated with antithyroid drugs; Group II (n = 30) patients who received 131I; and Group III (n = 30) patients treated with subtotal thyroidectomy. The thyroid hormones, Tg, antithyroglobulin antibodies and TBII were determined by radioimmunoassay (RIA), prior to treatment, and at 1, 3, 6, 12, 24, and 36 months of follow up, except in those patients from Group III who were followed up to 24 months. RESULTS: The rate of reactivation at 12 months did not significantly differ among the three groups. At 24 months a higher percentage of reactivations was observed in Group I (42%), versus Group II (16%, p < 0.001) and Group III (13%, p < 0.005). At 36 months reactivation was 30% in Group I, versus 5% in Group II (p < 0.01). Upon comparison of the TBII values among the three groups, the highest basal values corresponded to Group III with significant differences being found versus Group I (p < 0.05) and Group II (p < 0.001). TBII concentrations in the three groups studied remained high at 6 and 12 months with no significant differences being observed. Negativization was shown in the TBII at 24 months in Group II with a significant difference being seen versus Group I and III. At 36 months negativization was seen in the TBII in Group I with significant differences with respect to Group II. CONCLUSIONS: The rate of reactivation following antithyroid treatment is greater to that obtained in groups treated with iodine or surgery. The earliest negativization of TBII was obtained with radioiodine.

Reclassification after delivery of diabetes in pregnancy.

Gestational diabetes mellitus (GDM) constitutes a risk factor for the development of non insulin-dependent diabetes mellitus (NIDDM). The search for parameters to provide discrimination between a high risk and a low risk for future development of NIDDM is today the aim of many investigations. The absence or presence of several factors such as glycemia during pregnancy and post partum, the need for insulin treatment, disorders of the pancreatic insulin secretion, the number of pregnancies, maternal obesity, the early diagnosis of GDM, the family history of diabetes mellitus, the race and immune disorders give rise to a very high relative risk (RR) of developing NIDDM. To know the degree of risk will allow a future appropriate clinical intervention to reduce the incidence of NIDDM and its economic cost.

Bone mass in females with different thyroid disorders: influence of menopausal status.

The aim of this study was to evaluate the effect of thyroid functional state on cortical and trabecular bone mineral density (BMD) (g/cm2) in premenopausal and postmenopausal women. Control subjects were used as a reference population to calculate Z-scores from patient data. In patients with active hyperthyroidism, BMD was reduced in lumbar spine (LS; P < 0.01), femoral neck (FN; P < 0.01) and Ward triangle (WT; P < 0.0001) in comparison with reference standards. In premenopausal women treated in the past for hyperthyroidism or treated at the time of study with L-thyroxine in non-TSH-suppressive doses, there was no significant decrease in BMD. In postmenopausal women with hyperthyroidism in remission, we found a significant decrease in BMD in LS (P < 0.01), FN (P < 0.05) and WT (P < 0.0001). In postmenopausal women treated with L-thyroxine (L-T4), there was a significant decrease in BMD in LS (P < 0.01) and WT (P < 0.01). There was a significant negative correlation between the cumulative dose of L-T4 and BMD in FN (r = -0.688, P < 0.05) and WT (r = -0.657, P < 0.05) in postmenopausal women. Our findings suggest that the deleterious effects of thyroid hormones on BMD are accentuated in areas consisting predominantly of trabecular bone, e.g., the LS and WT. Postmenopausal women subjected to excess thyroid hormone represent a population at greater risk for osteoporosis.

Effect of captopril at two different dosage regimens in hypertensive non-insulin dependent patients.

Thirty patients (21 F, 9 M) of mean age 55.3 years with non-insulin dependent diabetes mellitus of mean duration 10.8 years and hypertension (blood pressure 160/95 mm Hg) of 0.3 to 4.0 years were randomly allocated to either a twice daily regimen of captopril (50 mg twice daily, Group A) or a once daily captopril schedule (50 mg once daily, Group B). Good glycaemic control (HbA1c, mean 7.63%) had been achieved with sulphonylureas in 22 patients and insulin in 8 patients. There were no statistical differences in baseline values between the two groups. For the 15 patients in Group A, blood pressure fell significantly from a baseline of 177 +/- 13.2/106 +/- 7.8 mm Hg to 161 +/- 14.3/91 +/- 6.9 after one month (P less than 0.05) and continued to decrease at 3 and 6 months. In Group B the blood pressure changed from 179 +/- 19.0/110 +/- 15.6 to 169 +/- 21.0/98 +/- 7.2 at 1 month (P less than 0.05) with further reductions again seen at 3 and 6 months. Nine patients had poorer response than the other 21 but there were no demographic differences between these subgroups nor were there any differences in plasma renin activity or aldosterone responses. There were no statistically significant changes in haematological or biochemical values in either group during treatment. In particular, HbA1c and fasting glucose were unaffected by captopril treatment. No side effects were encountered during the 6 months of follow-up. In conclusion, captopril is an effective antihypertensive in non-insulin dependent diabetes mellitus with mild to moderate hypertension and a once daily regimen could improve compliance.

Intensive insulin therapy and bone mineral density in type 1 diabetes mellitus: a prospective study.

To determine the effect of metabolic control on bone mineral density (BMD) in type 1 diabetes mellitus (type 1 DM), we studied BMD (by dual-energy X-ray energy absorptiometry) and bone remodeling parameters in 62 patients with type 1 DM both before and 7 years after commencement of intensive insulin therapy. Overall outcomes after the 7-year treatment included the stabilization of BMD at all sites, as well as a significant decrease in tartrate-resistant acid phosphatase (TRAP) (4.302 +/- 2.62 vs 2.65 +/- 0.97 IU/I; p=0.0001) and increase in intact parathyroid hormone (PTHi) (28.05 +/- 15.7 vs 39.78 +/- 22.41 ng/l; p=0.005). Presence of diabetic retinopathy (RTP) versus its absence (non-RTP) was associated with lower BMD in femoral neck (FN) (0.831 +/- 0.142 vs 0.756 +/- 0.153 mg/ cm2; p = 0.03) and Ward's triangle (WT) (0.736 +/- 0.165 vs 0.632 +/- 0.172 mg/cm2; p=0.03), and with a lower T-score in FN (-0.93 +/- 1.34 vs -1.70 +/- 1.46; p = 0.04) and WT (-0.72 +/- 1.42 vs -1.540 +/- 1.55; p = 0.04) and Z-score in FN (-0.591 +/- 1.23 vs -1.132 +/- 1.46; p=0.01). The percentage of patients with osteopenia or osteoporosis in the RTP group was significantly higher than in the non-RTP group (72% vs 53%, p=0.05; RR= 3.2) and the glycosylated hemoglobin (HbA1c) levels of the RTP group were also higher (8.53 +/- 1.6% vs 7.1+/- 1.1%; p=0.05). The improvement in metabolic control, increase in body mass index and decrease in resorption parameters could contribute to the stabilization of bone mass in type I DM but the presence of retinopathy is a critical factor in the progression of diabetic osteopenia.

Effects of risedronate on metabolic bone disease in patients with type 1 diabetes and osteoporosis

Evaluar el efecto de un antirresortivo sobre la masa ósea y los marcadores del remodelado óseo en pacientes con diabetes mellitus tipo 1 (DM-1) y osteoporosis(OP). El estudio incluyó 52 pacientes con DM-1 con una duración de 21 a 36 años y OP u osteopenia, con edades comprendidas entre los 26 y los 69 años. Los pacientes con OP recibieron 30 mg/semana de risedronato (n = 35) ycalcio + vitamina D; mientras que los pacientes con osteopenia y los que rechazaron el risedronato (n = 17) sólo recibieron calcio + vitamina D. A los 12meses, el grupo con risedronato demostró una mejora significativa en los niveles de fosfatasa ácida resistente al tartrato (FART) (p < 0,0001), proteína óseaGla (BGP por sus siglas en inglés) (p < 0,0001), fosfatasa alcalina ósea (FAO) (p < 0,0001) y hemoglobina A1c (HbA1c) (p < 0,0001). La densidad mineralósea (DMO) fue aumentada a 6 y 12 meses comparado con el nivel basal en la columna (CL) (p < 0,0001) y el cuello femoral (CF) (p < 0,0001). A los 12 meses, el grupo convencional demostró una mejora significativa en HbA1c (p < 0,012) y una reducción en BGP (p < 0,03) y en FAO (p<0,0001). El grupo con tratamiento convencional no demostró cambios significativos en la DMO en la CLy el CF durante el periodo de 12 meses. El tratamiento con risedronato mejora la DMO en pacientes con DM-1 crónica

To assess the effect of a antiresorptive on bone mass and remodeling markers in patients with type 1 diabetes mellitus (DM-1) and osteoporosis (OP). Studyincluded 52 patients with DM-1 of 21-36 years duration and OP or osteopenia, aged 29-69 years. OP patients received 30 mg/week risedronate (n = 35)and calcium + vitamin D; osteopenic patients and risedronate refusers (n = 17) received only calcium + vitamin D. At 12 months, the risedronate group showedsignificant improvements in tartrate resistant acid phosphatase (p < 0.0001), osteocalcin (BGP) (p < 0.0001), bone alkaline phosphatase (BAP) (p < 0.0001),and hemoglobin A1c (HbA1c) (p < 0.0001); bone mineral density (BMD) was increased at 6 and 12 months versus baseline in lumbar spine (LS) (p < 0.0001) and femoral neck (FN) (p < 0.0001). At 12 months, the conventional group showed a significant improvement in HbA1c (p < 0.012) and reduction in BGP (p < 0.03) and BAP (p < 0.0001). The conventional treatment group showedno significant changes in BMD at LS and FN during the 12-month period. Risedronate treatment improves BMD in long-term DM-1 patients (AU)