Adherence to commercial food thickener in patients with oropharyngeal dysphagia.

BACKGROUND: Oropharyngeal dysphagia (OD), a common symptom in the elderly, uses commercial thickener (CT) as part of its treatment. This is often accompanied of dislike and poor compliance. AIM: Describe adherence to CT and possible differences according to dwelling location in an area of influence of approximately 400.0000 inhabitants. METHODS: Cohort prospective observational study. Randomized patients from Nutrition and Dietetic (NDU)-database (4 calls-interviews/year). VARIABLES: Age, diagnostic, gender, dwelling/location: Home (H) / Nursing Home (NH), viscosity (nectar, honey, pudding), days with CT. Adherence measured with a questionnaire, considering implementation of treatment by combining CT use and consumption data, categorised in three groups good, moderate and poor. Change in patterns (improvement, maintenance, worsening) and non-adherence reasons. RESULTS: One hundred sixty-eight patients recruited with indicated viscosity: Nectar 39.7%, honey 29.3% and pudding 30.8%. Average age of 82.6 ± 11.1 years; 57.8% women (46.4% at H vs. 67% at NH, p < 0.01). Dwelling/location: 80 (47.6%) live at H and 88 (52.4%) at NH. Days with CT prior study were 509 ± 475.28. Implementation found in first call: good in 50%, moderate in 20.2% and poor in 29.8%. At first call, adherence parameters were more favourable in NH compared to H. However these parameters were reversed during the study period as there was an improvement at H vs. NH. Also in terms of change in patterns a significant improvement of implementation was found in patients living at H, 31.1% vs. those living at NH, 15.7%, p < 0.05. CT persistence throughout study was 89.7%. CONCLUSIONS: Low adherence to CT found in our community. Telephone follow-up resulted in improved adherence, especially in the H population. Our data provides valuable insights into the variability and changes in CT adherence among patients with OD. Adherence is complex and subject to many factors and dwelling/location is one of them. This study reveals the need to approach CT treatment for OD differently in NH.

Executive summary of the SEEN (Sociedad Española de Endocrinología y Nutrición[Spanish Society of Endocrinology and Nutrition])-SEGO (Sociedad Española deGinecología y Obstetricia [Spanish Society of Gynaecology and Obstetrics]) consensusdocument on the management of thyroid dysfunction during pregnancy.

During pregnancy, thyroid function disorders are associated with multiple complications, both maternal and foetal. In recent years, numerous Clinical Practice Guidelines have been developed to facilitate the identification and correct management of thyroid disease in pregnant women. However, this proliferation of guidelines has led to confusion by proposing different cut-off points for reference values and different recommendations for similar situations. For this reason, the Sociedad Española de Endocrinología y Nutrición and the Sociedad Española de Ginecología y Obstetricia have prepared this Consensus Document, with the aim of creating a framework for joint action to unify criteria for the diagnosis and treatment of thyroid dysfunction in these patients. The document is structured to answer the most frequently asked questions in clinical practice, grouped into five sections: 1/Reference values for thyroid function tests and screening during pregnancy 2/Iodine nutrition 3/Hypothyroidism and pregnancy 4/Hyperthyroidism and pregnancy 5/ Thyroid autoimmunity.

Trends in glycemic control, cardiovascular risk factors and chronic complications of type 2 diabetes, 2012-2016, in a healthcare area of Barcelona.

AIMS: This study aimed to analyse the evolution of the metabolic control, cardiovascular risk factors and chronic complications in a Type 2 Diabetes (T2D) population in a healthcare area of Barcelona. METHODS: We carried out a comparative study of T2D patients (20.457) between 2012 and 2016 (data recorded in the "Electronic Clinical-Station in Primary Care") concerning: age, gender, body mass index (BMI), arterial blood pressure (BP), HbA1c, LDL-Cholesterol, smoking, heart failure (HF), micro and macrovascular complications. RESULTS: Average HbA1c was 6.9 % in 2012 and 7 % in 2016 (Non significant differences)(NS). In 2012, 57.9 % of patients presented proper glycaemic control, 42.8 % LDL-Cholesterol < 100 mg/dL and 76.9 % BP < 140/90 while in 2016 it was 61.2 % (NS), 59.2 % (p = 0.001) and 82.9 % (p = 0.016) respectively. No changes were found in BMI or active smoking. Significant increases were found in the prevalence of microvascular complications, HF and peripheral vasculopathy (PV). Patients with vascular diseases (PVD) and adequate metabolic control increased from 57.5 % to 62.7 % (p = 0.006). Albuminuria > 30 mg/g were more frequent among PVD. CONCLUSIONS: Between 2012 and 2016 it was observed that, amongst our study population, glycaemic control was steady and cholesterol and BP levels were improved, while there was a significant increase of diabetic complications, HF and PV.

Differences in the use of food textures in oropharyngeal dysphagia according to the place of living.

BACKGROUND&AIMS: Modifying solid/liquid foods is the main treatment in oropharyngeal dysphagia (OD). Commercial Thickener (CT) for treatment is subsidized by health system and is delivered to patient's place of living, once is managed by our hospital Nutrition-Dietetics Unit (NDU). AIM: To describe the patterns of texture for foods/liquids follow in patients with OD who are treated with CT. METHODS: Cohort prospective study. Randomized patients from NDU-database followed throughout 2018 (4 calls-interviews/year). Variables; age, diagnostic, gender, residence type: Home(H)/Nursing Home(NH), thickener manager (patient, family member or caregiver), education, days with commercial thickener (CT), thickener regimen established by Volume/Viscosity test: nectar (N), honey (HY), pudding (P), type of diets; measured by FOIS scale and texture; pureed (PD); soft (SD); mixed (P&S/D); regular (RD), risk foods consumption (RFC), complete diet intake (CI), changes in; diets, intake and RFC. RESULTS: Analysed 204 patients, aged 85 years; (IQR: 78-90), from which 57.8% were women. Residence: 43.6% H/56.4% NH. Days with CT median 380 days (IQR: 153-682). A proper viscosity guideline was indicated in 168 patients: N 37.3%, HY 20.6% and P 24.5%. In 36 patients (17.5%) there were no indications, 75% of them coming from primary care. Despite this, 184 patients (90%) referred a concrete indication; N 35.8%, HY 26% and P 28.4%. The concordance between indicated and referred viscosity was significantly higher at H (Kappa 0.798) compared to NH (Kappa 0.428), p < 0.0001. FOIS: 65.7% followed the total oral diet of a single consistency. Diet textures: PD 66.7%, SD 2.9%, P&S/D 21.1%, RD 9.3%. Difference in PD given in NH 86.1% vs H 41.6%, p < 0.001. Under N viscosity different diet distributions, PD 28.6%H vs 71% NH, p < 0.05. CI in 66.7% with no difference among NH/H. RFC similar but higher consumption of jellies at NH, p < 0.001. CONCLUSIONS: According to this study the place of living determines a better approach to OD treatment. Viscosity and diet texture are more restricted in NH with worse compliance of indicated regimens. Increasing variety in diets and reassessment of OD treatment is desirable.

Register-based information on thyroid diseases in Europe: lessons and results from the EUthyroid collaboration.

Objective: Registers of diagnoses and treatments exist in different forms in the European countries and are potential sources to answer important research questions. Prevalence and incidence of thyroid diseases are highly dependent on iodine intake and, thus, iodine deficiency disease prevention programs. We aimed to collect European register data on thyroid outcomes to compare the rates between countries/regions with different iodine status and prevention programs. Design: Register-based cross-sectional study. Methods: National register data on thyroid diagnoses and treatments were requested from 23 European countries/regions. The provided data were critically assessed for suitability for comparison between countries/regions. Sex- and age-standardized rates were calculated. Results: Register data on ≥1 thyroid diagnoses or treatments were available from 22 countries/regions. After critical assessment, data on medication, surgery, and cancer were found suitable for comparison between 9, 10, and 13 countries/regions, respectively. Higher rates of antithyroid medication and thyroid surgery for benign disease and lower rates of thyroid hormone therapy were found for countries with iodine insufficiency before approx. 2001, and no relationship was observed with recent iodine intake or prevention programs. Conclusions: The collation of register data on thyroid outcomes from European countries is impeded by a high degree of heterogeneity in the availability and quality of data between countries. Nevertheless, a relationship between historic iodine intake and rates of treatments for hyper- and hypothyroid disorders is indicated. This study illustrates both the challenges and the potential for the application of register data of thyroid outcomes across Europe.

Estimation of the prevalence of thyroid dysfunction in Catalonia through two different registries: Pharmaceutical dispensing and diagnostic registration.

Background: Population studies on the prevalence of thyroid dysfunctions are costly. The pharmacy dispensing (PDR) and diagnosis (DR) registers allow us to study the epidemiology of these pathologies in a simpler way. Our aims: 1/Estimate the prevalence of thyroid dysfunction in Catalonia based on data from the PDR and the DR, 2/to evaluate the concordance of the results obtained by both strategies. Methods: The population studied was the one registered with the public health system in Catalonia(Catsalut). In the PDR analysis, the information obtained through the Pharmaceutical Provision file (during 2012, 2013, 2014) was used regarding the number of patients under treatment (NPT) (levothyroxine and antithyroid medication). The DR analysis (2014) was performed by ICD-9 codes (hyperthyroidism 242 and hypothyroidism 243, 244). Results: According to the NPT in the PDR analysis, the prevalence of treated hypothyroidism increased over 3 years: 2.81%(2012), 2.92%(2013) and 3.07%(2014) (P < .00001). The prevalence of hyperthyroidism in treatment was 0.14%(2012), 0.13%(2013) and 0.14%(2014). According to the DR analysis in 2014, the prevalence of hypothyroidism was 2.54% and 0.35% for hyperthyroidism. The PDR analysis estimated a higher hypothyroidism prevalence compared to that estimated by the DR (P < .0001) and vice versa in the case of hyperthyroidism. Conclusion: Both PDR and DR prevalence estimations of thyroid dysfunction show some degree of discordance probably due to undercoding bias in the case of DR and the absence of subclinical pathology in the case of PDR. However, both approaches are valid and complementary for estimating the prevalence of thyroid dysfunction.

Impact of Dietary Habit, Iodine Supplementation and Smoking Habit on Urinary Iodine Concentration During Pregnancy in a Catalonia Population.

(1) Background: The nutritional status of women during pregnancy can have a considerable effect on maternal and fetal health, and on the perinatal outcome. Aim: to assess the changes occurring in dietary iodine intake, potassium iodide supplementation, and smoking habit, and the impact of these changes on the urinary iodine concentration (UIC) during pregnancy in a population of women in Catalonia (Spain). (2) Methods: Between 2009-2011, an observational study included a cohort of women whose pregnancies were monitored in the public health system in the Central and North Metropolitan areas of Catalonia. Women received individual educational counseling, a dietary questionnaire was completed, and a urine sample was collected for iodine determination at each trimester visit. (3) Results: 633 (67.9%) women answered the questionnaire at all 3 visits. The percentage of women with a desirable UIC (≥150 µg/L) increased from the first to the second trimester and remained stable in the third (57.3%, 68.9%, 68%; p < 0.001). Analysis of the relationship between UIC≥150 µg/L and the women's dietary habits showed that the percentage with UIC ≥150 µg/L increased with greater consumption of milk in the first trimester, and the same was true for iodized salt use in all three trimesters and iodine supplementation in all three. (4) Conclusion: During pregnancy, increased intake of milk, iodized salt, and iodine supplements were associated with an increase in the UIC.

Standardized Map of Iodine Status in Europe.

Background: Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine-related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized urinary iodine concentration (UIC) data. Materials and Methods: We established a gold-standard laboratory in Helsinki measuring UIC by inductively coupled plasma mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to postharmonize the studies by standardizing the UIC data of the individual studies. Results: In comparison with the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from -36.6% to 49.5%. Of the 40 postharmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults, and 11 in pregnant women. Median standardized UIC was <100 µg/L in 1 out of 16 (6.3%) studies in schoolchildren, while in adults 7 out of 13 (53.8%) studies had a median standardized UIC <100 µg/L. Seven out of 11 (63.6%) studies in pregnant women revealed a median UIC <150 µg/L. Conclusions: We demonstrate that iodine deficiency is still present in Europe, using standardized data from a large number of studies. Adults and pregnant women, particularly, are at risk for iodine deficiency, which calls for action. For instance, a more uniform European legislation on iodine fortification is warranted to ensure that noniodized salt is replaced by iodized salt more often. In addition, further efforts should be put on harmonizing iodine-related studies and iodine measurements to improve the validity and comparability of results.

Iodine nutrition status in Spain Needs for the future. / La nutrición de yodo en España. Necesidades para el futuro.

Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities.

Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study.

RATIONALE: Oropharyngeal Dysphagia (OD) is a symptom commonly found in hospitalized patients and related to a vast array of clinical diagnosis and to high morbidity and mortality that is becoming very important to identify. Our aim was to assess the prevalence of OD in our hospital setting. METHODS: Cross-sectional randomized study to determine the prevalence of dysphagia in an acute care hospital (ACH) and long term care hospital (LTCH). Multiquestionnaire test performed to assess dysphagia with the bedside validated volume-viscosity swallow test (V-VST test), in those with the validated swallowing ability test, eating assessment tool (EAT-10)>3. Variables; sex, age (>65 y), diagnosis, mininutritional assessment (MNA), previous diagnosis of dysphagia (including any recommendations given before), EAT-10, V-VST, presence of dysphagia, type of diet prescribed (basal or therapeutic), use of thickener and diet texture (pureed with liquids allowed, pureed without liquids, soft diet, normal). RESULTS: N = 200 patients (100 in each centre). 49% male; Age = 81.1 [65-101] years; Diagnostics: medical 70%/surgery 30%. Dysphagia analysis: 42% patients showed an EAT-10 > 3 so the V-VST test was done in these patients resulting in global prevalence of 28.5% (95% CI: 22.7-35.1). Among centres no significant differences were observed: ACH 30% (95% CI: 14-34) and LTCH 27% (95% CI: 19-36). Highlighting a greater concentration of dysphagia in Orthogeriatric and Neurological patients in the LTCH than in ACH (Pneumology, Internal Medicine and Cardiology). MNA analysis: 27% normal 44% risk 29% malnutrition. Malnutrition present in 50.9% of patients diagnosed with dysphagia, 44% in those at risc (EAT-10 +) and 27.6% in those without risc or dysphagia (p = 0.020). From the novo patients, 75.4% did not have adequate complete adapted treatment (diet and thickener). Only 13.3% had their thickener prescribed. In those with history of dysphagia 37% had an inappropriate treatment. CONCLUSION: Prevalence of OD matches with what is described in the literature. There is a high proportion of infradiagnostic and overall inadequate treatment, more than a third of patients do not have their diet adapted correctly. It is important to identify this symptom to treat it properly and to raise awareness among sanitary professionals for best adaptation of treatment.

Recommendations for the detection, diagnosis and follow-up of patients with non-alcoholic fatty liver disease in primary and hospital care. / Recomendaciones para la detección, diagnóstico y seguimiento de los pacientes con enfermedad por hígado graso no alcohólico en atención primaria y hospitalaria.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, with a prevalence of 20-30% in the general population and 60-80% in at-risk populations. In a not negligible percentage of patients, NAFLD progresses from steatosis to different stages of fibrosis and cirrhosis. Due to its high prevalence, NAFLD has become a significant health problem that requires specific action in detection, diagnosis, follow-up and treatment. Furthermore, given that NAFLD presents an increased risk of cardiovascular morbidity and mortality, a multidisciplinary approach is required for its treatment and follow-up. Patients with early stages of the disease, without fibrosis, can be diagnosed and receive treatment in the Primary Care setting, while those with more advanced liver disease benefit from specialised follow-up in the hospital setting to prevent and treat liver complications. This consensus document, prepared by the Catalan Societies of Digestology, Primary Care, Endocrinology, Diabetes and Internal Medicine, arises from the need to design strategies to guide patient flows between Primary and Hospital Care in order to offer patients with NAFLD the best care according to the stage of their disease. The consensus document describes the most commonly used non-invasive diagnostic methods for patient diagnosis and two algorithms have been designed for patient management in both Primary Care and Hospital Care.

Iodine nutrition status and prevalence of abnormal TSH levels in schoolchildren aged 6-7 years in the autonomous community of the Basque Country. / Estado de nutrición de yodo y prevalencia de concentraciones anormales de TSH en la población escolar de 6-7 años de la comunidad autónoma del País Vasco.

INTRODUCTION: An epidemiological study conducted between 1988 and 1992 showed iodine deficiency and endemic goiter in the schoolchildren of the autonomous community of the Basque Country. OBJECTIVES: 1) To ascertain the iodine nutrition status of schoolchildren aged 6-7 years, and 2) to estimate the prevalence of abnormal TSH levels in capillary blood. POPULATION AND METHODS: The study was conducted on 497 schoolchildren selected by random sampling. Median urinary iodine concentration (mUIC) was used to assess iodine nutritional status, and the reference interval derived from the study population was used to estimate the prevalence of abnormal TSH levels. RESULTS: The mUIC (P25-P75) was 140 (82-217) µg/L. A higher value was found in those who used iodized salt at home than in those who did not (146 [85-222] versus 126 µg/L [73-198], P<0.05). It was also higher in those who consumed 2 or more daily servings of milk and yogurt than in those taking less than 2 servings (146 [87-225] versus 110 µg/L [66-160], P<0.0001). Abnormal TSH levels were found in 2% of children. There was no correlation between TSH levels in capillary blood and urinary iodine concentrations (R=0.082; P=0.076). DISCUSSION AND CONCLUSIONS: Schoolchildren aged 6-7 years of the autonomous community of the Basque Country have an adequate iodine nutrition status. Use of iodized salt at home and daily consumption of milk and yogurt were associated to the highest UICs.

Hypothyroidism during pregnancy and its association to perinatal and obstetric morbidity: a review.

There is currently no consensus among the different scientific societies on screening for thyroid dysfunction in the first trimester of pregnancy. Indeed, diagnosis and treatment of subclinical hypothyroidism during pregnancy are controversial, as no cut-off value for thyrotropin (TSH) is universally accepted. TSH measurement may be influenced by different factors throughout pregnancy, but especially during the first trimester. The association between overt hypothyroidism during pregnancy and obstetric and perinatal complications is well established. It is also accepted that thyroid hormones are important for neurodevelopment of the offspring. However, there is no scientific evidence available about the impact of subclinical hypothyroidism and its treatment during the first trimester of pregnancy on children's neurodevelopment. In recent years, studies conducted in the offspring of mothers with subclinical hypothyroidism have reported new biochemical parameters which may eventually serve as biomarkers of offspring neurodevelopment and which are more reproducible and are measured at an earlier time than the conventional clinical tests.

Causes of failure to achieve the low density lipoprotein cholesterol therapeutic target in patients with high and very high vascular risk controlled in Lipid and Vascular Risk Units. EROMOT study. / Causas de no consecución del objetivo terapéutico del colesterol de las lipoproteínas de baja densidad en pacientes de alto y muy alto riesgo vascular controlados en Unidades de Lípidos y Riesgo Vascular. Estudio EROMOT.

OBJECTIVES: Determination of the level of achievement of the low density lipoprotein cholesterol (LDL-C) therapeutic target in patients with high and very high vascular risk treated in Lipid Units, as well as the causes of non-achievement. PATIENTS AND METHOD: Multicentre retrospective observational study that included patients over 18 years with high and very high vascular risk, according to the criteria of the 2012 European Guidelines on Cardiovascular Disease Prevention, referred consecutively to Lipid Units between January and June 2012 and with follow-up two years after the first visit. RESULTS: The study included a total of 243 patients from 16 lipid units. The mean age was 52.2 years (SD 13.7), of whom 62.6% were males, and 40.3% of them were very high risk. At the first visit, 86.8% (25.1% in combination) and 95.0% (47.3% in combination) in the second visit (P<.001) were treated with lipid-lowering treatment. The therapeutic target was achieved by 28% (95 CI: 22.4-34.1). As regards the causes of non-achievement, 24.6% were related to the medication (10.3% maximum tolerated dose and 10.9% due to the appearance of adverse effects), 43.4% due to the physician (19.4% by inertia, 13.7% considering that target already reached), and 46.9% due to the patient, highlighting the therapeutic non-compliance (31,4%). CONCLUSIONS: LDL-C targets were achieved in about one-third of patients. The low adherence of the patient, followed by medical inertia are the most frequent causes that can explain these results.

Iodine nutritional status of women in their first trimester of pregnancy in Catalonia.

BACKGROUND: Sufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine <150 µg/L, and tobacco use in the first trimester of pregnancy in our setting. METHODS: Cross-sectional study. Data were collected during 2008-2009 from women in their first trimester at the primary care centers of the province of Barcelona (Spain). Pregnant women included in the study completed a questionnaire on eating habits and underwent urinary iodine concentration (UIC) assessment. RESULTS: Nine hundred forty five women completed the dietary questionnaire and urinary iodine testing. Median UIC was 172 µg/L, with 407 participants (43.1%) showing levels <150 µg/L. On multivariate logistic regression analysis, intake of 1-2 glasses of milk per day, OR = 0.636 95% CI (0.45-0.90) or >2 glasses, OR = 0.593 95% CI (0.37-0.95); iodized salt consumption, OR = 0.678 95% CI (0.51-0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31-0.54), protected against the risk of UIC <150 µg/L. Simultaneous consumption of iodized salt and milk (≥1 glass/day) showed a larger protective effect: OR = 0.427, 95% CI (0.31-0.54). CONCLUSION: The median UIC of the pregnant women surveyed indicated an acceptable iodine nutritional status according to the criteria established by the WHO and ICCIDD. The risk of urinary iodine <150 µg/L decreased with simultaneous consumption of milk and iodized salt, similar to the decrease seen with iodine supplementation.

Hypertriglyceridemic waist in type 1 diabetes patients: prevalence and related factors.

BACKGROUND: The hypertriglyceridemic waist has been linked to a higher number of cardiovascular risk factors and a greater probability of developing diabetes and cardiovascular disease. Around 50% of individuals with type 1 diabetes (T1D) are overweight or obese and triglyceridemia is associated with the onset of micro- and macrovascular complications. METHODS: A cross-sectional study was conducted in men with T1D to assess the association between the prevalence of hypertriglyceridemic waist and cardiovascular risk factors and hypogonadism. Triglyceride levels + abdominal circumference taken together were stratified into quartiles to identify the hypertriglyceridemic waist phenotype. RESULTS: One hundred and eighty-one male patients were included. An increased prevalence of hypogonadism and hypertension in parallel to increased triglyceride + waist circumference quartile was observed. Patients in the highest quartile had higher insulin resistance measured by estimated glucose disposal rate (eGDR 7.8±2.1 mg/kg-1.min-1 in 1st quartile vs. 5.8±1.8 mg/kg-1.min-1 in 4th quartile, P=0.000), insulin requirements, hip circumference, percentage of fat mass, glycosilated hemoglobin and total and LDL cholesterol as well as lower levels of total testosterone (27.24±9.3 nmol/L in 1st quartile vs. 17.4±8 nmol/L in 4th quartile, P=0.000) and HDL cholesterol. An inverse relationship was found between triglycerides + waist circumference and total testosterone levels (R=-0.367, P<0.0001). CONCLUSIONS: The hypertriglyceridemic waist in men with T1D is associated with an atherogenic lipid profile, hypertension, worse metabolic diabetes control, increased insulin resistance and a higher prevalence of hypogonadism.

Testosterone undecanoate improves lipid profile in patients with type 1 diabetes and hypogonadotrophic hypogonadism.

Testosterone deficiency (Td) has been associated with the metabolic syndrome. Few studies have evaluated this condition in type 1 diabetes (T1D). The primary aim of this study was to evaluate the effectiveness of testosterone undecanoate (TU) on insulin sensitivity, glycemic control, anthropometric parameters, blood pressure and lipid profile in patients with Td and T1D. We performed a randomized placebo-controlled multicenter study. INCLUSION CRITERIA: a) age ≥ 18 years; b) autoimmune diabetes; c) Td (total testosterone <10 nmol/L or calculated free testosterone <225 pmol/L and low/normal LH; d) ability to sign informed consent; e) comply with the study protocol. EXCLUSION CRITERIA: a) pituitary tumor, empty sella, hyperprolactinemia, panhypopituitarism or secondary hypogonadism; b) contraindications for treatment with testosterone undecanoate (TU); c) patients who did not agree to sign their informed consent. Six patients were randomly assigned to testosterone undecanoate (TU) treatment and 7 to placebo with the following dosing schedule: baseline, 6 weeks and 16 weeks. Blood test, anthropometric parameters, blood pressure and insulin sensitivity were determined at baseline, 6, 16 and 22 weeks. No differences were observed regarding insulin sensitivity, HbA1c or basal glucose, anthropometric parameters or blood pressure. At 22 weeks, the decrease in total cholesterol was 37.4 ± 27.5 mg/dL in the TU group compared with an increase of 13.2 ± 17.8 mg/dL in the placebo group (P<0.005), and LDL cholesterol concentration decreased 30.2 ± 22.1 mg/dL, compared with an increase of 10.5 ± 13.4 mg/dL in the placebo group (P=0.004). We conclude that treatment with TU in patients with T1D and Td improves lipid profile, with no effects on metabolic control or anthropometric parameters.

Ensuring Effective Prevention of Iodine Deficiency Disorders.

BACKGROUND: Programs initiated to prevent iodine deficiency disorders (IDD) may not remain effective due to changes in government policies, commercial factors, and human behavior that may affect the efficacy of IDD prevention programs in unpredictable directions. Monitoring and outcome studies are needed to optimize the effectiveness of IDD prevention. SUMMARY: Although the need for monitoring is compelling, the current reality in Europe is less than optimal. Regular and systematic monitoring surveys have only been established in a few countries, and comparability across the studies is hampered by the lack of centralized standardization procedures. In addition, data on outcomes and the cost of achieving them are needed in order to provide evidence of the beneficial effects of IDD prevention in countries with mild iodine deficiency. CONCLUSION: Monitoring studies can be optimized by including centralized standardization procedures that improve the comparison between studies. No study of iodine consumption can replace the direct measurement of health outcomes and the evaluation of the costs and benefits of the program. It is particularly important that health economic evaluation should be conducted in mildly iodine-deficient areas and that it should include populations from regions with different environmental, ethnic, and cultural backgrounds.

Age, insulin requirements, waist circumference, and triglycerides predict hypogonadotropic hypogonadism in patients with type 1 diabetes.

INTRODUCTION: The prevalence of hypogonadotropic hypogonadism (HH) in patients with type 2 diabetes mellitus is higher than in the general population and leads to detrimental effects on metabolic control, lipid profile, and body composition. Few studies have examined its role in type 1 diabetes mellitus. AIM: To determine the prevalence of HH in patients with type 1 diabetes and associated risk factors. MAIN OUTCOME MEASURES: Clinical and biochemical parameters were gathered on initial evaluation. An HH score creating different experimental models was devised to calculate the risk of HH for an individual with type 1 diabetes. METHODS: Cross-sectional study of 181 male patients with type 1 diabetes consecutively admitted to the Diabetes outpatient clinics of three urban hospitals. All participants were Caucasians aged ≥ 18 years with type 1 diabetes duration of more than 6 months. RESULTS: One hundred and eighty-one male patients with a mean age of 44.2 ± 13.2 years and a type 1 diabetes duration of 18.9 ± 12.7 years were included. Fifteen patients had HH, representing a prevalence of 8.3% (95% confidence interval [CI]: 4.3-12.3%). Age (odds ratio [OR] 1.066 [95% CI: 1.002-1.134]), waist circumference (OR 1.112 [95% CI: 1028-1203]), and insulin requirements ([IU/Kg] ×10 [OR 1.486 {95% CI: 1052-2.098}]) were independently associated with the presence of HH. The model that best predicted HH generated this formula: HH-score = (1.060 × age) + (1.084 × waist circumference) + (14.00 × insulin requirements) + triglycerides, where age was expressed in years, waist circumference in cm, insulin requirements in IU/kg/d, and triglycerides in mg/dL. An HH score > 242.4 showed 100% sensitivity and 53.2% specificity for HH diagnosis; positive and negative predictive values were 17.0 % and 100%, respectively. CONCLUSIONS: One in 10 men with type 1 diabetes presents HH. This condition is associated with age, waist circumference, and insulin requirements. A simple formula based on clinical parameters can rule out its presence.