Long-Term GH therapy: epidemiology and auxologic outcome.

OBJECTIVES: Epidemiologic and auxologic characteristics of patients treated with GH during childhood and adolescence and entered in a national registry in Catalonia were studied between 1988 and 1997. At the end of 1997, prevalence was 53.2 treatments/100,000 inhabitants aged 0-14 years. Maximum annual incidence rates were observed in 1990 and 1991 (34.0-35.6 cases/100,000 inhabitants aged 0-14 years). STUDY DESIGN: Analysis of treatments terminated in 1993 (n = 548) revealed, for the three principal reasons for cessation of treatment ('near-final height', 'adequate height but further growth potential', and 'poor growth response'), that males began and ended treatment at older ages with a better auxologic situation in SDS than girls at the beginning and end of therapy in the first two subgroups, with a similar duration of therapy. Severe GH deficiency (GHD) [both multiple pituitary hormone deficiency (MPHD) and the most severe isolated GHD (IGHD-A)] was more frequent in the group ending treatment at 'near-final height', whereas cessation of therapy because of 'poor growth response' was more frequent in the group with 'other causes of short stature' and no demonstrable GHD by routine tests. In the near-final height group, after excluding Turner's syndrome, MPHD and GHD cases secondary to brain tumors and GH deficiencies associated with malformative syndromes, positive linear correlations were observed between HSDS at the end of treatment and HSDS at the beginning, predicted adult height SDS (PAHSDS) and target height SDS (THSDS). Multiple regression analysis showed that in this group of patients, 41.4% of the variability in HSDS increment can be explained by the equation: HSDS increment = -0.33 + 0.29 THSDS - 0.68 HSDS at the beginning of treatment. RESULTS: The outcome showed a reasonable use of GH, since good-response cases generally continued treatment until final height whereas therapy was suspended in doubtful cases.

[Food consumption and nutrient intake in relation to smoking]. / Relación del consumo de alimentos y nutrientes con el hábito tabáquico.

BACKGROUND: It is well known that smoking and some nutritional habits are two of the most important risk factors for the development of certain cancers and cardiovascular diseases. The purpose of this study is to assess the food and nutrient consumption in relation to smoking in the Catalan population, Spain. SUBJECTS AND METHOD: A representative sample of the Catalan population of 1774 people aged 18 to 64 years from both sexes. Nutritional status was evaluated using selected anthropometrical indexes, and food consumption with two 24-hour recall. Questionnaires about smoking consumption and a semiquantitative frequency questionnaire about alcohol consumption were also administered. RESULTS: Male non smokers consumed more dairy products than smokers, and more fruits and nuts than smokers and ex-smokers. Female non-smokers consumed more chicken, fruits and less sweets than smokers and ex-smokers. In both genders, smokers consumed more alcohol. With respect to nutrients, smokers consumed less fiber than non smokers and more energy from lipids and saturated and monounsaturated fatty acids. CONCLUSIONS: The diet of smokers is less healthy than that of non smokers and ex-smokers, which indicates a higher risk for the incidence of certain cancers and cardiovascular diseases.

Prevalence of diabetes in Catalonia (Spain): an oral glucose tolerance test-based population study.

The goal of this study was to investigate the prevalence of diabetes mellitus and impaired glucose tolerance in the adult population of Catalonia and study their association with obesity, central obesity, hypertension and smoking habit. A random sample of 3839 subjects aged 30-89 years participated in this cross-sectional study: 2214 subjects underwent a health examination with oral glucose tolerance test (OGTT) and 1625 were interviewed by phone. Diabetes prevalence (known and unknown) in the 30-89-year-old population was 10.3%, (95% CI: 9.1-11.6). In this age group, the prevalence rates of known diabetes, unknown diabetes and impaired glucose tolerance were 6.4, 3.9 and 11.9% in men and 6.9, 3.4 and 11.9% in women. The age adjusted prevalence to the world population for the 30-64-year-old age group was 6.1% (7.1% in men and 5.2% in women).The factors significantly associated with diabetes were age, obesity, hypertension and family history of diabetes. The high ratio of previously known diabetic cases to newly discovered ones, specially in the oldest age group, suggests good levels of awareness and medical services. The prevalence in Catalonia is similar to that observed in other Mediterranean countries.

[Renal failure secondary to diabetic nephropathy. A review of the characteristics of the diabetic patients who started dialysis in Catalonia in 1994]. / Insuficiencia renal secundaria a nefropatía diabética. Revisión de las características de los pacientes diabéticos que iniciaron diálisis en Cataluña en 1994.

The appearance of diabetic nephropathy and its progression towards renal failure can be prevented if an early treatment is instituted. However, diabetes is currently one of the main causes of entry into a dialysis program. Therefore, the diagnostic characteristics of renal disease in 105 patients who started dialysis in Catalonia in 1994 were reviewed; the presence of other changes associated with diabetes were assessed. The results showed that 81.7% of patients had proteinuria higher than 0.5 g/24 h, and 40.5% had plasma creatinine higher than 5 mg/dl at the first nephrological control. As a result, the period between diagnosis of nephropathy and the inclusion in the dialysis program was very short (3.7 years) and considerably shorter than that reflected in literature for other countries, whereas the incidence of other micro and macrovascular complications was similar. Remarkably, a high number of smokers and treatment with oral antidiabetic drugs (33%) at the end stage of renal failure was observed. These results suggest that follow-up of diabetics should be more exhaustive and serial tests be performed to detect nephropathy early. An appropriate control during renal failure stage can also postpone the disease progression and avoid the appearance of complications which at present have a high morbid-mortality and high cost.

[Prevalence of nephropathy in type I diabetes]. / Prevalencia de nefropatía en la diabetes mellitus tipo I.

BACKGROUND: Diabetic nephropathy is a serious complication of diabetes, of which there are few epidemiological data in Spain. The aim of this study is to determine diabetic nephropathy prevalence in a group of patients with type I diabetes mellitus, representative of the population of Barcelona, Spain, evaluating several risk factors related with its development. PATIENTS AND METHODS: 639 patients (296 males and 343 women), from 6 hospitals, selected according with the diabetes duration (194 between 5 and 9 years [group I], 227 between 10 and 19 years [group II] and 218 with 20 years or more [group III]) were studied. In all patients urinary albumin excretion and plasma levels of creatinine, HbA1c, cholesterol and triglycerides were determined. The presence of retinopathy, neuropathy, vasculopathy and tobacco consumption were also evaluated. RESULTS: The prevalence of diabetic nephropathy increased with longer diabetes duration (8.1% [CI: 4.3-11.9] in group I, 24.7% [CI: 19.1-30.3] in group II and 44.7% [CI: 38.1-51.3] in group III), as well as that of hypertension, diabetes complications, cholesterol and triglycerides plasma levels. Related to people with normal renal function, after logistic regression, microalbuminuria was associated with hypertension and longer diabetes duration. Clinical nephropathy (macroalbuminuria + renal failure) to hypertension, longer duration, hypertriglyceridemia, male sex and tobacco consumption. CONCLUSIONS: The prevalence of diabetic nephropathy in Barcelona area is high and similar to that observed in other european regions. Its existence is associated with other diabetic complications. In addition to the classic risk factors, tobacco consumption must also be considered as a factor for diabetic nephropathy.

Cyclamate consumption in Catalonia, Spain (1992): relationship with the body mass index.

The dietary intake of cyclamate was evaluated in the north-east of Spain in 1992. In a random sample of the Catalan population consisting of 2450 people aged 6-75 years, two 24-h recalls at different seasons were collected; the amount and type of all foods, drinks and drugs consumed were obtained and the total daily intake of cyclamate was expressed in mg/kg body weight (bw), as the average of both 24-h recalls. Eighteen percent of the population consumed cyclamate, and the highest percentage was in men aged 35-44 years (33%). Average daily intake of cyclamate was 0.44 mg/kg bw in the whole population and 2.44 mg/kg bw among consumers. Subjects following a diet reported highest intakes, especially diabetics, and only 0.16% of the sample studied had levels above the Acceptable Daily Intake (ADI). Among consumers, the intake of cyclamate was negatively correlated with Body Mass Index (BMI). The results show the pattern of cyclamate intake in the Spanish population.

Epidemiology of renal involvement in type II diabetics (NIDDM) in Catalonia. The Catalan Diabetic Nephropathy Study Group.

The aim of this cross-sectional study was to establish the prevalence of renal involvement and to identify associations with its most important possible risk factors in a group of patients with Type II diabetes mellitus, representative of the population living in Catalonia. One thousand two hundred and three patients (47% males, mean age: 61 +/- 6 years, diabetes duration 9 +/- 6 years) were studied. Overnight urine samples were collected to determine urinary albumin excretion (UAE). If UAE was > 15 micrograms/min, a new 24-h urine collection for UAE measurement to establish the existence of microalbuminuria (20-200 micrograms/min) or macroalbuminuria (> 200 micrograms/min) was obtained. Clinic and metabolic evaluations were also performed. The prevalence (%) of microalbuminuria, macroalbuminuria and hypertension were, respectively, 23. 1, 5.4 and 42. In comparison with normoalbuminurics, patients with microalbuminuria were predominately male (P < 0.03), with a significantly higher systolic (P < 0.001) and diastolic (P < 0.001) blood pressure and body mass index (P < 0.001). The prevalence of smokers (former + current) was higher in patients with microalbuminuria (43 vs 32%, P < 0.025). Moreover, patients with nephropathy had more prevalence of retinopathy (P < 0.001), neuropathy (P < 0.001), peripheral angiopathy (P < 0.001) and coronary disease (P < 0.001). The prevalence of microalbuminuria in Type II diabetes in Catalonia is similar to that observed in other european countries. The existence of microalbuminuria is associated with several diabetic complications, as well as tobacco consumption and obesity.

[Analysis of the geographic distribution of the incidence of diabetes mellitus type I in Catalonia]. / Análisis de la distribución geográfica de la incidencia de diabetes mellitus tipo I en Cataluña.

BACKGROUND: The aim of the present study was to evaluate the geographic distribution of the incidence of diabetes mellitus type I (DMI) in Catalonia from 1987-1990. METHODS: The base of the study is the Catalonian registry of incidence of DMI in the period from 1987-1990. The definition criteria were: diagnostic criteria of diabetes (WHO norms 1985), age of diagnosis under 30 years, residence in Catalonia in the period of diagnosis and exclusion of other types of diabetes. The population at risk was estimated according to the general census of the population of 1986. The total incidence of Catalonia was calculated by provinces and counties according to the Poisson distribution. RESULTS: The incidence of DMI observed in Catalonia was of 11.5/100,000 inhabitants per year (CI 95%, 10.6-12.4) in the age group from 0-14 years and 10.7/100,000 inhabitants per year (CI 95% 10.1-11.3) in the age group from 0-29 years. The exhaustivity in the detection of the cases was of 90.3%. No differences were found in interprovincial incidence in the 0-14 age group: Barcelona 11.6 (10.6-12.7), Girona 10.2 (7.2-13.4), Lleida 11.7 (7.7-15.8), Tarragona 10.5 (7.6-13.5). In the 15-29 age group a lower incidence was observed in Tarragona. The incidence by counties varied between 2.9 and 15.0/100,000 inhabitants per year with those of greatest incidence being observed in the Vallés Oriental (15.0/100,000 inhabitants/years), Alt Penedés (14.5/100,000 inhabitants/year), Segrià (15.0/100,000 inhabitants/year) and the Priorat (13.7/100,000 inhabitants/year). CONCLUSIONS: No differences were found in the incidence of diabetes mellitus type I in the four Catalonian provinces. Distribution by counties was more heterogeneous without defining zones with a much higher incidence to that observed in the whole of Catalonia.

Changing patterns of fat consumption in Spain.

Trends of fat and fat-containing food consumption in Spain are analysed; information was obtained from data collected at two different levels: household and individual. Three major household budget surveys conducted by the National Institute of Statistics in 1964, 1980-1981, and 1990-1991 show the trends of food and fat consumption in Spain; we can observe a decrease in cereals, potatoes and pulses and an increase in dairy products and meat, similar to that observed in other countries. According to these studies, the consumption of fat and saturated fat and the other vegetable oils have increased, while olive oil intake has decreased. Food and fat consumption in Spain presents a large variation between the Spanish regions. Six individual dietary studies conducted among adult free-living populations are reviewed; intakes of fat ranged from 90 to 110 g/person/day, and percentage of total energy from saturated fat from 12 to 15%. The rise in fat intake in Spain urges dietary interventions.

[Epidemiology of obesity among the adult population of Catalonia]. / Epidemiología de la obesidad en la población adulta de Cataluña.

Several epidemiological studies have shown that obesity is related to the mortality from cardiovascular disease. In this study, the epidemiology of obesity and the correlation between body mass index and other cardiovascular risk factors was studied in a representative sample of the adult population of Catalonia. It was obtained a random sample (n = 704) of the adult population of Catalonia aged 15 or more years. Height and weight were measured and body mass index (BMI) was calculated (height in Kg/weight2 in m2). Obesity was defined as a BMI greater than 30, and overweight as a BMI from 25 to 30. In the first 314 participants, it was determined the concentration of total cholesterol, cholesterol-HDL and triglyceride, and it was measured the blood pressure. The correlation between BMI and other cardiovascular risk factors was analysed. The study was carried out in 1989. The mean of BMI increased with age in both sexes. BMI was significantly higher in men (26 kg/m2) than women (25 kg/m2). The prevalence of obesity was of 12% in both men and women, and the prevalence of overweight was of 48.5% in men and 38% in women. The prevalence of arterial hypertension, hypercholesterolemia and diabetes was greater individuals with obesity, with differences statistically significant for hypertension (odds ratio of 3.26). The multiple logistic regression analysis showed that the association between obesity and hypertension was not statistically significant (OR adj. = 2.09), when the effect of the other risk factors, the age and sex were controlled.(ABSTRACT TRUNCATED AT 250 WORDS)

[Care for the diabetic patient in Catalonia. A study of a population sample]. / La asistencia al diabético en Cataluña. Estudio en una muestra de población. Grupo Catalán de Estudio de la Diabetes (GCED).

BACKGROUND: The aim of this study was to determine the clinical and therapeutic profile of both types of diabetics (IDDM and NIDDM) attended at different levels of health care in Cataluña in order to establish quality control and rationalize diabetologic sanitary planning. METHODS: Fifteen centers in Cataluña participated in a study with a total of 1,430 patients. The centers represented different specialized care levels: 6 endocrinology public health out-patient clinics (EO), 4 county hospitals (CH), 3 university hospitals (UH) and 2 private diabetic units (DU). RESULTS: IDDM: a) the percentage was higher in UH and DU (39 and 37) than in CH (26 p less than 0.01) and EO (11 p less than 0.001); b) the youngest were attended in UH (24 +/- 14 years) and the oldest in the EO (39 +/- 17 years, p less than 0.001), occupying the CH and DU at an intermediate position (34 +/- 16 and 32 +/- 17 years) and different than the other two (p less than 0.05); c) 74% of those attended in UH had an evolution of less than 10 years vs 45-58% of the other levels (p less than 0.005); d) no differences were observed in the overall prevalence of complications; e) 37% of the males between 15 and 64 years of age were smokers; f) intensive insulin therapy is more frequently used (p less than 0.05) in DU and UH (56% and 42%) than in EO and CH (19% and 13%); g) the determination of capillary glycemia is generalized (96%); h) 14% had HbA1 or fructosamine lower than the maximum normal value. NIDDM: a) the age of the patients was somewhat lower in DU (59 +/- 11) and UH (58 +/- 11) than in CH (62 +/- 100 and EO (64 +/- 10 (p less than 0.05); b) globally, the rate of insulinization was 55% and home control of glycemia was 43%; c) 47% are hypertense (half of whom are inadequately controlled) and 55% are dyslipemic; d) between 15 and 64 years of age 39% of the males are smokers; e) 27% had HbA1 or fructosamine lower than the maximum normal value. CONCLUSIONS: a) The quality of medical care to diabetics in the centers analyzed is high; b) there is no "patient-type" for level of health care; c) there seems to be more therapeutic "aggressivity" among the health care workers responsible for diabetics in relation to the glucose vs other risk factors.

Incidence of type 1 (insulin-dependent) diabetes mellitus in Catalonia, Spain. The Catalan Epidemiology Diabetes Study Group.

The incidence of Type 1 (insulin-dependent) diabetes mellitus was prospectively evaluated in Catalonia, Spain in patients up to 30 years of age during the period 1987-1990. The population at risk (0-29 years) consisted of 2,690,394 inhabitants (total population of Catalonia 5,978,638). All the cases were independently identified from four sources: endocrinologists, sales of blood glucose monitors and insulin pen injectors, diabetes societies and diabetic summer camps. The degree of ascertainment was 90.1%. The overall observed incidence rate was 10.7 per 100,000 per year, being 11.5 per 100,000 per year in the 0-14 age group. The incidence in males (12.0 per 100,000 per year) was higher than in females (9.3 per 100,000 per year), with a male/female ratio of 1.36/l. The sex differences were only present in cases over 14 years of age. Age specific incidence rates per 100,000 per year were 4.4 (confidence interval 95%: 3.2-5.7) in the age group 0-4, 9.9 (8.5-11.4) in 5-9, 17.5 (15.7-19.4) in 10-14, 11.4 (9.9-13.0) in 15-19, 11.3 (9.7-13.0) in 20-24 and 8.5 (7.2-9.9) in 25-29. There was a seasonal onset pattern, with the highest incidence in winter (December-February). We conclude that the incidence of Type 1 diabetes observed in Catalonia during the period 1987-1990 is higher than that recently reported in other Mediterranean countries. This study offers the first standardized data on Type 1 diabetes incidence in Catalonia, including cases up to 30 years, and contributes to the knowledge of the epidemiology of diabetes in South Europe.

Autotransplantation of dispersed pancreatic islet tissue combined with total or near-total pancreatectomy for treatment of chronic pancreatitis.

Chronic pancreatitis is difficult to treat in patients with a nondilated duct. Patients experiencing intractable pain unresponsive to or judged untreatable by lesser procedures must decide between total pancreatectomy and resultant diabetes or a continuation of their pancreatitis. From 1977 through 1990, 26 patients underwent extensive pancreatectomy and dispersed pancreatic islet tissue autotransplantation for treatment of chronic pancreatitis pain and prophylaxis of surgical diabetes. Of these 26 patients, total (Whipple) or near-total (greater than 95%) pancreatectomy was performed in 24 patients. Of these 24 patients, pain relief could be assessed in 21 patients at 5 to 155 months (mean, 5.7 years), and 19 patients (90%) reported partial or complete remission. Of the patients who underwent total or near-total pancreatectomy, islets were injected intraportally in 22 patients and into the renal subcapsule in two patients. The latter two patients have required insulin since surgery. Of the other 22, one patient died from a complication of the pancreatectomy. Nine of the 21 evaluable recipients of intraportal islet autografts were insulin independent for at least several months after surgery. Five patients are currently insulin independent at 6 years, 4 years, 1.5 years, 9 months, and 5 months after surgery. Of the other four patients, one patient died insulin independent at 6 years, and three patients required insulin beginning 8 to 18 months after surgery. Insulin independence correlated with the number of islets recovered, which in turn correlated inversely with the degree of pancreatic fibrosis. Of our four most recent patients, three patients had mildly to moderately fibrotic glands, and higher numbers of islets were obtained. After total (Whipple) pancreatectomy, these three patients are insulin independent. A liver biopsy was performed in one patient 8 months after total pancreatectomy and islet autotransplantation; numerous clusters of islet cells staining strongly for insulin and glucagon were detected within portal triads on both wedge and needle biopsy specimens. Morbidity related to the intraportal-dispersed pancreatic islet tissue transplantation was low (no disseminated intravascular coagulation, significant portal hypertension, or hepatic dysfunction). Islet autotransplantation can be an effective and safe adjunct to extensive pancreatic resection for those patients who risk surgical diabetes for relief of their chronic pancreatitis pain.