Changes in thyroid function with age: results from the Pizarra population-based longitudinal study.

BACKGROUND: Results of studies examining the influence of age on thyroid function and TSH levels, in the absence of thyroid disease, remain controversial. The aim of this study was to determine the course of thyroid function over 11 years in a population with normal thyroid function. METHODS: This is a population-based prospective study started in 1995-1997 (first phase), and reassessed 6 (second phase) and 11 years later (third phase). RESULTS: The TSH and FT4 in the third phase were significantly increased (p=0.001 and p=0.001, respectively), with the values being higher particularly from the age of 50 years. In those persons with a baseline TSH≥1.2 and <3 µIU/mL, the OR of having a TSH of 3-5 µIU/mL in the third phase was 6.10 (p=0.004). In those with a baseline TSH≥3 and ≤5 µIU/mL, the OR of having a TSH of 3-5 µIU/mL in the third phase was 20.8 (p<0.0001). Similar results were found for FT4. CONCLUSION: In a population free of clinical thyroid disease, TSH and FT4 values rise over the years. This increase occurs in all age groups, but depends mainly on the basal concentrations of TSH and FT4.

Hypovitaminosis D and incidence of obesity: a prospective study.

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 (BMI <30 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.

Demanda de atención sanitaria en las unidades de identidad de género de Andalucía y Cataluña durante la década 2000 a 2009 / The demand for health care services in the gender identity units of Andalusia and Catalonia during the period of 2000 to 2009

Objetivo. Evaluar de forma comparada la demanda de atención sanitaria pública en dos unidades de trastornos de la identidad de género (Andalucía y Cataluña) durante la década 2000-2009. Método. Estudio descriptivo y comparativo de la demanda sanitaria, características de los solicitantes y cirugías realizadas. Resultados. Han solicitado asistencia sanitaria 828 pacientes en Andalucía y 549 en Cataluña. En ambas comunidades es similar el porcentaje de casos que cumplen criterios de transexualismo (88 vs. 89,8%), la frecuencia de casos excluidos del programa de reasignación sexual (16,7 vs. 15,3%), la razón de sexos hombre/mujer (1,6:1 vs. 2,1:1), y la edad media (28 vs. 29 años). Se han realizado 284 cirugías de reasignación sexual en Andalucía y 50 en Cataluña. Conclusiones. La demanda en Andalucía se ha mantenido estable y en Cataluña se ha incrementado en los últimos años. Las características demográficas y clínicas de los pacientes transexuales son similares y acordes con la mayoría de estudios realizados en otros países(AU)

Objective. To evaluate the demand for public health services in two gender identity disorder units (Andalusia and Catalonia) during the period of 2000-2009. Method. A descriptive and comparative study was made of the demand for health services, the demographic and clinical characteristics of the patients, and the sex reassignment surgeries performed. Results. A total of 828 subjects in Andalusia and 549 in Catalonia requested clinical assistance. In both communities, the percentages of cases diagnosed of transsexualism (88 vs 89.7%), the percentages excluded in the sex reassignment program (16.7 vs 15.3%), the male/female ratio (1.6:1 vs 2.1:1), and the mean age (28 vs 29years) were similar. A total of 284 sex-reassignment surgeries were performed in Andalusia and 50 in Catalonia. Conclusions. The demand has been maintained in Andalusia and has increased in Catalonia in recent years. The basic demographic (AU)

[The demand for health care services in the gender identity units of Andalusia and Catalonia during the period of 2000 to 2009]. / Demanda de atención sanitaria en las unidades de identidad de género de Andalucía y Cataluña durante la década 2000 a 2009.

OBJECTIVE: To evaluate the demand for public health services in two gender identity disorder units (Andalusia and Catalonia) during the period of 2000-2009. METHOD: A descriptive and comparative study was made of the demand for health services, the demographic and clinical characteristics of the patients, and the sex reassignment surgeries performed. RESULTS: A total of 828 subjects in Andalusia and 549 in Catalonia requested clinical assistance. In both communities, the percentages of cases diagnosed of transsexualism (88 vs 89.7%), the percentages excluded in the sex reassignment program (16.7 vs 15.3%), the male/female ratio (1.6:1 vs 2.1:1), and the mean age (28 vs 29 years) were similar. A total of 284 sex-reassignment surgeries were performed in Andalusia and 50 in Catalonia. CONCLUSIONS: The demand has been maintained in Andalusia and has increased in Catalonia in recent years. The basic demographic and clinical characteristics of transsexual patients were similar between both units and comparable to those of other countries.

Incidence of obesity is lower in persons who consume olive oil.

We undertook a population-based cohort study in Pizarra (Spain). Anthropometric and nutritional variables were recorded for 613 persons. The type of fat used was determined by measurement of the fatty acids contained in cooking oil. Serum fatty acid was used as a biological marker of the type of fat consumed. Obesity incidence in persons who were not obese at baseline was greater in those who consumed sunflower oil (Group 1: 41.5 (95% CI, 25.4-67.8) cases per 1000 person-years) than in those who consumed olive oil or a mixture of oils (Group 2: 17.3 (95% CI, 11.6-25.8) cases per 1000 person-years). The risk of developing obesity over 6 years, adjusted for age, sex, physical activity, smoking, instruction level, energy intake and baseline BMI, was 2.3 (95% CI, 1.06-5.02) in group 1 compared with that in group 2. The increase in the prevalence of obesity in the free-living population is associated with the type of fatty acids in the diet.

Effect of long-term administration of cross-sex hormone therapy on serum and urinary uric acid in transsexual persons.

BACKGROUND: Transsexual persons afford a very suitable model to study the effect of sex steroids on uric acid metabolism. DESIGN: This was a prospective study to evaluate the uric acid levels and fractional excretion of uric acid (FEUA) in a cohort of 69 healthy transsexual persons, 22 male-to-female transsexuals (MFTs) and 47 female-to-male transsexuals (FMTs). The subjects were studied at baseline and 1 and 2 yr after starting cross-sex hormone treatment. RESULTS: The baseline levels of uric acid were higher in the MFT group. Compared with baseline, uric acid levels had fallen significantly after 1 yr of hormone therapy in the MFT group and had risen significantly in the FMT group. The baseline FEUA was greater in the FMT group. After 2 yr of cross-sex hormone therapy, the FEUA had increased in MFTs (P = 0.001) and fallen in FMTs (P = 0.004). In MFTs, the levels of uric acid at 2 yr were lower in those who had received higher doses of estrogens (P = 0.03), and the FEUA was higher (P = 0.04). The FEUA at 2 yr was associated with both the estrogen dose (P = 0.02) and the serum levels of estradiol-17beta (P =0.03). In MFTs, a correlation was found after 2 yr of therapy between the homeostasis model assessment of insulin resistance and the serum uric acid (r = 0.59; P = 0.01). CONCLUSIONS: Serum levels of uric acid and the FEUA are altered in transsexuals as a result of cross-sex hormone therapy. The results concerning the MFT group support the hypothesis that the lower levels of uric acid in women are due to estrogen-induced increases in FEUA.

Incidence of type 2 diabetes in southern Spain (Pizarra Study).

BACKGROUND: Few European studies have used an oral glucose tolerance test (OGTT) to examine the incidence of type 2 diabetes. We determined the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes in a population from southern Spain. MATERIAL AND METHODS: A population-based cohort study was undertaken in Pizarra, Spain. Baseline data were recorded on age, sex, weight, height, waist and hip circumferences, and diabetes status for 1051 persons, of whom 910 were free of type 2 diabetes (at-risk sample). Of these, 714 completed the 6-year follow-up study. Body mass index, waist-to-hip ratio and weight increase since baseline were calculated. The homeostasis model assessment equations were used to estimate the indices of insulin resistance and beta-cell function. Each person received an OGTT at baseline and after 6 years. RESULTS: Type 2 diabetes developed in 81 people for a total of 4253 person-years, representing an incidence of 19.1 cases per 1000 person-years (95% confidence interval, 15.3-23.6). Age and the presence of obesity, central obesity and carbohydrate metabolism disorders [IFG (cut off = 100 mg dL(-1), capillary blood glucose level), IGT or both] at baseline were significant markers for the onset of type 2 diabetes during follow-up. After adjusting for these variables, multivariate analysis showed weight increase, waist-to-hip ratio and the indices of insulin resistance and beta-cell function were significantly associated with the risk for type 2 diabetes. CONCLUSIONS: The incidence of type 2 diabetes in a population from southern Spain is high. It is probably associated with the high prevalence of obesity and weight increase in this population.

Decreased levels of uric acid after oral glucose challenge is associated with triacylglycerol levels and degree of insulin resistance.

Hyperuricaemia is one of the components of metabolic syndrome. Both oxidative stress and hyperinsulinism are important variables in the genesis of this syndrome and have a close association with uric acid (UA). We evaluated the effect of an oral glucose challenge on UA concentrations. The study included 656 persons aged 18 to 65 years. Glycaemia, insulin, UA and plasma proteins were measured at baseline and 120 min after an oral glucose tolerance test (OGTT). The baseline sample also included measurements of total cholesterol, triacylglycerol (TAG) and HDL-cholesterol. Insulin resistance was calculated with the homeostasis model assessment. UA levels were significantly lower after the OGTT (281.93 (sd 92.19) v. 267.48 (sd 90.40) micromol/l; P < 0.0001). Subjects with a drop in UA concentrations >40.86 micromol/l (>75th percentile) had higher plasma TAG levels (P = 0.0001), baseline insulin (P = 0.02) and greater insulin resistance (P = 0.034). Women with a difference in plasma concentrations of UA above the 75th percentile had higher baseline insulin levels (P = 0.019), concentration of plasma TAG (P = 0.0001) and a greater insulin resistance index (P = 0.029), whereas the only significant difference in men was the level of TAG. Multiple regression analysis showed that the basal TAG levels, insulin at 120 min, glycaemia at 120 min and waist:hip ratio significantly predicted the variance in the UA difference (r2 0.077). Levels of UA were significantly lower after the OGTT and the individuals with the greatest decrease in UA levels are those who have greater insulin resistance and higher TAG levels.

Consumo de café y diabetes mellitus / Coffee consumption and diabetes mellitus

Desde hace muchos años se ha estudiado la relación entre el consumo de café y diversas enfermedades, principalmente cardiovasculares y cáncer, pero también enfermedades psiquiátricas y, más recientemente, relación con la diabetes mellitus. En este trabajo revisaremos los datos disponibles sobre la relación entre el café y el riesgo de presentar diabetes, con una breve referencia a la relación del café con las enfermedades cardiovasculares. Los trabajos sobre la relación entre la ingesta de café y la presencia de diabetes son divergentes, ya que, mientras algunos grandes estudios de cohortes parecen indicar un efecto protector sobre la aparición de diabetes mellitus, los estudios de intervención (todos a corto plazo) suelen demostrar un efecto deletéreo sobre el metabolismo glucídico. Las relaciones entre el consumo de café y el riesgo de presentar diabetes mellitus están lejos de establecerse definitivamente. Posiblemente, la relación entre el consumo de café y la salud esté condicionada no sólo por la presencia de sustancias bioactivas en el café ­que además poseen efectos opuestos sobre el metabolismo glucídico, por ejemplo­, sino también por la forma de preparar la bebida (filtrado, hervido, expreso, instantáneo, natural o torrefacto...) que altera su composición final, y por otro lado por la asociación entre el consumo de café y otros hábitos dietéticos o no (ingesta de alcohol, tabaquismo, actividad física, incluso costumbre de dormir la siesta) que pueden influir de manera directa en los aspectos de la salud en los que también parecen influir los componentes del café (AU)

The association between coffee consumption and various diseases, mainly cardiovascular diseases and cancer but also psychiatric disorders and, more recently, diabetes mellitus, has been investigated for many years. In the present article, we review the evidence available on the association between coffee intake and the risk of diabetes and briefly review the association between coffee intake and cardiovascular disease. Studies on the association between coffee intake and diabetes report contradictory results; while some large cohort studies seem to indicate a protective effect against the development of diabetes mellitus, intervention studies (all short-term) usually demonstrate a harmful effect on glucose metabolism. The association between coffee consumption and the risk of diabetes mellitus is far from being definitively established. The relationship between coffee intake and health may be influenced not only by the presence of bioactive substances in coffee (which, moreover, have opposite effects on glucose metabolism, for example) but also by the way the beverage is prepared (filtered, boiled, express, instant, natural or dark-roasted...), which affects its final composition. The relationship between coffee consumption and other dietary and health-related factors (alcohol intake, smoking, physical activity, even the habit of taking an afternoon nap) may also be of influence. These factors may have a direct effect on the aspects of health influenced by the components of coffee (AU)

Incidencia de amputaciones de extremidades inferiores en la población con diabetes mellitus de Málaga (1996-1997)

Objetivo. Conocer la frecuencia de amputaciones de miembros inferiores (AMI) para el diseño de un programa preventivo de AMI en personas con diabetes mellitus (DM).Diseño. Estudio observacional, retrospectivo.Emplazamiento. Estudio poblacional en Málaga y provincia. Pacientes. Se revisaron las historias clínicas de todas las personas con AMI de hospitales públicos o concertados de la provincia de Málaga entre el 1 de enero de 1996 y el 31 de diciembre de 1997. Se excluyeron las AMI traumáticas o tumorales. Se calculó la incidencia acumulada, el riesgo relativo (RR) de AMI y la tasa de mortalidad en personas con DM.Resultados. Se realizaron 449 AMI durante el período estudiado, 316 (70,3 por ciento) en personas con DM y 133 (29,6 por ciento) en población sin DM. La incidencia de AMI por 100.000 personas y año fue de 6,3 (IC, 4,7-7,8) en población sin DM y de 136,1 (IC, 114,9-157,3) en personas con DM. El RR de AMI fue 21,6 (IC, 17,6-26,4) para la población con DM, con diferencias entre varones y mujeres (16,8 frente a 36,1, respectivamente). La edad media de AMI fue significativamente mayor (p < 0,05) para la población con DM (70,0 ñ 10,2 frente a 68,9 ñ 15,9 años, respectivamente). Las AMI mayores fueron más numerosas tanto en mujeres como en varones en los 2 grupos estudiados. La tasa de mortalidad y las complicaciones, así como la estancia media hospitalaria, fueron mayores en la población con DM.Conclusiones. Este estudio confirma el mayor riesgo de AMI en personas con DM. La incidencia de AMI en este estudio fue menor que la de países del norte de Europa, Estados Unidos y Australia, y mayor que la publicada anteriormente en España (AU)

[Incidence of amputaciones of the lower extremities in the population with diabetes mellitus in Málaga (1996-1997)]. / Incidencia de amputaciones de extremidades inferiores en la población con diabetes mellitus de Málaga (1996-1997).

OBJECTIVE: To find the frequency of amputations of lower limbs (ALL) with the aim of designing a programme to prevent ALL in people with diabetes mellitus (DM). DESIGN: Retrospective observation study. SETTING: Population study in Malaga and its province. PATIENTS: The clinical records of everyone with ALL in public or subsidized hospitals in the province of Malaga between January 1 1996 and December 31 1997 were reviewed. Traumatic or tumoural ALL were excluded. Cumulative incidence, relative risk (RR) of ALL and the mortality rate of people with DM were calculated. RESULTS: 449 ALL took place during the period studied, 316 (70.3%) in people with DM and 133 (29.6%) in people not suffering DM. The incidence of ALL per 100,000 people and per year was 6.3 (CI: 4.7-7.8) in the population without DM and 136.1 (CI: 114.9-157.3) in people with DM. The RR of ALL was 21.6 (CI: 17.6-26.4) for the population with DM, with differences between men and women (16.8 vs. 36.1, respectively). Mean age of ALL was significantly greater (p < 0.05) for the population with DM (70.0 +/- 10.2 vs. 68.9 +/- 15.9 years old). Older ALL were more numerous in both women and men in the two groups studied. The mortality rate, complications and mean stay in hospital were greater in the population with DM. CONCLUSIONS: This study confirmed the greater risk of ALL run by people with DM. The incidence of ALL in this study was less than in countries of Northern Europe, the USA and Australia, but more than in any study published before in Spain.

Altered bioavailability due to changes in the formulation of a commercial preparation of levothyroxine in patients with differentiated thyroid carcinoma.

OBJECTIVES: In July 1995 we began noticing an unusually high rate of elevated TSH levels in patients with differentiated thyroid cancer treated with levothyroxine-specifically the brand Levothroid-becoming more obvious from September 1995. Faced with the possibility that these findings had some relationship to the drug taken, we carried out a prospective study, changing this brand of levothyroxine for another. DESIGN AND PATIENTS: We studied 58 patients with differentiated thyroid carcinoma (50 women and eight men; aged 22-75 years) who were being treated with levothyroxine and who had previously had adequate TSH suppression. Their Levothroid tablets were changed to the same dose of Dexnon tablets, and their clinical and analytical response was evaluated 2 months later. The patients were divided into two groups according to their TSH level at the start of the study: group 1, 42 patients with TSH > 0.2 mU/l (not suppressed) and group 2, 16 patients with TSH < or = 0.2 mU/l (suppressed). RESULTS: After 2 months with Dexnon the TSH levels in group 1 fell significantly (P < 0.0001) also decreasing in group (P < 0.09). The free T4 and free T3 rose significantly in both groups. After the change to Dexnon, 17 patients (40%) in group 1 had suppressed TSH and 26 (62%) had free T4 levels above the upper limit of normal vs none at baseline (P < 0.001). The group 2 patients maintained their inhibited TSH values after treatment with Dexnon, and the free T4 was above the upper limit of normal in 15 (94%) vs 3 (19%) at baseline (P < 0.001). The Levothroid tablets collected from the patients in both groups formed part of those which the manufacturer later withdraw from the market. These batches possessed the correct dosage, but they had been made from 'non-micronized' raw materials from another supplier. CONCLUSIONS: The most probable cause of the inadequate TSH suppression in our patients was the reduction in bioavailability in certain batches of Levothroid, although we are unable to rule out the possibility that the results obtained after the changeover to Dexnon were due to its greater bioavailability. Simple changes in the manufacture of levothyroxine tablets may produce important variations in their bioavailability, having an adverse effect on the clinical control of the patients, and causing extra expense by the need for repeated patient visits and thyroid function tests.