Effects of dietary intake and life style on bone density in patients with diabetes mellitus type 2.

OBJECTIVE: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. DESIGN: Cross-sectional study. SETTING: Tertiary care hospital. PARTICIPANTS: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. RESULTS: A total of 21.7% of patients had osteoporosis (T score <2.5 SD). Patients were overweight with a high BMI and a medium glucose control. Patients with osteoporosis were older than those without osteoporosis (67.8 +/- 6.9 vs. 62.1 +/- 9.2 years; p < 0.05). Significant differences were detected between patients without and with osteoporosis in calcium intake (1,219.37 +/- 387 vs. 839 +/- 251 mg/day; p < 0.05) and zinc intake (9.23 +/- 3.5 vs. 13.3 +/- 6.9 mg/day; p < 0.05), respectively. No differences were detected in other dietary dairy intakes. In correlation analysis age (r = -0.23; p < 0.05) and BMI (r = 0.48; p < 0.05) was correlated with BMD. In univariate analysis with dicotomic variables, only exercise was positive associated with osteoporotic status (87.5% exercise habit in patients without osteoporosis and 25% exercise habit in patients with osteoporosis; p < 0.05). In a logistic model with the dependent variable (osteoporosis), remained in the final model dietary dairy intake of calcium and zinc, BMI, age and exercise. Exercise, calcium intake and BMI were protective factors. Zinc intake, and age were risk factors. CONCLUSIONS: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population.

Relation between total homocysteine levels and beer intake in patients with diabetes mellitus Type 2.

BACKGROUND/AIM: The evaluation of the significance of hyperhomocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function, vitamin status, and lifestyle. The aim of our study was to investigate the relation between macro- and micronutrient intakes and homocysteine levels in a population having diabetes type 2. METHODS: A total of 155 patients with diabetes mellitus type 2 attending our Diabetes Service (90 females and 65 males) were enrolled in a consecutive way. All patients underwent determination of fasting blood homocysteine, glycated hemoglobin, glucose, vitamin B(12), and folate levels. Microalbuminuria was evaluated on the basis of a 24-hour urine. The patients were instructed to keep 3-day written food records incorporating the use of food scales and models to enhance portion size accuracy. Alcohol drinking, physical activity, and smoking habits were also registered. RESULTS: The mean homocysteine levels were 10.5 +/- 4.3 micromol/l. The mean glucose and Hb A(Ic) levels were 9.5 +/- 3 mmol/l and 7.8 +/- 1.4%, respectively. The vitamin status was normal: 592.6 +/- 522 pg/ml vitamin B(12) and 10.5 +/- 5.5 ng/ml folic acid. Mean microalbuminuria was 81.7 +/- 238 mg/day. The calorie intakes were normal (carbohydrates 43%, proteins 23.8%, and lipids 33.1%). A decrease in daily intakes of vitamins (A, B(1), D, and E) and trace elements (Zn, Mg, Se, and Ca) was detected. High daily intakes were detected for protein, P, and vitamins C, B(12), K and P 29.7% of the patients drank beer and 18% other alcoholic beverages. 11.7% of the patients smoked, and 77.7% maintained daily physical activity (mean/day 25.7 +/- 20.9 min). Only protein (g/day; r = 0.25; p < 0.005) and beer (ml/day; r = -0.46; p < 0.05) correlated with the total homocysteine levels. The daily intakes of vitamin B(12) and folic acid were inversely correlated with the total homocysteine levels: r = -0.29; p < 0.05) and (r = -0.12; p < 0.05), respectively. Physical activity and smoking habits were not correlated. In the multivariate analysis with a dependent variable (total homocysteine) adjusted for age, sex, microalbuminuria, and nutrient intakes (proteins, folic acid, and vitamin B(12)) and beer remained in the model. CONCLUSION: The present study shows that protein intake and beer could modify the levels of total homocysteine in patients with diabetes type 2.

Clinical and biochemical characteristics of patients with home enteral nutrition in an area of Spain.

OBJECTIVE: The widespread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence, clinical and biochemical characteristics of a cohort of patients on home enteral nutrition (HEN). DESIGN: Prospective observational study. SETTING: Tertiary care. SUBJECTS: Between January 1999 and December 2001, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. INTERVENTIONS: Information for each patients was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported. RESULTS: In 1999, the incidence of HEN in our area was patients 15 per 100000 inhabitants. This incidence rate rose to 21.3 in 2000 and decreased to 9.52 in 2001. The mean age of all patients was 58.7+/-13 y. The distribution of patients by diseases was: 71 (69.6%) had a head and neck cancer; 14 (13.7%) had a neurological disorder affecting swallowing (cerebrovacular accident and/or dementia); 6 (5.9%) had tumors in different locations with anorexia; and 11 (10.8%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered orally in 81 patients (79.4%), via a nasogastric tube (NGT) in 15 patients (14.7%), via a percutaneous gastrostomy (PEG) in five patients (4.9%), and via a jejunostomy in one patient (1%). The mean duration of HEN was 101+/-46.9 days. During the course of HEN, six patients had diarrhea (5.9%), and four (3.9%) constipation, and two vomiting (2%) that did not require cessation of HEN. Albumin, prealbumin, transferrin and lymphocytes improved in all the groups, when comparing the first review with the last. After the follow-up (3 y) with review, each 3 months, 10 of the 102 patients (9.8%) had died, and 92 (90.2%) were alive. Survival probability was influenced by the access route, with the worse outcome in patients with no oral nutrition (NGT, PEG and jejunostomy; hazard ratio: 24.9; 95% CI: 4.1-52), adjusted by age, sex and diagnosis. CONCLUSIONS: In conclusion, HEN is a valid and safe technique for nutrition support, with a good clinical outcome in our area.

[Relation among micronutrient intakes with CD4 count in HIV infected patients]. / Relación entre la ingesta de micronutrientes y el recuento de CD4 en una población de pacientes con infección por VIH.

INTRODUCTION: The impact of micronutrients on HIV disease progression has been an area of great interest. Several studies have shown an association between disease progression and micronutrient status. The aim of our study was to assess the correlation between micronutrients intakes and immune status in HIV infected patients. MATERIAL AND METHODS: A total of 119 patients were evaluated. Nobody dropped out. In all patients the following parameters were assessed; age, sex, treatment with anti-retroviral drugs, performed an anthropometric evaluation (weight, tricipital skinfold, midarm circumference, and body mass index (BMI)) and a biochemical evaluation (glucose, albumin, prealbumin, transferrin, total proteins, limphocytes and count of CD4). All patients received instruction in 24-hour written food record keeping. RESULTS: Patients had an average age 37.9 +/- 9.9 years, weight 64.5 +/- 13.2 kg and body mass index 22.5 +/- 3.5. Levels of total proteins, albumin, prealbumin y transferrin were normal. Percentile distribution of anthropometric parameters showed a deep depletion in muscular protein compartiment, 53.1% of patients had tricipital skinfold under P 50, 91.8% had midarm muscle circumference under P 50. The correlation analysis among dietary intake and immune status, showed a positive association among vitamin A intake and vitamin D with CD4+ (r = 0.35; p < 0.01) and (r = 0.51; p < 0.001), respectively. In the multivariant analysis with dependent variable (CD4 count), only vitamin D remained in the model (F = 16.99; p < 0.001), with an increase of 34 (CI 95%: 5.81-167.3) CD4+ (count/uL) with each microgram of vitamin D intake, adjusted by age, sex, energy and protein intake, and anti-retroviral drugs. CONCLUSION: Vitamin A, and D intakes were correlated with CD4 count, only vitamin D remained as a independent predictor parameter in a in multivariant model.

[Changes in intake pattern in obese patients treated with paroxetine]. / Modificación del patrón de ingesta en pacientes obesos tratados con paroxetina.

GOAL: Drugs used in cases of obesity can be classified in several groups: those which increase thermogenesis; those which reduce the absorption of fats; and those which reduce the appetite. It seems that the last named group affects the intake pattern. The goal of our study was to assess the change in eating habits and the adherence to the diet by obese patients treated with paroxetin. SCOPE: The population studied comprised 14 obese patients. All of them were prescribed a diet of 1,500 calories/day in two groups: Group I (n = 7; only diet) and Group II (n = 7; diet plus paroxetin). After three months, a 24-hour nutritional survey was carried out to compare habitual intake with recommended intake. RESULTS: The intake of Group I was significantly greater than in Group II in terms of total calories (2,094.2 +/- 415 calories/day) versus 1,403.4 +/- 368 cal/day; p < 0.05), grammes of protein (100.2 +/- 19.6 g/day versus 63.2 +/- 8.1 g/day; p < 0.05) and carbohydrates (218.8 +/- 60.8 g/day versus 164.3 +/- 64.1 g/day; p < 0.05), and there were no significant differences in the amount or type of fat eaten. There were differences in the consumption of iron (14.2 +/- 2.4 mg/day versus 8.7 +/- 1.7 mg/day; p < 0.05), phosphorus (1,623.5 +/- 301.9 mg/day versus 1,001.8 +/- 255.6 mg/day; p < 0.05) and potassium (3,820 +/- 1,629 mg/day versus 2,560 +/- 557 mg/day; p < 0.05), with the remainder of minerals and vitamins not presenting significant differences. In conclusion, paroxetin modifies the intake pattern by reducing the amounts of calorie, proteins and carbohydrates consumed.

Microgravity cultivation of cells and tissues.

In vitro studies of cells and tissues in microgravity, either simulated by cultivation conditions on earth or actual, during spaceflight, are expected to help identify mechanisms underlying gravity sensing and transduction in biological organisms. In this paper, we review rotating bioreactor studies of engineered skeletal and cardiovascular tissues carried out in unit gravity, a four month long cartilage tissue engineering study carried out aboard the Mir Space Station, and the ongoing laboratory development and testing of a system for cell and tissue cultivation aboard the International Space Station.

[A substitute treatment for dialysis?]. / Tratamiento sustitutivo de la diálisis?

One of the major problems regarding the administration of amino acids by intravenous feeding is the use of racemic mixtures that are forbidden by the pharmacological regulations; other current problems is the high cost of obtaining pure amino acids. Because of this, our group has been working in the obtention of L-amino acids (assimilables by living organisms) and ketoacids (used by the body as precursors of racemic amino acid mixtures) in a less expensive and simpler way, with the aim of using these products for different pathologies.

[Clinical characteristics of gastric infection caused by Helicobacter pylori]. / Características clínicas de la afección gástrica por Helicobacter pylori.

In a series of 150 patients submitted for diagnostic gastroscopy, a prospective study of nine anamnesis variables and four exploratory ones was done. Endoscopic and histopathologic diagnoses, as well as the clinical data, were obtained by blinded observers. Helicobacter pylory (Hp) presence in antral mucosa was determined by culture. A clear relationship between Hp presence and peptic ulcer disease, bulboduodenitis and histologic gastritis was found, as expected, but no clinical variable correlated positively with it. We conclude, therefore, that Hp presence in antral mucosa cannot be predicted clinically, a fact probably related to the unspecificity of symptoms in gastroduodenal disease and not to a lack of pathogenicity of this organism.

[Histopathologic changes associated with the presence of Helicobacter pylori in antral mucosa]. / Alteraciones histopatológicas asociadas a la presencia de Helicobacter pylori en mucosa antral.

Helicobacter pylori is a gram negative bacteria which has recently been associated to tissular changes of the upper digestive tract, however, the causal role has not yet been determined. Of 150 patients studied, 63 had tissular changes associated to Helicobacter pylori (Hp), 8 had Hp without tissular related changes (of whom 3 suffered bulbar ulcus and 1 gastric ulcus); the rest of the patients had hiatus hernia associated to distal esophagitis or pyloric stenosis; and only one patient was found to have normal tissue. A clear associated to distal esophagitis or pyloric stenosis; and only one patient was found to have normal tissue. A clear association between Hp and chronic or atrophic gastritis was determined, but no association was found between Hp and gastric cancer.