Decreased Consumption of Added Fructose Reduces Waist Circumference and Blood Glucose Concentration in Patients with Overweight and Obesity. The DISFRUTE Study: A Randomised Trial in Primary Care.

The relationship between fructose intake and insulin resistance remains controversial. Our purpose was to determine whether a reduction in dietary fructose is effective in decreasing insulin resistance (HOMA2-IR). This field trial was conducted on 438 adults with overweight and obese status, without diabetes. A total of 121 patients in a low fructose diet (LFD) group and 118 in a standard diet (SD) group completed the 24-week study. Both diets were prescribed with 30-40% of energy intake restriction. There were no between-group differences in HOMA2-IR. However, larger decreases were seen in the LFD group in waist circumference (-7.0 vs. -4.8 = -2.2 cms, 95% CI: -3.7, -0.7) and fasting blood glucose -0.25 vs. -0.11 = -0.14 mmol/L, 95% CI: -0.028, -0.02). The percentage of reduction in calorie intake was similar. Only were differences observed in the % energy intake for some nutrients: total fructose (-2 vs. -0.6 = -1.4, 95% CI: -2.6, -0.3), MUFA (-1.7 vs. -0.4 = -1.3, 95% CI: -2.4, -0.2), protein (5.1 vs. 3.6 = 1.4, 95% CI: 0.1, 2.7). The decrease in fructose consumption originated mainly from the reduction in added fructose (-2.8 vs. -1.9 = -0.9, 95% CI: -1.6, -0.03). These results were corroborated after multivariate adjustments. The low fructose diet did not reduce insulin resistance. However, it reduced waist circumference and fasting blood glucose concentration, which suggests a decrease in hepatic insulin resistance.

Risk of liver fibrosis progression in patients with suboptimal diagnosis of hepatitis C virus infection.

OBJECTIVE: Many hepatitis C virus (HCV)-infected patients have a suboptimal diagnosis. Particularly, the characteristics and risk of fibrosis progression of HCV antibody-positive patients without RNA testing are unknown. METHODS: Patients with a positive HCV antibody performed during 2005-2007 were classified based on RNA request and result until January 2017. Fibrosis was estimated with serologic scores. RESULTS: Of the 38 246 HCV tests performed, 791 (2.01%) patients tested positive. At the end of the follow-up (median 128.6 months, range 109.8-145.9), 49.43% (n = 391) of the subjects did not have RNA testing, 13.02% (n = 103) had undetectable RNA, and 37.55% (n = 297) had detectable RNA. After excluding patients without data for AST to platelet ratio index calculation (n = 334), patients without RNA testing (n = 122) compared with RNA undetectable (n = 92) were more frequently men (68.9 versus 46.7%), alcohol (52.6 versus 38.2%) and drug (53.0 versus 39.1%) users, lacking social support (50.4 versus 29.3%), and showed higher basal fibrosis. Patients without RNA testing had a significantly higher increase in the percentage of patients with ≥F2 (P = 0.035) and cirrhosis (P = 0.022). The relative risk for ≥F2 and cirrhosis in patients without RNA testing was 3.03 [95% confidence interval (CI): 1.54-5.98] and 4.31 (95% CI: 1.42-13.10), respectively. Non-RNA request was an independent predictor factor for progression to cirrhosis. CONCLUSION: In our cohort, patients with positive HCV antibody without RNA testing were more likely to be people at risk of social exclusion with an increased risk of fibrosis progression, because non-RNA request was a predictor for cirrhosis. Therefore, we urge support measures and strategies to link to care these difficult-to-treat populations.

Effectiveness of a low-fructose and/or low-sucrose diet in decreasing insulin resistance (DISFRUTE study): study protocol for a randomized controlled trial.

BACKGROUND: Research published to date on the relationship between insulin resistance (IR) and fructose consumption is scarce, has used different methods, and has yielded sometimes contradictory results. This study aims to determine whether a low-fructose and/or low-sucrose diet supervised by a physician or nurse decreases IR compared to a standard diet. METHODS/DESIGN: This field trial is located at primary care centers. The participants are adults aged 29 to 66 years, with a Body mass Index (BMI) between 29 and 40.99 kg/m2 and without diabetes. To date, 245 participants have been assigned randomly to the low-fructose diet intervention group (LFDI) at health centers in the western health service zone of Tenerife island, and 245 to the standard-diet control group (SDC) at health centers in the eastern health service zone. Recruitment is opportunistic and is carried out by physicians and nurses at participating health centers. Initially (baseline), and after 24 weeks of intervention, dietary records, physical activity, waist circumference, BMI, blood pressure, fasting blood glucose and insulin concentrations (HOMA2-IR) and lipid profile are recorded; blood glucose and insulin and lipid profile are also recorded 2 h after a 75-g glucose overload. After 48 weeks (24 weeks after the intervention), fasting blood samples are again obtained and a physical examination is performed. All tests and measures are repeated and recorded except dietary records, physical activity and oral glucose overload. Low-fructose diets are designed by calculating free and total (free + fructose associated with sucrose) fructose contents in standard diets, and removing foods with a fructose content in the highest quartile for the amounts in the standard diet. Participants in both groups are prescribed a diet that contains 30 to 40% less than the participant's energy requirements. The primary endpoint is change in HOMA2-IR between baseline and week 24, and other outcomes are change in HDL-cholesterol, LDL-cholesterol, triglycerides , waist circumference to height ratio and BMI. The secondary endpoint is change in HOMA2-IR between week 24 and week 48 together with the outcomes noted above. Comparisons between groups for variables used to indicate IR levels are done with a Student's t test for unpaired variables or the Mann-Whitney U test if the distribution is not normal. Multivariate regression models will be used to control for confounding factors not accounted for in the study design, and for independent prognostic factors. DISCUSSION: If the dietary intervention being tested, i.e., a diet low in fructose/sucrose, is able to reduce IR, the results - if translated into regular clinical practice - could provide a hitherto unavailable tool to prevent type-2 diabetes mellitus. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN41579277 . Registered retrospectively on 15 November 2016.

Consumo de cocaína y su relación con patología cardiaca y traumática atendida en un servicio de urgencias / Cocaine use and its relationship with cardiovascular pathology and trauma seen in an emergency department

Objetivo: Conocer la prevalencia de consumo de cocaína entre usuarios que consultan a un servicio de urgencias de un hospital de tercer nivel por patología traumática o cardiovascular, sin que exista una relación evidente de consumo y sin que el usuario hiciera explícito de manera espontánea dicho consumo, así como si dicho consumo se asocia a una mayor utilización de recursos sanitarios. Método: Entre octubre de 2005 y septiembre de 2006 se recogieron muestras de orina a los pacientes mayores de 16 años que acudieron a urgencias por un traumatismo de cualquier gravedad o un dolor torácico de probable causa cardiovascular. Se determinaron los niveles de cocaína en orina mediante ensayos semicuantitativos con tecnología de inmunoanálisis de polarización de la fluorescencia (FPIA).Resultados: Se obtuvieron 325 casos (206 traumatismos y 119 dolores torácicos). La prevalencia global de consumo no declarado de cocaína fue del 19,7% (18,9% para los traumatismos y 21% para el dolor torácico). En los traumatismos, la presencia de cocaína se asoció de forma significativa a una mayor petición de analítica (p < 0,05), en tanto que en el dolor torácico no se observaron diferencias en el consumo de recursos. Conclusiones: El consumo de cocaína no declarado entre los usuarios de un servicio de urgencias con patología cardiológica o traumática presenta una prevalencia alta. No parece que este hecho modifique en gran medida el gasto sanitario en la fase de atención aguda de estas patologías, cuando no son directamente el motivo de consulta del paciente (AU)

Objective: To determine the prevalence of cocaine use among patients seen in the emergency department of a tertiary hospital for trauma or cardiovascular disorders and in whom there was no obvious relationship with cocaine use and none was spontaneously declared by the patient. We also analyzed whether this substance abuse was associated with a greater use of health care resources. Material and methods: Between October 2005 and September 2006, urine samples were collected from patients over 16years of age who were seen in the emergency department for trauma of any severity or chest pain of probable cardiovascular origin. The cocaine levels were measured in urine using a semi quantitative fluorescence polarization immunoassay. Results: We studied 325 cases, 206 with trauma and 119 with chest pain. The overall prevalence of undisclosed use was19.7%; the prevalence was 18.9% among trauma patients and 21% among those with chest pain. In cases of trauma, cocaine use was significantly associated with more frequent requests for blood tests (P < .05), whereas no differences in the use of health care resources for chest pain patients were observed. Conclusions: There is a high prevalence of undisclosed cocaine use among patients attending an emergency department in relation to cardiovascular complaints or trauma. When cocaine use is not the direct reason for the patient’s visit, it does not appear to lead to a marked variation in health care costs during the acute phase of emergency treatment (AU)

Incidence and impact of undisclosed cocaine use in emergency department chest pain and trauma patients.

BACKGROUND: One of the highest rates of illicit cocaine consumption in Europe is in Spain. Our objective was to study the incidence and impact of undisclosed cocaine consumption in patients attending the emergency department (ED) for trauma or chest pain. METHODS: We analysed urine samples from consecutive patients attending the ED for trauma or chest pain to determine the presence of cocaine, cannabis, amphetamine/metaamphetamine and opioids by semiquantative tests with fluorescence polarization immunoassay (FPIA). RESULTS: Thirty percent of eligible patients participated. Of 75 cases, 61.3% had trauma and 38.7% chest pain; 25% presented a positive test for drugs. Cocaine was present in 13.3% and cannabis in the same proportion. No differences were found regarding positive cocaine test and chief complaint, ED or hospital stay, or additional tests. Cocaine-positive patients were significantly younger.