Impact of a 'school-based' nutrition intervention on anthropometric parameters and the metabolic syndrome in Spanish adolescents.

BACKGROUND/AIMS: In adolescents, overweight and obesity are associated with an increased cardiovascular risk. The aim of this study was to determine the impact of a school-based nutritional education program (NEP) on lifestyle changes in Spanish adolescents. METHODS: We selected 263 secondary school students (127 males) aged 12-16 years from Granada (Spain), who were followed up throughout 1 school year (2009-2010). At the beginning and end of the school year, data were gathered on the food consumption frequency, and anthropometric and biochemical profile. The NEP comprised a class on nutritional recommendations every 15 days, and administration of a daily breakfast of 275-350 kcal. RESULTS: After the intervention, the prevalence of overweight and obesity decreased among both male and female students (p < 0.001) and there was also a global reduction in the prevalence of the metabolic syndrome (MS) from 32.2 to 19.7% (p < 0.001); in addition, body mass index was significantly decreased in normal weight, overweight and obesity groups (p = 0.001 and p = 0.02, respectively), and high-density-lipoprotein cholesterol and lean body mass was increased in all groups (p = 0.001). CONCLUSION: The NEP achieved a medium-term reduction in the prevalence of overweight and obesity and had a significant and positive effect on MS components in all groups.

El polimorfismo K121Q del gen PC-1 no está asociado con alteración del metabolismo de la glucosa ni riesgo cardiovascular en mujeres con diabetes mellitus gestacional previa / The K121Q polymorphism of the PC-1 gene is not associated with abnormal glucose tolerance or cardiovascular risk factors in women with previous gestational diabetes mellitus

Introducción: Las pacientes diagnosticadas de diabetes mellitus gestacional(DMG) son una población de riesgo para desarrollar diabetes a largo plazo. Laresistencia a la insulina se relaciona tanto con factores ambientales como genéticos,entre ellos, el polimorfismo K121Q del gen que codifica la proteínaPC-1, aunque existe controversia en la bibliografía especializada. Objetivos:Examinar si el polimorfismo K121Q se asocia con alteración del metabolismode la glucosa y/o síndrome metabólico en la DMG. Material y métodos: Seestudiaron, en el posparto, 97 mujeres mediante sobrecarga oral de glucosa(SOG) y diferentes variables clínicas, analíticas y genotipos del codón 121 delgen de la proteína PC-1. Resultados: Un 61% presenta una tolerancia normala la glucosa, un 29% prediabetes y un 10% diabetes mellitus. No hubodiferencias significativas para la presencia del alelo 121Q entre las pacientescon y sin tolerancia normal a la glucosa o diabetes, ni con las variables relacionadascon el síndrome metabólico. Conclusiones: Aunque se necesitanmás estudios poblacionales, el polimorfismo K121Q no está relacionado, eneste estudio, con alteración del metabolismo de la glucosa o riesgo cardiovascularen mujeres con DMG previa(AU)

Introduction: Women suffering gestational diabetes mellitus (GDM) are a riskgroup for diabetes at long-term. Insulin resistance is related to environmentaland genetic factors. Controversial data exists about association betweenK121Q PC-1 gene polymorphism and diabetes, obesity and/or insulin resistance.The aim of the study was to investigate the relationship between K121QPC-1 gene polymorphism and the glucose metabolic alterations or metabolicsyndrome variables. Patients and methods: 97 women with previous GDMwere reclassified by means of oral glucose tolerance test in the early postpartum.Anthropometric, biochemical and K121Q genotypes frequencies werestudied. Results: 61% of the patients had normal glucose tolerance, 29%met diagnostic criteria of prediabetes, and 10% diabetes mellitus. No significantdifferences in the 121Q allele have been found between women with andwithout glucose intolerance, diabetes or metabolic parameters associated withmetabolic syndrome. Conclusion: Although further poblational studies arenecessary, in this study, the K121Q PC-1 gene polymorphism is not associatedwith type 2 diabetes, glucose intolerance or cardiovascular risk factors inwomen with previous GDM(AU)

Trastornos nutricionales tras cirugía bariátrica y su tratamiento / Nutritional disturbances and their treatment after bariatric surgery

La mayoría de las publicaciones sobre cirugía bariátrica analizan el exceso de peso perdido y la mejoría en las complicaciones metabólicas como los principales objetivos de esta intervención. Sin embargo, el éxito del tratamiento quirúrgico debe incluir el análisis de la calidad de vida, que puede verse limitada por trastornos nutricionales; por ello la importancia de un seguimiento y un tratamiento precoces. La prevalencia de estas deficiencias nutricionales es muy variable según las series, lo cual puede deberse a las distintas técnicas quirúrgicas empleadas, las diferentes recomendaciones en cuanto a suplementación y que muchos pacientes no cumplen bien el tratamiento (AU)

Most publications on bariatric surgery analyze weight loss and improvement in metabolic complications as the main objectives of the intervention. Nevertheless, assessment of the success of surgical treatment should include analysis of quality of life, which can be limited by the presence of nutritional disturbances; therefore, followup and early treatment are important. The prevalence of nutritional deficiencies varies widely according to the series, which could be due to the different surgical techniques used, the distinct supplementation recommendations, and poor treatment adherence (AU)

Actualización clínica de la enfermedad tiroidea autoinmune / Clinical update in autoimmune thyroid disease

El estudio y tratamiento de la enfermedad tiroidea autoinmune (ETAI) ha ido cumpliendo distintas etapas de investigación en nuestro grupo. Los estudios iniciales en pacientes con enfermedad de Graves (EG) evidenciaron la implicación de la inmunidad celular al demostrar, mediante un test in vitro de inhibición de la migración linfocitaria (test MIF), la sensibilización al antígeno tiroglobulina 19S y cómo el tratamiento con antitiroideos de síntesis (ATS) ejercía un efecto inmunosupresor claro en el grupo de pacientes tratados comparados con aquellos que presentaban un hipertiroidismo activo sin tratamiento1,2. Posteriormente estudiamos las tasas de reactivación con las tres terapias utilizadas en la EG (ATS, cirugía y radioyodo) demostrando que el mayor porcentaje corresponde a los ATS (42 por ciento) con una incidencia máxima a los 24 meses3. En la última década se ha avanzado en el conocimiento etiopatogénico de la ETAI de forma espectacular paralelo al desarrollo de las técnicas moleculares. La identificación del antígeno tiroperoxidasa y la medida de anticuerpos antitiroperoxidasa (Ac-TPO) han desplazado en la clínica diaria a los clásicos anticuerpos antimicrosomales (Ac-MIC) como test diagnóstico en ETAI4.Dado que la ETAI es más prevalente en la mujer en edad fértil, no es desdeñable el papel que el embarazo y el posparto añaden a la evolución de la misma5,6. Los estudios epidemiológicos sobre ETAI en una cohorte importante de gestantes antes de la semana 16 de gestación han puesto de manifiesto que un 9 por ciento presentan títulos positivos de Ac-TPO. A pesar del descenso en los títulos en el último trimestre de embarazo, la progresión hacia un hipotiroidismo clínico o subclínico está asociado con los valores de TSH y con la presencia de Ac-TPO en el primer trimestre7,8.El estudio de los mecanismos etiopatogénicos de la tiroiditis autoinmune (TA), que desde un punto de vista clínico aparece con deficiente función tiroidea y necesidad de tratamiento sustitutivo, cobra actualmente gran relevancia. En su patogenia ya conocemos el papel que desempeñan los Ac-TPO y/o anticuerpos bloqueadores de TSH a su receptor (TBII); sin embargo, no está bien establecida la implicación que tienen otros inmunomoduladores como las interleucinas (IL), el factor de necrosis tumoral (TNF) o el interferón (IFN), en el daño de la célula tiroidea. Otro problema aún sin resolver y de máxima actualidad, por las importantes implicaciones pronósticas y terapéuticas, es el de discernir qué pacientes pueden beneficiarse de la retirada del tratamiento sustitutivo con hormona tiroidea que se instaura como una sentencia de por vida. No hay estudios a largo plazo y, sobre todo, no son conocidos los factores pronósticos, de tipo inmune o genéticos, que puedan contestar a esta pregunta. La terapéutica con hormona tiroidea no está exenta de riesgos, fundamentalmente en el ámbito cardiovascular y del sistema óseo9, por lo que habría que evitar tratamientos injustificados (AU)

Trends in diagnostic and therapeutic criteria in Graves' disease in the last 10 years.

A questionnaire describing a typical clinical case of Graves' disease and 10 variations on it was mailed to 70 Spanish units of endocrinology with the aim of assessing the new diagnostic and therapeutic trends for hyperthyroidism caused by Graves' disease in Spain and to compare the results obtained from previous studies carried out in Europe and Spain 10 years previously. Responses indicated that thyrotrophin (98%) and free thyroxine (88%) were the most used tests in the in vitro diagnosis of Graves' disease with a significant decrease in the use of total thyroxine, total triiodothyronine, and thyroglobulin in comparison with the surveys conducted 10 years previously in Europe and Spain. The presence of antibodies against the thyrotrophin receptor was the most frequently used immune marker in the diagnosis (78%) and the new use of antithyroperoxidase antibodies (36%) in diagnosis is noteworthy. Antithyroid drugs remain the treatment of choice (98%). Surgery was used mainly for large size goitres (33%) and radioiodine for recurrences after medical (61%) or surgical (80%) treatment. In conclusion, the responses obtained from this questionnaire provide insight into current specialist diagnostic and therapeutic practices with respect to Graves' disease and which could be of value to non-specialist units of endocrinology.

Dapsone at onset of diabetes lowers glycated hemoglobin and delays death in NOD mice.

Dapsone (4,4'-diaminodiphenyl sulfone) is a compound that has a large clinical experience due to its antimicrobial effects against mycobacterium leprae, the causative agent of leprosy. It is increasingly used in a number of clinical situations where inflammation may play an ancillary role. An inhibitory effect of the drug or lack thereof in the cumulative incidence or propagation of diabetes mellitus in the NOD mouse has mechanistic as well as therapeutic implications. We previously showed that dapsone administered continuously as a percentage of food to NOD mice inhibits the cumulative incidence of diabetes in a dose dependent fashion. In the present experiment, female NOD litter mates were randomized to receive dapsone (0.001% w/w as a percentage of food) at onset of diabetes. There were no differences in weight, blood glucose, or glycated hemoglobin at 10 weeks of age among the animals that were ultimately to receive dapsone (n = 10), mouse chow alone (n = 9), or those who did not develop diabetes (n = 3). The mean time to onset of diabetes, mean blood glucose at onset, and mean glycated hemoglobin at onset did not differ between animals who did or did not receive dapsone. Animals receiving dapsone had significantly (p < or = 0.03) lower glycated hemoglobin at weeks 2, 3, and 4 following the onset of diabetes and lived significantly longer following diagnosis of diabetes (7 vs. 4 weeks, p < 0.05). In conclusion, dapsone modulates the progression of autoimmune diabetes in the NOD mouse even when administered after the initiation of hyperglycemia.

Increased plasma pancreastatin-like levels in gestational diabetes: correlation with catecholamine levels.

OBJECTIVE: To investigate plasma pancreastatin (a chromogranin A-derived peptide) and catecholamine levels (counterregulatory hormones) in subjects with gestational diabetes compared with normal pregnant subjects. RESEARCH DESIGN AND METHODS: Fasting blood samples were obtained from 11 normal pregnant and 12 nonobese gestational diabetic subjects at late pregnancy (30+/-1 weeks). Selection criteria were those recommended by the National Diabetes Data Group (modified from O'Sullivan original criteria). Plasma glucose, insulin, glucagon, pancreastatin-like, epinephrine, and norepinephrine were measured. RESULTS: Gestational diabetic subjects had significantly higher insulin levels than control pregnant subjects (18+/-1 vs. 15+/-1 microU/ml), whereas glucose and glucagon levels where comparable in the two groups. However, increased catecholamine levels (epinephrine and norepinephrine) were found in the gestational diabetic group. We also found increased pancreastatin-like levels in these patients compared with the pregnant control group (46+/-2 vs. 30+/-2 pmol/l). Actually, pancreastatin levels positively correlated with both epinephrine (r = 0.34) and norepinephrine (r = 0.80) levels. CONCLUSIONS: Catecholamine and pancreastatin-like levels were found elevated in gestational diabetic subjects. These counterregulatory hormones may play a role in the insulin resistance syndrome of gestational diabetes.

[Evolution of diagnostic and therapeutic criteria in Graves' disease in Spain. Comparison of the results of 2 surveys in 1987 and 1995]. / Evolución de los criterios diagnósticos y terapéuticos en la enfermedad de Graves en España. Comparación de los resultados de dos encuestas realizadas en 1987 y 1995.

BACKGROUND: To assess the new diagnostic and therapeutic trends for hyperthyroidism due to Graves' disease in Spain and the differences with respect to a previous study performed in 1987. METHODS: A questionnaire about a typical clinical case of hyperthyroidism due to Graves' disease and 10 variations to it, in which different diagnostic and therapeutic options are exposed. These questionnaires were mailed to 70 Spanish units of endocrinology during 1995, and 51 participated finally in the study. The results are compared with those obtained in Spain with a similar study in 1987. RESULTS: Thyrotropin (98%) and free thyroxine (88%) were the most used tests for diagnosis of Graves' disease, with a significant decrease (p < 0.001) in the use of total T4 and total T3 in comparison with the results of the questionnaire performed in 1987. The measurement of antibodies against thyrotropin receptor (TSH-R-Ab) was the most frequently used immune marker for the diagnosis (78%), with significant differences (p < 0.001) with respect to questionnaire in 1987. The use of anti-thyroperoxidase antibodies (anti-TPO-Ab) (36%) in diagnosis of this disease, significantly increased (p < 0.05) with respect to 1987. Antithyroid drugs were the most frequent initial treatment (98%) with significant differences (p < 0.001) in use of radioiodine (24%) as treatment of choice in elderly patients respect to 1987. Surgery was mainly used for large-size goiters (33%) and radioiodine for recurrences after medical (61%) or surgical (80%) treatment. Antithyroid drugs were the most frequent treatment for children and for recurrences during gestation. CONCLUSIONS: In Spain, the measurements of TSH, FT4 and TSH-R-Ab are the main diagnostic test of hyperthyroidism. Antithyroid drugs are still the treatment of choice in typical case of hyperthyroidism due to Graves' disease, in recurrences during gestation and children. Surgery is only used for large goiters and radioiodine is the treatment of choice in recurrences after medical or surgical treatment.

Thyroid function during pregnancy and the postpartum period: iodine metabolism and disease states.

OBJECTIVE: To review various aspects of thyroid function during and early after pregnancy. METHODS: We discuss biochemical and potential pathologic changes in the thyroid associated with the gestational and postpartum periods. RESULTS: Urinary iodine excretion during the last trimester of gestation in healthy euthyroid women shows that, in areas with mild iodine intake, iodine supplementation is necessary during pregnancy and the postpartum period. This measure should be considered in iodine-sufficient areas as well. Thyroglobulin is the main biochemical marker of persistent thyroidal stimulation. Alterations in thyroid volume during pregnancy can persist after delivery, especially in breast-feeding mothers. In most patients, the goitrogenic stimulus of pregnancy can be suppressed with iodine supplementation. Autoimmune thyroid disease during pregnancy and the postpartum period is reflected by monitoring of thyroid peroxidase antibodies (TPO-Ab). Women with positive test results for TPO-Ab early in gestation showed a highly significant decrease in free thyroxine and increased thyroid-stimulating hormone levels late in gestation. The main marker of Graves' disease during pregnancy is thyroid-stimulating antibodies. Nonautoimmune gestational hyperthyroidism differs from Graves' disease in that thyroid-stimulating antibodies are not detectable. CONCLUSION: Clinicians should be alert to the fact that pregnancy can induce thyroidal pathologic conditions.

Reclassification after delivery of diabetes in pregnancy.

Gestational diabetes mellitus (GDM) constitutes a risk factor for the development of non insulin-dependent diabetes mellitus (NIDDM). The search for parameters to provide discrimination between a high risk and a low risk for future development of NIDDM is today the aim of many investigations. The absence or presence of several factors such as glycemia during pregnancy and post partum, the need for insulin treatment, disorders of the pancreatic insulin secretion, the number of pregnancies, maternal obesity, the early diagnosis of GDM, the family history of diabetes mellitus, the race and immune disorders give rise to a very high relative risk (RR) of developing NIDDM. To know the degree of risk will allow a future appropriate clinical intervention to reduce the incidence of NIDDM and its economic cost.

Autoimmune thyroid disease and insulin-dependent diabetes mellitus during pregnancy and post partum.

The aim of this study was to assess thyroid dysfunction and autoimmunity in pregnant insulin-dependent diabetes mellitus (IDDM) women during pregnancy and early post partum. Fifteen pregnant IDDM women and 77 healthy pregnant women were studied. Free T4, TSH, TPO-Ab and Tg-Ab were assayed during the first and third trimester of pregnancy and 3 months post partum. In IDDM women FT4 levels significantly decreased (p < 0.05) during third trimester and 3 months post partum and also TPO-Ab during third trimester (p < .01). 26% of IDDM and 4% of the controls presented post partum thyroid dysfunction. We recommend that prepregnant IDDM be screened for TPO-Ab. Those with a positive result would be followed with serial monitoring of free T4 and TSH levels during each trimester as well as during the post partum period.

Comparison of fluoxetine and placebo in the treatment of obesity.

Our study aims at assessing the efficacy and safety of fluoxetine as compared with placebo in the treatment of obesity using a double-blind crossover design. We studied 42 obese women (body mass index 35.9 +/- 5.3 kg/m2). The obese patients were randomized to start treatment with fluoxetine (group A) or placebo (group B) for 3 months (period 1). After a 1-month washout period, treatment was crossed for the following 3 months (period 2). There was no significant difference in weight loss when the patients were treated with fluoxetine (group A period 1 and group B period 2) as compared with patients treated with placebo (group B period 1 and group A period 2). There were no significant differences in monthly weight reduction during both treatments. In conclusion, we demonstrated that serotoninergic drugs such as fluoxetine need further investigation before being used indiscriminately in obese subjects.

[Long-term evolution of immunologic and thyroid function in Graves disease according different therapeutic options]. / Evolución inmunológica y de la función tiroidea a largo plazo en la enfermedad de Graves según distintas opciones terapéuticas.

BACKGROUND: A prospective study was carried out to compare the evolution of thyroid hormones, thyroglobulin (Tg) and immunoglobulins inhibiting the binding of thyrotropin to its receptor (TBII) in patients with Graves disease treated with antithyroid drugs, radioactive iodine and subtotal thyroidectomy. METHODS: Ninety-five patients with Graves disease were studied, being distributed according to clinical criteria: Group I (n = 35) patients treated with antithyroid drugs; Group II (n = 30) patients who received 131I; and Group III (n = 30) patients treated with subtotal thyroidectomy. The thyroid hormones, Tg, antithyroglobulin antibodies and TBII were determined by radioimmunoassay (RIA), prior to treatment, and at 1, 3, 6, 12, 24, and 36 months of follow up, except in those patients from Group III who were followed up to 24 months. RESULTS: The rate of reactivation at 12 months did not significantly differ among the three groups. At 24 months a higher percentage of reactivations was observed in Group I (42%), versus Group II (16%, p < 0.001) and Group III (13%, p < 0.005). At 36 months reactivation was 30% in Group I, versus 5% in Group II (p < 0.01). Upon comparison of the TBII values among the three groups, the highest basal values corresponded to Group III with significant differences being found versus Group I (p < 0.05) and Group II (p < 0.001). TBII concentrations in the three groups studied remained high at 6 and 12 months with no significant differences being observed. Negativization was shown in the TBII at 24 months in Group II with a significant difference being seen versus Group I and III. At 36 months negativization was seen in the TBII in Group I with significant differences with respect to Group II. CONCLUSIONS: The rate of reactivation following antithyroid treatment is greater to that obtained in groups treated with iodine or surgery. The earliest negativization of TBII was obtained with radioiodine.

Thyroid function parameters and TSH-receptor antibodies in healthy subjects and Graves' disease patients: a sequential study before, during and after pregnancy.

The changes in thyroid function and in TSH receptor antibody titers were analyzed in a prospective sequential study before, during and after pregnancy in a group of 15 healthy women and 45 patients with Graves' disease. Twenty-five patients with Graves' disease were untreated before pregnancy (Group A) and twenty treated with carbimazole throughout pregnancy (Group B). In healthy pregnant women serum FT4 levels were slightly but significantly elevated early in pregnancy (p < 0.05) and lower during the third trimester (p < 0.01), compared to pregestational values (although within the reference range of nonpregnant subjects). During postpartum, serum FT4 reverted to values similar to those found before pregnancy. Serum TSH levels showed a slight increment during gestation with a significant decrease (p < 0.01) in the early postpartum period. There was a significant increase in serum thyroglobulin (Tg) during the first trimester (p < 0.01); Tg levels remaining markedly elevated throughout gestation. After delivery, Tg progressively decreased, but were still above normal, six months later in 27% of subjects. TSH-receptor antibody titers were normal but tended to decrease during late gestation; a significant rebound was observed in late postpartum, even though most individual values remained in the normal range. When we compared "active" and "remission" Graves' disease patients, the concentration of FT4 was significantly higher in group B ("active") than in group A ("remission" (p < 0.01) during early gestation. Serum Tg was also significantly higher in Group B than in Group A before pregnancy (p < 0.01), and during late gestation and postpartum (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Hyperthyroidism due to familial pituitary resistance to thyroid hormone: successful control with 3, 5, 3' triiodothyroacetic associated to propranolol.

We herein describe a family with thyroid hormone resistance. Thyroid hormones and basal TSH were elevated. Pituitary tumor or abnormality in thyroid hormone binding proteins were ruled out by appropriate tests. Mother and sister of the propositus presented similar abnormal hormonal features but no hyperthyroidism. Initially the patient was treated with carbimazole (30 mg/day): three months later a dramatic increase in the size of the thyroid gland and in TSH levels (12.5 to 28 mU/l) were noted. Thereafter, dextrothyroxine (D-T4) and 3, 5, 3'-triiodothyroacetic acid (TRIAC) were given consecutively and treatment was accompanied by a decrease of TSH levels (2 mU/l) but thyroid hormone remained elevated. The symptoms and signs of hyperthyroidism improved with the addition of propranolol (30-60 mg/day). In conclusion, the present report describes a new family with the syndrome of THR and variable degrees of involvement among relatives. We suggest the usefulness of TRIAC therapy to decrease TSH levels and propranolol to improve thyrotoxicosis due to pituitary resistance to thyroid hormone.