[Sensitivity and specificity of metabolic syndrome criteria for insulin resistance diagnosis in Spanish population]. / Sensibilidad y especificidad de los criterios del síndrome metabólico para el diagnóstico de insulinorresistencia en la población española.

BACKGROUND AND OBJECTIVE: Metabolic syndrome (MS) is an abdominal obesity and insulin resistance (IR)-related syndrome associated with a high cardiovascular risk. Recently, the International Diabetes Federation (IDF) has proposed a modification of the Adult Treatment Panel III (ATP III) diagnostic criteria. However, the sensitivity of these new criteria has not been established. The aim of the present study was to define the sensitivity and specificity of the different criteria used for the diagnosis of the MS in our population. SUBJECTS AND METHOD: We studied in 177 healthy subjects, 68 men and 109 women, the body mass index, waist circumference (WC), blood pressure, glucose, insulin, lipids and apolipoproteins A1 and B. The HOMA index was used as an IR indicator. IR was considered with an HOMA index > or = 3.8. RESULTS: Subjects with IR showed higher age, systolic blood pressure, triglycerides and apo B, and lower HDL cholesterol. A WC > or = 102 cm in men and > or = 88 cm in women (ATP III criteria) had a low sensitivity for IR (29.4% and 44.7% respectively), with high specificity (81% and 90%). A WC > or = 94 cm in men and > or = 80 cm in women (IDF criteria) showed good sensitivity (73.5% and 73.7% respectively) but less specificity (57.1% and 53.3%). The IDF criteria showed better sensitivity than ATP III, without substantial change in the specificity for the different HOMA cut-off points. CONCLUSIONS: ATP III criteria had low sensitivity in our population. The new criteria (WC > or = 94 cm in men and > or = 80 cm in women, and blood glucose > or = 100 mg/dL) improve three-fold the diagnostic sensitivity and, therefore, seems to be more useful for detecting IR in our country.

Ultrasonography for the evaluation of visceral fat and the metabolic syndrome.

Association between abdominal obesity and cardiovascular disease has been related with visceral adiposity, through the predisposition of developing type 2 diabetes mellitus and metabolic syndrome (MS). Sonography is a simple and reliable method to measure both subcutaneous and visceral fat. To analyze the relationship of anthropometric measurements with abdominal adiposity measured by sonography and to analyze the utility of sonography in the prediction of insulin resistance (IR) and the other components of MS. Visceral fat measurements by sonography correlated better with components of MS than did subcutaneous fat measurements. Preperitoneal circumference (PC) was strongly correlated with all components of MS and with IR expressed as a homeostasis model assessment (HOMA) index for IR. PC was better than waist circumference (WC) in predicting triglyceride levels, apolipoprotein B levels, and HOMA index, but WC was better than PC in predicting high-density lipoprotein cholesterol levels. The area under the receiver operating characteristic curve was 0.699 for PC and 0.684 for WC, in subjects with body mass index 25 kg/m2 or greater (P=.024 and .015, respectively). PC and WC showed good correlation with HOMA index (Spearman correlation coefficient=0.306, P<.001 and .206, P<.001, respectively). Abdominal visceral fat is better correlated with MS than subcutaneous fat; sonography is a useful method to evaluate the abdominal fat; PC is the best sonography parameter correlated with components of MS, and in overweight and obese subjects, PC is better than WC at predicting components of the MS.

[Continuous enteral nutrition versus single bolus: effects on urine C peptide and nitrogen balance]. / Nutrición enteral continua frente a nutrición en bolo: efectos sobre el péptido C urinario y el balance nitrogenado.

BACKGROUND AND OBJECTIVE: Our study was designed to assess the impact on nitrogen and glucose metabolism when it is administered either as discontinuous or as continuous infusion. PATIENTS AND METHOD: We assessed the nutritional efficacy (nitrogen balance) and hyperinsulinism risk (urine C peptide excretion) of enteral nutrition in 23 patients hospitalized because of acute stroke. RESULTS: The feeding tolerance of our enteral nutrition protocol (nasoenteric catheter) was full in every patient. The nitrogen balance was positive in both patterns, but the balance in the continuous feeding pattern was better than in the bolus feeding one. On the contrary, the urine C peptide excretion was increased when enteral nutrition was administered intermittently as compared with continuous feeding. Calciuria was greater in the continuous fed pattern than in the bolus feeding. CONCLUSIONS: Continuous feeding is associated with better nitrogen balance and less urine C peptide excretion than intermittent feeding. These results suggest that continuous feeding would be an interesting choice to improve glucose control in diabetic patients with enteral nutrition.

Nutrición enteral continua frente a nutrición en bolo: efectos sobre el péptido C urinario y el balance nitrogenado / Continuous enteral nutrition versus single bolus: effects on urine C peptide and nitrogen balance

FUNDAMENTO Y OBJETIVO: Valoramos el impactodel paso de nutrición enteral continua a nutriciónen bolo de nuestro protocolo sobre el metabolismonitrogenado y glucídico.PACIENTES Y MÉTODO: Valoramos la eficacia nutricionalmediante el cálculo del balance nitrogenadoy el posible riesgo de hiperinsulinismocon la determinación de péptido C urinario en23 pacientes hospitalizados por accidente cerebrovascularagudo.RESULTADOS: La tolerancia digestiva a la instauraciónde nutrición enteral por sonda nasogástricacon el protocolo descrito fue total en todoslos casos. El balance nitrogenado fuepositivo con las dos pautas, pero el balancefue mejor con la administración continua. Porel contrario, los valores urinarios de péptido Cse incrementan cuando se pasa de la administracióncontinua a bolo.CONCLUSIONES: La administración continua denutrición enteral se asoció con mejor balancenitrogenado y una menor excreción de péptidoC urinario. Estos resultados sugieren que estaforma de administración podría ser de interéspara mejorar el control glucémico del pacientediabético con nutrición enteral

BACKGROUND AND OBJECTIVE: Our study was designedto assess the impact on nitrogen and glucosemetabolism when it is administered either asdiscontinuous or as continuous infusion.PATIENTS AND METHOD: We assessed the nutritionalefficacy (nitrogen balance) and hyperinsulinismrisk (urine C peptide excretion) of enteralnutrition in 23 patients hospitalizedbecause of acute stroke.RESULTS: The feeding tolerance of our enteralnutrition protocol (nasoenteric catheter) wasfull in every patient. The nitrogen balance waspositive in both patterns, but the balance inthe continuous feeding pattern was better thanin the bolus feeding one. On the contrary, theurine C peptide excretion was increased whenenteral nutrition was administered intermittentlyas compared with continuous feeding.Calciuria was greater in the continuous fedpattern than in the bolus feeding.CONCLUSIONS: Continuous feeding is associatedwith better nitrogen balance and less urine Cpeptide excretion than intermittent feeding. Theseresults suggest that continuous feeding wouldbe an interesting choice to improve glucose controlin diabetic patients with enteral nutrition

Insulin-like growth factors in childhood-onset Gaucher disease.

There is a high prevalence of growth retardation in children with type 1 Gaucher disease. The cause of this poor growth is not yet known; however, studies have shown acceleration of growth with enzyme replacement therapy (ERT). IGF are recognized as important determinants of somatic growth. It has been proven that chronic diseases with liver involvement might cause IGF deficiency. The aim of this study was to assess the IGF system in patients with childhood-onset Gaucher disease, before and after ERT, and its association with other clinical and analytical parameters. Twenty-two patients with type I Gaucher disease were included. The diagnosis was established before 14 y of age in all patients. Baseline determinations of total IGF-I, free IGF-I, and IGF binding protein 3 (IGFBP-3) were obtained in 19 patients before starting ERT at a mean age of 13.8 +/- 11.2 y. A Spearman test was performed to establish the association with other clinical and analytical parameters. In a group of 13 patients receiving IGF, changes were evaluated during the initial 2 y of treatment. A Wilcoxon test was performed for the statistical analysis. Total IGF-I, free IGF-I, and IGFBP-3 were expressed as SD scores (SDS). We found low levels of IGF and its binding proteins before ERT. A significant association was found between the total IGF-I SDS before treatment and the age-adjusted severity score index: r = -0.62, p < 0.05. Total IGF-I and IGFBP-3 SDS correlated negatively with the presence of the L444P mutation (r = -0.53 and -0.5, respectively, p < 0.05). Height SDS correlated with total IGF-I and IGFBP-3 SDS in eight children (r = 0.84 and 0.78, respectively, p < 0.05). Total IGF-I SDS increased from -1.8 +/- 0.8 to -0.8 +/- 1.4 (p = 0.005) and free IGF-I increased from -1.2 +/- 1 to 1.1 +/- 2.1 after 12 +/- 6.8 mo (p = 0.011) of ERT. IGFBP-3 SDS increased from -1.3 +/- 0.6 to -0.2 +/- 1.2 (p = 0.012) after 12 +/- 4.5 mo of ERT. Type 1 Gaucher disease is associated with low levels of IGF and its binding proteins, which could be a consequence of liver involvement. Total IGF-I deficiency is associated with the severity of the illness. Growth retardation in pediatric patients with Gaucher disease is related to the alterations in IGF axis. Total IGF-I and IGFBP-3 are the two parameters that better correlate with height before treatment. ERT results in significant increase of total IGF-I, free IGF-I, and IGFBP-3 during the first year of treatment.