All-cause mortality and risk factors in patients with type 1 diabetes in Castilla-La Mancha, Spain. DIACAM1 2010-2020 study.

INTRODUCTION: Despite better treatments and care for patients with type 1 diabetes (T1DM), all-cause and cardiovascular mortality still remains higher compared to the general population. We evaluated mortality and risk factors for mortality in a representative cohort of patients with T1DM. METHODS: DIACAM1 was a cross-sectional, multicenter study on adult patients (≥ 16 years old) and diabetes with at least 5 years since diabetes diagnosis conducted between 2009 and 2010. DIACAM1 2010-2020 study was a follow-up study, extension of DIACAM1, where vital status of patients was evaluated between June 2019 and June 2020. RESULTS: 4.03% [CI95%, 2.53-5.62) of the 1465 patients with T1DM included in the cohort of the DIACAM1 in 2010 had died. Survival was lower than in the sex- and age-matched general population in the same region. 40.7% of deaths were due to cardiovascular disease. HbA1c levels < 7% and triglyceride levels < 150 mg/dL were associated with lower mortality, whereas retinopathy and plasma creatinine were associated with increased mortality. CONCLUSIONS: We confirmed a lower survival in people with T1DM, with cardiovascular disease being the main cause of mortality. High HbA1c, high triglycerides, retinopathy, and high creatinine are factors associated with mortality.

Prevalencia de enfermedades autoinmunes en pacientes con diabetes mellitus tipo 1. Estudio DIACAM 1 2010-2020 / Prevalence of autoimmune diseases in patients with type 1 diabetes mellitus. DIACAM 1 study 2010-2020

Objective: To evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM).Patients and methodsAnalytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020.ResultsIn this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p < 0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p < 0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p < 0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041).ConclusionsAfter 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD. (AU)

Objetivo: Conocer la prevalencia de las enfermedades autoinmunes (EA) asociadas a la diabetes mellitus tipo 1 (DM1).Pacientes y métodosEstudio transversal analítico, anidado en una cohorte prospectiva multicéntrica de 1.121 adultos con DM1 con seguimiento activo en consultas de endocrinología. Se analizaron variables sociodemográficas, clínicas y la presencia de EA en el año 2010 y en el año 2020.ResultadosEn este segundo análisis, la edad media fue de 49,4 ± 12,8 años, siendo el 49,5% varones, con una mediana de tiempo de evolución de la DM1 de 27,1 años (20,7-35,1) y una media de hemoglobina glicosilada de 7,66 ± 1,06%. Existe un incremento absoluto del 13% (IC 95% 11-15) (p < 0,001) de pacientes con al menos una EA y un incremento absoluto de 11,6% (IC 95% 9,7-13,5) (p < 0,0001) de cualquier tipo de enfermedad tiroidea autoinmune (ETA) tras 10 años de seguimiento. Así mismo, aumentó la prevalencia de manera estadísticamente significativa de la gastritis autoinmune, enfermedad celiaca y otras EA. En el análisis de regresión logística multivariante, los factores que se asociaron de manera independiente a la presencia de ETA fueron el género femenino (OR 2,9 [IC 95% 2,3-3,7]; p < 0,0001) y la DM1 tipo b (OR 0,5 [IC 95% 0,3-0,9]; p = 0,041).ConclusionesTras 10 años de seguimiento activo se produce un incremento sustancial de otro tipo de EA en pacientes con DM1. Parece necesario realizar un cribado sistemático de dichas EA para optimizar el seguimiento de los pacientes con DM1, fundamentalmente de la ETA. (AU)

Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study.

BACKGROUND: In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS: Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS: 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS: SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.

Prevalence of autoimmune diseases in patients with type 1 diabetes mellitus. DIACAM 1 study 2010-2020. / Prevalencia de enfermedades autoinmunes en pacientes con diabetes mellitus tipo 1. Estudio DIACAM 1 2010-2020.

OBJECTIVE: To evaluate the prevalence of autoimmune diseases (AD) associated with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS: Analytical cross-sectional study, nested in a multicenter prospective cohort of 1121 adults with DM1 with active follow-up in endocrinology clinics. Sociodemographic and clinical variables and the presence of AD were analysed in 2010 and 2020. RESULTS: In this second analysis, 49,5% were male, mean age was 49.4 ± 12.8 years, median T1DM duration was 27,1 years (20,7-35,1) and mean glycated hemoglobin was 7.66 ± 1.06%. There is an absolute increase of 13% (95% CI 11-15) (p < 0.001) of patients with at least one AE and an absolute increase of 11.6% (95% CI 9.7-13.5) (p < 0.0001) of any type of autoimmune thyroid disease (ATD) after 10 years of follow-up. Likewise, the prevalence of celiac disease, autoimmune gastritis and other AD increased statistically significantly. In the multivariate logistic regression analysis, the factors that were independently associated with the presence of ATD were female gender [OR 2.9 (95% CI 2.3-3.7); p < 0.0001] and the presence of type 1 b diabetes (OR 0.5 [95% CI 0.3-0.9]; p = 0.041). CONCLUSIONS: After 10 years of follow-up, there is a substantial increase in other types of AE in patients with DM1. It seems necessary to carry out a systematic screening of these AD to optimize the follow-up of patients with 1 TDM, mainly of the ATD.

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality.

Neoplasia endocrina múltiple tipo 1 y cáncer de mama. Una asociación a tener en cuenta / Multiple endocrine neoplasia type 1 and breast cancer. An association to consider

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Evolución clínica de una cohorte de pacientes con diabetes mellitus tipo 2 tras su valoración en endocrinología. Estudio a 26 semanas / Clinical course of a cohort with type 2 diabetes mellitus after endocrine assessment. A 26-week study

Objetivo: Evaluar el grado de control metabólico y los tratamientos hipoglucemiantes en una cohorte de pacientes con diabetes mellitus tipo 2 (DM2) tras su valoración en endocrinología. Material y métodos: Estudio de cohortes prospectivo. Se incluyeron 465 pacientes con DM2 que no realizaban seguimiento en una consulta de endocrinología. Se recogieron datos de control glucémico y tratamientos recibidos en una visita inicial y tras 26 semanas de seguimiento. Resultados: La hemoglobina glucosilada (HbA1c) inicial fue de 8,3±1,8%, mientras que tras 26 semanas de seguimiento fue de 6,6±0,9% (p<0,0001). El porcentaje de pacientes con HbA1c<7% ascendió de 33,1 a 71,3% (p<0,0001). En el 59,9% de los pacientes se observó un descenso ≥0,8% de HbA1c. En el análisis multivariante, las variables que predijeron una mejoría en el grado de control metabólico fueron una mayor edad (OR 1,038; IC 95%: 1-1,07; p=0,041), una mayor HbA1c inicial (OR 5,51; IC 95%: 3,4-9; p<0,0001), un tiempo de evolución de la DM2<5 años (OR 4,63; IC 95%: 1,6-13,3; p=0,005) y el cambio de tratamiento hipoglucemiante (OR 2,77; IC 95%: 1,1-6,9; p=0,03). En el 75,1% de los sujetos con DM2 incluidos en el estudio se modificó el tratamiento hipoglucemiante. El porcentaje de pacientes que no recibía tratamiento disminuyó del 7% al 0,3% tras 26 semanas de seguimiento (p<0,0001), así como el porcentaje de pacientes que recibía tratamiento con antidiabéticos orales (60,9 vs 55,5%) (p=0,003) e insulina (10,5 vs 6,2%) (p=0,021). Sin embargo, aumentó el porcentaje de pacientes que recibían tratamiento con insulina combinada con antidiabéticos orales de 21,1% a 38% (p<0,0001). Conclusiones: se produce una mejoría del control metabólico en esta cohorte de pacientes con DM2 tras su valoración en una consulta de endocrinología. No obstante, en el 28,7% no se alcanza un HbA1c<7%, lo que pone de manifiesto la dificultad en conseguir un buen control en la práctica clínica (AU)

Objective: To assess the degree of metabolic control and hypoglycemic treatments in a cohort of patients with type 2 diabetes mellitus (T2DM) after evaluation in an endocrinology clinic. Material and methods: A prospective cohort study on 465 patients with T2DM who were not being monitored at an endocrinology clinic. Blood glucose control data and treatments received were recorded at an initial visit and after 26 weeks of follow-up. Results: Baseline glycosylated hemoglobin (HbA1c) level was 8.3±1.8%, as compared to 6.6±0.9% after 26 weeks of follow-up (P<.0001). The proportion of patients with HbA1c levels <7% increased from 33.1% to 71.3% (P<.0001). In 59.9% of patients, a decrease ≥0.8% in HbA1c was seen. In the multivariate analysis, variables predicting for an improvement in the degree of metabolic control were older age (OR 1.038; 95%CI 1-1.07; P=.041), higher baseline HbA1c values (OR 5.51; 95%CI 3.4-9; P<.0001), T2DM duration <5 years (OR 4.63; 95%CI 1.6-13.3; P=.005), and change in hypoglycemic treatment (OR 2.77, 95%CI 1.1-6.9; P=.03). Hypoglycemic therapy was changed in 75.1% of study patients with T2DM. After 26 weeks of follow-up, decreases were seen in both the proportion of patients who receiveding no treatment (from 7% to 0.3%, P<.0001) and the proportions of patients on oral antidiabetic therapy (60.9% vs 55.5%, P=.003) and insulin (10.5% vs 6.2%, P=.021). However, the proportion of patients receiving insulin combined with oral antidiabetic drugs increased from 21.1% to 38% (P<.0001). Conclusions: An improved metabolic control was seen in this cohort of patients with T2DM after their evaluation in an endocrinology clinic. However, HbA1c levels <7% were not achieved in 28.7% of patients, which shows the difficulty to achieve adequate control in clinical practice (AU)

Linfomas primarios tiroideos. Experiencia en hospitales de Castilla-La Mancha / Primary thyroid lymphomas. Experience in hospitals of Castilla-La Mancha

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Clinical course of a cohort with type 2 diabetes mellitus after endocrine assessment. A 26-week study. / Evolución clínica de una cohorte de pacientes con diabetes mellitus tipo 2 tras su valoración en endocrinología. Estudio a 26 semanas.

OBJECTIVE: To assess the degree of metabolic control and hypoglycemic treatments in a cohort of patients with type 2 diabetes mellitus (T2DM) after evaluation in an endocrinology clinic. MATERIAL AND METHODS: A prospective cohort study on 465 patients with T2DM who were not being monitored at an endocrinology clinic. Blood glucose control data and treatments received were recorded at an initial visit and after 26 weeks of follow-up. RESULTS: Baseline glycosylated hemoglobin (HbA1c) level was 8.3±1.8%, as compared to 6.6±0.9% after 26 weeks of follow-up (P<.0001). The proportion of patients with HbA1c levels <7% increased from 33.1% to 71.3% (P<.0001). In 59.9% of patients, a decrease ≥0.8% in HbA1c was seen. In the multivariate analysis, variables predicting for an improvement in the degree of metabolic control were older age (OR 1.038; 95%CI 1-1.07; P=.041), higher baseline HbA1c values (OR 5.51; 95%CI 3.4-9; P<.0001), T2DM duration <5 years (OR 4.63; 95%CI 1.6-13.3; P=.005), and change in hypoglycemic treatment (OR 2.77, 95%CI 1.1-6.9; P=.03). Hypoglycemic therapy was changed in 75.1% of study patients with T2DM. After 26 weeks of follow-up, decreases were seen in both the proportion of patients who receiveding no treatment (from 7% to 0.3%, P<.0001) and the proportions of patients on oral antidiabetic therapy (60.9% vs 55.5%, P=.003) and insulin (10.5% vs 6.2%, P=.021). However, the proportion of patients receiving insulin combined with oral antidiabetic drugs increased from 21.1% to 38% (P<.0001). CONCLUSIONS: An improved metabolic control was seen in this cohort of patients with T2DM after their evaluation in an endocrinology clinic. However, HbA1c levels <7% were not achieved in 28.7% of patients, which shows the difficulty to achieve adequate control in clinical practice.

Soporte nutricional con nutrición parenteral. Evolución y complicaciones asociadas / Nutritional support with parenteral nutrition. Course and associated complications

Introducción La nutrición parenteral (NP) es una parte integral del tratamiento médico de aquellos pacientes que no tienen un tracto gastrointestinal funcionante o accesible. En este trabajo se describen las características clínicas de los pacientes que han recibido NP en un hospital de 420 camas desde 2009 hasta 2011. Además, se evaluaron los parámetros nutricionales al inicio y fin de la NP, y se analizaron las complicaciones asociadas. Material y métodos Estudio observacional retrospectivo de los episodios de NP en mayores de 18 años seguidos por la Unidad de Nutrición del Hospital Universitario de Guadalajara. Se recogieron: datos epidemiológicos y clínicos, número y tipo de vías empleadas, datos antropométricos, datos analíticos, número de días con NP, causa de la retirada, aporte calórico, prevalencia de flebitis, complicaciones metabólicas (hipertrigliceridemia, alteraciones en las pruebas de función hepática, hiperglucemia y síndrome de realimentación) y prevalencia de bacteriemia asociada a catéter venoso central (BAC).Resultados Se registraron 312 episodios de NP. La indicación inmediata fue íleo posquirúrgico en el 53,8% de los episodios. Se produjo una mejoría estadísticamente significativa de todos los parámetros analíticos que se evaluaron (albúmina, prealbúmina, proteína transportadora de retinol, transferrina, colesterol y linfocitos). El aporte calórico (Kcal por kg de peso) fue de 25,1 ± 6,6. En el 16,3% de los episodios no se registró ninguna complicación (..) (AU)

Introduction Parenteral nutrition (PN) is an integral part of medical management of patients who do not have a functioning or accessible gastrointestinal tract. This paper discusses the clinical characteristics of patients receiving PN in a 420-bed hospital from 2009 to 2011. In addition, nutritional parameters were assessed at the start and end of PN and associated complications were analyzed. Material and methods retrospective, observational study of PN episodes in adults conducted at the Nutrition Unit of Hospital Universitario de Guadalajara. Variables collected included epidemiological and clinical data, number and type of routes used, anthropometric data, analytical data, number of days on PN, reason for withdrawal, caloric provision, prevalence of phlebitis, metabolic complications (hypertriglyceridemia, abnormal liver function tests, hyperglycemia, and refeeding syndrome), and prevalence of bacteremia associated with central venous catheter (BAC).Results There were 312 episodes of PN. The immediate indication was postoperative ileus in 53.8% of the episodes. There was a statistically significant improvement in all analytical parameters assessed (albumin, prealbumin, retinol binding protein, transferrin, cholesterol, and lymphocytes). Caloric provision (kcal per kg) was 25.1 ± 6.6. No metabolic complication occurred in 16.3% of the episodes, and hyperglycemia was the most common complication (79.8%). There were 10 cases of phlebitis (32.2%) and 30 episodes of BAC (8.7%). Bacteriemia rate was 8.1 per 1000 days of PN. Discussion Although PN is an effective nutritional support technique, it is associated with complications of varying severity. Use of PN should therefore comply with the instructions accepted in the main clinical practice guidelines and requires careful monitoring by experienced professionals (AU)

[Nutritional support with parenteral nutrition. Course and associated complications]. / Soporte nutricional con nutrición parenteral. Evolución y complicaciones asociadas.

INTRODUCTION: Parenteral nutrition (PN) is an integral part of medical management of patients who do not have a functioning or accessible gastrointestinal tract. This paper discusses the clinical characteristics of patients receiving PN in a 420-bed hospital from 2009 to 2011. In addition, nutritional parameters were assessed at the start and end of PN and associated complications were analyzed. MATERIAL AND METHODS: retrospective, observational study of PN episodes in adults conducted at the Nutrition Unit of Hospital Universitario de Guadalajara. Variables collected included epidemiological and clinical data, number and type of routes used, anthropometric data, analytical data, number of days on PN, reason for withdrawal, caloric provision, prevalence of phlebitis, metabolic complications (hypertriglyceridemia, abnormal liver function tests, hyperglycemia, and refeeding syndrome), and prevalence of bacteremia associated with central venous catheter (BAC). RESULTS: There were 312 episodes of PN. The immediate indication was postoperative ileus in 53.8% of the episodes. There was a statistically significant improvement in all analytical parameters assessed (albumin, prealbumin, retinol binding protein, transferrin, cholesterol, and lymphocytes). Caloric provision (kcal per kg) was 25.1±6.6. No metabolic complication occurred in 16.3% of the episodes, and hyperglycemia was the most common complication (79.8%). There were 10 cases of phlebitis (32.2%) and 30 episodes of BAC (8.7%). Bacteriemia rate was 8.1 per 1000 days of PN. DISCUSSION: Although PN is an effective nutritional support technique, it is associated with complications of varying severity. Use of PN should therefore comply with the instructions accepted in the main clinical practice guidelines and requires careful monitoring by experienced professionals.

Enfermedades autoinmunes asociadas a la diabetes mellitus tipo 1 en el estudio DIACAM1 / Relationship between autoimmune disease and type 1 diabetes in the DIACAM1 Study

OBJETIVO: Evaluar las características de las enfermedades autoinmunes (EA) asociadas a la diabetes mellitus tipo 1 (DM1). PACIENTES Y MÉTODOS: Estudio transversal, multicéntrico, que incluyó a pacientes adultos con DM1 valorados en consultas externas de endocrinología durante 12 meses. Se analizaron variables sociodemográficas, clínicas y la presencia de EA (enfermedad tiroidea autoinmune [ETA], gastritis crónica, enfermedad celiaca [EC], vitíligo, insuficiencia suprarrenal primaria [ISR] y otras EA registradas en esta cohorte). RESULTADOS: De un total de 1.465 pacientes, el 51,5% varones, con una mediana de edad de 38,2 años (rango intercuartílico, 28,5-48,3) y una mediana de tiempo de evolución de la DM1 de 17,3 años (11,1-25,6), el 29,2% presentaron alguna EA, siendo la más frecuente la ETA (22% con normofunción o hipofunción y 3,4% con hiperfunción tiroidea). La ETA fue más frecuente en el sexo femenino (70,5% [p < 0,001]) y aumentó con la edad (41,7±14,5 vs 38,6±13,1 años en sujetos con y sin ETA, respectivamente [p < 0,001]). La ETA con normofunción o hipofunción tiroidea aumentó también con el tiempo de evolución de la DM1 (17,1% en <10 años de evolución, 21% en 10-20 años, 24,6% en 20-30 años y 26,3% en >30años [p < 0,05]). Otras EA que se asociaron fueron la gastritis crónica (3,6%), el vitíligo (1,6%), la EC (1,1%), la ISR (0,3%) y otras (3,4%). CONCLUSIONES: La ETA es la EA más prevalente. La EC y la gastritis crónica probablemente se encuentren infradiagnosticadas en este estudio por la falta de consenso en cuanto a su cribado. Parece necesario realizar un cribado sistemático de EA en pacientes con DM1

OBJECTIVE: To assess the characteristics of autoimmune diseases (AD) in patients with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS: A cross-sectional, multicentre study on adult patients with T1DM seen in outpatient endocrinology clinics over a 12 month period. Sociodemographic and clinical variables and the presence of AD [autoimmune thyroid disease (ATD), chronic gastritis, coeliac disease (CD), vitiligo, primary adrenal insufficiency, and other AD in this cohort] were investigated. RESULTS: The study included a total of 1,465 patients (51.5% male) with a median age of 38.2 years (interquartile range 28,5-48,3) and a median diabetes duration of 17.3 years (11.1-25.6). Just under one-third (29.2%) had AD, with ATD being the most frequent (22% with normal thyroid function or hypothyroidism, and 3.4% with hyperthyroidism). ATD was most frequent in females [70.5% (P<0.001)] and the prevalence increased with age [41.7±14.5 vs 38.6±13.1 years in patients with and without ATD respectively (P<.001)]. ATD with normal thyroid function or hypothyroidism increased also with longer duration of T1DM [17.1% with <10years, 21% with 10-20 years, 24.6% with 20-30 years and 26.3 with >30years (P<.05)]. Other AD were chronic gastritis (3.6%), vitiligo (1.6%), CD (1.1%), primary adrenal insufficiency (0.3%) and others (3.4%). CONCLUSIONS: ATD was the most prevalent AD. CD and chronic gastritis were probably underdiagnosed in our study as there is no consensus for screening. Screening for AD may be necessary in patients with T1DM

Concentraciones deficientes de vitamina D en pacientes con obesidad mórbida. Estudio de caso-control / Vitamin D deficiency in morbidly obese patients. A case-control study

Objetivos Estudios recientes muestran una elevada prevalencia de déficit de vitamina D en la población general, sobre todo en pacientes ancianos. También existen estudios que describen esta misma situación en los sujetos con obesidad mórbida (OM), aunque en pocos se compara a sujetos con OM y sin obesidad. Los objetivos de este estudio fueron estimar la prevalencia de déficit de vitamina D e hiperparatiroidismo secundario en ambos grupos y valorar si existe relación entre OM y deficiencia de vitamina D. Métodos El estudio se realizó en el Hospital Universitario de Guadalajara (España), desde diciembre de 2008 hasta diciembre de 2009, obteniéndose los datos de 138 sujetos. El 50,7% presentaba OM y el 49,3% no presentaba obesidad. En ambos grupos se obtuvo una muestra de sangre en ayunas para la determinación de 25-hidroxivitamina D, paratirina intacta, calcio, albúmina y fósforo, entre otros constituyentes bioquímicos. Resultados En el grupo de sujetos con OM, la concentración media de 25-hidroxivitamina D fue de 16,6±8,12ng/ml, mientras que en el grupo de sujetos sin obesidad fue de 21,9±7,34ng/ml (p<0,0001). El déficit de vitamina D fue del 80% en el grupo de pacientes con OM y del 41% en los sujetos sin obesidad (p<0,0001). No se obtuvieron diferencias estadísticamente significativas en las concentraciones de paratirina intacta, calcio y fósforo entre ambos grupos. Conclusiones Se confirma la elevada prevalencia de deficiencia de vitamina D en los grupos estudiados, aunque la concentración de 25-hidroxivitamina D fue significativamente menor en los sujetos con OM. La OM es un factor asociado a que exista déficit de vitamina D, por lo que podría valorarse incluir la determinación de 25-hidroxivitamina D en las guías para el manejo de los pacientes con OM con el fin de evitar estados carenciales (AU)

Objectives Recent studies show a high prevalence of vitamin D deficiency in the general population, especially in the elderly. There are also studies reporting the same observations in the morbidly obese, although few of these studies have compared morbidly obese individuals with non-obese persons. The objectives of this study were to estimate the prevalence of vitamin D deficiency and secondary hyperparathyroidism in both groups and to assess whether there is a relationship between obesity and vitamin D deficiency. Methods This study was carried out in 138 patients in the Guadalajara University Hospital (Spain) between December 2008 and December 2009. Of these, 50.7% were morbidly obese and 49.3% were not obese. Fasting blood samples were taken from both groups for determination of 25-hydroxyvitamin D, intact parathyroid hormone, calcium, albumin and phosphorus, among other biochemical parameters. Results The mean concentration of 25-hydroxyvitamin D was 16.6±8.12ng/ml in the morbidly obese group and 21.9±7.34ng/ml in the non-obese group (p<0.0001). The prevalence of vitamin D deficiency was 80% in morbidly obese patients and 41% in non-obese patients (p<0.0001). There were no statistically significant differences in concentrations of parathyroid hormone, calcium or phosphorus between the two groups. Conclusions A high prevalence of vitamin D deficiency was found in both groups studied, although the concentration of 25-hydroxyvitamin D was significantly lower in the morbidly obese. Morbid obesity is closely linked to vitamin D deficiency. To prevent this deficiency, determination of 25-hydroxyvitamin D should be included in clinical practice guidelines for the treatment of obesity (AU)

[Vitamin D deficiency in morbidly obese patients. A case-control study]. / Concentraciones deficientes de vitamina D en pacientes con obesidad mórbida. Estudio de caso-control.

OBJECTIVES: Recent studies show a high prevalence of vitamin D deficiency in the general population, especially in the elderly. There are also studies reporting the same observations in the morbidly obese, although few of these studies have compared morbidly obese individuals with non-obese persons. The objectives of this study were to estimate the prevalence of vitamin D deficiency and secondary hyperparathyroidism in both groups and to assess whether there is a relationship between obesity and vitamin D deficiency. METHODS: This study was carried out in 138 patients in the Guadalajara University Hospital (Spain) between December 2008 and December 2009. Of these, 50.7% were morbidly obese and 49.3% were not obese. Fasting blood samples were taken from both groups for determination of 25-hydroxyvitamin D, intact parathyroid hormone, calcium, albumin and phosphorus, among other biochemical parameters. RESULTS: The mean concentration of 25-hydroxyvitamin D was 16.6+/-8.12 ng/ml in the morbidly obese group and 21.9+/-7.34 ng/ml in the non-obese group (p<0.0001). The prevalence of vitamin D deficiency was 80% in morbidly obese patients and 41% in non-obese patients (p<0.0001). There were no statistically significant differences in concentrations of parathyroid hormone, calcium or phosphorus between the two groups. CONCLUSIONS: A high prevalence of vitamin D deficiency was found in both groups studied, although the concentration of 25-hydroxyvitamin D was significantly lower in the morbidly obese. Morbid obesity is closely linked to vitamin D deficiency. To prevent this deficiency, determination of 25-hydroxyvitamin D should be included in clinical practice guidelines for the treatment of obesity.