Cost of achieving HbA1c and weight loss treatment targets with IDegLira vs insulin glargine U100 plus insulin aspart in the USA.

BACKGROUND: Compared with basal-bolus insulin therapy (insulin glargine U100 plus insulin aspart), IDegLira has been shown to be associated with similar improvements in HbA1c, with superior weight loss and reduced hypoglycemia in patients with type 2 diabetes. The present analysis evaluated the cost per patient with type 2 diabetes achieving HbA1c-focused and composite treatment targets with IDegLira and insulin glargine U100 plus insulin aspart (≤4 times daily). METHODS: The proportions of patients achieving treatment targets were obtained from the treat-to-target, non-inferiority DUAL VII study (NCT02420262). The annual cost per patient achieving target (cost of control) was analyzed from a US healthcare payer perspective. The annual cost of control was assessed for eight prespecified endpoints and four post-hoc endpoints. RESULTS: The number needed to treat to bring one patient to targets of HbA1c <7.0% and HbA1c ≤6.5% was similar with IDegLira and insulin glargine U100 plus insulin aspart. However, when weight gain and/or hypoglycemia were included, the number needed to treat was lower with IDegLira. IDegLira and insulin glargine U100 plus insulin aspart had similar costs of control for HbA1c <7.0%. However, cost of control values were substantially lower with IDegLira when the more stringent target of HbA1c ≤6.5% was used, and when patient-centered outcomes of hypoglycemia risk and impact on weight were included. CONCLUSION: IDegLira was shown to be a cost-effective treatment vs insulin glargine U100 plus insulin aspart for patients with type 2 diabetes not achieving glycemic targets on basal insulin in the USA.

Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide in the treatment of type 2 diabetes: Insights from the SUSTAIN 1-7 trials.

In individuals with type 2 diabetes, glycaemic control and cardiovascular risk factor management reduces the likelihood of late-stage diabetic complications. Guidelines recommend treatment goals targeting HbA1c, body weight, blood pressure, and low-density lipoprotein cholesterol. Development of new treatments for type 2 diabetes requires an understanding of their mechanism and efficacy, as well as their relative effects compared to other treatment choices, plus demonstration of cardiovascular safety. Subcutaneous semaglutide is a glucagon-like peptide-1 receptor agonist currently approved in several countries for once-weekly treatment of type 2 diabetes. Semaglutide works via the incretin pathway, stimulating insulin and inhibiting glucagon secretion from the pancreatic islets, leading to lower blood glucose levels. Semaglutide also decreases energy intake by reducing appetite and food cravings, and lowering relative preference for fatty, energy-dense foods. Semaglutide was evaluated in the SUSTAIN clinical trial programme in over 8000 patients across the spectrum of type 2 diabetes. This review details the efficacy and safety profile of semaglutide in the SUSTAIN 1-5 and 7 trials, and its cardiovascular safety profile in the SUSTAIN 6 trial. Semaglutide consistently demonstrated superior and sustained glycemic control and weight loss vs. all comparators evaluated. In SUSTAIN 6, involving patients at high risk of cardiovascular disease, semaglutide significantly decreased the occurrence of cardiovascular events compared with placebo/standard of care (hazard ratio 0.74, P < 0.001 for non-inferiority). Through a comprehensive phase 3 clinical trial program, we have a detailed understanding of semaglutide's efficacy, safety, cardiovascular effects and comparative role in the treatment of type 2 diabetes.

Position statement for the management of comorbidities in psoriasis.

BACKGROUND: The association between psoriasis and some diseases has become relevant in recent years. Providing appropriate management of psoriasis from an early stage requires prompt diagnosis and treatment of concomitant diseases and to prevent any potential comorbidity. This approach should consider the adverse events of the drugs used to treat psoriasis potentially related to the onset of comorbidities. OBJECTIVE: To provide the dermatologist with an accurate and friendly tool for systematizing the diagnosis of psoriasis-associated comorbidities, which generally escapes the scope of the dermatology setting, and to facilitate decision-making about the referral and treatment of patients with comorbidities. METHODS: These position statement recommendations were developed by a working group composed of ten experts (four dermatologists, one cardiologist, one rheumatologist, one gastroenterologist, one nephrologist, one endocrinologist and one psychiatrist) and two health services researchers. The expert group selected the psoriasis comorbidities considered according to their relevance in the dermatology setting. The recommendations on diagnostic criteria are based on the current clinical practice guidelines for each of the comorbidities. The information regarding the repercussion of psoriasis medical treatments on associated comorbid diseases was obtained from the summary of product characteristics of each drug. RESULTS: Recommendations were developed to detect and refer the following psoriasis comorbidities: psoriatic arthritis, cardiovascular risk factors (diabetes, dyslipidaemia, obesity, hypertension and metabolic syndrome), non-alcoholic fatty liver disease, inflammatory bowel disease, kidney disease and psychological disorders (anxiety and depression). In addition, alcohol consumption and tobacco consumption were included. The tables and figures are precise, easy-to-use tools to systematize the diagnosis of comorbidities in patients with psoriasis and facilitate the decision-making process regarding referral and treatment of patients with an associated disease. CONCLUSION: The application of these position statement recommendations will facilitate the dermatologist practice, and benefit psoriasis patients' health and quality of life.

Spanish consensus on treat to target for osteoporosis.

To reach a Spanish expert consensus on a treat-to-target strategy in osteoporosis, a Delphi Consensus Study has been developed. Most of the experts (59.8%) were rheumatologist with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items. Therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been defined. INTRODUCTION: The paper aims to achieve a Spanish expert consensus on a treat-to-target (T2T) strategy in osteoporosis. METHODS: A scientific committee led the project and was involved in expert panel identification and Delphi questionnaire development. Two Delphi rounds were completed. The first-round questionnaire included 24 items and assessed, using a seven-point Likert scale, the experts' wish (W) and prognosis (P) in 5 years for each topic (applicability, therapeutic objectives, patient follow-up, and possible treatment to be prescribed). Items for which there was no consensus in the first round were included in the second round. Consensus was defined as ≥75% agreement (somewhat/mostly/entirely agree) or disagreement (somewhat/mostly/entirely disagree) responses. RESULTS: Of the experts, 112 and 106 completed the first and second rounds, respectively. 59.8% were rheumatologists with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items, and was established regarding the utility of a T2T strategy to define therapeutic objectives, optimal follow-up, and therapeutic algorithm. Participants agreed on the utility of the bone mineral density (BMD) value (T-score >-2.5 SD for spine and >-2.5/-2.0 SD for femoral neck), lack of fractures, and fracture risk (FRAX) as therapeutic objectives. For measuring BMD changes, consensus was achieved on the suitability of hip and femoral neck locations. Experts agreed to consider treatment failure as when a significant BMD gain could not be achieved, or when a new fracture occurs within 2-3 years. There was consensus that all proposed therapies should achieve a therapeutic target through T2T strategy (treatments with the highest consensus scores were denosumab and teriparatide). CONCLUSION: The therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been established by a panel of experts. Some aspects nevertheless still require further analysis.

Validation of PHPQoL, a Disease-Specific Quality-of-Life Questionnaire for Patients With Primary Hyperparathyroidism.

CONTEXT: Health-related quality of life (HRQoL) is impaired in primary hyperparathyroidism (PHPT) but instruments to specifically assess this are scarce. OBJECTIVE: Validate the new disease-specific Primary Hyperparathyroidism Quality of Life (PHPQoL) questionnaire in usual clinical practice. DESIGN: Observational, prospective, and multicenter. SETTING: Public hospital ambulatory care. PATIENTS: Patients with PHPT of both sexes, aged more than or equal to 18 years either initiated treatment for PHPT (group A) or had stable PHPT, not requiring therapy (group B). Patients in group A had at least one surgical criterion according to the 2009 Third International Workshop on Management of Asymptomatic PHPT. INTERVENTION: Sociodemographic, clinical, and HRQoL data (PHPQol, Short Form-36, Psychological Well-Being Index, and patients' self-perceived health status) were collected. Group A underwent 4 evaluations (baseline, 3 ± 1, 6 ± 1, and 12 ± 2 months after a therapeutic intervention) and group B 2, at baseline and 1 month later to assess test-retest reliability. RESULTS: A total of 182 patients were included (104 group A, 78 group B) with a mean age (SD) of 61.4 (12.1) years; 79.7% were women. Group A increased PHPQoL score (SD) (better HRQoL) (52 ± 23 at baseline; 62 ± 24 at 12 months; P < .001). At baseline, symptomatic patients had a lower PHPQoL score (worse) than asymptomatic ones (51 ± 21 vs 68 ± 21; P < .001). Correlations were seen between PHPQoL and Short Form-36, Psychological Well-Being Index, and self-perceived health status (P < .001). PHPQoL had good internal consistency (Cronbach's α = 0.80), test-retest reliability (group B, intraclass correlation coefficient > 0.80), and sensitivity to detect HQRoL changes over time. CONCLUSIONS: PHPQoL is a valid HRQoL measure to assess the impact of PHPT on health perception in clinical practice.

Perspectiva de los profesionales sobre la investigación biomédica / Health care professional view on biomedical research

La investigación biomédica es necesaria y goza de reconocido prestigio social. Objetivo: Conocer la opinión y expectativas de los profesionales sanitarios sobre la investigación, analizando la influencia de la formación académica y del nivel asistencial. Método: Se diseñó un cuestionario que se distribuyó entre médicos y enfermeras de un hospital universitario de tercer nivel, 7 centros de atención primaria y 2 centros sociosanitarios. Resultados: El coeficiente α de Cronbach fue de 0,817 y la participación, del 60%. Se repartieron 719 cuestionarios y respondieron 432 profesionales. Las mujeres fueron el 71%, la edad media fue de 37 años y el ejercicio profesional medio fue de 14 años. El 79% consideró que la investigación formaba parte de su trabajo, aunque en la práctica investigaba el 43%. Globalmente, la participación en actividades fue del 71% en congresos, 42% en docencia, 34% en publicaciones y 17% en proyectos activos. La investigación al margen de la jornada laboral fue un 37% más frecuente entre médicos que entre enfermeras (IC del 95%: 28 al 46%). El 100% de los doctores quería investigar, el 84% lo hacía en su tiempo libre y el 74% tenía proyectos activos. La mayor dificultad fue la presión asistencial. Las propuestas para potenciar la investigación se centraron en aumentar los recursos. Conclusiones: Mayoritariamente, los profesionales manifestaron una gran motivación. La percepción sobre la investigación variaba con la formación académica y el lugar de trabajo. Los doctores tenían una percepción diferente y se mostraban especialmente implicados con la investigación y críticos con los recursos disponibles. Por el contrario, los colectivos con menor formación y menor actividad investigadora mostraron una visión aparentemente idealizada (AU)

Biomedical research is a necessary subject and enjoys social prestige. Aims: To ascertain the views and expectations of health care professionals on research, analysing the influence of their academic training and professional level. Design and methods: An anonymous questionnaire was distributed to physicians and qualified nurses working in a, tertiary hospital, seven primary care centres and two nursing homes (health care centres for the elderly).Results: Cronbach's coefficient alfa=0.817. Response rate: 64% (432 out of 682 questionnaires distributed). Women: 71%. Mean age: 37 years. Mean years involved in health care: 14 years. 79% of people considered research as a part of their job, although in practice only 43% were doing it. Overall participation in activities was: Conferences (71%), education (42%), publications (34%) and ongoing projects (17%). Physicians dedicated more off duty time (37%) to research than qualified nurses (CI95%: 28 to 46%). The majority of physicians having their doctoral thesis would like to carry out research activities, and 84% did so in their free time and 74% had active research projects in progress. They identified physician workload as the main factor that impedes performing research. Proposals to increase research activities were focused on improving resources. Conclusions: The majority of health care professionals expressed a great motivation. The perception of research varies depending upon professional qualification. Physicians having their doctoral thesis were more involved and had a different perception of research, being more critical about available resources. Overall research perception was more positive among those with less academic training, as well as among those centres with less research activities (AU)

[Health care professional view on biomedical research]. / Perspectiva de los profesionales sobre la investigación biomédica.

UNLABELLED: Biomedical research is a necessary subject and enjoys social prestige. AIMS: To ascertain the views and expectations of health care professionals on research, analysing the influence of their academic training and professional level. DESIGN AND METHODS: An anonymous questionnaire was distributed to physicians and qualified nurses working in a, tertiary hospital, seven primary care centres and two nursing homes (health care centres for the elderly). RESULTS: Cronbach's coefficient alpha=0.817. Response rate: 64% (432 out of 682 questionnaires distributed). Women: 71%. Mean age: 37 years. Mean years involved in health care: 14 years. 79% of people considered research as a part of their job, although in practice only 43% were doing it. Overall participation in activities was: Conferences (71%), education (42%), publications (34%) and ongoing projects (17%). Physicians dedicated more off duty time (37%) to research than qualified nurses (CI95%: 28 to 46%). The majority of physicians having their doctoral thesis would like to carry out research activities, and 84% did so in their free time and 74% had active research projects in progress. They identified physician workload as the main factor that impedes performing research. Proposals to increase research activities were focused on improving resources. CONCLUSIONS: The majority of health care professionals expressed a great motivation. The perception of research varies depending upon professional qualification. Physicians having their doctoral thesis were more involved and had a different perception of research, being more critical about available resources. Overall research perception was more positive among those with less academic training, as well as among those centres with less research activities.

[Risk factors for osteoporosis in osteoporotic women followed in Primary Care and in Hospitals. OPINHO-PC study]. / Factores de riesgo de la osteoporosis en mujeres atendidas en Atención Primaria y en consultas hospitalarias. Estudio OPINHO-PC.

INTRODUCTION: Osteoporosis (OP) is a disease with high prevalence and high economic and social cost. This study has aimed to describe risk factors (RF) among women with osteoporosis (OP) treated in primary care (PC) and hospitals (HO). MATERIAL AND METHODS: Cross-sectional, epidemiological and multicenter study, including 194 PC and 186 HO women with OP. RESULTS: Patients in both groups had equivalent age (age+/-SD 67.6+/-9.8 PC and 67.6+/-10 years HO), and OP severity (-3.0+/-0.8 PC vs -3.1+/-0.8 HO). Some specific risk factors for falls such as prolonged use of benzodiazepines and heart rate higher than 80 pulses per minute were more frequent in the hospital setting (24.2% PC vs 15.6% HO, p=0.0354) and (12.9% PC vs 3.2% HO, p=0.0006), respectively. In contrast, intrinsically bone-related RFs for osteoporotic fracture were generally more prevalent in HO: surgical menopause (20.7% vs. 12.8%, p=0.047), previous vertebral fractures (20.6% PC vs 34.9% HO, p=0.0018), and prolonged use of steroids (7.7% PC vs 15.6% HO, p=0.0167). Sedentary lifestyle and tobacco consumption (cigarettes/day), however, were more prevalent in PC than in HO (48.5% PC vs 31.7% HO, p=0.0009 and 16.9+/-4.6 PC vs 11.4+/-9.7 HO, p=0.0344, respectively). CONCLUSIONS: Risk factors associated with the risk of falling (not bone-related factors) are more prevalent in OP patients, whilst factors associated with bone quality and density (bone-related factors) are more prevalent in HO patients.

Receptor Wnt: fisiología, fisiopatología y potenciales nuevas dianas terapéuticas / Wnt receptor: physiology and potential new therapeutic targets

La vía de señalización Wnt (canónica) constituye un mecanismo esencial en la regulación del remodelado óseo, implica el correcto funcionamiento de diversos factores conectados entre sí, y es capaz de ejercer un control global sobre el osteoblasto, favoreciendo su proliferación, diferenciación o apoptosis. Uno de los componentes imprescindibles de dicha vía es el complejo co-receptor formado por una proteína relacionada con el receptor de LDL (LRP5/6) y un receptor frizzled (Fz); el funcionamiento adecuado de este complejo conlleva la activación de mecanismos de transcripción genética en el núcleo, mediados por beta-catenina, que regulará la expresión de genes relacionados con la diferenciación o función del osteoblasto. La identificación de mutaciones en el gen del complejo co-receptor Fz-LRP5/6 ha derivado en un mayor entendimiento de enfermedades heredadas que cursan con masa ósea elevada o disminuida. Asimismo, el hallazgo de elementos antagonistas de la vía Wnt, como esclerostina o Dickkopf, está permitiendo descubrir nuevas dianas terapéuticas que ejerzan un efecto anabólico en el tejido óseo, al mismo tiempo que no alteren su función biomecánica fisiológica(AU)

The canonical Wnt/beta-catenin pathway constitutes an essential mechanism in the regulation of bone mass. It implies the correct functioning of different interconnected factors and can exercise a global control on the osteoblast, favoring its proliferation, differentiation or apoptosis. One of its most important components is a co-receptor complex formed by the Frizzled (Fz). The adequate function of this complex leads to the activation of the genetic transcription mechanisms in the nucleus mediated by beta-catenin. This will regulate gene expression related with the differentiation or function of the osteoblast. Identification of mutations in the co-receptor Fz receptor-LRP5/6 complex results in greater understanding of hereditary diseases that occur with elevated or decreased bone mass. Further, the finding of antagonist elements of the Wnt pathway, such as sclerostin or Dickkopf proteins is making it possible to discover new therapeutic targets that exercise an anabolic effect in the bone tissue but does not alter its physiological biomechanics(AU)

Effect of alendronate in elderly patients after low trauma hip fracture repair.

SUMMARY: One year of once weekly alendronate, when given shortly after the surgical repair of a hip fracture, produces reductions in bone markers and increases proximal femoral bone density. The therapy was well tolerated. INTRODUCTION: Hip fracture is the most devastating type of osteoporotic fracture and increases notably the risk of subsequent fractures. The aim of this paper was to evaluate the effects of 1 year therapy with a weekly dose of alendronate in the bone mineral density and bone markers in elderly patients after low trauma hip fracture repair. METHODS: Two hundred thirty-nine patients (81 +/- 7 years; 79.8% women) were randomized to be treated either with calcium (500 mg/daily) and vitamin D(3) (400 IU/daily; Ca-Vit D group) or with alendronate (ALN, 70 mg/week) plus calcium and vitamin D(3) (500 mg/daily and 400 IU/daily, respectively; ALN + Ca-Vit D group). RESULTS: One hundred forty-seven (61.5%) patients completed the trial. Alendronate increased proximal femoral bone mineral density (BMD) in the intention-to-treat analysis (mean difference (95% confidence interval); total hip 2.57% (0.67; 4.47); trochanteric 2.96% (0.71; 5.20), intertrochanteric 2.32% (0.36; 4.29)), but the differences were not significant in the BMD of the femoral neck (0.47%; (-2.03; 2.96) and the lumbar spine (0.69%; (-0.86; 2.23)). Bone turnover markers decreased during alendronate treatment. CONCLUSION: The present study demonstrates for the first time the anti-resorptive efficacy of alendronate given immediately after surgical repair in an elderly population with recent hip fracture. This effect should positively affect the rate of subsequent fractures.

Postmenopausal Canarian women receiving oral glucocorticoids have an increased prevalence of vertebral fractures and low values of bone mineral density measured by quantitative computer tomography and dual X-ray absorptiometry, without significant changes in parathyroid hormone.

BACKGROUND: Daily doses higher than 7.5 mg/daily of prednisone or equivalents confer a great risk of vertebral and hip fractures with a clear dose dependence of fracture risk. Information regarding the utility in assessing trabecular bone mineral density by quantitative computer tomography (QCT) in these patients, either in the Canaries or in Spain, is lacking. Moreover, in this setting, the importance of secondary hyperparathyroidism is still controversial. DESIGN, PATIENTS AND METHODS: Cross-sectional observational study performed on 1177 consecutive Canary postmenopausal women who attended our Bone Metabolic Unit. The Patient Group was composed of 88 postmenopausal women who were taking oral corticosteroids in dose higher than 7.5 mg/day of prednisone or equivalent for more than 6 months (OG group). The Control Group included 838 postmenopausal women who did not take steroids. A complete validated questionnaire for osteoporosis risk assessment and a complete physical examination were performed. A lateral X-ray of the spine was performed on every woman. Bone mineral density (BMD) was measured at the lumbar spine (LS) by dual X-ray Absorptiometry (DXA) and QCT and at the femoral neck by DXA. Fasting serum and 24 hour urine was collected and biochemical markers of bone remodelling were studied. RESULTS: Both groups were comparable in general characteristics and calcium intake. The OG group showed lower values of BMD estimated both by DXA and QCT (p<0.05). LS BMD was closely correlated by using both methods (r=0.636, p<0.001). The OG group showed lower values of osteocalcin (p=0.023) and TRAP (p=0.026) without significant differences in PTH. Patients in OG group had a higher prevalence of vertebral fractures than controls (13.3% vs 8.6%; crude values: p=0.049, OR: 1.63 (0.99-2.67); age adjusted: p=0.003, OR 2.29 (1.33-9.93)). CONCLUSIONS: In postmenopausal Canarian women, chronic glucocorticoid therapy is associated with low bone mineral density, measured either by DXA or QCT, with evidence of low turnover and high prevalence of fractures without significant changes in PTH. DXA and QCT provide similar information in the assessment of this high risk population.

Vitamina D y función muscular / Vitamin D and muscular function

El sistema hormonal de la vitamina D presenta múltiples e importantes relaciones con la función muscular, además de sus conocidos efectos sobre el metabolismo mineral. Tomados en conjunto estos datos resaltan la importancia del sistema hormonal de la vitamina D en la génesis de la fractura osteoporótica y en su reparación

The hormonal system of the vitamin D shows numerous and important relationships with the muscular function in addition to its known effects over the mineral metabolism. All these dates reflect the importance of the hormonal system of vitamin D in the generation of the osteoporotical fracture and in its reparation

Inhaled steroids do not decrease bone mineral density but increase risk of fractures: data from the GIUMO Study Group.

Although the negative effect of systemic steroids on bone is well documented, there is not clear evidence about possible adverse effects of inhaled steroids on bone metabolism and fractures. A cross-sectional study was performed on 105 women suffering from bronchial asthma treated with inhaled steroids and 133 controls. Bone mineral density (BMD) was measured by quantitative ultrasonography (QUS) at the calcaneus and by dual X-ray absorptiometry (DXA), at both the lumbar spine and proximal femur. Patients suffering from bronchial asthma showed no statistically significant changes in BMD as measured by DXA or QUS, compared with controls. A higher prevalence of fractures was found in the group of women with bronchial asthma, with an age-adjusted odds ratio of 2.79 (95% CI: 1.19-6.54). Inhaled steroids do not appear to decrease BMD, but are associated with an increased risk of fracture in women.

Autotratamiento de la insuficiencia suprarenal de origen hipofisario / Autotreatment of adrenal deficiency of pituitary source

No disponible

[Development of a questionnaire for the assessment and quantification of overweight and obesity related lifestyles]. / Desarrollo de un cuestionario para la valoración y cuantificación de los hábitos de vida relacionados con el sobrepeso y la obesidad.

INTRODUCTION: Lifestyle intervention is mandatory for obesity treatment. The aim of this study is to design a questionnaire to describe and quantify those behaviours more closely related to obesity in the Spanish obese population. METHODS AND PROCEDURES: An expert panel designed a preliminary 57 Liker-type item questionnaire, which was self-administered to 335 overweight patients (110 male, 225 female; age, 42 +/- 14 years; BMI, 32.6 +/- 3.7 kg/m2). After a subjacent dimensionality searching and item reducing first phase, a shrunk questionnaire of 24 items was then self-administered to 156 overweight patients (52 male, 104 female; age 42 +/- 12 years; BMI, 33.1 +/- 3.5 kg/m2); 56 of those patients were re-administered the questionnaire in order to provide test-retest information. RESULTS: Final questionnaire includes 22 items clustered in five dimensions: diet caloric intake, searching for psychological well-being eating, physical activity, healthy eating and alcohol intake. Proposed factorial structure is mostly reproduced in different samples and using different extraction methods: all dimensions but alcohol intake score alpha values > 0.75 for liability; test-retest stability is greater than 0.90 in all dimensions but alcohol intake; results for all validity tests performed (of construct, of content and discriminative) are highly satisfactory. CONCLUSION: Metrics study results (liability and validity) demonstrate that the proposed questionnaire provides an excellent tool to assess those lifestyles related to obesity control.

Desarrollo de un cuestionario para la valoración y cuantificación de los hábitos de vida relacionados con el sobrepeso y la obesidad / Development of a questionnaire for the assessment and quantification of overweight and obesity related lifestyles

Introducción: La modificación de la conducta es imprescindible en el tratamiento de la obesidad. El objetivo de este estudio es diseñar un cuestionario que permita describir y cuantificar las conductas relacionadas con la obesidad en la población obesa española. Material y métodos: Un grupo de expertos diseñó un cuestionario inicial de 57 preguntas tipo Likert que se administró a 335 pacientes con sobrepeso (110 hombres y 225 mujeres; edad, 42 ñ 14 años; IMC, 32,6 ñ 3,7 kg/m2). Tras una primera fase de búsqueda de la dimensionalidad subyacente y de reducción de preguntas, se administró un cuestionario depurado de 24 preguntas a una muestra de 156 pacientes con sobrepeso (52 hombres y 104 mujeres; edad 42 ñ 12 años; IMC, 33,1 ñ 3,5 kg/m2), repitiéndose en 56 de ellos para obtener información test-retest. Resultados: El cuestionario final incluye 22 preguntas agrupadas en cinco dimensiones: contenido calórico de la dieta, comer por bienestar psicológico, ejercicio físico, alimentación saludable y consumo de alcohol. La estructura factorial encontrada se reproduce en lo esencial utilizando muestras distintas y diferentes métodos de extracción: en todas las dimensiones se obtienen índices de fiabilidad alfa por encima de 0,75, excepto en consumo de alcohol; la estabilidad test-retest es superior a 0,90 en todas las dimensiones excepto en consumo de alcohol; en los análisis de validez efectuados (de constructo, de contenido y discriminativa) los resultados son muy satisfactorios. Conclusiones: Los resultados del estudio métrico (fiabilidad y validez) ponen de manifiesto que el cuestionario propuesto es una excelente herramienta para valorar los hábitos de vida relacionados con el control de la obesidad (AU)

Introduction: Lifestyle intervention is mandatory for obesity treatment. The aim of this study is to design a questionnaire to describe and quantify those behaviours more closely related to obesity in the Spanish obese population. Methods and procedures: An expert panel designed a preliminary 57 Liker-type item questionnaire, which was self-administered to 335 overweight patients (110 male, 225 female; age, 42 ± 14 years; BMI, 32,6 ± 3,7 kg/m2). After a subjacent dimensionality searching and item reducing first phase, a shrunk questionnaire of 24 items was then self-administered to 156 overweight patients (52 male, 104 female; age 42 ± 12 years; BMI, 33,1 ± 3,5 kg/m2); 56 of those patients were re-administered the questionnaire in order to provide test-retest information. Results: Final questionnaire includes 22 items clustered in five dimensions: diet caloric intake, searching for psychological well-being eating, physical activity, healthy eating and alcohol intake. Proposed factorial structure is mostly reproduced in different samples and using different extraction methods: all dimensions but alcohol intake score alpha values > 0,75 for liability; test-retest stability is greater than 0,90 in all dimensions but alcohol intake; results for all validity tests performed (of construct, of content and discriminative) are highly satisfactory. Conclusion: Metrics study results (liability and validity) demonstrate that the proposed questionnaire provides an excellent tool to assess those lifestyles related to obesity control (AU)

Bone mineral density in hypoparathyroid women on LT4 suppressive therapy. Effect of calcium and 1,25(OH)2 vitamin D3 treatment.

Our aim was to study the bone mineral density (BMD) of patients with chronic hypoparathyroidism (hypoPTH) after longterm calcium and vitamin D treatment. Twenty hypoPTH women (mean-/+SD, aged 50-/+15 years, IPTH 4-/+6 pg/ml) and 20 matched euparathyroid women (euPTH) after near total thyroidectomy for thyroid cancer, completed with I-131 ablation and on suppressive therapy with L-Thyroxine (LT(4)), were studied. In addition eight hypoPTH patients who were receiving LT(4) replacement therapy after surgery for compressive goiter were simultaneously studied. The hypoPTH patients were on calcium and 1,25(OH)(2) vitamin D(3) therapy to normalize serum calcium. Bone mineral density (BMD) (DXA, at the lumbar spine [L(2)- L(4), LS], femoral neck [FN] and Ward triangle [WT]), serum and urine calcium, serum phosphorus, TOTALALP and osteocalcin were measured. Patients with hypoPTH showed greater lumbar BMD than euPTH patients on suppressive therapy (Z-score; 1.01-/+1.34 vs. -0.52-/+0.70, p<0.05). Serum osteocalcin levels were higher in hypoPTH patients on suppressive therapy compared to hypoPTH patients on replacement therapy. The LS BMD from hypoPTH patients correlated with calcium supplements (r=0.439; p=0.02), 1,25(OH)(2)D(3) dose (r=0.382; p=0.04) and LT(4) dose (r=0.374; p=0.05). Our data suggest that long-term treatment with calcium and 1,25(OH)(2) vitamin D3 supplements in hypoPTH patients on suppressive LT4 therapy results in increased BMD when compared with patients with normal PTH levels.

Long-term follow-up of bone mass after orthotopic liver transplantation: effect of steroid withdrawal from the immunosuppressive regimen.

Glucocorticoids have been suggested to play a major role in transplantation-related osteopenia. In this study we assess the long-term changes and the effect of steroid withdrawal from the standard immunosuppressive regimen on bone mineral density (BMD) after orthotopic liver transplantation (OLT). Sixty-nine non-osteoporotic patients (20 women, 49 men), aged 48 +/- 9.5 years (mean +/- SD), and with a follow-up of 58.3 +/- 23.2 months (range 24-121 months) were studied. Immunosuppressive treatment consisted of prednisone, cyclosporin A and azathioprine. In 41 patients (group A), prednisone was tapered and withdrawn after 36.2 +/- 19.3 months (range 13-79 months), whereas in 28 patients (group B) prednisone was maintained. BMD in the spine (L1-L4) was serially measured by dual-energy X-ray absorptiometry (Hologic QDR 1,000w) at baseline, before steroid withdrawal and at the end of study. Age- and sex-matched Z-scores of BMD were calculated. No differences were found in age, body mass index, time since OLT, or baseline BMD between the two groups. BMD had significantly increased in both groups at the end of follow-up period (group A, +8.1 +/- 8.7%; group B, +3.2 +/- 8.0%, p < 0.05). However, the Z-score was significantly higher in group A than in group B at the end of study (-0.44 +/- 1.05 vs -0.99 +/- 0.77; p<0.05). BMD recovery was lower in pre-OLT biliary cirrhosis patients. Bone mass improvement was independent of the time since OLT in both groups, and of the time of steroid withdrawal in group A. Our data confirm that steroid withdrawal accelerates the recovery of bone mass in patients who have undergone a successful liver transplantation.