Sex and age differences in the association of fatty liver index-defined non-alcoholic fatty liver disease with cardiometabolic risk factors: a cross-sectional study.

BACKGROUND: Despite the extensive scientific evidence accumulating on the epidemiological risk factors for non-alcoholic fatty liver disease (NAFLD), evidence exploring sex- and age-related differences remains insufficient. The present cross-sectional study aims to investigate possible sex differences in the prevalence of FLI-defined NAFLD as well as in its association with common risk factors across different age groups, in a large sample of Spanish working adults. METHODS: This cross-sectional study included data from 33,216 Spanish adult workers (18-65 years) randomly selected during voluntary routine occupational medical examinations. Sociodemographic characteristics (age and social class), anthropometric (height, weight, and waist circumference) and clinical parameters (blood pressure and serum parameters) were collected. NAFLD was determined by the validated fatty liver index (FLI) with a cut-off value of ≥ 60. The presence of metabolic syndrome (MetS) was assessed according to the diagnostic criteria of the International Diabetes Federation. Cardiovascular risk was determined using the REGICOR-Framingham equation. The association between FLI-defined NAFLD and risk factors by sex and age was evaluated by multivariate logistic regression. RESULTS: The prevalence of FLI-defined NAFLD (FLI ≥ 60) was 19.1% overall, 27.9% (95% CI 23.3-28.5%) for men and 6.8% (95% CI 6.4-7.3%) for women and increasing across age intervals. As compared to women, men presented worse cardiometabolic and anthropometric profiles. The multivariate analysis model showed that hepatic steatosis assessed by FLI was strongly associated with age, HDL-cholesterol, social class, prediabetes, diabetes, prehypertension, hypertension, and smoking status for both men and women. The association between diabetes and hypertension with FLI-defined NAFLD was stronger in women than in men at both univariate and multivariate analyses. CONCLUSIONS: Men presented a higher prevalence of NAFLD than women across all age intervals, as well as a worse cardiometabolic profile and a higher cardiovascular risk. Nevertheless, the association between FLI-defined NAFLD and diabetes or hypertension was significantly stronger in women than in men, possibly indicating that the presence of a dysmetabolic state might affect women more than men with regard to liver outcomes.

Identifying risk factors of developing type 2 diabetes from an adult population with initial prediabetes using a Bayesian network.

Background: It is known that people with prediabetes increase their risk of developing type 2 diabetes (T2D), which constitutes a global public health concern, and it is associated with other diseases such as cardiovascular disease. Methods: This study aimed to determine those factors with high influence in the development of T2D once prediabetes has been diagnosed, through a Bayesian network (BN), which can help to prevent T2D. Furthermore, the set of features with the strongest influences on T2D can be determined through the Markov blanket. A BN model for T2D was built from a dataset composed of 12 relevant features of the T2D domain, determining the dependencies and conditional independencies from empirical data in a multivariate context. The structure and parameters were learned with the bnlearn package in R language introducing prior knowledge. The Markov blanket was considered to find those features (variables) which increase the risk of T2D. Results: The BN model established the different relationships among features (variables). Through inference, a high estimated probability value of T2D was obtained when the body mass index (BMI) was instantiated to obesity value, the glycosylated hemoglobin (HbA1c) to more than 6 value, the fatty liver index (FLI) to more than 60 value, physical activity (PA) to no state, and age to 48-62 state. The features increasing T2D in specific states (warning factors) were ranked. Conclusion: The feasibility of BNs in epidemiological studies is shown, in particular, when data from T2D risk factors are considered. BNs allow us to order the features which influence the most the development of T2D. The proposed BN model might be used as a general tool for prevention, that is, to improve the prognosis.

Lifestyle and Progression to Type 2 Diabetes in a Cohort of Workers with Prediabetes.

BACKGROUND: People with prediabetes have an increased risk of developing type 2 diabetes (T2D). Few studies have evaluated the influence of lifestyle factors on the risk of progression to diabetes and reversion to normoglycemia. The aim of this study was to determine the incidence of T2D in a large cohort of workers with prediabetes, and to evaluate the influence of sociodemographic, clinical, metabolic, and lifestyle factors that affect the persistence of prediabetes and the progression to T2D. METHODS: A cohort study of 27,844 adult workers (aged 20 to 65 years) from Spain who had prediabetes based on an occupational medical examination from 2012 to 2013. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL. At the baseline evaluation, sociodemographic, anthropometric, metabolic, and lifestyle data were collected. At the 5-year follow-up, incident T2D was defined as an FPG of at least 126 mg/dL or initiation of an antidiabetic medication. RESULTS: Among 235,995 initially screened workers, the prevalence of T2D was 14.19% (95% confidence interval (CI) 14.05 to 14.33) and the prevalence of prediabetes was 11.85% (95% CI 11.71 to 11.99). Follow-up data were available for 23,293 individuals with prediabetes. Among them, 36.08% (95% CI 35.46 to 36.70) returned to normoglycemia, 40.92% (95% CI 40.29 to 41.55) had persistent prediabetes, and 23.00% (95% CI 22.46 to 23.54) progressed to T2D. The risk for persistence of prediabetes and for progression to T2D increased with age, body mass index (BMI), triglyceride level, and less than 150 min/week of physical activity. An HbA1c level of 6% or greater was the strongest individual predictor of progression to T2D. CONCLUSIONS: Physical activity, diet, smoking, and BMI are modifiable factors that are associated with the persistence of prediabetes and the progression to T2D. The workplace is a feasible setting for the early detection of prediabetes and the promotion of lifestyles that can prevent progression to T2D.

Trastorno de estrés postraumático y trabajo. Criterios de valoración en incapacidad y discapacidad / Posttraumatic stress disorder and work. Incapacity and disability criteria

El trastorno por estrés postraumático se clasifica dentro de los trastornos de ansiedad, definido por síntomas específicos tras la exposición a un acontecimiento estresante, extremadamente traumático, que involucra un daño para el afectado. Sus criterios diagnósticos vienen clasificados por la CIE 10 y por el DSM-IV, siendo criterios de consenso. La principal dificultad para su valoración radica en la condición de determinación objetiva del trastorno. Para su valoración se utilizarán criterios generales de trastornos mentales basados en: entrevista psiquiátrica con apoyo de pruebas complementarias y uso de escalas, las terapias utilizadas y respuesta a las mismas, así como sus posibles efectos -positivos o adversos- sobre la actividad laboral. Aspecto a destacar es el despistaje de potenciales simuladores, sobresimuladores o con imputaciones falsas por su trascendencia médico-legal. En la valoración de discapacidad se seguirán las pautas marcadas para enfermedad mental, asignando el grado con aplicación de criterios generales y específicos (AU)

Posttraumatic stress disorder is classified as an anxiety disorder in the ICD-10 and DSM-IV by consensus diagnostic criteria; its characteristic symptoms follow exposure to an extremely violent traumatic event and can cause clinical impairment in significant areas of functioning. The main difficulty for its evaluation lies in the requirement of objective determination of the disorder. General criteria for mental disorders based on the psychiatric interview with support of complementary tests and use of scales, on used and in response to these therapies, as well as their potential effects -positive or adverse- at work will be used for the assessment of labour disability. Highlight is the importance of the screening of potential malingering, such as simulators, excessive simulators or false accusations by its medicolegal significance. In the assessment of disability will be followed the guidelines set for mental illness, by assigning a degree through the application of General and Specific criteria (AU)