Sex and age differences in the achievement of control targets in patients with type 2 diabetes: results from a population-based study in a South European region.

BACKGROUND: We aimed to determine the degree to which control targets of glycaemia and cardiovascular risk factors were achieved among patients with type 2 diabetes and to investigate sex- and age-related differences in this population. METHODS: This cross-sectional, population-based study was conducted in Spain. Glycated hemoglobin (HbA1c), blood pressure, LDL-c, HDL-c, triglycerides, BMI, and smoking history were obtained from electronic clinical primary care records (n = 32,638 cases). The proportions of patients who met control targets were determined according to sex and age groups. Comparisons between groups were conducted with t-tests for continuous variables, tests for trends in proportions for categorical and ordinal variables, and Pearson's chi-square tests and binary logistic regression models for categorical variables. RESULTS: The overall proportions of patients with type 2 diabetes who met the target objectives for HbA1c (<7 %, 53 mmol/mol), blood pressure (130/80 mmHg), and LDL-cholesterol (100 mg/dl) were 60, 40 and 41 %, respectively. Women were less likely than men to meet the control targets of HbA1c (59 vs 61 %), LDL (35 vs 45 %), and HDL (58 vs 78 %). Patients under 65 years of age presented poorer control than older age groups. Only a minority of patients with type 2 diabetes met the composite target objectives for glycemic control, blood pressure, and LDL. CONCLUSIONS: There are differential gaps in the control results of female patients and younger patients, which should prompt improvements in case management and care. There is room for further improvement in the cardiometabolic control of patients with type 2 diabetes.

Longitudinal changes in Mediterranean diet and transition between different obesity phenotypes.

BACKGROUND & AIMS: Little is known about the impact of specific dietary patterns on the development of obesity phenotypes. We aimed to determine the association of longitudinal changes in adherence to the traditional Mediterranean diet (MedDiet) with the transition between different obesity phenotypes. METHODS: Data of 5801 older men and women at high cardiovascular risk from PREDIMED trial were used. Adherence to MedDiet was measured with the validated 14p-Mediterranean Diet Adherence Screener (MEDAS). Using the simultaneous combination of metabolic health- and body size-related parameters participants were categorized into one of four phenotypes: metabolically healthy and abnormal obese (MHO and MAO), metabolically healthy and abnormal non-obese (MHNO and MANO). Cox regression models with yearly repeated measures during 5-year of follow-up were built with use of Markov chain assumption. RESULTS: Each 2-point increase in MEDAS was associated with the following transitions: in MAO participants, with a 16% (95% CI 3-31%) greater likelihood of becoming MHO; in MHO participants with a 14% (3-23%) lower risk of becoming MAO; in MHNO participants with a 18% (5-30%) lower risk of becoming MHO. In MANO women, but not in men, MEDAS was associated with 20% (5-38%) greater likely of becoming MHNO (p for interaction by gender 0.014). No other significant associations were observed. CONCLUSIONS: Better adherence to the traditional MedDiet is associated with transitions to healthier phenotypes, promoting metabolic health improvement in MAO, MANO (only in women), and MHO, as well as protecting against obesity incidence in MHNO subjects.

[Incidence of type 1 diabetes in Navarre (2009-2016): higher in the southern regions of the autonomous community]. / Incidencia de diabetes tipo 1 en Navarra (2009-2016): mayor en la zona sur de la comunidad.

BACKGROUND: Geographical and seasonal variations of type 1 diabetes (T1D) are useful for establishing the key ethio-pathogenic factors of the disease. The present work seeks to analyze the incidence rates of T1D in Navarre for the 2009-2016 period, its geographical distribution and seasonal variations in birth and diagnosis in affected persons. METHODS: Prospective study with one primary and three secondary sources. The completeness of the registry, determined using the capture-recapture method, was 96.08%. The confidence intervals of zone and onset season incidence rates were determined assuming an underlying Poisson distribution. Adjusted effect of onset age, sex, onset season and geographical area over changes in incidence rates were analyzed using a Poisson regression model. Comparison among areas was carried out after the corresponding adjustments of incidence by the indirect standardization method. RESULTS: Four hundred and twenty-eight new cases were detected (incidence= 8.36/100,000 inhabitants per year, CI95%: 7.58-9.19). The disease is predominant in males (63% of patients). The incidence in children under 15 years was higher than in adults (21.54, CI95%: 18.43-25.02 vs. 5.94, CI95%: 5.23-6.71; p<0.001). Incidence was highest in the four southern regions of Navarre, most of the cases being in winter and spring. No differences were found regarding birth season over incidence. CONCLUSION: Navarre maintains a high T1D incidence in childhood that decreases progressively with age. Sex, age group, geographical zone and onset season are independently associated with the incidence rates observed in the study.

[Glucocorticoid hypofunction in myotonic dystrophy]. / Hipofunción glucocorticoide en la distrofia miotónica.

INTRODUCTION: Myotonic dystrophy (DM1) is an autosomal dominant disorder whose genetic defect consists of the amplification of an unstable CTG trinucleotide repeat in the 3' untranslated region of the dystrophia myotonica protein kinase gene (DMPK). This is a multi-systemic disease with a well-known endocrinological repercussion. With respect to the adrenal function variable results have been described, although lately they are interpreted as indicators of a hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis. MATERIAL AND METHODS: Twenty-five patients (13 men and 12 women) with DM1 were recruited. They were analysed for: basal cortisol and ACTH, stimulus test with 0.25 mg of ACTH for cortisol and CRH test for cortisol and ACTH. Similarly, the degree of expansion of CTG was evaluated by Southern blot and PCR. Twenty-five healthy individuals, comparable by age and sex, were studied as a control group; the CRH test was carried out on 11 of them. RESULT: One patient was diagnosed with primary non-autoimmune adrenal failure. In the rest of the cases there were no differences between the basal ACTH of patients and controls, and the cortisol response to ACTH was normal. The patients showed a lower level of basal cortisol (p<0.01) and also showed, following stimulation with CRH, a lower cortisol response (p<0.05) with higher average values of ACTH. CONCLUSIONS: Our data differs from the latest publications and point to an adrenal hypofunction due to lack of efficacy of the ACTH on its receptor or at the post-receptor level. We suggest that the etiology might be related to the underlying defect in the gene that codifies DMPK.

[Paraneoplastic hormonal syndromes]. / Síndromes hormonales paraneoplásicos.

We can define paraneoplastic syndromes as a combination of effects occurring far from the original location of the tumour and independently from the local repercussion of its metastases. Paraneoplastic hormonal syndromes depend on the secretion of hormonal peptides or their precursors, cytokines and, more rarely, thyroidal hormones and Vitamin D, which act in an endocrine, paracrine or autocrine way. Sometimes, paraneoplastic syndromes can be more serious than the consequences of the primary tumour itself and can precede, develop in parallel, or follow the manifestations of this tumour. It is important to recognise a paraneoplastic hormonal syndrome for several reasons, amongst which we would draw attention to three: 1) It can lead to the diagnosis of a previously undetected, underlying malign or benign neoplasia; 2) It can dominate the clinical picture and thus lead to errors with respect to the origin and type of primary tumour; and 3) It can follow the clinical course of the underlying tumour and thus be useful for monitoring its evolution. The molecular mechanisms responsible for the development of these syndromes are not well-known, but it is believed that they might be inherent to the mutations responsible for the primary tumour or depend on epigenetic factors such as methylation. In this review, we consider the following paraneoplastic hormonal syndromes: malign hypercalcaemia, hyponatraemia (inappropiate secretion of the antidiuretic hormone), ectopic Cushing's syndrome, ectopic acromegaly, hypoglycaemia due to tumours different from those of the islet cells and paraneoplastic gynaecomastia; we make a brief final reference to other hormones (calcitonin, somatostatin, and VIP).

Postprandial de novo lipogenesis and metabolic changes induced by a high-carbohydrate, low-fat meal in lean and overweight men.

BACKGROUND: Adjustments of carbohydrate intake and oxidation occur in both normal-weight and overweight individuals. Nevertheless, the contribution of carbohydrates to the accumulation of fat through either reduction of fat oxidation or stimulation of fat synthesis in obesity remains poorly investigated. OBJECTIVE: The objective of this study was to assess the postprandial metabolic changes and the fractional hepatic de novo lipogenesis (DNL) induced by a high-carbohydrate, low-fat meal in lean and overweight young men. DESIGN: A high-carbohydrate, low-fat meal was administered to 6 lean and 7 overweight men after a 17.5-h fast. During the fasting and postprandial periods, energy expenditure (EE), macronutrient oxidation, diet-induced thermogenesis, and serum insulin, glucose, triacylglycerol, and fatty acids were measured. To determine DNL, [1-13C]sodium acetate was infused and the mass isotopomer distribution analysis method was applied. RESULTS: After intake of the high-carbohydrate meal, the overweight men had hyperinsulinemia and higher fatty acid and triacylglycerol concentrations than did the lean men. The overweight group showed a greater EE, whereas there was no significant difference in carbohydrate oxidation between the groups. Nevertheless, the overweight men had a marginally higher protein oxidation and a lower lipid oxidation than did the lean men. DNL was significantly higher before and after meal intake in the overweight men and was positively associated with fasting serum glucose and insulin concentrations. Furthermore, postprandial DNL was positively correlated with body fat mass, EE, and triacylglycerol. CONCLUSION: After a high-carbohydrate, low-fat meal, overweight men had a lower fat oxidation and a higher fractional hepatic fat synthesis than did lean men.

Relationship between lactose digestion, gastrointestinal transit time and symptoms in lactose malabsorbers after dairy consumption.

BACKGROUND: The relationship of symptoms with objective measurements, as well as some of the mechanisms involved in lactose tolerance after yoghurt consumption, remain unclear. METHODS: The trial had a double-blind design in which 22 lactose malabsorbers received 25 g daily lactose in fresh (living bacteria > 108 cfu/g) yoghurt or heated (< 102 cfu/g) yoghurt for 15 days, followed by a cross-over (15 days) after a wash-out period (14 days). The lactose digestion was determined by the breath H2 test, the gastric emptying (GE) with a 13C-acetate breath test and the revealed transit time (OCTT) by 15N-lactose-ureide test. Subjects reported their gastrointestinal symptoms (GIS) in a validated questionnaire. RESULTS: Breath H2 test indicated more effective lactose digestion after fresh yoghurt intake. The OCTT was shorter after heated yoghurt ingestion as compared with the fresh. There was lower severity of GIS (P < 0.05) after fresh yoghurt intake, and this showed an inverse correlation with OCTT (P < 0.05). CONCLUSIONS: Delayed orocoecal transit time was associated with fewer gastrointestinal symptoms. The improved lactose digestion and tolerance of fresh yoghurt should be mainly attributed to the presence of living bacteria.

[Primary suprarenal insufficiency and multiglandular atrophy in a patient affected by myotonic dystrophy]. / Insuficiencia suprarrenal primaria y atrofia pluriglandular en un paciente afecto de distrofia miotónica.

We present the case of a 27 year old man diagnosed as having myotonic dystrophy (MD) who showed two novelties with respect to those endocrinopathies hitherto described as being associated with MD: primary suprarenal failure and pluriglandular atrophy (thyroid and suprarenal, in addition to the already known testicular type). We describe here the results of a clonic, hormonal and genetic study of the proband and his family (a carrier father and an affected brother). We discuss the possible etiopathogenesis of the picture which, in our opinion, could consist of an abnormality of the AMPc dependent protein-kinase, related to the MD gene (PKMD). Consequently intracellular signaling was altered after the union of peptide hormones (in our case ACTH, LH and TSH) to their receptor leading, through the lack of trophic stimulus, to glandular atrophy. We conclude that before diagnosing MD, it is convenient to add suprarenal study to the traditional evaluations of possible associated endocrinopathies.

[Complications of obesity]. / Complicaciones de la obesidad.

Obesity, which was evaluated positively in our culture in past periods and which was even considered by some to be merely an aesthetic question, is a disease with serious consequences for the health of the person suffering from it, and for the economy of those who have to meet its costs. Its present prevalence in Spain is situated around 13% and, if we can trust the forecasts established for other western countries such as the USA, it will increase to become the epidemic of the present century. The consequences of excess weight on the cardiovascular, respiratory, digestive, osteoarticular, reproductive and endocrine-metabolic systems are well known, as well as the relation between obesity and some types of cancer. As a general rule, it is worth bearing in mind that the greatest complications will correspond to the greater overweight (morbid obesity and severe obesity) and that age, the duration of ponderal excess and the distribution of the additional fat also have an influence, given that android/visceral/abdominal obesity is accompanied by the so-called insulin resistance syndrome. It is thus usually accompanied by hypertension, dyslipemia, alterations of hydrocarbonate tolerance and coagulation, elements involved as a whole in cardio-vascular morbi-mortality.

[Administering toxins with antithyroids. Does this prevent recidivism of Graves disease? ]. / Administrar torixina junto a antitiroideos previene la recidiva de la enfermedad de Graves?

There are three possibilities in the treatment of Graves-Basedow disease: antithyroids drugs, sub-total thyroidectomy and I131. In the USA there is a clear preference for definitive therapy with I131 once the thyrotoxicosis has been controlled. In Europe and Japan, however, the preference is for trying a conservative treatment, in the hope of inducing a permanent remission without recourse to radical methods. The most usual conservative pattern involves starting with high doses of antithyroids which are progressively reduced over the course of one year. The high rate of recurrence obtained with this method has fired the imagination of the endocrinologists in the search for other patterns that would provide more satisfactory results. One of these alternative patterns consists of combining thyroxine with antithyroids drugs. In this paper the characteristics of this combined pattern are reviewed. Following the justification, the clinical and experimental foundations on which it is based are outlined. Thirdly, details are given of clinical experiences taken from the medical literature and, finally, our own clinical experience is described after a five years follow up. It is concluded that: 1. The combined treatment delays the appearance of recurrence but does not reduce its frequency. 2. The addition of thyroxine alone following a course of combined treatment is not justified and 3. Prospective studies are needed in which hyperthyroid patients are grouped according to the variables that can affect recurrence.

[Influence of the polymorphism 03826 A --> G in the UCP1 gene on the components of metabolic syndrome]. / Influencia del polimorfismo -3826 A --> G en el gen de la UCP1 sobre los componentes del síndrome metabólico.

BACKGROUND: The uncoupling protein UCP1 has been related to the development and/or maintenance of obesity through its involvement in regulating energy balance. The role of this mitochondrial protein in humans is uncertain due to the scarce presence of the brown adipose tissue in the adult individual. The polymorphism -3826 A/G of the UCP1 alone or in conjunction with the mutation Trp64Arg of the adrenergic receptor b3 has been associated with obesity, diabetes mellitus and related diseases although with contradictory results. With the aim of determining the influence of polymorphism -3826 A/G of the UCP1 on the classical components of the metabolic syndrome in our population, we studied 159 obese individuals and 154 of normal weight, with a study design of cases and controls. In all of them Body Mass Index (BMI), hip/waist index, % of body fat, arterial tension (AT), lipidic profile, leptine, basal glucemia and basal insulinemia were determined. Similarly, the presence of the above mentioned mutation of the UCPI gene was analysed. RESULTS: Significant differences were obtained in all of the variables studied between obese (cases) and normal weight (controls). Within the obese group, polymorphism -3826 A/G of the UCP1 gene (n=53) was associated with a greater BMI (p=0.03), greater percentage of body fat (p=0.04) and higher AT both systolic (p=0.009) and diastolic (p=0.02). There were no statistically significant differences in any of the other indices evaluated. CONCLUSION: The fundamental factor that influences the components of the metabolic syndrome is obesity. However, the polymorphism -3826 A/G of the UCP1 gene is associated with a greater degree of obesity and very high figures of AT.

[Lipidic changes in subclinical hypothyroidism. Evolution according to whether or not corrections are made of TSH levels]. / Modificaciones lipídicas en el hipotiroidismo subclínico. Evolución según se corrijan o no los nivels de TSH.

INTRODUCTION: The repercussion of subclinical hypothyroidism and its treatment on the levels of circulating lipids has received scarce definition. With the aim of obtaining our own data for evaluating the need of treatment in this pathology, we designed a study protocol in two phases. MATERIAL AND METHODS: In the first phase we determined the plasma values of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides, Apo A-I, Apo B-100 and Lp(a) in two groups of patients: a control group formed by 123 healthy women from a Pamplona Health Area and a second group formed by 29 women affected by subclinical hypothyroidism who were attending our surgeries. In the second phase we included 42 women with subclinical hypothyroidism, on whom we carried out a comparative longitudinal study for three months, dividing them into two groups. One that was formed by 30 women, who were treated until their levels of TSH were normalised, and another in which the women were left in subclinical hypothyroidism. In both groups we have evaluated the lipidic profile and Apo A-I, Apo B100 and Lp (a). RESULTS: 1st phase: The total cholesterol and the LD-cholesterol were significantly higher in the group with SH than in the control group. There were no differences in the HDL-cholesterol nor in the triglycerides. 2nd phase: Group 1: The figures of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and Lp (a) were not modified on normalisation of the levels of TSH. The Apo A-I increased significantly and the Apo B-100 showed a tendency to diminish although without significant differences. Group 2: None of the parameters changed significantly as they remained in subclinical hypothyroidism. On comparing the final parameters between groups 1 and 2 (after 3 months), only the Apo A-I and the Lp (a) increased significantly on correction of SH. CONCLUSIONS: Subclinical hypothyroidism is accompanied by a modification of the lipidic profile of an atherogenic character although its treatment, according to our data, does not achieve significant variations.

[Clinical usefulness of the glucagon test in the study of pancreatic islet cell function]. / Utilidad clínica del test de glucagón en el estudio de la función insular pancreática.

In an attempt to assess the utility of glucagon test as an index of beta cell function, we have studied the C-Peptide response to intravenous injection of 1 mg of glucagon in 77 patients with type I diabetes, 27 type II diabetics and 14 normal subjects. A significant difference between basal and glucagon-stimulated C-Peptide levels as well as a good relationship between both values were observed in all groups (r values 0.91, 0.80 and 0.89 respectively). Both basal and stimulated C-Peptide concentrations showed significant relationship with the body mass index and total cholesterol levels, whereas both parameters were negatively related to insulin requirements in type I diabetic group. Absolute C-Peptide increment was different in all groups, despite it was not related to basal C-Peptide levels. These findings confirm the usefulness of glucagon test as an investigative tool to assess the secretory capacity of beta-cell, suggesting that estimation of C-Peptide increment represents the best parameter to evaluate beta-cell reserve.

[Clinical study and hormonal evaluation of a 48, XXYY male. Comparison with previously published cases]. / Descripción clínica y evaluación hormonal de un varón 48, XXYY. Comparación con los casos previos publicados.

A new case of the infrequent 48, XXYY syndrome is presented. The somatomedin C and HGH values were high, perhaps playing a role in the above of the mean height of Klinefeter patients, of which this cromosomic abnormality is a variant.

[Incidence of type 1 diabetes in Navarre, 2009-2012]. / Incidencia de la diabetes tipo 1 en Navarra, 2009-2012.

BACKGROUND: A north-south gradient for the incidence of type 1 diabetes (DM1) has been described in Europe, with higher incidence in the northern countries. The aim of this study is to describe the incidence data for DM1 in Navarre from 2009-2012, regardless of age at diagnosis, including geographical distribution and age and sex characteristics. PATIENTS AND METHODS: Prospective study, based on one primary and three secondary sources. Completeness of records was assessed, using the capture-recapture method, at 98.42%. Incidence was compared between different gender and age groups by estimating the incidence ratio using Poisson regression methods. To compare the incidence between the different geographical areas, adjustments were made to the values obtained by the indirect standardization method. RESULTS: A total of 216 cases were detected (incidence: 8.4/100,000 population/year; 95 % CI: 7.3-9.5). Incidence was higher in children than in adults, although the number of new cases was highest in those aged over 15. The age group with the highest incidence was 10 to 14 years; however, the highest percentage of patients fell in the 15 to 29-year-old group. Incidence was higher in men than in women. The incidence rates in the three southern regions were generally higher than the mean for Navarre. CONCLUSIONS: Navarre has a very high incidence of DM1 in children and adults aged 15 to 29. DM1 is more common in men and shows some geographic variability.

Influence of age at diagnosis on glycaemic control evolution in patients with type 1 diabetes.

AIM: The objective of this study was to describe the relationship between age at onset, with no age limits, and glycaemic control evolution from the time of onset in patients with type 1 diabetes (T1D). METHODS: This observational retrospective follow-up study included 716 patients with T1D onset between 1990 and 2008 treated at the Navarre Hospital Complex. The mean (SD) follow-up lasted 10.1 (5.3) years. Information on their HbA(1c) levels was collected at onset and every year thereafter. Generalized additive mixed models and linear models were used, with patients' annual HbA1c levels as the response variable and the number of years since onset together with age at onset as covariates. RESULTS: The evolution of glycaemic control is not linear and differs across all age groups. Children reach their highest values in adolescence, while patients with onset at ages 10-15 years stabilize their HbA(1c) values after 7 or 8 years. In adults, it is notable that an age of onset ≥ 45 years is associated with the worst control. CONCLUSION: A non-linear increase in HbA(1c) levels can be observed from the time of T1D diagnosis, with significant differences across all age groups.

Incidencia de diabetes tipo 1 en Navarra (2009-2016): mayor en la zona sur de la comunidad / Incidence of type 1 diabetes in Navarre (2009-2016): higher in the southern regions of the autonomous community

Fundamento: Las variaciones geográficas y estacionales en la incidencia de diabetes tipo 1 (DM1) son útiles para intentar conocer la etiopatogenia de la enfermedad. El objetivo de este estudio consiste en conocer los datos de incidencia de DM1 en Navarra durante el período 2009-2016, su distribución geográfica y su variación en cuanto a la estación del año en la que tiene lugar tanto el nacimiento como el diagnóstico de las personas afectadas. Métodos: Estudio prospectivo, con una fuente primaria y tres secundarias. La exhaustividad del registro se evaluó mediante el método de captura-recaptura y fue del 96,08%. La estimación de las tasas e intervalos de confianza al 95% por zonas y estaciones al debut se realizó asumiendo una distribución subyacente de Poisson. La influencia independiente de las variables edad al debut, sexo, zonas y estaciones del año, se estudió mediante la regresión de Poisson. Para la comparación de la incidencia interregional, los valores obtenidos se ajustaron por el método de estandarización indirecta. Resultados: Se detectaron 428 casos (incidencia= 8,36/100.000 habitantes-año; IC95%: 7,58-9,19). La enfermedad predomina en hombres (63%). La incidencia en menores de 15 años fue mayor que en los adultos (21,54; IC95%: 18,43-25,02 vs. 5,94; IC95%: 5,23-6,71; p<0,001). Se observa mayor incidencia en las cuatro regiones del sur de la Comunidad Foral, y en invierno y primavera como estaciones al debut. No hay diferencias en la estación al nacimiento. Conclusión: Navarra mantiene una alta incidencia de DM1 en la infancia que va disminuyendo progresivamente con la edad. Se detectan diferencias por sexo, edad, zona geográfica y estación al diagnóstico (AU)

Background: Geographical and seasonal variations of type 1 diabetes (T1D) are useful for establishing the key ethiopathogenic factors of the disease. The present work seeks to analyze the incidence rates of T1D in Navarre for the 2009-2016 period, its geographical distribution and seasonal variations in birth and diagnosis in affected persons. Methods: Prospective study with one primary and three secondary sources. The completeness of the registry, determined using the capture-recapture method, was 96.08%. The confidence intervals of zone and onset season incidence rates were determined assuming an underlying Poisson distribution. Adjusted effect of onset age, sex, onset season and geographical area over changes in incidence rates were analyzed using a Poisson regression model. Comparison among areas was carried out after the corresponding adjustments of incidence by the indirect standardization method. Results: Four hundred and twenty-eight new cases were detected (incidence= 8.36/100,000 inhabitants per year, CI95%: 7.58-9.19). The disease is predominant in males (63% of patients). The incidence in children under 15 years was higher than in adults (21.54, CI95%: 18.43-25.02 vs. 5.94, CI95%: 5.23-6.71; p<0.001). Incidence was highest in the four southern regions of Navarre, most of the cases being in winter and spring. No differences were found regarding birth season over incidence. Conclusion: Navarre maintains a high T1D incidence in childhood that decreases progressively with age. Sex, age group, geographical zone and onset season are independently associated with the incidence rates observed in the study (AU)

[Descriptive study of transexuality in Navarre]. / Estudio descriptivo de la transexualidad en Navarra.

BACKGROUND: Transexuality has been recognized in Navarre as a clinical entity that must be attended to in a multidisciplinary form in the Navarre Health Service. METHODS: An analysis was made of the epidemiological data of 35 subjects who have attended the Navarre Transexual and Intersex Unit (UNATI - Unidad Navarra de Transexuales e Intersexos) since April 2011. The variables related to socio-demographic parameters, transexuality and treatment were collected. RESULTS: The average age was 37.3 years. Sixty-five point seven percent of the subjects were born in Spain. Seventy-one point four percent of the users are feminine transsexuals. At present 62.9% of the subjects are receiving hormonal treatment. Amongst the feminine transexuals 20% have had a mamoplasty, 4% have had a vaginoplasty and 20% have had both operations. Ten percent of the masculine transsexuals have had a mastectomy, 10% have had a hysterectomy with double anexectomy and 10% have had both operations. CONCLUSIONS: The majority of the transsexuals in Navarre are being evaluated in the UNATI. More feminine transsexuals have attended than masculine ones. The feminine transsexuals more frequently have reassignation surgery, while the masculine ones have extirpative surgery.

The reduction of the metabolyc syndrome in Navarra-Spain (RESMENA-S) study: a multidisciplinary strategy based on chrononutrition and nutritional education, together with dietetic and psychological control.

INTRODUCTION: The high prevalence of metabolic syndrome (MS) in Spain requires additional efforts for prevention and treatment. OBJECTIVE: The study RESMENA-S aims to improve clinical criteria and biomarkers associated with MS though an integral therapy approach. METHODS: The study is a randomized prospective parallel design in which is expected to participate a total of 100 individuals. The RESMENA-S group (n = 50) is a personalized weight loss (30% energy restriction) diet, with a macronutrient distribution (carbohydrate / fat / protein) of 40/30/30, high meal frequency (7 / day), low glycemic index/load and high antioxidant capacity as well as a high adherence to the Mediterranean diet. The control group (n = 50) is assigned to a diet with the same energy restriction and based on the American Heart Association pattern. Both experimental groups are under dietary and psychological control during 8 weeks. Likewise, for an additional period of 16 weeks of self-control, is expected that volunteers will follow the same pattern but with no dietary advice. RESULTS: Anthropometrical data and body composition determinations as well as blood and urine samples are being collected at the beginning and end of each phase. This project is registered at www.clinicaltrials.gov with the number NCT01087086 and count with the Research Ethics Committee of the University of Navarra approval (065/2009). CONCLUSIONS: Intervention trials to promote the adoption of dietary patterns and healthy lifestyle are of great importance to identify the outcomes and nutritional mechanisms that might explain the link between obesity, metabolic syndrome and associated complications.