Determinants of weight outcomes in type 2 diabetes prevention intervention in primary health care setting (the DE-PLAN project).

BACKGROUND: Real life implementation studies performed in different settings have proved that lifestyle interventions in the prevention of type 2 diabetes (DM2) can be effective, although the weight reduction results are typically modest compared to randomized control trials. Our objective was to identify the factors that predict successful weight loss in a less intensive, lower budget, real life setting lifestyle diabetes prevention intervention. METHODS: Study participants (n = 175) with increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC) > 14) but no diabetes at baseline received ten group lifestyle counselling sessions, physical activity and motivation sessions during a ten-month intervention. Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of successful weight reduction defined as a reduction of ≥5% of the initial body weight. RESULTS: At 12 months following the initiation of the intervention, 23.4% of study participants lost ≥5% weight (mean loss of 7.9 kg, SD = 5.8). Increased physical activity (44% vs 25%, p = 0.03), decreased total fat consumption (88% vs 65%, p = 0.006) and adherence to four-five lifestyle goals (71% vs 46%, p = 0.007) were more often reported among those who managed to lose ≥5% weight versus those who did not. In a multivariate analysis, meeting the ≥5% weight loss goal was most effective in individuals with a higher baseline BMI (OR 1.1, 95%CI 1.0-1.2), baseline and medium versus higher education (OR 5.4, 95% CI 1.2-24.7) and a history of increased glucose (OR 2.6, 95%CI 1.1-1.3). A reduction of total fat in the diet was an independent lifestyle predictor, increasing the probability of successful weight loss by 3.8 times (OR 3.8, 95% CI 1.2-11.4). CONCLUSION: Baseline higher BMI, lower education and a history of increased glucose predicted the successful weight loss among individuals with a high risk for the DM2 following lifestyle intervention in a real life primary health care setting. People who manage to lose weight more often adhere to lifestyle changes, while the reduction of total fat in diet independently predicts successful weight loss. Further studies exploring the predictors of success in implementation studies in DM2 prevention should help health care providers redesign interventions to improve their effectiveness and outcomes. TRIAL REGISTRATION: ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.

Sustained diabetes risk reduction after real life and primary health care setting implementation of the diabetes in Europe prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project.

BACKGROUND: Real life implementation studies performed in different settings and populations proved that lifestyle interventions in prevention of type 2 diabetes can be effective. However, little is known about long term results of these translational studies. Therefore, the purpose of this study was to examine the maintenance of diabetes type 2 risk factor reduction achieved 1 year after intervention and during 3 year follow-up in primary health care setting in Poland. METHODS: Study participants (n = 262), middle aged, slightly obese, with increased type 2 diabetes risk ((age 55.5 (SD = 11.3), BMI 32 (SD = 4.8), Finnish Diabetes Risk Score FINDRISC 18.4 (SD = 2.9)) but no diabetes at baseline, were invited for 1 individual and 10 group lifestyle counselling sessions as well as received 6 motivational phone calls and 2 letters followed by organized physical activity sessions combined with counselling to increase physical activity. Measurements were performed at baseline and then repeated 1 and 3 years after the initiation of the intervention. RESULTS: One hundred five participants completed all 3 examinations (baseline age 56.6 (SD = 10.7)), BMI 31.1 (SD = 4.9)), FINDRISC 18.57 (SD = 3.09)). Males comprised 13% of the group, 10% of the patients presented impaired fasting glucose (IFG) and 14% impaired glucose tolerance (IGT). Mean weight of participants decreased by 2.27 kg (SD = 5.25) after 1 year (p = <0.001). After 3 years a weight gain by 1.13 kg (SD = 4.6) (p = 0.04) was observed. In comparison with baseline however, the mean total weight loss at the end of the study was maintained by 1.14 kg (SD = 5.8) (ns). Diabetes risk (FINDRISC) declined after one year by 2.8 (SD = 3.6) (p = 0.001) and the decrease by 2.26 (SD = 4.27) was maintained after 3 years (p = 0.001). Body mass reduction by >5% was achieved after 1 and 3 years by 27 and 19% of the participants, respectively. Repeated measures analysis revealed significant changes observed from baseline to year 1 and year 3 in: weight (p = 0.048), BMI (p = 0.001), total cholesterol (p = 0.013), TG (p = 0.061), fasting glucose level (p = 0.037) and FINDRISC (p = 0.001) parameters. The conversion rate to diabetes was 2% after 1 year and 7% after 3 years. CONCLUSIONS: Type 2 diabetes prevention in real life primary health care setting through lifestyle intervention delivered by trained nurses leads to modest weight reduction, favorable cardiovascular risk factors changes and decrease of diabetes risk. These beneficial outcomes can be maintained at a 3-year follow-up. TRIAL REGISTRATION: ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.

[Assessement of the usefulness of whole body scintigraphy after administration of 6 MBq of 131I in the diagnostic of breast cancer]. / Ocena mozliwosci zastosowania scyntygrafii calego ciala po podaniu 6 MBq 131I w diagnostyce raka sutka.

INTRODUCTION: Sodium-iodine symporter (NIS) belongs to a large family of natrium dependent ion transporters found in normal thyroid cells located on the basilar membrane of tyreocytes. Under physiologic conditions, the NIS is also present in other tissues: salivary glands, gastric mucosa, mammary glands during lactation, and vascular plexus of the fourth ventricle. NIS expression has also been found in many tumors, including breast cancer. AIM: The aim of this study was to evaluate the usefulness of whole body scintigraphy after administration of relatively low activity of 131I (6 MBq)in the diagnostics of breast cancer. MATERIAL AND METHODS: The study included nine women with breast cancer, aged 38-73 years (mean 55.6 +/- 11.7 years) and a control group of 14 women aged 29-84 years (mean 48.8 +/- 16.7 years). The uptake of radioiodine in whole body scintigraphy 24 hours after administration of 131I radioiodine (6 MBq) was compared between the control group and breast cancer patients. No pharmaceuticals reducing thyroid iodine uptake or increasing NIS expression were used. RESULTS: Whole body scans using 6 MBq 131I activity revealed no focal radioiodine uptake outside the thyroid tissue in patients with breast cancer as well as volunteers from the control group. CONCLUSIONS: Whole body scintigraphy using 131I, dosed at 6 MBq, with no additional treatment increasing extrathyroidal uptake of radioiodine, appears to be ineffective in the imaging of breast cancer.

Iodine-deficiency prophylaxis and the restriction of salt consumption - a 21st century challenge.

The World Health Organization (WHO) issued a recommendation (Technical Consultation: Paris 2006, Luxembourg 2007) that salt consumption, as a risk factor for hypertension, atherosclerosis, myocardial infarction, stroke, and select cancers, should be restricted. The European Commission looked to adhere to this recommendation by creating the High Level Group on Nutrition and Physical Activity. According to WHO recommendations, a daily allowance of 5 g NaCl (i.e., 2 g Na) for individual salt consumption should not be exceeded. At present, mean individual salt consumption in Poland totals 13.5 g, of which salt used in household constitutes 8.8 g. In some regions of Poland, this number reaches upwards of 15.0 g/person. The Position Paper on Initiatives Aimed at Decreasing Salt Consumption in Poland, developed by an expert group at the National Food and Nutrition Institute, set the course for intervention, including changing recipes for massproduced food products and large-scale catering, improving oversight by food control agencies, and continuing legislative changes. These interventions should also include education directed towards consumers, food producers, public health professionals, healthcare workers, and media representatives. The Position Paper of the Polish Hypertension Society also sets the course for promoting restricted salt consumption and controlling hypertension on a population level. However, household salt is the main carrier of iodine in the Polish model of iodine prophylaxis. Thus, any interventions also require synchronized action with the Polish Council for Control of Iodine Deficiency Disorders. Current efforts aimed at preventing iodine-deficiency look to increase consumption of other iodine-rich products (e.g., milk, mineral water) with standardized levels of iodine. Once they achieve an iodine concentration of 0.1-0.2 mg, these products can easily supplement any decrease in physiological iodine levels resulting from reduced salt consumption. Also required are wide-ranging educational campaigns which will be coordinated by the new designated WHO Collaborating Centre for Nutrition at the Chair of Endocrinology at Jagiellonian University, Collegium Medicum in Kraków. (Pol J Endocrinol 2010; 61 (1): 135-140).

Iodine concentration in Polish milk - variations due to season and region.

INTRODUCTION: Iodine concentration was studied in Polish consumer milk. MATERIAL AND METHODS: The milk originated from 13 provincial cities and 65 dairy cooperatives located in Poland. RESULTS: Milk iodine concentration in the winter season of 2007-2008 was 146.8 mg/L, with a standard deviation for the provinces of 27.9 mg/L and variation coefficient of 19.0% (n = 66 samples). Iodine concentration for provincial cities ranged from 76.3 to 192.0 mg/L. It was highest in the milk samples from the Lubelskie province (191.9 mg/L) and lowest in the milk samples from Podlasie (113.8 mg/L). In the summer season, milk iodine concentration averaged 100.4 mg/L, with a standard deviation of 38.9 ìg/L and variation coefficient of 38.8% (n = 27 samples). CONCLUSIONS: Iodine concentration for provincial cities ranged from 63.8 to 173.7 mg/L. Compared to the winter season, milk iodine concentration in the summer season was lower by an average of 25.2%, with a standard deviation of 4.3% (Kielce) to 52.2% (Wroclaw).

Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project.

It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.

Predictors of long term weight loss maintenance in patients at high risk of type 2 diabetes participating in a lifestyle intervention program in primary health care: The DE-PLAN study.

Lifestyle interventions in type 2 diabetes (DM2) prevention implementation studies can be effective and lasting. Long-term weight loss maintenance enhances the intervention effect through a significant decrease in diabetes incidence over time. Our objective was to identify factors predicting long-term successful weight reduction maintenance achieved during a DM2 prevention program in patients with high DM2 risk in primary health care. Study participants (n = 263), middle-aged, slightly obese with baseline increased DM2 risk (Finnish Diabetes Risk Score (FINDRISC)>14), but no diabetes were invited to receive 11 lifestyle counselling sessions, guided physical activity sessions and motivational support during 10-months. The study participants had three clinical examinations during the study (baseline, one and three years). Stepwise regression analysis was used to determine demographic, clinical, and lifestyle predictors of weight reduction maintenance two years after the discontinuation of the intervention. Out of 105 patients who completed all three examinations (baseline age 56.6 (standard deviation (SD) = 10.7), body mass index 31.1 kg/m2 (SD = 4.9), FINDRISC 18.6 (SD = 3.1)), 73 patients (70%) showed weight loss during the intervention (mean weight loss 4.2 kg, SD = 5.1). The total weight loss achieved in the maintainers (27 of 73 study participants) two years after the intervention had finished was 6.54 kg (4.47 kg+2.0 kg). The non-maintainers, on the other hand, returned to their initial weight at the start of the intervention (+0.21 kg). In multivariable analysis baseline history of increased glucose (odds ratio (OR) = 3.7; 95% confidence interval (CI) 1.0-13.6) and reduction of total fat in diet during follow-up (OR = 4.3; 95% CI 1.5-12.2) were independent predictors of successful weight loss. Further studies exploring predictors of weight loss maintenance in diabetes prevention are needed to help health care providers to redesign interventions and improve long-term outcomes of real life interventions.

Nontraditional atherosclerotic risk factors and extent of coronary atherosclerosis in patients with combined impaired fasting glucose and impaired glucose tolerance.

Partially inconsistent data exist on mutual relations between nontraditional atherosclerotic risk factors, including the magnitude of insulin resistance (IR), as well as on their relevance for atherogenesis in the metabolic syndrome. Subjects exhibiting combined impaired fasting glucose and impaired glucose tolerance (IFG/IGT) are exposed to an exceptionally high risk for atherogenesis and development of type 2 diabetes mellitus. Because of islet Beta-cell dysfunction, the usefulness of commonly used indices of IR is limited in IFG/IGT. Our aim was to assess the relationship between extent of angiographic coronary artery disease (CAD) and nontraditional atherosclerotic risk factors (including IR by a clamp-based golden standard method) in IFG/IGT. Fifty-three subjects (32 men, 21 women; mean age, 55 +/- 11 years) with stable angina, preserved left ventricular systolic function, and IFG/IGT were divided into 3 groups: group A (no coronary stenoses >50%, n = 22), group B (1-vessel CAD, n = 15), and group C (2/3-vessel CAD, n = 16). Insulin sensitivity was quantified by a hyperinsulinemic euglycemic clamp technique and expressed as M. M value, plasma homocysteine (Hcy) level, and asymmetric dimethyl-L-arginine (ADMA)/L-arginine ratio were independent determinants of CAD extent as shown by forward stepwise discriminant function analysis. Compared with group A (M = 32.7 +/- 9.3 micromol/kg fat-free mass [FFM] per minute; Hcy, 8.1 +/- 1.4 micromol/L), lower M and higher Hcy levels were found in group B (M = 16.9 +/- 8.2 micromol/kg FFM per minute, P < .001; Hcy, 11.2 +/- 2.9 micromol/L, P = .003) and C (M = 16.4 +/- 7.8 micromol/kg FFM per minute, P < .001; Hcy, 12.8 +/- 3.9 micromol/L, P < .001). The ADMA/L-arginine ratio was increased in group C (0.0078 +/- 0.0011) compared with group A (0.0063 +/- 0.0013, P = .03) and B (0.0058 +/- 0.0012, P = .01). Multivariate correlates (P < .05) of plasma Hcy concentrations were M (beta = -.34 +/- .12, P = .008), creatinine clearance (beta = -.23 +/- .10, P = .03) and fasting insulin (beta = .25 +/- .12, P = .04). This indicates an additive contribution of IR, plasma Hcy, and elevated ADMA/L-arginine ratio to the extent of angiographic CAD in combined IFG/IGT.

[Environmental factors in the development of type 1 diabetes -- a new insight]. / Rola czynników srodowiskowych w rozwoju cukrzycy typu 1 -- nowe spojrzenie.

According to the traditional model of pathogenesis of type 1 diabetes - it develops in genetically susceptible individuals in whom environmental factors trigger an autoimmune process of beta-cell destruction. Although susceptibility may be inherited, there is a growing body of evidence showing the role of environmental factors that might not only trigger but also perpetuate the chronic autoimmune process. These factors may exert their action long before the disease manifests itself clinically, which significantly hampers their identification. Three groups of environmental factors that were most widely studied include of viral infections, feeding patterns in infancy and toxic compounds (especially nitrites). Other factors possibly playing a role in modifying the development of the disease are vaccinations, psychological stress and climatological factors. The authors summarize the data supporting the role of environmental factors in the development of the disease and show a more recent model of type 1 diabetes pathogenesis. It may partly explain why the disease incidence increased has so much in the last three decades despite markedly improved hygiene and health care standards.

[Alcohol consumption and the risk of insulin resistance--population based study]. / Spozywanie alkoholu i ryzyko wystqpienia insulinoopornosci--badanie populacyjne.

UNLABELLED: The aim of the study was to assess the relationship between alcohol consumption and insulin resistance in the adult Kraków's inhabitants. MATERIALS AND METHODS: 6000 subjects at age 35-75, participants of the Polish Multicenter Study on Diabetes Epidemiology, were randomized and invited to the study. Finally in 2838 participants the standardized questionnaire examination of the life style especially alcohol consumption was performed. In all persons anthropometric and blood pressure examination was performed. Fasting lipids, fasting and after glucose load glucose and insulin were determined. Glucose tolerance was determined in all study participants according WHO 1999 criteria. Insulin-resistance was defined as the highest quartile of the distribution of the HOMA-IR index assessed for population with normal glucose tolerance (NGT). RESULTS: In examined group 472 (29.2%) women and 150 (12.2%) men were abstainers. Alcohol consumption below 10 glday declared 68.4% of women and 54.9% of men, between 10 and 30 g/day--2.0% of women and 24.7% of men, above 30 g/day--8.2% of men and 0.4% of women. In men with normal glucose tolerance the lowest HOMA-IR we observed in the group drinking daily above 30 g of alcohol (2.05 +/- 1.3). In men with impaired glucose tolerance the lowest HOMA-IR was observed in the group drinking daily below 10 g of alcohol, the highest in the group of abstainers (2.81 +/- 2.04 vs. 3.23 +/- 1.72; ns). For men drinking between 10 and 30 g of alcohol daily decreased the risk of insulin resistance at 40% (OR = 0.6; 95% CI: 0.37-0.96), drinking above 30 g daily decreased the risk at 49% (OR = 0.51; 95% CI: 0.27-0.96). We didn't observed this relationship in the group of women. CONCLUSION: Our results confirm positive impact of daily alcohol intake above 10 g for the risk of insulin resistance in the group of men.

[Prevalence of the glucose metabolism disturbances in screening of adult inhabitants of Krakow]. / Czestosc wystepowania zaburzen tolerancji weglowodanów wsród doroslych mieszkanców Krakowa--badania przesiewowe.

OBJECTIVES: In Poland, similarly like in the other European countries type 2 diabetes screening and prevention projects have been run. In Krakow, Krakow's Municipality had undertaken a decision of financing a prevention program directed to adult inhabitants of the city. The aim of the study was to assess the prevalence of the glucose metabolism disturbances in adult inhabitants of Krakow city. MATERIAL AND METHOD: The study was conducted in 2004-2005 in 42 Krakow's primary health care units in patients aged over 25, not treated due to the diabetes type 2 and/or coronary artery disease, with no history of myocardial infarction or stroke. In all study participants anthropometric examination, blood pressure and fasting glucose were measured. Diabetes risk score (DRS) and fasting glyceamia were used to classify patients to receive oral glucose tolerance test (OGTT). RESULTS: 40989 people (67.2% women and 32.8% men) aged 25 to 97 were examined. 12495 people received OGTT, in 1858 fasting glycaemia measurement was repeated. In 15.1% of men and 12.7% of women impaired glucose metabolism was found (p < 0.01). IFG was found in 5.9% men and 4.7% women (p < 0.01). The prevalence of IGT was the same in men and women (3.7% vs 3.8%, ns). Newly diagnosed diabetes type was found in 5.5% men and 4.2 % of women (p < 0.01). The prevalence of impaired glucose metabolism was increasing with age in men and women, in all categories of glucose disturbances, age related trends were statistically significant. Overweight was more frequent in men than in women (50.3% vs 36.8%, p < 0.0001), while obesity was more frequent in women compared to men (20.7% vs 19.5%, p < 0.02). Obesity was statistically more frequent in people with impaired glucose metabolism compared to those with normal glucose tolerance. Overweight was more frequent in women with impaired glucose metabolism compared to women with normal glucose metabolism, no relation with overweight was observed in men. CONCLUSIONS: The prevalence of newly diagnosed type 2 diabetes is increased in people aged over 55, what confirms the necessity of screening in this group of age. Due to more prevalent newly diagnosed type 2 diabetes and IFG in men, in all age groups implementation of routine screening for impaired glucose metabolism in men aged over 35 should be considered. Results of the study confirm the importance of the implementation of early prevention programs focused on lifestyle modification, especially addressed to men.

[Prevalence of the metabolic syndrome and its components in adult inhabitants of Krakow]. / Czestosc wystepowania zespolu metabolicznego i jego skladowych w populacji doroslych mieszkanców Krakowa.

OBJECTIVES: There are only few studies on the prevalence of the metabolic syndrome in Polish population. The aim of the study was to assess the prevalence of the metabolic syndrome according to NCEP definition in adult inhabitants of Krakow. MATERIAL AND METHOD: The study was conducted in 2004-2005 in 42 Krakow's primary health care units in patients aged over 25, not treated due to the diabetes type 2 and/or coronary artery disease, with no history of myocardial infarction or stroke. In all study participants anthropometric examination, blood pressure, fasting total cholesterol and fasting glucose were measured. In those with total cholesterol > 5.2 mmol/l additional triglicerides and HDL-cholesterol were measured. RESULTS: 40989 people (67.2% women and 32.8% men) aged 25 to 97 (54.1 +/- 14.1 years) were examined. In 19,4% of the examined population the MS was diagnosed (20.9% women and 16.2% men). In age group below 55 years the MS was more frequent in men than in women. Impaired glucose tolerance was found in 5394 study participants (3239 women and 2155 men). Mean systolic blood pressure was higher in men than in women (131.5 +/- 16,1 vs 127.0 +/- 17.5, p < 0.0001), the same was found for diastolic blood pressure (81.5 +/- 0.3 vs 78.6 +/- 9.6 p < 0.0001). 33.5% of women and 34.9% of men (p < 0.01) were treated from hypertension. In age group below 55 years men were more frequently treated due to hypertension than women (p < 0.001). In 8.7% of women and 14.1% of men (p < 0.001) newly diagnosed hypertension was found. In all age groups untreated hypertension was more frequent among men than in women. In 26.1% women and 33.5% men hypertriglicrdymia was found. In age group below hypertiglicerydemia was more frequent in men than in women (p < 0.001). Low HDL-cholesterol was found in 20.9% of women and 10.1% of men (p < 0.001). Visceral fat distribution was found in 19.9% of men and 33.3% of women. CONCLUSIONS: The MS was found in 20% of examined inhabitants of Krakow. Special attention should be paid to high prevalence of the MS among men younger than 45 years, as well as high prevalence of hypertriglicerydemia and newly diagnosed hypertension present in this group of men. The study results confirm the necessity of implementation of screening and early prevention of cardiovascular disease programs especially focused on younger men.

Association of coronary atherosclerosis with insulin resistance in patients with impaired glucose tolerance.

OBJECTIVES: The purpose of the study was to evaluate the role of insulin resistance (IR) in the development of coronary atherosclerosis in patients with impaired glucose tolerance. METHODS AND RESULTS: The study group consisted of 42 patients with impaired glucose tolerance. Based upon coronary angiography the patients were divided into group A--with prior myocardial infarction and critical coronary stenosis (n=20) and group B--without prior myocardial infarction and without critical coronary stenosis (n=22). In each patient glucose disposal rate (GDR) during metabolic clamp, insulinaemia in the fasting state and during the clamp, glycaemia during oral glucose tolerance test (OGTT), BMI and body mass composition were measured. The groups did not differ in age, BMI, percent fat content and distribution, and blood pressure. Fasting insulinaemia (56.7 microU/ml) was higher in group A than in group B (22.3 microU/ml). GDR in group A (2.96 mg/kg b.m./min) was lower than in group B (5.36 mg/kg b.m./min). There was a negative correlation between the number of critically narrowed coronary vessels and GDR in group A. GDR below 3.97 mg/kg b.m./min was found, based on regression analysis, to be a powerful risk factor for myocardial infarction. CONCLUSIONS: The relationship between IR and severity of coronary atherosclerosis implies its unfavourable role in the development of atherosclerosis. The present findings indicate a negative role of IR in the development of myocardial infarction and suggest that it is an independent risk factor, which identifies high-risk patients requiring treatment that would increase tissue insulin sensitivity.

[Insulin resistance indices in population-based study and their predictive value in defining metabolic syndrome]. / Wskazniki insulinoopornosci w badaniu populacyjnym i ich wartosc predykcyjna w okresgleniu zespllu metabolicznego.

UNLABELLED: In clinical studies insulin resistance, the main factor of the Metabolic Syndrome (MS), is determined directly by metabolic clamp technique, while in epidemiological studies is estimated on the basis of indices calculated from oral glucose tolerance test glycemia and insulinemia. The aim of the study was to find out which insulin resistance indicator best predicts the risk of the MS. MATERIAL AND METHODS: The study population consisted of 2673 inhabitants of Kraków, aged 35-75 years, who participated in the "Polish Multicenter Study on Diabetes Epidemiology". Fasting insulin, HOMA-IR, QUICKI and Matsuda's index were determined for all subjects. Insulin resistance was defined as the cutoff values for the population with normal glucose tolerance and with BMI < 25 kg/m2. RESULTS: All insulin resistance indices were closely correlated (r=0.78-0.98), and the frequency of insulin resistance in the general population was similar (47%-54%), however the highest prevalence of insulin resistance was observed when Matsuda index was used. The risk of insulin resistance, increased with the category of glucose tolerance, and was the highest when Matsuda index was used. The MSWHO was observed in 42% to 45% of the studied population and the predictive value of insulin resistance indices were similar when using WHO criteria. The highest sensitivity in the MSNCEP identification was observed when Matsuda index was used. Matsuda index had also the highest sensitivity to diagnose MSNCEP as compared with the remaining insulin resistance indices. CONCLUSIONS: The study insulin resistance indices have a similar value in predicting the MSWHO while Matsuda index predicts best the MSNCEP. Matsuda index as well predicts best the risk of insulin resistance. This argues in favor of using oral glucose tolerance test to estimate risk for diabetes mellitus and cardiovascular disease.

[Disturbances of thyroid function in adult population of the city of Cracow followed up for ten years observation]. / Zaburzenia funkcji tarczycy w populacji doroslych mieszkanców Krakowa w okresie 10-letniej obserwacji.

UNLABELLED: The aim of the study was to define disturbances of thyroid function in adult population of the city of Cracow followed up for ten years. The analysis included the results obtained from 891 individuals, 571 females and 320 males aged 18-78 years examined prior to and after implementation of the obligatory model of iodine prophylaxis (years 1989-1990 and 1998-1999). After the exclusion of patients diagnosed earlier as having hyperthyroidism or hypothyroidism, the mean TSH level in the years 1998-1999 was significantly higher as compared to data obtained between 1989 and 1990 (1.44 microj/ml vs. 1.30 microj/ml) in the examined population. Our 10 years observation revealed an insignificant increase in frequency of hyperthyroidism only among females (1.6% vs. 0.9%) which did not indicate a clear, endemic in character increase at the population level. In the present investigations, hypothyroidism was demonstrated to occur more frequently as compared to the 1989-90 study (2.1% vs. 1.4% among females and 0.3% vs. 0% in males). Both differences were not statistically significant. As seen from the present results, over the investigated 10-year period, in the Cracow population, there occurred a clear, statistically significant (p<0.001) increase of the percentage of individuals with an elevated TPO antibody titter (3.8% vs. 11.8%). In our investigation no correlation was observed between anti-TPO antibodies and ioduria levels. CONCLUSIONS: The results reveal no statistically significant increase in incidence of hyperthyroidism and hypothyroidism after implementation of the obligatory model of iodine prophylaxis. The future studies are needed to clarify the mechanisms involved in increase of anti-TPO autoantibodies and verify its possible temporary nature.

[Studies on iodine deficiency in adult population of Cracow]. / Badania nad niedoborem jodu wsród doroslych mieszkanców Krakowa.

The aim of the study carried out in 1989-90 and 1998-99 was to define the iodine deficiency state and goiter prevalence in adult population of Cracow. The analysis included data obtained from 230 individuals (143 females and 87 males). The mean age was 36 +/- 15 years. The thyroid size and morphology was determined by ultrasound method using Aloka unit equipped with 7.5 MHz linear transducer. The concentration of iodine in casual morning urine sample was measured using Sandell-Kolthoff's method. The 10- year observation revealed an insignificant decrease in prevalence of goiter from 26.2% to 21.8%. We observed statistically significant (p = 0.001) decrease in the parenchymal goiter prevalence from 22.7% to 11.7 in the same period of time. The significant increase in incidence of nodular goiter was found (6.5% vs 20.8%, p < 0.001). In all groups investigated through 1989-99, there was an increase in medians of ioduria over the 10-year period. The level of urinary iodine excretion was not essential element for risk of nodular goitre. Thus, the results indicate the beneficial effect of iodine prophylaxis which reflects in decrease of prevalence of parenchymal goiter. No clear effect of iodine prophylaxis was noticed regarding rise in nodular goiter incidence.

[Iodine deficiency in pregnancy--a continuing public health problem]. / Niedobór jodu w ciazy--nadal aktualy problem zdrowia publicznego.

Iodine prophylaxis in Poland started in 1997 and is based on mandatory iodzation of household salt with 20-40 mg KI/ 1 kg, supplementation of bottle fed infants with iodized formulas with 10,0 microg KI/100 ml, and a voluntary supplementation of pregnant and breast feeding women with additional 100-150 microg of iodine/ day. Last evaluation of efficacy of the iodine prophylaxis performed in 2003 by WHO and International Council for the Control of Iodine Deficiency Disorders allocated Poland within the group of the European countries with sufficient iodine supplementation on the population level. However according to data of the Institute of Mather and Chield in Poland, around 50 % of pregnant women only is additionally supplemented with iodine. Iodine deficiency during pregnancy even as a moderate iodine deficiency, creates a risk of mental retardation, perinatal complication like low and very low births weigt of neonates with increased perinatal mortality rate and late consequences in adult life: metabolic syndrom and type 2 diabetes. Another limitation of the actual model of iodine prophylaxis in Poland, it is too high consumption of natrum chloride (over 5,0 g of household salt/day/ capita). It is around 50% over WHO recommendation. Intensive preventive program against hypertension, type 2 diabetes, atherosclerosis, osteoporosis and some neoplasmatic diseases includes limitation of natrum chloride consumption- as one of the risk factors. Therefore new scope of the National Programme for Elimination of Iodine Deficiency will include: a special prorgramme for the iodization of animal food according to european standard, increased rate of pregnant women additionally supplemented with iodine, strengthening public awarness on necessary increase of milk consumption especially in pregnancy and in children and continouse monitoring system of biologic effects and technologic quality of the model of iodine prophylaxis.

The effects of iodised salt licks and teat dipping on the iodine content of cow's milk and blood plasma.

INTRODUCTION: Milk has been identified as the ideal carrier of iodine in the human diet. The iodine concentration in cow's milk depends on the iodine intake in the animal's daily rations. MATERIALS AND METHODS: The first experiment, which lasted for 90 days, investigated the effectiveness of salt licks containing 0 (control group), 150, and 300 mg I/kg (experimental groups) and the effect on the iodine content of cow's milk and blood plasma. The second experiment determined the effect of udder disinfection and iodine teat dipping with iodine disinfectant (experimental group) compared to chlorine dip (control group) on the iodine content of milk and blood plasma. Milk iodine and blood plasma concentrations were meas- ured using the Sandell-Kolthoff method modified by the Bobek and Kolczak procedure. RESULT: Salt licks containing 150 and 300 mg I/kg increased iodine intake by 7.5 and 15.0 mg I/day, respectively. Average iodine intake in the control group was 6.23 mg I/day, and 13.68 and 21.10 mg I/day in the experimental groups, respectively. There were no significant differences in the average cows' milk yield, which averaged 21.0 ± 1.1 kg/day. Average milk iodine content was 53.8 µg/1000 mL (control group), 65.0 and 84.7 µg/1000 mL (experimental groups). Average plasma iodine content tended to increase in the experimental groups, but the differences between the groups were not significant. In the second experiment iodine udder disinfection and teat dipping increased average milk iodine content from 44.0 ± 1.6 to 59.3 ± 2.3 µg/1000 mL. Average plasma iodine content increased only slightly, with a non- significant difference between the control and experimental groups. CONCLUSION: The iodine content of salt licks at 150 and 300 mg I/kg makes it possible to obtain from 65 to 85 µg I/1000 mL of cow's milk. Pre-milking udder hygiene and post-milking iodine teat dipping additionally increase the iodine content of milk by around 15 µg I/1000 mL milk, i.e. an increase of 35% in relation to cows from the control group.

Association between gastric emptying rate and nutritional status in patients treated with continuous ambulatory peritoneal dialysis.

OBJECTIVE: To estimate gastric emptying rate in continuous ambulatory peritoneal dialysis (CAPD) patients, with or without indwelling dialysate, and to evaluate if there is an association between gastric motility and nutritional status. DESIGN: Single-center cross-sectional study. SETTING: Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Krakow, Poland. PATIENTS AND METHODS: 20 end-stage renal disease patients [11 F, 9 M; mean age 50.1 +/- 11 years; treated with CAPD for median 13.5 (2-61) months] were studied. All patients were nondiabetic and had no comorbidity that might influence gastric motility; nor were they receiving any prokinetic drugs. Gastric emptying rate was estimated with dynamic abdominal scintigraphy, started immediately after complete ingestion of a standard 200-kcal solid meal injected with 99mTc-labeled colloid, activity 40 MBq. Scintigraphy was performed at the rate of 23 images in 4-minute intervals for 92 minutes. Two consecutive procedures--with and without PD fluid--were performed at weekly intervals. As nutritional parameters, protein catabolic rate (PCR) and lean body mass (LBM) (based on urea and creatinine kinetics, respectively), body mass Index (BMI), and serum albumin were measured. RESULTS: All analyzed gastric emptying parameters, measured with or without dialysis fluid, were markedly prolonged in patients compared to values accepted as normal in the local scintigraphy unit. Gastric emptying half-time (T(1/2)) and percent of initial activity in minute 46 and in minute 92 were 60.5 +/- 25.0 minutes, 57.19% +/- 17.5%, and 33.8% +/- 20.9% with a full peritoneal cavity, and 63.9 +/- 28.2 minutes, 59.1% +/- 23.9%, and 33.9% +/- 24.3% with an empty peritoneal cavity. The T(1/2) and percent of initial activity after 46 and 92 minutes for healthy subjects were 39 +/- 9 minutes, 45% +/- 11%, and 15% +/- 6%, respectively. T(1/2) without dialysis fluid revealed a negative correlation with LBM and BMI values (r = -0.5, p < 0.05, and r = -0.56, p < 0.01; respectively). Patients with dialysate-free T(1/2) > 40 minutes were characterized by significantly lower serum albumin level compared to subjects with T(1/2) < 40 minutes (39.2 +/- 2.9 vs 42.9 +/- 3.6 g/L, p < 0.05). The values of all gastric emptying parameters measured for an empty abdomen were prolonged in subjects with BMI < 25 kg/m2. No difference was found between patients with and without PD fluid. CONCLUSIONS: Gastric emptying is markedly impaired in CAPD patients compared to healthy subjects. However, the presence of dialysate does not influence it significantly. Gastric emptying rate was negatively associated with the nutritional status of treated subjects. This association can be demonstrated when gastric motility is measured with an empty peritoneal cavity.

Early and late changes in myocardial function and heart rate variability in patients after myocardial revascularisation.

BACKGROUND: The purpose of the study was to evaluate the effect of myocardial revascularisation and associated improvement of left ventricular systolic function on heart rate variability in patients after myocardial infarction. MATERIAL AND METHODS: The study population consisted of 35 patients, who within the previous 6 months had suffered from myocardial infarction and in whom low dose dobutamine ventriculography revealed hibernating myocardium, whereas coronary angiography provided indications to revascularisation. CABG was performed in 22 patients, PTCA of the infarct-related artery in 13 patients. At baseline, 3 months and 3 years after the procedure radionuclide ventriculography, myocardial perfusion scintigraphy and 24hr continuous ECG recording were performed. RESULTS: After initial improvement of systolic function in ventriculography (EF = 48.63 +/- 11.6 v. 52.37 +/- 11.27 at p < 0.001) it slightly but not significantly decreased at long-term follow-up (EF = 51.8 +/- 10.77). The remaining parameters of systolic function function behaved in a similar way in radionuclide ventriculography. Diastolic function parameters did not change significantly at early and long-term follow-up. HRV measures did not change at 3 months but at 3 years both sympathetic- and parasympathetic- related parameters and global autonomic activity were diminished. At 3 years global autonomic activity and parasympathetic activity were diminished with their values similar in both groups. CONCLUSIONS: It seems that HRV measures diminish at long- -term follow-up. The type of revascularisation procedure is only of short-range value with the parameters stabilising on a similar level at long-term follow-up.