Gemma Rojo-Martínez

Evolución de la prevalencia de la diabetes tipo 2 en población adulta española

La diabetes mellitus tipo 2 ha sido catalogada como la epidemia del siglo XXI tanto por su creciente magnitud como por su impacto en la enfermedad cardiovascular, primera causa de mortalidad en las sociedades desarrolladas. En esta revision analizamos la evolucion de la prevalencia de la diabetes en Espana en los ultimos anos, basandonos en los distintos estudios transversales realizados. Segun este analisis, las estimaciones previas han sido superadas, y actualmente se puede estimar que entre el 10 y el 15% de la poblacion adulta espanola tiene diabetes. Varios factores, como el cambio de criterios diagnosticos, el envejecimiento de la poblacion, la menor mortalidad de los diabeticos o un verdadero aumento de la incidencia, han podido influir en este fenomeno.

Prevalence of latent autoimmune diabetes of adults (LADA) in Southern Spain

OBJECTIVE To study the prevalence of diabetes mellitus and islet autoantibodies in an adult population from Southern Spain. RESEARCH AND METHODS A cross-sectional study in Southern Spain of 1226 people, age 18-65 years. Clinical data were obtained and a blood sample taken to measure autoantibodies (glutamic acid decarboxylase antibodies (GADAb), tyrosine phosphatase antibodies (IA2Ab), and insulin antibodies (IAA)). An oral glucose tolerance test (OGTT) was also given to 982 of the subjects. RESULTS The overall prevalence of diabetes mellitus according to the WHO 1979 criteria was 10.9% and according to the ADA 1997 criteria it was 14.7% (8.8% were unaware of their diabetes). The prevalence of impaired fasting glucose (IFG) was 12.4% and of impaired glucose tolerance (IGT) 11.5%. The prevalence of GADAb+ in the general population was 0.9% and in the diabetic population 3.7%. There were no significant differences between groups in the prevalence of IA2Ab or IAA (both were 0.8% in the general population). Of the three autoantibodies studied, only GADAb were significantly different in the diabetic population (P=0.0006). CONCLUSIONS The prevalence of Type 2 diabetes and LADA are high in the south of Spain.

Effect of long-term administration of cross-sex hormone therapy on serum and urinary uric acid in transsexual persons.

BACKGROUND Transsexual persons afford a very suitable model to study the effect of sex steroids on uric acid metabolism. DESIGN This was a prospective study to evaluate the uric acid levels and fractional excretion of uric acid (FEUA) in a cohort of 69 healthy transsexual persons, 22 male-to-female transsexuals (MFTs) and 47 female-to-male transsexuals (FMTs). The subjects were studied at baseline and 1 and 2 yr after starting cross-sex hormone treatment. RESULTS The baseline levels of uric acid were higher in the MFT group. Compared with baseline, uric acid levels had fallen significantly after 1 yr of hormone therapy in the MFT group and had risen significantly in the FMT group. The baseline FEUA was greater in the FMT group. After 2 yr of cross-sex hormone therapy, the FEUA had increased in MFTs (P = 0.001) and fallen in FMTs (P = 0.004). In MFTs, the levels of uric acid at 2 yr were lower in those who had received higher doses of estrogens (P = 0.03), and the FEUA was higher (P = 0.04). The FEUA at 2 yr was associated with both the estrogen dose (P = 0.02) and the serum levels of estradiol-17beta (P =0.03). In MFTs, a correlation was found after 2 yr of therapy between the homeostasis model assessment of insulin resistance and the serum uric acid (r = 0.59; P = 0.01). CONCLUSIONS Serum levels of uric acid and the FEUA are altered in transsexuals as a result of cross-sex hormone therapy. The results concerning the MFT group support the hypothesis that the lower levels of uric acid in women are due to estrogen-induced increases in FEUA.

Prevalence of obesity in south-east Spain and its relation with social and health factors

Recent studies have confirmed important regional differences in the prevalence of obesity, as well as a tendency for this prevalence to increase. Determination of the social factors involved in obesity may be very useful to design intervention and prevention strategies. This transverse study was undertaken in Pizarra (Malaga, Spain) from a random sample of the population between 18 and 65 years of age (n = 1226). All participants were interviewed and given a physical examination. Standardized anthropometrical measurements were made, and a baseline blood sample was taken after an oral glucose tolerance test. The overall prevalence of obesity (BMI > 30 kg/m2) was 28.8%. This figure increased continuously from 10% in the group aged 18–25 years to above 50% in the groups aged over 55 years. This prevalence is higher than that reported in most other studies in Spain. The obese persons ate differently, at least from a qualitative viewpoint, probably more saturated fats and fewer unsaturated fats, and had a different behaviour concerning alcohol and smoking. Marital status was related with the rate of obesity, and the close relation between the level of education and the risk of obesity was confirmed (OR = 3.8 for being obese and having no education compared to having university studies). The most important consequence of the study was that all these factors are potentially modifiable and preventable. An increased level of general education in the population may well contribute decisively to a reduction in the prevalence of obesity.

Incidence of type 2 diabetes in southern Spain (Pizarra Study)

Background  Few European studies have used an oral glucose tolerance test (OGTT) to examine the incidence of type 2 diabetes. We determined the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes in a population from southern Spain.

Hypovitaminosis D and incidence of obesity: a prospective study

The aim of this study was to assess the relationship between obesity and vitamin D status cross-sectionally, the relationship between obesity and the incidence of hypovitaminosis D prospectively and inversely the relationship between vitamin D status and incidence of obesity in a population-based cohort study in Spain. At baseline (1996–1998), 1226 subjects were evaluated and follow-up assessments were performed in 2002–2004 and 2005–2007, participants undergoing an interview and clinical examination with an oral glucose tolerance test. At the second visit, 25-hydroxyvitamin D and intact parathyroid hormone concentrations were also measured. Prevalence of obesity at the three visits was 28.1, 36.2 and 39.5%, respectively. The prevalence of vitamin D deficiency (25-hydroxyvitamin D ⩽20 ng/ml (⩽50 nmol/l)) was 34.7%. Neither obesity at baseline (OR=0.98, 95% CI: 0.69-1.40, P=0.93) nor the development of obesity between baseline and the second evaluation (OR=0.80, 95% CI: 0.48–1.33, P=0.39) were significantly associated with vitamin D status. In subjects who were non-obese (BMI <30 kg/m2) at the second evaluation, 25-hydroxyvitamin D values ⩽17 ng/ml (⩽42.5 nmol/l) were significantly associated with an increased risk of developing obesity in the next 4 years (OR=2.35, 95% CI: 1.03–5.4, P=0.040 after diverse adjustments). We conclude that vitamin D deficiency is associated with an increased risk of developing obesity.

Déficit de yodo y función tiroidea en una población de mujeres embarazadas sanas

Fundamento y objetivo: Estudios realizados en Espana demuestran que la ingesta de yodo en mujeres gestantes esta por debajo de los requerimientos nutricionales. Con este estudio se pretende comprobar la ingesta de yodo y su relacion con el volumen tiroideo a lo largo del embarazo en una poblacion de mujeres embarazadas en el sudeste espanol. Pacientes y metodo: Se ha estudiado a 520 mujeres sanas embarazadas a lo largo de los 3 trimestres de embarazo. Como grupo control se ha estudiado a 373 mujeres no gestantes. Se han medido las siguientes variables: hormona tirotropa (TSH) y T3 y T4 libres, tiroglobulina, anticuerpos antiperoxidasa, yoduria y volumen tiroideo. Resultados: Tanto en las controles como en las mujeres embarazadas en el primer trimestre, las medianas de las yodurias estuvieron por debajo de 100 µg/l, para aumentar progresiva y significativamente en el segundo y tercer trimestres. El volumen tiroideo se incremento en el segundo y tercer trimestres respecto al primero. Los valores de TSH fueron menores en el primer trimestre que los de las controles, para aumentar significativamente en el tercer trimestre. La T4 libre disminuyo significativamente en el tercer trimestre. Los valores de TSH se han correlacionado de forma negativa y significativa con el volumen tiroideo (r = ?0,22; p = 0,005). Conclusiones: La ingesta de yodo en las mujeres embarazadas de Malaga es baja. Los resultados indican una situacion de deficit de la funcion tiroidea secundaria al deficit de yodo que se agrava a lo largo del embarazo. Los datos apoyan la conveniencia de administrar sistematicamente un suplemento yodado en la mujer embarazada sana.

Stearoyl-CoA desaturase-1 is associated with insulin resistance in morbidly obese subjects.

Animal studies have revealed the association between stearoyl-CoA desaturase 1 (SCD1) and obesity and insulin resistance. However, only a few studies have been undertaken in humans. We studied SCD1 in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) from morbidly obese patients and their association with insulin resistance, sterol regulatory element binding protein-1 (SREBP-1) and ATPase p97, proteins involved in SCD1 synthesis and degradation. The insulin resistance was calculated in 40 morbidly obese patients and 11 overweight controls. Measurements were made of VAT and SAT SCD1, SREBP-1 and ATPase p97 mRNA expression and protein levels. VAT and SAT SCD1 mRNA expression levels in the morbidly obese patients were significantly lower than in the controls (P = 0.006), whereas SCD1 protein levels were significantly higher (P < 0.001). In the morbidly obese patients, the VAT SCD1 protein levels were decreased in patients with higher insulin resistance (P = 0.007). However, SAT SCD1 protein levels were increased in morbidly obese patients with higher insulin resistance (P < 0.05). Multiple linear regressions in the morbidly obese patients showed that the variable associated with the SCD1 protein levels in VAT was insulin resistance, and the variables associated with SCD1 protein levels in SAT were body mass index (BMI) and ATPase p97. In conclusion, these data suggest that the regulation of SCD1 is altered in individuals with morbid obesity and that the SCD1 protein has a different regulation in the two adipose tissues, as well as being closely linked to the degree of insulin resistance.

Plasma visfatin concentrations in severely obese subjects are increased after intestinal bypass

Objective: Visfatin has shown to be increased in obesity and in type 2 diabetes. The aim of this study was to determine the change in plasma visfatin in severely obese (SO) persons after weight loss following bariatric surgery in relation to glucose concentration.

Dietary fatty acids and insulin secretion: a population-based study

Objective:Few epidemiological studies have examined the relationship of dietary fatty acids, especially MUFA, with the interrelation between insulin secretion and insulin resistance. We assessed the relation of dietary fatty acids with insulin secretion in a free-living population.Design and setting:This cross-sectional, population-based study was undertaken in Pizarra, a small town in Spain.Subjects and methods:Anthropometrical data were collected for 1226 persons selected randomly from the municipal census, 538 of whom (randomly chosen) were given a prospective, quantitative, 7-day nutritional questionnaire. The fatty acid composition of the serum phospholipids was used as a biological marker of the type of fat consumed. Beta-cell function (βCFI) and insulin-resistance index (IRI) were estimated by the Homeostasis Model Assessment.Results:To determine which factors influence the variability of the βCFI, we analyzed the variance of the βCFI according to sex, the presence of carbohydrate metabolism disorders and the different components of the diet, adjusting the models for age, body mass index (BMI) and IRI. The dietary MUFA and polyunsaturated fatty acids (PUFA) contributed to the variability of the βCFI, whereas only the proportion of serum phospholipid MUFA, but neither the saturated fatty acids nor the PUFA accounted for part of the variability of the βCFI in a multiple regression analysis.Conclusion:The results of this population-based study corroborate the results of other clinical and experimental studies suggesting a favorable relationship of MUFA with β-cell insulin secretion.Sponsorship:Fondo de Investigación Sanitaria, Junta de Andalucía and the Asociación Maimónides.