Infliximab-induced hypoglycemia, a rare but relevant side effect.

Tumor necrosis factor (TNF) inhibitors are part of the therapeutic arsenal for many immune-mediated diseases and, especially in inflammatory bowel disease (IBD), have led to a change in the management of this disease.

MEN1-associated primary hyperparathyroidism in the Spanish Registry: clinical characterictics and surgical outcomes.

Primary hyperparathyroidism is the most frequent manifestation of multiple endocrine neoplasia type 1 (MEN1) syndrome. Bone and renal complications are common. Surgery is the treatment of choice, but the best timing for surgery is controversial and predictors of persistence and recurrence are not well known. Our study describes the clinical characteristics and the surgical outcomes, after surgery and in the long term, of the patients with MEN1 and primary hyperparathyroidism included in the Spanish Registry of Multiple Endocrine Neoplasia, Pheochromocytomas and Paragangliomas (REGMEN). Eighty-nine patients (49 men and 40 women, 34.2 ± 13 years old) were included. Sixty-four out of the 89 underwent surgery: a total parathyroidectomy was done in 13 patients, a subtotal parathyroidectomy in 34 and a less than subtotal parathyroidectomy in 15. Remission rates were higher after a total or a subtotal parathyroidectomy than after a less than subtotal (3/4 and 20/22 vs 7/12, P < 0.05), without significant differences in permanent hypoparathyroidism (1/5, 9/23 and 0/11, N.S.). After a median follow-up of 111 months, 20 of the 41 operated patients with long-term follow-up had persistent or recurrent hyperparathyroidism. We did not find differences in disease-free survival rates between different techniques, patients with or without permanent hypoparathyroidism and patients with different mutated exons, but a second surgery was more frequent after a less than subtotal parathyroidectomy.

Epigenetic Deregulation of Protocadherin PCDHGC3 in Pheochromocytomas/Paragangliomas Associated With SDHB Mutations.

CONTEXT: SDHB mutations are found in an increasing number of neoplasms, most notably in paragangliomas and pheochromocytomas (PPGLs). SDHB-PPGLs are slow-growing tumors, but ∼50% of them may develop metastasis. The molecular basis of metastasis in these tumors is a long-standing and unresolved problem. Thus, a better understanding of the biology of metastasis is needed. OBJECTIVE: This study aimed to identify gene methylation changes relevant for metastatic SDHB-PPGLs. DESIGN: We performed genome-wide profiling of DNA methylation in diverse clinical and genetic PPGL subtypes, and validated protocadherin γ-C3 (PCDHGC3) gene promoter methylation in metastatic SDHB-PPGLs. RESULTS: We define an epigenetic landscape specific for metastatic SDHB-PPGLs. DNA methylation levels were found significantly higher in metastatic SDHB-PPGLs than in SDHB-PPGLs without metastases. One such change included long-range de novo methylation of the PCDHA, PCDHB, and PCDHG gene clusters. High levels of PCDHGC3 promoter methylation were validated in primary metastatic SDHB-PPGLs, it was found amplified in the corresponding metastases, and it was significantly correlated with PCDHGC3 reduced expression. Interestingly, this epigenetic alteration could be detected in primary tumors that developed metastasis several years later. We also show that PCDHGC3 down regulation engages metastasis-initiating capabilities by promoting cell proliferation, migration, and invasion. CONCLUSIONS: Our data provide a map of the DNA methylome episignature specific to an SDHB-mutated cancer and establish PCDHGC3 as a putative suppressor gene and a potential biomarker to identify patients with SDHB-mutated cancer at high risk of metastasis who might benefit from future targeted therapies.

Clinical significance and peculiarities of succinate dehydrogenase B and hypoxia inducible factor 1α expression in parasympathetic versus sympathetic paragangliomas.

BACKGROUND: Succinate dehydrogenase subunit B (SDHB) immunohistochemistry was considered a valuable tool to identify patients with inherited paraganglioma/pheochromocytoma (PGL/PCC). However, previous studies jointly analyzed 2 related but clinically distinct entities, parasympathetic head and neck paragangliomas (HNPGLs) and sympathetic PCCs/PGLs. Additionally, a role for hypoxia inducible factor-1α (HIF-1α) as a biomarker for succinate dehydrogenase (SDHx)-mutated tumors has not been studied. Here, we evaluated the utility of SDHB/HIF-1α proteins in HNPGLs and PCCs/PGLs as clinically useful biomarkers. METHODS: The SDHB/succinate dehydrogenase subunit A (SDHA)/HIF-1α immunohistochemistry analysis was performed in 158 genetically defined patients. RESULTS: Similarly to PCCs/PGLs, SDHB immune-negativity correlated with SDHx-mutations in HNPGLs (P < .0001). The HIF-1α stabilization was associated with SDHx-mutations in HNPGLs (P = .020), not in PCCs/PGLs (P = .319). However, 25% of SDHx-HNPGLs lacked HIF-1α positive cells. CONCLUSION: As in PCCs/PGLs, SDHB immunohistochemistry in HNPGLs is a valuable method for identification of candidates for SDHx-genetic testing. On the contrary, although SDHx mutations may favor HIF-1α stabilization in HNPGLs, this is not a clinically useful biomarker.

Total and subtypes of dietary fat intake and risk of type 2 diabetes mellitus in the Prevención con Dieta Mediterránea (PREDIMED) study.

Background: The associations between dietary fat and cardiovascular disease have been evaluated in several studies, but less is known about their influence on the risk of diabetes.Objective: We examined the associations between total fat, subtypes of dietary fat, and food sources rich in saturated fatty acids and the incidence of type 2 diabetes (T2D).Design: A prospective cohort analysis of 3349 individuals who were free of diabetes at baseline but were at high cardiovascular risk from the PREvención con DIeta MEDiterránea (PREDIMED) study was conducted. Detailed dietary information was assessed at baseline and yearly during the follow-up using a food frequency questionnaire. Multivariable Cox proportional hazards models were used to estimate T2D HRs and 95% CIs according to baseline and yearly updated fat intake.Results: We documented 266 incident cases during 4.3 y of follow-up. Baseline saturated and animal fat intake was not associated with the risk of T2D. After multivariable adjustment, participants in the highest quartile of updated intake of saturated and animal fat had a higher risk of diabetes than the lowest quartile (HR: 2.19; 95% CI: 1.28, 3.73; and P-trend = 0.01 compared with HR: 2.00; 95% CI: 1.29, 3.09; and P-trend < 0.01, respectively). In both the Mediterranean diet and control groups, participants in the highest quartile of updated animal fat intake had an ∼2-fold higher risk of T2D than their counterparts in the lowest quartile. The consumption of 1 serving of butter and cheese was associated with a higher risk of diabetes, whereas whole-fat yogurt intake was associated with a lower risk.Conclusions: In a Mediterranean trial focused on dietary fat interventions, baseline intake of saturated and animal fat was not associated with T2D incidence, but the yearly updated intake of saturated and animal fat was associated with a higher risk of T2D. Cheese and butter intake was associated with a higher risk of T2D, whereas whole-fat yogurt intake was associated with a lower risk of T2D. This trial was registered at www.isrctn.com as ISRCTN35739639.

Chronic Pancreatitis-Like Changes Detected by Endoscopic Ultrasound in Type 1 Diabetics Are Not Associated With Gastrointestinal Symptoms or Nutritional Deficiencies.

OBJECTIVES: Previous studies have shown changes in the pancreas of type 1 diabetic (T1-DM) patients, similar to those present in patients with chronic pancreatitis. Our aim was to analyze the prevalence of endoscopic ultrasound (EUS) criteria for chronic pancreatitis in T1-DM, to determine the association with factors related to the diabetes and to define its clinical significance. METHODS: Eighty-six T1-DM patients were prospectively included. All of them underwent EUS. Standard criteria were used. Patients were divided into 3 groups according to the number of EUS criteria they met: group A, 0 to 2 criteria; group B, 3 to 4; and group C, more than 4. Association between EUS findings and demographic or clinical factors was studied as well as the relationship between EUS abnormalities and the presence of gastrointestinal symptoms or nutritional deficiencies. RESULTS: Fifty-three patients (61.6%) showed at least 1 morphologic abnormality. Fifty-eight patients were included in group A, 21 in group B, and 7 in Group C. No significant differences were found when comparing the 3 groups. CONCLUSIONS: Chronic pancreatitis-like changes are frequent in the pancreas of T1-DM patients. These changes are not associated with demographic or clinical data. Therefore, the clinical relevance seems to be scarce.

RET Cys634Arg mutation confers a more aggressive multiple endocrine neoplasia type 2A phenotype than Cys634Tyr mutation.

OBJECTIVE: Specific germline mutations in the RET proto-oncogene are correlated with clinical features in multiple endocrine neoplasia type 2A (MEN2A); however, data are scarce regarding differences in clinical profiles dependent on the type of nucleotide and amino acid substitution at the same codon. We aimed to analyse differences in clinical risk profiles and outcomes among different amino acids encoded by codon 634. DESIGN: The study was retrospective and multicentric. METHODS: We collected data included in the Spanish Online National Database from patients with MEN2A carrying a RET proto-oncogene mutation on codon 634. The mean follow-up time was 7.6±6.9 years (1-32). RESULTS: Patients (n=173) from 49 unrelated families were C634Y carriers, and 26 patients from eight different families had C634R mutation. We found higher penetrance of medullary thyroid carcinoma, phaeochromocytoma and hyperparathyroidism (P<0.001, P=0.007 and P<0.001 respectively) in C634R carriers than in C634Y carriers. The Kaplan-Meier estimate of cumulative lymph node and distant metastases rates showed that these events occurred earlier in patients harbouring the C634R mutation (P<0.001). A multivariate adjusted Cox regression analysis indicated that the C634R mutation was an independent factor for persistent/recurrent disease (hazard ratio, 3.17; 95% CI: 1.66-6.03; P<0.001). CONCLUSIONS: Our results suggest that there could be clinical differences caused by different amino acid substitutions at codon 634; specifically, the C634R mutation was associated with a more aggressive MEN2A phenotype than the C634Y mutation.

Short-term role of the dietary total antioxidant capacity in two hypocaloric regimes on obese with metabolic syndrome symptoms: the RESMENA randomized controlled trial.

BACKGROUND: Dietary strategies seem to be the most prescribed therapy in order to counteract obesity regarding not only calorie restriction, but also bioactive ingredients and the composition of the consumed foods. Dietary total antioxidant capacity (TAC) is gaining importance in order to assess the quality of the diet. METHODS: Ninety-six obese adults presenting metabolic syndrome (MetS) symptoms completed an 8-week intervention trial to evaluate the effects of a novel dietary program with changes in the nutrient distribution and meal frequency and to compare it with a dietary pattern based on the American Heart Association (AHA) guidelines.Anthropometric and biochemical parameters were assessed at baseline and at the endpoint of the study, in addition to 48-hours food dietary records. RESULTS: Both diets equally (p > 0.05) improved MetS manifestations. Dietary TAC was the component which showed the major influence on body weight (p = 0.034), body mass index (p = 0.026), waist circumference (p = 0.083) and fat mass (p = 0.015) reductions. Transaminases (ALT and AST) levels (p = 0.062 and p = 0.004, respectively) were associated with lower TAC values. CONCLUSION: RESMENA diet was as effective as AHA pattern for reducing MetS features. Dietary TAC was the most contributing factor involved in body weight and obesity related markers reduction. TRIAL REGISTRATION: http://www.clinicaltrials.gov; NCT01087086.

Weight-loss diet alone or combined with progressive resistance training induces changes in association between the cardiometabolic risk profile and abdominal fat depots.

BACKGROUND/AIMS: A weight-loss diet alone or combined with a progressive resistance training program induced different adaptations on cardiometabolic risk, i.e. regional changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume distribution patterns. We hypothesized that a heterogeneous adipose tissue metabolism may exist between visceral fat at different discal levels. METHODS: Thirty-four obese women, aged 40-60 years, were randomized to three groups: a control group (n = 9), a diet group (WL; n = 12) with a caloric restriction of 500 kcal/day during 16 weeks, or a diet-plus-resistance-training group (WL+RT; n = 13) with the same caloric restriction and a 16-week resistance training of 2 sessions per week. RESULTS: The association pattern between abdominal fat depots and glucose metabolism variables showed a change from the L4-L5 region (preintervention) to VAT L2-L3 and SAT L2-L3 in the WL and WL+RT groups, respectively. It is noteworthy that accumulation of fat in the midthigh was not characterized by a more favorable lipid profile or glucose metabolism. CONCLUSION: Our results reinforce the importance of considering L2-L3 images to predict insulin resistance after a weight-loss diet, alone or combined with resistance training.

Effect of smoking on body weight: longitudinal analysis of the SUN cohort.

INTRODUCTION AND OBJECTIVES: Our aim was to investigate prospectively the association between two major cardiovascular risk factors: smoking and weight gain. METHODS: We prospectively evaluated 7565 individuals taking part in a dynamic cohort study over a median follow-up period of 50 months. Self-reported weight and physical activity levels had been validated previously. The adjusted mean difference in weight gain relative to never-smokers (the reference group) was estimated for different levels of tobacco exposure. RESULTS: After adjusting for age, baseline body mass index, sedentary lifestyle, changes in physical activity level, total energy intake, fiber intake, food consumption between meals, and sugary soft drink, fast food and alcohol consumption, it was found that individuals who stopped smoking during follow-up had a greater relative weight gain: men 1.63 kg (95% confidence interval [CI], 1.07-2.19 kg), and women 1.51 kg (95% CI, 1.11-1.91 kg). In addition, active smokers had a greater weight gain than never-smokers: men 0.49 kg (95% CI, 0.11-0.87 kg), and women 0.36 kg (95% CI, 0.07-0.65 kg). CONCLUSIONS: Individuals who stopped smoking during follow-up and active smokers both experienced significantly greater weight gains than never-smokers. This association between cardiovascular risk factors should be taken into account when developing prevention programs.

Evolución de los cambios en el peso corporal según hábito tabáquico: análisis longitudinal de la cohorte SUN / Effect of smoking on body weight: longitudinal analysis of the SUN cohort

Introducción y objetivos. El objetivo de este estudio es evaluar prospectivamente la asociación de dos factores de riesgo cardiovascular, el hábito tabáquico y la ganancia de peso. Métodos. Se evaluó prospectivamente a 7.565 participantes de una cohorte dinámica durante una mediana de seguimiento de 50 meses. El peso y la actividad física declarados fueron validados previamente. Como referenciase usó a los nunca fumadores, y se calcularon diferencias ajustadas de ganancia media de peso para diferentes exposiciones al tabaco. Resultados. Tras ajustar por edad, índice de masa corporal inicial, sedentarismo, cambios de actividad física, ingesta energética y de fibra, comidas entre horas, consumo de refrescos, de comida rápida y de alcohol, los participantes que dejaron de fumar durante el seguimiento presentaron una mayor ganancia relativa de peso: varones, +1,63 (intervalo de confianza [IC] del 95%, 1,07-2,19) kg; mujeres, +1,51 (IC del 95%, 1,11-1,91) kg. Los fumadores activos presentaron también mayor ganancia de peso que los nunca fumadores: varones, +0,49 (IC del95%, 0,11-0,87) kg; mujeres, +0,36 (IC del 95%, 0,07-0,65) kg. Conclusiones. Los participantes que dejaron de fumar durante el seguimiento y los fumadores activos experimentaron mayores ganancias de peso que los nunca fumadores. La asociación de estos dos factores de riesgo cardiovascular debe ser tenida en cuenta en los programas de prevención (AU)

Introduction and objectives. Our aim was to investigate prospectively the association between two major cardiovascular risk factors: smoking and weight gain. Methods. We prospectively evaluated 7565 individuals taking part in a dynamic cohort study over a median follow-up period of 50 months. Self-reported weight and physical activity levels had been validated previously. The adjusted mean difference in weight gain relative to never smokers(the reference group) was estimated for different levels of tobacco exposure. Results. After adjusting for age, baseline body mass index, sedentary lifestyle, changes in physical activity level, total energy intake, fiber intake, food consumption between meals, and sugary soft drink, fast food and alcohol consumption, it was found that individuals who stopped smoking during follow-up had a greater relative weight gain: men 1.63 kg (95% confidence interval [CI],1.07-2.19 kg), and women 1.51 kg (95% CI, 1.11-1.91 kg).In addition, active smokers had a greater weight gain than never-smokers: men 0.49 kg (95% CI, 0.11-0.87 kg), and women 0.36 kg (95% CI, 0.07-0.65 kg).Conclusions. Individuals who stopped smoking during follow-up and active smokers both experienced significantly greater weight gains than never-smokers. This association between cardiovascular risk factors should be taken into account when developing prevention programs (AU)

Genetic diagnosis of familial hypercholesterolemia using a DNA-array based platform.

OBJECTIVES: The aim of this study was to validate the Lipochip genetic diagnostic platform by assessing effectiveness, sensitivity, specificity and costs for the identification of patients with familial hypercholesterolemia (FH) in Spain. This platform includes the use of a DNA micro array, the detection of large gene rearrangements and the complete resequencing of the low-density lipoprotein receptor gene. DESIGN AND METHODS: DNA samples of patients with clinically diagnosed FH were analyzed for mutations by application of the Lipochip platform. Results obtained were confirmed by DNA sequencing and MLPA analysis by two other, independent laboratories. RESULTS: Of 808 patients tested, Lipochip detected a mutation in 66% of the cases and of these 78% were detected by the micro array. A specificity of 99.5% at a sensitivity of 99.8% was reached. A positive test result could be reported within 22 days after start of analysis. The total average screening costs of $350 per case were significantly lower compared to other existing screening programs. CONCLUSION: Lipochip provides a reliable, fast and cheap alternative for the genetic testing of patients with clinically diagnosed FH.

Changes in weight and physical activity over two years in Spanish alumni.

PURPOSE: To investigate the relationship between baseline leisure-time physical activity and changes in leisure activity during follow-up on long-term weight changes. METHODS: We evaluated prospectively 11,974 participants (university graduates) who participated in a dynamic cohort (Seguimiento Universidad de Navarra cohort) with an average follow-up of 27 months. Self-reported data from validated mailed questionnaires were used. Baseline leisure activity was assessed with a previously validated questionnaire. RESULTS: After adjusting for age, hours sitting down, smoking status, snacking, fiber intake, and consumption of sugar-sweetened beverages, fast food, and alcohol, participants who decreased their leisure activity during follow-up experienced a significant increase in body mass index (BMI; relative change): for men, 0.9% (95% confidence interval [CI] = 0.5-1.2%); for women, 1.0% (95% CI = 0.6-1.3%). Participants who increased their leisure activity during follow-up experienced a significant reduction (relative change) in BMI: for men, -0.8% (95% CI = -1.1% to -0.5%); for women, -0.6% (95% CI = -0.9% to -0.4%). This inverse association between changes in leisure activity and weight gain was significantly stronger for participants with a baseline BMI >or=25 kg x m(-2), but the absolute magnitude of this interaction effect was trivial. Baseline physical activity was not significantly associated with weight changes after 2-yr of follow-up. CONCLUSION: Longitudinal changes in leisure activity during follow-up were inversely associated with changes in body weight. The true relationships between leisure activity and body weight are likely to have been larger than observed, owing to attenuation of effects by measurement error in self-reported data.

The relationship of serum osteocalcin concentration to insulin secretion, sensitivity, and disposal with hypocaloric diet and resistance training.

CONTEXT: Bone has recently been described as exhibiting properties of an endocrine organ by producing osteocalcin that increases insulin sensitivity and secretion in animal models. OBJECTIVE AND DESIGN: We aimed to evaluate circulating osteocalcin in association with insulin sensitivity and insulin secretion in three different studies in nondiabetic subjects: one cross-sectional study in 149 men (using minimal model), and two longitudinal studies in two independent groups (one formed by 26 women, and the other by 9 men and 11 women), after a mean of 7.3 and 16.8% weight loss, and after a mean of 8.7% weight loss plus regular exercise. RESULTS: In the cross-sectional study, circulating osteocalcin was associated with insulin sensitivity, mainly in lean subjects, and with insulin secretion (only in lean subjects). A mean of 16.8%, but not 7.3% weight loss, led to significant increases in circulating osteocalcin. However, a mean of 8.7% weight loss plus regular exercise led to the more pronounced effects on the serum osteocalcin concentration, which increased in parallel to reduced visceral fat mass, unchanged thigh muscle mass, and increased leg strength and force. The postintervention serum levels of osteocalcin were associated with both insulin sensitivity (r = 0.49; P = 0.03) and fasting triglycerides (r = -0.54; P = 0.01). The change in visceral fat was the parameter that best predicted the change in serum osteocalcin, once age, body mass index, and insulin sensitivity changes were controlled for (P = 0.002). CONCLUSION: Circulating osteocalcin could mediate the role of bone as an endocrine organ in humans.

Validación de la diabetes mellitus, la hipertensión arterial y la hipercolesterolemia declaradas en la Encuesta Nacional de Salud / Validation of self-reported diabetes mellitus, hypertension and hypercholesterolemia in the Spanish National Health Survey

Fundamento y objetivo: Validar los diagnósticos de diabetes mellitus, hipertensión arterial e hipercolesterolemia declarados en la Encuesta Nacional de Salud (ENS).Material y metodo: Se seleccionó a 147 participantes del Servicio de Salud Laboral (edad media ± desviación estándar, 51,6 ± 13,5 años) a quienes se les realizaron las preguntas para diagnóstico de diabetes mellitus, hipertensión arterial e hipercolesterolemia que se usan en la ENS. A continuación, y tras obtener el consentimiento informado, se procedió a la determinación de la presión arterial, así como de la glucemia y la colesterolemia plasmáticas. Con estas mediciones, el consumo de fármacos y los antecedentes del paciente, se consideraba si el participante tenía o no las condiciones que se estaban estudiando. Se calculó la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y el índice kappa de los datos declarados frente al estándar. Para todos los datos se calculó el intervalo de confianza. Resultados: La diabetes mellitus declarada presentó una sensibilidad del 80% y una especificidad del 100%. La hipertensión arterial declarada tuvo una sensibilidad del 53,8% (punto de corte, 140/90 mmHg) o del 83,3%(punto de corte, 160/100 mmHg), siendo en ambos casos la especificidad fue superior al 97%. Finalmente, la sensibilidad hallada para la hipercolesterolemia declarada fue del 44,1% (punto de corte: colesterol total, 220 mg/dl) o del 70% (punto de corte: colesterol total, 240 mg/dl y lipoproteínas de baja densidad, > 130 mg/dl). En ambos casos la especificidad de la hipercolesterolemia declarada fue superior al 91%.Conclusiones: Los datos declarados son un modo eficiente de obtener información sobre diagnósticos de diabetes mellitus, hipertensión arterial e hipercolesterolemia. Sin embargo, infradiagnostican, sobre todo, los casos de hipertensión arterial de grado 1 o hipercolesterolemia leve (AU)

Background and objetive: To assess the validity of self-reported diabetes mellitus, hypertension and hypercholesterolemia in the Spanish National Health Survey (NHS).Material and method: A total of 147 participants were selected from the occupational health department (mean age ± SD, 51.6 ± 13.5 years) and were questioned about diabetes mellitus, hypertension and hypercholesterolemia, using the NHS questions. Then, after informed consent had been obtained, blood pressure, glycemia and cholesterolemia were objectively measured. The gold standard was based on these measurements, documentation of a written medical diagnosis, or the use of specific drugs for these conditions. The sensitivity, specificity, positive predictive value, negative predictive value, and Kappa index of the self-reported data were calculated and compared with the gold standard. For all results, 95% confidence intervals were calculated. Results: Self-reported diabetes mellitus had a sensitivity of 80% and a specificity of 100%. Self reported hypertension had a sensitivity of 53.8% (cut-off: 140/90 mmHg) or 83.3% (cut-off: 160/100 mmHg); in both cases specificity was above 97%. The sensitivity obtained for self-reported hypercholesterolemia was 44.1% (cut-off: total cholesterol 220 mg/dl) or 70% (cut-off: total cholesterol 240 mg/dl and low-density lipoprotein > 130 mg/dl). In both cases, self reported hypercholesterolemia had a specificity of more than 91%.Conclusions: Self-reported data are an efficient way to obtain information about diagnoses of diabetes mellitus, hypertension and hypercholesterolemia. However, self-reported data may under diagnose hypertension or hypercholesterolemia, particularly in cases of stage 1 hypertension or borderline hypercholesterolemia (AU)

[Trends in obesity, diabetes mellitus, hypertension and hypercholesterolemia in Spain (1997-2003)]. / Tendencias de la obesidad, diabetes mellitus, hipertensión e hipercolesterolemia en España (1997-2003).

BACKGROUND AND OBJECTIVE: To evaluate the trend in the prevalence in Spain of obesity, diabetes mellitus, hypertension and hypercholesterolemia. MATERIAL AND METHOD: The Spanish National Health Surveys (ENS) of 1997, 2001, 2003, which select representative samples of the Spanish general population were used. In total, 49,113 participants of both sexes were included. Self-reported data about weight and height were used to estimate the body mass index. The prevalence of diabetes, hypertension and hypercholesterolemia was estimated. Linear trend chi2 tests and multivariate logistic regression models adjusted for age, sex and educational level, were estimated. RESULTS: A significant increasing temporal trend for the prevalence of obesity, diabetes, hypertension and hypercholesterolemia was found for the studied period (1997-2003) according to the ENS. We found that the increased trend in obesity prevalence was restricted to younger participants with a significant interaction. CONCLUSIONS: The prevalence of obesity, diabetes mellitus, hypertension and hypercholesterolemia has increased in Spain between 1997 and 2003.

Tendencias de la obesidad, diabetes mellitus, hipertensión e hipercolesterolemia en España (1997-2003) / Trends in obesity, diabetes mellitus, hypertension and hypercholesterolemia in Spain (1997-2003)

Fundamento y objetivo: Evaluar la tendencia de la prevalencia en España de la obesidad, diabetes mellitus, hipertensión e hipercolesterolemia. Material y método: Se usaron las Encuestas Nacionales de Salud (ENS) de 1997, 2001 y 2003, todas ellas representativas de la población española. Sumando las bases de datos se valoró en total a 49.113 personas de ambos sexos. Para calcular el índice de masa corporal se usó la información referente al peso y la talla autorreferidos. Se estimó la prevalencia de diabetes, hipertensión e hipercolesterolemia. Se realizaron tests de la *2 de tendencia lineal y regresiones logísticas multivariantes para ajustar por edad, sexo y nivel educativo. Resultados: Se estimó una tendencia temporal significativa de incremento de la prevalencia de obesidad, diabetes, hipertensión arterial e hipercolesterolemia en el período estudiado (1997-2003). Se observó que el incremento de la prevalencia de obesidad sólo afecta a los participantes más jóvenes, con una interacción significativa. Conclusiones: La prevalencia de obesidad, diabetes mellitus, hipertensión e hipercolesterolemia ha aumentado en España entre los años 1997 y 2003

Background and objective: To evaluate the trend in the prevalence in Spain of obesity, diabetes mellitus, hypertension and hypercholesterolemia. Material and method: The Spanish National Health Surveys (ENS) of 1997, 2001, 2003, which select representative samples of the Spanish general population were used. In total, 49,113 participants of both sexes were included. Self-reported data about weight and height were used to estimate the body mass index. The prevalence of diabetes, hypertension and hypercholesterolemia was estimated. Linear trend *2 tests and multivariate logistic regression models adjusted for age, sex and educational level, were estimated. Results: A significant increasing temporal trend for the prevalence of obesity, diabetes, hypertension and hypercholesterolemia was found for the studied period (1997-2003) according to the ENS. We found that the increased trend in obesity prevalence was restricted to younger participants with a significant interaction. Conclusions: The prevalence of obesity, diabetes mellitus, hypertension and hypercholesterolemia has increased in Spain between 1997 and 2003