Antibiotic prescribing over the last 16 years: fewer antibiotics but the spectrum is broadening.

The purpose of this study was to quantify the antibiotics prescribed in the outpatient setting of all primary health care professionals in Catalonia during 1992-2007. We calculated prescribed defined daily doses per 1,000 inhabitants and day (DID) from data provided by the Catalonian Health Service. The antibiotics analysed belonged to the J01 group (ATC/DDD classification). The overall prescribing of antibacterials has decreased by 11.9% during this period (1992: 16.75 DID, 2007: 14.75 DID). During this 16-year period, an increase was observed for penicillins (from 46.1% in 1992 to 59.6% in 2007) and for quinolones (from 13.3% to 15.7%). The prescription of cephalosporins remained steady and, conversely, a decrease in macrolides was found (from 14.8% to 12.2%). The leading antibiotic prescribed in 2007 was amoxicillin plus clavulanic acid (5.15 DID), followed by amoxicillin (2.95 DID). The former has increased by 84.4% since 2002. Penicillin V prescribing reached a peak in 2007 with 0.034 DID. There has been a slight reduction in antibiotic prescription in this 16-year study, with an increase of penicillins, mainly at the expense of those of broader antibacterial spectrum. Awareness of the rational use of antibiotics is mandatory, basically aimed at reducing the overall prescribing of antibiotics and encouraging those with a narrower spectrum.

Clinical utility of a combination of tumour markers in the diagnosis of malignant pleural effusions.

BACKGROUND: The aim of the present study was to evaluate the diagnostic value of the tumour markers carcinoembryonic antigen (CEA), carbohydrate antigens CA 125, CA 15.3, CA 19.9 and tumor-associated glycoprotein 72 (TAG 72) in the pleural fluid (PF) of patients with pleural effusions of different etiologies. PATIENTS AND METHODS: One hundred and fifty-five patients with pleural effusions (40 malignant, 84 benign and 31 paraneoplastic) were studied prospectively. The concentration of the tumour markers in serum and PF were measured by magnetic particle enzyme immunoassay. The PF to serum (PF/S) concentration ratios were calculated. RESULTS: The concentrations of CEA, CA 15.3, CA 19.9 and TAG 72 in PF and the PF/serum ratios were significantly higher in effusions of malignant and paraneoplastic origin than in those of benign origin. The receiver operating characteristic (ROC) curves were calculated for each marker and the diagnostic cut-off point was selected as the value that offered a specificity of 100% (CEA: 6.5 ng/ml; CA 15.3:62.4 IU/l; TAG 72:10.9 IU/l). CEA presented the greatest sensitivity [45% in the malignant group, 38.7% in the paraneoplastic group, and 41.4% in the pooled group (combined malignant and paraneoplastic)]. TAG 72 presented the largest area under the curve (0.89 in the malignant group and 0.80 in the pooled group). The diagnostic efficacy of the PF/S ratios was not better than measurement of the tumour markers in pleural fluid. The highest diagnostic accuracy for the diagnosis of malignant pleural effusions was achieved by grouping the markers in a panel comprising CEA, CA 15.3 and TAG 72; this showed a sensitivity of 75% and a negative predictive value of 79.1% . In the subgroup of patients with negative cytology, the sensitivity was 41.2% for CEA, 35.5% for CA 15.3 and 33.3% for TAG 72. The combination of these three markers achieved a sensitivity of 84.6%. CONCLUSION: The combined measurement of CEA, CA 15.3 and TAG 72 in pleural fluid is a useful complementary test in the differential diagnosis of pleural effusions of malignant origin.

Clinical value of CEA and CA125 regarding relapse and metastasis in resectable non-small cell lung cancer.

BACKGROUND: The aim of the present study was to evaluate the value of serum Carcinoembryonic Antigen (CEA) and CA125 antigen assay for monitoring the activity of non-small cell lung cancer (NSCLC) after curative surgical resection. PATIENTS AND METHODS: Serum CEA and CA 125 were determined preoperatively and at every postoperative visit, in 113 patients with NSCLC (TNM stages I, II, IIIA). Both markers were assayed by magnetic particle enzyme immunoassay. RESULTS: Tumor recurrence was more frequent in patients with preoperative CA 125 levels above the cut-off (15 U/ml) (28 out of 47) (59.5%) than in those with low values (18 out of 66) (27.2%) (p < 0.001). The 36-month disease-free survival was lower for patients with elevated CA 125 (37%) than among those with low levels (72%) (p = 0.006). High CA 125 was an independent predictor of the risk of postoperative recurrence (Hazard Ratio: 3.02)(95% CI: 1.41-6.49). No relationship was detected between preoperative serum CEA and risk of recurrence. High preoperative CA125 indicated elevated risk for disseminated recurrence (Hazard Ratio: 7) (95% CI: 2.39-20.51), but not for locoregional failure. No significance was detected for CEA, either in locoregional or disseminated recurrence. Forty-six subjects (40.7%) developed tumor recurrence. At the diagnosis of relapse, serum CEA was elevated in 16 patients (34.7%) and CA125 in 26 (56.5%). Sensitivity was higher in the case of disseminated recurrence (63% for CA125 and 43.3% for CEA) and decreased in locoregional relapse (43.7% for CA125 and 18.7% for CEA). The specificity was 97% for CEA and 59% for CA125. CONCLUSION: Serum CA125 is a useful prognostic marker in NSCLC. The predictive information is especially useful to estimate the risk of disseminated recurrence. Serial determinations of CEA and CA125 during the postoperative follow-up do not show enough sensitivity/specificity to recommend their use for diagnosis of tumor relapse.

The contribution of the CEA marker to CA 15.3 in the follow-up of breast cancer.

PURPOSE OF INVESTIGATION: The clinical use of tumor markers during breast cancer follow-up is still surrounded by controversy. The objective of this study consisted of determining the contribution of the CEA marker to CA 15.3 in the follow-up of breast cancer patients as applied to clinical practice. METHODS: Three hundred and eighteen cases of women with breast cancer were analyzed retrospectively as far as the sensitivity, the specificity and the positive and negative predictable values of the CA 15.3 and CEA markers. RESULTS: Of the 318 patients, 59 suffered a relapse during the study. After evaluation of both markers the sensitivity was 56.8% (CA 15.3: 47.4%), the specificity 85.3% (CA 15.3: 88.4%), the positive predictable value was 46.4% (CA 15.3: 48.2%) and the negative predictable value was 89.41% (CA 15.3: 88%). CONCLUSIONS: The low sensitivity of studied tumor markers proved of limited use on a clinical scale.

Utilidad del marcador cea en el seguimiento del cáncer de mama / The value of tumour marker cea in the follow up of breast cancer

El uso clínico de los marcadores tumorales en el seguimiento del cáncer de mama es controvertido. En 1.920 muestras de suero de 318 mujeres con historia de cáncer de mama, se analizó de forma retrospectiva la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo del marcador CEA. Un total de 59 pacientes recidivaron durante el estudio. La sensibilidad fue de 20,3 por ciento, la especificidad de 95,7 por ciento. El valor predictivo positivo de 52,1 por ciento y el valor predictivo negativo de 84,0 por ciento. La baja sensibilidad del marcador tumoral limita la utilidad clínica (AU)

Prognostic value of carcinoembryonic antigen, CA 19-9 and CA 72-4 in gastric carcinoma.

The prognostic value of preoperative serum levels of carcinoembryonic antigen (CEA), CA 19-9 and CA 72-4 tumor markers was investigated in patients with gastric cancer. Eighty-two patients who underwent surgical resection of gastric cancer were entered in the study. Correlation analyses showed that CA 72-4 was more frequently positive in patients with advanced tumors (p = 0.04), lymph node invasion (p = 0.02), liver metastasis (p = 0.02) and peritoneal involvement (p = 0.03). CA 19-9 was more frequently positive in patients with advanced tumors (p = 0.01) and with serosal (p = 0.04), lymph node (p = 0.008) and peritoneal involvement (p = 0.02). CEA was more frequently positive in patients with liver metastasis (p = 0.03). Low 3-year cumulative survival was significantly associated with elevated serum levels of CA 72-4 (p = 0.004), CA 19-9 (p = 0.001) and CEA (p < 0.001). Age, tumor stage and CA 72-4 provided prognostic information in the multivariate analysis. Patients with elevated serum levels of CA 72-4 showed a 4.2 times higher risk of death than patients with low levels of the marker. Our results suggest that CA 72-4 has prognostic value in gastric cancer, and patients with a high preoperative serum level of CA 72-4 have a greater risk of death due to gastric cancer.

[Usefulness of the percentage of free prostatic specific antigen in the differential diagnosis between benign prostatic hyperplasia and prostate cancer]. / Utilidad de la fracción libre del antígeno prostático específico en el diagnóstico diferencial entre hiperplasia prostática benigna y cáncer de próstata.

BACKGROUND: PSA (prostatic specific antigen) is the most used tumor marker to monitor prostate cancer (PC). It is an acceptably sensitive test. Molecular forms of PSA give a chance to improve its specificity. We have evaluated the usefulness of the ratio free PSA/total PSA (f-PSA/t-PSA%) to diagnose prostate cancer, in the range between 4 and 20 ng/ml; i.e. the interval in which values overlap for patients with PC and benign prostatic hyperplasia (BPH) in our environment. PATIENTS AND METHODS: Prospective study on 269 patients, 73 with PC and 196 with BPH. Both t-PSA and f-PSA were determined using microparticles enzyme immune assay (MEIA) with AXSYM (Abbott) analyzer. RESULTS: Statistically significant differences were evidenced in f-PSA/t-PSA% for patients with PC vs. BPH; but that did not happen for t-PSA values. Sensitivity and specificity values were established for different cut-off points. ROC curve analysis proved diagnostic efficacy was better for f-PSA/t-PSA% than for t-PSA. CONCLUSIONS: f-PSA/t-PSA percentage is a useful tool for the differential diagnosis between PC and BPH. A ratio lower than 12% selects a population with high risk of cancer. A percentage over 18% is useful to avoid or delay the indication of biopsy.

Time-dependency of the prognostic effect of carcinoembryonic antigen and p53 protein in colorectal adenocarcinoma.

BACKGROUND: This study examined the prognostic information regarding the risk of postoperative tumor recurrence obtained by simultaneous determination of preoperative serum carcinoembryonic antigen (CEA) and immunohistochemical expression of p53 protein in tumor tissue from patients with colorectal carcinoma. METHODS: A retrospective study of 174 patients (AJCC/UICC Stages I, II and III) was conducted. Serum CEA levels were determined by an enzyme-linked immunoadsorbent assay. Immunohistochemical expression of nuclear p53 protein was assessed in formalin fixed, paraffin embedded archival tumor tissue. The results of both factors were categorized by clinical and histopathologic variables. The relative prognostic significance of all factors with regard to disease free survival was assessed by Cox proportional hazards regression analysis. The stability of the predictive value of both markers was assessed: 1) by splitting the follow-up into three intervals and performing separate analyses for each period and 2) graphically by plotting the corresponding cumulative hazards ratio along the follow-up. RESULTS: Eighty-two (47%) tumors manifested overexpression of p53 protein and 60 tumors (34.4%) exhibited elevated serum CEA levels (cutoff value of 5 ng/mL). p53 positive immunostaining and elevated CEA levels were associated with low cumulative disease free survival at 60 months' of follow-up, and proved to have independent prognostic significance. Analysis performed in different time periods of follow-up showed that the prognostic effect of both markers was not stable over time. The predictive significance of CEA and p53 changed along the study periods. An elevated preoperative CEA level was an indicator of a high risk of recurrence only during the first 2 years after surgery (hazards ratio, 3.26; 95% confidence interval 95% CI, 1.65-6.42). The presence of p53 immunoreactivity in the primary tumor was an indicator of a high risk of recurrence only after the first year of follow-up (hazards ratio, 4.02; 95% CI, 1.68-9.6). CONCLUSIONS: The serum CEA level and expression of p53 protein provide complementary prognostic information. Time-dependency of the prognostic influence of both parameters should be taken into consideration when establishing postoperative predictive estimations.

[Interferon treatment of chronic viral hepatitis in Catalonia, Spain. Retrospective analysis]. / Tratamiento de la hepatitis crónica viral con interferón en Cataluña. Análisis retrospectivo.

AIM: To analyze the results of interferon treatment in chronic hepatitis B and C in Catalonia, Spain, during the first two years of the Assessment Board of the therapeutic use of interferon. MATERIAL AND METHODS: A retrospective analysis of the results of 2,142 applications for interferon treatment for chronic hepatitis B (n = 158) and C (n = 1,970) from January, 1993 to December, 1994 presented to the Interferon Assessment Board, was performed by the study of the data of the applications-questionnaires send by the applying physicians. RESULTS: The global rate of response to the questionnaires was of 85%. For chronic hepatitis C, three treatment schedules were evaluated included 936 cases out of the 1,931 authorizations. A sustained response was observed in 20% of the cases treated with 3 MU of interferon for 6 months, in 32% of those treated over 12 months and 20% of those treated with 5-6 MU of interferon for 6 months. The patients with chronic hepatitis B were divided into 2 groups in relation to the presence or absence of HBeAg. Of the 153 applications, 34 belonging to HBeAg positive patients and 52 anti-HBe positive patients who received interferon treatment at 5-10 MU three times per week for 4-6 months were evaluated. Sustained response was observed in 44% of the chronic hepatitis HBeAg positive cases and in 25% of the anti-HBe cases treated. In general, response to treatment was higher in females and in those subjects under the age of 40 years than in male and in older subjects. No differences were observed in the response among the different types of interferon. Withdrawal from treatment due to adverse effects or because of the patient's wish was similar among the patients with chronic hepatitis B (5%) and C (3%), being higher in those undergoing treatment for a longer period of time. CONCLUSIONS: The data obtained from the Interferon Assessment Board for the treatment of viral hepatitis demonstrates the use of very variable schedules of this drug, especially in chronic 85% and complete evaluation was achieved in 54% of the chronic hepatitis B and in 48% of the cases of chronic hepatitis C.

The age at which meat is first included in the diet affects the incidence of iron deficiency and ferropenic anaemia in a group of pre-school children from Madrid.

A study was made into the effect of the age at which meat was first included in the diet on a series of haematological parameters and biochemical indicators of iron status in 94 pre-school children (aged 2-6 years) from Madrid (Spain). Those children who first took meat during their eighth month of life or earlier (Group A) showed better iron status that did those who were introduced to meat later (Group B). Significant differences were found in hemoglobin levels (P < 0.01), mean corpuscular haemoglobin (MCH) (P < 0.05), serum ferritin (P < 0.05), transferrin levels (P < 0.05) and total iron binding capacity (TIBC) (P < 0.001). Some 13.8% of all subjects showed iron deficiency and 5.3% showed ferropenic anaemia. These latter subjects were the last to have meat included in their diets (9.3 +/- 1.2 months compared to 7.4 +/- 2.0 months in those without ferropenic anaemia) (P < 0.05). It would appear that the age at which meat is included in the diet has an important effect on iron status in pre-school children. Delaying its inclusion beyond the age of eight months seems to be associated with an impairment of later iron status.

[Dietary cholesterol as a conditioner of ingestion of other nutrients and various blood parameters in young women]. / El colesterol dietético como condicionante de la ingesta de otros nutrientes y de diversos parámetros sanguíneos en mujeres jóvenes.

The aim of the study was to determine the effects of cholesterol intakes of greater (HC) or less than 300 mg/day (LC) (the upper advisable limit for the control of cholesterolaemia and the risk of cardiovascular disease) on a range of blood parameters, and to determine any influence such intakes might have on the consumption of food, energy and nutrients. The study subjects we one hundred and thirty young women. Food intake was determined using a 7-day dietary record (including a Sunday). A range of serum lipid parameters, and haematological and biochemical indicators of iron status were also determined. The percentage discrepancy between observed energy intake and theoretical energy expenditure was greater amongst LC subjects (9.7 +/- 18.8% compared to 5.5 +/- 24.4% in HC subjects) (P < 0.05). Analysis of covariance was therefore performed with respect to the degree of underestimation/overestimation of intake. The comparison of the adjusted means showed that HC subjects consumed greater quantities of eggs and meat and less alcohol, than did LC subjects. HC subjects also showed greater intakes of protein, carbohydrates, total fats, monounsaturated fatty acids, polyunsaturated fatty acids, saturated fatty acids, cholesterol, riboflavin, niacin, folic acid, vitamin E, zinc and iron. At blood level, HC subjects showed greater quantities of red blood cells, haemoglobin and HDL cholesterol. No significant differences were seen between LC and HC subjects for the remaining blood and biochemical parameters investigated. The development of criteria for the greatest protection against cardiovascular disease whilst maintaining good nutritive condition, is the subject of studies soon to be commenced. Women may need different advice to men, owing to their greater need of iron. Greater quantities of foods rich in haem iron, such as meat and fish, might be appropriate for the female population.

[Relationship between the number of daily meals and the energy and nutrient intake in the elderly. Effect on various cardiovascular risk factors]. / El número de comidas diarias como condicionante de la ingesta de alimentos energía y nutrientes en ancianos. Influencia en relación con diversos factores de riesgo cardiovascular.

The metabolic consequences of the consumption of a diet depend, in part, on the frequency and distribution of meals. The aim of the present study was to examine the number of meals taken per day by elderly persons, and to analyse the relationship between the number of meals per day on the intake of energy and nutrients, the incidence of obesity/overweight, and different cardiovascular risk factors. Food intake was monitored for five consecutive days using 'precise individual weighing' for institutionalised subjects (n = 58), and by means of a 'food intake record' for independent subjects (n = 92). The number of meals taken per day was recorded, along with anthropometric data, blood pressure and serum lipid and lipoprotein levels. No subject took only one meal per day, 7.3% took two, 56.7% took three, 33.3% took four and 2.7% took five. Only 10% of subjects took a mid-morning meal. Breakfast and merienda (a light evening snack) were the meals most frequently omitted. A positive, significant relationship was found to exist between the number of meals taken per day and the intake of fibre (r = 0.2737), thiamin (r = 0.1671), pyridoxine (r = 0.2060), magnesium (r = 0.2423) and the percentage of energy provided by carbohydrates (r = 0.2144). Women subjects who took 2-3 meals per day showed greater body mass indices and a greater proportion were overweight/obese compared to those who took 4-5 meals per day. Subjects who took 4-5 meals per day showed higher levels of HDL-cholesterol and lower levels of LDL-cholesterol/HDL-cholesterol and cholesterol/HDL-cholesterol than did those who took fewer meals per day. Inverse, significant relationships were also found between the number of meals per day and serum cholesterol (r = 0.2297) and LDL-cholesterol levels (r = 0.1984). Taking into account energy and nutrient intakes, the incidence of obesity/overweight and serum lipid and lipoprotein levels, the consumption of 4-5 meals per day would seem more advisable for the elderly than the taking of fewer meals.

The influence of meat consumption on dietary data, iron status and serum lipid parameters in young women.

In a group of 130 women of fertile age (24.5 +/- 2.7 years), the consumption of meat and meat products was evaluated in order to determine the effect of this food group on blood and biochemical parameters that act as indicators of iron status, and on a range of serum lipid parameters that indicate cardiovascular risk. Food intake was monitored using a "Food Record" for seven days, including a Sunday. Subjects were divided into two groups: those who took > or = 100 g/day of meat (25th percentile) (high consumption--HC) (n = 102), and those with lesser intakes (low consumption--LC) (n = 28). Dietary data were adjusted to take into account differences in discrepancies in reporting between the two groups. The greater consumption of meat observed in HC subjects, despite its association with greater intakes of lipids (both in g/day and % of energy) and cholesterol (in mg/day and mg/1000 Kcal), did not seem to be related to any impairment of blood lipid profiles. Neither was it seen to be related to increased bodyweight nor raised blood pressure. It should not, therefore, bring about any increased risk of cardiovascular disease. However, the greater intake of thiamine, niacin, zinc and iron (total and haem) in HC subjects suggests that these may have a better nutritive status (with respect to certain nutrients) than do LC subjects. In relation to iron status. HC subjects showed higher levels of haemoglobin, haematocrit and mean corpuscular haemoglobin concentration (MCHC). These results show that restrictive criteria, with respect to the consumption of meat and meat products, could have negative repercussions on the nutritive status and health of certain groups within the population. In the female population, such criteria may be associated with impairment of iron status, without affording any greater level of protection against cardiovascular disease, or be of any help in the control of bodyweight.

The female Spanish population: a group at risk of nutritional iron deficiency.

Iron deficiency is one of the most common nutritional problems in the world. It is frequent in both developed and developing countries and mainly affects women of childbearing age. The aim of the present study was to investigate the prevalence of iron deficiency in a group of young women from Madrid, Spain. The study subjects were a group of 130 women aged between 19 and 35 (24.53 +/- 0.24 years). Measurements were made of iron intake and also of the haematological and biochemical indicators of iron status. 10.7% of subjects showed iron deficiency (defined as the recording of at least two indicator parameters with values below normal). The high incidence of iron deficiency at blood level (10.7%) coincided with the low iron intake of these subjects (11.08 +/- 2.98 mg/day). 98.3% of subjects showed intakes below recommended. Observed intake covered only 61.6% of recommended intake. 3.9% of subjects presented ferropenic anaemia, i.e. they showed both iron deficiency and low haemoglobin levels.

Folate and vitamin B12 status in a group of preschool children.

UNLABELLED: An adequate intake of folates and vitamin B12 is essential for the rapid growth rates characteristic of infancy. However, little information exists on the prevalence of deficiencies of these nutrients in preschool children. The status of these vitamins was therefore evaluated in a group of 79 children between 2 and 6 years of age. A 5 day dietary record (including a Sunday) was kept for all subjects. All food taken at day care centres was monitored using "Precise individual weighing" and recorded by trained personnel. Measurements were made of serum and erythrocyte folate levels, vitamin B12 levels, number of red blood cells, haemoglobin and haematocrit levels, and mean corpuscular volume. Though the mean intake of folic acid surpassed recommended levels for this age group 31.4% of the subjects showed intakes below those recommended. 7.7% of the subjects showed serum folate levels between 3 and 6 ng/mL, values which indicate a moderate deficiency of this vitamin. A correlation was found between folate intake and serum folate levels r = 0.3654 (P < 0.01). Vitamin B12 intake was 438% that recommended. Only 2.9% of the subjects showed vitamin B12 intake below recommended and none showed serum values below 150 pg/ml, the lower normal limit below which deficiency is considered to exist. CONCLUSION: Amongst preschool children, folate deficiency is probably much more common than vitamin B12 deficiency. However, its incidence is low, and much lower than that observed in other age groups.

Influence of the number of meals taken per day on cardiovascular risk factors and the energy and nutrient intakes of a group of elderly people.

The aim of this investigation was to analyse the influence of the number of meals per day on a range of cardiovascular risk factors and on the energy and nutrient intakes of a group of elderly people. The participants in this study were 150 elderly people (64 men and 86 women) from Madrid. Food intake was followed over a period of 5 days. "Precise individual weighing" was used to determine the intake of institutionalized subjects (n = 58) whilst "food intake records" were used to register the same for independent subjects (n = 92). The nutrient and energy intake of the studied population was then determined from these data. The number of meals taken was also recorded. Serum cholesterol and triacylglycerol levels were determined using enzymatic methods. In this population, the meal most frequently omitted was breakfast. No subject took only one meal per day, though 7.4% took only two. 56.6% took three meals and 36% took four. No subject took more than four meals per day. As the number of meals taken increased, so too the covering of theoretical energy expenditure, and the intakes of a range of nutrients became closer to those recommended e.g. proteins, fibre, vitamin C, thiamin, riboflavin, calcium, magnesium and iodine. As the number of meals taken per day increased, carbohydrate intake (in g/1000 Kcal and as % of energy) also increased, and approached recommended levels more closely. As observed in other studies, blood cholesterol levels were seen to be negatively correlated with increasing number of meals (r = -0.2297, p < 0.05). Further, those subjects who distributed their food intake more evenly throughout the day showed lower serum cholesterol (p < 0.05). VLDL-cholesterol (p < 0.05) and triacylglycerol levels (p < 0.05). The results favour the distribution of energy intake over the day as a method of improving nutritional status and as a factor that might improve blood lipid profiles.

Prevalence and associated factors for gallstone disease: results of a population survey in Spain.

We conducted a cross-sectional survey to determine the prevalence of gallstone disease (gallstone or cholecystectomy) in a random sample of the adult population of Guadalajara, Spain. The sample stratified by age and sex was drawn from the municipal census. Stratum sample sizes were proportional to population sizes and to the expected prevalence rates calculated through a meta-analysis of the European literature. The screening protocol included a gallbladder ultrasonography, a questionnaire on personal and family history, a physical examination, and a blood sample for biochemical determinations. The response rate was 61.2%. The overall prevalence of gallstone disease was 9.7% (95% CI, 7.3-12.0). Prevalence was higher (but not statistically significant) in women (11.5%; 95% CI, 8.2-14.7) than in men (7.8%; 95% CI, 4.6-11.1). After controlling for confounding by multiple logistic regression, increasing age, body mass index, dyspeptic symptoms, smoking habit, and use of hypolipidemic drugs were positively associated with gallstone disease. Total serum cholesterol and alcohol consumption were negatively associated.

Functional and psychic deterioration in elderly people may be aggravated by folate deficiency.

The deterioration of functional and mental capacity is one of the major problems of the elderly. This deterioration may be caused or worsened by folate deficiency. The aim of this investigation was to analyze the relationship between mental and functional capacities and folate status in a group of 177 elderly Spanish people. Folate deficiency is common in the Spanish population. In this study, 48.6% of the elderly subjects had folate intakes below recommended values (200 microg/day), 34.9% had serum concentrations < 14 nmol/L and 6.6% had <360 nmol/L erythrocyte folate. Subjects took part in a series of tests: Katz' scale of activities of daily living, Lawton's scale of instrumental activities of daily living, Pfeiffer's mental status questionnaire, Folstein's Mini-Mental State Test and the Geriatric Depression scale of Yesavage. The results for Lawton's scale of instrumental activities of daily living were significantly better (indicating greater independence and capacity) when folate intake and serum or erythrocyte folate concentrations were adequate (i.e., folate intake no less than recommended, > or = 14 nmol/L serum folate or > or = 360 nmol/L erythrocyte folate). Subjects with adequate Mini-Mental State Exam results (> or = 28 points) had serum and erythrocyte folate concentrations significantly higher than those with less adequate results (<28 points). Thus, there is evidence to suggest that the folate status of the elderly should be monitored and, if possible, improved.

Influence of the intake of fortified breakfast cereals on dietary habits and nutritional status of Spanish schoolchildren.

A study was performed on the breakfast habits of 200 schoolchildren between 9 and 13 years of age. The subjects were classified into two groups: group C, children who consumed fortified breakfast cereals (65 boys and 35 girls), and group NC, children who did not (64 boys and 36 girls). The different dietary habits and the nutritional status of the two groups were analyzed. Haematological, biochemical, anthropometric, and dietary data were collected, the latter involving a 5-day food record. The children of the C group were found not only to have a more complete and nutritive breakfast, but also showed better dietary patterns for the rest of the day. Their lipid intake (% kJ) was lower and the carbohydrate intake (g/d and % kJ) higher than in the NC children. The intakes of thiamine, pyridoxine, folates, and beta-carotenes were also higher in group C. Better dietary habits were reflected in higher blood levels of some important compounds. Group C children had higher retinol, serum folate, and riboflavin levels than NC children. The percentage of children with hypercholesterolaemia (serum cholesterol > 4.5 mmol/l) was higher amongst those of the NC group: 37% as compared with 18% of the C children.