Bone Mineral Density in Adult Patients with Type 1 Diabetes Mellitus Assessed by Both DXA and QCT.

Purpose: Bone mineral density (BMD) was measured in uncomplicated young adult patients with type 1 diabetes mellitus (T1DM) and sex- and age-matched controls, using both dual X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to investigate their diagnostic ability in detecting abnormal values in these patients. Methods: 118 patients with T1DM (65 females, mean age 30.12 ± 8.78 years) and 94 sex- and age-matched controls were studied. BMD was assessed in all participants by DXA and QCT at lumbar spine (LS). Biochemical markers of bone metabolism were also measured. Results: T1DM was associated with lower BMD at L1-L3 vertebrae measured by both DXA and QCT and lower bone turnover compared to sex- and age-matched controls. In T1DM subjects, QCT detected more patients with abnormal BMD values compared to DXA. BMI and HbA1c levels were the only determinants of BMD. Bone turnover markers were lower in patients with longer duration of diabetes. Conclusion: QCT provides a higher sensitivity compared to DXA in detecting abnormal BMD values in patients with uncomplicated T1DM. In these patients, the diabetes-related decreased BMD may be present early, before it is detected by DXA, the clinical gold standard for BMD measurements, and before the presence of any other diabetes complications, stressing the importance of an early intervention for fracture prevention.

Eating habits and factors affecting food choice of adolescents living in rural areas.

OBJECTIVE: To establish factors that affect food choices among adolescents living in rural areas and to identify their food choices. DESIGN: A random sample of adolescents living in a Greek rural area (n=382) aged 12-18 years were individually interviewed. Food consumption was assessed by a semi-quantitative food-frequency questionnaire and adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. Information was collected regarding self-perceived body size, dieting, dietary knowledge, parental control, meal and snack frequency, eating out of home, eating takeaways and precooked meals, eating from the school canteen. RESULTS: Body image concerns, dieting, education about food, parental control, maternal education level and eating with family and peers are factors that were found to affect food choices in this group of Greek adolescents. The adherence to the Mediterranean diet was low (KIDMED index was 4.5±2.7). Regular family meals at home were frequent in this group and 99% of the adolescents ate lunch daily at home. Eating out with peers and eating from the school canteen was related with higher consumption of 'junk type of food'. Girls and younger adolescents and those whose mothers had a higher education level seem to make healthier choices. CONCLUSIONS: Factors such as personal issues, family and peer pressure significantly affect food choices among adolescents living in a Greek rural area and highlight the importance of implementing multilevel strategies to promote healthy eating among adolescents.

Evidence of increased muscle atrophy and impaired quality of life parameters in patients with uremic restless legs syndrome.

BACKGROUND: Restless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival. METHOD#ENTITYSTARTX003BF;LOGY/PRINCIPAL FINDINGS: Using the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition. CONCLUSIONS: The low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep.

AR CAG repeat length is not associated with serum gonadal steroids and lipid levels in healthy men.

Cardiovascular risk factors seem to be affected by androgens, which exert their action through the androgen receptor (AR). Androgenic action correlates inversely with a polymorphic CAG repeat region in the AR gene encoding for glutamine residues the length of which appears to influence high density lipoprotein (HDL) cholesterol levels. The aim of the study was to investigate the possible association between AR gene polymorphism and serum sex steroids and lipids. 170 healthy males, aged 22-59 years (mean 42 years), were included in the study. Anthropometrical as well as sociometrical parameters were recorded. Body fat content (BFC) (% fat mass) was measured by bioelectrical impedance. Serum lipids and total and free testosterone (T) and estradiol (E(2)) levels were measured in each subject. AR gene CAG repeats length was determined. No significant correlation was found between the length of AR gene polyglutamine tract and the levels of gonadal steroids (total and free T, total and free E(2)) or to the lipid levels (Triglycerides, total, HDL and LDL cholesterol). In addition, serum lipid levels were not significantly different in the lower compared to higher half of CAG repeats length distribution. On multiple regression analysis BFC was found to predict HDL-cholesterol and triglycerides were found to show, respectively, significant negative and positive correlation with body fat content. In conclusion, AR gene polymorphism may not predict sex steroid levels in healthy males. Possible impact of CAG repeats length on lipids profile has not been established.

Lower prevalence of epsilon 4 allele of apolipoprotein E gene in healthy, longer-lived individuals of Hellenic origin.

Apolipoprotein E (ApoE), and especially its epsilon4 isoform, is considered a risk factor predisposing to coronary heart disease. We hypothesized that the absence of epsilon4 allele offers a better chance for longer life. So we compared the prevalence of ApoE genotypes in 80 healthy aged individuals (HAI) (>80 years) and 391 Greek adults (median age 43 years) with ApoE genotype distribution consistent with the Hardy-Weinberg equilibrium (chi(2) = 5.93, p >.05). ApoE genotypes were comparable in both groups with the exception of E3/3 and E3/4, which were significantly higher (87.50% vs 75.99%, p =.025) and lower (5.00% vs 13.19%, p =.036), respectively, in HAI. The epsilon2 and epsilon3 allele frequencies were not different between the groups. The epsilon4 allele was significantly less frequent in HAI compared to controls (3.1% vs 8.58%, p =.020). Our results indicate an unfavorable effect of epsilon4 allele on longevity that may be attenuated by environmental and/or other genetic factors.

Endothelin-1 plasma levels in hemodialysis treatment--the influence of type 2 diabetes.

In patients on chronic hemodialysis the prevalence of atherosclerosis is increased and is by far the leading cause of morbidity and mortality. Endothelin-1, an endothelium-derived peptide with vasoconstrictive and mitogenic effects on vascular smooth muscles, is involved in the pathogenesis of atherosclerosis. The aim of the present study was to investigate the time course of plasma endothelin-1 levels during a hemodialysis session and to explore the influence of preexisting type 2 diabetes mellitus. Forty-five clinically stable hemodialysis patients (21 females, 24 males; mean age 62 +/- 12 years) were evaluated. Patients with type 2 diabetes (n= 11) were compared with the group of patients without diabetes (n=34). Relative blood volume (BV) changes (hemoglobinometry) and blood pressure (BP) was measured. Samples were taken before, every hour during, and after hemodialysis. Plasma endothelin-1 levels were measured by enzyme-linked immunoassay (ELISA) and results were corrected according to hemoconcentration. Hemodialysis with an ultrafiltration of 2215 +/- 952 mL was performed. Total BV at the end of hemodialysis was 89.3% +/- 8.3% of the pretreatment volume. Plasma endothelin-1 was enhanced in hemodialysis patients compared to normal subjects and increased from 1.28 +/- 0.47 before to 1.44 +/- 0.54 pg/mL (ref. 0.3-0.9) at the end of hemodialysis (p<0.05). The BV change (r=0.41) and the BP (mean BP: r=0.34) correlated with plasma endothelin-1 at the end of hemodialysis (p<0.05). The levels of endothelin-1 were significantly higher in the group of dialysis patients with type 2 diabetes compared to nondiabetics in all measurements (p<0.05). These findings suggest a potential role of endothelin-1 in the pathogenesis of vascular dysfunction in diabetes mellitus. The dialysis procedure per se, through vasoconstriction due to BV decrease, local endothelial injury (a.v. fistula), or bioincompatibility reactions (foreign surface contact) may additionally alter endothelial cell functions.