Resistencia insulínica en pacientes pediátricos con fibrosis quística y sobrepeso / Insulin resistance in overweight cystic fibrosis paediatric patients

Introducción y objetivos: Conocer la prevalencia de sobrepeso en pacientes pediátricos con fibrosis quística (FQ) y su importancia como factor de resistencia insulínica diabetogénica y riesgo de hipertrigliceridemia. Material y métodos: Ciento nueve pacientes con FQ (47% varones) de 5-18 años se calificaron por su índice de masa corporal (IMC): desnutridos, normales o con sobrepeso. Se determinaron colesterol, triglicéridos y proteína C reactiva (PCR), glucohemoglobina y los índices HOMA-IR y QUICKI y en la sobrecarga oral de glucosa (SOG) su índice insulinogénico e ISI composite y áreas bajo la curva (ABC) de glucosa e insulina. Resultados: Seis pacientes (5,5%) tenían sobrepeso. Su edad, distribución sexual y base genética son similares al resto; aunque la proporción de suficientes pancreáticos (3/6; 50%) es superior (p=0,003). Los trastornos glucídicos no son más frecuentes que en el resto; pero la insulina basal, HOMA-IR, y la insulina durante la SOG (pico máximo y ABC) identifican su hiperinsulinismo, diferenciándolos de los otros dos grupos. Todos los pacientes muestran en la SOG respuesta insulínica tardía, sin diferencias en los índices derivados. Conclusiones: Entre los pacientes FQ con sobrepeso no hay mayor incidencia de trastornos glucídicos pero sí de hiperinsulinismo y resistencia insulínica, con el consiguiente riesgo añadido a la tendencia diabetogénica inherente a estos pacientes(AU)

Aim: To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia. Patients and methods: A total of 109 CF patients (47% males) between 5 and 18 years were divided into 3 groups according to body mass index (BMI): underweight, normal and overweight. Total cholesterol, triglycerides, C- reactive protein (CRP), glycosylated haemoglobin, HOMA-IR and QUICKI index were determined. Insulinogenic index, ISI composite and areas under the curve (AUC) for glucose and insulin were obtained by oral glucose tolerance test (OGTT). Results: Six patients (5.5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although the proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (P=.003). The prevalence of glycaemic disorders was similar between groups. Baseline insulin, HOMA-IR, and insulin during the OGTT (peak and AUC) were higher in overweight patients. All patients had a delayed insulin response in OGTT. Conclusions: Overweight CF patients do not have a higher incidence of glycaemic disorders, but their hyperinsulinism and insulin resistance may be additional diabetogenic risk factors(AU)

[Insulin resistance in overweight cystic fibrosis paediatric patients]. / Resistencia insulínica en pacientes pediátricos con fibrosis quística y sobrepeso.

AIM: To determine the prevalence of overweight in paediatric patients with cystic fibrosis (CF) and to analyse its role as diabetogenic insulin resistance factor and risk of hypertriglyceridaemia. PATIENTS AND METHODS: A total of 109 CF patients (47% males) between 5 and 18 years were divided into 3 groups according to body mass index (BMI): underweight, normal and overweight. Total cholesterol, triglycerides, C- reactive protein (CRP), glycosylated haemoglobin, HOMA-IR and QUICKI index were determined. Insulinogenic index, ISI composite and areas under the curve (AUC) for glucose and insulin were obtained by oral glucose tolerance test (OGTT). RESULTS: Six patients (5.5%) were overweight. All groups had similar distribution by age, sex and CFTR mutation, although the proportion of pancreatic sufficient (3/6, 50%) was higher in overweight patients (P=.003). The prevalence of glycaemic disorders was similar between groups. Baseline insulin, HOMA-IR, and insulin during the OGTT (peak and AUC) were higher in overweight patients. All patients had a delayed insulin response in OGTT. CONCLUSIONS: Overweight CF patients do not have a higher incidence of glycaemic disorders, but their hyperinsulinism and insulin resistance may be additional diabetogenic risk factors.

[Prevalence of celiac disease in apparently healthy blood donors in the autonomous community of Madrid]. / Prevalencia de la enfermedad celiaca en donantes de sangre de la Comunidad de Madrid.

OBJECTIVE: The aim of this study was to determine the prevalence of celiac disease among the adult population of Madrid by measuring antibodies against tissue transglutaminase as serologic screening method. POPULATION AND METHODS: 2,215 subjects participated voluntarily in this study. All of them completed a clinical questionnaire. We determined the levels of total IgA and antibodies to tissue transglutaminase (tTG). An intestinal biopsy by endoscopy was proposed to all subjects who were tTG-positive. The histologic lesion was classified in accordance to Marsh. RESULTS: Three known CD cases were identified by the questionnaire. Eleven donors with tTG positivity were detected, all of them asymptomatic. Four subjects rejected the intestinal biopsy. Seven out of 11 positive subjects consented to undergo a duodenal biopsy -3 had villous atrophy and 4 had increased intraepithelial lymphocyte counts with normal villi. In our study the number of donors with biopsy-proven CD was 6, and the prevalence was 1/370. If we include the subcategories of gluten sensitive enteropathy (Marsh I), the prevalence would be 1/222. When we considered antibody positivity the prevalence of gluten sensitivity was 1 in 201, and it reached 1 in 158 when the three known CD cases were included. CONCLUSIONS: Data on CD prevalence in this study confirm that CD is a first-line healthcare problem that may warrant universal screening. We detected a high number of lymphocytic enteritis cases, and thus some sort of action is mandatory.

Prevalencia de la enfermedad celiaca en donantes de sangre de la Comunidad de Madrid / Prevalence of celiac disease in apparently healthy blood donors in the Autonomous Community of Madrid

Objetivo: conocer la prevalencia de enfermedad celiaca en la población adulta de la Comunidad de Madrid utilizando como método de despistaje los anticuerpos frente a la transglutaminasa tisular. Población y métodos: han participado de modo voluntario 2.215 donantes de sangre. Todos ellos rellenaron una encuesta. Se determinó la IgA sérica total y los anticuerpos antitransglutaminasa tisular. A los donantes con anticuerpos positivos, se les ofreció la realización de biopsia intestinal por endoscopia. La histología de la mucosa intestinal se graduó según los criterios de Marsh. Resultados: mediante la encuesta se identificaron tres celiacos diagnosticados previamente. Once donantes presentaban anticuerpos positivos, todos ellos asintomáticos. Cuatro rechazaron la biopsia intestinal. De los siete en los que se realizó, tres tenían atrofia vellositaria y cuatro infiltrado linfocitario con vellosidades normales. En nuestro estudio el número total de donantes con enfermedad celiaca confirmada por biopsia fue de seis, lo que supone una prevalencia del 1/370. Considerando el grado I de Marsh, la prevalencia de la enteropatía por gluten sería de 1/222. La respuesta inmunológica anómala al gluten medida por la positividad de los anticuerpos fue de 1/201 que alcanza valores de 1/158 si consideramos los tres celiacos diagnosticados previamente. Conclusiones: los datos de prevalencia hallados en este estudio confirman que la enfermedad celiaca constituye un problema sanitario de primer orden, que podría justificar la instauración de un programa de despistaje universal. Se ha detectado un alto número de casos de enteritis linfocitaria lo que obliga a plantearse la actitud a seguir

Objective: the aim of this study was to determine the prevalence of celiac disease among the adult population of Madrid by measuring antibodies against tissue transglutaminase as serologic screening method. Population and methods: 2,215 subjects participated voluntarily in this study. All of them completed a clinical questionnaire. We determined the levels of total IgA and antibodies to tissue transglutaminase (tTG). An intestinal biopsy by endoscopy was proposed to all subjects who were tTG-positive. The histologic lesion was classified in accordance to Marsh. Results: three known CD cases were identified by the questionnaire. Eleven donors with tTG positivity were detected, all of them asymptomatic. Four subjects rejected the intestinal biopsy. Seven out of 11 positive subjects consented to undergo a duodenal biopsy –3 had villous atrophy and 4 had increased intraepithelial lymphocyte counts with normal villi. In our study the number of donors with biopsy-proven CD was 6, and the prevalence was 1/370. If we include the subcategories of gluten sensitive enteropathy (Marsh I), the prevalence would be 1/222. When we considered antibody positivity the prevalence of gluten sensitivity was 1 in 201, and it reached 1 in 158 when the three known CD cases were included. Conclusions: data on CD prevalence in this study confirm that CD is a first-line healthcare problem that may warrant universal screening. We detected a high number of lymphocytic enteritis cases, and thus some sort of action is mandatory

[Dermatitis herpetiformis vs. celiac disease]. / Dermatitis herpetiforme versus enfermedad celíaca.

Twenty-nine patients affected with dermatitis herpetiformis (HD), all of whom were on a diet including gluten, were investigated for symptoms of enteropathy. Of these patients, 71% presented severe intestinal lesions, indistinguishable from those found in coeliac disease (CD). However, there were little other clinical manifestations of this finding since only three children in this group had weight and height < or = P3. Of the remaining children, 18% had moderate intestinal atrophy and 10% had normal mucosa or mucosa with negligible changes. When changed to a gluten free diet, the intestinal lesions subsided, dermic lesions disappeared in 17 patients, improved in 8 others and remained the same in the other three patients that were still on variable diets. A study of human leukocyte antigens (HLA) class II showed a total association with Dqw2 and 85% association to DR3, which was identical to the coeliac disease control group. These findings lead one to conclude that HD and CD are different clinical expressions of the same sensitivity to gluten which is associated to an immunological disorder with a common genetic base linked to certain HLA molecules.