Fatty liver index as a predictor for type 2 diabetes in subjects with normoglycemia in a nationwide cohort study.

Our aim was to evaluate whether fatty liver index (FLI) is associated with the risk of type 2 diabetes (T2DM) development within the Spanish adult population and according to their prediabetes status; additionally, to examine its incremental predictive value regarding traditional risk factors. A total of 2260 subjects (Prediabetes: 641 subjects, normoglycemia: 1619 subjects) from the Di@bet.es cohort study were studied. Socio-demographic, anthropometric, clinical data and survey on habits were recorded. An oral glucose tolerance test was performed and fasting determinations of glucose, lipids and insulin were made. FLI was calculated and classified into three categories: Low (< 30), intermediate (30-60) and high (> 60). In total, 143 people developed diabetes at follow-up. The presence of a high FLI category was in all cases a significant independent risk factor for the development of diabetes. The inclusion of FLI categories in prediction models based on different conventional T2DM risk factors significantly increase the prediction power of the models when all the population was considered. According to our results, FLI might be considered an early indicator of T2DM development even under normoglycemic condition. The data also suggest that FLI could provide additional information for the prediction of T2DM in models based on conventional risk factors.

Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study.

Our aim was to determine the incidence of type 2 diabetes mellitus in a nation-wide population based cohort from Spain (di@bet.es study). The target was the Spanish population. In total 5072 people older than 18 years,were randomly selected from all over Spain). Socio-demographic and clinical data, survey on habits (physical activity and food consumption) and weight, height, waist, hip and blood pressure were recorder. A fasting blood draw and an oral glucose tolerance test were performed. Determinations of serum glucose were made. In the follow-up the same variables were collected and HbA1c was determined. A total of 2408 subjects participated in the follow-up. In total, 154 people developed diabetes (6.4% cumulative incidence in 7.5 years of follow-up). The incidence of diabetes adjusted for the structure of age and sex of the Spanish population was 11.6 cases/1000 person-years (IC95% = 11.1-12.1). The incidence of known diabetes was 3.7 cases/1000 person-years (IC95% = 2.8-4.6). The main risk factors for developing diabetes were the presence of prediabetes in cross-sectional study, age, male sex, obesity, central obesity, increase in weight, and family history of diabetes. This work provides data about population-based incidence rates of diabetes and associated risk factors in a nation-wide cohort of Spanish population.

Prevalence of diabetes mellitus and impaired glucose metabolism in the adult population of the Basque Country, Spain.

AIMS: To assess the prevalence of diabetes mellitus and impaired glucose metabolism in the Basque Country and their relationship with cardiovascular risk factors. METHODS: A population-based, cross-sectional, cluster sampling design study was carried out in an adult (≥18 years) Basque population. A total of 847 participants completed a questionnaire on personal and family medical history and lifestyle. Anthropometric variables and blood pressure were measured and biochemical analysis and an oral glucose tolerance test (75 g) were also performed. RESULTS: The total prevalence of diabetes was 10.6% (95% CI 8.65-12.95). Among them 6.3% (95% CI 4.79-8.22) had previously been diagnosed and 4.3% (95% CI 3.04-5.92) were not aware that they had diabetes. Impaired glucose tolerance was present in 7.2% (95% CI 5.53-9.15) and impaired fasting glucose in 3.8% (95% CI 2.64-5.37) of the population. In total, 21.6% of the population had some type of glucose metabolism disturbance, with a higher rate among men (28.3 vs 16.3%; P<0.001) and with the rate increasing with age. Risk factors independently associated with the development of diabetes were: male sex [odds ratio 4.58 (95% CI 2.34-8.97)]; abdominal obesity [odds ratio 2.80 (95% CI 1.47-5.36)]; high triglyceride levels [odds ratio 2.46 (95% CI 1.26-4.81)]; hypertension [odds ratio 2.40 (95% CI 1.16-4.96)]; family history of diabetes [odds ratio 2.30 (95% CI 1.25-4.24)]; high LDL cholesterol levels [odds ratio 1.83 (95% CI 1.01-3.31)] and older age [odds ratio 1.08 (95% CI 1.05-1.10)]. CONCLUSIONS: The prevalence of diabetes in the Basque Country was lower than in Spain and was independently associated with family history of diabetes and with cardiovascular risk factors such as abdominal obesity, hypertension, high LDL cholesterol levels and high triglyceride levels, which were also observed in those with prediabetes.

Tratamiento de la alergia a alimentos / Treatment of food allergy

Una vez que se ha establecido con certeza el diagnóstico de alergia alimentaria, el siguiente paso es instaurar una dieta estricta de eliminación del alimento causante de la sintomatología. Por ello, la educación del paciente y de sus familias es fundamental para saber cómo evitar el antígeno alimentario responsable. Los alergenos se pueden encontrar ocultos en alimentos insospechados, por lo que hay que tener muy en cuenta el etiquetado de los mismos y la contaminación cruzada. Por último, se ha de garantizar que la dieta sea la adecuada para asegurar un crecimiento y desarrollo adecuados. En la alergia a alimentos, lo más frecuente es que se produzca una tolerancia con el curso del tiempo. Sin embargo, existen casos en que la sensibilización puede durar toda la vida. Hay que tener en cuenta que los alimentos que se eliminan de la dieta pueden ser cruciales en determinadas etapas de la vida. Además, esta dieta de eliminación tiene especial relevancia en el caso de las alergias múltiples que puede crear situaciones de riesgo nutricional en las que el crecimiento puede ser comprometido. Se debe realizar una correcta evaluación nutricional y, en casos de necesidad, se debe considerar incluir suplementos con el fin de complementar la ingesta de determinados nutrientes. Las dietas de eliminación se deben manejar con precaución especialmente si un grupo o varios alimentos están restringidos. La provocación oral es importante para determinar si es necesario continuar con la dieta de eliminación de un determinado alimento o, por el contrario, si éste se puede incluir de nuevo en la dieta. El tratamiento de la alergia a la leche de vaca (LV) en el lactante consiste en la completa eliminación de las proteínas de LV de la dieta del paciente. La fórmula alternativa ideal es la que no tenga reactividad cruzada entre las proteínas de la leche de vaca, que nutricionalmente sea adecuada, tenga un sabor agradable y sea de bajo coste

Once diagnosis of food allergy has been established, strict elimination of the offending food allergen from diet is the next step. Therefore, patient and family education about allergen avoidance of the suspect food is essential. Food allergens, can be hidden in unsuspecte foods, so food labels and cross-contamination should be considered. Finally, diet should provide an adequate diet to ensure appropriate growth and development of the child. Most food allergy is indeed lost over time, a patients becomes tolerant to a food that had previously caused a reaction. However, certain sensitizations may persist over the long term. The restriction of several foods from diet is of particular importance in certain periods. Moreover, elimination diets should be undertaken with caution, specially in children with multiple allergies because there is a risk for growth and nutritional deficiencies. Correct assessment of growth and nutrition is fundamental and, if needed supplements should be considered to enhance the intake of particular nutrients. Oral food challenge should be conducted to determine whether elimination diet with a single restricted food needs to be followed or, on the contrary, the offering food may be included in the diet. Treatment for cow´s milk allergy in infancy consists of complete elimination of cow´s milk proteins from the patient´s diet. The idela alternative formula is such which lacks cross reactivity with cow´s milk proteins, meets all nutrients requirements and, has good taste and low cost