The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: the EPIC-InterAct study.

AIMS/HYPOTHESIS: Although a family history of type 2 diabetes is a strong risk factor for the disease, the factors mediating this excess risk are poorly understood. In the InterAct case-cohort study, we investigated the association between a family history of diabetes among different family members and the incidence of type 2 diabetes, as well as the extent to which genetic, anthropometric and lifestyle risk factors mediated this association. METHODS: A total of 13,869 individuals (including 6,168 incident cases of type 2 diabetes) had family history data available, and 6,887 individuals had complete data on all mediators. Country-specific Prentice-weighted Cox models were fitted within country, and HRs were combined using random effects meta-analysis. Lifestyle and anthropometric measurements were performed at baseline, and a genetic risk score comprising 35 polymorphisms associated with type 2 diabetes was created. RESULTS: A family history of type 2 diabetes was associated with a higher incidence of the condition (HR 2.72, 95% CI 2.48, 2.99). Adjustment for established risk factors including BMI and waist circumference only modestly attenuated this association (HR 2.44, 95% CI 2.03, 2.95); the genetic score alone explained only 2% of the family history-associated risk of type 2 diabetes. The greatest risk of type 2 diabetes was observed in those with a biparental history of type 2 diabetes (HR 5.14, 95% CI 3.74, 7.07) and those whose parents had been diagnosed with diabetes at a younger age (<50 years; HR 4.69, 95% CI 3.35, 6.58), an effect largely confined to a maternal family history. CONCLUSIONS/INTERPRETATION: Prominent lifestyle, anthropometric and genetic risk factors explained only a marginal proportion of the excess risk associated with family history, highlighting the fact that family history remains a strong, independent and easily assessed risk factor for type 2 diabetes. Discovering factors that will explain the association of family history with type 2 diabetes risk will provide important insight into the aetiology of type 2 diabetes.

Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition-Elderly Network on Ageing and Health study.

OBJECTIVE: Later life weight change and mortality amongst elders. DESIGN: Nested case-control study. SETTING: Six countries from the European Investigation into Cancer and nutrition-Elderly, Network on Ageing and Health. SUBJECTS: A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34,239 participants, > or = 60 years at enrolment (1992-2000) who were followed-up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from-date-of-death re-assessment, divided by the respective time. OUTCOME MEASURES: Mortality in relation to weight change was examined using conditional logistic regression. RESULTS: Weight loss > 1 kg year(-1) was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41-1.92) compared to minimal weight change (+/-1 kg year(-1)). Weight gain > 1 kg year(-1) was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98-1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17-2.05). In analyses by time interval since weight re-assessment, the association of mortality with weight loss was stronger for the interval proximal (< 1 year) to death (OR = 3.10; 95% CI: 2.03-4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07-2.33). Similar patterns were observed regarding death from circulatory diseases and cancer. CONCLUSIONS: In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short-term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term.

Evaluación del riesgo nutricional e instauración de soporte nutricional en pacientes oncológicos, según el protocolo del grupo español de Nutrición y Cáncer / Nutricional risk evaluation and establishment of nutricional support in oncology patients according to the protocol of the spanish nutrition and cancer group

Introducción: El cáncer, los tratamientos que lo acompañan y los síntomas consecuentes que a su vez generan, aumentan en los pacientes el riesgo de sufrir malnutrición. La cual produce un gran deterioro del estado de salud, con el consecuente aumento de complicaciones, disminución de la tolerancia al tratamiento oncológico y una disminución de la calidad de vida del paciente. Por este motivo, un grupo de profesionales sanitarios de diferentes puntos de España se reunieron con el objetivo de mejorar la intervención nutricional en pacientes oncológicos, con el apoyo de la Sociedad Española de Nutrición Básica y Aplicada (SENBA). Metodología: Este grupo multidisciplinar de profesionales elaboró un documento de consenso basado en la literatura y en la experiencia personal, creando un protocolo de evaluación y de intervención nutricional en forma de algoritmos. Se clasifican los pacientes en tres pasos: 1. según el tipo de tratamiento oncológico que reciben, ya sea de tipo curativo o paliativo; 2. riesgo nutricional de la terapia antineoplásica (bajo, mediano, o alto riesgo), y 3. de acuerdo a la Valoración Global Subjetiva-Generada por el paciente (VGS-gp), que clasifica a los pacientes en: A. pacientes con adecuado estado nutricional, B. pacientes con malnutrición o a riesgo de malnutrición y C. pacientes con malnutrición severa. Durante un año el protocolo se puso en marcha en 226 pacientes mayores de 18 años de ambos sexos, escogidos al azar en las consultas externas de Radioterapia Oncológica y Oncología Médica. Resultados: Más de la mitad sufren malnutrición (64%), y este valor se incrementa llegando hasta un 81% en pacientes con tratamiento paliativo. La mayoría de los pacientes tienen tratamiento de intención curativa (83%) y reciben tratamiento oncológico de intensidad moderada o de alto riesgo nutricional (69%). Un 68% de los pacientes tienen algún tipo de dificultad en la alimentación. La media en el porcentaje de pérdida de peso es del 6,64% ± 0,87 (min 0, máx 33%). El 32% de la población presenta cifras de albúmina entre 3 y 3,5 g/dl, existiendo una correlación negativa entre ésta y las dificultades con la alimentación p = 0,001. El IMC no mostró ser un parámetro significativo para detectar malnutrición (sólo un 10% se encontraba por debajo de 19,9 kg/m2), pero tiene una tendencia lineal significativa con las dificultades en la alimentación, de forma tal que a medida que disminuye el IMC aumentan las dificultades p = 0,001. Más de la mitad de la población, requirió recomendaciones dietéticas específicas para el control de los síntomas que dificultaban la ingesta y una tercera parte de la población necesitó la indicación de suplementos nutricionales. Tras la intervención nutricional más de la mitad (60%) mantuvo su peso y una sexta parte lo aumentó. Conclusión: La aplicación de este protocolo es útil, sencillo y podría facilitar la detección de malnutrición en los pacientes oncológicos. Seleccionando a los pacientes que realmente se podrían beneficiar de una intervención nutricional específica, pero debería aplicarse al inicio coincidiendo si fuera posible con el diagnóstico de la enfermedad. El soporte nutricional resulta eficaz en la mayoría de los pacientes (AU)

Introduction: Cancer and its oncological treatment cause symptoms which increase the patients risk to suffer from malnutrition. This affects the patients health status negatively by increasing the number of complications, reducing the tolerance to the oncology treatment and a decrease of the patients quality of life. Motivated by this, a group of health professionals from several spanish regions met with the backing of the Sociedad Española de Nutrición Básica y Aplicada (SENBA) to address strategies to improve the quality of nutritional intervention in cancer patients. Methods: This multidisciplinary group developed a protocol describing nutritional assessment and intervention in form of algorithms based on literature and personal experience. The patients are classified in a three step process: 1. type of their oncology treatment (curative or palliative); 2. nutritional risk of the antineoplastic therapy (low, medium or high risk) and 3. depending on the Subjective Global Assessment patient-generated (SGApg). The patients are classified as: A. patients with adequate nutritional state, B. patients with malnutrition or risk of malnutrition and C. patients suffering from severe malnutrition. During one year, the protocol has been used for 226 randomly chosen female and male patients older than 18 years. They were treated by the Medical and Radiotherapy Oncology outpatient clinic. Results: More than a half of the patients were suffering from malnutrition (64%) increasing up to 81% for patients undergoing palliative treatment. Most of them were treated curatively (83%) and received oncology treatment with moderate or high nutritional risk (69%). 68% of patients were affected by some feeding difficulty. The mean percentage of weight loss has been 6.64% ± 0.87 (min 0%, max 33%). Albumin values of 32% of the patients were between 3 and 3.5 g/dl and negatively correlated with feeding difficulties (p = 0.001). The body mass index (BMI) has not found to be a significant parameter for detecting malnutrition (only in 10% of the patients, the value was below 19.9 kg/m2). But a significant linear tendency when compared to feeding problems could be shown, such that in patients with less feeding problems a higher BMI has been found (p = 0.001). More than a half of the patients required nutritional counselling to control symptoms which made food intake difficult. One third of the patients needed oral nutritional supplementation. Following the nutritional intervention the weight of about 60% of the patients could be maintained and of one sixth it could be increased. Conclusion: The application of this protocol is useful, easy and could help detecting malnutrition in oncology patients. It provides the possibility to select those patients who can benefit from a specific nutritional intervention. If possible, the application of the protocol should be started immediatly after cancer is diagnosed. Nutritional support proves efficient for most of the patients (AU)

[Nutritional risk evaluation and establishment of nutritional support in oncology patients according to the protocol of the Spanish Nutrition and Cancer Group]. / Evaluación del riesgo nutricional e instauración de soporte nutricional en pacientes oncológicos, según el protocolo del grupo Español de Nutrición y Cáncer.

INTRODUCTION: Cancer and its oncological treatment cause symptoms which increase the patients risk to suffer from malnutrition. This affects the patients health status negatively by increasing the number of complications, reducing the tolerance to the oncology treatment and a decrease of the patients quality of life. Motivated by this, a group of health professionals from several spanish regions met with the backing of the Sociedad Española de Nutrición Básica y Aplicada (SENBA) to address strategies to improve the quality of nutritional intervention in cancer patients. METHODS: This multidisciplinary group developed a protocol describing nutritional assessment and intervention in form of algorithms based on literature and personal experience. The patients are classified in a three step process: 1. type of their oncology treatment (curative or palliative); 2. nutritional risk of the antineoplastic therapy (low, medium or high risk) and 3. depending on the Subjective Global Assessment patient-generated (SGA-pg). The patients are classified as: A. patients with adequate nutritional state, B. patients with malnutrition or risk of malnutrition and C. patients suffering from severe malnutrition. During one year, the protocol has been used for 226 randomly chosen female and male patients older than 18 years. They were treated by the Medical and Radiotherapy Oncology outpatient clinic. RESULTS: More than a half of the patients were suffering from malnutrition (64%) increasing up to 81% for patients undergoing palliative treatment. Most of them were treated curatively (83%) and received oncology treatment with moderate or high nutritional risk (69%). 68% of patients were affected by some feeding difficulty. The mean percentage of weight loss has been 6.64% +/- 0.87 (min 0%, max 33%). Albumin values of 32% of the patients were between 3 and 3.5 g/dl and negatively correlated with feeding difficulties (p = 0.001). The body mass index (BMI) has not found to be a significant parameter for detecting malnutrition (only in 10% of the patients, the value was below 19.9 kg/m2). But a significant linear tendency when compared to feeding problems could be shown, such that in patients with less feeding problems a higher BMI has been found (p = 0.001). More than a half of the patients required nutritional counselling to control symptoms which made food intake difficult. One third of the patients needed oral nutritional supplementation. Following the nutritional intervention the weight of about 60% of the patients could be maintained and of one sixth it could be increased. CONCLUSION: The application of this protocol is useful, easy and could help detecting malnutrition in oncology patients. It provides the possibility to select those patients who can benefit from a specific nutritional intervention. If possible, the application of the protocol should be started immediatly after cancer is diagnosed. Nutritional support proves efficient for most of the patients.

Documento de recomendaciones para la nutrición del paciente oncológico adulto: objetivo y metodología / No disponible

No disponible

[The reliability of the ankle/arm index for the study of chronic arteriopathy of the lower limbs in primary care]. / Fiabilidad del índice tobillo/brazo para el estudio de la arteriopatía crónica de los miembros inferiores en atención primaria.

OBJECTIVE: To validate the "ankle/arm" index (AAI) or "Yao index" for the primary care assessment of chronic arteriopathy in the lower limbs (CALL). DESIGN: A descriptive crossover study. SETTING: Primary care. PATIENTS: 21 with suspected or diagnosed CALL. MEASUREMENTS AND MAIN RESULTS: Four primary-care doctors made 164 examinations by means of palpation and determination of blood pressure with Doppler waves. The presence or absence of pulses was recorded and the AAI calculated. The interobserver Kappa ranged from 0.20 to 0.47 and the intraobserver from 0.52 to 0.76, according to the pulse examined. The intraclass interobserver correlation coefficient for the AAI was 0.80 and the intraobserver 0.79. Interobserver SD for the AAI was 0.14, and intraobserver SD 0.15. CONCLUSIONS: The ankle-arm index obtained by primary-care doctors using Doppler is a reliable method of studying CALL. However, due to its wide variability, it is advisable always to evaluate its evolution together with clinical data.

[Evaluation of the impact of early retirement on the quality of life]. / Evaluación del impacto de la jubilación anticipada en la calidad de vida.

AIM: To evaluate the impact of early retirement, quality of life and general health level of a sample of industrial workers. SUBJECTS: 78 early retired industrial workers were evaluated on two separate occasions, baseline and after three years. INSTRUMENTS: A sociodemographic and clinical "ad hoc" protocol and the Spanish versions ot the following scales: the Quality of Life Questionnaire (1) the GHQ-28 (2, 3) and the MMSE (4, 5), the Self-Concept Scale (6, 7) and the Depression-Anxiety Scale from Goldberg (8-10). RESULTS: Those retired for physical or accident purpose showed a worse self-image and greater levels of anxiety CONCLUSIONS: Being retired for physical or accident purpose plays a significant role in the development of psychopathology.