Aims
To analyze the serum lipid and inflammatory biomarker profile in the early insulin resistance (e-IR).
Methods
Cross-sectional study of 5943 adults without diabetes, stratified into no IR group ...(C-peptide <third tertile and glucose <100 mg/dL), e-IR group (C-peptide ≥third tertile and glucose <100 mg/dL) and advanced IR group (glucose ≥100 mg/dL).
Results
E-IR showed significant differences with no IR in the serum concentration of triglycerides (
P
< 0.001), HDL cholesterol (
P
< 0.001), LDL cholesterol (
P
< 0.001), sCD40L (
P
< 0.001), C-reactive protein (
P
< 0.004), leptin (
P
< 0.001) and adiponectin (
P
< 0.001). Adjusting for age, gender and abdominal obesity, corroborated the association of e-IR with highest quintile of triglycerides (OR 3.88 3.07–4.89), HDL cholesterol (OR 0.35 0.28–0.44), sCD40L (OR 0.47 0.24–0.94), C-reactive protein (OR 2.31 1.29–4.12), adiponectin (OR 0.11 0.04–0.32), PAI-1 (OR 3.29 1.29–8.40) and resistin (OR 1.25 1.01–1.54); the same biomarkers were associated with advanced IR although resistin was a protective factor (OR 0.73 0.58–0.93).
Conclusions
Euglycemic patients with e-IR present an unfavorable serum lipid and inflammatory biomarker profile. Measuring C-peptide in euglycemic patients with elevated triglycerides identifies e-IR.
Few studies have analized the effect of vascular risk factors and lifestyle habits affecting the middle age of postmenopausal women on later cognitive performance in old age. We have carried out an ...observational study to identify those factors and whether they differ from those acting in men. Postmenopausal women and males, both aged 40-60 years old at recruitment, from a community dwelling cohort were included. Data for this study were collected from the first visit at recruitment (2001 to 2005). Participants were interviewed with a questionnaire on their health-related antecedents and underwent a physical exam. The cohort was contacted again for a new presential visit between 2014 and 2015. A semantic verbal fluency test was included in this new visit protocol as a brief measure of cognition. Besides educational attainment, Mediterranean diet adherence 20th percentile (OR = 1.93; 95%CI = 1.07-3.47) and waist to hip ratio 80th percentile (OR = 1.81; 95%CI = 1.10-2,98) were the main factors associated to low semantic fluency performance in postmenopausal women, while declared diabetes mellitus (OR = 2.24; 95%CI = 1.16-4,33), HOMA 2 insulin resistance index (OR = 1.77; 95%CI =1.04-3,02), light physical activity in leisure time (OR = 0.41; 95%CI = 0.19-0,93) and recommended moderate to vigorous physical activity (OR = 2.09; 95%CI = 1.23-3.56) did in men. Factors in middle age that explain semantic verbal fluency in old age are different between postmenopausal women and men. Menopause related fat redistribution may be a precondition for other vascular risk factors. The effect of Mediterranean diet on cognition deserves new specific studies centered on postmenopausal women as group.
Highlights ► Serum parietal cell autoantibodies (PCA) are typical of autoimmune gastritis. ► In the general population PCA are more frequent in postmenopausal women. ► PCA are more frequent in people ...with insulin resistance. ► Smoking and alcohol consumption have a strong protective association with PCA. ► In patients who smoke or drink alcohol, clinicians should be cautious about PCA.
Highlights ► This paper evaluates the clinical and economic impact generated by starting ANA dilution at 1:160. ► A total of 13,233 samples were processed, and only ANA dilutions of 1:160 and higher ...showed significantly increased positive predictive value for anti-ENA and anti-dsDNA when compared to 1:40 titer. ► The cut-off 1:160 achieved making 17% less ANA tests, 42% less anti-ENA determinations and 36% less anti-dsDNA tests. ► Setting the starting dilution of ANA at 1:160 avoids unnecessary studies, increases ANA positive predictive values for anti-ENA and anti-dsDNA, and generates clinical and economic benefits.
Autoantibodies to extractable nuclear antigens (anti-ENA) are identified mainly in samples positive for antinuclear antibodies (ANA). Although the method of choice for ANA screening is indirect ...immunofluorescence (IIF), several techniques are available to detect anti-ENA. The aim of this study was to compare the efficiency of five different strategies to determine anti-ENA. During a 2-year period we screened ANA in 30375 samples with IIF, and the 4475 samples ANA positive were tested for anti-ENA by double immune diffusion screening or fluoroenzymeimmunoassay (Screening FI); anti-ENA specificities were then determined by line immunoassay (LIA) or fluoroenzymeimmunoassay (FI). We compared five strategies that involved FI or LIA identification of anti-ENA with or without prior screening, or an algorithm that combined fluorescence pattern, number of anti-ENA specificities requested by the clinician and ANA dilution titer. One cost unit (CU) was defined as the cost of 1 test of ANA determination. We detected 553 anti-ENA positive samples. The most efficient strategy was the algorithm, at a cost of 3.3
CU per sample processed, the second most efficient strategy was screening plus FI identification (cost
=
3.8
CU), and the third most efficient strategy was screening plus LIA identification (cost
=
3.9
CU). The fourth most efficient strategy was FI identification without prior screening (13.3
CU per sample) and the least efficient was LIA identification without prior screening (13.6
CU per sample). In conclusion, an algorithm that combined techniques for detection, ANA titer, fluorescence pattern and number of specificities requested was the most efficient strategy for determining anti-ENA.
ETAP: A smoking scale for Primary Health Care González Romero, Pilar María; Cuevas Fernández, Francisco Javier; Marcelino Rodríguez, Itahisa ...
Atención primaria
48, Številka:
5
Journal Article
Recenzirano
Odprti dostop
To obtain a scale of tobacco exposure to address smoking cessation.
Follow-up of a cohort. Scale validation.
Primary Care Research Unit. Tenerife.
A total of 6729 participants from the "CDC de ...Canarias" cohort.
A scale was constructed under the assumption that the time of exposure to tobacco is the key factor to express accumulated risk. Discriminant validity was tested on prevalent cases of acute myocardial infarction (AMI; n=171), and its best cut-off for preventive screening was obtained. Its predictive validity was tested with incident cases of AMI (n=46), comparing the predictive power with markers (age, sex) and classic risk factors of AMI (hypertension, diabetes, dyslipidaemia), including the pack-years index (PYI).
The scale obtained was the sum of three times the years that they had smoked plus years exposed to smoking at home and at work. The frequency of AMI increased with the values of the scale, with the value 20 years of exposure being the most appropriate cut-off for preventive action, as it provided adequate predictive values for incident AMI. The scale surpassed PYI in predicting AMI, and competed with the known markers and risk factors.
The proposed scale allows a valid measurement of exposure to smoking and provides a useful and simple approach that can help promote a willingness to change, as well as prevention. It still needs to demonstrate its validity, taking as reference other problems associated with smoking.
Despite the higher prevalence of diabetes and hypertension in populations residing at moderate altitudes, mortality in these populations is lower than in populations residing at low altitudes. To ...examine whether metabolic and hemodynamic differences can explain this apparent paradox, we performed a cross-sectional study of a general population sample recruited in the Canary Islands, Spain (n=6729). We recorded altitude of residence, age, heart rate, blood pressure, body mass index, social class, physical activity, energy intake, alcohol intake, smoking habit, prevalence of type 2 diabetes mellitus and hypertension. In a subsample (n=903), we recorded serum concentration of cholesterol, triglycerides, glucose, C peptide, leptin, soluble leptin receptor (sObR), C-reactive protein, resistin, soluble CD40 ligand (sCD40L), and paraoxonase activity (PON), and we estimated insulin resistance and free leptin index. We found an inverse association between altitude and heart rate (p<0.001), leptin (p<0.001), free leptin index (p<0.001), resistin (p<0.001), and sCD40L (p<0.05) and a direct association between altitude and hypertension (odds ratio=1.29 for altitude >600 m; 95% confidence interval=1.03-1.62), glycemia (p<0.05), C peptide (p<0.001), insulin resistance (p<0.001), sObR (p<0.05), and PON (p<0.05). When social class was included in the multivariate model, the association with PON was no longer significant. In conclusion, individuals residing at moderate altitudes have a lower heart rate and lower serum concentration of total leptin, free leptin, and sCD40L. These differences may partially explain the lower mortality in these populations.
Resumen Objetivo Obtener una escala de exposición al tabaco para abordar la deshabituación. Diseño Seguimiento de una cohorte. Validación de una escala. Emplazamiento Unidad de investigación de ...atención primaria. Tenerife. Participantes Seis mil setecientos veintinueve participantes de la cohorte «CDC de Canarias». Métodos Se construyó una escala bajo la hipótesis de que el tiempo de exposición al tabaco es el factor clave para expresar riego acumulado; su validez discriminante fue probada sobre casos prevalentes de infarto agudo de miocardio (IAM) (n = 171) y se obtuvo su mejor punto de corte para cribado preventivo. Se comprobó su validez predictiva con casos incidentes de IAM (n = 46), comparándose el poder predictivo con factores (hipertensión, diabetes, dislipemia) clásicos de riesgo de IAM, incluido el índice años a paquete diario (APD). Resultados La escala obtenida fue la suma del triple de años que se había fumado, más los expuestos al tabaco en casa y en el trabajo. La frecuencia de IAM aumentó con los valores de la escala, siendo el valor 20 años de exposición el mejor punto de corte para la actuación preventiva puesto que presentó adecuados valores predictivos para el IAM incidente. La escala superó a APD en la predicción del IAM y compitió con los marcadores y factores de riesgo conocidos. Conclusión La escala propuesta permite una medición válida de exposición al tabaco y proporciona un criterio útil y sencillo que puede ayudar a promover una disposición al cambio y realizar una prevención oportuna. Aún requiere probar su validez tomando como referente otros problemas asociados al tabaco.
Background Sun exposure, light skin pigmentation, and melanocortin 1 receptor (MC1R) gene variants are independent risk factors for skin cancer. The Canary Islands have a sunny and temperate ...climate, but data regarding the phenotypic and genotypic risk factors among the population are lacking.
Methods The main phenotypic features (skin color, hair color, eye color, and freckling) of 5116 healthy individuals are described. The genotypic findings of six MC1R gene variants (V60L, D84E, R150C, R160W, R163Q, and T314T) in 116 healthy individuals from a population‐based cohort with at least three generations of Canary Islands’ ancestry are evaluated. The variants were analyzed by SNaPshot.
Results Fifty per cent of the population showed at least one phenotypic risk factor (fair skin, 34.3%; freckling, 17.4%; green or blue eyes, 16.8%; red or blonde hair, 7.8%), although brown skin (65.7%), dark eyes (83.2%), and dark hair (92.2%) prevailed. Forty‐three per cent of the individuals showed at least one of the MC1R variants studied. Allelic frequencies for V60L, D84E, R150C, R160W, R163Q, and T314T were 9.1%, 1.7%, 3.0%, 0.8%, 3.0%, and 8.2%, respectively.
Conclusion A significant proportion of the population showed risk factors for skin cancer. The inhabitants of the Canary Islands are phenotypically and genotypically close to Mediterranean populations.
PDF
