Objective: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. Design: Cross-sectional study. Setting: Tertiary care hospital. Participants: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. Results: A total of 21.7% of patients had osteoporosis (T score <2.5 SD). Patients were overweight with a high BMI and a medium glucose control. Patients with osteoporosis were older than those without osteoporosis (67.8 ± 6.9 vs. 62.1 ± 9.2 years; p < 0.05). Significant differences were detected between patients without and with osteoporosis in calcium intake (1,219.37 ± 387 vs. 839 ± 251 mg/day; p < 0.05) and zinc intake (9.23 ± 3.5 vs. 13.3 ± 6.9 mg/day; p < 0.05), respectively. No differences were detected in other dietary dairy intakes. In correlation analysis age (r = –0.23; p < 0.05) and BMI (r = 0.48; p < 0.05) was correlated with BMD. In univariate analysis with dicotomic variables, only exercise was positive associated with osteoporotic status (87.5% exercise habit in patients without osteoporosis and 25% exercise habit in patients with osteoporosis; p < 0.05). In a logistic model with the dependent variable (osteoporosis), remained in the final model dietary dairy intake of calcium and zinc, BMI, age and exercise. Exercise, calcium intake and BMI were protective factors. Zinc intake, and age were risk factors. Conclusions: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population.
Objective: The widespread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence, clinical and biochemical characteristics of a cohort of patients on home enteral nutrition (HEN). Design: Prospective observational study. Setting: Tertiary care. Subjects: Between January 1999 and December 2001, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. Interventions: Information for each patients was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported. Results: In 1999, the incidence of HEN in our area was patients 15 per 100 000 inhabitants. This incidence rate rose to 21.3 in 2000 and decreased to 9.52 in 2001. The mean age of all patients was 58.7 AE 13 y. The distribution of patients by diseases was: 71 (69.6%) had a head and neck cancer; 14 (13.7%) had a neurological disorder affecting swallowing (cerebrovacular accident and/or dementia); 6 (5.9%) had tumors in different locations with anorexia; and 11 (10.8%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered orally in 81 patients (79.4%), via a nasogastric tube (NGT) in 15 patients (14.7%), via a percutaneous gastrostomy (PEG) in five patients (4.9%), and via a jejunostomy in one patient (1%). The mean duration of HEN was 101 AE 46.9 days. During the course of HEN, six patients had diarrhea (5.9%), and four (3.9%) constipation, and two vomiting (2%) that did not require cessation of HEN. Albumin, prealbumin, transferrin and lymphocytes improved in all the groups, when comparing the first review with the last. After the follow-up (3 y) with review, each 3 months, 10 of the 102 patients (9.8%) had died, and 92 (90.2%) were alive. Survival probability was influenced by the access route, with the worse outcome in patients with no oral nutrition (NGT, PEG and jejunonostomy; hazard ratio: 24.9; 95% CI: 4.1 -52), adjusted by age, sex and diagnosis. Conclusions: In conclusion, HEN is a valid and safe technique for nutrition support, with a good clinical outcome in our area.
Background/Aim: The evaluation of the significance of hyperhomocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function, vitamin status, and lifestyle. The aim of our study was to investigate the relation between macro- and micronutrient intakes and homocysteine levels in a population having diabetes type 2. Methods: A total of 155 patients with diabetes mellitus type 2 attending our Diabetes Service (90 females and 65 males) were enrolled in a consecutive way. All patients underwent determination of fasting blood homocysteine, glycated hemoglobin, glucose, vitamin B12, and folate levels. Microalbuminuria was evaluated on the basis of a 24-hour urine. The patients were instructed to keep 3-day written food records incorporating the use of food scales and models to enhance portion size accuracy. Alcohol drinking, physical activity, and smoking habits were also registered. Results: The mean homocysteine levels were 10.5 ± 4.3 µmol/l. The mean glucose and Hb AIc levels were 9.5 ± 3 mmol/l and 7.8 ± 1.4%, respectively. The vitamin status was normal: 592.6 ± 522 pg/ml vitamin B12 and 10.5 ± 5.5 ng/ml folic acid. Mean microalbuminuria was 81.7 ± 238 mg/day. The calorie intakes were normal (carbohydrates 43%, proteins 23.8%, and lipids 33.1%). A decrease in daily intakes of vitamins (A, B1, D, and E) and trace elements (Zn, Mg, Se, and Ca) was detected. High daily intakes were detected for protein, P, and vitamins C, B12, K and P 29.7% of the patients drank beer and 18% other alcoholic beverages. 11.7% of the patients smoked, and 77.7% maintained daily physical activity (mean/day 25.7 ± 20.9 min). Only protein (g/day; r = 0.25; p < 0.005) and beer (ml/day; r = –0.46; p < 0.05) correlated with the total homocysteine levels. The daily intakes of vitamin B12 and folic acid were inversely correlated with the total homocysteine levels: r = –0.29; p < 0.05) and (r = –0.12; p < 0.05), respectively. Physical activity and smoking habits were not correlated. In the multivariate analysis with a dependent variable (total homocysteine) adjusted for age, sex, microalbuminuria, and nutrient intakes (proteins, folic acid, and vitamin B12) and beer remained in the model. Conclusion: The present study shows that protein intake and beer could modify the levels of total homocysteine in patients with diabetes type 2.
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