Type 1 diabetes mellitus (T1DM) is associated with chronic complications that lead to high morbidity and mortality rates in young adults of productive age. Intensive insulin therapy has been able to reduce the likelihood of the development of chronic diabetes complications. However, this treatment is still associated with an increased incidence of hypoglycemia. In patients with “brittle T1DM”, who have severe hypoglycemia without adrenergic symptoms (hypoglycemia unawareness), islet transplantation may be a therapeutic option to restore both insulin secretion and hypoglycemic perception. The Edmonton group demonstrated that most patients who received islet infusions from more than one donor and were treated with steroid-free immunosuppressive drugs displayed a considerable decline in the initial insulin independence rates at eight years following the transplantation, but showed permanent C-peptide secretion, which facilitated glycemic control and protected patients against hypoglycemic episodes. Recently, data published by the Collaborative Islet Transplant Registry (CITR) has revealed that approximately 50% of the patients who undergo islet transplantation are insulin independent after a 3-year follow-up. Therefore, islet transplantation is able to successfully decrease plasma glucose and HbA1c levels, the occurrence of severe hypoglycemia, and improve patient quality of life. The goal of this paper was to review the human islet isolation and transplantation processes, and to describe the establishment of a human islet isolation laboratory at the Endocrine Division of the Hospital de Clínicas de Porto Alegre – Rio Grande do Sul, Brazil.

Introduction: Cardiovascular diseases (CVDs) represent the main cause of morbi-mortality in western countries. Serum cholesterol levels have been related to cardiovascular disease (CVD). Egg intake has been indirectly related to the risk of developing CVD because of its high cholesterol content. Objective: The aim of the present study was to examine the association between egg intake and CVD risk factors in adolescents, assessing the possible influence of physical activity. Methods: We studied 380 adolescents enrolled in the HELENA (HEalthy Lifestyle in Europe by Nutrition in Adolescence) study. Food intake was estimated by 2 non-consecutive 24 h recalls. We measured adiposity indicators, lipid profile, blood glucose and insulin levels, insulin resistance, blood pressure and cardiorespiratory fitness. A CVD risk score was computed as a measure of the overall CVD risk profile. Physical activity was objectively measured by accelerometry. Sexual development was examined. Socioeconomic and smoking statuses were obtained by questionnaire. The association between egg intake and CVD risk factors was examined using a multilevel analysis adjusted for potential confounders. Results: Egg intake was not associated with lipid profile, adiposity, insulin resistance, blood pressure, cardiorespiratory fitness or the integrated CVD risk score. This lack of association was not influenced by physical activity. Conclusions: The findings of the present study suggest that egg intake is not associated with a less favorable lipid or CVD risk profile in adolescents. This lack of association is not influenced by the level of physical activity.

Introducción: Las enfermedades cardiovasculares (ECVs) suponen la principal causa de morbi-mortalidad en los países occidentales. El incremento del colesterol plasmático se ha relacionado con el desarrollo de ECV. El huevo, por su alto contenido en colesterol, ha sido indirectamente relacionado con el riesgo de desarrollar ECVs. Objetivo: Examinar la asociación entre ingesta de huevo y factores de riesgo cardiovascular en adolescentes, estudiando si dicha relación está influenciada por la actividad física. Método: Se estudiaron 380 adolescentes pertenecientes al estudio HELENA (HEalthy Lifestyle in Europe by Nutrition in Adolescence). La ingesta de alimentos se estimó mediante anamnesis nutricional de dos días no consecutivos. Se midieron indicadores de adiposidad, perfil lipídico, glucosa, insulina, resistencia a la insulina, tensión arterial y capacidad aeróbica. Se calculó un índice integrado de riesgo cardiovascular (IRCV) como medida del perfil cardiovascular global. La actividad física se midió mediante acelerometría. Se examinó el desarrollo madurativo. El estatus socioeconómico y consumo de tabaco se obtuvieron mediante cuestionario. La asociación entre ingesta de huevo y factores de riesgo de ECV se examinó mediante un modelo de regresión multinivel ajustado por factores de confusión. Resultados: La ingesta de huevo no se asoció con perfil lipídico, nivel de adiposidad, tensión arterial, resistencia a la insulina, capacidad aeróbica o IRCV (todos P > 0,05). Esta falta de asociación no estuvo influenciada por el nivel de actividad física. Conclusiones: Estos resultados sugieren que no existe asociación entre ingesta de huevo y perfil lipídico, adiposidad, resistencia a la insulina, tensión arterial, capacidad aeróbica o el IRCV en adolescentes. La actividad física no influencia dicha falta de asociación.

Objective: To assess five years trends in total and abdominal fat in Spanish adolescents. Design: Two cross-sectional studies: adolescents from the city of Zaragoza (Spain) assessed during 2001-2002 and 2006-2007. Subjects: 399 adolescents in 2001-02 and 392 adolescents in 2006-07. Main outcome measurements: Socio-economic status was assessed using the education level of both parents. A complete anthropometric assessment was performed in both surveys using the same methodology: weight, height, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh and calf) and circumferences (waist and hip). The body mass index (BMI) and the sum of 6 skinfold thicknesses were calculated. Body fat percentage (BF%) was also calculated by the formulas described by Slaughter et al. Results: After adjusting for age and pubertal status, only females showed a significantly decrease in weight, BMI and waist circumference, and a significant increase in the sum of 6 skinfolds (all P < 0.05 and Cohen's d ≥ 0.25) in 2006-2007, when compared to values obtained in 2001-2002. Males did not show any significant change between the two surveys. Concerning centile values, a slight general reduction was observed in weight, BMI and waist circumference for both males and females. On the contrary, the sum of 6 skinfolds and the BF% were higher in 2006-2007 than in 2001-2002. Conclusion: According to these results, there might be a levelling-off in the trends of BMI, BF% and waist circumference in male adolescents from Zaragoza. In females, despite a trend towards higher body fat mass, there was a trend towards lower BMI and waist circumference values.

Objetivo: Evaluar las tendencias de cinco años de la grasa total y abdominal de adolescentes españoles. Diseño: Dos estudios transversales: adolescentes de la ciudad de Zaragoza (España) evaluados durante 2001-2002 y 2006-2007. Sujetos: 399 adolescentes en 2001-02 y 392 adolescentes en 2006-07. Principales variables estudiadas: El estado socioeconómico se evaluó usando el nivel educativo de ambos progenitores. Se realizó una evaluación antropométrica completa en ambos estudios con la misma metodología: peso, talla, grosor del pliegue (bíceps, tríceps, subescapular, suprailíaco, muslo y pantorrilla) y circunferencias (cintura y cadera). Se calcularon el índice de masa corporal (IMC) y la suma del grosor de 6 pliegues. También se calculó el porcentaje de grasa corporal (%GC) con las fórmulas descritas por Slaughter et al. Resultados: tras ajustar por edad y estado puberal, sólo las chicas mostraron un descenso significativo del peso, IMC y la circunferencia de la cintura, y un aumento significativo en la suma de los 6 pliegues cutáneos (todos ellos P < 0,05 y d de Cohen ≥ 0,25) en 2006-2007, en comparación con los valores obtenidos en 2001-2002. Los chicos no mostraron cambios significativos entre ambos estudios. Con respecto a los percentiles, se observó una reducción leve del peso, IMC y circunferencia de la cintura en chicos y chicas. Por el contrario, la suma de los 6 pliegues cutáneos y el %GC fueron mayores en 2006-2007 que en 2001-2002. Conclusión: de acuerdo con estos resultados, podría haber un resultado neutro en las tendencias del IMC, %GC y circunferencia de la cintura en los adolescentes varones de Zaragoza. En las chicas, a pesar de una mayor tendencia a una mayor grasa corporal, hubo una tendencia a unos menores valores de IMC y de circunferencia de la cintura.

Introduction: The influence of socioeconomic status on health-related fitness is not clear. Aim: To examine the influence of socioeconomic status on health-related fitness in adolescents. Methods: A total of 3,259 adolescents (15.0 ± 1.3 y) from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) participated in the study. Socioeconomic status was assessed by the family affluence scale (FAS). Speed-agility, muscular strength and cardiorespiratory fitness were assessed. Covariates included total body fat, physical activity and pubertal status. Results: Adolescents with high FAS had significantly higher fitness levels than their peers of lower FAS categories except for speed-agility and handgrip in boys. Overall, the associations observed presented a medium to large effect size. Conclusion: These results suggest that socioeconomic status is positively associated with physical fitness in European adolescents independently of total body fat and habitual physical activity.

Introducción: La influencia del estatus socioeconómico sobre la condición física en relación con la salud no está clara. Objetivo: Examinar la influencia del estatus socioeconómico sobre la condición física en relación con la salud en adolescentes. Metodología: Un total de 3259 adolescentes (15,0 ± 1,3 años) del "Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study" (HELENA-CSS) participaron en el estudio. El estatus socioeconómico fue medido con una escala de riqueza familiar "family affluence scale (FAS)". Se midieron velocidad-agilidad, fuerza muscular y capacidad aeróbica. Las covariables incluidas fueron grasa corporal total, actividad física y estadio madurativo. Resultados: Los adolescentes con alto FAS tuvieron significativamente mayores niveles de condición física que aquellos con bajo FAS exceptuando los tests de velocidad-agilidad y fuerza de prensión manual en chicos. En general, las asociaciones observadas presentaron un efecto del tamaño de la muestra (effect size) entre medio y largo. Conclusión: Estos resultados sugieren que el estatus socioeconómico esta positivamente asociado con la condición física en adolescentes Europeos independientemente de la grasa corporal total y el nivel de actividad física.

O papel da dieta na síndrome metabólica (SM) tem sido estudado em relação a cada um de seus componentes: obesidade, níveis pressóricos elevados, dislipidemia e alterações no metabolismo da glicose. Entretanto, poucos estudos avaliaram os efeitos da dieta na presença da SM como uma entidade clínica independente. O objetivo deste manuscrito foi revisar a importância dos fatores dietéticos e as recomendações dietoterápicas na SM. Estudos recentes demonstraram que o consumo de grãos integrais foi associado negativamente com SM. Já alimentos com alto índice glicêmico foram associados positivamente com resistência à insulina e prevalência de SM. O seguimento de uma dieta mediterrânea foi capaz de reduzir o número de componentes da SM. Também a adoção da dieta DASH melhorou o perfil de todos os componentes da SM. Recomenda-se, para pacientes com SM, um valor energético total compatível com a obtenção e/ou manutenção do peso corporal desejável. O conteúdo de gordura, em especial o consumo de gordura saturada, e colesterol deve ser reduzido e o consumo de grãos integrais, frutas e vegetais, aumentado. Provavelmente as fibras alimentares têm um papel importante no manejo dietoterápico da SM. Novos estudos que avaliem o papel da dieta na presença e no desenvolvimento da SM são necessários.

The role of diet in metabolic syndrome (MS) has been studied regarding each one of its components: obesity, high blood pressure, dyslipidemia, and abnormal glucose metabolism. However, few studies evaluated the effects of diet in the presence of MS as a unique independent disease. The aim of this manuscript was to review the role of dietary factors and dietary recommendations for MS. Recently some studies demonstrated that intake of whole-grain foods were negatively associated with MS. Foods with high glycemic index were positively associated with insulin resistance and the prevalence of MS. Following a Mediterranean-style diet caused a reduction in the number of MS components. Also, the adoption of the DASH diet improved the profile of all MS components. A total daily energy intake to obtain and/or to maintain a desirable weight is recommended for patients with MS. The fat content, especially from saturated fat, and cholesterol must be reduced and the intake of whole-grain foods, fruits, and vegetables must be increased. Probably, dietary fibers have an important role in the management of MS. New studies to evaluate the role of diet in the presence and development of MS are needed.

Background: The effects of alcohol consumption on body weight have been evaluated in a large number of studies suggesting to be inversely as well as positively related to body weight and body fat. Objective: This study examined the relationships between moderate beer consumption and anthropometrical parameters in Spanish healthy adults. Method: After a 30 day alcohol abstemious period, 58 healthy volunteers were submitted to a daily moderate consumption of beer during the following 30 days. Weight, height, skinfolds and circumferences were measured at three points: a) basal; b) abstemious and c) after moderate consumption of beer. Results: Biceps skinfold (mm) increased (p < 0.05) in men after moderate beer consumption in regard to abstinence period (5.74 ± 1.70 vs 6.23 ± 1.74). No significant differences were observed in the rest of anthropometrical parameters studied in both women and men along the study intervention. Conclusion: Moderate beer consumption during one month did not mostly change weight and weight-related parameters in healthy adults.

Introducción: Son numerosos los estudios que han investigado los efectos del consumo de alcohol en el peso corporal, sugiriendo una relación tanto inversa como positiva en relación al peso y la grasa corporal. Objetivo: Examinar la relación entre un consumo moderado de cerveza y el peso corporal en una población adulta española sana. Material y métodos: Después de un período de 30 días de abstinencia alcohólica, 58 voluntarios sanos (31 varones y 27 mujeres) fueron sometidos a un consumo moderado de cerveza diario durante los 30 días siguientes. Se evaluaron los parámetros antropométricos correspondientes a la talla, peso, pliegues cutáneos y perímetros, al principio del estudio (a), tras un mes de abstinencia de alcohol (b), y tras un mes de consumo moderado de cerveza (c). Resultados: Se observó un aumento significativo (p < 0,05) en el pliegue bicipital (mm) en el grupo de los hombres tras el consumo moderado de cerveza al compararlo con el mes de abstinencia (5,74 ± 1,70 vs 6,23 ± 1,74). No se observaron cambios en el resto de los parámetros antropométricos estudiados a lo largo del estudio, ni en el grupo de las mujeres ni en el de los hombres. Conclusión: En una población adulta sana, el consumo moderado de cerveza durante un mes no modifica los parámetros ponderales, ni los relacionados con la composición corporal a excepción del pliegue bicipital en los hombres.

OBJETIVO: Analisar os testes usados na prática clínica de rotina para diagnóstico de isquemia miocárdica na predição do desenvolvimento de eventos cardíacos em pacientes com diabetes mellitus tipo 2 (DM2). MÉTODOS: A ocorrência de eventos cardíacos (novo infarto do miocárdio [IM], procedimentos de re-vascularização miocárdica, insuficiência cardíaca congestiva, edema agudo de pulmão, morte súbita e morte após IM ou edema pulmonar) foi avaliada prospectivamente em uma coorte de 135 pacientes com DM2 após até 7 anos de acompanhamento. Na condição basal, a doença arterial coronariana (DAC) foi avaliada pelo questionário cardiovascular da OMS, eletrocardiograma de repouso e cintilografia do miocárdio sob stress. RESULTADOS: 48 eventos cardíacos foram observados em 41 pacientes (10,5 eventos/100 pacientes-ano). No modelo de risco proporcional de Cox apenas a presença de sintomas de DAC no questionário cardiovascular da OMS isoladamente (RR= 2,13, 95% CI 1,114,07, P= 0,022) ou em combinação com anormalidades no ECG de repouso (RR= 2,03, 95% CI 1,053,92, P= 0,034) ou cintilografia do miocárdio (RR= 1,89, 95% CI 1,0013,57, P= 0,050) predisseram eventos cardíacos, ajustados para a glicemia de jejum, pressão arterial média, índice de massa corporal, doença vascular periférica e nefropatia diabética. CONCLUSÃO: O questionário cardiovascular da OMS, um procedimento simples para o diagnóstico da DAC, é um preditor significativo de eventos cardíacos em pacientes com DM2.

OBJECTIVE: To analyze tests used in routine clinical practice for the diagnosis of myocardial ischemia to predict the development of cardiac events in type 2 diabetic patients. METHODS: The occurrence of cardiac events (new myocardial infarct, myocardial re-vascularization procedures, congestive heart failure, acute pulmonary edema, sudden death, and death after myocardial infarction or pulmonary edema) were prospectively assessed in a cohort of 135 type 2 diabetic patients after up to seven years of follow-up. At baseline, coronary artery disease was assessed by the WHO cardiovascular questionnaire, resting electrocardiogram, and stress myocardial scintigraphy. RESULTS: Forty-eight cardiac events were observed in 41 patients (10.5 events/100 patients-year). In a Cox's proportional-hazard model only the presence of symptoms of coronary artery disease on the WHO cardiovascular questionnaire alone (RR= 2.13, 95% CI 1.114.07, P= 0.022) or in combination with abnormalities on resting ECG (RR= 2.03, 95% CI 1.053.92, P= 0.034) or on myocardial scintigraphy (RR= 1.89, 95% CI 1.0013.57, P= 0.050) predicted cardiac events, adjusted for fasting plasma glucose, mean blood pressure, body mass index, peripheral vascular disease and diabetic nephropathy. CONCLUSION: The WHO cardiovascular questionnaire, a simple tool for the diagnosis of coronary artery disease, is a significant predictor of cardiac events in type 2 diabetic patients.

OBJECTIVE: Moderate beer consumption can be part of a healthy diet, like the Mediterranean diet. The aim of the present study was to analyse the contribution a moderate beer consumption makes to energy and nutrient intake in Spanish healthy adults. MATERIAL AND METHODS: As part of a larger intervention study, dietary intake was measured by means of a 7-day food dietary record in 24 men and 22 women (age 34.18 ± 5.80 years) twice: during the last week of the 30 days of complete alcohol abstinence and during the last week of 30 days of moderate beer consumption. Energy and nutrient content of food was analysed by means of the GEA program, based on the Spanish food composition tables. RESULTS: In women, moderate beer consumption increased significantly (p < 0.05) mean vitamin B6 (1.24 ± 0.32 to 1.47 ± 0.34 mg), B12 (3.87 ± 1.46 to 5.58 ± 2.76 µg), A (614.45 ± 224.75 to 788.3 ± 486.1 µg), and folate (139.5 ± 39.88 to 168.25 ± 56.32 µg) intake, whereas there was a decrease in mean iodine intake (327.1 ± 148.4 to 281.2 ± 135.02 µg). In men, mean vitamin B2 (1.64 ± 0.62 to 1.91 ± 0.46 mg), B6 (1.54 ± 0.63 to 1.80 ± 0.37 mg), niacin (30.01 ± 8.13 to 34.78 ± 6.26 mg) and folate (153.23 ± 68.70 to 192.32 ± 46.73 mg) intake also increased significantly. Energy, macronutrient and mineral intake had non-significant oscillations. CONCLUSION: Moderate beer consumption can improve diet quality in regard to B vitamins in healthy adults.

OBJETIVO: El consumo moderado de cerveza puede formar parte de una dieta saludable, como la dieta mediterránea. El objetivo de este estudio fue analizar la contribución del consumo moderado de cerveza a la ingestión de energía y nutrientes en adultos españoles sanos. MATERIAL Y MÉTODOS: Como parte de un estudio intervencionista más amplio, se midió la ingestión dietética mediante un registro de 7 días de los alimentos de la dieta en 24 hombres y 22 mujeres (edad: 34,18 ± 5,80 años) dos veces: durante la última semana de un periodo de 30 días de abstinencia absoluta de alcohol y durante la última semana de un periodo de 30 días de consumo moderado de cerveza. Se analizó el contenido energético y en nutrientes de los alimentos mediante el programa GEA, basado en las tablas españolas de composición de los alimentos¹. RESULTADOS: En las mujeres, el consumo moderado de cerveza aumentó de forma significativa (p < 0,05) el promedio de ingestión de vitamina B6 (1,24 ± 0,32 a 1,47 ± 0,34 mg), B12 (3,87 ± 1,46 a 5,58 ± 2,76 µg) A (614.45 ± 224.75 to 788.3 ± 468.1 µg), y folatos (139,5 ± 39,88 a 168,25 ± 56,32 µg). En hombres, también aumentó de forma significativa la ingestión de vitamina B12 (1,64 ± 0,62 a 1,91 ± 0,46 mg), B6 (1,54 ± 0,63 a 1,80 ± 0,37 mg), niacina (30,01 ± 8,13 a 34,78 ± 6,26 mg), y folatos (153,23 ± 68,70 a 192,32 ± 46,73 mg). No hubo oscilaciones significativas en la ingestión de macronutrientes ni minerales. CONCLUSIÓN: El consumo moderado de cerveza puede mejorar la calidad de la dieta con respecto a las vitaminas del grupo B in adultos sanos.

A retinopatia e a nefropatia estão entre as mais prevalentes e incapacitantes complicações associadas a dano microvascular no diabete melito (DM). A gravidade da hiperglicemia e a presença de hipertensão arterial sistêmica estão entre os principais fatores de risco para essas complicações. A monitorização ambulatorial da pressão arterial (MAPA) permitiu uma melhor compreensão dos padrões de variação da pressão arterial em pacientes diabéticos. Vêm-se acumulando evidências de que pacientes com DM podem apresentar padrões alterados da homeostase pressórica durante as 24h. Mesmo pequenas alterações da homeostase pressórica, freqüentemente vistas em pacientes normotensos na avaliação da pressão arterial por aferição em consultório, podem estar implicadas em aumento de risco de complicações microvasculares. Essas alterações pressóricas, associadas à hiperglicemia, podem produzir perda da auto-regulação dos vasos retinianos, acelerando ou agravando a retinopatia diabética. Provavelmente a MAPA poderá se tornar um instrumento útil de avaliação clínica em pacientes diabéticos normotensos, auxiliando no processo de identificação precoce do risco de desenvolvimento de complicações microangiopáticas. O objetivo desse artigo é fornecer uma revisão atualizada e orientada para a prática clínica sobre homeostase pressórica e DM.

The retinopathy and nephropathy are among the most prevalent and disabling complications associated to microvascular damage in diabetes mellitus. The severity of hyperglicaemia and the presence of arterial systemic hypertension are among the main risk factors for these complications. The ambulatory blood pressure provided a better understanding of patterns of blood pressure in diabetic patients. There is a growing number of evidence relating diabetic patients with abnormal 24h blood pressure patterns. Even subtle modifications of these patterns, frequently shown by patients diagnosed as normotensives in office blood pressure measurings, may be implicated in an increased risk of microvascular complications. Hyperglicaemia and these abnormal pressure patterns appear to have a synergistic effect on promoting and aggravating diabetic retinopathy. Impairment of the normal retinal autoregulation is one of the implicated physiopathological mechanisms. Probably, ABP may be useful in predicting an increased risk of microvascular complications on diabetic normotensive patients. The objective of this paper is to provide an updated and clinically oriented review in blood pressure homeostasis and diabetes mellitus.

A nefropatia diabética (ND) acomete até 40% dos pacientes com diabetes melito (DM) tipo 1 e tipo 2, sendo a principal causa de insuficiênca renal crônica naqueles pacientes que ingressam em programa de tratamento de substituição renal. A dieta parece ter um papel importante no desenvolvimento da doença. Existem evidências de que não apenas a quantidade mas o tipo de proteína ingerida também está associado à ND. Poucos estudos analisaram o papel dos lipídeos da dieta na ND. Dietas hipoprotéicas têm sido úteis em modificar de forma favorável a evolução da ND, desacelerando a perda de função renal em pacientes DM tipo 1 e ND. Existem poucos estudos em pacientes com DM tipo 2, porém estudos a curto prazo sugerem que esta dieta reduz a albuminúria. Entretanto, o seu uso a longo prazo é comprometido pela dificuldade de aderência à restrição protéica e pela sua segurança nutricional não estar ainda estabelecida. Resultados promissores são observados quando comparadas diferentes fontes de ingestão de proteína animal sobre a função renal e perfil lipídico sérico de pacientes com ND, podendo estas intervenções representar uma alternativa à dieta hipoprotéica no manejo dietoterápico nestes pacientes, ao atuar sobre os fatores de risco cardiovasculares e na função endotelial.

Diabetic nephropathy (DN) is the leading cause of kidney disease in patients starting renal replacement therapy, and affects up to 40% of type 1 and type 2 diabetic patients. Diet seems to play an important role in the development of the disease. There are evidences supporting the concept that not only the amount but also the origin of dietary protein are associated with DN. Few studies analyzed the role of dietary lipids. A low-protein diet slows down the decline of renal function and ameliorates the DN prognosis and death in patients with type 1 diabetes with micro- and macroalbuminuria. Studies in type 2 diabetic patients are scanty but short-term studies suggest that this approach decreases albuminuria. However, the use of low-protein diet for long periods is compromised by poor compliance and its long-term safety is not firmly established. Enthusiastic results come up when comparing the effect of different sources of animal protein on renal function and lipid profile in patients with DN, which may represent an alternative strategy for low-protein diet on medical nutritional therapy in patients with DN and in cardiovascular risk factors and endothelial function.

With the increase of life expectancy, the desire to maintain good health, functionality and maximum quality of life at advanced ages, for which nutrition plays a critical role, is a priority for the elderly. Though genetic factors are a determinant of life expectancy, there are several extrinsic factors which have a great influence on the quality of life of the elderly. Diet and nutritional status have a great influence, especially in the prevention and treatment of several diseases, which affect this heterogeneous and vulnerable age group. The nutritional status and needs of elderly people are associated with age-related biological, psychological and often socio-economic changes. All of these changes can increase the risk of developing a number of age-related diseases. In developed countries the elderly are the most affected by malnutrition, either because of a deficiency (energy and several nutrients) or an excess, leading to obesity and related diseases. This review highlights the most important factors affecting nutritional status in elderly people and focus on the need to maintain adequate physical activity level and an optimal physic, psychic and social functional capacity. It discusses dietary reference intakes and guidelines to improve and/or maintain adequate nutritional status in older people in order to reduce susceptibility to some illness and disease.

Con el incremento de la esperanza de vida, el deseo de mantener una buena salud, funcionalidad y una máxima calidad de vida en edades avanzadas constituye una prioridad en las personas mayores. Aunque la genética es un determinante de esta expectativa de vida, existen otros factores extrínsecos directamente implicados en la calidad de vida del anciano, entre los que cabe destacar la alimentación. La dieta y el estado nutricional tienen gran influencia, particularmente en la prevención o tratamiento de diversas enfermedades que afectan a este grupo, uno de los más heterogéneos y vulnerables de la población de los países desarrollados con un mayor riesgo de sufrir desequilibrios, carencias y problemas nutricionales. Esto es debido, por un lado, a que las necesidades de algunos nutrientes pueden ser mayores que en etapas anteriores y, por otro, a su menor capacidad para regular todos los procesos relacionados con la ingesta de alimentos como consecuencia del progresivo deterioro de casi todas las funciones biológicas. Los numerosos cambios físicos, psíquicos y sociales que acompañan al envejecimiento y la mayor prevalencia de enfermedades crónicas, también contribuyen a esta situación. Diversos estudios han puesto de manifiesto el riesgo de ingestas inadecuadas y de malnutrición proteico-energética, aumentando la vulnerabilidad a otras enfermedades. En este trabajo se hace una revisión de los principales condicionantes del estado nutricional en el anciano, de la importancia de la capacidad funcional física, psíquica y social y de la actividad física y de su repercusión en el estado nutricional. Se describen las ingestas de referencia y las recomendaciones dietéticas más actuales, tratando de establecer las condiciones dietéticas y de estilo de vida que pueden contribuir a preservar las funciones corporales y minimizar las enfermedades crónicas en las personas de edad.

Background: Adolescence is a decisive period in human life due to the multiple physiological and psychological changes that take place. These changes will condition both nutritional requirements and eating/physical activity behavior. It has been demonstrated that these "adolescence" factors are of significant influence in health status during adult life. Due to its importance and adequate development the project has been granted by the Fondo de Investigación Sanitaria of the Institute of Health Carlos III. Objective: To develop a methodology to evaluate the health and nutritional status of a representative population of Spanish adolescents. Specific attention is paid to three specific health problems: obesity, anorexia nervosa/ bulimia, dislipidemia. Methodology: The following magnitudes will be studied: 1) dietary intake, food habits and nutrition knowledge; 2) daily physical activity and personal approach; 3) physical condition; 4) anthropometry and body composition; 5) hematobiochemical study: plasma lipid phenotypic and metabolic profile, blood cell counts; 6) genotipic profile of cardiovascular risk lipid factors; 7) immune function profile related to nutritional status; 8) psychological profile. Conclusion: This project includes the co-ordinate activity of five Spanish centers of five different cities (Granada, Madrid, Murcia, Santander, Zaragoza). Each center is specialized in a specific area and will be responsible for the corresponding part of the study. From the data obtained, we will elaborate a specific intervention program in order to improve nutrition and neutralize the risk for nutritional related problems in adolescence. By this, we will contribute to improve the health status of the Spanish population in the new millennium.

Antecedentes: La adolescencia es una etapa decisiva en el desarrollo humano por los múltiples cambios fisiológicos y psicológicos que en ella ocurren los cuales, a su vez, condicionan tanto las necesidades nutricionales como los hábitos de alimentación, actividad física y comportamiento. Además, está demostrado que estos hábitos tienen repercusión en el estado de salud en la vida adulta. El interés de este tema así como su apropiado desarrollo ha merecido una financiación por parte del Fondo de Investigación Sanitaria del Instituto de Salud Carlos III. Objetivo: Desarrollar una metodología que evalúe el estado de salud así como la situación nutricional-metabólica y forma física de una muestra representativa de adolescentes españoles. Especial atención se prestará a tres tipos específicos de patologías como son obesidad, anorexia nerviosa/bulimia, dislipidemia. Metodología: Para alcanzar el objetivo, se van a estudiar ocho tipos diferentes de magnitudes: 1) ingesta dietética, hábitos alimentarios y conocimientos nutricionales; 2) actividad física habitual y actitud frente a la práctica físico-deportiva; 3) nivel de condición física; 4) antropometría y composición corporal; 5) estudio hematobioquímico: perfil fenotípico lipídico y metabólico, estudio hematológico; 6) perfil genotípico de factores lipídicos de riesgo cardiovascular; 7) perfil inmunológico de estado nutricional; 8) perfil psicológico. Conclusión: Este proyecto incluye la actividad coordi nada de cinco centros españoles situados en otras tantas ciudades (Granada, Madrid, Murcia, Santander, Zaragoza). Cada uno de esos centros tiene larga y acreditada experiencia en la parte del estudio de la que es responsable. En función de los resultados obtenidos, se propondrá un programa específico de intervención que permita mejorar la alimentación y neutralizar el riesgo que, para las patologías antes mencionadas, existe entre los adolescentes españoles. Con ello se pretende contribuir a mejorar el estado de salud de la población española del nuevo milenio.

Diabetes e alterações da tolerância à glicose são freqüentes na população adulta e estão associados a um aumento da mortalidade por doença cardiovascular e complicações microvasculares. O diagnóstico destas situações deve ser feito precocemente, utilizando métodos sensíveis e acurados, já que mudanças no estilo de vida e a correção da hiperglicemia podem retardar o aparecimento do diabetes ou de suas complicações. O teste oral de tolerância à glicose é o método de referência, considerando-se a presença de diabetes ou tolerância à glicose diminuída quando a glicose plasmática de 2h após a ingestão de 75g de glicose for > ou = 200mg/dl ou > ou = 140 e <200mg/dl, respectivamente. Quando este teste não puder ser realizado, utiliza-se a medida da glicose plasmática em jejum, considerando-se como diabetes ou glicose alterada em jejum quando os valores forem > ou = 126mg/dl ou > ou = 110 e <126mg/dl, respectivamente. A medida da glico-hemoglobina não deve ser utilizada para o diagnóstico, mas é o método de referência para avaliar o grau de controle glicêmico a longo prazo. A classificação etiológica proposta atualmente para o diabetes melito inclui 4 categorias: diabetes melito tipo 1, diabetes melito tipo 2, outros tipos específicos de diabetes e diabetes gestacional. A classificação do paciente é usualmente feita em bases clínicas, mas a medida de auto-anticorpos e do peptídeo C pode ser útil em alguns casos.

Diabetes mellitus and other categories of impaired glucose tolerance are frequent in the adult population and are associated with an increased risk for cardiovascular disease and microvascular complications. The diagnosis of these entities should be performed early and using sensitive and accurate methods, since lifestyle changes and correction of hyperglycemia may delay the incidence of diabetes and its complications. Glucose tolerance test is the reference method and the diagnosis of diabetes and impaired glucose tolerance are established when the 2h plasma glucose after an oral intake of 75g of glucose is > or = 200mg/dl or > or = 140 and <200mg/dl, respectively. When it is not possible to perform this test, fasting plasma glucose levels > or = 126mg/dl or > or = 110 and <126mg/dl, respectively, are used to establish the diagnosis of diabetes and impaired fasting plasma glucose. Glycohemoglobin should not be used for the diagnosis but it is the reference method for evaluation of the long-term glucose control. The etiological classification of diabetes mellitus includes 4 categories: type 1 diabetes, type 2 diabetes, other specific types of diabetes and gestational diabetes. The assignment of the patient in each category usually is made on clinical grounds, however in some case the measurement of C-peptide and autoantibodies are necessary.

Foram analisados 167 casos de adenomas da hipófise pelo método imuno-histo-químico utilizando o Complexo da Avidina Biotina (ABC) descrito por Hsu e col. (1981). Foram usados 6 anti-hormônios hipofisários: anti-prolactina (aPRL), na diluição de 1:1.500, anti-hormônio do crescimento (aHGH), na diluição de 1:4.000, anti-hormônio adrenocortico-trófico (aACTH), na diluição de 1:3.000, anti-hormônio tireotrófico (aTSH), na diluição de 1:3.000, anti-hormônio luteinizante (aLH), na diluição de 1:1.000, anti-hormônio folículo estimulante (aFSH), na diluição de 1:300. O período de incubação foi de 14 a 16 horas a 4ºC. Foi realizada também a coloração pelo Orange G-PAS. O levantamento dos dados clínicos, laboratoriais, e radiológicos dos casos de adenomas da hipófise foi realizado após a leitura das lâminas pelo método imuno-histoquímico. Dos 167 casos de adenomas da hipófise, 136 (81,4%) mostraram imuno-reação positiva a um ou mais anti-hormônios, variando o índice de positividade entre 1 e 90% das células neoplásicas. A imuno-reação foi positiva exclusivamente a um anti-hormônio em 80 casos (58,8%) e para dois ou mais anti-hormônios nos 56 casos restantes (41,2%), sendo a associação mais freqüentemente encontrada aquela em aue a positividade ocorreu para o aPRL e o aHGH. A positividade à reação imuno-his-toquímica distribuiu-se da seguinte forma: 100 casos foram positivos para o aPRL, em 49 pacientes de forma isolada; 65 casos foram positivos para o aHGH, em 22 pacientes de forma isolada; 31 casos foram positivos para o aACTH, em 8 pacientes de forma isolada; 5 casos foram positivos ao aTSH, em um paciente de forma isolada; um paciente apresentou adenoma positivo ao aLH; um caso foi positivo ao aFSH.

One hundred and sixty seven cases of pituitary adenoma were analysed using the immunocytochemical method of the Avidin-Biotin Complex (ABC), described by Hsu et al. (1981). Six pituitary anti-hormones were utilized: anti-prolactin (aPRL») at a 1:1,500 dilution; anti-growth hormone (aHGH) at a 1:4,000 dilution; anti-adrenocorticotro-phic hormone (aACTH) at a 1:3,000 dilution; anti-thyrothrophic hormone (aTSH) at a 1:3,000 dilution; anti-luteinizing hormone (aLH) at a 1:1,000 dilution; and a anti_follicle-stimulating hormone (aFSH) at a 1:300 dilution. Incubation period was 14 to 16 hours at 4°C. The survey of clinical, laboratory and radiological data of cases of pituitary adenomas was performed (after reading- the stained slides using the immunocytochemical method. Of the 167 cases of pituitary adenomas, 136 (81,4%) disclosed a positive immuno-reaction to one or more anti-hormones, and the positivity index of neoplastic cells varied from 1 to 90%. The immunoreaction was positive exclusively to one anti-hormone in 80