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Vol. 52. Núm. 9.
Páginas 476-483 (Noviembre 2005)
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Vol. 52. Núm. 9.
Páginas 476-483 (Noviembre 2005)
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Acceso a texto completo
Estudio sobre la nutrición en la diabetes y las complicaciones (DNCT): hábitos nutricionales en la población con diabetes en España y su relación con la presencia de neuropatía
The diabetes nutrition and complications trial: nutritional habits among diabetics in spain and their association with neuropathy
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...
Grupo de Nutrición De La Sociedad Española De Diabetes (GSEDNu) 1,2
Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Madrid. España
Información del artículo
Objetivo

Evaluar la influencia de la alimentación en la aparición de polineuropatía (PN) en una población española con diabetes mellitus.

Métodos

El “Ensayo sobre la nutrición en la Diabetes y las Complicaciones (DNCT, Diabetes Nutrition and Complications Trial)” es un estudio prospectivo, poblacional multicéntrico y observacional diseñado para conocer los hábitos nutricionales, basado en un diario de consumo de alimentos durante 7 días, de una población de 192 pacientes con diabetes (93 tipo 1 y 99 tipo 2) de larga evolución (de 20 y 18 años de evolución, respectivamente), y con un aceptable grado de control glucémico (HbA1c del 6,9 y el 6,4%, respectivamente), y su relación con la aparición de PND diagnosticada por una puntuación = 6 del cuestionario de signos Neuropathy Disability Score.

Resultados

Inicialmente la PND se detectó en 4 (4,3%) pacientes con diabetes tipo 1 y 14 (14,1%) con diabetes tipo 2. Después de un seguimiento de 6,5 años, se detectaron 10 (5,7%) casos nuevos, 0,88 por 100 pacientes y año, 1 (1,1%) en pacientes diabéticos tipo 1, 0,2 por 100 pacientes y año, y 9 (10,6%) en pacientes diabéticos tipo 2, 1,6 por 100 pacientes y año. Mientras, 164 (85,4%) pacientes permanecieron sin datos de PND, 88 (94,6%) con diabetes tipo 1 y 76 (76,8%) con diabetes tipo 2. Los pacientes que desarrollaron PND presentaban una edad mayor y un mayor tiempo de evolución, así como un índice de masa corporal (IMC), un perímetro de la cintura, unas cifras de presión arterial sistólica y unos valores de HbA1c, triglicéridos, lipoproteína A, apolipoproteína B y una tasa de excreción de albúmina mayores (todos p<0,05) que los pacientes que permanecieron sin signos de PND. Los pacientes que desarrollaron PND consumieron una mayor proporción de grasa saturada, y presentaron un cociente poliinsaturada/saturada y monoinsaturada/saturada significativamente menor (p<0,05) que los pacientes que no desarrollaron PND.

Conclusión

Los datos obtenidos en este estudio sugieren que el consume de unas dietas con una proporción de grasa monoinsaturada/saturada y de poliinsaturada/saturada elevadas en personas con diabetes de larga evolución y con un aceptable grado de control glucémico puede prevenir la aparición de PND. Diferentes estrategias deben desarrollarse para inducer un incremento en el consumo de grasa poliinsaturada y monoinsaturada, y reducir el consumo de grasa saturada.

Palabras clave:
Nutrición
Grasa insaturada
Complicaciones microvasculares
Diabetes
Neuropatía
Objective

To evaluate the influence of nutritional patterns on the presence and progression of diabetic distal neuropathy (DN) in a Spanish population with diabetes mellitus.

Methods

The Diabetes Nutrition and Complications Trial (DNCT) is a prospective, population-based, observational, multicenter study designed to determine the nutritional patterns, based on 7-day food diaries, of a population of 192 diabetic patients (93 with type 1 and 99 with type 2 diabetes mellitus) with longstanding diabetes mellitus (20 and 18 years of diabetes duration, respectively) and with acceptable glycemic control (6.9% and 6.4% HbA1c values respectively), and their association with DN defined as a neuropathy disability score of ≥ 6.

Results

At baseline, DN was diagnosed in 4 (4.3%) type 1 diabetic patients and in 14 (14.1%) type 2 diabetic patients. After a median follow-up period of 6.5 years, 10 (5.7%) new DN cases were detected (0.88 per 100 patients per year): one (1.1%) type 1 diabetic patient, (0.2 per 100 patients per year) and nine (10.6%) type 2 diabetic patients (1.6 per 100 patients per year). A total of 164 (85.4%) diabetic patients remained free of DN: 88 (94.6) type 1 diabetic patients and 76 (76.8%) type 2 diabetic patients. Diabetic patients with progression to DN were older and had longer diabetes duration, as well as higher body mass index, waist circumference, systolic blood pressure, albumin excretion rate, and values of HbA1c%, triglyceride, lipoprotein A, and apolipoprotein B (all p<0.05) than diabetic patients who remained free of DN.Consumption of saturated fatty acids was significantly higher and the ratio monounsaturated/saturated and polyunsaturated/saturated fatty acids was significantly lower in patients with progression to DN than in those who remained free of DN (p<0.05).

Conclusion

The data obtained from this study suggest that in patients with longstanding diabetes with near-optimal HbA1c levels, diets with high monounsaturated/saturated and polyunsaturated/saturated fatty acid ratios may prevent the onset of DN. Several strategies should be developed to increase the consumption of polyunsaturated and monounsaturated fatty acids and to reduce intake of saturated fatty acids.

Key words:
Nutrition
Unsaturated fat
Microvascular complications
Diabetes
Neuropathy
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En el apéndice 1 se detallan los miembros y centros participantes.

Correspondencia: L. Calle Pascual. Servicio de Endocrinología y Nutrición. 1.ª S. Hospital Clínico San Carlos. Profesor Martín Lagos, s/n. 28040 Madrid. España. Correo electrónico: acalle.hcsc@salud.madrid.org.

Copyright © 2005. Sociedad Española de Endocrinología y Nutrición
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