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The relationship between fructose intake and insulin resistance remains controversial. Our purpose was to determine whether a reduction in dietary fructose is effective in decreasing insulin resistance (HOMA2-IR). This field trial was conducted on 438 adults with overweight and obese status, without diabetes. A total of 121 patients in a low fructose diet (LFD) group and 118 in a standard diet (SD) group completed the 24-week study. Both diets were prescribed with 30&ndash, 40% of energy intake restriction. There were no between-group differences in HOMA2-IR. However, larger decreases were seen in the LFD group in waist circumference (&minus, 7.0 vs. &minus, 4.8 = &minus, 2.2 cms, 95% CI: &minus, 3.7, &minus, 0.7) and fasting blood glucose &minus, 0.25 vs. &minus, 0.11 = &minus, 0.14 mmol/L, 95% CI: &minus, 0.028, &minus, 0.02). The percentage of reduction in calorie intake was similar. Only were differences observed in the % energy intake for some nutrients: total fructose (&minus, 2 vs. &minus, 0.6 = &minus, 1.4, 95% CI: &minus, 2.6, &minus, 0.3), MUFA (&minus, 1.7 vs. &minus, 0.4 = &minus, 1.3, 95% CI: &minus, 2.4, &minus, 0.2), protein (5.1 vs. 3.6 = 1.4, 95% CI: 0.1, 2.7). The decrease in fructose consumption originated mainly from the reduction in added fructose (&minus, 2.8 vs. &minus, 1.9 = &minus, 0.9, 95% CI: &minus, 1.6, &minus, 0.03). These results were corroborated after multivariate adjustments. The low fructose diet did not reduce insulin resistance. However, it reduced waist circumference and fasting blood glucose concentration, which suggests a decrease in hepatic insulin resistance.

Background Research published to date on the relationship between insulin resistance (IR) and fructose consumption is scarce, has used different methods, and has yielded sometimes contradictory results. This study aims to determine whether a low-fructose and/or low-sucrose diet supervised by a physician or nurse decreases IR compared to a standard diet. Methods/design This field trial is located at primary care centers. The participants are adults aged 29 to 66 years, with a Body mass Index (BMI) between 29 and 40.99 kg/m2 and without diabetes. To date, 245 participants have been assigned randomly to the low-fructose diet intervention group (LFDI) at health centers in the western health service zone of Tenerife island, and 245 to the standard-diet control group (SDC) at health centers in the eastern health service zone. Recruitment is opportunistic and is carried out by physicians and nurses at participating health centers. Initially (baseline), and after 24 weeks of intervention, dietary records, physical activity, waist circumference, BMI, blood pressure, fasting blood glucose and insulin concentrations (HOMA2-IR) and lipid profile are recorded; blood glucose and insulin and lipid profile are also recorded 2 h after a 75-g glucose overload. After 48 weeks (24 weeks after the intervention), fasting blood samples are again obtained and a physical examination is performed. All tests and measures are repeated and recorded except dietary records, physical activity and oral glucose overload. Low-fructose diets are designed by calculating free and total (free + fructose associated with sucrose) fructose contents in standard diets, and removing foods with a fructose content in the highest quartile for the amounts in the standard diet. Participants in both groups are prescribed a diet that contains 30 to 40% less than the participant’s energy requirements. The primary endpoint is change in HOMA2-IR between baseline and week 24, and other outcomes are change in HDL-cholesterol, LDL-cholesterol, triglycerides , waist circumference to height ratio and BMI. The secondary endpoint is change in HOMA2-IR between week 24 and week 48 together with the outcomes noted above. Comparisons between groups for variables used to indicate IR levels are done with a Student’s t test for unpaired variables or the Mann-Whitney U test if the distribution is not normal. Multivariate regression models will be used to control for confounding factors not accounted for in the study design, and for independent prognostic factors. Discussion If the dietary intervention being tested, i.e., a diet low in fructose/sucrose, is able to reduce IR, the results – if translated into regular clinical practice – could provide a hitherto unavailable tool to prevent type-2 diabetes mellitus. Trial registration ISRCTN, ID: ISRCTN41579277. Registered retrospectively on 15 November 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2043-z) contains supplementary material, which is available to authorized users.

ResumenObjetivoDeterminar la efectividad de una intervención multifactorial en atención primaria para prevenir caídas en personas mayores que se habían caído el año anterior.DiseñoEstudio de intervención con grupo control.EmplazamientoTres consultorios de área rural.SujetosDoscientos veinticuatro pacientes de 65 años o mayores, independientes para la movilidad (113 en el grupo de intervención [GI] y 111 en el de control [GC]).IntervencionesSe intervino a los pacientes del GI.Valoración inicial1) Cuestionario de datos demográficos, número, circunstancias y consecuencias de las caídas, comorbilidad y fármacos; 2) exploración orientada, y 3) valoración domiciliaria de riesgos.IntervenciónRemisión a cardiología si presentaba arritmia o bradicardia, remisión a valoración ocular si presentaba alteración de agudeza visual, modificación en fármacos de riesgo, recomendación de sistemas de apoyo si presentaba trastornos de marcha o equilibrio, medidas posturales si presentaba hipotensión ortostática, medidas conductuales en incontinencia urinaria y recomendación de modificación de riesgos en domiciliosGrupo controlCuestionario de datos demográficos, número y consecuencias de las caídas, comorbilidad y uso de fármacos. Reciben la atención médica habitual.ResultadosAl año se había vuelto a caer el 44% del GI y el 33% del GC (p=0,123). En el subgrupo con más de una caída al inicio, en el GI se volvió a caer el 63% y en el GC el 56% (p=0,599). El GI presentó un 6% de consecuencias graves frente al 14% en el GC (p=0,277).ConclusionesLa intervención multifactorial en atención primaria no es efectiva para disminuir las caídas ni para reducir la gravedad de sus consecuencias.AbstractObjectiveTo determine the effectiveness of multifactorial intervention by Primary Care in the prevention of falls in the elderly who had fallen the year before.DesignIntervention study with a control group.SettingThree clinics in a rural area.Subjects224 patients ≥65 years, independent for mobility (113 in the intervention (IG) and 111 in the control (GC) group.InterventionsIntervention Group.Initial assessment1) Demographic data questionnaire, number, circumstances and consequences of falls, comorbidity and drugs. 2) Oriented examination. 3) Home risks assessment.Interventionsreferred to cardiology if arrhythmia or bradycardia, referred for eye examination if changes in acute vision, recommendation for systems support if gait or balance problems, postural measures if orthostatic hypotension, behavioural measures in urinary incontinence and recommendations to modify home risks.Control groupQuestionnaire on: demographic data, number, circumstances and consequences of falls and medication use. They received normal medical care.ResultsAt one year 44% of the IG and 33% in the CG fell again (P=0.123). In the sub-group with more than one fall at the beginning of the study, 63% in the IG, and 56% in CG fell again (P=0.599). There were serious consequences in 6% of the IG compared to 14% in the CG (P=0.277).ConclusionsMultifactorial intervention from primary care is not effective in reducing falls or for reducing the severity of their consequences.

OBJECTIVE: To study to what extent a brief intervention increases the rate of participation in the programme of early diagnosis of breast cancer (EDBC). DESIGN: Before-and-after intervention study without a control group on women who had not had a mammography. SETTING: Primary care: 3 rural lists and 2 urban ones. PARTICIPANTS: All women between 52 and 67 who attended the clinic during a 6-month period. INTERVENTION: If they had had no mammography in the previous 2 years, the reasons were explored and a brief structured intervention, depending on the reason, was conducted. After this, the woman was invited to make an appointment with the EDBC Unit. MAIN MEASUREMENTS: Effective intervention: checking that the mammography had been done at the EDBC Unit. It was checked whether women who had not attended for consultation attended the unit with their mammography done. RESULTS: Out of a target population of 565 women, 403 (71%) attended for consultation. Ofthese,315 (78%) were in the programme, 51 (13%) had had a mammography outside the programme, and 37 (9%) had not had a mammography. After the intervention, 21 women had a mammography (56.7% [95% CI, 41-73] success of intervention). Seventy ofthe 162 women who did not attend for consultation had a mammography in the programme. The rate of participation in the EDBC rose from 68% (385/565) to 72% (406/565). CONCLUSIONS: The brief intervention was effective in over half the women. This small increase contributed to reaching the minimum levels of coverage recommended in a programme of this kind.