Triglyceride-Glucose Index Cutoff Point Is an Accurate Marker for Predicting the Prevalence of Metabolic Syndrome in Obese Caucasian Subjects.

BACKGROUND: Recently, the triglyceride-glucose (TyG) index has been suggested as a surrogate insulin resistance marker. This index could act as an early screening marker in individuals with a high risk of metabolic syndrome (MS) such as obese subjects. AIMS: The objective of this work was to detect the cutoff point of the TyG index for the diagnosis of MS according to ATPIII criteria on obese subjects and to compare with HOMA-IR. METHODS: We conducted a cross-sectional study in 1,494 obese subjects. Measurements of adiposity parameters, blood pressure, fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), lipid profile, C-reactive protein, adipokines, and the prevalence of MS were determined. The TyG index was calculated from the next equation: Ln (fasting triglycerides (mg/dL) × fasting glucose (mg/dL))/2. RESULTS: A total of 1,494 subjects were recruited, 421 males (28.1%) and 1,073 females (71.8%), with an average age of 45.8 ± 15.3 years (range: 29-62). A total of 677 subjects had MS (45.5%) and 817 did not show MS (54.6%). The averages of HOMA-IR and TyG index values increased as the components of MS were aggregated, and both indexes were higher in subjects with MS. The area under the curve (AUC) of the TyG index according to ATPIII criteria showed values of 0.746 (0.721-0.771; p = 0.001). The cutoff point according to the Youden index was 4.72, with sensitivity and specificity of 87% and 88.2%, respectively. For the HOMA-IR, AUC showed values of 0.682 (0.654-0.710; p = 0.01). The cutoff point was 3.23, with sensitivity and specificity of 78% and 70.1%, respectively. CONCLUSIONS: The TyG index is more powerful for predicting MS than HOMA-IR in Caucasian obese subjects.

APOA5 Variant rs662799, Role in Cardiovascular Traits and Serum Adipokine Levels in Caucasian Obese Subjects.

BACKGROUND AND AIMS: This ApoA5-1131C allele of rs662799 variant is related with a higher serum triglyceride levels, and it contributes to increase risk of cardiovascular disease. The aim of the present investigation was to evaluate single nucleotide polymorphism rs662799 in APOA5 gene and its associations with cardiovascular risk factors, MS, and serum adipokine levels. METHODS: The study involved a population of 1,002 Caucasian obese subjects. Measurements of body weight, waist circumference, fat mass, arterial blood pressure, blood glucose, C-reactive protein, insulin levels, insulin resistance (HOMA-IR), lipid profile, and adipokines levels were recorded. Genotype of ApoA5 gene polymorphism (rs662799) and prevalence of metabolic syndrome (MS) were evaluated. RESULTS: The distribution of the rs662799 polymorphism in this adult population (n = 1,002) was 88.3% (n = 885) (TT), 11.4% (n = 114) (TC), and 0.3% (n = 3) (CC). No significant differences were found between the 2 genotypes in the anthropometric data, MS, or blood pressure. Triglyceride levels were higher in C-allele carriers (delta total group: 19.7 ± 2.1 mg/dL: p = 0.02) than non C-allele carriers. HDL-cholesterol levels were lower in C-allele carriers (delta total group: -6.7 ± 1.1 mg/dL: p = 0.02) than non C-allele carriers. Adiponectin levels were lower in C-allele carriers (delta total group: -11.6 ± 1.0 mg/dL: p = 0.02) too. In C-allele carriers, logistic regression analysis showed an increased risk of hypertriglyceridemia (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.2-3.4, p = 0.001) and percentage of low-HDL-C (OR = 2.2, 95% CI = 1.3-3.7, p = 0.002) after adjusting by body mass index and age. CONCLUSIONS: C-allele carriers of rs662799 of APOA5 gene showed high rates of low levels of HDL and hypertriglyceridemia, with differences in triglyceride, HDL cholesterol, and adiponectin levels in Caucasian obese subjects.

Prevalence of Risk of Malnutrition and Risk of Sarcopenia in a Reference Hospital for COVID-19: Relationship with Mortality.

INTRODUCTION: Many elderly patients with COVID-19 are at risk of malnutrition. The aim of our study was to evaluate the risk of malnutrition and sarcopenia in elderly COVID-19 patients with the R-MAPP (Remote-Malnutrition APP). MATERIALS AND METHODS: A cross-sectional study of 337 consecutive outpatients ≥65 years who attended the Central Emergency COVID-19 Hospital of Castilla y Leon was conducted. In all patients, the protocol of R-MAPP (Malnutrition Universal Screening Tool [MUST] and Simple Questionnaire to Rapidly Diagnose Sarcopenia [SARC-F]) was realized. RESULTS: The mean age was 86.1 ± 8.7 years, with a sex distribution of 167 males (49.5%) and 170 females (51.5%). According to the MUST test, patients with 0 points have a low nutritional risk (n = 50, 14.8%), 1 point a medium nutritional risk (n = 19, 5.6%), and 2 or more points a high nutritional risk (n = 268, 79.6%). The SARC-F questionnaire generates patients with 4 or more points as predictive of sarcopenia (n = 304, 80.2%) and <4 points without prediction of sarcopenia (n = 33, 9.8%). Global mortality was 24.03% (n = 81). The mortality rate was related to the pathological SARC-F score ≥4 (27.1% vs. 3.1%; p = 0.01) and MUST score ≥2 (26.7% vs. 16.4%; p = 0.04). In the logistic regression analysis, only the SARC-F score ≥4 remained as an independent variable related to mortality; odds ratio was 8.34 (95% CI: 1.1-63.8; p = 0.04), adjusted for age, sex, albumin levels, and MUST test. CONCLUSIONS: During COVID-19 infection, hospitalized patients at risk of sarcopenia have a high risk of mortality and have a poor nutritional status.

Effect on Liver Enzymes of Biliopancreatic Diversion: 4 Years of Follow-Up.

BACKGROUND: Elevated serum aminotransferase levels are commonly associated with obesity and with a progression to chronic liver disease. Bariatric surgery is the most effective strategy to achieve weight loss. METHODS: We conducted the present study with the aim of evaluating the influence of biliopancreatic diversion (BPD) on liver enzymes levels during 4 years in morbid obese patients with normal aminotransferase (n = 65) and in morbid obese patients with high aminotransferase basal levels (n = 50). RESULTS: A decrease in alanine aminotransferase and aspartate aminotransferase activities was significant after biliopancreatic diversion. The basal percentage of high aminotransferase levels and percentage of ratio ALT/AST <1 also decreased significantly at 1-, 2-, 3- and 4-years of follow-up in both groups. ALT (52 to 20%), AST (42 to 10%) and ALT/AST (80 to 22%) in patients with normal aminotransferase. ALT (82 to 20%), AST (70 to 6%) and ALT/AST (90 to 20%) in patients with elevated transaminase basal levels. Bariatric surgery was associated with a significant and sustained decrease in body weight in both groups. Serum trasnaminases level changes were positively correlated to body weight changes during follow-up. CONCLUSION: BPD is an effective method of achieving sustainable weight loss and reduced aminotransferase levels and enzyme ratios of liver damage.

Impact of the rs822393 Variant on Adiponectin Levels and Metabolic Parameters after Weight Loss Secondary to a High-Fat Hypocaloric Diet with Mediterranean Pattern.

INTRODUCTION: The effects of the rs822393 variant of ADIPOQ gene on metabolic parameters such as insulin resistance and adiponectin levels following weight loss through dietary intervention are still uncertain. The aim of this study was to evaluate the role of rs822393 of ADIPOQ gene on adiponectin levels and metabolic parameters after weight loss with a high-fat hypocaloric diet with Mediterranean pattern during 12 weeks. METHODS: A population of 283 patients with obesity was allocated to a dietary intervention trial with a high-fat hypocaloric diet during 12 weeks. Adiposity and biochemical parameters were determined. rs822393 was assessed with a dominant model analysis (CC vs. CT + TT). RESULTS: These patients had three different genotypes: CC (59.0%), CT (33.6%), and TT (7.4%). The allelic frequencies for C and T were 0.89 and 0.20, respectively. Basal and post-intervention HDL cholesterol, adiponectin levels, and adiponectin/leptin ratio were lower in T-allele than non-T-allele carriers. After dietary intervention, BMI, weight, fat mass, waist circumference, systolic blood pressure, insulin, HOMA-IR, leptin, total cholesterol, and LDL cholesterol levels improved significantly in both genotype groups. Moreover, HDL cholesterol (CC vs. CT + TT) (delta: 8.9 ± 1.1 mg/dL vs. 1.7 ± 0.8 mg/dL; p = 0.02), serum adiponectin in non-T-allele carriers (43.1 ± 5.9 ng/dL vs. 2.8 ± 3 0.0 ng/dL; p = 0.01), and adiponectin/leptin ratio (1.37 ± 0.1 units vs. 0.17 ± 0.08 units; p = 0.02) improved only in non-T-allele carriers after weight loss. CONCLUSION: Individuals with obesity and without the T allele of rs822393 experienced improvements in adiponectin levels, adiponectin/leptin ratio, and HDL cholesterol levels after following a high-fat hypocaloric diet with a Mediterranean pattern.

Relationship of fat distribution with adipokines in patients with acquired immunodeficiency virus infection.

BACKGROUND: The aim was to examine the relationship of fat distributions with adipokines concentrations in HIV-infected patients. METHODS: This was a cross-sectional analysis of 36 HIV (free of lipodystrophy) infected patients. Dual-energy X-ray absorptiometry was used. RESULTS: In the multivariate analysis, basal adiponectin concentration was a dependent variable, whereas waist to hip ratio and abdominal fat mass were independent predictors in the model (F = 5.1; P < 0.05). Adiponectin concentration decreases by 5.541.2 µg/ml (CI 95%: 8,071.9-3,029.1) for each unit of waist to hip ratio and 561.9 ng/ml (CI 95%: 918.2-213.4) for each kilogram of fat mass of abdominal area. In the multivariate analysis, basal leptin concentration was a dependent variable, whereas waist circumference remained an independent predictor in the model (F = 6.3; P < 0.05), with a direct correlation. Leptin concentration increases by 0.067 ng/ml (CI 95%: 0.001-0.12) for each centimeter of waist circumference. CONCLUSIONS: Leptin and adiponectin are related with adiposity in HIV-infected patients.

[C358A polymorphism of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH) and adipocytokine levels in the morbidly obese]. / Polimorfismo C358A de la enzima "amida hidrolasa de ácidos grasos" y los niveles de adipocitoquinas en obesos mórbidos.

INTRODUCTION: The 385 C/A polymorphism of fatty acid amide hydrolase (FAAH) has recently been demonstrated to be associated with overweight and obesity. The aim of our study was to investigate the association between missense polymorphism (cDNA 385 C->A) of the FAAH gene and anthropometric parameters, cardiovascular risk factors and adipocytokines in morbidly obese patients. MATERIAL AND METHODS: A sample of 66 morbidly obese patients was analyzed. In all patients, weight, blood pressure, fasting glycemia, lipoprotein(a), C-reactive protein, insulin, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglyceride and adipocytokine levels, as well as the genotype of the C358A polymorphism of FAAH, were determined. RESULTS: The mean age was 48.0(16.1) years and the mean body mass index was 44.4 (4.1). There were 17 males (25.8%) and 49 females (74.2%). Forty-five patients (8 males/37 females) (68.2%) were G358G (wild genotype) and 21 patients (4 males/17 females) were G358A (31.8%) (mutant group). Biochemical, anthropometrical and adipocytokine levels showed no statistically significant differences between the two genotypes. CONCLUSION: In patients with morbid obesity, the C358A polymorphism of FAAH was not associated with anthropometric parameters, biochemical markers or adipocytokine levels.

Serum Lipid and Adiponectin Improvements after a Mediterranean Dietary Pattern in Non-G-Allele Carriers of the Variant rs3774261.

BACKGROUND: The role of adiponectin (ADIPOQ) polymorphisms in weight loss and serum lipid changes following different dietary interventions remain unclear. The Mediterranean dietary pattern has been associated with improved cardiovascular risk factors in different studies. OBJECTIVE: Our aim was to analyze the effects of a hypocaloric diet with a Mediterranean dietary pattern on the metabolic response and adiposity parameters, taking into account the 712 G/A rs3774261 polymorphisms in ADIPOQ. DESIGN: A population of 135 obese patients was enrolled. Anthropometric and serum parameters (lipid profile, insulin, homeostasis model assessment for insulin resistance [HOMA-IR], glucose, C-reactive protein [CRP], adiponectin, resistin, and leptin levels) were measured before and after the dietary intervention (12 weeks). All of the patients were genotyped for the rs3774261 polymorphism. RESULTS: The genotype distribution of this population was 36 patients with AA (26.7%), 68 patients with AG (50.4%), and 31 patients with GG (22.9%). After the dietary intervention and in both genotypes, BMI, weight, fat mass, systolic blood pressure, waist circumference, glucose, insulin, HOMA-IR, and leptin levels all decreased. After the dietary intervention with secondary weight loss and in non-G-allele carriers (AA vs. AG+GG), total cholesterol (Δ = -15.7 ± 3.9 vs. -4.9 ± 2.9 mg/dL; p = 0.02), LDL cholesterol (Δ = -15.3 ± 3.8 vs. -1.7 ± 1.9 mg/dL; p = 0.01), triglyceride levels (Δ = -23.4 ± 5.6 vs. 2.3 ± 2.3 mg/dL; p = 0.01), and CRP (Δ = -1.1 ± 0.1 vs. -0.4 ± 0.2 mg/dL; p = 0.01) decreased. Adiponectin levels (Δ = 7.2 ± 2.1 vs. -0.4 ± 0.3 ng/dL; p = 0.02) increased. Notably, G-allele carriers did not show this improvement. CONCLUSION: Non-G-allele carriers of the ADIPOQ variant (rs3774261) showed significant improvement in serum levels of adiponectin, lipid profiles, and CRP in response to a hypocaloric diet with a Mediterranean dietary pattern.

[Metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a familial hypercholesterolemia cohort in a Public Health Program]. / Evaluación del control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de hipercolesterolemia familiar en un programa de salud pública.

INTRODUCTION: Introduction and objective: familial heterozygous hypercholesterolemia (HFH) is the most common monogenic lipid metabolism disorder that associates premature cardiovascular disease. Our aim was to describe the degree of metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a cohort of HFH patients. Subjects and methods: a retrospective cohort study of the index cases and their relatives genetically diagnosed with HFH by the Endocrinology and Nutrition Service in the HCUV from 2009 to 2017. Anthropometric, clinical, laboratory, genetic, and treatment data were analyzed. Results: a total of 138 subjects were studied, with a mean age of 48.8 (17.7) years, 55.8% of them women. A gene mutation was found in 55.8%, and 10.1% had previous ischemic heart disease. At diagnosis mean total cholesterol was 281.1 (68.4) mg/dL, and LDL-C was 204 (65) mg/dL. Among family cases, at diagnosis, a lower mean age was observed [32.89 (19.2) years vs 50.3 (17.6) years, p < 0.001] as well as lower LDL values [181.9 (64.3) mg/dL vs 226.8 (52) mg/dL, p < 0.005] as compared to index cases. A positive correlation was observed between lipid-lowering treatment dose and LDL level reduction (r = 0.254, p < 0.05), although only 30% of patients reached their LDL target. Patients with HFH were highly adherent to Mediterranean diet, with an average score of 9.5 (1.9) in the Predimed test. Conclusions: early HFH detection is necessary to prevent premature cardiovascular events. A diagnosis of cases among family members anticipates the treatment of patients with HFH. Patients with HFH are more sensitive to heart-healthy diets.

INTRODUCCIÓN: Antecedentes y objetivo: la hipercolesterolemia familiar heterocigota (HFH) es el trastorno del metabolismo lipídico monogénico más común que se asocia a patología cardiovascular prematura. Nuestro objetivo fue describir el grado de control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de pacientes con HFH. Material y métodos: estudio de cohortes retrospectivo de casos índices y familiares diagnosticados genéticamente de HFH desde 2009 a 2017. Se analizaron los datos antropométricos, clínicos, analíticos, del estudio genético y del tratamiento. Resultados: se estudiaron 138 sujetos con una edad media de 48,8 (17,7) años, el 55,8% mujeres. Se encontró la mutación positiva en el 55,8%. La media de colesterol total al diagnóstico fue de 281,1 (68,4) mg/dl y la de LDL de 204 (65) mg/dl. El 10,1% presentaban cardiopatía isquémica previa. Entre los casos familiares se observó una menor edad media [32,89 (19,2) años vs. 50,3 (17,6) años, p < 0,001], así como valores de LDL inferiores en el momento del diagnóstico [181,9 (64,3) mg/dl vs. 226,8 (52) mg/dl, p < 0,005] en comparación con los casos índice. Se evidenció una correlación positiva entre dosis de tratamiento hipolipemiante y reducción de los niveles de LDL (r = 0,254, p < 0,05), aunque solo el 30% de los pacientes alcanzaron sus objetivos de LDL. Los pacientes con HFH presentaron una elevada adherencia a la dieta mediterránea, con una puntuación media de 9,5 (1,9) en el test Predimed. Conclusiones: la detección precoz de la HFH es necesaria para prevenir eventos cardiovasculares prematuros. El diagnóstico de casos familiares anticipa el tratamiento de los pacientes con HFH. Los pacientes con HFH están más sensibilizados sobre la adherencia a las dietas cardiosaludables.

[The effects of a low-fat versus a low carbohydrate diet in obese adults]. / Efectos de una dieta baja en grasas frente a una dieta rica en proteínas y grasa en pacientes obesos.

BACKGROUND AND OBJECTIVE: The aim of our study was to compare the effect of a high fat and a high protein diet vs a fat restricted diet on weight loss in obese patients. SUBJECTS AND METHODS: A population of 74 obesity non diabetic outpatients was analyzed in a prospective way. Patients were randomly allocated to two groups: a) diet I (low fat diet: 1500kcal/day, 52% carbohydrates, 20% proteins, 27% fats) with a distribution of fats and b) diet II (high fat and high protein diet: 1507kcal/day, 38% carbohydrates, 26% proteins, 36% fats). After three months with diet, weight, blood pressure, glucose, C reactive protein, insulin, insulin resistance, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were evaluated. RESULTS: There were randomized 35 patients (4 males and 31 females) in the group I and 39 patients (6 males and 33 females) in diet group II. In group I, systolic pressure, BMI, weight, fat free mass, fat mass total body water, intracellular body water and waist circumference decreased significantly. In group II, glucose, total cholesterol, LDL cholesterol, systolic blood, BMI, weight, fat mass, total body water and waist circumference decreased significantly. Differences among averages of parameters before treatment with both diets were not detected. CONCLUSIONS: No differences were detected on weight loss between a fat-restricted diet and a high fat and high protein enhanced diet.

[Randomized clinical trial between nutritional counselling and commercial hypocaloric diet in weight loss in obese patients with chronic arthropathy]. / Ensayo clínico aleatorizado entre consejo dietético una dieta hipocalórica comercial para la pérdida de peso de pacientes obesos con artropatía crónica.

BACKGROUND AND OBJECTIVE: The aim of our work was to evaluate in obese patients with an indication of replacement surgery for degenerative osteoarthritis, the utility of a hypocaloric diet with Optisource vs nutritional counseling. MATERIAL AND METHOD: Thirty six patients were randomized in both branches: diet I with lunch and dinner substituted by two Optisource (1109,3 kcal/day, 166,4g of carbohydrates (60%), 63g of proteins (23%), 21,3g of lipids 17%) and diet II with nutritional counselling with a decrease of 500 cal/day from the previous dietary intake. Before and 3 months after treatment, a nutritional and biochemical study was performed. RESULTS: Nineteen patients were randomized in group I and 17 patients in group II. 19 patients finished the study in group I and 14 in group II. Weight loss was higher in group I than II (7,7 [4,7] vs 3,92 [3,32] kg; P=.05), with a significant decrease of HOMA and diastolic blood pressure in group I. Decreases of body mass index (-2,9 [1,8] vs -1,4 [0,9]; P=.05), fat mass (-3,8 [3,4] vs -2,3 [1,7] kg; P=.0,05) and HOMA (-2,0 [2,2] vs -0,4 [1,82]; P=.05) were higher in group I than II. CONCLUSIONS: Obese patients with chronic osteoarthritis treated with a mixed diet supplemented with a commercial hypocaloric formula improved weight, fat mass and HOMA in a better way than patients treated with a dietary counselling alone.

Influence of Lys656Asn polymorphism of the leptin receptor gene on insulin resistance in nondiabetic obese patients.

BACKGROUND: Alterations of the normal leptin receptor (LEPR) gene may be involved in the development of obesity. Leptin has been shown to be able to modulate insulin secretion. Different polymorphisms in the LEPR gene have been studied, albeit with unclear results. The polymorphism on codon 656 produces a change in charge, making this change possibly functional. OBJECTIVE: The objective of this study was to investigate the influence of Lys656Asn polymorphism in the LEPR gene on serum insulin, glucose values, and insulin resistance in the fasted state among obese men and women without diabetes mellitus. DESIGN: Two hundred thirty-three (body mass index, >30 kg/m(2)) nondiabetic obese patients were analyzed. Indirect calorimetry, tetrapolar electrical bioimpedance, blood pressure determination, serial assessment of nutritional intake with 3-day written food records, and biochemical analysis were performed. Statistical analysis was performed for Lys656/Asn656 and Asn656/Asn656 jointly as a mutant allelic group and for Lys656/Lys656 as a wild allelic group. RESULTS: The subjects' (67 males and 166 females) mean age and mean body mass index were 43.6+/-16.6 years and 35.3+/-5.6 kg/m(2), respectively. One hundred forty-three patients (61.9%) had the genotype Lys656/Lys656 (wild group), whereas 88 (38.1%) had either the genotype Lys656/Asn656 (n=81; 30.7%) or the genotype Asn656/Asn656 (n=7; 7.4%) (mutant group). Age and sex distribution were similar in both groups. No difference was detected between the mutant and wild allelic groups in anthropometric parameters and dietary intakes. Homeostasis model assessment (HOMA; 2.8+/-1.7 vs. 5.6+/-4.8; P<.05) and insulin (18.1+/-10.7 vs. 32.1+/-25 mUI/ml; P<.05) levels were higher in males with the genotypes Lys656/Asn656 and Asn656/Asn656 than in males with the genotype Lys656/Lys656. Leptin levels were higher in males with a mutant genotype than in males with a wild genotype (39.3+/-23 vs. 63.5+/-28 ng/ml; P<.05). CONCLUSION: The novel findings of our study are those of the association of the Lys656/Asn656 and Asn656/Asn656 genotypes with higher levels of insulin, HOMA, and leptin in males and the lack of such an association in females.

Effect of a hypocaloric diet on serum visfatin in obese non-diabetic patients.

OBJECTIVE: Obesity and insulin resistance are associated with classic and new cardiovascular risk factors, such as inflammatory markers and adipocytokines. The aim of this study was to examine whether weight reduction could change visfatin serum concentrations in obese patients. METHODS: This was an interventional longitudinal study analyzing a population of 80 obese non-diabetic outpatients. Weight, blood pressure, fasting serum glucose, C-reactive protein, plasma insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols, and insulin resistance (homeostatic model assessment) were measured before and after 3 mo on a hypocaloric diet. RESULTS: Eighty patients were enrolled. The mean age was 46.7 +/- 16.7 y, the mean body mass index was 34.1 +/- 4.8 kg/m(2), with 20 men (25%) and 60 women (75%). After 3 mo on a hypocaloric diet, body mass index, fat mass, waist circumference, systolic blood pressure, fasting serum glucose, total cholesterol, and low-density lipoprotein cholesterol decreased. The serum concentration of visfatin decreased with weight loss (112.14 +/- 70.2 versus 99.4 +/- 58.1 ng/mL, P < 0.05). In the multivariate analysis of visfatin concentration before and after treatment, as a dependent variable, only age remained an independent predictor in the model (F = 12.5, P < 0.02), with an inverse correlation: visfatin decreased 4.1 g/mL (F = 12.5, P < 0.05) and 3.7 g/mL (95% confidence interval 1.2-6.1), respectively, for each year of age. CONCLUSION: Weight reduction after a 3-mo period of a hypocaloric diet is associated with a significant decrease in circulating serum concentrations of the novel adipokine visfatin in obese subjects. Visfatin is inversely correlated with age.

Influence of Ala54Thr polymorphism of fatty acid-binding protein-2 on clinical results of biliopancreatic diversion.

OBJECTIVE: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate the fatty acid-binding protein-2 Ala54Thr polymorphism outcomes 1 y after biliopancreatic diversion in morbidly obese patients. METHODS: A sample of 41 morbidly obese patients (body mass index >40 kg/m(2)) were operated upon from December 2004 to December 2006. Weight, fat mass, blood pressure, basal glucose, triacylglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at the basal visit and at each visit. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit. RESULTS: Twenty-three patients (56.1%) had genotype Ala54/Ala54 (wild group) and 18 patients had genotype Ala54/Thr54 (15 patients, 36.5%) or Thr54/Thr54 (3 patients, 7.4%; mutant group). In the wild group, body mass index, weight, fat mass, systolic blood pressure, glucose, total cholesterol, low-density lipoprotein cholesterol, and triacylglycerol concentrations decreased. Diastolic blood pressure remained unchanged. In the mutant group, the same parameters improved, without statistical differences from the wild group. Initial excess weight percent loss at 1 y of follow-up was similar in both genotype groups (61.8% versus 61.9%, NS). CONCLUSION: Polymorphism Ala54Thr of fatty acid-binding protein did not have an effect on weight loss or clinical outcomes after bariatric surgery.

Metabolomic-based noninvasive serum test to diagnose nonalcoholic steatohepatitis: Results from discovery and validation cohorts.

Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease worldwide and includes a broad spectrum of histologic phenotypes, ranging from simple hepatic steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). While liver biopsy is the reference gold standard for NAFLD diagnosis and staging, it has limitations due to its sampling variability, invasive nature, and high cost. Thus, there is a need for noninvasive biomarkers that are robust, reliable, and cost effective. In this study, we measured 540 lipids and amino acids in serum samples from biopsy-proven subjects with normal liver (NL), NAFL, and NASH. Using logistic regression analysis, we identified two panels of triglycerides that could first discriminate between NAFLD and NL and second between NASH and NAFL. These noninvasive tests were compared to blinded histology as a reference standard. We performed these tests in an original cohort of 467 patients with NAFLD (90 NL, 246 NAFL, and 131 NASH) that was subsequently validated in a separate cohort of 192 patients (7 NL, 109 NAFL, 76 NASH). The diagnostic performances of the validated tests showed an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.88 ± 0.05, 0.94, and 0.57, respectively, for the discrimination between NAFLD and NL and 0.79 ± 0.04, 0.70, and 0.81, respectively, for the discrimination between NASH and NAFL. When the analysis was performed excluding patients with glucose levels >136 mg/dL, the area under the receiver operating characteristic curve for the discrimination between NASH and NAFL increased to 0.81 ± 0.04 with sensitivity and specificity of 0.73 and 0.80, respectively. Conclusion: The assessed noninvasive lipidomic serum tests distinguish between NAFLD and NL and between NASH and NAFL with high accuracy. (Hepatology Communications 2018;2:807-820).

Financial impact of disease-related malnutrition at the San Pedro de Alcántara hospital. Estimated cost savings associated to a specialized nutritional survey. / Impacto económico de la desnutrición relacionada con la enfermedad en el hospital San Pedro de Alcántara. Estimación del ahorro asociado a una atención nutricional especializada de calidad.

INTRODUCTION AND OBJECTIVES: DRM is a highly prevalent condition in Spanish hospitals and is associated to increased healthcare costs. Costs associated to DRM were calculated using the methods of the PREDyCES study. The potential savings derived from specialized nutritional treatment were calculated by extrapolating the results of the SNAQ strategy. RESULTS: Median cost per procedure in patients with DRM was €9,679.85, with a final cost of €28,700,775.2. The cost of each patient with DRM was 2.63 times higher than the cost of patients with no DRM. The potential cost saving associated to specialized nutritional treatment was estimated at €1,682,317.28 (5.86% of total cost associated to DRM). CONCLUSIONS: Patients with DRM showed a higher consumption of financial resources as compared to well-nourished patients. Specialized nutritional treatment is a potential cost-saving procedure.

Study of tolerance and acceptance of a high energy density enteral formula in patients coronary unit study / Estudio de tolerancia y aceptación de una fórmula enteral con alta densidad energética en pacientes de una unidad de coronarias.

Objective: The aim of our study was to evaluate the tolerance of enteral formula with high energetic density in patients hospitalized in a coronary care unit requering enteral support for at least five days. Methods: Opened, non-comparative, nonrandomized, descriptive study, evaluating the tolerance of enteral formula with high energy density in patients admitted to a coronary care unit. Results: 31 patients were included with a mean age of 67.32 ± 13.8 years, 66.7% were male. The average prescribed final volume Nutrison Energy® was 928.5 ± 278.5 mL/day (range: 800-1,500 mL/day). The average duration of enteral nutrition was 11.2 ± 3.2 days. The average calorie intake was 1,392 ± 417 cal/day, with 169.9 ± 50.9 g/day of carbohydrates, 53.8 ± 16.1 g/day of fat and 55.7 ± 16.9 g/day of protein. After administration there was a significant increased levels of transferrin. A total of 3 patients had an episode of diarrhea (9.7%). The number of patients experiencing at least one episode of gastric residue was 5 (16.1%) not forced in any way to withdra wing enteral nutrition, forcing in 2 patients to diminish the nutritional intake volume for 24 hours. During nutritional support, in only 3 patients it was required to decrease the volume made the previous day energy formula. With regard to vomiting, in 1 patient this situation (3.2%) was verified. No patient in the study presented any digestive complications associated with the administration of the enteral nutrition formula. Finally, no adverse events related to the administered formulation were recorded. Conclusions: The results show that enteral formula with high energy density is a well-tolerated formula with a very low frequency of gastrointestinal symptoms, which favors compliance.

Objetivo: el objetivo de nuestro trabajo fue evaluar la tolerancia de una fórmula enteral con alta densidad energética en pacientes hospitalizados en una unidad de coronarias con indicación de soporte enteral al menos durante cinco días. Métodos: estudio abierto, no comparativo, no aleatorizado, descriptivo, para evaluar la tolerancia de una fórmula enteral con alta densidad energética en pacientes ingresados en una unidad coronaria. Resultados: se incluyeron 31 pacientes con una media de edad de 67,32 ± 13,8 años y de los cuales el 66,7% eran varones. El volumen medio final prescrito de Nutrison Energy® fue de 928,5 ± 278,5 ml/día (rango: 800-1.500 ml/día). La duración media de la nutrición enteral fue de 11,2 ± 3,2 días. El aporte final promedio de calorías fue de 1.392 ± 417 cal/día, con 169,9 ± 50,9 g/día de hidratos de carbono, 53,8 ± 16,1 g/día de grasas y 55,7 ± 16,9 g/día de proteínas. Tras la administracion existió un aumento significativo de los niveles de transferrina. Un total de 3 pacientes habían presentado algún episodio de diarrea (9,7%). El número de pacientes que presentaron al menos un episodio de residuo gástrico fue de 5 (16,1%) que no obligo en ningún caso a la suspensión de la nutrición enteral, obligando en 2 pacientes a disminuir el volumen del aporte nutricional durante 24 horas. Durante el soporte nutricional, solo en 3 pacientes fue necesario disminuir el volumen aportado el día previo de la fórmula energética. Con respecto a los vómitos, solo en 1 paciente se constató esta situación (3,2%). Ningún paciente presentó en el estudio otras complicaciones digestivas asociadas a la administración de la fórmula de nutrición enteral. Por último, no se registraron acontecimientos adversos relacionados con la fórmula administrada. Conclusiones: los resultados reflejan que una fórmula enteral con alta densidad energética es una fórmula bien tolerada con una muy baja frecuencia de síntomas gastrointestinales, lo que favorece el cumplimiento de la pauta.

Association of the rs9939609 gene variant in FTO with insulin resistance, cardiovascular risk factor and serum adipokine levels in obese patients.

INTRODUCTION: The aim of our study was to analyze the relationship of the rs9939609 FTO gene polymorphism with insulin resistance and serum adipokine levels. MATERIAL AND METHODS: A population of 610 patients with obesity was analyzed in a cross sectional design. Weight, blood pressure, basal glucose, c-reactive protein (CRP), insulin, insulin resistance (HOMA), lipid profile and adipocytokines (leptin, adiponectin, resistin, TNF alpha, and interleukin 6) levels were measured. RESULTS: Insulin (122.2 ± 101.8 pmol/L vs. 104.5 ± 61.5 pmol/L vs.112.1 ± 74.3 pmol/L:p < 0.05) and HOMA-IR values (4.76 ± 4.4 vs. 3.71 ± 2.5 vs.3.76 ± 3.1;p < 0.05) were higher in TT group than AT and AA groups. Triglycerides values were higher in TT group than AA group (1.42 ± 0.71 mmol/L vs.1.39 ± 0.69 mmol/L vs.1.23 ± 0.64 mmol/L;p < 0.05). Adiponectin levels were lower in TT genotype group than AA genotype group (35801.2 ± 35,912.3 ng/L vs.26,718.1 ± 36,323.1 ng/L vs. 21,112.3 ± 25,623.1 ng/L p < 0.05). CONCLUSION: The FTO gene polymorphism, rs9939609, was found to be associated with insulin resistance, insulin, triglyceride and adiponectin levels in obese patients with TT variant.

[Not Available]. / Association of the TNF-alpha -308 G/A polymorphisms with metabolic responses secondary to a high protein/low carbohydrate versus a standard hypocaloric diet.

BACKGROUND: Mutation analysis has identified a G-> A transition in the promoter region of TNF-alpha gene at position -308 (rs1800629). OBJECTIVE: The aim of our study was to investigate the influence of polymorphism in -308 GA promoter variant of the TNF alpha gene on metabolic response and weight loss secondary to two hypocaloric diets. METHOD: A sample of 283 obese subjects was enrolled in a consecutive prospective way. In the basal visit, patients were randomly allocated during 9 months to diet HP (high protein/low carbohydrate hypocaloric diet) and diet S (standard hypocaloric diet). RESULTS: There were no significant differences between the positive effects on weight loss in either genotype group with both diets. With both diets and only in wild genotype (diet HP vs. diet S), total cholesterol (-9.1 ± 3.4 mg/dL vs. -6.9 ± 2.0 mg/dL; p > 0.05), LDL cholesterol (-9.0 ± 2.9 mg/dL vs. -6.5 ± 2.1 mg/dL; p > 0.05) and triglycerides (-23.1 ± 5.1 mg/dL vs. -12.3 ± 4.8 mg/dL; p < 0.05) decreased. The improvement in triglycerides was higher in subjects without A allele. With diet HP and only in wild genotype, insulin levels (-3.1 ± 1.8 UI/L; p < 0.05) and HOMA-R (-0.8 ± 0.1 units; p < 0.05) decreased. CONCLUSION: Carriers of -308 GG promoter variant of TNF-alpha gene have a better metabolic response than -308 GA obese with a high protein hypocaloric diet.

Economic impact of and satisfaction with a high resolution thyroid nodule clinic at the endocrinology department. / Impacto económico y satisfacción de la implantación de una consulta de alta resolución de patología nodular tiroidea en Endocrinología.

BACKGROUND AND OBJECTIVE: No conclusive data exist on the value of a high resolution thyroid nodule clinic for management of nodular thyroid disease. The aim of this study was to evaluate the economic impact of and user satisfaction with a high resolution thyroid nodule clinic (HRTNC) in coordination with primary care. PATIENTS AND METHOD: A prospective, observational, descriptive study was conducted to analyze data from 3,726 patients (mean age 61±12 years; 85% women) evaluated at an HRTNC during 2014 and 2015. Demographic data (sex and age), number of ultrasound examinations and fine needle aspiration cytologies (FNAC), referral center and consultation type were assessed. RESULTS: In 2014 and 2015, 3,726 neck ultrasound examinations and 926 FNACs (3.8% rated as non-diagnostic) were performed. Among the 1,227 patients evaluated for the first time, 21.5% did not require a second endocrine appointment, which resulted in mean estimated savings of 14,354.55 euros. Of all patients, 41.1% were referred from primary care, 33.4% from endocrinology, and 26.5% from other specialties. As compared to 2013, the number of thyroid ultrasound examinations requested decreased by 65.3% and 59.7% in 2014 and 2015 respectively, with mean estimated savings of 137,563.92 euros. Mean user satisfaction assessed was 4.0 points (95% confidence interval, 3.7-4.3) on a 5-point scale. CONCLUSIONS: HRTNCs at endocrinology departments, coordinated with primary care, are a viable, cost-effective alternative with a positive user perception.