Outcomes of Bariatric Surgery in Patients with Schizophrenia.

BACKGROUND: Outcomes of bariatric surgery (BS) in patients with schizophrenia are poorly understood. We aimed to analyze the effects of BS in patients with schizophrenia (SZ) or schizoaffective disorder (SZA). METHODS: This was a multicenter, retrospective case-control study in patients with SZ or SZA who had undergone BS in seven public referral hospitals in Spain. Controls without psychiatric comorbidity were selected in a 1:4 ratio. Detailed clinical and biochemical data were collected preoperatively and at 12, 24, 36, 48, and 60 months after BS. RESULTS: Twenty patients with SZ (n = 15; 75%) or SZA (n = 5; 25%) and 80 matched controls were studied. There were no differences between patients and controls concerning the evolution of the percentage of total weight loss. The remission rate of the main comorbidities was similar between groups except for hypertension, which was lower in patients with a psychotic disorder from year 3. There were no mortalities within 30 days of surgery in either group. The psychiatric medication burden did not change during follow-up. CONCLUSIONS: BS is safe and effective in carefully selected patients with SZ. The course of the psychiatric disease does not seem to be worsened by the procedure.

Minerals and trace elements in pregnancy in women with previous bariatric surgery consequences on maternal and foetal health.

BACKGROUND: Bariatric surgery (BS) may decrease the risk of these obesity-related complications; however, due to its effect on nutrient intake and absorption, it can also have adverse consequences on maternal and foetal health. The aim of this study is to describe the evolution of electrolytes and trace elements serum levels throughout pregnancy after BS, according to the surgical technique and to evaluate the effect of nutritional deficiencies on the risk of maternal-foetal complications. METHODS: This is a retrospective observational study of the clinical evolution and maternal-foetal complications in a group of women with pregnancies that occurred after BS. Clinical evolution during pregnancy, body weight, and plasma electrolytes, vitamins, and trace elements, as well as their influence on maternal-foetal outcomes were evaluated. Composite neonatal variable (CNV) was defined to evaluate unfavourable foetal outcome. Published reference values for micronutrients during pregnancy have been used. RESULTS: The study includes data on 164 singleton pregnancies in 91 women. A hundred and twenty-seven pregnancies got to full term. The average birth weight was 2966 (546) g., 26.8% < P10 and 13.8% < P3 of a reference population. New-born of gestations after malabsorptive bariatric surgery had a higher risk of having a percentile of birth weight < P3. Plasma electrolytes, trace elements and vitamins throughout pregnancy showed differences depending on the surgical technique, with lower haemoglobin, ferritin, calcium, zinc, copper, vitamin A and vitamin E in the malabsorptive techniques. A high percentage of deficiency was observed, especially in the third trimester (Hb < 11 g/dl: 31.8%; ferritin < 30 mg/ml: 85.7%; zinc < 50 µg/dl: 32.4%, vitamin D < 30 ng/ml: 75.5% and < 20 ng/ml: 53.3%). A decreased plasma copper in the first trimester or zinc in the third trimester were associated with a lower percentile of new-born birth weight. A higher risk of CNV was observed in predominant malabsorptive BS and in pregnancies that had presented at least one vitamin D level lower than 20 ng/ml throughout pregnancy (30.4% vs. 7.1%, p=0.018). CONCLUSIONS: Trace elements and vitamin deficiencies are common in pregnant women after bariatric surgery, especially of iron, zinc, and vitamin D. These deficiencies might negatively affect foetal development. Further studies are needed to better define the role of micronutrients in maternal-foetal health after bariatric surgery.

Does the Prevalence of Obesity in the Different Regions of Spain Influence the Attitudes, Perception, and Barriers to Its Treatment?

INTRODUCTION: The differences in the prevalence of obesity between the various regions of Spain, partly attributed to socioeconomic differences, may influence the approach to this disease. The aim of this study was to compare differences in attitudes, perception, and barriers to the treatment of obesity between people with obesity (PwO) and health care professionals (HCPs), between the different regions of Spain. METHODS: Sub-analysis of the ACTION-IO Spain study, which included 1,500 PwO and 306 HCP, was performed to identify differences in PwQ and HCPs belonging to regions with high prevalence of obesity (>16%, n = 9 regions, high prevalence of obesity [HPO] group) and low prevalence of obesity (<16%, n = 8 regions, low prevalence of obesity [LPO] group) (self-reported data), according to the 2017 National Health Survey of Spain. STATISTICS: comparison of proportions (χ2). RESULTS: A total of 746 PwO belonged to HPO and 754 to LPO group. The PwO in HPO group were younger, had lower income, a lower level of higher education, higher unemployment rate, and fewer comorbidities. Obesity was considered a chronic disease to a higher extent in HPO compared to LPO group (62 vs. 56%), but this difference was not statistically significant. The PwO in HPO group discussed less with the HCPs about their excess weight (57 vs. 70%), did not feel motivated to lose weight in a higher percentage (26 vs. 18%), and felt less emotionally supported (16 vs. 24%). In HPO group, the preference for unhealthy food (51 vs. 36%), and the costs of healthy eating, anti-obesity drugs and bariatric surgery were perceived barriers to losing weight. A higher proportion of PwO in HPO group considered that exercise (58 vs. 40%) was more effective for achieving weight loss. In contrast, LPO group considered diet more effective (48 vs. 32%). HCPs in HPO group felt more motivated to treat obesity (83 vs. 68%) and a higher proportion (14 vs. 5%) identified the economic burden as one of the main reasons why PwO do not start conversations to lose weight. CONCLUSIONS: There is less concern and conversation about excess weight in PwO in regions with a higher prevalence of obesity, with socioeconomic limitations being one of the main perceived barriers to treatment.

Isolated hypoaldosteronism is a cause of hypovolemic but not euvolemic hyponatremia.

Introduction: Hypoaldosteronism is characterized by hyperkalemia, and/or hypovolemic hyponatremia (HH), often accompanied by metabolic acidosis. HH is typical of hypoaldosteronism, whereas euvolemic hyponatremia (EH) is not. The purpose of the current study is to describe the characteristics of hyponatremia in hypoaldosteronism and elucidate whether EH can be considered part of the disease's spectrum. Methods: In a hypoaldosteronism cohort, we analyzed the factors associated with hyponatremia, comparing the characteristics of EH and HH and their associated factors. Correlation analyses of mineralocorticoid biomarkers, such as the transtubular potassium gradient (TTKG), the urinary Na+/K+ ratio (UNa+/UK+) with serum, and urinary electrolytes were performed in both types of hyponatremia. Results: Of 112 hypoaldosteronism episodes, 77.7% were ≥65 years old, 44.6% were women, and 80 (71.4%) had hyponatremia. Hyponatremia was negatively associated with the presence of chronic kidney disease, and positively with a hypovolemic state, malnutrition, a prior history of hyponatremia, and glucocorticoid therapy. HH: 61/80 and EH: 19/80 episodes. HH was associated with an age ≥65 years and the use of diuretics, as well as factors related to an aldosterone deficit and/or mineralocorticoid resistance. In HH but not in EH, urinary potassium was correlated with the TTKG, and urinary sodium with both the TTKG and the UNa+/UK+. Conclusion: Both HH and EH can be observed in hypoaldosteronism. However, only the former would be related to insufficient mineralocorticoid activity. Significance statement: Isolated hypoaldosteronism is a poorly understood and underdiagnosed endocrinological disorder, classically recognized only when hyperkalemia is present. The development of hypovolemic hyponatremia, however, is also easily explained by the physiopathology of the disorder. The current study addresses the features of hyponatremia when found in the context of mineralocorticoid insufficiency, and confirms an association between hypovolemic hyponatremia and isolated hypoaldosteronism. Thus, the clinical spectrum of hypoaldosteronism is extended to include hypovolemic hyponatremia as a frequent manifestation of the disorder.

Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review.

Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.

Clinical manifestations and associated factors in acquired hypoaldosteronism in endocrinological practice.

Introduction: Hypoaldosteronism can be congenital or acquired, isolated or part of primary adrenal insufficiency, and caused by an aldosterone deficit, resistance, or a combination of both. Reduced mineralocorticoid action can induce a decrease in urine K+ and H+ excretion and an increase in urine Na+ excretion, leading to hyperkalemia, and/or hyponatremia, often combined with metabolic acidosis. We aimed to characterize the clinical manifestations of hypoaldosteronism, and their associated factors. Methods: Retrospective analysis of 112 episodes of hypoaldosteronism diagnosed in 86 adult patients from 2012-2019 by the Endocrinology and Nutrition Department of a tertiary hospital. The frequency of hyperkalemia, hypovolemic hyponatremia (HH) and metabolic acidosis (MA), and their associated factors were evaluated. Results: Patients had a median age of 77 [65 - 84], 55.4% were male. 94.6% cases showed hyperkalemia, 54.5% HH, and 60.3% MA. The mean serum K+ of all cases was 5.4 ± 0.5 mmol/L, Na+: 132.1 ± 6.3 mmol/L, HCO3: 22.6 ± 3.3 mmol/L. Hypoaldosteronism was isolated in the majority of cases: only 6/112 (5%) had primary adrenal insufficiency. Hypovolemia was associated with hyponatremia and a more florid clinical presentation. HH was associated with a combined presence of aldosterone-lowering and mineralocorticoid resistance factors. MA was associated with the presence of mineralocorticoid resistance factors. Conclusions: Hypoaldosteronism in adult endocrinological clinical practice is primarily isolated, and acquired. It predisposes not only to the development of hyperkalemia and MA, but also to that of HH. Hypoaldosteronism must be considered in the differential diagnosis of HH with urinary sodium wasting.

Changes in Serum Creatinine Levels Can Help Distinguish Hypovolemic from Euvolemic Hyponatremia.

Background and Objectives: Differentiating between hypovolemic (HH) and euvolemic hyponatremia (EH) is crucial for correct diagnosis and therapy, but can be a challenge. We aim to ascertain whether changes in serum creatinine (SC) can be helpful in distinguishing HH from EH. Materials and Methods: Retrospective analysis of patients followed in a monographic hyponatremia outpatient clinic of a tertiary hospital during 1 January 2014−30 November 2019. SC changes during HH and EH from eunatremia were studied. The diagnostic accuracy of the SC change from eunatremia to hyponatremia (∆SC) was analyzed. Results: A total of 122 hyponatremic patients, median age 79 years (70−85), 46.7% women. In total, 70/122 patients had EH, 52/122 HH. During hyponatremia, median SC levels increased in the HH group: +0.18 mg/dL [0.09−0.39, p < 0.001], but decreased in the EH group: −0.07 mg/dL (−0.15−0.02, p < 0.001), as compared to SC in eunatremia. HH subjects presented a higher rate of a positive ∆SC than EH (90.4% vs. 25.7%, p < 0.001). EH subjects presented a higher rate of a negative/null ∆SC than HH (74.3% vs. 9.6%, p < 0.001). ROC curve analysis found an AUC of 0.908 (95%CI: 0.853 to 0.962, p < 0.001) for ∆SC%. A ∆SC% ≥ 10% had an OR of 29.0 (95%CI: 10.3 to 81.7, p < 0.001) for HH. A ∆SC% ≤ 3% had an OR of 68.3 (95%CI: 13.0 to 262.2, p < 0.001) for EH. Conclusions: The assessment of SC changes from eunatremia to hyponatremia can be useful in distinguishing between HH and EH.

How the COVID-19 pandemic has affected the training of Endocrinology and Nutrition Residents. Results of a survey by the Spanish Society of Endocrinology and Nutrition.

INTRODUCTION: COVID-19 disease has become a priority for our healthcare system. The resident physicians training in endocrinology and nutrition (E&N residents) have been integrated into the COVID-19 teams. This study has been designed with the aim of analysing the educational, occupational and health impact on E&N residents. MATERIAL AND METHODS: Cross-sectional observational study via a web survey, aimed at E&N residents who are members of the SEEN, carried out in November 2020. The following data were analysed: demographic variables, number of beds in the training hospital, alteration of rotations, integration in COVID-19 teams, participation in telemedicine, scientific activity and impact on physical and emotional health. RESULTS: 87 responses were obtained (27% of all E&N residents), 67.8% women, 28.1 ±â€¯1.8 years, 60% 4th year E&N residents. 84% participated in COVID-19 teams and 93% in the telemedicine consultations of their service. Most have had their rotations interrupted. 97.7% have participated in scientific meetings or virtual congresses and a third of them have collaborated in scientific work on COVID-19 in relation to endocrinology and nutrition. Overall, 75.8% think the pandemic has affected their mood a lot or quite a lot, and 73.8% think that the pandemic has negatively impacted their training. CONCLUSIONS: The SARS-CoV-2 pandemic has compromised the training, work activity and health of E&N residents. They have been integrated both in COVID-19 teams and in the restructured activity of their departments. However, they have managed to continue their training in virtual format and have participated in scientific work.

Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are indicated in type 2 diabetes and obesity for their high efficacy in controlling glycaemia and inducing body weight loss, respectively. Patients may develop gastrointestinal adverse events (GI AEs), namely nausea, vomiting, diarrhoea and/or constipation. To minimize their severity and duration, healthcare providers (HCPs) and patients must be aware of appropriate measures to follow while undergoing treatment. An expert panel comprising endocrinologists, nephrologists, primary care physicians, cardiologists, internists and diabetes nurse educators convened across virtual meetings to reach a consensus regarding these compelling recommendations. Firstly, specific guidelines are provided about how to reach the maintenance dose and how to proceed if GI AEs develop during dose-escalation. Secondly, specific directions are set about how to avoid/minimize nausea, vomiting, diarrhoea and constipation symptoms. Clinical scenarios representing common situations in daily practice, and infographics useful to guide both HCPs and patients, are included. These recommendations may prevent people with T2D and/or obesity from withdrawing from GLP-1 RAs treatment, thus benefitting from their superior effect on glycaemic control and weight loss.

[How the COVID-19 pandemic has affected the training of Endocrinology and Nutrition Residents. Results of a survey by the Spanish Society of Endocrinology and Nutrition]. / Cómo ha afectado la pandemia COVID-19 en la formación de los MIR de Endocrinología y Nutrición. Resultados de una encuesta de la Sociedad Española de Endocrinología y Nutrición.

INTRODUCTION: COVID-19 disease has become a priority for our healthcare system. The resident physicians training in endocrinology and nutrition (E&N residents) have been integrated into the COVID-19 teams. This study has been designed with the aim of analysing the educational, occupational and health impact on E&N residents. MATERIAL AND METHODS: Cross-sectional observational study via a web survey, aimed at E&N residents who are members of the SEEN, carried out in November 2020. The following data were analysed: demographic variables, number of beds in the training hospital, alteration of rotations, integration in COVID-19 teams, participation in telemedicine, scientific activity and impact on physical and emotional health. RESULTS: 87 responses were obtained (27% of all E&N residents), 67.8% women, 28.1 ± 1.8 years, 60% 4th year E&N residents. 84% participated in COVID-19 teams and 93% in the telemedicine consultations of their service. Most have had their rotations interrupted. 97.7% have participated in scientific meetings or virtual congresses and a third of them have collaborated in scientific work on COVID-19 in relation to endocrinology and nutrition. Overall, 75.8% think the pandemic has affected their mood a lot or quite a lot, and 73.8% think that the pandemic has negatively impacted their training. CONCLUSIONS: The SARS-CoV-2 pandemic has compromised the training, work activity and health of E&N residents. They have been integrated both in COVID-19 teams and in the restructured activity of their departments. However, they have managed to continue their training in virtual format and have participated in scientific work.

Evaluation of Myocardial Function Following SADI-S.

PURPOSE: The aim of this study was to compare myocardial mechanics using global longitudinal strain (GLS) before and after single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). MATERIALS AND METHODS: A total of 21 obese patients undergoing SADI-S were prospectively included. Transthoracic echocardiography was performed before and after the procedure, and left ventricle (LV) and right ventricle (RV) strain was assessed by two-dimensional speckle-tracking imaging (2DST). RESULTS: Mean time between pre-procedural and post-procedural echocardiograms was 9.2 ± 3.3 months. Postoperatively, %total weight loss (%TWL) was 33.0 ± 1.7 and % excess weight loss (%EWL) was 75.5 ± 3.6. Body mass index (BMI) significantly decreased after surgery (45.6 ± 1.2 vs 29.6 ± 1.0; p < 0.001). Postoperatively, LV GLS experienced a significant improvement (-19.8% ± 0.5 vs -22.2% ± 0.4; p < 0.001). Regarding other relevant functional parameters, RV free-wall strain was equally recovered (-19.1% ± 0.7 vs -21.0% ± 0.8; p 0.047). CONCLUSIONS: This study demonstrates important and favourable changes in cardiac deformation parameters after performing SADI-S. Malabsorptive bariatric techniques such as SADI-S induce significant weight loss, leading to an improvement in subclinical myocardial function in patients with obesity.

Exercise-Induced Hyponatremia: An Assessment of the International Hydration Recommendations Followed During the Gran Trail De Peñalara and Vitoria-Gasteiz Ironman Competitions.

Introduction: Hyponatremia often occurs during the practice of endurance sports. We evaluated the impact on hyponatremia of the hydration recommendations of the Third International Exercise-Associated Hyponatremia Consensus Development Conference 2015 (3IE-AHCD) during the 2017 Gran Trail de Peñalara marathon (GTP) and the Vitoria Gasteiz Ironman triathlon (VGI). Methods: Prospective study of GTP and VGI athletes participating in four information sessions in the months prior to the events, to explain that hydration should only be according to their level of thirst, per the recommendations of the 3IE-AHCD. Consenting event finishers were included in final analysis. Pre- and post-race anthropometric and biochemical parameters were compared. Results: Thirty-six GTP (33 male) and 94 VGI (88 male) finishers were evaluated. GTP race median fluid intake was 800 ml/h, with 900 ml/h in the VGI race. 83.3% GTPfin and 77.6% VGIfin remained eunatremic (blood sodium 135-145 mmol/L). Only 1/36 GTP and 1/94 VGI participant finished in hyponatremia, both with a sodium level of 134 mmol/L. Fourteen percent of GTP, and 21.2% of VGI participants finished in hypernatremia, with no increase in race completion times. No participating athlete required medical attention, except for musculoskeletal complaints. Pro-BNP and Copeptin levels rose significantly. Changes in copeptin levels did not correlate with changes in plasma osmolality, nor total body water content in impedance analysis. Conclusions: Recommending that athletes' fluid intake in endurance events be a function of their thirst almost entirely prevented development of hyponatremia, without induction of clinically significant hypernatremia, or a negative repercussion on race completion times.

The SEEN comprehensive clinical survey of adult obesity: Executive summary. / Abordaje clínico integral SEEN de la obesidad en la edad adulta: resumen ejecutivo.

Obesity is one of the great challenges in healthcare nowadays with important implications for health so requiring comprehensive management. This document aims to establish practical and evidence-based recommendations for the diagnosis and management of in Spain, from the perspective of the clinical endocrinologist. A position statement has been made that can be consulted at www.seen.es, and that has been agreed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), together with the Nutrition Area (NutriSEEN) and the Working Group of Endocrinology, Nutrition and Physical Exercise (GENEFSEEN).

Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. / Obesidad y SARS-CoV-2: consideraciones sobre la cirugía bariátrica y recomendaciones para el inicio de la actividad quirúrgica.

The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.

Interaction between age and vitamin D deficiency in severe COVID-19 infection.

INTRODUCTION: Background: coronavirus disease 2019 (COVID-19) can induce an exaggerated inflammatory response. Vitamin D is a key modulator of the immune system. We hypothesized that vitamin D deficiency (VDD) could increase the risk of developing severe COVID-19 infection. Methods: patients with confirmed COVID-19 seen at the emergency department of our hospital with recent measurements of 25(OH)D were recruited. We explored the association of vitamin D deficiency (VDD), defined as 25-hydroxyvitamin D < 20 ng/mL, with a composite of adverse clinical outcomes. Results: we included 80 patients, of which 31 (39 %) presented the endpoint. VDD tended to predict an increased risk of developing severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease [OR 3.2 (95 % CI: 0.9-11.4), p = 0.07]. Age had a negative interaction with the effect of VDD on the composite outcome (p = 0.03), indicating that the effect was more noticeable at younger ages. Furthermore, male gender was associated with VDD and with severe COVID-19 at younger ages. Conclusions: in this retrospective study, vitamin D deficiency showed a signal of association with severe COVID-19 infection. A significant interaction with age was noted, suggesting VDD may have a greater impact in younger patients. These findings should be confirmed in larger, prospective, adequately powered studies.

INTRODUCCIÓN: Antecedentes: la enfermedad por coronavirus 2019 (COVID-19) puede inducir una respuesta inflamatoria exagerada. La vitamina D es un modulador clave del sistema inmune. Planteamos que la deficiencia de vitamina D (VDD) podría aumentar el riesgo de desarrollar infección grave por COVID-19. Métodos: se reclutaron pacientes consecutivos que acudieron al servicio de urgencias de nuestro centro con diagnóstico de COVID-19 confirmado (PCR-COVID-19 positiva) y mediciones recientes de 25(OH)D. Exploramos la asociación de la deficiencia de vitamina D (VDD), definida como una 25-hidroxivitamina D < 20 ng/ml, con un compuesto de resultados clínicos adversos. Resultados: se incluyeron 80 pacientes, de los cuales 31 (39 %) presentaron el criterio de valoración primario. El VDD tendió a predecir un mayor riesgo de desarrollar COVID-19 grave después de ajustar edad, sexo, obesidad, enfermedad cardíaca y enfermedad renal [OR: 3,2 (IC 95 %: 0,9-11,4), p = 0,07]. La edad tuvo una interacción negativa con el efecto de la VDD en el resultado compuesto (p = 0,03), lo que indica que el efecto fue más notable a edades más tempranas. Además, el género masculino se asoció con la VDD y con la COVID-19 grave en las edades más jóvenes. Conclusiones: en este estudio retrospectivo, la deficiencia de vitamina D mostró una tendencia de asociación con la infección grave por COVID-19. Se observó una interacción significativa con la edad, lo que sugiere que la VDD puede tener un mayor impacto en los pacientes más jóvenes. Estos hallazgos deben confirmarse en estudios más grandes, prospectivos y con potencia adecuada.

Effects of Milk and Dairy Products on the Prevention of Osteoporosis and Osteoporotic Fractures in Europeans and Non-Hispanic Whites from North America: A Systematic Review and Updated Meta-Analysis.

Nutrition plays an important role in bone health. The aim of our study was to update the evidence regarding dairy intake, osteoporotic fracture (OF) risk, and prospective bone mass density (BMD) evolution assessed by dual-energy X-ray absorptiometry in Europeans and non-Hispanic whites from North America. A systematic search was conducted in MEDLINE, EMBASE, and Scopus for papers published from 1 January, 2000 to 30 April, 2018. The eligibility criteria were as follows: healthy adults; measurable dairy exposure; hip, vertebral, wrist or OF as outcomes; and cohort or case-control studies. Two independent investigators conducted the search and the data extraction. A pooled analysis was conducted with random-effects models. Publication bias and meta-regression were considered. Ten cohort studies relating to OF risk were selected for meta-analysis. Three papers reporting BMD changes associated with dairy intake could not be aggregated in the meta-analysis. The pooled HRs of the highest compared with the lowest levels of dairy intake were 0.95 (95% CI: 0.87, 1.03; I2 = 82.9%; P-heterogeneity < 0.001) for OF at any site; 0.87 (95% CI: 0.75, 1.01; I2 = 86.7%; P-heterogeneity < 0.001) for hip fractures; and 0.82 (95% CI: 0.68, 0.99; I2 = 0.0%; P-heterogeneity = 0.512) for vertebral fractures. Concerning BMD, the selected studies described a 1.7-3% lower hip BMD in young and postmenopausal women with poor intake of milk in their youth, a positive relationship between baseline milk ingestion and the percentage of trochanter BMD change in elderly people, and a positive correlation between milk consumption and BMD change at the radius in women aged >65 y. In conclusion, in the studied population, the highest consumption of dairy products did not show a clear association with the total OF or hip fracture risks; however, a diminished risk of vertebral fracture could be described. The results regarding BMD change were heterogeneous and did not allow for a definitive conclusion.

Effect of Roux-en-Y gastric surgery on ciprofloxacin pharmacokinetics: an obvious effect?

PURPOSE: To evaluate pharmacokinetic parameters of ciprofloxacin in patients undergoing Roux-en-Y gastric surgery (RYGS). METHODS: Controlled, single-dose, open-label study in patients undergoing RYGS. Healthy overweight/obese patients 18-60 years old were included. The assessment was performed once in control patients and three times in case patients (before surgery and 1 and 6 months after surgery). In each visit, the subjects received a single oral dose of ciprofloxacin 500 mg. Venous blood samples were obtained at baseline and 0.5, 1, 1.25, 1.5, 1.75, 2, 2.5, 3, 4, 8 and 14 h after ciprofloxacin intake. Pre- and post-surgery variables were compared using paired ANOVA or the Wilcoxon tests and control vs cases using ANOVA or Mann Whitney. Given the post-surgery change in body weight, the parameters were corrected by dose (mg)/body weight (kg). The analysis was performed using SPSS. RESULTS: Ciprofloxacin Cmax was significantly reduced 1 month after surgery (1840.9 ± 485.2 vs 1589.6 ± 321.8 ng/ml; p = 0.032) but not 6 months after. Cmax on the sixth month was lower than Cmax in control group (2160.4 ± 408.6 vs 1589.6 ± 321.8 ng/ml; p < 0.001). After correcting by the dose (mg)/patient's body weight, both Cmax and AUClast showed significant decrease 1 and 6 months after surgery: Cmax, 289.1 ± 65.3 and 263.5 ± 52.1 (ng/ml)/(dose (mg)/weight (kg)) respectively vs 429.3 ± 127.6 (ng/ml)/(dose (mg)/weight (kg)) at baseline; AUC, 1340.6 ± 243.0 and 1299.2 ± 415.4 (h × ng/ml)/(dose (mg)/weight (kg)) respectively vs 1896.7 ± 396.8 (h × ng/ml)/(dose (mg)/weight (kg)) at baseline. Cmax 1 month post-surgery showed lower values than the control group (375.4 ± 77.4 vs 263.5 ± 52.1 ng/ml; p < 0.001). CONCLUSION: Ciprofloxacin absorption is impaired 1 month and 6 months after RYGS. The effect on Cmax and AUClast faded on the sixth month due to weight loss. It is no necessary to modify the doses of ciprofloxacin in these patients.

Variability of nutrients intake, lipid profile and cardiovascular mortality among geographical areas in Spain: The DRECE study.

It has often been suggested that cardiovascular mortality and their geographical heterogeneity are associated with nutrients intake patterns and also lipid profile. The large Spanish study Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) investigated this theory from 1991 to 2010. Out of the 4,783 Spanish individuals making up the DRECE cohort, 220 subjects (148 men and 72 women) died (4.62%) during the course of the study. The mean age of patients who died from cardiovascular causes (32 in all) was 61.08 years 95% CI (57.47-64.69) and 70.91% of them were males. The consumption of nutrients and the lipid profile by geographical area, studied by geospatial models, showed that the east and southern area of the country had the highest fat intake coupled to a high rate of unhealthy lipid profile. It was concluded that the spatial geographical analysis showed a relationship between high fat intake, unhealthy lipid profile and cardiovascular mortality in the different geographical areas, with a high variability within the country.

Improvement of serum lipids concentration in a general population historical cohort. Why?

BACKGROUND: Knowledge about the harmful effects of high levels of low-density lipoprotein cholesterol (cLDL) in adults increased after the publication of various guidelines, leading to closer control and more treatment. We hypothesized that these health care changes would result in an overall improvement in the lipid profile of the population. OBJECTIVE: To determine the evolution of the lipid profile in the population of Spain from the Diet and Risk of Cardiovascular Disease in Spain cohort. METHODS: A comparison was made between the baseline population-based probabilistically sampled DRECE cohort (DRECE 1 study, 1992-1994, n=4787) and its 13 years later revisit (DRECE 3 study, 2005-2007). A cross-sectional comparison was made of the overall population of DRECE1 and DRECE3, including only individuals aged 20 to 60 years (inter-individual variations). For subjects participating in both DRECE1 and DRECE3 (n=1039), individual variations over time (intra-individual analyses) were examined. RESULTS: In the overall population, the prevalence of lipid-lowering therapy increased from 3.8% in DRECE1 to 10.7% in DRECE3. Comparing the lipid profile of the population aged 20-60 years in DRECE1 with the same age group in DRECE3, an overall decrease is observed in total cholesterol from a mean of 203.31mg/dl (SD 43.51) in 1992-1994 to 196.31mg/dl (SD 38.53) in 2005-2007, and in cLDL from a mean of 125.78mg/dl (SD 38.53) to 121.37mg/dl (SD 34.22). The proportion of the population with total cholesterol >200mg/dl decreased from 51% in DRECE1 to 47% in DRECE3, although this difference did not reach statistical significance (p=0.077). As regards the intra-individual analyses, total cholesterol increased from DRECE1 to DRECE3 in men and women younger than 40 years at baseline, but decreased in those who were older. Index of individuality for total cholesterol, cLDL, cHDL and triglycerides ranged from 0.53 to 0.87. CONCLUSIONS: The lipid profile of the Spanish population improved between 1992-1994 and 2005-2007. Within individuals, lipid concentrations, especially total cholesterol and cLDL have increased, although the trend is favorable in the middle-age group (40-59 years). These changes seem to be due to several causes, impacted by dietary and lifestyle factors, and also by a greater emphasis in lipid-lowering therapy in middle-aged people. Lipid parameters had a low index of individuality, which limits their usefulness as population reference values.