Body mass index, systemic inflammation and cognitive performance in adolescents: A cross-sectional study.

BACKGROUND: Excessive body weight has been related to lower cognitive performance. One of the mechanisms through which excess body weight may affect cognition is inflammation. HYPOTHESIS: Our hypothesis is that both body mass index (BMI) and circulating levels of inflammatory biomarkers will be negatively related to cognitive performance. DESIGN: Cross-sectional study. SETTING: Users of the public health centres of the Consorci Sanitari de Terrassa (Terrassa, Spain) between 2010 and 2017 aged 12-21 years. PARTICIPANTS: One hundred and five adolescents (46 normoweight, 18 overweight, 41 obese). MEASUREMENTS: Levels of high sensitivity C-reactive protein, interleukin 6, tumour necrosis factor α (TNFα) and fibrinogen were determined from blood samples. Cognitive performance was evaluated and six cognitive composites were obtained: working memory, cognitive flexibility, inhibitory control, decision-making, verbal memory, and fine motor speed. A single multivariate general lineal model was used to assess the influence of the four inflammatory biomarkers, as well as participants' BMI, sex, and age on the 6 cognitive indexes. RESULTS: An inverse relationship between BMI and inhibitory control (F = 5.688, p = .019; ß = -0.212, p = .031), verbal memory (F = 5.404, p = .022; ß = -0.255, p = .009) and fine motor speed (F = 9.038, p = .003; ß = -0.319, p = .001) was observed. Levels of TNFα and fibrinogen were inversely related to inhibitory control (F = 5.055, p = .027; ß = -0.226, p = .021) and verbal memory (F = 4.732, p = .032; ß = -0.274, p = .005), respectively. LIMITATIONS: The cross-sectional nature of the study, the use of cognitive tests designed for clinical purposes, and the use of BMI as a proxy for adiposity are limitations of our study that must be taken into account when interpreting results. CONCLUSIONS: Our data indicate that some components of executive functions, together with verbal memory, are sensitive to specific obesity-related inflammatory agents at early ages.

[Cardiovascular risk factors: a follow up study in a non-diabetic population]. / Factores de riesgo cardiovascular: estudio de seguimiento en población no diabética.

OBJECTIVES: To evaluate the cardiovascular risk factors (CVRF), their relationship with insulin resistance (IR) and pancreatic beta-cell (PBC) function in a known non-diabetic population, and to follow its progress over a period of 5 years. DESIGN: Nested case-control study developed in two phases: the identification and characterisation of the cohort to study and the follow up. SETTING: Urban Primary Care Centre. PARTICIPANTS: A non-diabetic population sample from 40 to 70 years. MAIN MEASUREMENTS: History of CVRF, physical examination (body mass index, abdominal girth, blood pressure), laboratory tests (fasting glucose, lipid profile and fasting insulin) and calculation of IR and PBC using the Homeostasis Model Assessment mathematical program. RESULTS: Identification phase: 326 subjects. CVRF 32.5% dyslipaemia, 28.8% smoking, 28.2% obesity and 24.8% increased blood pressure. Number of CVRF: 37.7% had one, 21.5% two, 10.1% three and 2.1% four. Relationship between number of CVRF and IR. More IR in hypertensive, obese and dyslipaemic subjects. Follow up phase (5 years): 121 subjects. Significant proportion of dyslipaemia and impaired fasting glucose (IFG). CONCLUSIONS: The most common CVRF were dyslipaemia, smoking, obesity and raised blood pressure, with more IR in patients with high blood pressure, dyslipaemia and obesity and a higher number of CVRF in comparison with the rest of the population. At five years of follow up, an increase was only observed in the number of dyslipaemia and IFG and no reduction was achieved in the percentage of active smokers.

Exploración oftalmológica básica del paciente diabético en la atención primaria / Basic eye examination in a diabetic population: disease management in a primary health care setting

Objetivo general: conocer la viabilidad de la realización de la exploración oftalmológica básica de la enfermedad ocular del paciente diabético (exploración de la agudeza visual, de la presión intraocular y del fondo de ojo) desde el ámbito de la atención primaria de la salud (APS). Objetivos concretos: a) conocer la fiabilidad del diagnóstico de la exploración oftalmológica básica del paciente diabético realizado por el médico de APS mediante la concordancia con el diagnóstico realizado por un oftalmólogo de referencia experimentado: b) conocer las repercusiones, en los diferentes servicios de oftalmología, de la exploración oftalmológica básica del paciente diabético realizada en la APS; c) estudio de costo-efectividad de la exploración oftalmológica básica del paciente diabético en el ámbito de la APS. Metodología del proyecto: estudio de cohortes prospectivo multicéntrico de 3 años de duración. Pacientes: muestra representativa de pacientes adultos (1 023), diagnosticados de diabetes mellitus tipo 2. Realización, por parte de un optometrista,, de una exploración de agudeza visual, medición de la presión intraocular y fotografía de fondo de ojo con cámara de retina no midriática. Interpretación de los resultados mediante doble lectura a ciego, por los oftalmólogos y médicos de APS del equipo investigador, con la posterior indicación de derivación a los servicios de oftalmología de referencia. Previamente los oftalmólogos del equipo investigador imparten, a los médicos de APS, un curso de formación en relación con la patología oftalmológica básica estudiada. Conclusión: la exploración oftalmológica básica de rutina en la atención primaria conllevará una clara mejora en la calidad de atención a la población diabética