Effects of an antioxidants cocktail on glucose metabolism at rest, during exercise, and during a glucose load in healthy young subjects

Background: Reactive oxygen species (ROS) regulate glucose metabolism (GM) in skeletal muscle by improving the translocation of GLUT4. Antioxidant supplementation could block this physiological effect, altering glucose signaling during exercise. However, there is limited evidence in humans on whether antioxidant intake affects GM. Therefore, we aimed to determine the effect of an antioxidant cocktail (AOC) on GM at rest and during metabolic challenges. Methods: Ten healthy male subjects received AOC supplementation (1000 mg of Vitamin C, 600 IU of Vitamin E, and 600 mg of α-lipoic acid) or placebo (2.000 mg of talc) before two trials conducted 7 days apart. Trial 1: AOC 120 and 90 minutes before an endurance exercise (EEX) bout at 60 % of maximal oxygen uptake (VO2max); Trial 2: AOC 120 and 90 minutes before an oral glucose tolerance test (OGTT; 75 g glucose). Measurements of gas exchange and capillary blood samples were collected every 15 minutes during both trials. Results: AOC supplementation increased resting glucose levels (p<0.05). During Trial 1 (EEX), the AOC increased carbohydrate oxidation (CHOox) (p= 0.03), without effect in glucose blood levels. During Trial 2 (OGTT), the AOC supplementation had no significant effect on GM parameters. Conclusion: Acute supplementation with AOC increased resting glucose levels and CHOox during EEX in healthy subjects, with no effect on GM during the OGTT.

Antecedentes: Las especies reactivas de oxígeno (ROS) regulan el metabolismo de la glucosa (GM) en el músculo esquelético al mejorar la translocación de GLUT4. La suplementación con antioxidantes podría bloquear este efecto fisiológico, alterando la señalización de la glucosa durante el ejercicio. Sin embargo, existe evidencia limitada en humanos sobre si la ingesta de antioxidantes afecta el GM. Por lo tanto, nuestro objetivo fue determinar el efecto de un cóctel de antioxidantes (AOC) en el GM en reposo y durante desafíos metabólicos. Métodos: Sujetos sanos (sexo masculino; n= 10) recibieron suplementos de AOC (1.000 mg de vitamina C, 600 UI de vitamina E y 600 mg de ácido α-lipoico) o placebo (2.000 mg de talco) previo a dos pruebas realizadas con 7 días de diferencia. Prueba 1: AOC 120 y 90 minutos antes de una serie de ejercicio de resistencia (EEX) al 60% del consumo máximo de oxígeno (VO2max); prueba 2: AOC 120 y 90 minutos antes de una prueba de tolerancia oral a la glucosa (OGTT; 75 g de glucosa). Se obtuvieron datos de intercambio de gaseoso y muestras de sangre capilar cada 15 minutos durante ambas pruebas. Resultados: la suplementación con AOC aumentó los niveles de glucosa en reposo (p<0,05). Durante la prueba 1 (EEX), el AOC aumentó la oxidación de carbohidratos (CHOox) (p= 0,03), sin efecto en los niveles de glucosa en sangre. Durante la prueba 2 (OGTT), la suplementación con AOC no tuvo un efecto significativo en los parámetros de GM. Conclusión: Una suplementación aguda con AOC aumentó los niveles de glucosa en reposo y la CHOox durante EEX en sujetos sanos, sin efecto sobre el GM durante la OGTT.

Clinical and Endoscopic Characterization of Gastrointestinal Kaposi's Sarcoma in an Institution in Southwestern Colombia between 2011 and 2020

Kaposi's sarcoma is an angioproliferative neoplasm associated with the human herpesvirus 8. According to the clinical characteristics and the degree of immunosuppression, there are four epidemiological forms: classic, endemic, iatrogenic, and epidemic. The latter is associated with acquired immunodeficiency syndrome (AIDS) and 40% GI involvement. There is little epidemiological, clinical, and endoscopic evidence of the disease. This study sought to characterize this condition in a Colombian population and compare the findings with publications from other countries. One hundred thirty-five records of patients who consulted between 2011 and 2020 for Kaposi's sarcoma were reviewed, of which 24 had GI involvement. Epidemiological, clinical, endoscopic, and treatment characteristics were obtained. Twenty-two patients were men. There were 21 patients infected with human immunodeficiency virus (HIV; 87.5%) and 19 receiving antiretroviral therapy (90%); 33.3% had HIV viral load > 100,000 copies/mL. The CD4+ count was <50 cells/µL in 28.6% of cases, between 50 and 100 cells/µL in 19.0%, and between 100 and 200 cells/µL in 14.4%. The rate of infection by other opportunistic infections was 41.7%. There were GI symptoms in 33% of the patients, and the most frequent were hematochezia, abdominal pain, nausea, and diarrhea. Most had concomitant skin lesions (70.8%). GI lesions were located mainly in the oropharynx (41.7%), stomach (20.8%), and colon (16.7%). The most common endoscopic finding was maculopapular erythema. This article provided insight into the local epidemiology of gastrointestinal Kaposi's sarcoma. In contrast to studies in other populations, GI symptoms were more frequent in this one, and there was a difference in endoscopic findings. Studies with larger populations are needed.

El sarcoma de Kaposi es una neoplasia angioproliferativa asociada al virus del herpes humano 8. Según las características clínicas y el grado de inmunosupresión, son cuatro las formas epidemiológicas: clásica, endémica, iatrogénica y epidémica, esta última asociada al síndrome de inmunodeficiencia adquirida (SIDA) y con un 40% de compromiso gastrointestinal. Existe escasa evidencia epidemiológica, clínica y endoscópica de la enfermedad. Este estudio buscó caracterizar esta condición en una población colombiana y contrastar los hallazgos con publicaciones de otros países. Se revisaron 135 registros de pacientes que consultaron entre el 2011 y 2020 por sarcoma de Kaposi, de los cuales 24 tenían compromiso gastrointestinal. Se obtuvieron características epidemiológicas, clínicas, endoscópicas y tratamientos. Veintidós pacientes eran hombres. Hubo 21 pacientes infectados por virus de la inmunodeficiencia humana (VIH; 87,5%) y 19 recibían terapia antirretroviral (90%). El 33,3% tenía carga viral VIH > 100 000 copias/mL. El recuento de CD4+ fue < 50 cel/µL en el 28,6% de los casos, entre 50 y 100 cel/µL en el 19,0%, y entre 100 y 200 cel/µL en el 14,4%. La tasa de infecciones por otros oportunistas fue de 41,7%. Hubo síntomas gastrointestinales en el 33% de los pacientes y los más frecuentes fueron hematoquecia, dolor abdominal, náuseas y diarrea. La mayoría tuvo lesiones cutáneas concomitantes (70,8%). Las lesiones gastrointestinales se localizaron principalmente en la orofaringe (41,7%), estómago (20,8%) y colon (16,7%). El hallazgo endoscópico más común fue eritema maculopapular. Este artículo mostró una visión de la epidemiología local del sarcoma de Kaposi gastrointestinal. En contraste con estudios en otras poblaciones, en este, los síntomas gastrointestinales fueron más frecuentes y hubo diferencia en los hallazgos endoscópicos. Son necesarios estudios con poblaciones más grandes.

Targeting Mitochondria for the Prevention and Treatment of Nonalcoholic Fatty Liver Disease: Polyphenols as a Non-pharmacological Approach.

SCOPE: Nonalcoholic fatty liver disease (NAFLD) has a high and growing prevalence globally. Mitochondria are fundamental in regulating cell energy homeostasis. Nevertheless, mitochondria control mechanisms can be exceeded in this context of energy overload. Damaged mitochondria worsen NAFLD progression. Diet and lifestyle changes are the main recommendations for NAFLD prevention and treatment. Some polyphenols have improved mitochondrial function in different NAFLD and obesity models. OBJECTIVE: The study aims to discuss the potential role of polyphenols as a nonpharmacological approach targeting mitochondria to prevent and treat NAFLD, analyzing the influence of polyphenols' chemical structure, limitations and clinical projections. METHODS: In vivo and in vitro NAFLD models were considered. Study searches were performed using the following keywords: nonalcoholic fatty liver disease, liver steatosis, mitochondria, mitochondrial activity, mitochondrial dynamics, mitochondrial dysfunction, mitochondrial morphology, mitochondrial cristae, fusion, fission, polyphenols, flavonoids, anthocyanins, AND/OR bioactive compounds. CONCLUSION: Polyphenols are a group of diverse bioactive molecules whose bioactive effects are highly determined by their chemical structure. These bioactive compounds could offer an interesting non-pharmacological approach to preventing and treating NAFLD, regulating mitochondrial dynamics and function. Nevertheless, the mitochondria' role in subjects with NAFLD treatment is not fully elucidated. The dosage and bioavailability of these compounds should be addressed when studied.

Cholic and deoxycholic acids induce mitochondrial dysfunction, impaired biogenesis and autophagic flux in skeletal muscle cells

BACKGROUND: Skeletal muscle is sensitive to bile acids (BA) because it expresses the TGR5 receptor for BA. Cholic (CA) and deoxycholic (DCA) acids induce a sarcopenia-like phenotype through TGR5-dependent mechanisms. Besides, a mouse model of cholestasis-induced sarcopenia was characterised by increased levels of serum BA and muscle weakness, alterations that are dependent on TGR5 expression. Mitochondrial alterations, such as decreased mitochondrial potential and oxygen consumption rate (OCR), increased mitochondrial reactive oxygen species (mtROS) and unbalanced biogenesis and mitophagy, have not been studied in BA-induced sarcopenia.METHODS: We evaluated the effects of DCA and CA on mitochondrial alterations in C2C12 myotubes and a mouse model of cholestasis-induced sarcopenia. We measured mitochondrial mass by TOM20 levels and mitochondrial DNA; ultrastructural alterations by transmission electronic microscopy; mitochondrial biogenesis by PGC-1α plasmid reporter activity and protein levels by western blot analysis; mitophagy by the co-localisation of the MitoTracker and LysoTracker fluorescent probes; mitochondrial potential by detecting the TMRE probe signal; protein levels of OXPHOS complexes and LC3B by western blot analysis; OCR by Seahorse measures; and mtROS by MitoSOX probe signals. RESULTS: DCA and CA caused a reduction in mitochondrial mass and decreased mitochondrial biogenesis. Interestingly, DCA and CA increased LC3II/LC3I ratio and decreased autophagic flux concordant with raised mitophagosome-like structures. In addition, DCA and CA decreased mitochondrial potential and reduced protein levels in OXPHOS complexes I and II. The results also demonstrated that DCA and CA decreased basal, ATP-linked, FCCP-induced maximal respiration and spare OCR. DCA and CA also reduced the number of cristae. In addition, DCA and CA increased the mtROS. In mice with cholestasis-induced sarcopenia, TOM20, OXPHOS complexes I, II and III, and OCR were diminished. Interestingly, the OCR and OXPHOS complexes were correlated with muscle strength and bile acid levels. CONCLUSION: Our results showed that DCA and CA decreased mitochondrial mass, possibly by reducing mitochondrial biogenesis, which affects mitochondrial function, thereby altering potential OCR and mtROS generation. Some mitochondrial alterations were also observed in a mouse model of cholestasis-induced sarcopenia characterised by increased levels of BA, such as DCA and CA.

Ursodeoxycholic acid induces sarcopenia associated with decreased protein synthesis and autophagic flux

BACKGROUND: Skeletal muscle generates force and movements and maintains posture. Under pathological conditions, muscle fibers suffer an imbalance in protein synthesis/degradation. This event causes muscle mass loss and decreased strength and muscle function, a syndrome known as sarcopenia. Recently, our laboratory described secondary sarcopenia in a chronic cholestatic liver disease (CCLD) mouse model. Interestingly, the administration of ursodeoxycholic acid (UDCA), a hydrophilic bile acid, is an effective therapy for cholestatic hepatic alterations. However, the effect of UDCA on skeletal muscle mass and functionality has never been evaluated, nor the possible involved mechanisms. METHODS: We assessed the ability of UDCA to generate sarcopenia in C57BL6 mice and develop a sarcopenic-like phenotype in C2C12 myotubes and isolated muscle fibers. In mice, we measured muscle strength by a grip strength test, muscle mass by bioimpedance and mass for specific muscles, and physical function by a treadmill test. We also detected the fiber's diameter and content of sarcomeric proteins. In C2C12 myotubes and/or isolated muscle fibers, we determined the diameter and troponin I level to validate the cellular effect. Moreover, to evaluate possible mechanisms, we detected puromycin incorporation, p70S6K, and 4EBP1 to evaluate protein synthesis and ULK1, LC3 I, and II protein levels to determine autophagic flux. The mitophagosome-like structures were detected by transmission electron microscopy. RESULTS: UDCA induced sarcopenia in healthy mice, evidenced by decreased strength, muscle mass, and physical function, with a decline in the fiber's diameter and the troponin I protein levels. In the C2C12 myotubes, we observed that UDCA caused a reduction in the diameter and content of MHC, troponin I, puromycin incorporation, and phosphorylated forms of p70S6K and 4EBP1. Further, we detected increased levels of phosphorylated ULK1, the LC3II/LC3I ratio, and the number of mitophagosome-like structures. These data suggest that UDCA induces a sarcopenic-like phenotype with decreased protein synthesis and autophagic flux. CONCLUSIONS: Our results indicate that UDCA induces sarcopenia in mice and sarcopenic-like features in C2C12 myotubes and/or isolated muscle fibers concomitantly with decreased protein synthesis and alterations in autophagic flux.

Prevalencia de Helicobacter pylori en pacientes llevados a endoscopia de vías digestivas altas en un hospital de referencia en Cali, Colombia, en 2020 / Prevalence of Helicobacter pylori in patients undergoing upper digestive tract endoscopy at a referral hospital in Cali, Colombia, in 2020

Resumen Introducción: la infección por Helicobacter pylori tiene una alta prevalencia y distribución a nivel mundial. Por su asociación con el desarrollo de adenocarcinoma gástrico, las actualizaciones sobre su prevalencia son de interés para el médico internista o gastroenterólogo, así como para la generación de políticas públicas. Este estudio midió la prevalencia de H. pylori y evaluó su asociación con hallazgos endoscópicos e histopatológicos en adultos con indicación de endoscopia de vías digestivas altas (EVDA). Metodología: estudio de cohorte analítica para describir la prevalencia de H. pylori y evaluar factores de riesgo asociados a esta infección en pacientes adultos sometidos a EVDA ambulatoria por cualquier indicación médica en la unidad de endoscopia de un hospital universitario de cuarto nivel de complejidad entre junio y diciembre de 2020. Se describen hallazgos endoscópicos, histopatológicos y la prevalencia de H. pylori. Para explorar los factores de riesgo se usó la prueba chi cuadrado (χ2) para evaluar diferencias en las proporciones y las pruebas t de Student y U de Mann-Whitney para las variables continuas según su distribución. Resultados: 613 pacientes cumplieron los criterios de selección y fueron incluidos en el análisis. La indicación más frecuente de EVDA fue dispepsia. La prevalencia de H. pylori fue de 38,5% (intervalo de confianza [IC] 95%: 34,7%-42,4%). Conclusión: H. pylori es un tema de gran interés en las patologías gastrointestinales. La búsqueda endoscópica debe ser en el antro y cuerpo. Su presencia fue mayor en pacientes con esófago normal, gastritis nodular folicular, úlcera duodenal e inflamación aguda al estudio histológico. Se requieren más estudios que complementen el comportamiento epidemiológico local.

Abstract Introduction: Helicobacter pylori infection has a high prevalence and distribution worldwide. Due to its association with the development of gastric adenocarcinoma, updates on its prevalence are of interest to the internist or gastroenterologist and policymaking. This study measured the prevalence of H. pylori and evaluated its association with endoscopic and histopathological findings in adults with an indication for upper GI endoscopy (EGD). Materials and methods: This analytical cohort study describes the prevalence of H. pylori and assesses risk factors associated with this infection in adult patients undergoing outpatient EGD for any medical indication in the endoscopy unit of a quaternary care university hospital between June and December 2020. Endoscopic and histopathological findings and the prevalence of H. pylori are described. To explore the risk factors, the chi-square (χ2) test was used to evaluate differences in proportions and the Student's t and Mann-Whitney U tests for continuous variables according to their distribution. Results: 613 patients met the selection criteria and were included in the analysis. The most frequent indication for EGD was dyspepsia. The prevalence of H. pylori was 38.5% (95% confidence interval [CI]: 34.7-42.4%). Conclusion: H. pylori is a topic of great interest in gastrointestinal pathologies. The endoscopic search should take place in the antrum and body. Its presence was most common in patients with a normal esophagus, follicular nodular gastritis, duodenal ulcer, and acute inflammation upon the histological study. More studies are required to complement the local epidemiological behavior.

Sedación administrada por médicos generales para procedimientos endoscópicos de baja complejidad: experiencia en una unidad de endoscopia de una clínica de alta complejidad en Cali / Sedation Administered by General Practitioners for Low Complexity Endoscopic Procedures: Experience in an Endoscopy Unit of a Tertiary Referral Hospital in Cali

Resumen Objetivos: en Colombia se ha venido implementando la sedación por médicos no anestesiólogos para procedimientos endoscópicos fuera del quirófano. Se describió la experiencia en la unidad de gastroenterología de una clínica de alto nivel de atención en Cali, Colombia. Materiales y métodos: estudio observacional, de tipo cohorte analítica para describir la frecuencia y el tipo de eventos adversos asociados a los procedimientos de sedación por médicos generales, y evaluar los factores asociados a su ocurrencia en pacientes que acudieron a la unidad de endoscopia de la Fundación Valle del Lili para la realización de estudios endoscópicos bajo sedación intravenosa que, por ser de bajo riesgo, fue aplicada por un médico no anestesiólogo entre noviembre de 2018 y junio de 2019. Se realizó análisis descriptivo, se calcularon mediana y rango intercuartílico para las variables numéricas, y frecuencias para las variables cualitativas. Resultados: se incluyeron 1506 participantes, 59,4 % ASA I y 40,6 % ASA II. En promedio, la dosis inicial de propofol fue de 60 mg y la dosis total, de 140 mg. Se registraron eventos adversos no serios en 46 pacientes (3,05 %) y el más común fue la desaturación transitoria (80,4 %). Ningún paciente presentó eventos adversos serios. El puntaje inicial promedio de la escala de Aldrete fue 8, mientras que al alta el puntaje promedio fue de 10. Conclusiones: la sedación para procedimientos endoscópicos dada por médicos no anestesiólogos es segura, siempre y cuando sea realizado por personal entrenado que realice una adecuada valoración de los antecedentes (cardiovasculares, gastrointestinales y neurológicos) y factores de riesgo del paciente dentro del marco de los lineamientos institucionales vigentes.

Abstract Objectives: in Colombia, sedation by non-anesthesiologists for endoscopic procedures outside the operating room has been implemented. A description of an experience in the gastroenterology unit of a tertiary referral hospital in Cali, Colombia, was conducted. Materials and methods: an analytical cohort observational study to describe the frequency and type of adverse events associated with sedation procedures performed by general practitioners and evaluate the factors related to their occurrence in patients who attended the endoscopy unit of Fundación Valle del Lili for endoscopic studies under intravenous sedation. Between November 2018 and June 2019, non-anesthesiologist physicians performed this procedure due to the minimal risk implied. A descriptive analysis was completed, and the median and interquartile range were calculated for numerical variables and frequencies for qualitative variables. Results: There were 1506 participants, 59.4% ASA I and 40.6% ASA II in this study. On average, the starting dose of propofol was 60 mg, and the total dose was 140 mg. Forty-six patients (3.05%) reported non-severe adverse events; the most common occurrence was transient desaturation (80.4%). No patients experienced severe adverse events. The average initial Aldrete scale score was 8, while at discharge, the average score was 10. Conclusions: sedation for endoscopic procedures performed by non-anesthesiologists is safe provided that it is performed by trained personnel conducting a correct assessment of the patient's (cardiovascular, gastrointestinal, and neurological) history and risk factors within the framework of the current institutional guidelines.

Effect of Epicatechin on Skeletal Muscle.

Loss of skeletal muscle (SkM) quality is associated with different clinical conditions such as aging, diabetes, obesity, cancer, and heart failure. Nutritional research has focused on identifying naturally occurring molecules that mitigate the loss of SkM quality induced by pathology or syndrome. In this context, although few human studies have been conducted, epicatechin (Epi) is a prime candidate that may positively affect SkM quality by its potential ability to mitigate muscle mass loss. This seems to be a consequence of its antioxidant and anti-inflammatory properties and its stimulation of mitochondrial biogenesis to increase myogenic differentiation, as well as its modulation of key proteins involved in SkM structure, function, metabolism, and growth. In conclusion, the Epi could prevent, mitigate, delay, and even treat muscle-related disorders caused by aging and diseases. However, studies in humans are needed.

Características clínicas de pacientes con pancreatitis aguda atendidos en un hospital de alta complejidad en Cali / Clinical characteristics of patients with acute pancreatitis treated in a tertiary referral hospital in Cali

Resumen Introducción: la pancreatitis aguda (PA) es una enfermedad de alta complejidad clínica y, de acuerdo con su gravedad, puede tener una elevada morbimortalidad con altos costos para el sistema de salud, especialmente a nivel intrahospitalario. Materiales y métodos: se desarrolló un estudio descriptivo basado en historias clínicas de un hospital universitario de alta complejidad. Se revisaron las historias con diagnóstico CIE 10 de pancreatitis aguda entre enero de 2011 y diciembre de 2018. Se incluyeron todos los pacientes mayores de 18 años, de ambos sexos, con diagnóstico de PA por cumplimiento de al menos 2 de los criterios de Atlanta de 2012. Resultados: se revisaron 1353 historias clínicas, de las cuales 386 cumplieron criterios para PA. Entre ellas se identificaron 205 mujeres (53 %) y 181 hombres (47 %), y la prevalencia de comorbilidades fue inferior al 10 %. El 38 % de los casos de pancreatitis ocurrieron en personas entre los 50 y 70 años de edad. Con respecto a la etiología de la PA, el origen biliar fue el de mayor frecuencia, con 200 casos del total (52 %); seguido de idiopático (19,7 %) y poscolangiopancreatografía retrógrada endoscópica (CPRE), que ocurrió en 33 pacientes (8,5 %). Conclusiones: la PA es una entidad frecuente que afecta a adultos de todas las edades y genera una cantidad importante de consultas en urgencias. En Colombia, los datos previos apuntaban a pacientes con pancreatitis graves y no se tenía conocimiento del comportamiento sociodemográfico y clínico de las pancreatitis agudas en urgencias.

Abstract Introduction: Acute pancreatitis (AP) is a disease with a high degree of clinical complexity, and depending on its severity, it can have high morbidity and mortality rates, resulting in substantial health-care costs, particularly at the hospital level. Materials and methods: A descriptive study was developed based on the medical records of a tertiary referral university hospital. The records that included an ICD 10 diagnosis of acute pancreatitis between January 2011 and December 2018 were reviewed. All patients over the age of 18, of both sexes, with an AP diagnosis who met at least two of the 2012 Atlanta criteria were included in the study. Results: 1 353 records were reviewed, of which 386 met the criteria for AP. There were 205 women (53%) and 181 males (47%) among them, and comorbidities were found in less than 10% of the participants. 38% of cases of pancreatitis occurred in people between 50 and 70 years of age. Regarding the etiology of AP, biliary origin was the most frequent with 200 cases (52%), followed by idiopathic (19.7%) and post-endoscopic retrograde cholangiopancreatography (ERCP) in 33 patients (8.5%). Conclusions: AP is a common condition that affects adults of all ages and results in a high number of emergency room visits. Previous data in Colombia was only available for individuals with severe pancreatitis, and nothing was known about the sociodemographic and clinical characteristics of acute pancreatitis in the emergency room.

Microencapsulated pomegranate peel extract induces mitochondrial complex IV activity and prevents mitochondrial cristae alteration in brown adipose tissue in mice fed on a high-fat diet.

Pomegranate peel is an agro-industrial residue obtained after fruit processing with high total polyphenol (TP) content, making it an attractive by-product for its reuse. Pomegranate peel extract (PPE) and its bioactive compounds have shown positive effects on obesity models. Effects on favouring mitochondrial biogenesis and function have also been described. However, once phenolic compounds are extracted, their stability can be affected by diverse factors. Microencapsulation could improve PPE stability, allowing its incorporation into functional foods. Nevertheless, studies on the potential biological effects of PPE microparticles (MPPE) in obesity models are lacking. This study aims to evaluate the effect of MPPE on brown adipose tissue (BAT) mitochondrial structure and function and metabolic alterations related to obesity in mice fed a high-fat diet (HFD). PPE was microencapsulated by spray drying using inulin (IN) as a wall material and physically-chemically characterised. Eight-week-old male C57BL/6J mice (n 40) were randomly distributed into five groups: control diet (CD), HFD, HFD + IN, HFD + PPE (50 mg/kg per d TP) and HFD + MPPE (50 mg/kg per d TP), for 14 weeks. A glucose tolerance test and indirect calorimetry were conducted. Blood and adipose tissue samples were obtained. MPPE supplementation prevented HFD-induced body weight gain (P < 0·001), fasting glycaemia (P = 0·007) and total cholesterol rise (P = 0·001). MPPE resulted in higher BAT mitochondrial complex IV activity (P = 0·03) and prevented HFD-induced mitochondrial cristae alteration (P = 0·02). In conclusion, MPPE prevented HFD-induced excessive body weight gain and associated metabolic disturbances, potentially by activating complex IV activity and preserving mitochondrial cristae structure in BAT in mice fed with a HFD.

Hepatocyte expression of the micropeptide adropin regulates the liver fasting response and is enhanced by caloric restriction.

The micropeptide adropin encoded by the clock-controlled energy homeostasis-associated gene is implicated in the regulation of glucose metabolism. However, its links to rhythms of nutrient intake, energy balance, and metabolic control remain poorly defined. Using surveys of Gene Expression Omnibus data sets, we confirm that fasting suppresses liver adropin expression in lean C57BL/6J (B6) mice. However, circadian rhythm data are inconsistent. In lean mice, caloric restriction (CR) induces bouts of compulsive binge feeding separated by prolonged fasting intervals, increasing NAD-dependent deacetylase sirtuin-1 signaling important for glucose and lipid metabolism regulation. CR up-regulates adropin expression and induces rhythms correlating with cellular stress-response pathways. Furthermore, adropin expression correlates positively with phosphoenolpyruvate carboxokinase-1 (Pck1) expression, suggesting a link with gluconeogenesis. Our previous data suggest that adropin suppresses gluconeogenesis in hepatocytes. Liver-specific adropin knockout (LAdrKO) mice exhibit increased glucose excursions following pyruvate injections, indicating increased gluconeogenesis. Gluconeogenesis is also increased in primary cultured hepatocytes derived from LAdrKO mice. Analysis of circulating insulin levels and liver expression of fasting-responsive cAMP-dependent protein kinase A (PKA) signaling pathways also suggests enhanced responses in LAdrKO mice during a glucagon tolerance test (250 µg/kg intraperitoneally). Fasting-associated changes in PKA signaling are attenuated in transgenic mice constitutively expressing adropin and in fasting mice treated acutely with adropin peptide. In summary, hepatic adropin expression is regulated by nutrient- and clock-dependent extrahepatic signals. CR induces pronounced postprandial peaks in hepatic adropin expression. Rhythms of hepatic adropin expression appear to link energy balance and cellular stress to the intracellular signal transduction pathways that drive the liver fasting response.

Descripción clínico-epidemiológica de pacientes con enfermedad inflamatoria intestinal en una clínica de cuarto nivel en Cali / Clinical-epidemiological description of patients with inflammatory bowel disease in a fourth level clinic in Cali

Resumen Introducción: en América Latina, la enfermedad inflamatoria intestinal (EII) es poco frecuente y la información, limitada. Se describieron características de los pacientes con EII en una unidad de gastroenterología de una clínica de alto nivel de atención en Cali, Colombia. Materiales y métodos: estudio descriptivo de pacientes que consultaron con diagnóstico de enfermedad de Crohn (EC) o colitis ulcerativa (CU) a la Clínica Fundación Valle del Lili entre enero de 2011 y diciembre de 2015. Se realizó un análisis con Statistical Package for the Social Sciences de IBM (SPSS) versión 19, se calcularon la mediana y el rango intercuartílico para las variables numéricas, y frecuencias para las variables cualitativas. Resultados: se incluyeron 416 participantes, 115 con EC y 301 con CU. El 41 % se clasificó como enfermedad leve, 23,5 % moderada y 35,3 % grave. Se realizó cirugía a 24 pacientes (9,0 %) con CU y 53 (46,1 %) con EC. En esta última, el manejo más frecuente fue los medicamentos biológicos (32,2 %), seguidos de inmunomoduladores (27,8 %), esteroides (20 %) y ácido 5-aminosalicílico (5-ASA) (11,3 %). El tratamiento más frecuente de CU fue 5-ASA (84,8 %), seguido de esteroides (32,19 %), azatioprina (24,6 %) y biológicos (15,9 %). Conclusiones: el diagnóstico precoz sigue siendo un reto. La gravedad de la CU en los pacientes estudiados fue menor a la reportada en el mundo, lo cual no ocurrió con los pacientes con EC y podría estar en relación con el retraso diagnóstico. El uso de medicamentos biológicos se acercó a lo reportado en el primer mundo. Es difícil determinar si las menores tasas de cirugía se deben a una mejor respuesta clínica o a un difícil acceso a estas intervenciones.

Abstract Objectives: In Latin America, inflammatory bowel disease (IBD) is rare, and information about it is limited. This article describes characteristics of IBD patients in a gastroenterology unit at a high-level clinic in Cali, Colombia. Materials and methods: This is a descriptive study of patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) at the Clínica Fundación Valle de Lili between January 2011 and December 2015. Statistical analysis was performed with SPSS version 19. Medians and interquartile ranges were calculated for numerical variables. Frequencies were calculated for qualitative variables. Results: The 416 participants included 115 with CD and 301 with UC. Of the total cases, 41% were classified as mild, 23.5% as moderate and 35.3% as severe. Surgery was performed in 24 patients (9.0%) with UC and 53 (46.1%) with CD. CD was most frequently managed with biologicals (32.2%), followed by immunomodulators (27.8%), steroids (20%) and 5-ASA (11.3%). The most frequent treatment for UC was 5-ASA (84.8%), but 32.19% received steroids, 24.6% received azathioprine and 15.9% received biologicals. Conclusions: Early diagnosis remains a challenge. The severity of UC but not CD in the patients studied was less than that reported elsewhere in the world. The difference could be related to diagnostic delay. The use of biologicals was close to that reported in the first world. It is difficult to determine if lower surgery rates are due to better clinical response or to difficult access to these interventions.

Relative lipid oxidation associates directly with mitochondrial fusion phenotype and mitochondria-sarcoplasmic reticulum interactions in human skeletal muscle.

Disturbances in skeletal muscle lipid oxidation might induce ectopic fat deposition and lipotoxicity. Nevertheless, the cellular mechanisms that regulate skeletal muscle lipid oxidation have not been fully determined. We aimed to determine whether there was an association between relative whole body lipid oxidation and mitochondrial size or mitochondria-sarcoplasmic reticulum interactions in the skeletal muscle. Twelve healthy men were included [mean (standard deviation), 24.7 (1.5) yr old, 24.4 (2.6) kg/m2]. The respiratory quotient (RQ) was used to estimate relative lipid oxidation at rest and during exercise (50% maximal oxygen consumption, 600 kcal expended). A skeletal muscle biopsy was obtained from the vastus lateralis at rest. Transmission electron microscopy was used to determine mitochondrial size and mitochondria-sarcoplasmic reticulum interactions (≤50 nm of distance between organelles). Protein levels of fusion/fission regulators were measured in skeletal muscle by Western blot. Resting RQ and exercise RQ associated inversely with intermyofibrillar mitochondrial size (r = -0.66 and r = -0.60, respectively, P < 0.05). Resting RQ also associated inversely with the percentage of intermyofibrillar mitochondria-sarcoplasmic reticulum interactions (r = -0.62, P = 0.03). Finally, intermyofibrillar mitochondrial size associated inversely with lipid droplet density (r = -0.66, P = 0.01) but directly with mitochondria fusion-to-fission ratio (r = 0.61, P = 0.03). Our results show that whole body lipid oxidation is associated with skeletal muscle intermyofibrillar mitochondrial size, fusion phenotype, and mitochondria-sarcoplasmic-reticulum interactions in nondiabetic humans.

Basal Serum Cortisol and Testosterone/Cortisol Ratio Are Related to Rate of Na+ Lost During Exercise in Elite Soccer Players.

During exercise, the human body maintains optimal body temperature through thermoregulatory sweating, which implies the loss of water, sodium (Na+), and other electrolytes. Sweat rate and sweat Na+ concentration show high interindividual variability, even in individuals exercising under similar conditions. Testosterone and cortisol may regulate sweat Na+ loss by modifying the expression/activity of the cystic fibrosis transmembrane conductance regulator. This has not been tested. As a first approximation, the authors aimed to determine whether basal serum concentrations of testosterone or cortisol, or the testosterone/cortisol ratio relate to sweat Na+ loss during exercise. A total of 22 male elite soccer players participated in the study. Testosterone and cortisol were measured in blood samples before exercise (basal). Sweat samples were collected during a training session, and sweat Na+ concentration was determined. The basal serum concentrations of testosterone and cortisol and their ratio were (mean [SD]) 13.6 (3.3) pg/ml, 228.9 (41.4) ng/ml, and 0.06 (0.02), respectively. During exercise, the rate of Na+ loss was related to cortisol (r = .43; p < .05) and to the testosterone/cortisol ratio (r = -.46; p < .01), independently of the sweating rate. The results suggest that cortisol and the testosterone/cortisol ratio may influence Na+ loss during exercise. It is unknown whether this regulation depends on the cystic fibrosis transmembrane conductance regulator.

Heterotopia de mucosa gástrica en el intestino delgado, hallazgo en videocápsula endoscópica. Reporte de caso / An endoscopic videocapsule finding of heterotopia of the gastric mucosa of the small intestine

Resumen Introducción: la heterotopia de mucosa gástrica se refiere a la localización ectópica de mucosa gástrica en cualquier parte del tracto gastrointestinal. Es una causa poco frecuente de úlceras gastrointestinales y sangrado digestivo oculto. La videocápsula endoscópica se ha convertido en una herramienta fundamental para el estudio del intestino delgado. Métodos: estudio descriptivo de reporte de caso. La información de la historia clínica, reporte de patología y estudios endoscópicos, se extrajo de las bases de datos de la Fundación Valle del Lili. Resultados: paciente masculino de 71 años, en quien se realizó videocápsula endoscópica por un sangrado digestivo oculto y se encontraron segmentos de estenosis y úlceras en el yeyuno. La histopatología reveló la presencia de mucosa gástrica heterotópica. Conclusión: la heterotopia de mucosa gástrica debe considerarse como una causa posible de sangrado del intestino delgado.

Abstract Introduction: Heterotopia of the gastric mucosa refers to an ectopic location of gastric mucosa in any part of the gastrointestinal tract. It is a rare cause of gastrointestinal ulcers and occult digestive bleeding. Endoscopic videocapsules have become fundamental tools for study of the small intestine. Methods: This is a descriptive case study based on information from the medical history, pathology report and endoscopic studies extracted from the databases of the Fundación Valle del Lili in Cali, Colombia. Results: An endoscopic videocapsule was used to examine a 71-year-old male patient who suffered from occult digestive bleeding. Segments of stenosis and ulcers were found in the jejunum and histopathology revealed heterotopic gastric mucosa. Conclusion: Heterotopy of the gastric mucosa should be thought of as a possible cause of bleeding in the small intestine.

Association of maximal voluntary isometric handgrip strength with age, gender and handedness in older people / Fuerza de agarre isométrica máxima en relación a la edad, sexo y dominancia de mano

ABSTRACT Background: Maximal voluntary isometric handgrip strength (MVIHS) is influenced by age, sex, and handedness. Aim: To assess the association of MVIHS with age, sex, and handedness in older adults. Material and Methods: MVIHS was measured using a digital dynamometer in 60 men and 60 women aged 73 ± 6 years. Weight, height and handedness were also recorded. For analysis purposes, participants were divided into two age groups (65 to 70.9 years of age and ≥ 71 years). Results: A negative correlation was observed between age and MVIHS in the non-dominant (r = −0.65 and −0.59 in men and women, respectively) and dominant hands (r = −0.71 and −0.64 in men and women, respectively). When age and MVIHS were correlated in the group aged 65-70 years, a significant correlation was observed in the non-dominant (r = −045 and −0.61 in men and women, respectively) and dominant hands (r = −0.47 and −0.64 in men and women, respectively). In the group aged ≥ 71 years, a stronger correlation with age was also observed in the non-dominant (r = −0.92 and −0.90 in men and women, respectively) and dominant hands (r = −0.95 and −0.90 in men and women, respectively). MVIHS was 2.8 to 8.9% lower in the non-dominant than in the dominant hand in all age groups. MVIHS was lower in women than in men in both age groups. Conclusions: MVIHS declines with age (especially after 71 years of age), is higher in men than women, and higher in the dominant than the non-dominant hand.

Antecedentes: La fuerza de agarre isométrica voluntaria máxima (FAIVM) puede verse influenciada por la edad, el sexo y la dominancia. Objetivo: Describir la FAIVM y su relación con la edad, el sexo y la dominancia en adultos mayores. Material y Métodos: La FAIVM, la masa corporal, la talla, y la dominancia fueron medidas mediante protocolos estandarizados en 60 hombres e igual número de mujeres que fueron divididos en dos grupos acorde a su edad (65 a 70,9 años, y ≥ 71 años, respectivamente). Resultados: Se observó una correlación entre la edad y la FAIVM de mano no-dominante (hombres: r = −0,65; mujeres: r = −0,59) y dominante (hombres: r = −0,71; mujeres: r = −0,64). Al correlacionar la FAIVM y la edad en el grupo de 65-70 años, una correlación significativa fue observada en la mano no-dominante (hombres, r = −0,45; mujeres, r = −0,61) y mano dominante (hombres, r = −0,47; mujeres, r = −0,64). En el grupo ≥ 71 años, la edad tuvo una mayor correlación con la FAIVM de la mano no-dominante (hombres, r = −0,92; mujeres, r = −0,90) y mano dominante (hombres, r = −0,95; mujeres, r = −0,90). Comparada con la mano dominante, la mano no-dominante presentó menores valores de FAIVM en todos los grupos, variando entre −2,8 a −8,9%. Comparadas con los hombres, las mujeres presentaron menor FAIVM en mano dominante y no-dominante, en ambos grupos de edad. Conclusión: La FAIVM disminuye con la edad, especialmente desde los 71 años; es mayor en hombres comparados con mujeres y es mayor en mano dominante comparada con mano no-dominante.

Hepatitis C: una aproximación clínica y epidemiológica en Cali, Colombia / Clinical and epidemiological approach to Hepatitis C in Cali, Colombia

Resumen Introducción: en Colombia, la infección por el virus de la hepatitis C (VHC) representa alta morbilidad y elevados costos. Con la llegada de nuevos tratamientos más efectivos, se hace necesario conocer las características propias de esta población para su adecuado uso. Objetivos: describir las características epidemiológicas y clínicas de los pacientes con VHC manejados en un centro de referencia en enfermedades hepáticas. Materiales y métodos: se realizó un estudio descriptivo de corte transversal en una población de adultos con diagnóstico serológico de VHC entre el 2011 y el 2016. Resultados: se evaluaron 214 historias clínicas de pacientes con diagnóstico serológico confirmado de VHC. La mediana de edad fue de 59 años y el 62 % fue de sexo femenino. El genotipo se reportó en 114 pacientes, el 75 % presentó genotipo 1B. El 36,9 % de los pacientes había recibido algún hemoderivado y el 5 % tenía tatuajes. La prevalencia de cirrosis fue del 29,4 % y de hepatocarcinoma fue del 3,3 %. El 1,8 % y el 5,1 % de los pacientes presentó coinfección con el virus de la hepatitis B (VHB) y virus de la inmunodeficiencia humana (VIH), respectivamente. Conclusión: los factores determinantes de la infección por el VHC en Cali presentan un comportamiento clínico similar al que reporta la literatura científica a nivel mundial, lo que obliga a enfatizar en la prevención de la población en riesgo. El genotipo 1B continúa siendo el más frecuente en nuestro medio, lo que hace a esta población susceptible a los nuevos tratamientos.

Abstract Introduction: In Colombia, Hepatitis C virus infections have high rates of morbidity and high costs. The advent of new more effective treatments has produced a need for better knowledge of this population's characteristics to allow their proper use. Objectives: The objective of this study is to describe the epidemiological and clinical characteristics of patients with hepatitis C at a referral center for liver diseases. Materials and methods: We conducted a cross-sectional descriptive study of a population of adults with serological diagnoses of hepatitis C between 2011 and 2016. Results: We evaluated 214 clinical records of patients with confirmed serological diagnoses of hepatitis C. Their median age was 59 years, and 62 % were women. The HCV genotypes of 114 patients were reported: 75 % had genotype 1B. Transfusions of one or another type of blood product had been administered to 36.9 % of the patients, and 5% had tattoos. The prevalence of cirrhosis was 29.4 % while that of hepatocellular carcinoma was 3.3 %. Hepatitis B virus coinfections were found in 1.8 % of these patients, and 5.1 % of the patients had human immunodeficiency virus coinfections. Conclusion: The determinants of hepatitis C virus infection in Cali are similar to those reported in scientific literature worldwide and requires emphasis on prevention in the at-risk population. Genotype 1b continues to be the most frequent in our environment which makes this population susceptible to new treatments.

Influence of a Gas Exchange Correction Procedure on Resting Metabolic Rate and Respiratory Quotient in Humans.

OBJECTIVE: The aim of this study was to determine the influence of a gas exchange correction protocol on resting metabolic rate (RMR) and respiratory quotient (RQ), assessed by a Vmax Encore 29n metabolic cart (SensorMedics Co., Yorba Linda, California) in overnight fasted and fed humans, and to assess the predictive power of body size for corrected and uncorrected RMR. METHODS: Healthy participants (23 M/29 F; 34 ± 9 years old; 26.3 ± 3.7 kg/m2 ) ingested two 3-hour-apart glucose loads (75 g). Indirect calorimetry was conducted before and hourly over a 6-hour period. Immediately after indirect calorimetry assessment, gas exchange was simulated through high-precision mass-flow regulators, which permitted the correction of RMR and RQ values. RESULTS: Uncorrected and corrected RMR and RQ were directly related at each time over the 6-hour period. However, uncorrected versus corrected RMR was 6.9% ± 0.5% higher (128 ± 7 kcal/d; P < 0.0001), while RQ was 14.0 ± 0.4% lower (-0.114 ± 0.003; P < 0.0001) when compared throughout the whole period. Body weight, sex, and age explained a larger fraction of the variance when corrected RMR was considered (adjusted R2 = 0.71; P < 0.0001) versus uncorrected RMR (adjusted R2 = 0.59; P < 0.0001). CONCLUSIONS: Applying a protocol to correct gas exchange in humans over a 6-hour period is feasible and provides information of improved accuracy.

Diferencias de composición corporal y condición fisica en educadoras de párvulo con normopeso, sobrepeso y obesidad: estudio transversal / Diffences of body max index, body composition, and fitness in normo weight, overweight and obese kindergarten teachers: cross-sectional study

Objective: To describe body mass index (BMI), body composition, basal metabolic rate, physical condition and the relation-ship between them in Chilean kindergarten teachers. Subjects and Methods: 46 teachers (age 39,5 ± 8,6) from the Bio Bio province(Chile) were weighed and heighted and BMI was measured. In addition, fat mass, lean and bone percentages, basal metabolic rate, muscular strength and cardiorespiratory fitness were measured. Results: The teachers had an average BMI of overweight (26,7 ± 3,5) and a high fat percentage (35,1 ± 5,9) according to national reference values. 58,7%were overweight and moderately obese. When teachers were compared according BMI, teachers with obesity had on average a higher percentage of fat mass (P =,000), less lean mass (P = ,000), took more time to complete the UKK test (P = ,035 ) and had a lower vo2max (P = ,001) than normal weight teachers. BMI had a negative association in relation to scores of the physical performance test. Conclusions: The overweight/obese teachers had more fat mass, reduced muscle mass and had worse results on fitness tests. Condition worrying thinking about the important role in modeling healthy habits to preschoolers.

Objetivo: Describir el índice de masa corporal (IMC), composición corporal, la tasa metabólica basal, condición física y su relación en educadoras de párvulos chilenas. Sujetos y Métodos: 46 educadoras (edad 39,5±8,6) de la provincia de Bio-Bio (Chile) se pesaron, midieron y se obtuvo su IMC. Se midió el porcentaje de masa grasa, magra, ósea, tasa metabólica basal, fuerza explosiva y capacidad cardiorrespiratoria. Resultados: Las educadoras tuvieron un IMC promedio de sobrepeso (26,7±3,5) y un elevado porcentaje de grasa (35,1±5,9) de acuerdo a referencias nacionales. El 58,7% de ellas presentó sobrepeso y obesidad moderada. Cuando se comparó por IMC, las educadoras con obesidad presentaron en promedio un mayor porcentaje de masa grasa (P =,000), menor de masa magra (P =,000), demoraron más tiempo en terminar el UKK test (P =,035) y tuvieron un menor vo2max (P =,001) en comparación a las educadoras con normopeso. El IMC se asoció negativamente a los test de rendimiento físico. Conclusión: Las maestras con sobrepeso/obesidad presentaron más masa grasa, menos masa muscular y peores resultados en las pruebas de condición física. Condición preocupante pensando en su importante rol modelando hábitos de vida saludables en los prescolares.

MOTOR SKILLS AND NUTRITIONAL STATUS OUTCOMES FROM A PHYSICAL ACTIVITY INTERVENTION IN SHORT BREAKS ON PRESCHOOL CHILDREN CONDUCTED BY THEIR EDUCATORS: A PILOT STUDY.

INTRODUCTION: childhood obesity is a worldwide health concern. For this issue different intervention have being planned to increase physical activity patterns and reduce the excess of weight in children with limited or no success. OBJECTIVE: the aim of this study is to evaluate the results of a pilot intervention consisting in three 15-minute breaks conducted by educators and supervised by physical education teachers on motor skills and nutritional status in preschool children. METHODS: sample was 70 preschool children (32 boys and 38 girls), age 4 ± 0,6 years. The physical activity classes were performed three times a week, 45 minutes daily, distributed in three 15 minutes breaks. The circuits were planned to have; jumps, sprints, carrying medicinal balls, gallops and crawling. Motor skill tests that were performed Standing long jump (SLJ) and Twelve meter run. RESULTS: with the intervention no significant differences in nutritional status where found on mean Z score (boys p = 0.49, girls p = 0.77). An increment on weight and height was fount after the intervention (p < 0.0001). Regarding the 12 meter run test, we found significant changes after the intervention when we normalize by weight in boys (p = 0.002) and girls (p < 0.0001). Our results have shown than boys significantly increased their SLJ and SLJ normalized by weight (p < 0.0001); a similar result was found in girls after the intervention (p < 0.0001) suggesting the increment of power independent of weight gain. CONCLUSIONS: in conclusion, this pilot study found that an intervention with more intense activities in small breaks (15 minutes), and guided by the educators could improve essential motor skills (running and jumping) in preschool children of a semi-rural sector independent of nutritional status. This gaining in motor skills is the first step to increase physical activity levels in preschool children.

Introducción: la obesidad infantil es ya un problema de salud pública. Para su disminución, han sido planteadas diferentes estrategias con el fin de aumentar la actividad física y con ello reducir la ganancia de peso en niños; estas estrategias se han llevado a cabo con un éxito limitado. Objetivo: el objetivo de este estudio es evaluar los resultados de una intervención piloto, la cual consiste en tres recreos de 15 minutos tres veces por semana conducidos por las educadoras y guiados por educadores físicos en los patrones motores y el estado nutricional de niños preescolares. Métodos: la muestra consta de 70 niños preescolares (32 niños y 38 niñas), edad 4 ± 0.6. Las clases de educación física fueron llevadas a cabo tres veces por semana en recreos de 15 minutos. Se plantearon circuitos, los cuales contenían saltos, gateo, galopes, carreras, carga y manipulación de balones medicinales. Las pruebas motoras evaluadas fueron el salto horizontal y la carrera de 12 metros. Resultados: con la intervención no se encontraron diferencias significativas en el estado nutricional (media Z score niños p = 0,49, media Z score niñas p = 0,77). Sí se encontró un aumento significativo en el peso (p < 0,0001) y la talla ( p < 0,0001) tanto en niños como en niñas al término de la intervención. En cuanto a las pruebas motoras, la carrera de 12 metros ajustada al peso tuvo cambios significativos en niños (p = 0,002) y en niñas ( p < 0,0001); mientras que el salto horizontal mejoró en ambos grupos tras la intervención (p < 0,0001). Cuando se ajustaron las pruebas motoras por estado nutricional, se encontraron cambios significativos tanto en la carrera de 12 metros en los niños con sobrepeso (p = 0,008) como en el salto horizontal/talla (p < 0,0001), lo que sugiere el incremento de la potencia independientemente del aumento de peso observado. Conclusión: este estudio piloto encontró que una intervención con actividades más intensas en pequeños recreos guiadas por educadoras pueden incrementar los patrones motores básicos en niños preescolares, independientemente del incremento de peso. Esta ganancia en los patrones motores es el primer paso para el incremento de los niveles de actividad física en niños preescolares.