A novel model for predicting diabetes remission after bariatric surgery based on the measurement of C-peptide and creatinine in serum: A pilot study.

BACKGROUND AND AIMS: Bariatric surgery is effective for treating type 2 diabetes (T2D) in patients with obesity, although a significant proportion of these patients do not achieve diabetes remission after the surgery even after significant weight loss and metabolic improvement. C-peptide is a valuable marker of beta cell function and insulin secretion, but renal function must be considered when interpreting measurements in patients with T2D. The study aims to investigate the association of serum levels of C-peptide adjusted for creatinine with diabetes remission and glycemic target achievement after bariatric surgery in patients with obesity and T2D. METHODS AND RESULTS: Prospective data from a cohort of 84 patients with obesity and T2D submitted to Roux-en-Y gastric bypass (RYGB) were collected at baseline and at least a 6-month follow up. A multivariate binomial regression model showed that Ln(C-peptide/creatinine) and age were significantly associated with 6-month T2D remission. The area under the curve for the receiver operating characteristic analysis (AUROC) to predict remission was 0.87, and more accurate than the AUROC based on C-peptide levels alone (0.75). The same model was also able to predict achieving an HbA1c target of 7 % (53 mmol/mol) (AUROC 0.96). CONCLUSION: In conclusion, Ln(C-peptide/creatinine) ratio could be a useful tool in predicting T2D remission and target achievement after RYGB surgery, providing a more accurate reflection of beta cell function in bariatric patients.

Short-medium-long-term efficacy of interdisciplinary intervention against overweight and obesity: Randomized controlled clinical trial.

AIM: The aim of the study is to evaluate the efficacy of a nurse-led interdisciplinary programme based on healthy eating, physical exercise, and cognitive behavioural therapy applied to anthropometric and cardiovascular measures, which are related to obesity in short, medium, and long term. METHODS: We conducted a randomised controlled clinical trial with 74 obese and overweight participants (experimental group, n = 37; control group, n = 37). An interdisciplinary programme of 12 months was applied and coordinated by a nurse. Anthropometric and cardiovascular measures were taken at the pretest stage, every 6 months during the programme, and 1 year after it finished. RESULTS: A beneficial effect was found regarding all anthropometric parameters. Tests for weight (F3;207  = 93.27; P < .001) and body mass index (F3;207  = 89.95; P < .001) indicate efficacy of intervention: The experimental group had a weight loss of 7.2 kg (-8.3%) compared to a 0.9 kg (+1.0%) gained in the control group. Systolic (F3;207  = 37.06; P < .001) and diastolic (F3;216  = 57.31; P < .001) blood pressure improved greatly in the experimental group. Forced vital capacity was also increased (F2;138  = 15.51; P < .001). CONCLUSION: The interdisciplinary programme coordinated by nurses improved the health of participants, maintaining long-term effects.

Hepatic and serum branched-chain fatty acid profile in patients with nonalcoholic fatty liver disease: A case-control study.

OBJECTIVE: Alterations in the hepatic lipidome are a crucial factor involved in the pathophysiology of nonalcoholic fatty liver disease (NAFLD). The aim of this study was to evaluate the serum and hepatic profile of branched-chain fatty acids (BCFAs) in patients with different stages of NAFLD. METHODS: This was a case-control study performed in 27 patients without NAFLD, 49 patients with nonalcoholic fatty liver, and 17 patients with nonalcoholic steatohepatitis, defined by liver biopsies. Serum and hepatic levels of BCFAs were analyzed by gas chromatography-mass spectrometry. The hepatic expression of genes involved in the endogenous synthesis of BCFAs was analyzed by real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS: A significant increase in hepatic BCFAs was found in subjects with NAFLD compared with those without NAFLD; no differences were observed in serum BCFAs between study groups. Trimethyl BCFAs, iso-BCFAs, and anteiso-BCFAs were increased in subjects with NAFLD (either nonalcoholic fatty liver or nonalcoholic steatohepatitis) compared with those without NAFLD. Correlation analysis showed a relationship between hepatic BCFAs and the histopathological diagnosis of NAFLD, as well as other histological and biochemical parameters related to this disease. Gene expression analysis in liver showed that the mRNA levels of BCAT1, BCAT2, and BCKDHA were upregulated in patients with NAFLD. CONCLUSIONS: These results suggest that the increased production of liver BCFAs might be related to NAFLD development and progression.

Plasma short-chain fatty acid changes after bariatric surgery in patients with severe obesity.

BACKGROUND: Obesity has reached epidemic dimensions in recent decades. Bariatric surgery (BS) is one of the most effective interventions for weight loss and metabolic improvement in patients with obesity. Short-chain fatty acids (SCFA) are gut microbiota-derived metabolites with a key role in body weight control and insulin sensitivity. Although BS is known to induce significant changes in the gut microbiota composition, its impact on the circulating levels of certain metabolites produced by the gut microbiota such as SCFA remains poorly understood. OBJECTIVE: To determine the impact of BS on the circulating SCFA levels in patients with severe obesity. SETTING: University hospital. METHODS: An observational, prospective study was performed on 51 patients undergoing Roux-en-Y gastric bypass. Plasma samples were collected at baseline (1 day before surgery) and at 6 and 12 months after BS. Plasma SCFA levels were determined by liquid chromatography-mass spectrometry. RESULTS: The results revealed significant changes in the circulating levels of SCFA after BS. A marked increase in propionate, butyrate, isobutyrate, and isovalerate levels and a decrease in acetate, valerate, hexanoate, and heptanoate levels were observed 12 months after BS. Furthermore, the changes in the levels of propionate, butyrate, and isobutyrate negatively correlated with changes in body mass index, while those of isobutyrate correlated negatively with changes in the homeostatic model assessment for insulin resistance index. CONCLUSION: These results suggest that propionate, butyrate, and isobutyrate levels could be related to weight loss and improved insulin sensitivity in patients with severe obesity after BS.

Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial.

Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6-12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect (p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.

Analysis of Quality of Life and Nutritional Status in Elderly Patients with Dysphagia in Order to Prevent Hospital Admissions in a COVID-19 Pandemic.

(1) Background: Oropharyngeal dysphagia (OD) is currently recognized as one of the geriatric syndromes due to its high frequency in older people and its associated complications, which have a direct impact on quality of life. The main objective is to determine the effectiveness of telehealth consultation for the re-evaluation of nutritional status and quality of life assessment in older people diagnosed with OD associated with active use of thickeners to prevent hospital admissions in a COVID-19 pandemic. (2) Methods: an observational, descriptive, and longitudinal study that included a sample of 33 subjects with age equal or superior to 65 years diagnosed with OD with conserved cognitive capacity. The nutritional status was evaluated through the Mini-Nutritional Assessment (MNA) questionnaire and biochemical parameters and, the quality of life was determined through the Swallowing Quality of Life (SWAL-QOL) questionnaire. (3) Results: Thirty-three older patients with OD were recruited (54.5% women), with a mean age of 83.5 ± 7.6 years. The main cause of OD in the study population was neurodegenerative disease (51.5%), followed by cerebrovascular disease (33.3%), and other causes (15.2%). Sixty point six percent of patients were found to be at risk of malnutrition. The MNA score was significantly correlated to albumin (r: 0.600, p < 0.001) and total proteins (r: 0.435, p = 0.015), but not to total cholesterol (r: -0.116, p = 0.534) or lymphocytes (r: -0.056, p = 0.758). The mean total score of the SWAL-QOL was 75.1 ± 16.4 points. (4) Conclusions: the quality of life of the subjects related to the use of a thickener is good. Although the body mass index (BMI) and average biochemical, nutritional parameters of the subjects are within the range of normality, the MNA has detected a high percentage of subjects with the risk of malnutrition, which suggests the need for continuous re-evaluation in these patients, demonstrating the viability of the telematic route in this research.

[Prevalence of metabolic syndrome and cardiovascular risk in an urban area of Murcia]. / Prevalencia de síndrome metabólico y riesgo cardiovascular en un área urbana de Murcia.

INTRODUCTION: It is extensive scientific literature that has defined the metabolic syndrome as a precursor of cardiovascular disease. OBJECTIVES: To estimate the prevalence of metabolic syndrome and cardiovascular risk in the population of a basic health area of Murcia. METHODS: Cross sectional study population of the district health "The Esparragal" random sample of the population between 18 and 86 years living in the area. Personal history were collected and held a relevant clinical, anthropometric data and analytics for the estimation of Metabolic Syndrome and Cardiovascular Risk following criteria dictated by the current literature, adjusted for sex and age. RESULTS: The mean age of the study population was 59.34 ± 14.79 years, with 52.5% males. The overall prevalence of metabolic syndrome criteria World Health Organization is presented 36.8%, a figure increased under International Diabetes Ferderation recommendations to 58.2% and according to National Cholesterol Education Program, an estimated 53.5%. The presentation of this syndrome is slightly higher in men (54.1 versus 52.8 %), and in parallel with increasing age (p < 0.001). The prevalence of people at high risk of cardiovascular disease is 32.1 % (95 % CI 29.4 to 34.8), with 45.2 % (95% CI 41.2 to 49.2) in men and 17.6% (95% CI 14.4 to 20.8) in women. DISCUSSION: The prevalence of metabolic syndrome and cardiovascular risk in the study population is the highest found in Spain in population studies, indicating an invaluable population on which preventive measures.

Introducción: Es extensa la literatura científica que ha definido al síndrome metabólico como precursor de la enfermedad cardiovascular. Objetivos: Estimar la prevalencia de Síndrome Metabólico y Riesgo Cardiovascular en la población de una zona básica de salud de Murcia. Métodos: Estudio poblacional de corte transversal de la zona básica de salud "El Esparragal", muestra aleatoria de la población entre 18 y 86 años residentes en dicha zona. Se recogieron los antecedentes personales y se llevo a cabo una evaluación clínica, antropométrica y analítica pertinente para la estimación de Síndrome Metabólico y el Riesgo Cardiovascular siguiendo criterios dictados por la literatura actual, ajustados a sexo y edad. Resultados: La edad media de la población estudiada resultó de 59,34±14,79 años, siendo el 52,5% varones. La prevalencia global de Síndrome Metabólico según criterios Organización Mundial de la Salud es del 36,8% presenta, cifra incrementada bajo recomendaciones International Diabetes Ferderation a un 58,2% y según National Cholesterol Education Program, se estimó un 53,5%. La presentación de dicho síndrome es ligeramente superior en varones (54,1 frente al 52,8%), y aumentando paralelamente con la edad (p.