[Efectos sobre el perfil metabólico, el índice de masa corporal, la composición corporal y la comorbilidad en adolescentes con obesidad mórbida, que han fallado al manejo conservador para bajar de peso, operados de manga gástrica laparoscópica. Reporte del primer grupo de cirugía bariátrica pediátrica en México].

INTRODUCTION: Obesity is a world pandemic; in Mexico 3 out of 10 adolescents suffer from it. Conservative management of morbid obesity is not effective and bariatric surgery is the only useful therapy. International pediatric bariatric surgery series are scarce and in Mexico there is limited experience. METHOD: We analyze the metabolic repercussions, comorbidities and complications in our series of Mexican adolescents with morbid obesity who underwent a gastric sleeve between 2011 and 2015. RESULTS: 54 morbid obese adolescents were included, 10 fulfilled criteria for surgery. 5 were male, mean age 14.3 ± 1.4 years, weight 117.3 ± 15.2 kg, initial body mass index 43.71 ± 4.1, waist 130.3 ± 6.8 cm, 8 dyslipidemia, 6 metabolic syndrome, 5 liver steatosis, 4 hypertension, 3 type-2 diabetes. Complications: 2 atelectasis, 1 fistula, 1 pneumonia, 1 cholelithiasis; no patient developed nutritional deficits. Weight loss of 33% one-year after surgery and 23% at 2 years. Body fat decreased 22.4% and water content increased 36.1%. Excess weight loss was significant p = 0.001. Two-years after surgery severe steatosis and diabetes had subsided, lipid profile improved and only one patient remained hypertensive. DISCUSSION: Our results demonstrate that all serious comorbidities associated to morbid obesity were improved (diabetes, dyslipidemia and hypertension) and will confer a better prognosis for these children. CONCLUSIONS: Gastric sleeve is useful in morbid obese adolescents. Longer follow-up is needed.

INTRODUCCIÓN: La obesidad es una pandemia mundial; 3 de cada 10 adolescentes en México la padecen. En la obesidad mórbida, el manejo conservador es un fracaso y la cirugía bariátrica es el único tratamiento útil. No hay experiencia en México y los reportes internacionales son aislados. MÉTODO: Análisis de las repercusiones metabólicas, efecto sobre la comorbilidad y complicaciones, en adolescentes con obesidad mórbida operados con manga gástrica de 2011 a 2015. RESULTADOS: De 54 pacientes con obesidad mórbida, 10 cumplieron criterios; 5 varones; edad de 14.3 ± 1.4 años; peso de 117.3 ± 15.2 kg; índice de masa corporal basal de 43.71 ± 4.1; cintura de 130.3 ± 6.8 cm; 8 con dislipidemia; 6 con síndrome metabólico; 5 con esteatosis hepática; 4 con hipertensión; 3 con diabetes tipo 2. Complicaciones: 2 atelectasias, 1 fístula, 1 neumonía, 1 colelitiasis; ninguno con carencia nutricional. Disminución del peso al año del 33% y a los 2 años del 23%. Disminución de la grasa del 22.4%. Aumento de agua corporal del 36.1%. Pérdida del exceso de peso significativa p = 0.001. A los 2 años, remisión de esteatosis grave y de diabetes, el perfil lipídico mejoró, la hipertensión arterial persistió solo en uno. DISCUSIÓN: Lo más destacado es la mejoría o curación de la comorbilidad, con curación de la diabetes, la hipertensión y la dislipidemia, que dará mejor pronóstico a estos niños. CONCLUSIONES: La manga gástrica es útil en adolescentes con obesidad mórbida, con mejoría de la comorbilidad grave. Se requiere un mayor seguimiento.

Contribution of common genetic variants to obesity and obesity-related traits in mexican children and adults.

BACKGROUND: Several studies have identified multiple obesity-associated loci mainly in European populations. However, their contribution to obesity in other ethnicities such as Mexicans is largely unknown. The aim of this study was to examine 26 obesity-associated single-nucleotide polymorphisms (SNP) in a sample of Mexican mestizos. METHODS: 9 SNPs in biological candidate genes showing replications (PPARG, ADRB3, ADRB2, LEPR, GNB3, UCP3, ADIPOQ, UCP2, and NR3C1), and 17 SNPs in or near genes associated with obesity in first, second and third wave GWAS (INSIG2, FTO, MC4R, TMEM18, FAIM2/BCDIN3, BDNF, SH2B1, GNPDA2, NEGR1, KCTD15, SEC16B/RASAL2, NPC1, SFRF10/ETV5, MAF, PRL, MTCH2, and PTER) were genotyped in 1,156 unrelated Mexican-Mestizos including 683 cases (441 obese class I/II and 242 obese class III) and 473 normal-weight controls. In a second stage we selected 12 of the SNPs showing nominal associations with obesity, to seek associations with quantitative obesity-related traits in 3 cohorts including 1,218 Mexican Mestizo children, 945 Mexican Mestizo adults, and 543 Indigenous Mexican adults. RESULTS: After adjusting for age, sex and admixture, significant associations with obesity were found for 6 genes in the case-control study (ADIPOQ, FTO, TMEM18, INSIG2, FAIM2/BCDIN3 and BDNF). In addition, SH2B1 was associated only with class I/II obesity and MC4R only with class III obesity. SNPs located at or near FAIM2/BCDIN3, TMEM18, INSIG2, GNPDA2 and SEC16B/RASAL2 were significantly associated with BMI and/or WC in the combined analysis of Mexican-mestizo children and adults, and FTO locus was significantly associated with increased BMI in Indigenous Mexican populations. CONCLUSIONS: Our findings replicate the association of 8 obesity-related SNPs with obesity risk in Mexican adults, and confirm the role of some of these SNPs in BMI in Mexican adults and children.

Expresión del receptor tipo-Toll 4 en la inflamación alérgica de niños asmáticos-obesos / Toll-Like receptor 4 expression in obese asthmatic children with allergic inflammation

Introducción. El asma se caracteriza por la inflamación de las vías respiratorias y la obesidad por la inflamación sistémica persistente. La exposición a lipopolisacáridos influye en el desarrollo y severidad del asma. El receptor tipo-Toll 4 reconoce a los lipopolisacáridos y dirige la respuesta de las células T cooperadoras. A la fecha, se desconoce el nivel de expresión del receptor tipo-Toll 4 en pacientes con asma-obesidad. Métodos. Este es un estudio piloto de pacientes con asma-obesidad, con asma, con obesidad y aparentemente sanos. Mediante inmu-nocitoquímica se determinó el nivel de expresión del receptor tipo-Toll 4 utilizando anticuerpos específicos anti-TLR4, bloqueando los receptores Fc. Con un microscopio Olimp BX-40 se evaluaron 100 células por laminilla. Las diferencias en el número y el grado de células positivas se estableció mediante las pruebas de Kruskal-Wallis y Dunn post hoc. Resultados. La expresión del receptor tipo-Toll 4 en las células del grupo de pacientes asmáticos fue considerablemente mayor que en el grupo de individuos sanos y mayor que en cualquiera de los otros dos grupos. En el grupo de pacientes obesos el receptor tipo-Toll 4 se expresó menos que en el grupo de individuos sanos y que en los otros dos grupos (p < 0.001). El grupo de pacientes asmáticos-obesos no mostró diferencia significativa con respecto al grupo de sanos. Adicionalmente, se observaron diferencias significativas entre los tres grupos de pacientes (p < 0.05). Conclusiones. La expresión del receptor tipo-Toll 4 resultó diferente en cada uno de los tres grupos de pacientes; la expresión elevada en el grupo de pacientes asmáticos probablemente puede explicar la alta sensibilización a lipopolisacáridos o a otros ligandos del receptor tipo-Toll 4. En este trabajo, por primera vez, se muestra el nivel de expresión del receptor tipo-Toll 4 en pacientes asmáticos-obesos.

Background. Asthma is characterized by chronic inflammation of airways and obesity by persistent systemic inflammation. Exposure to lipopolysaccharide (LPS) may induce the development and severity of asthma. Toll like-receptor 4 (TLR4) recognizes LPS and can direct the response of T-helper cells. Level of expression of TLR4 in patients with asthma and obesity is currently unknown. Methods. We conducted a pilot study that included patients with asthma-obesity, asthma, obesity and those who were apparently healthy. Using immunocytochemistry, we determined the level of expression of TLR4 with specific anti-TLR4 monoclonal antibody, blocking Fc receptors. With a BX-40 Olympus microscope, 100 cells were evaluated per slide. Differences in the number and degree of positive cells were established by Kruskal-Wallis test and Dunn post hoc analysis. Results. Expression of TLR4 in the cells of the asthmatic group of patients was significantly greater than in the healthy group of patients and higher than any of the other two groups. Conversely, the obese group expressed less TLR4 than the healthy group and any of the other two groups (P<0.001). The asthma-obese group showed no significant difference with respect to healthy controls. Additionally, we observed significant differences among the three groups of patients (P<0.05). Conclusions. TLR4 expression was different in the three groups of patients. The highest level in the asthmatic patient may be explained by the high sensitivity to LPS or to other TLR4 ligands. This is the first study to show the level of expression in obese patients with asthma.