[Metabolic morbidity in the prison population of Catalonia, Spain]. / Morbilidad metabólica en la población penitenciaria de Cataluña.

OBJECTIVE: To investigate the prevalence of metabolic morbidity (MM) amongst prison inmates. DESIGN: Multicentric, cross-sectional observational study. SETTING: All (nine) prisons in Catalonia. PARTICIPANTS: Convicted inmates that are not in an «open regime¼, whose healthcare relies on the Prison Primary Care Teams. INTERVENTIONS: MM was defined as the presence of at least one component of the metabolic syndrome, i.e., obesity, arterial hypertension, type2 diabetes, and/or dyslipidemia. The variables collected included anthropometric measurements, medical history and laboratory values related to MM. The source of information was the Catalan Primary Healthcare Services Information System (SISAP). MAIN MEASUREMENTS: The prevalence of MM, overall and by several participant subcategories, was calculated. To investigate the risk factors associated to a higher prevalence of MM, a multivariable logistic regression analysis was carried out and expressed as adjusted odds ratios and 95% confidence intervals. RESULTS: 4338 inmates were studied, of whom 93.9% were male. Mean age was 38.4years, 51.7% were born in European Union countries, and 6.7% were infected by HIV. The variables associated with a significantly increased risk of presenting MM were older age and HIV infection, whereas certain geographical origins (i.e., non-UE European countries, Maghreb and Sub-Saharan Africa) were associated with lower risk of MM. CONCLUSIONS: In spite of being an overall young population, prison inmates present high rates of MM. Older age, HIV infection and geographic origin appear as the most strongly associated factors with MM in the prison population. MM should be detected early in order to prevent complications. Prevention, screening and treatment of MM ought to be considered a priority in the clinical routine of prison healthcare professionals.

TG/HDL index to identify subjects with metabolic syndrome in the Mexican population.

BACKGROUND: The triglyceride/high-density lipoprotein (TG/HDL) index has been proposed as an indicator of cardiovascular risk. In Mexico, there is a study in young adults that relates it to insulin resistance, but no cutoff point that distinguishes subjects with metabolic syndrome has been defined. OBJECTIVE: To determine the cutoff point for the TG/HDL index that identifies subjects with metabolic syndrome in the Mexican population. METHODS: Metabolic syndrome was diagnosed using the criteria established in the Third Report of the Adult Treatment Panel of the National Cholesterol Education Program adapted to the Mexican population. To identify the TG/HDL index cutoff point, ROC curve analysis and the Youden index were used. RESULTS: 1,318 subjects aged 40.9 ± 13.0 years participated in the study; 65.6% were women and 34.4% men; 41.2% had metabolic syndrome. The TG/HDL index obtained an area under the curve of 0.85 and an optimal cutoff point value ≥ 3.46, with a sensitivity of 79.6% and specificity of 76.4%. CONCLUSIONS: TG/HDL index cutoff point ≥ 3.46 is suitable for identifying subjects with metabolic syndrome in the Mexican population.

ANTECEDENTES: El índice triglicéridos/lipoproteína de alta densidad (TG/HDL) ha sido propuesto como un indicador de riesgo cardiovascular. En México, existe un estudio en adultos jóvenes que lo relaciona con resistencia a la insulina, pero no se ha definido un punto de corte que distinga a sujetos con síndrome metabólico. OBJETIVO: Determinar el punto de corte para el índice TG/HDL que identifique a sujetos con síndrome metabólico en población mexicana. MÉTODOS: El síndrome metabólico se diagnosticó mediante los criterios establecidos en el Tercer Reporte del Panel de Tratamiento para Adultos del Programa Nacional de Educación en Colesterol adaptados a la población mexicana. Para identificar el punto de corte del índice TG/HDL se utilizó el análisis de curvas ROC y el índice de Youden. RESULTADOS: En el estudio participaron 1318 sujetos con edad de 40.9 ± 13.0 años; 65.6 % fuerin mujeres y 34.4 % hombres; 41.2% presentó síndrome metabólico. El índice TG/HDL obtuvo un valor del área bajo la curva de 0.85 y un valor óptimo de punto de corte ≥ 3.46, con sensibilidad de 79.6 % y especificidad de 76.4 %. CONCLUSIONES: El punto de corte ≥ 3.46 para el índice TG/HDL es adecuado para identificar a sujetos con síndrome metabólico en población mexicana.

Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study. / Caracterización del fenotipo de cintura hipertrigliceridémica en pacientes con diabetes mellitus tipo2 en España: un estudio epidemiológico.

BACKGROUND AND OBJECTIVES: In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS: We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS: Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001). CONCLUSIONS: The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.

Relación de la hiperuricemia con las alteraciones metabólicas y factores de riesgo cardiovascular en jóvenes mexicanos.

INTRODUCTION: Hyperuricemia is a risk factor for cardiovascular disease, but its impact has not been properly documented. OBJECTIVE: To assess the impact of hyperuricemia on metabolic parameters and cardiovascular risk factors (CRF) in apparently healthy Mexicans. METHOD: Cross-sectional study of 768 young adults. Association of hyperuricemia with alterations in metabolic parameters and CRF (hypertension, mixed dyslipidemia, metabolic syndrome) was sought. Log-linear and regression models were used to determine the influence of hyperuricemia. A multivariate analysis of variance was applied to observe the interaction of hyperuricemia and overweight or obesity with changes in metabolic parameters. RESULTS: Metabolic parameters were higher in patients with hyperuricemia than with normal uric acid (all < 0.05). Hyperuricemia was significantly associated with hypertension (OR=6.8, 95 % CI: 1.1-46), dyslipidemia (OR=2.5, 95% CI: 1.3-4.7) and metabolic syndrome (OR=2.3, 95% CI: 1.1-4.6). Hyperuricemia and overweight or obesity significantly predict changes in cardiovascular risk metabolic parameters (Wilks' l=0.91, F (6.175)=3.1, p=0.007). CONCLUSIONS: Hyperuricemia is significantly associated with metabolic alterations and different CRF.

INTRODUCCIÓN: La hiperuricemia es un factor de riesgo para enfermedad cardiovascular, pero su impacto no ha sido bien documentado. OBJETIVO: Evaluar el impacto de la hiperuricemia en los parámetros metabólicos y los factores de riesgo cardiovascular en mexicanos aparentemente sanos. MÉTODO: Estudio trasversal de 768 adultos jóvenes. Se buscó asociación de la hiperuricemia con alteraciones de los parámetros metabólicos y factores de riesgo cardiovascular (hipertensión, dislipidemia mixta y síndrome metabólico). Se aplicaron modelos loglineales y de regresión para determinar la influencia de la hiperuricemia. Se aplicó análisis multivariado de varianza para observar la interacción de la hiperuricemia y el sobrepeso u obesidad en los cambios de los parámetros metabólicos. RESULTADOS: Los parámetros metabólicos fueron mayores en los individuos con hiperuricemia que con ácido úrico normal (< 0.05). La hiperuricemia se asoció significativamente con hipertensión (RM = 6.8, IC 95 % = 1.1-46), dislipidemia (RM = 2.5, IC 95 % = 1.3-4.7) y síndrome metabólico (RM = 2.3, IC 95 % = 1.1-4.6). La hiperuricemia y el sobrepeso u obesidad predicen significativamente los cambios en los parámetros metabólicos de riesgo cardiovascular (l de Wilks = 0.91, F [6.175] = 3.1, p = 0.007). CONCLUSIONES: La hiperuricemia está asociada significativamente con las alteraciones metabólicas y los distintos factores de riesgo cardiovascular.

Síndrome metabólico y aterosclerosis carotídea subclínica en niños y adolescentes mexicanos con acantosis nigricans.

INTRODUCCIÓN: La acantosis nigricans es un marcador de resistencia a la insulina, la cual se asocia con alteraciones metabólicas y cardiovasculares. OBJETIVO: Investigar la frecuencia de síndrome metabólico y aterosclerosis carotídea subclínica en niños y adolescentes mexicanos con acantosis nigricans y comparar los resultados entre sexos. MÉTODO: Estudio transversal. Se incluyeron 30 sujetos masculinos y 30 femeninos con diagnóstico de acantosis nigricans, menores de 18 años. Se investigó síndrome metabólico (criterios de Cook), riesgo cardiovascular (proteína C reactiva ultrasensible [PCRus]) y aterosclerosis carotídea (grosor íntima-media). Para el análisis de datos se utilizó estadística descriptiva e inferencial. RESULTADOS: La frecuencia de síndrome metabólico fue de 43 % (sexo masculino 42 % versus femenino 58 %, p = 0.58). Todos presentaron niveles anormales de PCRus: 67 % fue clasificado con riesgo cardiovascular moderado y 27 % con riesgo alto. Frecuencia de aterosclerosis carotídea 98 % (masculino 49 % versus femenino 51 %, p = 0.45). La severidad de la acantosis nigricans no influyó en los resultados. CONCLUSIONES: La búsqueda intencionada de síndrome metabólico y aterosclerosis carotídea subclínica en niños y adolescentes mexicanos con acantosis nigricans, independientemente del sexo o severidad de la enfermedad, permitirá implementar medidas para disminuir la morbimortalidad en la edad adulta. INTRODUCTION: Acanthosis nigricans is a marker of insulin resistance that is associated with metabolic and cardiovascular alterations. OBJECTIVE: To investigate the frequency of metabolic syndrome and subclinical carotid atherosclerosis in children and adolescents with acanthosis nigricans, and to compare the results between genders. METHOD: Cross-sectional study, where 30 male and 30 female subjects younger than 18 years of age diagnosed with acanthosis nigricans were included. The presence of metabolic syndrome (Cook's criteria), cardiovascular risk (ultrasensitive C-reactive protein and [us-CRP]), and carotid atherosclerosis (intima-media thickness [IMT]) was investigated. Descriptive and inferential statistics was used for data analysis. RESULTS: The frequency of metabolic syndrome was 43% (males 42 % versus females 58%, p = 0.58). All patients showed us-CRP abnormal levels: 67% were classified with moderate cardiovascular risk and 27% with high risk. The prevalence of carotid atherosclerosis was 98% (males 49% versus females 51%, p = 0.45). Acanthosis nigricans severity did not influence on the results. CONCLUSIONS: Intentional search for metabolic syndrome and subclinical carotid atherosclerosis in Mexican children and adolescents with acanthosis nigricans, regardless of gender or disease severity, will enable the implementation of measures to decrease the morbidity and mortality seen in adult age.

[Asociación del estado hormonal con el riesgo cardiovascular evaluado por Globorisk en mujeres mexicanas].

INTRODUCTION: Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known. OBJECTIVE: To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteins cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria. METHOD: Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio. RESULTS: Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tg/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52). CONCLUSION: Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.

INTRODUCCIÓN: La enfermedad cardiovascular es la principal causa de mortalidad en el mundo. En la mujer se incrementa en la sexta década de la vida, coincidiendo con la posmenopausia. Se desconoce si este efecto se debe a cambios hormonales relacionados con la menopausia. OBJETIVO: Evaluar diferencias del riesgo cardiovascular en mujeres pre y posmenopáusicas mediante la escala de riesgo Globorisk, el índice triglicéridos/c-HDL (Tg/c-HDL) y los criterios de síndrome metabólico (SM). MÉTODOS: Estudio transversal que incluyó a 408 mujeres de 40 a 60 años; se realizaron mediciones antropométricas y bioquímicas. Las participantes se clasificaron en premenopáusicas y posmenopáusicas. El riesgo cardiovascular se evaluó utilizando los criterios de SM, calculadora de riesgo Globorisk y el índice Tg/c-HDL. RESULTADOS: Las mujeres en etapa posmenopáusica presentaron incremento significativo en la circunferencia de cintura, de colesterol total y triglicéridos, en comparación con las mujeres premenopáusicas. Se encontraron asociaciones significativas del estado hormonal con el riesgo cardiovascular evaluado por Globorisk (RM = 2.50, IC 95 % = 1.67-3.74) y con el índice Tg/c-HDL (RM = 1.66, IC 95 % = 1.09-2.52). CONCLUSIÓN: Los factores de riesgo cardiovascular tienen mayor prevalencia en la posmenopausia. La escala Globorisk y el índice Tg/c-HDL identifican el riesgo cardiovascular en la mujer posmenopáusica.

Metabolic syndrome in patients on first-line antiretroviral therapy containing zidovudine or tenofovir in rural Lesotho, Southern Africa.

OBJECTIVE: To assess the prevalence of metabolic syndrome (MetS) among patients in rural Lesotho who are taking first-line antiretroviral therapy (ART) containing either zidovudine or tenofovir disoproxil. METHODS: Cross-sectional survey in 10 facilities in Lesotho among adult (≥16 years) patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART for ≥6 months. MetS was defined according to the International Diabetes Federation criteria. RESULTS: Among 1166 patients (65.8% female), 22.2% (95% CI: 19.3-25.3) of women and 6.3% (4.1-9.1) of men met the IDF definition of MetS (P < 0.001). In both sexes, there was no significant difference in MetS prevalence between NNRTIs. However, in women taking zidovudine as nucleoside reverse transcriptase inhibitor (NRTI), MetS prevalence was 27.9%, vs. 18.8% in those taking tenofovir. In the multivariate logistic regression allowing for socio-demographic and clinical covariates, ART containing zidovudine was associated with MetS in women (aOR 2.17 (1.46-3.22), P < 0.001) but not in men. CONCLUSION: In this study, taking ART containing zidovudine instead of tenofovir disoproxil was an independent predictor of MetS in women but not in men. This finding endorses WHO's recommendation of tenofovir as preferred NRTI.

Association of Psoriasis and Metabolic Syndrome in Latin America: A Systematic Review and Meta-Analysis. / Relación entre psoriasis y síndrome metabólico en Latinoamérica. Revisión sistemática y metaanálisis.

INTRODUCTION: Meta-analyses have found evidence of a relationship between psoriasis and metabolic syndrome, but Latin American populations have not been included. METHODOLOGY: We performed a systematic review and meta-analysis of observational studies including adults with psoriasis and metabolic syndrome indexed in Medline, Scopus, SciELO, Google Scholar, Science Direct, and LILACS between 1980 and 2016. We computed pooled odds ratios (OR) with a random effects model and analyzed subgroups according to patient variables used in the studies. RESULTS: Five studies with a total of 241 patients with psoriasis were found; 46.5% of the patients also had metabolic syndrome (pooled OR, 2.63; 95% CI: 1.11-6.23; P=.03). In studies using the Adult Treatment Panel III (ATP-III) criteria for metabolic syndrome, the pooled OR was similar at 3.97 (95% CI: 1.27-21.42). Studies that included patients with chronic and severe disease detected higher risk for metabolic syndrome (pooled OR, 6.65; 95% CI: 3.32-13.31). Limitations are that few studies have been done in Latin America, heterogeneity was high, and inconsistency was found across studies. CONCLUSION: The association between psoriasis and metabolic syndrome is high in Latin America. The association is stronger when psoriasis is chronic and severe and when the ATP-III criteria are used for diagnosis.

Cardiovascular Risk Factors and Carotid Intima-Media Thickness in a Colombian Population With Psoriasis. / Factores de riesgo cardiovascular y grosor de la íntima media carotídea en una población colombiana con psoriasis.

BACKGROUND AND OBJECTIVES: Psoriasis is now known to have a clear association with metabolic syndrome and its components. The aim of our study was to determine the prevalence of cardiovascular risk factors (CVRFs) and increased carotid intima-media thickness in psoriasis patients seen in the dermatology department of a quaternary hospital. MATERIAL AND METHODS: This was a descriptive cross-sectional study of psoriasis patients aged over 18 years seen in the dermatology department of Hospital de San José in Bogota, Colombia, between March and August, 2015. Directed medical history and physical examination were performed to detect CVRFs, laboratory studies to exclude metabolic syndrome, and ultrasound examination to measure carotid intima-media thickness. RESULTS: Forty patients with psoriasis were included in the study. The prevalence of the distinct CVRFs was 35% for systemic hypertension, 17.5% for dyslipidemia, 17.5% for smoking, and 10% for type 2 diabetes mellitus. A history of acute myocardial infarction was detected in 12.5% of patients. Metabolic syndrome was found in 20 patients (50%), and blood biochemistry revealed dyslipidemia in 32 patients (80%). Based on the Framingham score, the cardiovascular risk was low in 11 patients (31.4%), intermediate in 22 (62.8%), and high in 2 (5.7%). Mean (SD) carotid intima-media thickness was 0.7 (0.12) mm, with thickening observed in 6 patients (15%). CONCLUSIONS: This study provides evidence of the high prevalence of CVRFs in psoriasis patients and indicates the need for strict clinical control to monitor cardiovascular risk in this population.

High prevalence of asymptomatic carriers of Tropheryma whipplei in different populations from the North of Spain.

INTRODUCTION: Tropheryma whipplei is the causative agent of Whipple disease. T. whipplei has also been detected in asymptomatic carriers with a very different prevalence. To date, in Spain, there are no data regarding the prevalence of T. whipplei in a healthy population or in HIV-positive patients, or in chronic fatigue syndrome (CFS). Therefore, the aim of this work was to assess the prevalence of T. whipplei in stools in those populations. METHODS: Stools from 21 HIV-negative subjects, 65 HIV-infected, and 12 CFS patients were analysed using real time-PCR. HIV-negative and positive subjects were divided into two groups, depending on the presence/absence of metabolic syndrome (MS). Positive samples were sequenced. RESULTS: The prevalence of T. whipplei was 25.51% in 98 stool samples analysed. Prevalence in HIV-positive patients was significantly higher than in HIV-negative (33.8% vs. 9.09%, p=0.008). Prevalence in the control group with no associated diseases was 20%, whereas no positive samples were observed in HIV-negative patients with MS, or in those diagnosed with CFS. The prevalence observed in HIV-positive patients without MS was 30.35%, and with MS it was 55.5%. The number of positive samples varies depending on the primers used, although no statistically significant differences were observed. CONCLUSIONS: There is a high prevalence of asymptomatic carriers of T. whipplei among healthy and in HIV-infected people from Spain. The role of T. whipplei in HIV patients with MS is unclear, but the prevalence is higher than in other populations.

[Hyperuricaemia and metabolic syndrome in obese children and adolescents]. / Hiperuricemia y componentes del síndrome metabólico en niños y adolescentes obesos.

INTRODUCTION: Hyperuricaemia has been suggested as an additional metabolic factor in adult obese patients, but it has not been sufficiently studied in paediatric. OBJECTIVES: To assess the relationship between serum uric acid levels (SUAL) with the level of general and visceral obesity, and other biochemical parameters in children and adolescents of Santiago, Chile. SUBJECTS AND METHOD: A cross sectional study was conducted on 770 children and adolescents (ages: 6-15 y.) from a public school in Santiago, Chile, of whom 227 (29%) were obese (BMI>2 SD, WHO growth standards). Ninety subjects were randomly selected and 77 with no other chronic disease (41 males) accepted to participate. Data was collected on weight, stature, abdominal circumference (AC), visceral adiposity using ultrasound, and other biochemical measurements including fasting glucose, insulin, serum lipids, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and SUAL. RESULTS: The mean SUAL was 0.200±0.065 mmol/L, and was increased in children with hyperinsulinism (adjusted by age: 0.221±0.075 vs. 0.183±0.054 mmol/L; P<.01), with no significant differences according to HOMA. Differences were also found between children with ALT>or<26 U/mL: 0.238±0.070 vs. 0.178±0.054 mmol/L, P<.001. The logistic regression showed the increased SUAL was only associated with increased ALT. No significant differences were found in general or visceral adiposity measurements or fatty liver. CONCLUSIONS: Children and adolescents from Santiago, Chile have higher uric acid serum uric acid levels as well as an association with increased ALT and insulin. It is demonstrated in this study that uric acid should be measured in obese children and adolescents, and in their follow up.

Darwinian medicine and psoriasis.

Darwinian medicine, or evolutionary medicine, regards some pathological conditions as attempts by the organism to solve a problem or develop defense mechanisms. At certain stages of human evolution, some diseases may have conferred a selective advantage. Psoriasis is a high-penetrance multigenic disorder with prevalence among whites of up to 3%. Psoriatic lesions have been linked with enhanced wound-healing qualities and greater capacity to fight infection. Leprosy, tuberculosis, and infections caused by viruses similar to human immunodeficiency virus have been postulated as environmental stressors that may have selected for psoriasis-promoting genes in some human populations. The tendency of patients with severe psoriasis to develop metabolic syndrome may reflect the body's attempt to react to environmental stresses and warning signs by triggering insulin resistance and fat storage.

[Effects of gastric bypass on estimated cardiovascular risk in morbidly obese patients with metabolic syndrome]. / Efectos del bypass gástrico sobre el riesgo cardiovascular estimado.

INTRODUCTION: The major goal of surgical treatment in morbid obesity is to decrease morbidity and mortality associated with excess weight. In this sense, the main factors of death are cardiovascular disease and metabolic syndrome. The objective of this study is to evaluate the effects of gastric bypass on cardiovascular risk estimation in patients after bariatric surgery. MATERIAL AND METHODS: We retrospectively evaluated pre and postoperative cardiovascular risk estimation of 402 morbidly obese patients who underwent laparoscopic gastric bypass. The major variable studied is the cardiovascular risk estimation that is calculated preoperatively and after 12 months. Cardiovascular risk estimation analysis has been performed with the REGICOR Equation. REGICOR formulation allows calculating a 10 year risk of cardiovascular events adapted to the Spanish population and is expressed in percentages. RESULTS: We reported an overall 4.1±3.0 mean basal REGICOR score. One year after the operation, cardiovascular risk estimation significantly decreased to 2,2±1,6 (P<.001). In patients with metabolic syndrome according to ATP-III criteria, basal REGICOR score was 4.8±3.1 whereas in no metabolic syndrome patients 2.2±1.8. Evaluation 12 months after surgery, determined a significant reduction in both groups (metabolic syndrome and non metabolic syndrome) with a mean REGICOR score of 2.3±1.6 and 1.6±1.0 respectively. CONCLUSION: The results of our study demonstrate favorable effects of gastric bypass on the cardiovascular risk factors included in the REGICOR equation.

Obesity and psoriasis: inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications.

Obesity, particularly abdominal obesity, is currently considered a chronic low-grade inflammatory condition that plays an active role in the development of the pathophysiologic phenomena responsible for metabolic syndrome and cardiovascular disease through the secretion of proinflammatory adipokines and cytokines. In recent years clear genetic, pathogenic, and epidemiologic links have been established between psoriasis and obesity, with important implications for health. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity. Obesity also has important implications in the treatment of psoriasis, such as a greater risk of adverse effects with conventional systemic drugs and reduced efficacy and/or increased cost with biologic agents, for which dosage should be adjusted to the patient's weight.

[Limitations and opportunities for the appropriation of the Mediterranean diet in Chilean adults with diagnostic elements of metabolic syndrome]. / Limitaciones y oportunidades para la adopción de la dieta mediterránea en adultos chilenos con elementos diagnósticos del síndrome metabólico.

Introduction: Background: a healthy food intake pattern, specifically the Mediterranean diet (MedDiet), is a factor associated with reduced risk, lower prevalence, and better management of chronic diseases. However, there is limited information regarding how patients integrate proposals for adherence to this food pattern in their daily lives. Objective: to identify factors and conditions that influence adherence to the MedDiet in Chile. Methods: an exploratory qualitative study was applied in 35 to 65-year-old patients of both sexes who presented at least one diagnostic criterion of metabolic syndrome (MetS). Through in-depth interviews and focal groups, knowledge, assessment, attitudes, and practices associated with changes and maintenance of healthy eating habits, with emphasis on the MedDiet, were investigated. Information analysis was carried out under the grounded theory approach using the ATLAS.ti software. Results: participants recognized the value of healthy eating, including the MedDiet, but declared low knowledge (identification of single foods items) together with facilitators (variety of ingredients) and limiting factors (taste, availability/cost of some items, family dynamics) for its routine adoption. In addition, change in eating habits generates a high initial cognitive and emotional load that requires not only individual but also relational effort as it implies modifications of family and collective practices. Conclusions: information obtained on barriers and opportunities to adhere to healthy eating such as the MedDiet is key to design and implement nutritional interventions based on this food pattern and that can be sustainable in time for chronic disease management in Chile.

Introducción: Antecedentes: un estilo de alimentación saludable, específicamente la dieta mediterránea (DMed), es un factor asociado a bajo riesgo, menor prevalencia y mejor manejo de las enfermedades crónicas. Sin embargo, existe información limitada respecto a cómo los pacientes incorporan propuestas de este patrón alimentario en su vida cotidiana. Objetivo: identificar factores y condiciones que pueden influir en la adherencia a la DMed en Chile. Métodos: estudio cualitativo exploratorio en 17 pacientes de ambos sexos de entre 35 y 65 años que presentaban algún criterio diagnóstico de síndrome metabólico (SMet). Mediante entrevistas en profundidad y grupos focales se indagaron el conocimiento, la valoración, las actitudes y las prácticas asociadas a cambios y mantenimiento de alimentación con énfasis en la DMed. El análisis de la información se realizó bajo el enfoque de teoría fundada usando el software ATLAS.ti. Resultados: los participantes reconocieron el valor de una alimentación saludable tipo DMed, pero declararon bajo conocimiento (identificación de algunos alimentos aislados, dinámica familiar) de ella, junto con facilitadores (variedad de ingredientes) y limitantes (sabor, disponibilidad/costo de algunos alimentos) para su adopción rutinaria. Además, el cambio de hábitos alimentarios genera alta carga cognitiva y emocional inicial que requiere esfuerzo no solo individual sino también relacional, pues implica modificaciones de prácticas familiares y colectivas. Conclusiones: la información obtenida sobre barreras y oportunidades para adherir a una alimentación saludable como la DMed resulta clave para diseñar e implementar intervenciones nutricionales basadas en este patrón alimentario y que puedan ser sostenibles en el tiempo para el enfrentamiento de las enfermedades crónicas en Chile.

Clinical implications of persistent joint pain after gout flare.

OBJECTIVES: A subset of gout patients developed persistent joint pain after flares. Analysis of this clinical phenomenon may shed further light on the factors related to worsening gout and even provide clues to its pathogenesis. METHODS: We analyzed the clinical, laboratory, and ultrasound data of gout patients to explore the associations of these data with persistent joint pain after gout flares. RESULTS: A total of 1029 gout patients were included: 182 (17.7%) patients with persistent joint pain and 847 (82.3%) patients with nonpersistent joint pain. Patients with persistent joint pain had more total involved joints, more gout flares in the past year, and more joints with simultaneous gout flares (P<0.01). Among the ultrasound-detected lesions, patients with persistent joint pain had a higher incidence of tophus (36.4% vs. 21.1%) and bone erosion (18.6% vs. 8.6%) (P<0.05). Higher UA and lower TBil were found in patients with persistent joint pain (P<0.001). Hypertension (54.9% vs. 38.7%) and metabolic syndrome (58.8% vs. 46.4%) were both more frequent in patients with persistent joint pain (P<0.05). TBil was negatively correlated with the incidence of persistent joint pain (P<0.001, r=-0.190), UA values (P<0.001, r=-0.125), and metabolic syndrome scores (P<0.001, r=-0.192). A correlation curve was fitted using LOESS (locally weighted region). CONCLUSION: Persistent joint pain after gout flares is a marker of increased disease burden in gout. The significance of the level of total bilirubin for the exacerbation of gout deserves further study.

Liraglutide for the treatment of obesity among patients with hidradenitis suppurativa.

BACKGROUND AND AIMS: Hidradenitis suppurativa (HS) is associated with obesity. Weight loss is frequently reflected in an amelioration in the severity of the lesions. Case reports have suggested that liraglutide might improve not only weight but also skin. We aimed to study the effects of liraglutide 3mg in patients with obesity and HS on metabolic and dermatological parameters. METHODS: 14 patients started treatment with liraglutide for 3 months. Severity of the lesions was evaluated using the Hurley Staging System and quality of life with the DLQI (Dermatology Quality Index). RESULTS: There was a significant reduction in BMI (39.3±6.2 vs 35.6±5.8; p=0.002), waist circumference (121.3±19.2 vs 110.6±18.1cm; p=0.01), CRP (4.5±2.2 vs 3±2.1mg/L; p=0.04), homocysteine (16.2±2.9 vs 13.3±3µmol/L; p=0.005) and plasma cortisol (15.9±4.8 vs 12.6±4.5µg/dL; p=0.007). Hurley (2.6±0.5 vs 1.1±0.3; p=0.002) and DLQI (12.3±2.8 vs 9.7±6.9; p=0.04) improved significantly. In multiple regression analysis, weight loss did not correlate with any inflammatory parameter or Hurley. CONCLUSIONS: Liraglutide 3mg is effective and safe among patients with HS and obesity. Long-term studies are mandatory to assess the effects of liraglutide on skin lesions and inflammatory markers among subjects with HS beyond weight loss.

Metabolic syndrome in systemic lupus erythematosus patients under Mediterranean diet.

BACKGROUND AND AIMS: Metabolic syndrome (MetS) is a chronic proinflammatory and prothrombotic condition that exacerbates insulin resistance, oxidative damage, and cardiovascular risk, being more prevalent in patients with systemic lupus erythematosus (SLE), a chronic multisystemic autoimmune disorder. This study aim was to determine the prevalence of MetS and associations with SLE clinical characteristics, cardiovascular risk and dietary pattern in a population of Spanish SLE patients. DESIGN AND METHODS: Cross-sectional study of 293 patients was conducted (90.4% females; mean age 46.8 (12.94)). The diagnosis of MetS was established based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. SLE Disease Activity Index (SLEDAI-2K) and SDI Damage Index were used to assess disease activity and disease-related damage, respectively. Med Diet adherence was assessed through a 14 items questionnaire on food consumption frequency and habits. RESULTS: MetS was present in 15% SLE patients. Triglycerides, high-density lipoprotein cholesterol, systolic blood pressure and waist circumference were significantly increased (p<0.001) in the group of MetS patients. Patients with MetS showed significantly increased SDI damage index (1.70 (1.69) vs 0.88 (1.12), p<0.001) and complement C3 level (118.70 (32.67) vs 107.55 (26.82), p=0.011). No significant differences were observed according to Med Diet adherence level. CONCLUSION: We observed a lower prevalence of MetS in SLE than that reported in previous studies, which may be a result of the good level of adherence to the MedDiet in our study sample. Additionally, MetS was associated with higher SDI and complement C3 levels but no with medication use.

Metabolic disorders across the body mass index spectrum in a Colombian population with nonalcoholic fatty liver disease.

BACKGROUND AND AIMS: The relationship between obesity and nonalcoholic fatty liver disease (NAFLD) has long been established, and the prevalence of both conditions has grown together. Recent interest in NAFLD in nonobese individuals has led to an increasing number of studies, especially in Asia. Despite the fact that the prevalence of NAFLD in Latin America is one of the highest in the world, there is a lack of information on lean NAFLD populations from the region. The aim of the present study was to assess the risk of metabolic comorbidities across the whole body mass index spectrum when nonalcoholic steatohepatitis (NASH) was first diagnosed in a Latin American population. METHODS: A single-center, cross-sectional study on Colombian patients newly diagnosed with NAFLD, within the time frame of 2010-2020, compared their metabolic biochemical profile, liver enzymes, risk of prevalent metabolic abnormalities, and liver disease. RESULTS: Data from 300 patients were collected. Ninety-two percent of the patients were men and the median patient age was 47 (IQR 20) years. We found no significant differences in the biochemical, metabolic profile, or liver enzyme plasma concentration between lean, overweight, and obese individuals. Obese patients had significantly higher LDL cholesterol, and a higher risk of dyslipidemia (OR 1.86, 95% CI 1.14-3.05). Every 1kg increase in body weight increased the risk of having NASH by 2% (95% CI 2-4). CONCLUSIONS: We evaluated the metabolic risk across the entire body mass index spectrum in a Colombian cohort with NAFLD and presented the characteristics of what we believe is the first Latin American lean NAFLD population to be described.

Study of the metabolic syndrome severity index as a predictive factor of a major cardiovascular event in premenopausal women with systemic lupus erythematosus. / Estudio del índice de gravedad del síndrome metabólico como factor predictivo de un episodio cardiovascular mayor en mujeres premenopáusicas con lupus eritematoso sistémico.

BACKGROUND: Patients with systemic lupus erythematosus (SLE) have an increased risk of metabolic syndrome (MS) and cardiovascular (CV) disease. MS is evaluated binary, limiting the understanding of each component's severity individually. Therefore, severity scores for MS that evaluate them separately have been developed. This study aims to determine the prognosis between MS severity and the occurrence of major adverse cardiovascular events (MACE) in SLE patients. METHODS: Ten-year follow-up cohort study. Premenopausal>18-year-old women with a previous diagnosis of SLE were included. Patients with recent CV events, pregnancy, thyroid disease, and liposuction were excluded. The variables of interest were CV events; the confounding variables, and the MS severity indexes were examined. Hazard ratios and Kaplan-Meier survival curves were estimated through Cox regression. RESULTS: A total of 238 women were analyzed: 22 presented MACE, and 216 did not. MS prevalence, measured according to consensus and ATP-III criteria, was higher in MACE patients (50 and 40,95%, respectively). The MetSx-IMC severity index was higher within the MACE group. Cox analysis showed an increase in the MetSx-IMC associated with the risk of suffering MACE in a 1.107 ratio. CONCLUSIONS: The MetSx-IMC severity index, contrary to the binary approaches, is recommended to evaluate MS as a predictor of MACE in SLE patients. Offering improved and more accurate prognosis in patients at risk of developing MCE.