Evolution of Mitochondrially Derived Peptides Humanin and MOTSc, and Changes in Insulin Sensitivity during Early Gestation in Women with and without Gestational Diabetes.

Our purpose is to study the evolution of mitochondrially derived peptides (MDPs) and their relationship with changes in insulin sensitivity from the early stages of pregnancy in a cohort of pregnant women with and without gestational diabetes (GDM). MDPs (humanin and MOTSc) were assessed in the first and second trimesters of gestation in 28 pregnant women with gestational diabetes mellitus (GDM) and a subgroup of 45 pregnant women without GDM matched by BMI, age, previous gestations, and time of sampling. Insulin resistance (IR) was defined as a HOMA-IR index ≥70th percentile. We observed a significant reduction in both humanin and MOTSc levels from the first to the second trimesters of pregnancy. After adjusting for predefined variables, including BMI, statistically nonsignificant associations between lower levels of humanin and the occurrence of a high HOMA-IR index were obtained (adjusted OR = 2.63 and 3.14 for the first and second trimesters, linear p-trend 0.260 and 0.175, respectively). Regarding MOTSc, an association was found only for the second trimester: adjusted OR = 7.68 (95% CI 1.49-39.67), linear p-trend = 0.012. No significant associations were observed in humanin change with insulin resistance throughout pregnancy, but changes in MOTSc levels were significantly associated with HOMA-IR index: adjusted OR 3.73 (95% CI 1.03-13.50). In conclusion, MOTSc levels, especially a strong decrease from the first to second trimester of gestation, may be involved in increasing insulin resistance during early gestation.

Efficacy and safety of endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy in obese subjects with Non-Alcoholic SteatoHepatitis (NASH): study protocol for a randomized controlled trial (TESLA-NASH study).

BACKGROUND: Non-alcoholic steatohepatitis (NASH) is frequently associated with obesity, and its standard treatment is weight loss with diet and exercise; a dy% weight reduction has been associated with improvement in liver histological and analytical abnormalities. However, less than 25% of subjects achieve this goal. Laparoscopic sleeve gastrectomy (LSG) represents the most common procedure of bariatric surgery, providing effective weight loss and improvement in comorbidities such as NASH, but it is associated with several postoperative complications. Endoscopic bariatric techniques are currently on the rise as a new tool in the fight against obesity, offering patients an alternative to more invasive surgery. However, their efficacy and safety compared with LSG is unclear. METHODS: The TESLA-NASH study is a randomized, controlled, open-label, unicentric clinical trial with a medical device. The aim of this study is to evaluate and compare the efficacy and safety of endoscopic sleeve gastroplasty (ESG) versus laparoscopic sleeve gastrectomy (LSG) in liver histology improvement of patients with obesity +/- metabolic syndrome and NASH. A total of 30 patients will be randomized 1:1 to the experimental or control group. DISCUSSION: LSG is an effective treatment for weight reduction and for the remission of hepatic alterations. However, LSG is associated with acute and chronic postoperative complications. Bariatric endoscopic techniques promise less invasive and more cost-effective approaches to the treatment of obesity and metabolic comorbidities. ESG represents one of the most promising novel endoscopic interventions and it is mainly proposed for patients with mild-to-moderate obesity, but there are still no guidelines that specify its applicability criteria. This clinical trial will help us apply different tactics to the treatment of obesity and NASH. TRIAL REGISTRATION: ClinicalTrials.gov NCT04060368. Registered on Nov 15, 2019.

[Nutrition and gastronomy in the community of Cantabria]. / Nutrición y gastronomía en la comunidad de Cantabria.

INTRODUCTION: Introduction: Cantabria is characterized by a large coastal territory and an important livestock tradition, which define its gastronomy. Objectives: population increasingly demands a healthy gastronomy, which promotes a state of health. We will analyze how is the gastronomy, food consumption, and nutritional profile in the community of Cantabria. We will try to relate it to the prevalence of obesity in Cantabria Methods: bibliographic search of scientific articles in PubMed, Google academic databases, and nutrition books. In addition, a search of materials in newspapers of Cantabria and institutions of Cantabria has been developed. Results: in Cantabria a greater amount of fish, oil, dairy products, pastries, pastries, cookies and cereals and fresh fruits is consumed compared to the national average. However, the consumption of soft drinks and soda, fresh vegetables, and bread is lower. With Galicia it occupies the first place in the consumption of fish, food of high nutritional value and high protein content. This consumption profile could contribute to lower energy intake (2038 kcal in 2016) and influence the prevalence of obesity in our community. According to data from 2016, Cantabria with a rate of 17,6% is the fourth community with the lowest prevalence of obesity in Spain. Conclusions: although the prevalence of obesity in our community is in the last places in Spain, the recommendations and nutritional objectives established for the Spanish population have not been reached. Cantabrian gastronomy has to promote a healthy diet, based on a lower contribution of fats and more complex carbohydrates to reach these recommendations.

INTRODUCCIÓN: Introducción: Cantabria se caracteriza por un gran territorio costero y una importante tradición ganadera, que definen su gastronomía. Objetivos: la población demanda cada vez más una gastronomía saludable que promueva un buen estado de salud. Analizaremos cómo es la gastronomía, el consumo alimentario y el perfil nutricional en Cantabria, y trataremos de relacionarlo con la prevalencia de obesidad. Métodos: búsqueda bibliográfica de artículos científicos en las bases de datos PubMed, Google Académico y en tratados de nutrición. Además, se ha realizado una búsqueda de materiales en la prensa local y en las instituciones de Cantabria. Resultados: en Cantabria se consume más pescado, aceite, derivados lácteos, bollería, pastelería, galletas y cereales y frutas frescas que la media nacional. Sin embargo, el consumo de bebidas refrescantes y gaseosas, hortalizas frescas y pan es menor. Junto a Galicia, ocupa el primer puesto en el consumo de pescado, alimento de alto valor nutritivo y elevado contenido proteico. Este perfil de consumo podría contribuir a que la ingesta energética sea menor (2038 kcal en 2016) e influir en la prevalencia de obesidad. Cantabria, en 2016, con una tasa de 17,6%, fue la cuarta comunidad con menor obesidad en España. Conclusiones: aunque la prevalencia de obesidad en nuestra comunidad se encuentra en los últimos puestos de España, no se alcanzan las recomendaciones y objetivos nutricionales establecidos para la población española. La gastronomía cántabra ha de promover una alimentación saludable, basada en un menor aporte de grasas y mayor de hidratos de carbono complejos para cumplir estas recomendaciones.

Bone mineral density evolution and incidence of fractures in a cohort of patients with primary hyperparathyroidism treated with parathyroid surgery vs active surveillance during 6 years of follow-up. / Evolución de la densidad mineral ósea y aparición de fracturas en una cohorte de pacientes con hiperparatiroidismo primario tratados con cirugía paratiroidea vs. vigilancia activa sin cirugía en 6 años de seguimiento.

INTRODUCTION: The need for parathyroidectomy to treat asymptomatic patients with primary hyperparathyroidism is controversial. The aim of this study was to assess the impact of parathyroidectomy vs. surveillance on skeletal outcomes such as bone mineral density (BMD) and incident fractures. METHODS: This was a retrospective cohort study including 170 patients (112 treated with surgery and 58 subject to active surveillance) between 1991 and 2014. Changes in BMD in lumbar spine, femoral neck, total hip, and radius, and incidence of fractures, were monitored for 2-6 years. RESULTS: Patients treated with surgery had BMD gains at 2years of 4.37%, as compared to 1.59% in non-operated patients (p<0.05) in the lumbar spine, 3.90% vs. 0.19% (p<0.05) in the femoral neck, and 2.70% vs. 0.14% (p<0.05) in total hip. Gain in BMD in the lumbar spine and femoral neck remained significant in operated patients at 4 and 6 years. No improvement was seen in the radius in operated patients. No significant difference was seen in fracture occurrence between operated and non-operated patients. CONCLUSION: Patients with primary hyperparathyroidism treated with surgery experience greater BMD gains than non-operated patients, especially in the lumbar spine and femoral neck. The risk of fracture does not decrease in the group of operated patients.

Cortisol and adrenal androgens as independent predictors of mortality in septic patients.

OBJECTIVE: To determine the prognostic value of cortisol, Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone-sulfate (DHEAS), together with their ratios (cortisol/DHEA and cortisol/DHEAS), as independent predictors of mortality in septic patients. METHODS: Prospective cohort study of 139 consecutive patients with a diagnosis of severe sepsis or septic shock. Adrenal hormones were determined within the first 24 hours of the septic process. To determine and compare the predictive ability of each marker for the risk of unfavorable evolution (in-hospital, 28-day and 90-day mortality), ROC (Receiver Operating Characteristic) curves were constructed and the area under the curve (AUC) was determined. As measures of association, adjusted odds ratios (OR) with their 95% confidence intervals (95%CI) were estimated by unconditional logistic regression. Cortisol, DHEA and DHEAS results were compared to lactate, CRP, SOFA and APACHE II Scores. RESULTS: Cortisol showed the best predictive ability, with AUCs of 0.758, 0.759 and 0.705 for in-hospital mortality, and 28-day and 90-day mortality, respectively; whereas AUCs for 28 days mortality for SOFA and APACHE II scores, and other biomarkers studied, such as Lactate or CRP, were 0.644, 0.618, 0.643 and 0.647, respectively. Associations between high cortisol levels (>17.5 µg/dL) and mortality were strong and statistically significant for in-hospital and 28-day mortality: adjusted ORs 10.13 and 9.45 respectively, and lower for long term mortality (90 days): adjusted OR 4.26 (95% CI 1.34-13.56), p trend 0.014. Regarding adrenal androgens, only positive associations were obtained for DHEAS and most of these positive associations did not yield statistical significance. Regarding Cortisol/DHEA and cortisol/DHEAS ratios, they did not improve the predictive ability of cortisol. The only exception was the cortisol/DHEAS ratio, which was the best predictor of mortality at 90 days (AUC 0.737), adjusted OR for highest cortisol/DHEAS ratio values 6.33 (95%CI 1.77-22.60), p trend 0.002. CONCLUSION: Basal cortisol measured within the first 24 hours of the septic process was the best prognostic factor for in-hospital and 28-day mortality, even superior to the Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. The cortisol/DHEAS ratio was an independent predictor of long-term mortality.

Bone disease in long-term adult kidney transplant patients with normal renal function.

BACKGROUND: In successful renal transplantation, the degree of renal function recovery is usually incomplete and information is scarce about the abnormalities of mineral metabolism in long-term adult renal recipients with normal renal function. This study was designed to investigate bone mineral metabolism in patients with a long-term normal functioning kidney. METHODS: Twenty-nine adult asymptomatic renal transplant (RT) recipients with stable graft function for more than 10 years and serum creatinine <2 mg/dL were studied. They were classified into two groups according to glomerular filtration rate: Group A (N = 12; nine men, three women)>70 mL/min (x: 126 +/- 55 mL/min) and Group B (N = 17; nine men, eight women) <70 mL/min (x: 56 +/- 11 mL/min). Circulating biochemical markers of bone remodelling, bone histomorphometry, and densitometry (lumbar spine and hip) were obtained to investigate bone disease in these patients. RESULTS: Serum PTH was slightly elevated in 10 patients (83%) in group A. Serum PTH levels were positively related to serum calcium, osteocalcin, BAP, telopeptide, OH-proline, and creatinine. There was no histologic data to support overactivity on bone in this group of patients, with only one showing high bone turnover. Mineralization was prolonged in 34% of patients. Twenty-two patients (75%) exhibited normal bone turnover. In the group with GFR>70 mL/min the prevalence of mineralization defect in the presence of normal serum levels of calcitriol suggested vitamin D resistance. Lumbar and femoral neck osteoporosis was present in 25% and 33% of patients in group A, and 23% and 53% in group B, respectively. T-score at lumbar spine was negatively correlated with months since transplantation. Patients under treatment with cyclosporine (CsA) showed increased concentrations of osteocalcin and D-pyr and higher lumbar bone mineral density (BMD), but bone histomorphometry was not influenced by CsA. CONCLUSION: Patients with long-term renal transplantation with normal renal function frequently present with slight increases in PTH, but without an effect on bone histology. CsA did not induce changes in bone histology and delayed mineralization was frequently observed.