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INTRODUCTION: Up to 83% of oncology patients are affected by cancer-related malnutrition, depending on tumour location and patient age. Parenteral nutrition can be used to manage malnutrition, but there is no clear consensus as to the optimal protein dosage. The objective of this systematic literature review (SLR) was to identify studies on malnourished oncology patients receiving home parenteral nutrition (HPN) where protein or amino acid delivery was reported in g/kg bodyweight/day, and to compare outcomes between patients receiving low (< 1 g/kg bodyweight/day), standard (1-1.5 g/kg/day), and high-protein doses (> 1.5 g/kg/day). METHODS: Literature searches were performed on 5th October 2021 in Embase, MEDLINE, and five Cochrane Library and Centre for Reviews and Dissemination databases. Searches were complemented by hand-searching of conference proceedings, a clinical trial registry, and bibliographic reference lists of included studies and relevant SLRs/meta-analyses. RESULTS: Nineteen publications were included; sixteen investigated standard protein, two reported low protein, and one included both, but none assessed high-protein doses. Only one randomised controlled trial (RCT) was identified; all other studies were observational studies. The only study to compare two protein doses reported significantly greater weight gain in patients receiving 1.15 g/kg/day than those receiving 0.77 g/kg/day. CONCLUSION: At present, there is insufficient evidence to determine the optimal protein dosage for malnourished oncology patients receiving HPN. Data from non-HPN studies and critically ill patients indicate that high-protein interventions are associated with increased overall survival and quality of life; further studies are needed to establish whether the same applies in malnourished oncology patients.
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Desnutrición , Neoplasias , Nutrición Parenteral en el Domicilio , Humanos , Nutrición Parenteral en el Domicilio/efectos adversos , Desnutrición/etiología , Desnutrición/terapiaRESUMEN
Sodium-glucose co-transporters type 2 inhibitors (SLGT2i) are highly effective in controlling type 2 diabetes, but reported beneficial cardiovascular effects suggest broader actions on insulin resistance. Weight loss may be initially explained by glycosuria-induced net caloric output and secondary volumetric reduction, but its maintenance could be due to loss of visceral fat mass. Structured ultrasound (US) imaging of abdominal adipose tissue ("eco-obesity") is a recently described methodology used to measure 5 consecutive layers of abdominal fat, not assessable by DEXA or CT scan: superficial subcutaneous (SS), deep subcutaneous (DS), preperitoneal (PP), omental (Om) and right perirenal (RK). PP, Om and RK are predictors of metabolic syndrome (MS) with defined cut-off points. To assess the effect of SLGT2i on every fat depot we enrolled 29 patients with type 2 Diabetes (HbA1c 6.5-9%) and Obesity (IMC > 30 kg/m2) in an open-label, randomized, phase IV trial (EudraCT: 2019-000979-16): the Omendapa trial. Diabetes was diagnosed < 12 months before randomization and all patients were treatment naïve. 14 patients were treated with metformin alone (cohort A) and 15 were treated with metformin + dapaglifozin (cohort B). Anthropometric measures and laboratory tests for glucose, lipid profile, insulin, HOMA, leptin, ultrasensitive-CRP and microalbuminuria (MAL) were done at baseline, 3rd and 6th months. At 6th month, weight loss was -5.5 ± 5.2 kg (5.7% from initial weight) in cohort A and -8.4 ± 4.4 kg (8.6%) in cohort B. Abdominal circumference showed a -2.7 ± 3.1 cm and -5.4 ± 2.5 cm reduction, respectively (p = 0.011). Both Metformin alone (-19.4 ± 20.1 mm; -21.7%) or combined with Dapaglifozin (-20.5 ± 19.4 mm; -21.8%) induced significant Om fat reduction. 13.3% of cohort A patients and 21.4% of cohort's B reached Om thickness below the cut-off for MS criteria. RK fat loss was significantly greater in cohort B group compared to cohort A, at both kidneys. Only in the Met + Dapa group, we observed correlations between Om fat with leptin/CRP/MAL and RK fat with HOMA-IR. US is a useful clinical tool to assess ectopic fat depots. Both Metformin and Dapaglifozin induce fat loss in layers involved with MS but combined treatment is particularly effective in perirenal fat layer reduction. Perirenal fat should be considered as a potential target for cardiovascular dapaglifozin beneficial effects.
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Compuestos de Bencidrilo , Diabetes Mellitus Tipo 2 , Glucósidos , Metformina , Obesidad , Humanos , Metformina/uso terapéutico , Metformina/farmacología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Glucósidos/uso terapéutico , Glucósidos/farmacología , Femenino , Masculino , Obesidad/tratamiento farmacológico , Obesidad/complicaciones , Persona de Mediana Edad , Compuestos de Bencidrilo/uso terapéutico , Compuestos de Bencidrilo/farmacología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/farmacología , Anciano , Quimioterapia Combinada , AdultoRESUMEN
INTRODUCTION: Ultrasonography (US) in patients with obesity allows us to measure different layers of abdominal fat (superficial subcutaneous, deep subcutaneous, preperitoneal, omental, and perirenal), not assessable by DEXA or CT scan. Omental and perirenal fat depots are considered predictors of metabolic complications. Liraglutide is particularly effective in reducing weight in patients with insulin-resistance, but its direct impact on each abdominal fat layer is unknown. METHODS: We measured, at the L4 level, all 5 abdominal fat depots in 860 patients with obesity (72.8% women, mean age 56.6 ± 1.5 years, BMI 34.4 ± 4.7 kg/m2, body fat 47 ± 2%, abdominal circumference 105.8 ± 3 cm), before and after 6 months of liraglutide treatment. Laboratory tests for glucose, insulin, and lipid profile were routinely done. T-student was used to compare intraindividual differences. RESULTS: Weight loss was 7.5 ± 2.8 kg (7.96% from baseline), with no differences by sex/age/BMI. Greater loss was observed in patients with higher dosages and NAFLD. All US-measured fat layers showed a significant reduction (p < 0.05) at 6th months. Preperitoneal fat showed a -26 ± 5.5% reduction and 46% of the patients went below metabolic syndrome (MS) risk cut-off values. Omental fat was reduced by -17.8 ± 5% (67% of the patients below MS risk) and perirenal fat by -22.4 ± 4.4% (56% of the patients below MS). Both omental and perirenal fat reduction correlated with total and LDL cholesterol. Higher perirenal fat reduction (-28%) was seen among patients with obesity and hypertension. Perirenal fat also correlated with blood pressure reduction. CONCLUSION: Liraglutide induces greater fat loss in the layers involved with MS. However, the maximal reduction is seen at perirenal fat, which has been recently related with hypertension and could play an important role in modulating kidney's expansion and intraglomerular pressure. US is a reproducible clinical tool to assess pathologic fat depots in patients living with obesity.
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Grasa Abdominal , Liraglutida , Obesidad , Ultrasonografía , Humanos , Femenino , Liraglutida/uso terapéutico , Liraglutida/farmacología , Persona de Mediana Edad , Masculino , Ultrasonografía/métodos , Grasa Abdominal/diagnóstico por imagen , Grasa Abdominal/efectos de los fármacos , Obesidad/diagnóstico por imagen , Pérdida de Peso/efectos de los fármacos , Índice de Masa Corporal , Riñón/diagnóstico por imagen , Riñón/efectos de los fármacos , Riñón/metabolismo , Resistencia a la Insulina , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/farmacologíaRESUMEN
[This corrects the article DOI: 10.2196/12612.].
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OBJECTIVE: Abdominal fat ultrasound (US) is a simple clinical tool that may allow measures of fat depots not visible using common dual-energy X-ray absorptiometry (DEXA) or computerized tomography (CT) imaging. The aim of this study was to validate the technique, give measures of superficial and profound subcutaneous, preperitoneal, omental and perirenal (retroperitoneal) fat and correlate them with MS markers. METHODS: Sequential US measures of these five abdominal fat layers were done at 397 adults. Blood pressure (BP), body mass index (BMI), waist, body fat %, HOMA-IR index (homeostatic model assessment of insulin resistance), lipid profile and leptin were recorded. Metabolic syndrome (MS) was defined according to Cholesterol education programme adult treatment panel III (ATPIII) criteria. RESULTS: Subcutaneous and omental fat were increased among people with obesity, whereas preperitoneal and perirenal fat did not show any difference according to BMI or waist. Women showed thicker subcutaneous fat (both superficial and profound), whereas men had bigger omental fat. Both postmenopausal and diabetic patients had changes in omental fat only, whereas patients with fatty liver showed thicker preperitoneal and perirenal fat, as well. MS patients showed both thicker perirenal and omental fat. A cut-off of 54 mm in male (M)/34 mm in female (F) of omental fat and 22.5 mm (M)/12.5 mm (F) of perirenal fat could be predictive of later MS onset. CONCLUSIONS: US is a valid method to measure all different abdominal fat depots. Omental and perirenal fat measures may classify patients at risk for MS. Preperitoneal fat depot may also correlate with fatty liver disease.
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BACKGROUND: The use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking. OBJECTIVE: The aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review. METHODS: PubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables. RESULTS: From 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46%) were randomized control trials, 11 were single-arm studies (39%), 3 were nonrandomized controlled trials (11%), and 1 study was a cluster randomized trial (4%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4). CONCLUSIONS: There is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity. TRIAL REGISTRATION: PROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx.
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Manejo de la Obesidad/normas , Programas de Reducción de Peso/normas , Índice de Masa Corporal , Humanos , Obesidad/psicología , Obesidad/terapia , Manejo de la Obesidad/tendencias , Seguridad del Paciente/normas , Resultado del Tratamiento , Programas de Reducción de Peso/tendenciasRESUMEN
CONTEXT: Administration of glucocorticoids increases serum leptin levels in lean and obese individuals. A morning meal produces an increase in insulin, a cortisol peak, and an increase in leptin; these changes do not occur during fasting. OBJECTIVE: The objective of this study was to investigate whether inhibiting endogenous cortisol secretion with metyrapone decreases 24-h serum leptin levels and to determine whether a meal-related midmorning surge in cortisol is a prerequisite for the meal-entrained nocturnal rise in leptin. DESIGN: This was a randomized, cross-over study. SETTING: The study was performed at the General Clinical Research Center. PARTICIPANTS: Lean males were studied. INTERVENTION: In study 1, seven lean men were studied for 24 h while their endogenous cortisol secretions were manipulated as follows: 1) CONTROL; 2) cortisol suppression by metyrapone (MET); and 3) MET and oral hydrocortisone (at 0900 h) (MET + CORT). Subjects were all fed a eucaloric diet (two meals at 1100 and 1700 h). In study 2, six men were studied without pharmacological intervention for 24 h on two occasions: once under a complete fast (FAST) and once in a feeding condition (one meal at 1100 h; FED). MAIN OUTCOME MEASURE: The main outcome measure was serum leptin. RESULTS: MET significantly suppressed serum cortisol at 0800 h, midmorning, and over the 24-h period. As a result of cortisol suppression, 24-h serum leptin levels were decreased vs. control values despite similar insulin responses to meals. Administering a single dose of hydrocortisone to MET subjects potently stimulated serum leptin compared with the effect of MET alone. CONCLUSIONS: Our data demonstrate that endogenous cortisol secretion is necessary for the maintenance of serum leptin levels over 24 h in lean, normally fed males.
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Hidrocortisona/fisiología , Leptina/sangre , Metirapona/farmacología , Adolescente , Adulto , Estudios Cruzados , Humanos , Hidrocortisona/antagonistas & inhibidores , Hidrocortisona/sangre , Insulina/metabolismo , Secreción de Insulina , MasculinoRESUMEN
BACKGROUND: The authors evaluated whether adipose adiponectin expression is related to adipose tissue lipolytic activity and fatty acid oxidation rate in lean and obese women. METHODS: The study consisted of 60 adult females distributed in a wide range of adiposity (BMI 24.0-53.4 kg/m2). Body composition was estimated by bioelectrical impedance. Respiratory quotient was measured by open-circuit indirect calorimetry. RT-PCR assays were performed to measure TNFalpha and adiponectin expression in subcutaneous adipose tissue biopsies. Lipolysis studies were performed in fresh tissue samples obtained from subcutaneous abdominal depots during bariatric surgery in 19 morbidly obese females or by an incisional biopsy or during abdominal elective surgery in normal weight and obese females. Glycerol release was measured with a colorimetric endpoint method. RESULTS: Patients with a higher degree of adiposity showed lower adipose tissue adiponectin expression and hormone-sensitive lipase (HSL) activity than women in the low range of adiposity. HSL activity was positively related to adiponectin expression. No relationship was observed between adiponectin and TNFalpha subcutaneous adipose tissue expression. The positive relationship between respiratory quotient and adiponectin expression was in the limit of statistical significance (P=0.05). Percentage of body fat and mRNA adiponectin explained 26% of the variance of the adipose tissue HSL activity. CONCLUSIONS: Low adipose tissue adiponectin expression observed in obese people may contribute to the progression of obesity and its co-morbidities by modulating hormone-sensitive lipase activity and fatty acid oxidation.
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Tejido Adiposo/metabolismo , Colágeno/análisis , Péptidos y Proteínas de Señalización Intercelular/análisis , Lipólisis/fisiología , Obesidad/metabolismo , Adiponectina , Adulto , Anciano , Composición Corporal/fisiología , Índice de Masa Corporal , Dióxido de Carbono/metabolismo , Estudios de Cohortes , Ácidos Grasos/metabolismo , Femenino , Glicerol/análisis , Humanos , Insulina/sangre , Resistencia a la Insulina , Persona de Mediana Edad , Obesidad Mórbida/metabolismo , Oxidación-Reducción , Consumo de Oxígeno/fisiología , Esterol Esterasa/metabolismo , Factor de Necrosis Tumoral alfa/análisisRESUMEN
AIMS: To evaluate the effect of a whole formula diet on nutritional and cognitive status in Alzheimer's disease patients. METHODS: Patients were randomly assigned to two interventions: a whole formula diet based on lyophilised foods (Treatment Group, n=24) or nutritional advice (Control Group, n=29). Energy intake, body weight, biochemistry, Mini Nutritional Assessment (MNA) and Pfeiffer's tests were determined at baseline and at 3 months of treatment. RESULTS: No differences were observed between groups at baseline. Energy intake tended to increase in the Treatment Group and to decrease in the Control Group, although differences were not significant. The improvement in MNA and Pfeiffer test scores was not significantly different between groups. Body weight increased by 2.06+/-1.9 kg in the Treatment Group and by 0.32+/-3.04 kg in the Control Group (P=0.007). The increases in albumin (P=0.007), haemoglobin (P=0.002) and serum ferritin (P=0.009) were higher in the Treatment Group than in controls. A similar rate of serious adverse events (hospitalisation or death) was observed in both groups. CONCLUSIONS: Administration of this whole formula has a positive impact on nutritional status. The great diversity in textures and tastes enable these formulations to be administered to a wide range of patients with or without liquid dysphagia.
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Enfermedad de Alzheimer/dietoterapia , Enfermedad de Alzheimer/metabolismo , Cognición , Alimentos Formulados , Anciano , Enfermedad de Alzheimer/psicología , Peso Corporal , Ingestión de Energía , Femenino , Humanos , Masculino , Estado Nutricional/fisiología , Estudios Prospectivos , EspañaRESUMEN
Recent evidences from epidemiological and intervention trials suggest that a higher calcium intake is associated with a lower body weight and a reduction in total and central body fat. The potential role of calcium intake in the regulation of body adiposity has been explained by the intracellular calcium, which is able to promote adipocyte fat accumulation by exerting a coordinate regulation stimulating lipogenesis and suppressing lipolysis. Moreover, the intracellular calcium has been implicated on the etiopathogenesis of hypertension, insulin resistance and dyslipidemia, appearing as a potential common substrate in the metabolic syndrome. Dietary modulation of intracellular calcium through calciotropic hormones opens an exciting possibility to prevent and tackle obesity and its associated complications by increasing the calcium intake. However, available evidences are mostly indirect and further studies specifically designed for this purpose are needed.
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Calcio de la Dieta/administración & dosificación , Obesidad/prevención & control , Tejido Adiposo , Humanos , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/etiologíaRESUMEN
OBJECTIVE: To explore the determinants of the tumor necrosis factor alpha (TNFalpha) system and their relationship with plasma leptin levels. METHODS: We studied a cohort of 157 diabetic and non-diabetic females with a wide range of adiposity distributed into five groups: control--body mass index (BMI) between 19 and 27 kg/m(2) (n=24); obese--BMI between 27 and 40 kg/m(2) (n=63); obese type 2 diabetes mellitus--BMI between 27 and 40 kg/m(2) with diabetes mellitus (n=19); morbid obese--BMI >40 kg/m(2) (n=29); and morbid obese type 2 diabetes mellitus--BMI >40 kg/m(2) with diabetes (n=22). Fasting glucose levels, plasma total triglycerides and cholesterol, high-, low- and very low-density lipoprotein cholesterol were assayed by enzymatic and colorimetric methods. Plasma TNFalpha levels were measured by ELISA assay and insulin and leptin levels by radioimmunoenzymatic assays. Both soluble TNFalpha (sTNFalpha) receptors were measured by immunoenzymometric assays. RESULTS: All groups of patients showed significant increases in both sTNFalpha receptors relative to control. sTNFalpha receptor 1 (sTNFR1) was higher in morbid obese diabetic individuals compared with their non-diabetic counterparts (P=0.003), while sTNFR2 was significantly different between obese and morbid obese subjects (P=0.036). Bivariate correlation analysis showed a significant relationship between both plasma sTNFalpha receptors and BMI, percentage of body fat, fasting glucose, insulin and leptin. In multivariate analysis, both sTNF receptor plasma levels were predicted by percentage of body fat and the presence of diabetes (R(2)=0.20 for sTNFR1 and sTNFR2). When plasma leptin levels were added into the model, this protein and the presence of diabetes explained 27% of the variance of the plasma sTNFR1 levels. CONCLUSION: The presence of diabetes, adiposity or leptin levels are independent determinants of both sTNFalpha receptors. The independent association between plasma TNFalpha receptors and leptin levels in obese patients is consistent with the hypothesis that these proteins could be involved in the same pathway that regulates body adiposity.
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Diabetes Mellitus Tipo 2/metabolismo , Leptina/sangre , Obesidad/metabolismo , Receptores del Factor de Necrosis Tumoral/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo , Adulto , Anciano , Envejecimiento/fisiología , Estatura , Peso Corporal/fisiología , Diabetes Mellitus Tipo 2/patología , Femenino , Humanos , Hiperinsulinismo/sangre , Persona de Mediana Edad , Obesidad/patología , Obesidad Mórbida/sangre , Receptores de LeptinaRESUMEN
BACKGROUND: We evaluated the prevalence of co-morbidities, in particular diabetes, in a diverse population of morbidly obese patients who underwent gastric bypass surgery at our institution in New York City. METHODS: A retrospective study of 300 patients who had bariatric surgery between January 2001 and April 2002 was conducted. RESULTS: 57% of the patients had at least one metabolic complication, 30% had diabetes, 38% hypertension and 35% dyslipidemia. Our population was ethnically diverse, with 40% Hispanic, 34% Caucasian, 25% African-American and 1% Asian. There was no difference in the prevalence of diabetes among races. However, Caucasians had the highest prevalence of hyperlipidemia, and the Hispanic patients were the least hypertensive. Among patients with diabetes, one-third were undiagnosed and 50% untreated. Similarly, 45% of the hypertensive patients and 51% of those with hyperlipidemia remained undiagnosed. Men had more co-morbidities than women. CONCLUSION: These results suggest a high prevalence of co-morbid conditions in severely obese patients undergoing bariatric surgery. Age, ethnicity and gender influence the type of co-morbid conditions. More research is needed to understand why diabetes and other metabolic complications remain undiagnosed and untreated in a large number of these high risk patients.
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Población Negra , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Neoplasias/epidemiología , Obesidad Mórbida/epidemiología , Prevalencia , Población Blanca , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Distribución por Edad , Anciano , Análisis de Varianza , Pueblo Asiatico , Índice de Masa Corporal , Enfermedades Cardiovasculares/diagnóstico , Comorbilidad , Femenino , Gastroplastia , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Ciudad de Nueva York/epidemiología , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/cirugía , Probabilidad , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Análisis de Supervivencia , Población Urbana , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: Our aim was to measure the plasma concentrations of various vitamins and micronutrients involved in the immune response and antioxidant systems of an HIV+ population and to determine how they are related to the inflammatory response. PATIENTS AND METHOD: We studied 86 subjects with known HIV-infection who were divided into three groups (asymptomatic HIV+; AIDS without opportunistic infection; and AIDS with active opportunistic infection) which were compared with a control group. Serum concentrations of vitamin A, vitamin E, copper and zinc were measured, as well as several inflammatory parameters. Absorption tests for fat and sugar were performed in all patients. RESULTS: Serum vitamin A and E levels were below the reference range in 36.4% and 14.3% patients, respectively, but not in controls subjects. The prevalence of vitamin A deficiency increased with the severity of the disease. Fewer patients than controls had values below the reference range regarding serum copper. AIDS patients with active opportunistic infection showed significantly lower serum concentrations of vitamin A (p < 0.001) and significantly higher serum concentrations of copper (p < 0.0001). Both serum concentrations of vitamin A and copper were correlated with various inflammatory parameters. CONCLUSIONS: Micronutrient deficiencies are prevalent in HIV-infected patients including asymptomatic patients. Vitamin A and copper were significantly correlated with inflammatory parameters, suggesting that their serum concentrations have more to do with the inflammatory response than with the nutritional status.
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Cobre/sangre , Infecciones por VIH/sangre , Infecciones por VIH/inmunología , Vitamina A/sangre , Vitamina E/sangre , Zinc/sangre , Adulto , Anciano , Femenino , Humanos , Inflamación/sangre , Inflamación/inmunología , Masculino , Persona de Mediana EdadAsunto(s)
Glucemia/efectos de los fármacos , Glucosamina/farmacología , Leptina/sangre , Administración Oral , Adolescente , Adulto , Glucemia/análisis , Dexametasona/farmacología , Relación Dosis-Respuesta a Droga , Ayuno , Glucosamina/administración & dosificación , Glucosamina/metabolismo , Humanos , Resistencia a la Insulina , Leptina/biosíntesis , Obesidad/complicaciones , Obesidad/metabolismoAsunto(s)
Anciano , Trastornos Nutricionales/epidemiología , Factores de Edad , Anciano de 80 o más Años , Estudios Transversales , Enfermedades Carenciales/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Estado Nutricional , Factores de Riesgo , Factores Sexuales , España/epidemiologíaRESUMEN
OBJECTIVE: The aims of this study were to assess the changes that have occurred in food patterns in Europe over the last 40 years based on food availability data and to compare the stability of the traditional Mediterranean diet in the south of Europe in this period. DESIGN: An ecological study carried out on the basis of Food and Agriculture Organization food balance sheets for three geographical areas of Europe (Mediterranean, north and east) over two time periods: 1961-1963 and 1998-2000. The average availability of total energy, energy provided from macronutrients and food groups was calculated for each area and each period studied. RESULTS: Over the last 40 years total energy availability and energy availability from lipids have increased considerably in the three European areas, while the percentage of energy from carbohydrates has fallen. The greatest changes have occurred in Mediterranean Europe, with an increase of 20.1% in total energy availability, an increase of 48.1% in energy availability from lipids and a fall of 20.5% from carbohydrates. Moreover, Mediterranean Europe showed a significant fall in the energy supplied by cereals (29.9%) and wine (55.2%), while the contribution of milk (77.8%) and dairy products (23.6%) increased. CONCLUSIONS: The results of this study suggest that European Mediterranean countries should take nutrition policy action to maintain their traditional healthy food pattern, with a cultural added value. This implies actions at all levels, including raising awareness of consumers, collaboration with the food sector and a call to set the agenda of the concerned politicians and stakeholders.
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Encuestas sobre Dietas , Dieta Mediterránea , Dieta/tendencias , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Abastecimiento de Alimentos/estadística & datos numéricos , Análisis por Conglomerados , Dieta/estadística & datos numéricos , Dieta Mediterránea/estadística & datos numéricos , Grasas de la Dieta/efectos adversos , Grano Comestible , Ingestión de Energía/fisiología , Europa (Continente) , Conducta Alimentaria , Frutas , Humanos , Región Mediterránea , Aceite de Oliva , Aceites de Plantas , Verduras , VinoRESUMEN
Al-Andalus society (711-1492) based its idea of health on the wisdom of Classical Greece, the Hippocratic-Galenic theories, as well as the Persian and Hindu cultures. The twelfth century in al-Andalus is considered to be the most prolific period for works of a scientific and technical nature. At the time, the main treatises on dietetics were written and this science reached its widest expression with such leading figures as Ibn Wafid, Avenzoar, Averroes and Maimonides, whose works revealed the first scientific knowledge on the nutritional processes of the human body. Diet was regarded as being essential for health and the prevention of disease. Dietary guidelines were written for different age groups, different body types and different seasons of the year. The amount of food to be ingested, the number of meals recommended and the order in which the food should be consumed were all issues that were discussed. A variety of foods were thought to have medicinal properties, some of which are known today. The diet in al-Andalus was varied and very probably made a substantial contribution to the origin of the present-day Mediterranean diet, rich in olive oil, wholemeal cereals, fruit and vegetables, fish, lamb, poultry, nuts and spices. We also find that many of the terms in current use in diet and agriculture are a living testimony to the Arabic influence, as are many of the dishes of our varied Mediterranean gastronomy.
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Dieta/historia , Dietética/historia , Historia Medieval , Humanos , EspañaRESUMEN
OBJECTIVES: To explore the links between tumor necrosis factor alpha (TNFalpha) and leptin adipose tissue expression and low-grade systemic inflammation and to determine the relationship between inflammation and the degree of adiposity, the presence of type 2 diabetes, and other cardiovascular risk factors. RESEARCH METHODS AND PROCEDURES: Ninety-one women (BMI 19 to 65 kg/m(2)) were divided into tertiles of CRP. Insulin resistance was calculated using the HOMA method. Albumin, fibrinogen, C-reactive protein (CRP), interleukin-6, sTNFR1, sTNFR2, and leptin levels were measured in serum and plasma samples. TNFalpha and leptin expression were measured by reverse transcription-polymerase chain reaction in abdominal subcutaneous adipose tissue samples. RESULTS: CRP was positively related to BMI and upper distribution of adiposity. TNFalpha and leptin adipose tissue expression were higher in the upper tertile of CRP. Also, peripheral levels of both soluble TNFRs and leptin were higher in patients with the greatest inflammation degree. Diabetes, dislipidemia, and hypertension were most prevalent in patients in the upper CRP tertile. Inflammatory markers of diabetic women were significantly different from those of nondiabetic women, even after adjusting for differences in body fat. BMI, type 2 diabetes, and adipose TNFalpha mRNA levels were significant predictors of serum CRP levels (r(2) = 0.28, p < 0.001). DISCUSSION: These results are in agreement with the hypothesis that the synthesis of adipose tissue TNFalpha and leptin could induce the production of interleukin-6, CRP, and other acute-phase reactants, thus contributing to the maintenance of chronic low-grade inflammation state involved in the progression of obesity and its associated comorbidities.
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Tejido Adiposo/química , Expresión Génica , Inflamación/metabolismo , Leptina/genética , Factor de Necrosis Tumoral alfa/genética , Adulto , Antígenos CD/sangre , Composición Corporal , Índice de Masa Corporal , Proteína C-Reactiva/análisis , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Humanos , Hiperlipidemias/metabolismo , Hipertensión/metabolismo , Resistencia a la Insulina , Interleucina-6/sangre , Leptina/sangre , Recuento de Leucocitos , ARN Mensajero/análisis , Receptores de Leptina , Receptores del Factor de Necrosis Tumoral/sangre , Receptores Tipo I de Factores de Necrosis Tumoral , Receptores Tipo II del Factor de Necrosis TumoralRESUMEN
The hypocholesterolemic effects of phytosterols have not been evaluated in bakery products, and the addition of liposoluble antioxidants to the carrier has never been tested. We investigated the effects of consuming croissants and magdalenas (Spanish muffins) enriched with sterol esters, alpha-tocopherol and beta-carotene on plasma lipid and fat-soluble antioxidant concentrations in normocholesterolemic, habitual consumers of bakery products following their usual diet and lifestyle. Using a randomized, double-blind, placebo-controlled design, the control (C) group (n = 29) received two pieces daily (standard croissant and muffin) and the sterol ester (SE) group (n = 28), the same products with sterol esters added (3.2 g/d) for 8 wk. Total and LDL cholesterol (LDL-C) decreased in the SE group by 0.24 mmol/L (P < 0.01) and 0.26 mmol/L (P < 0.005), respectively, whereas these variables did not change in the control group. The total difference in total and LDL-C changes between groups was 0.38 mmol/L (8.9%) and 0.36 mmol/L (14.7%), respectively (P < 0.001). Within-group changes in HDL cholesterol, triacylglycerol or lipoprotein(a) concentrations did not differ. Similarly, within-group changes over time in plasma tocopherol and carotenoid concentrations did not differ between groups. Our findings suggest that bakery products are excellent carriers for phytosterols, and their consumption is associated with a decrease in total and LDL-C concentrations, with no changes in alpha-tocopherol and beta-carotene. The ability of bakery products to include sufficient quantities of beta-carotene to compensate for a potential deficiency, and the fact that their efficacy was not associated with the time of day at which they were consumed, are interesting findings.
Asunto(s)
LDL-Colesterol/sangre , Alimentos Fortificados , Fitosteroles/administración & dosificación , alfa-Tocoferol/administración & dosificación , beta Caroteno/administración & dosificación , Adulto , Apolipoproteínas B/sangre , Índice de Masa Corporal , Carotenoides/sangre , Colesterol/sangre , HDL-Colesterol/sangre , Método Doble Ciego , Femenino , Alimentos Fortificados/efectos adversos , Humanos , Licopeno , Masculino , Placebos , Esteroles/sangre , alfa-Tocoferol/sangre , beta Caroteno/sangreRESUMEN
En los últimos años diversos datos derivados de estudios epidemiológicosy de intervención sugieren que una mayor ingesta de calcio seacompaña de un menor peso corporal y una disminución de la adiposidadtotal y troncular. Este papel potencial de la ingesta de calcio enla regulación de la adiposidad corporal se ha explicado a través delcalcio intracelular, capaz de promover la acumulación de grasa en losadipocitos ejerciendo un control coordinado sobre la estimulación dela lipogénesis y la inhibición de la lipólisis. A su vez, el calcio intracelularse ha implicado en la etiopatogenia de la hipertensión arterial, laresistencia a la insulina y la dislipemia, presentándose como un posiblesustrato común en el síndrome metabólico. La posibilidad de modularel calcio intracelular a través de la regulación de las hormonascalciotropas ejercida por el calcio dietético abre una potencial vía deprevención y abordaje de la obesidad y sus complicaciones. Sin embargo,las evidencias disponibles en este sentido son indirectas y serequieren estudios específicamente diseñados a este fin
Recent evidences from epidemiological and intervention trials suggestthat a higher calcium intake is associated with a lower body weight anda reduction in total and central body fat. The potential role of calciumintake in the regulation of body adiposity has been explained by the intracellularcalcium, which is able to promote adipocyte fat accumulationby exerting a coordinate regulation stimulating lipogenesis and suppressinglipolysis. Moreover, the intracellular calcium has beenimplicated on the etiopathogenesis of hypertension, insulin resistanceand dyslipidemia, appearing as a potential common substrate in themetabolic syndrome. Dietary modulation of intracellular calcium throughcalciotropic hormones opens an exciting possibility to preventand tackle obesity and its associated complications by increasing thecalcium intake. However, available evidences are mostly indirect andfurther studies specifically designed for this purpose are needed