Triglyceride-Glucose Index Cutoff Point Is an Accurate Marker for Predicting the Prevalence of Metabolic Syndrome in Obese Caucasian Subjects.

BACKGROUND: Recently, the triglyceride-glucose (TyG) index has been suggested as a surrogate insulin resistance marker. This index could act as an early screening marker in individuals with a high risk of metabolic syndrome (MS) such as obese subjects. AIMS: The objective of this work was to detect the cutoff point of the TyG index for the diagnosis of MS according to ATPIII criteria on obese subjects and to compare with HOMA-IR. METHODS: We conducted a cross-sectional study in 1,494 obese subjects. Measurements of adiposity parameters, blood pressure, fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), lipid profile, C-reactive protein, adipokines, and the prevalence of MS were determined. The TyG index was calculated from the next equation: Ln (fasting triglycerides (mg/dL) × fasting glucose (mg/dL))/2. RESULTS: A total of 1,494 subjects were recruited, 421 males (28.1%) and 1,073 females (71.8%), with an average age of 45.8 ± 15.3 years (range: 29-62). A total of 677 subjects had MS (45.5%) and 817 did not show MS (54.6%). The averages of HOMA-IR and TyG index values increased as the components of MS were aggregated, and both indexes were higher in subjects with MS. The area under the curve (AUC) of the TyG index according to ATPIII criteria showed values of 0.746 (0.721-0.771; p = 0.001). The cutoff point according to the Youden index was 4.72, with sensitivity and specificity of 87% and 88.2%, respectively. For the HOMA-IR, AUC showed values of 0.682 (0.654-0.710; p = 0.01). The cutoff point was 3.23, with sensitivity and specificity of 78% and 70.1%, respectively. CONCLUSIONS: The TyG index is more powerful for predicting MS than HOMA-IR in Caucasian obese subjects.

Prevalence of Risk of Malnutrition and Risk of Sarcopenia in a Reference Hospital for COVID-19: Relationship with Mortality.

INTRODUCTION: Many elderly patients with COVID-19 are at risk of malnutrition. The aim of our study was to evaluate the risk of malnutrition and sarcopenia in elderly COVID-19 patients with the R-MAPP (Remote-Malnutrition APP). MATERIALS AND METHODS: A cross-sectional study of 337 consecutive outpatients ≥65 years who attended the Central Emergency COVID-19 Hospital of Castilla y Leon was conducted. In all patients, the protocol of R-MAPP (Malnutrition Universal Screening Tool [MUST] and Simple Questionnaire to Rapidly Diagnose Sarcopenia [SARC-F]) was realized. RESULTS: The mean age was 86.1 ± 8.7 years, with a sex distribution of 167 males (49.5%) and 170 females (51.5%). According to the MUST test, patients with 0 points have a low nutritional risk (n = 50, 14.8%), 1 point a medium nutritional risk (n = 19, 5.6%), and 2 or more points a high nutritional risk (n = 268, 79.6%). The SARC-F questionnaire generates patients with 4 or more points as predictive of sarcopenia (n = 304, 80.2%) and <4 points without prediction of sarcopenia (n = 33, 9.8%). Global mortality was 24.03% (n = 81). The mortality rate was related to the pathological SARC-F score ≥4 (27.1% vs. 3.1%; p = 0.01) and MUST score ≥2 (26.7% vs. 16.4%; p = 0.04). In the logistic regression analysis, only the SARC-F score ≥4 remained as an independent variable related to mortality; odds ratio was 8.34 (95% CI: 1.1-63.8; p = 0.04), adjusted for age, sex, albumin levels, and MUST test. CONCLUSIONS: During COVID-19 infection, hospitalized patients at risk of sarcopenia have a high risk of mortality and have a poor nutritional status.

APOA5 Variant rs662799, Role in Cardiovascular Traits and Serum Adipokine Levels in Caucasian Obese Subjects.

BACKGROUND AND AIMS: This ApoA5-1131C allele of rs662799 variant is related with a higher serum triglyceride levels, and it contributes to increase risk of cardiovascular disease. The aim of the present investigation was to evaluate single nucleotide polymorphism rs662799 in APOA5 gene and its associations with cardiovascular risk factors, MS, and serum adipokine levels. METHODS: The study involved a population of 1,002 Caucasian obese subjects. Measurements of body weight, waist circumference, fat mass, arterial blood pressure, blood glucose, C-reactive protein, insulin levels, insulin resistance (HOMA-IR), lipid profile, and adipokines levels were recorded. Genotype of ApoA5 gene polymorphism (rs662799) and prevalence of metabolic syndrome (MS) were evaluated. RESULTS: The distribution of the rs662799 polymorphism in this adult population (n = 1,002) was 88.3% (n = 885) (TT), 11.4% (n = 114) (TC), and 0.3% (n = 3) (CC). No significant differences were found between the 2 genotypes in the anthropometric data, MS, or blood pressure. Triglyceride levels were higher in C-allele carriers (delta total group: 19.7 ± 2.1 mg/dL: p = 0.02) than non C-allele carriers. HDL-cholesterol levels were lower in C-allele carriers (delta total group: -6.7 ± 1.1 mg/dL: p = 0.02) than non C-allele carriers. Adiponectin levels were lower in C-allele carriers (delta total group: -11.6 ± 1.0 mg/dL: p = 0.02) too. In C-allele carriers, logistic regression analysis showed an increased risk of hypertriglyceridemia (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.2-3.4, p = 0.001) and percentage of low-HDL-C (OR = 2.2, 95% CI = 1.3-3.7, p = 0.002) after adjusting by body mass index and age. CONCLUSIONS: C-allele carriers of rs662799 of APOA5 gene showed high rates of low levels of HDL and hypertriglyceridemia, with differences in triglyceride, HDL cholesterol, and adiponectin levels in Caucasian obese subjects.

Serum Lipid and Adiponectin Improvements after a Mediterranean Dietary Pattern in Non-G-Allele Carriers of the Variant rs3774261.

BACKGROUND: The role of adiponectin (ADIPOQ) polymorphisms in weight loss and serum lipid changes following different dietary interventions remain unclear. The Mediterranean dietary pattern has been associated with improved cardiovascular risk factors in different studies. OBJECTIVE: Our aim was to analyze the effects of a hypocaloric diet with a Mediterranean dietary pattern on the metabolic response and adiposity parameters, taking into account the 712 G/A rs3774261 polymorphisms in ADIPOQ. DESIGN: A population of 135 obese patients was enrolled. Anthropometric and serum parameters (lipid profile, insulin, homeostasis model assessment for insulin resistance [HOMA-IR], glucose, C-reactive protein [CRP], adiponectin, resistin, and leptin levels) were measured before and after the dietary intervention (12 weeks). All of the patients were genotyped for the rs3774261 polymorphism. RESULTS: The genotype distribution of this population was 36 patients with AA (26.7%), 68 patients with AG (50.4%), and 31 patients with GG (22.9%). After the dietary intervention and in both genotypes, BMI, weight, fat mass, systolic blood pressure, waist circumference, glucose, insulin, HOMA-IR, and leptin levels all decreased. After the dietary intervention with secondary weight loss and in non-G-allele carriers (AA vs. AG+GG), total cholesterol (Δ = -15.7 ± 3.9 vs. -4.9 ± 2.9 mg/dL; p = 0.02), LDL cholesterol (Δ = -15.3 ± 3.8 vs. -1.7 ± 1.9 mg/dL; p = 0.01), triglyceride levels (Δ = -23.4 ± 5.6 vs. 2.3 ± 2.3 mg/dL; p = 0.01), and CRP (Δ = -1.1 ± 0.1 vs. -0.4 ± 0.2 mg/dL; p = 0.01) decreased. Adiponectin levels (Δ = 7.2 ± 2.1 vs. -0.4 ± 0.3 ng/dL; p = 0.02) increased. Notably, G-allele carriers did not show this improvement. CONCLUSION: Non-G-allele carriers of the ADIPOQ variant (rs3774261) showed significant improvement in serum levels of adiponectin, lipid profiles, and CRP in response to a hypocaloric diet with a Mediterranean dietary pattern.

[Metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a familial hypercholesterolemia cohort in a Public Health Program]. / Evaluación del control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de hipercolesterolemia familiar en un programa de salud pública.

INTRODUCTION: Introduction and objective: familial heterozygous hypercholesterolemia (HFH) is the most common monogenic lipid metabolism disorder that associates premature cardiovascular disease. Our aim was to describe the degree of metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a cohort of HFH patients. Subjects and methods: a retrospective cohort study of the index cases and their relatives genetically diagnosed with HFH by the Endocrinology and Nutrition Service in the HCUV from 2009 to 2017. Anthropometric, clinical, laboratory, genetic, and treatment data were analyzed. Results: a total of 138 subjects were studied, with a mean age of 48.8 (17.7) years, 55.8% of them women. A gene mutation was found in 55.8%, and 10.1% had previous ischemic heart disease. At diagnosis mean total cholesterol was 281.1 (68.4) mg/dL, and LDL-C was 204 (65) mg/dL. Among family cases, at diagnosis, a lower mean age was observed [32.89 (19.2) years vs 50.3 (17.6) years, p < 0.001] as well as lower LDL values [181.9 (64.3) mg/dL vs 226.8 (52) mg/dL, p < 0.005] as compared to index cases. A positive correlation was observed between lipid-lowering treatment dose and LDL level reduction (r = 0.254, p < 0.05), although only 30% of patients reached their LDL target. Patients with HFH were highly adherent to Mediterranean diet, with an average score of 9.5 (1.9) in the Predimed test. Conclusions: early HFH detection is necessary to prevent premature cardiovascular events. A diagnosis of cases among family members anticipates the treatment of patients with HFH. Patients with HFH are more sensitive to heart-healthy diets.

INTRODUCCIÓN: Antecedentes y objetivo: la hipercolesterolemia familiar heterocigota (HFH) es el trastorno del metabolismo lipídico monogénico más común que se asocia a patología cardiovascular prematura. Nuestro objetivo fue describir el grado de control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de pacientes con HFH. Material y métodos: estudio de cohortes retrospectivo de casos índices y familiares diagnosticados genéticamente de HFH desde 2009 a 2017. Se analizaron los datos antropométricos, clínicos, analíticos, del estudio genético y del tratamiento. Resultados: se estudiaron 138 sujetos con una edad media de 48,8 (17,7) años, el 55,8% mujeres. Se encontró la mutación positiva en el 55,8%. La media de colesterol total al diagnóstico fue de 281,1 (68,4) mg/dl y la de LDL de 204 (65) mg/dl. El 10,1% presentaban cardiopatía isquémica previa. Entre los casos familiares se observó una menor edad media [32,89 (19,2) años vs. 50,3 (17,6) años, p < 0,001], así como valores de LDL inferiores en el momento del diagnóstico [181,9 (64,3) mg/dl vs. 226,8 (52) mg/dl, p < 0,005] en comparación con los casos índice. Se evidenció una correlación positiva entre dosis de tratamiento hipolipemiante y reducción de los niveles de LDL (r = 0,254, p < 0,05), aunque solo el 30% de los pacientes alcanzaron sus objetivos de LDL. Los pacientes con HFH presentaron una elevada adherencia a la dieta mediterránea, con una puntuación media de 9,5 (1,9) en el test Predimed. Conclusiones: la detección precoz de la HFH es necesaria para prevenir eventos cardiovasculares prematuros. El diagnóstico de casos familiares anticipa el tratamiento de los pacientes con HFH. Los pacientes con HFH están más sensibilizados sobre la adherencia a las dietas cardiosaludables.

Metabolomic-based noninvasive serum test to diagnose nonalcoholic steatohepatitis: Results from discovery and validation cohorts.

Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease worldwide and includes a broad spectrum of histologic phenotypes, ranging from simple hepatic steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). While liver biopsy is the reference gold standard for NAFLD diagnosis and staging, it has limitations due to its sampling variability, invasive nature, and high cost. Thus, there is a need for noninvasive biomarkers that are robust, reliable, and cost effective. In this study, we measured 540 lipids and amino acids in serum samples from biopsy-proven subjects with normal liver (NL), NAFL, and NASH. Using logistic regression analysis, we identified two panels of triglycerides that could first discriminate between NAFLD and NL and second between NASH and NAFL. These noninvasive tests were compared to blinded histology as a reference standard. We performed these tests in an original cohort of 467 patients with NAFLD (90 NL, 246 NAFL, and 131 NASH) that was subsequently validated in a separate cohort of 192 patients (7 NL, 109 NAFL, 76 NASH). The diagnostic performances of the validated tests showed an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.88 ± 0.05, 0.94, and 0.57, respectively, for the discrimination between NAFLD and NL and 0.79 ± 0.04, 0.70, and 0.81, respectively, for the discrimination between NASH and NAFL. When the analysis was performed excluding patients with glucose levels >136 mg/dL, the area under the receiver operating characteristic curve for the discrimination between NASH and NAFL increased to 0.81 ± 0.04 with sensitivity and specificity of 0.73 and 0.80, respectively. Conclusion: The assessed noninvasive lipidomic serum tests distinguish between NAFLD and NL and between NASH and NAFL with high accuracy. (Hepatology Communications 2018;2:807-820).

Financial impact of disease-related malnutrition at the San Pedro de Alcántara hospital. Estimated cost savings associated to a specialized nutritional survey. / Impacto económico de la desnutrición relacionada con la enfermedad en el hospital San Pedro de Alcántara. Estimación del ahorro asociado a una atención nutricional especializada de calidad.

INTRODUCTION AND OBJECTIVES: DRM is a highly prevalent condition in Spanish hospitals and is associated to increased healthcare costs. Costs associated to DRM were calculated using the methods of the PREDyCES study. The potential savings derived from specialized nutritional treatment were calculated by extrapolating the results of the SNAQ strategy. RESULTS: Median cost per procedure in patients with DRM was €9,679.85, with a final cost of €28,700,775.2. The cost of each patient with DRM was 2.63 times higher than the cost of patients with no DRM. The potential cost saving associated to specialized nutritional treatment was estimated at €1,682,317.28 (5.86% of total cost associated to DRM). CONCLUSIONS: Patients with DRM showed a higher consumption of financial resources as compared to well-nourished patients. Specialized nutritional treatment is a potential cost-saving procedure.

Study of tolerance and acceptance of a high energy density enteral formula in patients coronary unit study / Estudio de tolerancia y aceptación de una fórmula enteral con alta densidad energética en pacientes de una unidad de coronarias.

Objective: The aim of our study was to evaluate the tolerance of enteral formula with high energetic density in patients hospitalized in a coronary care unit requering enteral support for at least five days. Methods: Opened, non-comparative, nonrandomized, descriptive study, evaluating the tolerance of enteral formula with high energy density in patients admitted to a coronary care unit. Results: 31 patients were included with a mean age of 67.32 ± 13.8 years, 66.7% were male. The average prescribed final volume Nutrison Energy® was 928.5 ± 278.5 mL/day (range: 800-1,500 mL/day). The average duration of enteral nutrition was 11.2 ± 3.2 days. The average calorie intake was 1,392 ± 417 cal/day, with 169.9 ± 50.9 g/day of carbohydrates, 53.8 ± 16.1 g/day of fat and 55.7 ± 16.9 g/day of protein. After administration there was a significant increased levels of transferrin. A total of 3 patients had an episode of diarrhea (9.7%). The number of patients experiencing at least one episode of gastric residue was 5 (16.1%) not forced in any way to withdra wing enteral nutrition, forcing in 2 patients to diminish the nutritional intake volume for 24 hours. During nutritional support, in only 3 patients it was required to decrease the volume made the previous day energy formula. With regard to vomiting, in 1 patient this situation (3.2%) was verified. No patient in the study presented any digestive complications associated with the administration of the enteral nutrition formula. Finally, no adverse events related to the administered formulation were recorded. Conclusions: The results show that enteral formula with high energy density is a well-tolerated formula with a very low frequency of gastrointestinal symptoms, which favors compliance.

Objetivo: el objetivo de nuestro trabajo fue evaluar la tolerancia de una fórmula enteral con alta densidad energética en pacientes hospitalizados en una unidad de coronarias con indicación de soporte enteral al menos durante cinco días. Métodos: estudio abierto, no comparativo, no aleatorizado, descriptivo, para evaluar la tolerancia de una fórmula enteral con alta densidad energética en pacientes ingresados en una unidad coronaria. Resultados: se incluyeron 31 pacientes con una media de edad de 67,32 ± 13,8 años y de los cuales el 66,7% eran varones. El volumen medio final prescrito de Nutrison Energy® fue de 928,5 ± 278,5 ml/día (rango: 800-1.500 ml/día). La duración media de la nutrición enteral fue de 11,2 ± 3,2 días. El aporte final promedio de calorías fue de 1.392 ± 417 cal/día, con 169,9 ± 50,9 g/día de hidratos de carbono, 53,8 ± 16,1 g/día de grasas y 55,7 ± 16,9 g/día de proteínas. Tras la administracion existió un aumento significativo de los niveles de transferrina. Un total de 3 pacientes habían presentado algún episodio de diarrea (9,7%). El número de pacientes que presentaron al menos un episodio de residuo gástrico fue de 5 (16,1%) que no obligo en ningún caso a la suspensión de la nutrición enteral, obligando en 2 pacientes a disminuir el volumen del aporte nutricional durante 24 horas. Durante el soporte nutricional, solo en 3 pacientes fue necesario disminuir el volumen aportado el día previo de la fórmula energética. Con respecto a los vómitos, solo en 1 paciente se constató esta situación (3,2%). Ningún paciente presentó en el estudio otras complicaciones digestivas asociadas a la administración de la fórmula de nutrición enteral. Por último, no se registraron acontecimientos adversos relacionados con la fórmula administrada. Conclusiones: los resultados reflejan que una fórmula enteral con alta densidad energética es una fórmula bien tolerada con una muy baja frecuencia de síntomas gastrointestinales, lo que favorece el cumplimiento de la pauta.

Association of the rs9939609 gene variant in FTO with insulin resistance, cardiovascular risk factor and serum adipokine levels in obese patients.

INTRODUCTION: The aim of our study was to analyze the relationship of the rs9939609 FTO gene polymorphism with insulin resistance and serum adipokine levels. MATERIAL AND METHODS: A population of 610 patients with obesity was analyzed in a cross sectional design. Weight, blood pressure, basal glucose, c-reactive protein (CRP), insulin, insulin resistance (HOMA), lipid profile and adipocytokines (leptin, adiponectin, resistin, TNF alpha, and interleukin 6) levels were measured. RESULTS: Insulin (122.2 ± 101.8 pmol/L vs. 104.5 ± 61.5 pmol/L vs.112.1 ± 74.3 pmol/L:p < 0.05) and HOMA-IR values (4.76 ± 4.4 vs. 3.71 ± 2.5 vs.3.76 ± 3.1;p < 0.05) were higher in TT group than AT and AA groups. Triglycerides values were higher in TT group than AA group (1.42 ± 0.71 mmol/L vs.1.39 ± 0.69 mmol/L vs.1.23 ± 0.64 mmol/L;p < 0.05). Adiponectin levels were lower in TT genotype group than AA genotype group (35801.2 ± 35,912.3 ng/L vs.26,718.1 ± 36,323.1 ng/L vs. 21,112.3 ± 25,623.1 ng/L p < 0.05). CONCLUSION: The FTO gene polymorphism, rs9939609, was found to be associated with insulin resistance, insulin, triglyceride and adiponectin levels in obese patients with TT variant.

[Not Available]. / Association of the TNF-alpha -308 G/A polymorphisms with metabolic responses secondary to a high protein/low carbohydrate versus a standard hypocaloric diet.

BACKGROUND: Mutation analysis has identified a G-> A transition in the promoter region of TNF-alpha gene at position -308 (rs1800629). OBJECTIVE: The aim of our study was to investigate the influence of polymorphism in -308 GA promoter variant of the TNF alpha gene on metabolic response and weight loss secondary to two hypocaloric diets. METHOD: A sample of 283 obese subjects was enrolled in a consecutive prospective way. In the basal visit, patients were randomly allocated during 9 months to diet HP (high protein/low carbohydrate hypocaloric diet) and diet S (standard hypocaloric diet). RESULTS: There were no significant differences between the positive effects on weight loss in either genotype group with both diets. With both diets and only in wild genotype (diet HP vs. diet S), total cholesterol (-9.1 ± 3.4 mg/dL vs. -6.9 ± 2.0 mg/dL; p > 0.05), LDL cholesterol (-9.0 ± 2.9 mg/dL vs. -6.5 ± 2.1 mg/dL; p > 0.05) and triglycerides (-23.1 ± 5.1 mg/dL vs. -12.3 ± 4.8 mg/dL; p < 0.05) decreased. The improvement in triglycerides was higher in subjects without A allele. With diet HP and only in wild genotype, insulin levels (-3.1 ± 1.8 UI/L; p < 0.05) and HOMA-R (-0.8 ± 0.1 units; p < 0.05) decreased. CONCLUSION: Carriers of -308 GG promoter variant of TNF-alpha gene have a better metabolic response than -308 GA obese with a high protein hypocaloric diet.

Economic impact of and satisfaction with a high resolution thyroid nodule clinic at the endocrinology department. / Impacto económico y satisfacción de la implantación de una consulta de alta resolución de patología nodular tiroidea en Endocrinología.

BACKGROUND AND OBJECTIVE: No conclusive data exist on the value of a high resolution thyroid nodule clinic for management of nodular thyroid disease. The aim of this study was to evaluate the economic impact of and user satisfaction with a high resolution thyroid nodule clinic (HRTNC) in coordination with primary care. PATIENTS AND METHOD: A prospective, observational, descriptive study was conducted to analyze data from 3,726 patients (mean age 61±12 years; 85% women) evaluated at an HRTNC during 2014 and 2015. Demographic data (sex and age), number of ultrasound examinations and fine needle aspiration cytologies (FNAC), referral center and consultation type were assessed. RESULTS: In 2014 and 2015, 3,726 neck ultrasound examinations and 926 FNACs (3.8% rated as non-diagnostic) were performed. Among the 1,227 patients evaluated for the first time, 21.5% did not require a second endocrine appointment, which resulted in mean estimated savings of 14,354.55 euros. Of all patients, 41.1% were referred from primary care, 33.4% from endocrinology, and 26.5% from other specialties. As compared to 2013, the number of thyroid ultrasound examinations requested decreased by 65.3% and 59.7% in 2014 and 2015 respectively, with mean estimated savings of 137,563.92 euros. Mean user satisfaction assessed was 4.0 points (95% confidence interval, 3.7-4.3) on a 5-point scale. CONCLUSIONS: HRTNCs at endocrinology departments, coordinated with primary care, are a viable, cost-effective alternative with a positive user perception.

[NEURODEGENERATIVE DISEASES; NUTRITIONAL ASPECTS]. / ENFERMEDADES NEURODEGENERATIVAS; ASPECTOS NUTRICIONALES.

INTRODUCTION: neurodegenerative diseases cause changes in the level of consciousness or swallowing mechanisms that often necessitate a specialized nutritional support. OBJECTIVE: review the risk of malnutrition and its treatment in patients with cerebral vascular disease, Parkinson's disease, dementia and amyotrophic lateral sclerosis. DEVELOPMENT: degenerative neurological diseases are one of the main indications for nutritional support in our country. In acute processes (cerebral vascular disease), proper nutritional management is related to better outcomes and reduced complications. In chronic neurodegenerative processes (amyotrophic lateral sclerosis and dementia), malnutrition is a major problem that worsens the prognosis of these patients, the proper management of dysphagia and its complications, as well as the use of different stages of support being necessary nutritional. A correct nutritional evaluation of these patients and a right nutrition intervention is essential in monitoring their disease. Finally, in advanced Parkinson's disease, nutritional support, as in previous neurodegenerative diseases, is of huge importance. Protein dietary load and its distribution in the diet of these patients are important, too. Finally, American Society for Parenteral and Enteral Nutrition ASPEN recommend, with a degree of evidence B, performing a screening of malnutrition in patients with neurological diseases. CONCLUSIONS: a correct nutritional evaluation and adequate nutritional support should be part of diagnostic and therapeutic process of these diseases.

Introducción: las enfermedades neurodegenerativas producen alteraciones en el nivel de conciencia o en los mecanismos de la deglución que con frecuencia hacen necesario un soporte nutricional especializado. Objetivo: revisar el riesgo de desnutrición, así como su tratamiento, en pacientes con enfermedad cerebral vascular, enfermedad de Parkinson, demencia y esclerosis lateral amiotrófica. Desarrollo: las enfermedades neurológicas degenerativas son una de las principales indicaciones de soporte nutricional en nuestro país. En los procesos agudos (enfermedad vascular cerebral), el correcto manejo nutricional se relaciona con una mejor evolución y con una disminución de las complicaciones. En los procesos neurodegenerativos crónicos (esclerosis lateral amiatrófica y demencia), la malnutrición es un problema importante que empeora el pronóstico de estos pacientes siendo, necesario un correcto manejo de la disfagia y sus complicaciones, así como la utilización de diferentes etapas de soporte nutricional. Una correcta valoración nutricional de estos pacientes, así como un claro esquema de intervención nutricional, es imprescindible en el seguimiento de su enfermedad. Por último, en la enfermedad de Parkinson avanzada, el soporte nutricional, como en las enfermedades neurodegenerativas anteriores, es de vital importancia, sin olvidarnos de la carga proteica y su distribución en la dieta de estos pacientes. Las sociedades científicas internacionales (American Society for Parenteral and Enteral Nutrition ASPEN) recomiendan, con un grado de evidencia B, realizar un cribaje de malnutrición a los pacientes con enfermedades neurológicas. Conclusiones: una correcta valoración nutricional, así como un adecuado soporte nutricional deben formar parte del proceso diagnóstico y terapéutico de estas enfermedades.

Single-Cell Phenotypic Characterization of Human Pituitary GHomas and Non-Functioning Adenomas Based on Hormone Content and Calcium Responses to Hypothalamic Releasing Hormones.

Human pituitary tumors are generally benign adenomas causing considerable morbidity due to excess hormone secretion, hypopituitarism, and other tumor mass effects. Pituitary tumors are highly heterogeneous and difficult to type, often containing mixed cell phenotypes. We have used calcium imaging followed by multiple immunocytochemistry to type growth hormone secreting (GHomas) and non-functioning pituitary adenomas (NFPAs). Individual cells were typed for stored hormones and calcium responses to classic hypothalamic releasing hormones (HRHs). We found that GHomas contained growth hormone cells either lacking responses to HRHs or responding to all four HRHs. However, most GHoma cells were polyhormonal cells responsive to both thyrotropin-releasing hormone (TRH) and GH-releasing hormone. NFPAs were also highly heterogeneous. Some of them contained ACTH cells lacking responses to HRHs or polyhormonal gonadotropes responsive to LHRH and TRH. However, most NFPAs were made of cells storing no hormone and responded only to TRH. These results may provide new insights on the ontogeny of GHomas and NFPAs.

Predictive factors of non-alcoholic steatohepatitis: relationship with metabolic syndrome.

UNLABELLED: Non-alcoholic fatty liver disease (NAFLD) has been proposed as the hepatic manifestation of the metabolic syndrom (Ms), with insulin resistance (IR) as the common pathophysiological mechanism. METHODS: We included 145 patients with NAFLD proven liver biopsy. NAS-score was employed to grading NAFLD. We determined anthropometric measurements, basal blood pression (BP), biochemical measurements including high lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), triglycerides and leptin levels, homeostasis model assessment index (HOMA-IR), and abdominal ultrasound scan (US) was performed. Diagnosis of Ms was performed based on ATP III criteria. RESULTS: Average age was 43.6 + 11.2 years old and the mean body mass index (BMI) was 39 ± 10.7 kg/m2. Sex distribution was: females 66 and males 79. Forty patients (27.5%) presented a NAS score > = 5. Waist circumference (p = 0.007), systolic and diastolic BP (p = 0.002 and p = 0.003 respectively), (HOMA-IR) (p = 5. Independent factors associated to NAS-score > = 5 were Ms and BMI > 30. Leptin levels were higher in patients with advanced fibrosis (≥ F2) compared to patients with mild fibrosis (F0-F1) (75.5 + 50.2 ng/ml vs - 39.7 + 38.4 ng/ml respectively; p = 0.002). CONCLUSION: Presence of Ms and obesity (BMI >30) are the principal independent factors associated to NASH (NAS score > = 5). Leptin levels and BMI are higher in patients with advanced fibrosis.

La esteatohepatitis no alcoholica (EHNA) se ha propuesto como la manifestacion hepatica del sindrome metabolico (SM), con la resistencia a la insulina (IR) como mecanismo fisiopatologico comun. Métodos: se incluyeron 145 pacientes con biopsia hepatica con enfermedad por higado graso no alcoholica. NAS-score se utilizo para graduar la EHNA. Se realizaron las siguientes determinaciones; antropometria, presion arterial basal (BP), LDL colesterol, HDL colesterol, trigliceridos, leptina, resistencia a la insulina (HOMA- IR) y ecografia abdominal. El diagnostico de sindrome metabolico se realizo en base a los criterios del ATP III. Resultados: la edad fue 43,6 + 11,2 anos y la media de indice de masa corporal (IMC) 39 + 10.7 kg/ m2 (66 mujeres y 79 varones). Cuarenta pacientes (27,5%) presentaron una puntuacion NAS> = 5. La circunferencia de la cintura (p = 0,007), la presion arterial sistolica y diastolica (p = 0,002 y p = 0,003, respectivamente, la resistencia a la insulina (HOMA-IR) (p = 5. Los factores independientes asociados a NAS-score > = 5 fueron el SM y el IMC > 30. Los niveles de leptina fueron mayores en pacientes con fibrosis avanzada (≥ F2) en comparacion con los pacientes con fibrosis leve (F0-F1) (75,5 + 50,2 ng / ml frente a 39,7 + 38,4 ng / ml, respectivamente; p = 0.002). Conclusión: la presencia de SM y obesidad (IMC> 30) son los principales factores independientes asociados a la EHNA (puntuacion NAS> = 5). Los niveles de leptina y el IMC son mayores en los pacientes con fibrosis avanzada.

Effect on Liver Enzymes of Biliopancreatic Diversion: 4 Years of Follow-Up.

BACKGROUND: Elevated serum aminotransferase levels are commonly associated with obesity and with a progression to chronic liver disease. Bariatric surgery is the most effective strategy to achieve weight loss. METHODS: We conducted the present study with the aim of evaluating the influence of biliopancreatic diversion (BPD) on liver enzymes levels during 4 years in morbid obese patients with normal aminotransferase (n = 65) and in morbid obese patients with high aminotransferase basal levels (n = 50). RESULTS: A decrease in alanine aminotransferase and aspartate aminotransferase activities was significant after biliopancreatic diversion. The basal percentage of high aminotransferase levels and percentage of ratio ALT/AST <1 also decreased significantly at 1-, 2-, 3- and 4-years of follow-up in both groups. ALT (52 to 20%), AST (42 to 10%) and ALT/AST (80 to 22%) in patients with normal aminotransferase. ALT (82 to 20%), AST (70 to 6%) and ALT/AST (90 to 20%) in patients with elevated transaminase basal levels. Bariatric surgery was associated with a significant and sustained decrease in body weight in both groups. Serum trasnaminases level changes were positively correlated to body weight changes during follow-up. CONCLUSION: BPD is an effective method of achieving sustainable weight loss and reduced aminotransferase levels and enzyme ratios of liver damage.

Surgical infection and malnutrition.

BACKGROUND: Malnutrition in surgical patients is associated with delayed recovery, higher rates of morbidity and mortality, prolonged hospital stay, increased healthcare costs and a higher early re-admission rate. METHODS: Data synthesis after review of pertinent literature. RESULTS: The aetiology of malnutrition is multifactorial. In cancer patients, there is an abnormal peripheral glucose disposal, gluconeogenesis, and whole-body glucose turnover. Malnourished cancer patients undergoing major operations are at significant risk from perioperative complications such as infectious complications. Surgical aggression generates an inflammatory response which worsens intermediary metabolism. CONCLUSIONS: Nutritional evaluation and nutritional support must be performed in all surgical patients, in order to minimize infectious complications. Enteral nutrition early in the postoperative period is effective and well tolerated reducing infectious complications, improving wound healing and reducing length of hospital stay. Pharmaconutrition is indicated in those patients, who benefit from enteral administration of arginine, omega 3 and RNA, as well as parenteral glutamine supplementation. When proximal sutures are used, tubes allowing early jejunal feeding should be used.

Introducción: La malnutrición en pacientes quirúrgicos está relacionada con un retraso en la recuperación, tasas más elevadas de morbilidad y mortalidad, estancia hospitalaria prolongada, mayores costes de atención sanitaria y una tasa más elevada de re-hospitalización temprana. Métodos: Síntesis de datos tras la revisión de la bibliografía pertinente. Resultados: La etiología de la malnutrición es multifactorial. En pacientes con cáncer, existe una alteración en la utilización de la glucosa periférica, en la gluconeogénesis, y en la producción de glucosa en todo el cuerpo. Los pacientes con cáncer que se someten a operaciones mayores tienen un riesgo significativo de complicaciones perioperativas, como es el caso de las complicaciones de tipo infeccioso. La agresión quirúrgica genera una respuesta inflamatoria que empeora el metabolismo intermediario. Conclusiones: Es necesario realizar una evaluación nutricional y llevar a cabo un soporte nutricional en todos los pacientes quirúrgicos con el fin de minimizar las posibles complicaciones infecciosas. La nutrición enteral justo al inicio del periodo postoperatorio es bien tolerada y resulta eficaz a la hora de reducir complicaciones infecciosas, mejorando el proceso de curación de la herida y la duración de la estancia hospitalaria. La nutrición farmacológica está indicada en pacientes que reciben administración enteral de arginina, omega 3 y ARN, además de suplementación por vía parenteral. Cuando se utilizan suturas proximales, se deben emplear sondas que permitan una alimentación yeyunal temprana.

[Modified texture diet and useful in patients with nutritional risk]. / Menú de textura modificada y su utilidad en pacientes con situaciones de riesgo nutricional.

In the nutritional management of patients with dysphagia and/or elderly must make a multidisciplinary approach and a main tool is changing the texture of food. Patients with dysphagia, who need a texture modified diet, generally do not have a calorie and nutrient requirements different from those exhibited by people of the same age and sex, unless a condition or disease coexist. In these patients, Texture of foods should be individualized according to the patient and the time course of their disease. The use of texture modified diets without specifying produces a clear decrease in caloric and protein intakes and nutritional disorders. These patients may have other characteristics associated diseases, which would require special modification, as in the case of diabetes mellitus, hypertension, osteoporosis and constipation. Sometimes it is necessary to use artificial products to achieve different desired textures and precooked dishes, too.

En el tratamiento nutricional de los pacientes con disfagia y/o ancianos debemos realizar un abordaje multidisciplinar, y una herramienta de trabajo es la modificación de la textura de los alimentos. Los pacientes con disfagia y con necesidades de una dieta modificada de textura, en general no tienen unos requerimientos de calorías y nutrientes diferentes de los que presentan las personas de su misma edad y sexo, salvo que coexista alguna condición o enfermedad. En todos ellos se debe individualizar su textura en función del paciente y del momento evolutivo de su enfermedad. EL uso de dietas modificadas de textura sin individualizar, conlleva una clara disminución de la ingesta calórica y proteica, así como potenciales alteraciones nutricionales. Estos pacientes por sus características pueden tener otras patologías asociadas que obligarían a realizar modificaciones especiales, como es el caso de la diabetes mellitus, hipertensión arterial, osteoporosis y estreñimiento. En ocasiones es necesario utilizar diferentes productos artificiales para alcanzar las texturas deseadas, así como platos ya precocinados.

Papel de la variante del promotor G308 del factor de necrosis tumoral α sobre el peso y parámetros metabólicos tras una dieta rica en grasas monoinsaturadas frente a una dieta rica en grasas poliinsaturadas / Role of G308 promoter variant of tumor necrosis factor alpha gene on weight loss and metabolic parameters after a high monounsaturated versus a high polyunsaturated fat hypocaloric diets

Background and objective: The aim of our study was to investigate the influence of G-308 promoter variant of the tumor necrosis factor (TNF) alpha gene on metabolic changes and weight loss secondary to a high monounsaturated fat vs a high polyunsaturated fat hypocaloric diet in obese subjects. Patients and method: A sample of 261 obese subjects were enrolled in a consecutive prospective way, from May 2011 to July 2012 in a tertiary hospital. In the basal visit, patients were randomly allocated during 3 months to Diet M (high monounsaturated fat hypocaloric diet) and Diet P (high polyunsaturated fat hypocaloric diet). Results: One hundred and ninety seven patients (73.2%) had the genotype G-308G and 64 (26.8%) patients had the genotype G-308A. There were no significant differences between the effects (on weight, body mass index (BMI), waist circumference, fat mass) in either genotype group with both diets. With the diet type P and in genotype G-308G, glucose levels (−6.7(22.1) mg/dl vs −3.7(2.2) mg/dl: p = 0.02), HOMA-R (−0.6(2.1) units vs −0.26(3.1) units: p = 0.01), insulin levels (−1.7(6.6) UI/L vs −0.6(7.1) UI/L: p = 0.009), total cholesterol levels (−15.3(31.1) mg/dl vs −8.4(22.1) mg/dl: p = 0.01), LDL cholesterol levels (−10.7(28.1) mg/dl vs −3.8(21.1) mg/dl: p = 0.008) and triglycerides (−12.1(52.1) mg/dl vs −6.6(43.1) mg/dl: p = 0.02) decreased. Conclusion: Carriers of the G-308G promoter variant of TNF alpha gene have a better metabolic response than A-308 obese with a high polyunsaturated fat hypocaloric diet (AU)

Fundamento y objetivo: El objetivo de este estudio es investigar la influencia de la variante G-308 del promotor del gen TNF-αsobre los cambios metabólicos y pérdida de peso secundaria a una dieta hipocalórica rica en grasas monoinsaturadas frente a una dieta rica en grasas poliinsaturadas. Pacientes y método: Una muestra de 261 obesos fue reclutada de una manera prospectiva consecutiva, desde mayo de 2011 a julio de 2012 en un hospital terciario. En la visita basal fueron aleatorizados a recibir las siguientes dietas durante al menos 3 meses: dieta M (rica en grasa monoinsaturada) y dieta P (rica en grasa poliinsaturada). Resultados: Ciento noventa y siete (73,2%) obesos presentaron el genotipo G-308G, y 64 (26,8%), el genotipo G-308A. No hubo diferencias significativas en la mejoría de peso, IMC, circunferencia de la cintura y masa grasa con ambas dietas y en ambos genotipos. Tras la dieta P y con el genotipo G-308G, los niveles de glucosa (−6,7 [22,1] vs. −3,7 [2,2] mg/dl; p = 0,02), HOMA-R (−0,6 [2,1] vs. −0,26 [3,1] unidades; p = 0,01), insulina (−1,7 [6,6] vs. −0,6 [7,1] UI/l; p = 0,009), colesterol total (−15,3 [31,1] vs. −8,4 [22,1] mg/dl; p = 0,01), colesterol LDL (−10,7 [28,1] vs. −3,8 [21,1] mg/dl; p = 0,008) y triglicéridos (−12,1 [52,1] mg/dl vs. −6,6 [43,1] mg/dl; p = 0,02) disminuyeron. Conclusión: Los portadores del genotipo G-308G presentan mayores beneficios metabólicos tras la pérdida de peso generada por la dieta rica en grasas poliinsaturadas (AU)

Role of G308 promoter variant of tumor necrosis factor alpha gene on weight loss and metabolic parameters after a high monounsaturated versus a high polyunsaturated fat hypocaloric diets.

BACKGROUND AND OBJECTIVE: The aim of our study was to investigate the influence of G-308 promoter variant of the tumor necrosis factor (TNF) alpha gene on metabolic changes and weight loss secondary to a high monounsaturated fat vs a high polyunsaturated fat hypocaloric diet in obese subjects. PATIENTS AND METHOD: A sample of 261 obese subjects were enrolled in a consecutive prospective way, from May 2011 to July 2012 in a tertiary hospital. In the basal visit, patients were randomly allocated during 3 months to Diet M (high monounsaturated fat hypocaloric diet) and Diet P (high polyunsaturated fat hypocaloric diet). RESULTS: One hundred and ninety seven patients (73.2%) had the genotype G-308G and 64 (26.8%) patients had the genotype G-308A. There were no significant differences between the effects (on weight, body mass index (BMI), waist circumference, fat mass) in either genotype group with both diets. With the diet type P and in genotype G-308G, glucose levels (-6.7(22.1)mg/dl vs -3.7(2.2)mg/dl: p = 0.02), HOMA-R (-0.6(2.1)units vs -0.26(3.1)units: p = 0.01), insulin levels (-1.7(6.6)UI/L vs -0.6(7.1)UI/L: p = 0.009), total cholesterol levels (-15.3(31.1)mg/dl vs -8.4(22.1)mg/dl: p = 0.01), LDL cholesterol levels (-10.7(28.1)mg/dl vs -3.8(21.1)mg/dl: p = 0.008) and triglycerides (-12.1(52.1)mg/dl vs -6.6(43.1)mg/dl: p = 0.02) decreased. CONCLUSION: Carriers of the G-308G promoter variant of TNF alpha gene have a better metabolic response than A-308 obese with a high polyunsaturated fat hypocaloric diet.

Lys656Asn polymorphism of leptin receptor gene is related with leptin changes after a high monounsaturated fat diet in obese patients.

BACKGROUND: Human obesity is characterized by high levels of leptin, and it has been suggested that obese patients may be leptin resistant. The aim of our study was to investigate the influence of Lys656Asn polymorphism in the leptin receptor gene on metabolic response, weight loss, and serum leptin levels to a high monounsaturated fat hypocaloric diet in obese patients. DESIGN: A sample of 126 obese patients was analyzed in a prospective way. The hypocaloric diet had 1342 kcal, 46.6% of carbohydrates, 34.1% of lipids, and 19.2% of proteins, with a 67.5% of monounsaturated fats, during 3 months. RESULTS: In Lys656Lys genotype, body mass index (-1.8 ± 1.4 kg/m), weight (-4.3 ± 3.7 kg), fat mass (-3.5 ± 3.5 kg), waist circumference (-5.0 ± 2.9 cm), systolic blood pressure (-3.8 ± 10.5 mm Hg), insulin (-1.5 ± 4.6 mUI/L), and homeostasis model assessment of insulin resistance (-0.4 ± 1.9 Units) decreased. In Asn allele carriers, body mass index (1.5 ± 2.1 kg/m), weight (-3.7 ± 3.1 kg), waist circumference (-4.4 ± 3.1 cm) decreased. Only leptin levels have a significant decrease in the Lys656Lys group (-6.9 ± 10.1 ng/mL) (24.2%). CONCLUSIONS: Patients with Asn656 allele have a different response than Lys656Lys genotype subjects, with a lack of decrease in insulin levels, leptin levels, and homeostasis model assessment of insulin resistance after weight loss.