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1.
Clin Nutr ; 42(7): 1168-1174, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-37230851

RESUMEN

BACKGROUND AND AIMS: Atherosclerosis is the major risk factor for cardiovascular disease (CVD), the first cause of death worldwide. Chronic low-grade inflammation and a sustained oxidative milieu are causatively related to atherosclerosis onset and progression, and therefore, dietary patterns rich in bioactive compounds with anti-inflammatory and antioxidant activities might likely contribute to revert or slowing the progression of atherosclerosis. The aim of this study is to analyse the association between fruit and vegetables intake, quantitatively measured through carotene plasma concentrations, and atherosclerotic burden, as a surrogate biomarker of CVD, in free-living subjects from the DIABIMCAP cohort study. METHODS: The 204 participants of the DIABIMCAP Study cohort (Carotid Atherosclerosis in Newly Diagnosed Type 2 Diabetic Individuals, ClinicalTrials.gov Identifier: NCT01898572), were included in this cross-sectional study. Total, α-, and ß-carotenes were quantified by HPLC-MS/MS. Lipoprotein analysis in serum was performed by 2D- 1H NMR- DOSY, and atherosclerosis and intima media thickness (IMT) were measured through standardized bilateral carotid artery ultrasound imaging. RESULTS: Subjects with atherosclerosis (n = 134) had lower levels of large HDL particles than subjects without atherosclerosis. Positive associations were found between α-carotene and both large and medium HDL particles, and inverse associations were found between ß- and total carotene, and VLDL and its medium/small particles. Subjects with atherosclerosis presented significantly lower plasma concentrations of total carotene compared with subjects without atherosclerosis. Plasma concentrations of carotene decreased as the number of atherosclerotic plaques increased, although after multivariate adjustment, the inverse association between ß- and total carotene with plaque burden remained significant only in women. CONCLUSIONS: A diet rich in fruit and vegetables results in higher plasmatic carotene concentrations, which are associated with a lesser atherosclerotic plaque burden.


Asunto(s)
Aterosclerosis , Enfermedades de las Arterias Carótidas , Placa Aterosclerótica , Humanos , Femenino , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/complicaciones , Grosor Intima-Media Carotídeo , Estudios de Cohortes , Estudios Transversales , Espectrometría de Masas en Tándem , Enfermedades de las Arterias Carótidas/etiología , Aterosclerosis/complicaciones , Carotenoides , Factores de Riesgo , Inflamación/complicaciones
2.
Nutrients ; 12(6)2020 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-32517202

RESUMEN

Diabetic subjects are at increased risk of cardiovascular disease. Atherosclerosis, the common soil of most of the cardiovascular complications, is more prevalent and extensive in this population due not only to hyperglycemia, insulin resistance, and dyslipidemia, but also to inflammation and oxidative stress. Lycopenes are bioactive compounds with antioxidant and anti-inflammatory activities mostly supplied by tomato and tomato byproducts. We investigated the association between circulating lycopenes and carotid plaque burden in diabetic patients, in a cross-sectional study in 105 newly diagnosed diabetic subjects. Atheroma plaque (wall thickness ≥ 1.5 mm), number of plaques, and plaque burden (sum of maximum heights of all plaques) were assessed by sonographic evaluation of carotid arteries. Plasma lycopenes (5-cis-, 9-cis-, 13-cis-, and trans-lycopene) were quantified by high performance liquid chromatography-mass spectrometry HPLC-MS. Atheroma plaque was observed in 75 participants, from which 38 presented one plaque and 37 two or more carotid plaques. No differences were observed in the plasmatic concentrations of lycopenes between subjects with and without atherosclerotic plaque presence. However, plaque burden was inversely associated with 5-cis-lycopene, all cis-lycopene isomers, trans-lycopene, and total lycopene isomers (all, p < 0.05). High plasma levels of lycopenes inversely relate to atherosclerotic burden. We provide novel evidence that suggests that the consumption of compounds found in tomato and tomato byproducts might be beneficial for the prevention of atherosclerosis.


Asunto(s)
Aterosclerosis/etiología , Aterosclerosis/prevención & control , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/metabolismo , Licopeno/sangre , Placa Aterosclerótica/metabolismo , Solanum lycopersicum , Adulto , Anciano , Antioxidantes , Arterias Carótidas/metabolismo , Arterias Carótidas/patología , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/patología , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/patología
3.
J Clin Lipidol ; 11(2): 551-561.e7, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28502513

RESUMEN

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is an emerging, highly prevalent, cardiovascular risk factor, and lipoprotein proatherogenic disturbances likely explain a large part of this risk. However, information regarding associations between detailed nuclear magnetic resonance (NMR) lipoprotein changes and noninvasive NAFLD scores is lacking. OBJECTIVE: The objective of the study was to investigate the NMR-assessed atherogenic lipoprotein profile according to noninvasive NAFLD status. METHODS: Lipoprotein profiles by NMR spectroscopy and NAFLD status by fatty liver index (FLI) and Gholam's models. RESULTS: We assessed 173 participants (55% males), mean age 60.8 ± 7.8 years, 87% overweight/obese, 53% with diabetes. An FLI <30, 30 to 60, and >60 was found in 32, 50, and 91 participants, respectively. Individuals with FLI >60 had lower high-density lipoprotein (HDL)-cholesterol (P < .001), higher triglyceride (P < .001), and similar non-HDL-cholesterol (P = .912) concentrations. In NMR analysis, FLI was related with very-low-density lipoprotein (VLDL) and HDL parameters in a dose-dependent manner. VLDL particle number (P < .001) and VLDL size (39.1 ± 0.99, 39.7 ± 0.96, 40.8 ± 1.19 nm, P < .001) increased with increased FLI (<30, 30-60, and >60, respectively). Conversely, although total HDL particle number did not differ by FLI (P = .377), larger HDL particles (P < .001), amount of cholesterol within HDL particles (P < .001), and HDL size (median [p25-p75]: 8.23 [8.08-8.41], 8.12 [8.03-8.29], 8.04 [7.93-8.16] nm, P < .001) decreased as FLI increased. FLI >60 (vs <60) was associated with a higher proportion of small LDL particles (P = .010) and lower LDL size (19.85 ± 0.34 vs 19.98 ± 0.25 nm; P = .005). Similar findings were found for Gholam's model. CONCLUSION: Simple and noninvasive NAFLD scores are useful to detect many of the proatherogenic changes (especially in VLDL and HDL), beyond conventional lipids parameters that are common in individuals with this high-risk condition.


Asunto(s)
Aterosclerosis/complicaciones , Dislipidemias/complicaciones , Lipoproteínas/sangre , Enfermedad del Hígado Graso no Alcohólico/sangre , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Anciano , Femenino , Humanos , Lipoproteínas/química , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad
4.
J Nutr Biochem ; 38: 81-85, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27732912

RESUMEN

Consistent evidence supports the pro-atherogenic properties of dietary trans-fatty acids (TFAs). However, there are no clinical data on TFA intake and atheroma plaque. We cross sectionally investigated whether the proportion of total C18:1 TFA in red blood cells (RBCs), which mirrors dietary TFA intake, independently relates to carotid plaque prevalence in subjects with new-onset type 2 diabetes mellitus without prior cardiovascular disease (n=101, 56% men, mean age 61 years) and age- and sex-matched controls (n=96). RBC fatty acid composition was determined by gas chromatography. Plaque (defined as carotid intima-media thickness ≥1.5 mm) was sonographically assessed at three bilateral carotid segments. In multivariate models adjusting for group (diabetes or control) and classical cardiovascular risk factors, for each 0.1% increase in RBC total C18:1 TFA isomers, plaque prevalence increased by 53% (P=.002). In contrast, for each 0.1% increase in RBC alpha-linolenic acid, the vegetable omega-3 fatty acid, plaque prevalence decreased by 43% (P<.001). We conclude that the RBC membrane proportion of total C18:1 TFA, considered a proxy of intake, directly relates to the ultrasound feature that best predicts future cardiovascular events. Our findings support current recommendations to limit TFA intake for cardiovascular health promotion.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/sangre , Grasas Insaturadas en la Dieta/efectos adversos , Membrana Eritrocítica/metabolismo , Ácidos Oléicos/sangre , Placa Aterosclerótica/complicaciones , Ácidos Grasos trans/sangre , Anciano , Biomarcadores/sangre , Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Estudios Transversales , Angiopatías Diabéticas/epidemiología , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/prevención & control , Grasas Insaturadas en la Dieta/uso terapéutico , Ácidos Grasos Omega-3/sangre , Ácidos Grasos Omega-3/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ácidos Oléicos/efectos adversos , Placa Aterosclerótica/sangre , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/epidemiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , España/epidemiología , Ácidos Grasos trans/efectos adversos , Ultrasonografía Doppler en Color
5.
Atherosclerosis ; 247: 161-9, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26921744

RESUMEN

BACKGROUND AND AIMS: Atherogenic dyslipidemia is common in type 2 diabetes (T2DM) and predicts cardiovascular disease, but information on the association of its components with atherosclerosis is scarce. We aimed to assess differences in the lipoprotein profile in newly-diagnosed T2DM and matched control individuals and their associations with preclinical carotid atherosclerosis. METHODS: In a case-control study, we evaluated lipoprotein profiles by nuclear magnetic resonance (NMR) spectroscopy and determined carotid intima-media thickness (IMT) and plaque presence (IMT ≥1.5 mm) by B-mode ultrasonography. RESULTS: We assessed 96 T2DM patients (median age 63 years, 44% women, 19% smokers, 54% hypertension, 38% dyslipidemia) and 90 non-diabetic controls matched for age, sex, and cardiovascular risk factors. In T2DM VLDL-particles (mainly large and enriched in cholesterol and triglycerides) were increased, and large HDL-particles (enriched in triglycerides and depleted in cholesterol) were reduced (p < 0.05; all comparisons). Regarding associations with preclinical atherosclerosis, VLDL triglyceride content (odds ratio [OR], 8.975; 95% confidence interval [CI], 2.330-34.576), total number of VLDL particles (OR, 2.713; CI, 1.601-4.598) and VLDL size (OR, 2.044; CI, 1.320-3.166), and the ratio cholesterol/triglycerides in HDL (OR, 0.638; CI, 0.477-0.852) were associated with plaque burden (≥3 plaques) independently of confounders, including conventional lipid levels. CONCLUSION: NMR-assessed advanced lipoprotein profile identifies lipid abnormalities associated with newly-diagnosed T2DM and preclinical atherosclerosis that are not captured by the traditional lipid profile. At this early stage of diabetes, NMR lipoproteins could be useful to identify candidates for a more comprehensive cardiovascular risk prevention strategy.


Asunto(s)
Enfermedades de las Arterias Carótidas/sangre , Diabetes Mellitus Tipo 2/sangre , Dislipidemias/sangre , Lipoproteínas/sangre , Espectroscopía de Resonancia Magnética , Anciano , Enfermedades Asintomáticas , Biomarcadores/sangre , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Arteria Carótida Común/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Placa Aterosclerótica , Valor Predictivo de las Pruebas , Prevalencia , Factores de Riesgo , España/epidemiología
6.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 29(10): 759-772, dic. 2011. tab
Artículo en Español | IBECS | ID: ibc-97002

RESUMEN

La evaluación de nuevos casos de infección por el virus de la inmunodeficiencia humana (VIH) es relativamente frecuente, ya que en España se diagnostican cada año varios miles de pacientes con nuevas infecciones. El 80% de los casos tienen una infección crónica por el VIH que puede ser sintomática (diagnóstico tardío) hasta en un 30% de pacientes. La evaluación clínica inicial de la infección por el VIH no está dirigida solo a conocer la situación clínica, virológica (carga viral del VIH, estudio de resistencias y tropismo viral) e inmunológica (cifra de linfocitos CD4) del VIH, sino que debe dirigirse también al estudio de las coinfecciones (virus de la hepatitis, tuberculosis) y comorbilidades (cardiovascular, hepática, renal y ósea) del paciente y al riesgo de transmisión del VIH con el fin de decidir si se debe iniciar o no el tratamiento antirretroviral y con qué fármacos antirretrovirales iniciarlo, la profilaxis de las infecciones oportunistas y el tratamiento de las coinfecciones y comorbilidades. La anamnesis, el examen físico y las pruebas complementarias nos ayudarán a decidir si el paciente es tributario de una intervención terapéutica. El nivel de linfocitos T CD4+, además de sugerir el momento de iniciar el tratamiento (..) (AU)


The evaluation of new cases of HIV infection is relatively common in Spain, where several thousands of patients with new infections are diagnosed each year. Eighty per cent of them have a chronic HIV infection at the first clinical evaluation, which is symptomatic (late presenters) in up to 30% of patients. The initial evaluation of HIV infection is not only directed at determining the clinical, virological (plasma HIV RNA viral load, resistance test and viral tropism) and immunological (CD4+ T-cell cell count) situation of the patients, but must also address the study of their co-infections (hepatitis, tuberculosis) and comorbidities (cardiovascular, hepatic, renal and bone) and the risk of HIV transmission. This is needed in order to decide, whether or not to start antiretroviral treatment, and with which combined antiretroviral treatment to start with, the prophylaxis of opportunistic infections, and the treatment of coinfections and comorbidities. The past and current medical history, the physical examination and laboratory tests will help us decide if the patient is to receive therapeutic intervention. The level of CD4+ T-cell lymphocytes is the best marker to suggest when to start combined antiretroviral treatment, indicating whether or not to start prophylaxis against opportunistic infections (if patients have a CD4+ T-cell count below 200 cells/mm3), and in advanced patients should make us suspect the presence of active opportunistic diseases in symptomatic cases. The management of patients with HIV infection must also include appropriate health education on the modes of transmission and prevention of HIV infection, and also to explain its natural history and how it can be modified with proper antiretroviral treatment, as well as to promote a healthy life. No less important is the psychological support, as these patients must learn to live with a chronic infection, which managed properly can ensure a very good long-term prognosis and quality of life (AU)


Asunto(s)
Humanos , Infecciones por VIH/epidemiología , Seropositividad para VIH/complicaciones , Antirretrovirales/uso terapéutico , Linfocitos T CD4-Positivos , Síndrome de Inmunodeficiencia Adquirida/inmunología , Carga Viral , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Factores de Riesgo , Progresión de la Enfermedad
7.
Enferm Infecc Microbiol Clin ; 29(10): 759-72, 2011 Dec.
Artículo en Español | MEDLINE | ID: mdl-22078726

RESUMEN

The evaluation of new cases of HIV infection is relatively common in Spain, where several thousands of patients with new infections are diagnosed each year. Eighty per cent of them have a chronic HIV infection at the first clinical evaluation, which is symptomatic (late presenters) in up to 30% of patients. The initial evaluation of HIV infection is not only directed at determining the clinical, virological (plasma HIV RNA viral load, resistance test and viral tropism) and immunological (CD4+ T-cell cell count) situation of the patients, but must also address the study of their co-infections (hepatitis, tuberculosis) and comorbidities (cardiovascular, hepatic, renal and bone) and the risk of HIV transmission. This is needed in order to decide, whether or not to start antiretroviral treatment, and with which combined antiretroviral treatment to start with, the prophylaxis of opportunistic infections, and the treatment of coinfections and comorbidities. The past and current medical history, the physical examination and laboratory tests will help us decide if the patient is to receive therapeutic intervention. The level of CD4+ T-cell lymphocytes is the best marker to suggest when to start combined antiretroviral treatment, indicating whether or not to start prophylaxis against opportunistic infections (if patients have a CD4+ T-cell count below 200 cells/mm(3)), and in advanced patients should make us suspect the presence of active opportunistic diseases in symptomatic cases. The management of patients with HIV infection must also include appropriate health education on the modes of transmission and prevention of HIV infection, and also to explain its natural history and how it can be modified with proper antiretroviral treatment, as well as to promote a healthy life. No less important is the psychological support, as these patients must learn to live with a chronic infection, which managed properly can ensure a very good long-term prognosis and quality of life.


Asunto(s)
Infecciones por VIH/terapia , VIH-1 , Serodiagnóstico del SIDA , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Comorbilidad , Diagnóstico Tardío , Manejo de la Enfermedad , Farmacorresistencia Viral , Infecciones por VIH/sangre , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , VIH-1/efectos de los fármacos , VIH-1/aislamiento & purificación , Humanos , Estado de Ejecución de Karnofsky , Anamnesis , Examen Físico , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Carga Viral , Viremia/tratamiento farmacológico
8.
Med. clín (Ed. impr.) ; 137(9): 390-397, oct. 2011.
Artículo en Español | IBECS | ID: ibc-91900

RESUMEN

Background and objectives: To validate four instruments to detect domestic violence in health-care settings against external criteria -Index of Spouse Abuse (ISA), Psychological Maltreatment of Women Inventory short form (PMWI-SF), Woman Abuse Screening Tool (WAST), Partner Violence Screen (PVS)- and to assess the concordance and compare the diagnostic accuracy.Subjects and method: This was a case-control study. The study sample was recruited from primary care and domestic violence centers. The ISA, PMWI-SF, WAST and PVS were administered to 223 controls and 182 intimate partner violence cases. Received Operating Characteristic (ROC) curve analysis was carried out. Measures were compared in terms of ROC curves and overall agreement. Results:The areas under the curve (AUC) were: ISA 0.99 (IC 95%, 0.98-0.99), PMWI-SF 0.98 (IC 95% 0.97-0.99), WAST 0.95 (IC 95% 0.93-0.97), PVS 0.91 (IC 95% 0.87-0.94). The overall agreement between the four tools was excellent (Fleiss Kappa=0.82). The ISA and the PMWI-SF performed slightly better than WAST, and these three instruments performed better than PVS for detecting domestic violence. The PVS had lower concordance values with the other instruments.Conclusions: The four instruments demonstrated adequate diagnostic accuracy and overall agreement for detect domestic violence. Some overestimation of sensitivity may occur due to different source of cases (AU)


Fundamento y objetivo: Estudio de la validación externa y comparación de la precisión diagnóstica y concordancia de cuatro instrumentos para la identificación de la violencia de pareja (VP) en el ámbito sanitario: Index of Spouse Abuse (ISA), Psychological Maltreatment of Women Inventory short form (PMWI-SF), Woman Abuse Screening Tool (WAST), Partner Violence Screen (PVS).Sujetos y método: Estudio de casos y controles. La muestra se reclutó en centros de asistencia primaria y centros especializados en VP. Completaron los cuestionarios ISA, PMWI-SF, WAST y PVS un total de 223 mujeres sin maltrato (controles) y 182 con maltrato de pareja (casos). Se evaluó la precisión diagnóstica mediante la estimación por intervalo del área bajo la curva ROC, se compararon las áreas bajo la curva (ABC) y se realizó un análisis de la concordancia entre ellos.Resultados: Los valores de ABC fueron: ISA 0,99 (intervalo de confianza del 95% [IC 95%] 0,98-0,99), PMWI-SF 0,98 (IC 95% 0,97-0,99), WAST 0,95 (IC 95% 0,93-0,97), PVS 0,91 (IC 95% 0,87-0,94). La concordancia entre los cuatro cuestionarios fue excelente (Kappa de Fleiss=0,82). Los valores del ABC del ISA y el PMWI-SF fueron significativamente mayores que el del WAST, y los tres obtuvieron un mejor funcionamiento que el PVS. El PVS fue el cuestionario que obtuvo menor concordancia con el resto.Conclusiones: Todos los cuestionarios estudiados obtuvieron un buen funcionamiento global para la detección de la VP y una alta concordancia entre ellos. La sensibilidad puede estar sobreestimada debido a la distinta procedencia de los casos (AU)


Asunto(s)
Humanos , Femenino , Violencia Doméstica/estadística & datos numéricos , Encuestas y Cuestionarios , Maltrato Conyugal/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Encuestas Epidemiológicas/métodos
9.
Med Clin (Barc) ; 137(9): 390-7, 2011 Oct 08.
Artículo en Español | MEDLINE | ID: mdl-21757210

RESUMEN

BACKGROUND AND OBJECTIVES: To validate four instruments to detect domestic violence in health-care settings against external criteria -Index of Spouse Abuse (ISA), Psychological Maltreatment of Women Inventory short form (PMWI-SF), Woman Abuse Screening Tool (WAST), Partner Violence Screen (PVS)- and to assess the concordance and compare the diagnostic accuracy. SUBJECTS AND METHOD: This was a case-control study. The study sample was recruited from primary care and domestic violence centers. The ISA, PMWI-SF, WAST and PVS were administered to 223 controls and 182 intimate partner violence cases. Received Operating Characteristic (ROC) curve analysis was carried out. Measures were compared in terms of ROC curves and overall agreement. RESULTS: The areas under the curve (AUC) were: ISA 0.99 (IC 95%, 0.98-0.99), PMWI-SF 0.98 (IC 95% 0.97-0.99), WAST 0.95 (IC 95% 0.93-0.97), PVS 0.91 (IC 95% 0.87-0.94). The overall agreement between the four tools was excellent (Fleiss Kappa=0.82). The ISA and the PMWI-SF performed slightly better than WAST, and these three instruments performed better than PVS for detecting domestic violence. The PVS had lower concordance values with the other instruments. CONCLUSIONS: The four instruments demonstrated adequate diagnostic accuracy and overall agreement for detect domestic violence. Some overestimation of sensitivity may occur due to different source of cases.


Asunto(s)
Mujeres Maltratadas/psicología , Refugio de Emergencia , Atención Primaria de Salud , Maltrato Conyugal/diagnóstico , Encuestas y Cuestionarios , Adulto , Área Bajo la Curva , Estudios de Casos y Controles , Femenino , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Curva ROC , Reproducibilidad de los Resultados , España/epidemiología , Maltrato Conyugal/estadística & datos numéricos , Adulto Joven
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