Lack of association between serum apelin levels and sarcopenia in elderly malnourished subjects.

OBJECTIVE: Sarcopenia is a condition characterized by muscle mass loss. Skeletal muscle is capable of producing and secreting different molecules called myokines, and apelin is one of them. The literature contains contradictory data on the relationship between apelin and sarcopenia. We decided to investigate the role of apelin in sarcopenia in subjects with disease-related malnutrition (DRM), a group of patients with a high rate of sarcopenia. PATIENTS AND METHODS: 83 elderly patients with DRM assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria were included in the study, with a mean age of 69.9±3.8 years. Anthropometric data, muscle mass by ultrasound at the rectus femoris quadriceps (RFQ) level, bioimpedance [skeletal muscle mass (SMM), appendicular SMM (aSMM) and aSMM index (aSMMI)], dynamometry, biochemical parameters, dietary intake, circulating apelin levels were determined in all patients. RESULTS: a total of 33 patients (37.9%) were diagnosed with sarcopenia, while 54 patients did not present sarcopenia (60.1%). Body weight (-5.5±2.0 kg, p=0.01), calf circumference (-1.9±0.2 cm, p=0.02), phase angle (-0.6±0.2º, p=0.01), reactance (-6.8±2.3 Ohms, p=0.03), resistance (-38.8±12.3 Ohms, p=0.04), SMM (-2.2±0.3 kg, p=0.04), aSMM (-2.2±0.2 kg, p=0.03) and aSMMI (-0.6±0.2 kg, p=0.02), dominant muscle area (-0.6±0.2 cm2, p=0.04), dominant Y axis (-0.4±0.1 cm, p=0.03), dominant X/Y axis (1.1±0.3 cm, p=0.04), strength (-5.1±1.3 kg, p=0.01), albumin (-0.9±0.1 g/dl, p=0.02) and prealbumin (-4.6±0.7 mg/dl, p=0.02) were worse in patients with sarcopenia than non-sarcopenic patients. Circulating apelin levels were similar in both groups. No significant correlation of apelin levels was detected, either with bioimpedance data or with muscle ultrasonography data. The multivariant analysis did not detect a significant association of apelin with the presence of sarcopenia. CONCLUSIONS: Our study shows a lack of association between apelin and sarcopenia in elderly malnourished patients.

Relationship between fat-free mass and metabolic syndrome in obese females.

OBJECTIVE: A greater fat-free mass (FFM) could be negatively or positively associated with metabolic syndrome (MS). The objective of this work was to evaluate the relationship of FFM with MS, through three determinations; absolute FFM, relative to body weight FFM% and relative to squared height (FFMi). PATIENTS AND METHODS: We conducted a cross-sectional study on 1,008 obese Caucasian females. Fat-free mass index (FFMi) was calculated by dividing FFM by squared height [FFM (kg)/height (m2)]. Fat-free mass percentage (FFM%) was calculated (absolute FFM/body weight) x100. RESULTS: The odds ratio adjusted by age of having MS per tertiles were significantly higher in tertile 3 of FFM (OR=1.74, 95% CI=1.26-2.41; p=0.01) and FFMi (OR=3.38, 95% CI=2.42-3.72; p=0.001) and tertile 2 of FFM (OR=1.45, 95% CI=1.08-1.94; p=0.02) and FFMi (OR=2.37, 95% CI=1.75-3.20; p=0.01) compared with its reference (tertile-1). In contrast, odds ratio adjusted by age of having MS per tertiles were significantly lower in tertile-3 of FFM% (OR=0.29, 95% CI=0.20-0.41; p=0.01) and tertile- 2 of FFM% (OR=0.68, 95% CI=0.51-0.91; p=0.01) compared with its reference (tertile-1). CONCLUSIONS: The prevalence of MS relative to FFM varies depending on the method used to represent it.

Valoración morfofuncional del estado nutricional y vinculación con Atención Primaria / Morphofunctional assessment of nutritional status and connection with Primary Care

Una evaluación e intervención nutricional adecuada se asocia a un mejor pronóstico y a una disminución de los costes en el paciente hospitalizado. Tras el alta, es necesaria una buena comunicación entre el médico especialista en endocrinología y nutrición y el médico especialista de Atención Primaria (AP) para asegurar la continuidad asistencial. Teniendo en cuenta el punto del médico de AP y del especialista en nutrición clínica, en este artículo se resumen las herramientas de valoración morfofuncional del estado nutricional, tanto clásicas como emergentes, destacando aquellas que se pueden utilizar en AP. Además, se dan algunas claves para mejorar la relación bidireccional y la comunicación entre los especialistas en nutrición y los médicos de AP (AU)

Appropriate nutritional assessment and interventions are associated with improved prognosis for hospitalized patients and reduced healthcare expenditure. After discharge, good communication between endocrinology specialists and primary care physicians is necessary to ensure continuity of care. Regarding the primary care provider and the specialist in clinical nutrition, this article summarizes traditional and novel tools for the morphofunctional assessment of nutritional status, with an emphasis on those that can be used in primary care. We also give some key points to improve relationships and communication between specialists in nutrition and primary care physicians (AU)

RS9939609 FTO gene variant modified weight loss and insulin resistance after a partial meal-replacement hypocaloric diet.

OBJECTIVE: Some studies have demonstrated that the allele A of FTO rs9939609 is related to both higher waist circumference and body mass index. Subsequently, some designs related biochemical variables and body weight changes with this genetic variant. We decide to analyze the effects of rs9939609 genetic variant of FTO gene on metabolic parameters and weight loss secondary to partial meal replacements hypocaloric diets (pMRHDs) in obese subjects. PATIENTS AND METHODS: This was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects. The patients received nutritional education and a pMRHDs with two intakes of normocaloric hyperproteic formula during 12 weeks. Anthropometric parameters and biochemical profiles were measured at basal time and after 12 weeks. The variant of FTO gene rs9939609 was determined. RESULTS: Genotype distribution (n=44) was (16 TT (36.4%), 17 TA (38.6%) and 11 AA (25.0%)). After the pMRHD, body weight, body mass index (BMI), fat mass, waist circumference, serum leptin levels and systolic blood pressure improved in both genotypes without statistical differences in both branches. After dietary intervention with pMRHD, subjects with A allele showed a significant improvement in total cholesterol levels (TT vs. TA+AA) (-3.8±1.4 md/dL vs. -12.6±1.7 mg/dl: p=0.01), LDL-cholesterol (-0.2±1.5 md/dL vs. -10.5±1.9 mg/dl: p=0.02), insulin levels (-1.9±0.2 mU/L vs. -3.8±0.3 mU/L: p=0.02) and HOMA-IR (-0.6±0.2 units vs. -1.1±0.1 units: p=0.01). CONCLUSIONS: Our data suggest that the genetic variant (rs9939609) of FTO gene showed better improvement of LDL-cholesterol, insulin and HOMA-IR in subjects with A allele.

Effects of a High-Protein/Low-Carbohydrate versus a Standard Hypocaloric Diet on Weight and Cardiovascular Risk Factors during 9 Months: Role of a Genetic Variation in the Cannabinoid Receptor Gene (CNR1) (G1359A Polymorphism).

OBJECTIVE: We decided to investigate the role of this polymorphism on cardiovascular risk factors and weight loss secondary to a high-protein/low-carbohydrate vs. a standard hypocaloric diet (1,000 kcal/day) over a period of 9 months. MATERIAL AND METHODS: A nutritional evaluation was performed at the beginning and at the end of a 9-month period in which subjects received 1 of 2 diets (diet HP: high protein/low carbohydrate vs. S: standard diet). RESULTS: One hundred and four patients (54.7%) had the genotype G1359G and 86 (45.3%) patients had G1359A (77 patients, 25.8%) or A1359A (9 patients, 3.7%) (A-allele-carriers). In subjects with both genotypes, the body mass index, weight, fat mass, waist circumference and systolic blood pressures decreased with both diets. After the diet type HP and in subjects with both genotypes, the glucose, leptin, total cholesterol, LDL-cholesterol, insulin and HOMA-R levels decreased. After diet S and in all subjects, the total cholesterol, LDL cholesterol and leptin levels decreased, too. CONCLUSION: Our interventional study didn't show a relationship between the rs1049353 CNR-1 polymorphism and body weight response after two different hypocaloric (low carbohydrate/high protein vs. standard) diets over a period of 9 months. However, a low-carbohydrate/high-protein diet for 9 months improved glucose metabolism in subjects with both genotypes.

[Effect of nutritional support on survival in patients with amyotrophic lateral sclerosis]. / Efecto del soporte nutricional sobre la supervivencia en pacientes con esclerosis lateral amiotrófica.

INTRODUCTION: Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease. METHODS: A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition. RESULTS: There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38). CONCLUSIONS: The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.

[Changes on dietary habits of the late-breakfast in a school population]. / Modificación de los hábitos alimentarios del almuerzo en una población escolar.

BACKGROUND: The establishment of healthy eating habits in children at school and in family life is very important for preventing obesity in children. AIMS: To know the habits of late-breakfast in a scholar population, the prevalence of overweight and obesity, and establish healthy dietary habits through the late-breakfast. METHODS: A prospective interventional study was performed in a school group. Children from 10 to 13 years-old were included. The study had three phases: pre-intervention (anthropometric assessment and questionnaire of late-breakfast frequency), intervention (parents and teachers received information about "the importance of proper nutrition in school" focused on the transcendence of a healthy and balanced diet that includes a suitable late-breakfast every day at school, and the students received the late-breakfast during two weeks that included milk, fruit and a traditional sandwich), and post-intervention (questionnaire of late-breakfast frequency). RESULTS: Frequency of overweight was 10.6% and obesity 2.6%. After the intervention the proportion of children who had late-breakfast increased by 9.2%, and the kind of food which they ate changed. CONCLUSION: Dietary habits can be modified in a scholar population with an easy nutritional intervention.

Enfermedad de Cushing en la edad pediátrica. Tratamiento y evolución / Cushing’s syndrome in pediatric age. Treatment and evolution

El síndrome de Cushing endógeno es infrecuente en pediatría. La causa principal son los tumores hipofisarios productores de corticotropina (enfermedad de Cushing). Debe sospecharse en todo niño con una ganancia ponderal injustificada asociada a una disminución de la velocidad de crecimiento. La primera opción terapéutica en la enfermedad de Cushing es la adenomectomía transesfenoidal, seguida de la radioterapia si persiste el hipercortisolismo. Tras el tratamiento pueden asociarse alteraciones hipofisarias que precisen terapia sustitutiva; el déficit de hormona del crecimiento en niños puede originar un crecimiento recuperador insuficiente. Presentamos el caso de una niña de casi 11 años de edad, con ganancia ponderal injustificada, estancamiento del crecimiento, virilización y miopatía proximal. Mediante las determinaciones hormonales se confirmó un hipercortisolismo dependiente de corticotropina. La resonancia magnética craneal puso de manifiesto un microadenoma hipofisario, que se resecó mediante adenomectomía transesfenoidal, con remisión clínica y analítica. Previamente se había instaurado tratamiento con ketoconazol para controlar el hipercortisolismo. Al cabo de 4 años no había signos de recidiva (AU)

Endogenous Cushing’s syndrome is rare endocrine disorders in pediatric age whose most common cause are the pituitary tumors producers of adrenocorticotropin (ACTH) (Cushing’s syndrome, CS). This disease must be suspected in any children with unjustified weight gain associated with a decrease in the speed of growth. The first therapeutic option in the CS is the transsphenoidal adenomectomy, followed by radiotherapy if CS persists. After the treatment pituitary disorders can be associated which will need a substitutive therapy, growth hormone deficit can cause an inadequate catch-up growth in children. We report the case of a nearly 11 years-old girl with unjustified weight gain, growth stagnation, signs of virilization and proximalmyopathy. Through hormonal determinations was confirmed an ACTH-dependent hypercortisolism was confirmed. The cranial MRI showed a pituitary micro adenoma that was removed through transsphenoidal adenomectomy with clinical and analytic remission. Before surgery, ketoconazole was used in order to control hypercortisolism. There were no signs of relapse four years later (AU)

[Impact of nutritional treatment in the evolution of inflammatory bowel disease]. / Impacto de la nutrición en la evolución de la enfermedad inflamatoria intestinal.

Inflammatory bowel disease is an entity with not wellknown pathogenesis, and important nutritional and metabolic implications because of the high prevalence of malnutrition, the possible implication of dietary factors in its pathogenesis and because of the hypothesis that nutritional intervention could be a primary treatment for the disease. Some nutrients could induce a low antigenic stimuli, regulate inflammatory and immunological responses and stimulate intestinal mucosal trophism. Present available evidence supports enteral nutrition in Crohn's disease as a primary treatment if treatment with steroids is not possible (failure or contraindication) (grade of recommendation A) or either combined treatment with drugs in malnourished patients or those with inflammatory bowel stenosis. In those patients with sustained clinical remission, no benefit of either enteral nutrition or supplements in the absence of nutritional deficits has been shown. Elemental or modified formula (glutamine, omega 3 fatty acids) could not be recommended. In ulcerative colitis, nutritional influence over the activity of the disease has not been shown, although there are some promising results regarding enteric coated W3 fatty acids and a possible role for probiotics. In the treatment and prevention of pouchitis, there could be a role for probiotics (VSL#3). Nutritional treatment should be considered an integral component in the Management of patients with inflammatory bowel disease.

[Effectiveness of dietetic treatment in nephrotic syndrome]. / Eficacia del tratamiento dietético en el síndrome nefrótico.

We present the case of a male patient suffering from a primary amyloidosis and a nephrotic syndrome who came to dietotherapy clinic. In the first visit we made a nutritional record including an anthropometric evaluation, body composition, biochemistry, and food intake. The patient had an excess of body water, proteinuria, low plasma protein, albumin, prealbumin and HDL cholesterol levels, and high concentrations of total cholesterol, LDL and triglycerides. The consumption of protein and sodium was higher than the recommendation. An individualized diet was made. Six months later, his weight and the excess of body water decreased, but the fat free mass remained unchanged. The levels of albumin and prealbumin increased, the proteinuria decreased. Total cholesterol, LDL and triglycerides decreased until normal levels. Dietetary treatment in nephrotic syndrome is effective to decrease proteinuria, improve cholesterol and triglycerides levels, and to prevent malnutrition.