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Dietary protein restriction induces adaptive changes in food preference, increasing protein consumption over carbohydrates or fat. We investigated whether motivation and reward signaling underpin these preferences. In an operant task, protein-restricted male mice increased their responding for liquid protein rewards, but not carbohydrate, fat, or sweet rewards. The protein restriction-induced increase in operant responding for protein was absent in Fgf21-KO mice and mice with neuron-specific deletion of the FGF21 co-receptor beta-Klotho (KlbCam2ka) mice. Fiber photometry recording of VTA dopamine neurons revealed that oral delivery of maltodextrin triggered a larger activation of dopamine neurons as compared to casein in control-fed mice, while casein produced a larger response in protein-restricted mice. This restriction-induced shift in nutrient-specific VTA dopamine signaling was lost in Fgf21-KO mice. These data demonstrate that FGF21 acts in the brain to induce a protein-specific appetite by specifically enhancing the reward value of protein-containing foods and the motivation to consume them.
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Free-feeding animals navigate complex nutritional landscapes in which food availability, cost, and nutritional value can vary markedly. Animals have thus developed neural mechanisms that enable the detection of nutrient restriction, and these mechanisms engage adaptive physiological and behavioral responses that limit or reverse this nutrient restriction. This review focuses specifically on dietary protein as an essential and independently defended nutrient. Adequate protein intake is required for life, and ample evidence exists to support an active defense of protein that involves behavioral changes in food intake, food preference, and food motivation, likely mediated by neural changes that increase the reward value of protein foods. Available evidence also suggests that the circulating hormone fibroblast growth factor 21 (FGF21) acts in the brain to coordinate these adaptive changes in food intake, making it a unique endocrine signal that drives changes in macronutrient preference in the context of protein restriction. This article is part of the Special Issue on "Food intake and feeding states".
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Ingestión de Alimentos , Factores de Crecimiento de Fibroblastos , Preferencias Alimentarias , Factores de Crecimiento de Fibroblastos/metabolismo , Animales , Preferencias Alimentarias/fisiología , Ingestión de Alimentos/fisiología , Humanos , Nutrientes , Proteínas en la Dieta/administración & dosificación , Adaptación Fisiológica/fisiología , Dieta con Restricción de Proteínas , Encéfalo/metabolismo , Encéfalo/fisiologíaRESUMEN
Metabolic syndrome (MetS), which includes obesity, diabetes, hypertension, hyperlipidemia, and fatty-liver disease, affects more than two-thirds of the U.S. population. Surgical weight loss has been popularized in the last several decades as a means to produce significant weight loss and improvements in the comorbidities of MetS. Women are by far the most common recipients of these surgeries (more than 85%). Women of childbearing age are very likely to pursue surgical weight loss to improve their reproductive function and fertility for childbearing purposes. Significant research using pre-clinical models from our laboratory and clinical data from around the world suggest that surgical weight loss before pregnancy may have negative consequences for offspring. The present study investigates the metabolic endpoints in female-rodent offspring born to dams who had previously received vertical sleeve gastrectomy (VSG) before pregnancy. Comparisons were made to offspring from lean and obese dams. In the adult offspring of either maternal VSG or sham surgery, no differences in body weight, body fat, or lean body mass between groups were identified. The blood pressure measured in a subset of female offspring showed no differences between the VSG and the sham groups. Estrus cyclicity measured by lavage on serial days showed altered cycles in the VSG offspring compared to the controls. For animals that had previously only been exposed to chow, rats were fasted overnight and then given a 1 g meal of either chow or a novel high-fat diet (HFD). The animals were euthanized and paraformaldehyde (PFA)-perfused to perform brain immunohistochemistry for c-Fos, an immediate-early gene activated by novel stimuli. In the VSG rats exposed to either the chow or the HFD meal, the c-Fos-activated cells were significantly blunted in the nucleus of the solitary tract (p < 0.05), the paraventricular nucleus of the hypothalamus (PVN) (p < 0.05), and the dorsal medial nucleus of the hypothalamus (DMH) (p < 0.05) in comparison to the sham controls. These data suggest that the hypothalamic wiring within the brain that controls the response to nutrients and reproductive function was significantly altered in the VSG offspring compared to the offspring of the dams that did not receive weight-loss surgery.
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Dietary protein restriction is increasingly recognized as a unique approach to improve metabolic health, and there is increasing interest in the mechanisms underlying this beneficial effect. Recent work indicates that the hormone FGF21 mediates the metabolic effects of protein restriction in young mice. Here we demonstrate that protein restriction increases lifespan, reduces frailty, lowers body weight and adiposity, improves physical performance, improves glucose tolerance, and alters various metabolic markers within the serum, liver, and adipose tissue of wildtype male mice. Conversely, mice lacking FGF21 fail to exhibit metabolic responses to protein restriction in early life, and in later life exhibit early onset of age-related weight loss, reduced physical performance, increased frailty, and reduced lifespan. These data demonstrate that protein restriction in aging male mice exerts marked beneficial effects on lifespan and metabolic health and that a single metabolic hormone, FGF21, is essential for the anti-aging effect of this dietary intervention.
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Factores de Crecimiento de Fibroblastos , Fragilidad , Longevidad , Animales , Dieta con Restricción de Proteínas , Factores de Crecimiento de Fibroblastos/metabolismo , Fragilidad/metabolismo , Hormonas/metabolismo , Hígado/metabolismo , Masculino , RatonesRESUMEN
The goal of this study was to investigate the distribution of serotypes and clonal composition of Streptococcus pneumoniae isolates causing invasive pneumococcal disease (IPD) in Catalonia, before and after systematic introduction of PCV13. Pneumococcal strains isolated from normally sterile sites obtained from patients of all ages with IPD received between 2013 and 2019 from 25 health centers of Catalonia were included. Two study periods were defined: presystematic vaccination period (2013 and 2015) and systematic vaccination period (SVP) (2017 to 2019). A total of 2,303 isolates were analyzed. In the SVP, there was a significant decrease in the incidence of IPD cases in children 5 to 17 years old (relative risk [RR] 0.61; 95% confidence interval [CI] 0.38 to 0.99), while there was a significant increase in the incidence of IPD cases in 18- to 64-year-old adults (RR 1.33; 95% CI 1.16 to 1.52) and adults over 65 years old (RR 1.23; 95% CI 1.09 to 1.38). Serotype 8 was the major emerging serotype in all age groups except in 5- to 17-year-old children. In children younger than 5 years old, the main serotypes in SVP were 24F, 15A, and 3, while in adults older than 65 years they were serotypes 3, 8, and 12F. A significant decrease in the proportions of clonal complexes CC156, CC191, and ST306 and an increase in those of CC180, CC53, and CC404 were observed. A steady decrease in the incidence of IPD caused by PCV13 serotypes indicates the importance and impact of systematic vaccination. The increase of non-PCV13 serotypes highlights the need to expand serotype coverage in future vaccines and rethink vaccination programs for older adults. IMPORTANCE We found that with the incorporation of the PCV13 vaccine, the numbers of IPD cases caused by serotypes included in this vaccine decreased in all of the age groups. Still, there was an unforeseen increase of the serotypes not included in this vaccine causing IPD, especially in the >65-year-old group. Moreover, a significant increase of serotype 3 included in the vaccine has been observed; this event has been reported by other researchers. These facts call for the incorporation of more serotypes in future vaccines and a more thorough surveillance of the dynamics of this microorganism.
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Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas/inmunología , Serogrupo , Streptococcus pneumoniae/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/prevención & control , Polisacáridos Bacterianos/inmunología , España/epidemiología , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/aislamiento & purificación , Vacunación , Adulto JovenRESUMEN
Feeding behavior is guided by multiple competing physiological needs, as animals must sense their internal nutritional state and then identify and consume foods that meet nutritional needs. Dietary protein intake is necessary to provide essential amino acids and represents a specific, distinct nutritional need. Consistent with this importance, there is a relatively strong body of literature indicating that protein intake is defended, such that animals sense the restriction of protein and adaptively alter feeding behavior to increase protein intake. Here, we argue that this matching of food consumption with physiological need requires at least two concurrent mechanisms: the first being the detection of internal nutritional need (a protein need state) and the second being the discrimination between foods with differing nutritional compositions. In this review, we outline various mechanisms that could mediate the sensing of need state and the discrimination between protein-rich and protein-poor foods. Finally, we briefly describe how the interaction of these mechanisms might allow an animal to self-select between a complex array of foods to meet nutritional needs and adaptively respond to changes in either the external environment or internal physiological state.
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Fenómenos Fisiológicos Nutricionales de los Animales/fisiología , Apetito/fisiología , Proteínas en la Dieta/metabolismo , Conducta Alimentaria/fisiología , Estado Nutricional/fisiología , Adaptación Psicológica/fisiología , Animales , Ingestión de Alimentos/fisiología , Preferencias Alimentarias/fisiología , Homeostasis/fisiologíaRESUMEN
Hypoglycemia is a major barrier to clinical management of persons with diabetes. Emerging evidence supports a role for leptin in gating hypoglycemic counterregulation. This work demonstrates that male leptin receptor null, Zucker (fa/fa), rats display severe impairments in hypoglycemic counterregulation. Thus, augmenting leptin levels may have clinical utility for preventing hypoglycemia.
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Hipoglucemia , Hipoglucemiantes/farmacología , Leptina/metabolismo , Receptores de Leptina , Animales , Receptor del Péptido 1 Similar al Glucagón , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control , Masculino , Obesidad/complicaciones , Ratas , Ratas Zucker , Receptores de Leptina/genéticaRESUMEN
Fibroblast growth factor 21 (FGF21) is a hormone that is involved in the regulation of lipid, glucose, and energy metabolism. Pharmacological FGF21 administration promotes weight loss and improves insulin sensitivity in rodents, non-human primates, and humans. However, pharmacologic effects of FGF21 likely differ from its physiological effects. Endogenous FGF21 is produced by many cell types, including hepatocytes, white and brown adipocytes, skeletal and cardiac myocytes, and pancreatic beta cells, and acts on a diverse array of effector tissues such as the brain, white and brown adipose tissue, heart, and skeletal muscle. Different receptor expression patterns dictate FGF21 function in these target tissues, with the primary effect to coordinate responses to nutritional stress. Moreover, different nutritional stimuli tend to promote FGF21 expression from different tissues; i.e., fasting induces hepatic-derived FGF21, while feeding promotes white adipocyte-derived FGF21. Target tissue effects of FGF21 also depend on its capacity to enter the systemic circulation, which varies widely from known FGF21 tissue sources in response to various stimuli. Due to its association with obesity and non-alcoholic fatty liver disease, the metabolic effects of endogenously produced FGF21 during the pathogenesis of these conditions are not well known. In this review, we will highlight what is known about endogenous tissue-specific FGF21 expression and organ cross-talk that dictate its diverse physiological functions, with particular attention given to FGF21 responses to nutritional stress. The importance of the particular experimental design, cellular and animal models, and nutritional status in deciphering the diverse metabolic functions of endogenous FGF21 cannot be overstated.
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Factores de Crecimiento de Fibroblastos/metabolismo , Adipocitos/metabolismo , Animales , Factores de Crecimiento de Fibroblastos/genética , Edición Génica , Expresión Génica , Humanos , Hígado/metabolismo , Enfermedades Metabólicas/metabolismo , Enfermedades Metabólicas/terapia , Modelos Animales , Músculo Esquelético/metabolismo , Páncreas/metabolismo , Estrés FisiológicoRESUMEN
Bariatric surgery is the most effective and durable means of treating obesity and its comorbidities. Women make up 80% of those receiving weight loss surgery and they experience improvements in fertility. Unfortunately, bariatric surgery in the context of pregnancy is associated with complications, including growth restriction and small-for-gestational age offspring (SGA). SGA offspring have a greater risk for obesity in adulthood, although the mechanism for this SGA-induced obesity is unknown. In a rat model of vertical sleeve gastrectomy (VSG), we previously identified reductions during pregnancy in ghrelin, a stomach-derived hormone that increases appetite and induces growth hormone secretion. Here, we hypothesise that VSG offspring will have altered ghrelin signalling compared to offspring of Sham dams as a result of reduced in utero ghrelin. At postnatal day (PND)21, male and female offspring of dams that have previously received VSG have an increase in mRNA expression for the ghrelin receptor in the hypothalamus compared to Sham offspring, and the expression of GOAT is lower in females compared to males. Liver expression of endogenous ghrelin antagonist, LEAP2, is elevated at PND60 in VSG offspring. Expression of other genes in the growth hormone system (growth hormone-releasing hormone and growth hormone) were not altered. Plasma levels of total ghrelin at PND21 are also not different between VSG and Sham pups. In adult pups, 1-hour chow intake of male but not female VSG offspring given is less than Sham offspring when given 50 µg kg-1 of exogenous ghrelin by i.p. injection. These results indicate that maternal VSG surgery has an impact on ghrelin signalling in offspring and that, as adults, male VSG offspring may be functionally less responsive to ghrelin than controls.
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Gastrectomía , Ghrelina/metabolismo , Hipotálamo/metabolismo , Obesidad/metabolismo , Receptores de Ghrelina/metabolismo , Transducción de Señal/fisiología , Animales , Glucemia/metabolismo , Dieta Alta en Grasa , Femenino , Masculino , Obesidad/cirugía , Ratas , Factores SexualesRESUMEN
Approximately 250,000 individuals seek bariatric surgery each year in the USA for the long-term resolution of obesity-related comorbidities. Greater than 80% of these individuals are women and approximately half are of child-bearing age. Although there are many positive metabolic benefits that are realized through surgical weight loss for both men and women, the various long-term hormonal, molecular, nutrient, and epigenetic changes following bariatric surgery have not been evaluated for the surgical recipient or in the context of pregnancy and the offspring. Pregnancy may be a vulnerable period of time for the bariatric surgery recipient, and thoughtful consideration of pregnancy management should be taken by health care providers and recipients alike. The purpose of this review is to explore potential etiologies of some of the gestation-specific outcomes for the mother and offspring.
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Cirugía Bariátrica , Peso Corporal/fisiología , Obesidad/prevención & control , Obesidad/cirugía , Adulto , Femenino , Humanos , Embarazo , Resultado del EmbarazoRESUMEN
Spinal cord injury (SCI) results in perturbations to the immune system leading to increased infection susceptibility. In parallel, the consumption of high-fat diets (HFD) leads to a chronic inflammation in circulation and body tissues. We investigated the impact of 16 weeks of HFD on chronically-injured rats. SCI rats under both chow and HFD showed peripheral leukocyte changes that include reduced percentages of total, helper and cytotoxic T, and natural killer cells. Expression of immune-related genes in the spleen and thymus reflected the impact of both chronic injury and diet. Changes to the immune system following SCI are adversely impacted by HFD consumption.
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Dieta Alta en Grasa/efectos adversos , Traumatismos de la Médula Espinal/inmunología , Bazo/inmunología , Linfocitos T/inmunología , Timo/inmunología , Animales , Masculino , Ratas , Ratas Long-Evans , Traumatismos de la Médula Espinal/sangre , Transcriptoma/inmunologíaRESUMEN
Bariatric surgery produces significant positive benefits to recipients such as significant body fat loss and resolution of the various obesity-related comorbidities, such as reduced reproductive function. Females of childbearing age seek bariatric surgical remedies to improve their chance of successful pregnancy; however, limited knowledge exists on the impact of surgical weight loss to subsequently born offspring. We previously reported that circulating leptin levels were reduced in pregnant females having previously received vertical sleeve gastrectomy (VSG) in comparison to control dams having received Sham surgery. Furthermore, the levels of leptin receptors in the VSG placenta were also reduced in VSG. These data suggest a significant difference in leptin signaling during pregnancy that may produce an altered developmental environment for the offspring. Here, we investigate the adult offspring of dams having received VSG or Sham-VSG prior to pregnancy. Endogenous fasting plasma leptin levels were not different between Sham and VSG offspring. Fasting leptin receptor mRNA in the medial basal hypothalamus (MBH) was elevated in VSG offspring in comparison to Sham. Intraperitoneal administration of exogenous leptin produced reductions in acute food intake in male Sham offspring, but did not reduce food intake at any time point measured in male VSG offspring. Using Western blot, we identified elevated pSTAT3 and pSTAT3/STAT3 ratios in the MBH of post-VSG offspring in comparison to controls. Using immunohistochemistry, we found an increased number of pSTAT positive cells in the arcuate nucleus in the Sham offspring in comparison to VSG. In contrast, within the paraventricular and ventromedial nuclei in the hypothalamus of the VSG offspring had elevated numbers of pSTAT-positive cells in comparison to controls. Collectively, these data support our hypothesis that leptin signaling is dysregulated in VSG offspring and may be partially responsible for the long-term impact of maternal bariatric surgery on the metabolic health of offspring.
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Obesity in women results in reduced fertility and increased complications during pregnancy. Vertical sleeve gastrectomy (VSG) effectively reduces weight, type 2 diabetes, and dyslipidemia, but is also associated with preterm and small-for-gestational age births. The mechanism by which VSG influences fetal development remains unknown. Here we hypothesize that previously reported immune changes during rat VSG pregnancy are reflected long term in the immune system of the offspring. Offspring of VSG and sham dams were evaluated at postnatal day (PND) 21 and PND60. At PND21, VSG pups have lower numbers of circulating B lymphocytes compared with sham pups (P < 0.05) and have lower transcription of lymphocyte marker Ptprc (P < 0.01) in the spleen, while other lymphocyte populations measured are not different. Total plasma IgG is higher (P < 0.01) and C-reactive protein is lower (P < 0.05) in VSG offspring compared with sham offspring at PND21. The central nervous system of VSG pups is also affected at PND21, having higher expression of Il1b mRNA (P < 0.05) and higher immunoreactivity of microglia marker, IBA1, in the hypothalamus. At PND60, the immune-hematological differences are not present; however, mRNA expression of Il1b is elevated (P < 0.001) in the spleen of VSG offspring along with markers of T cells. These data suggest that the immune system of VSG offspring is compromised early in life, but rebounds after weaning and may even become hyperactive. Future work is needed to determine whether the immune system of VSG offspring is capable of mounting a proper defense and whether other aspects of development are affected.
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Animales Recién Nacidos/inmunología , Gastrectomía/métodos , Efectos Tardíos de la Exposición Prenatal , Animales , Linfocitos B , Biomarcadores , Femenino , Inmunoglobulina G/sangre , Inflamación/sangre , Inflamación/metabolismo , Antígenos Comunes de Leucocito/metabolismo , Masculino , Embarazo , Ratas , Ratas Long-Evans , Bazo/inmunologíaAsunto(s)
Sangre/metabolismo , Gastrectomía/efectos adversos , Sistema Inmunológico/metabolismo , Esplenectomía , Adiposidad , Animales , Peso Corporal , Proteína C-Reactiva/metabolismo , Diferenciación Celular/genética , Quimiocina CCL5/sangre , Femenino , Regulación de la Expresión Génica , Tamaño de los Órganos , Ratas Long-Evans , Bazo/patología , Linfocitos T/citología , Timo/citologíaRESUMEN
Bariatric surgery is increasingly employed to improve fertility and reduce obesity-related co-morbidities in obese women. Surgical weight loss not only improves the chance of conception but reduces the risk of pregnancy complications including pre-eclampsia, gestational diabetes, and macrosomia. However, bariatric procedures increase the incidence of intrauterine growth restriction (IUGR), fetal demise, thromboembolism, and other gestational disorders. Using our rodent model of vertical sleeve gastrectomy (VSG), we tested the hypothesis that VSG in diet-induced, obese dams would cause immune and placental structural abnormalities that may be responsible for fetal demise during pregnancy. VSG dams studied on gestational day (G) 19 had reduced circulating T-cell (CD3+ and CD8+) populations compared with lean or obese controls. Further, local interleukin (IL) 1ß and IL 1 receptor antagonist (il1rn) cmRNA were increased in placenta of VSG dams. Placental barrier function was also affected, with increased transplacental permeability to small molecules, increased matrix metalloproteinase 9 expression, and increased apoptosis in VSG. Furthermore, we identified increased placental mTOR signaling that may contribute to preserving the body weight of the fetuses during gestation. These changes occurred in the absence of a macronutrient deficit or gestational hypertension in the VSG dams. In summary, previous VSG in dams may contribute to fetal demise by affecting maternal immune system activity and compromise placental integrity.
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Retardo del Crecimiento Fetal/patología , Gastrectomía/métodos , Obesidad/cirugía , Complicaciones del Embarazo/patología , Animales , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodos , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/metabolismo , Dieta Alta en Grasa/efectos adversos , Femenino , Retardo del Crecimiento Fetal/etiología , Retardo del Crecimiento Fetal/inmunología , Gastrectomía/efectos adversos , Expresión Génica , Humanos , Interleucina-1beta/genética , Interleucina-1beta/metabolismo , Masculino , Obesidad/etiología , Placenta/inmunología , Placenta/metabolismo , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/inmunología , Ratas Long-EvansRESUMEN
Individuals that suffer injury to the spinal cord can result in long-term, debilitating sequelae. Spinal cord-injured patients have increased risk for the development of metabolic disease, which can further hinder the effectiveness of treatments to rehabilitate the cord and improve quality of life. In the present study, we sought to understand the impact of high-fat diet (HFD)-induced obesity on spinal cord injury (SCI) by examining transcriptome changes in the area of the injury and rostral and caudal to site of damage 12 wk after injury. Adult, male Long-Evans rats received either thoracic level contusion of the spinal cord or sham laminectomy and then were allowed to recover on normal rat chow for 4 wk and further on HFD for an additional 8 wk. Spinal cord tissues harvested from the rats were processed for Affymetrix microarray and further transcriptomic analysis. Diverse changes in gene expression were identified in the injured cord in genes such as MMP12, APOC4, GPNMB, and IGF1 and 2. The greatest signaling changes occurred in pathways involved in cholesterol biosynthesis and immune cell trafficking. Together, the cord changes in the chronically obese rat following thoracic SCI reveal further potential targets for therapy. These could be further explored as they overlap with genes involved in metabolic disease.
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Contusiones/genética , Médula Espinal/patología , Vértebras Torácicas/patología , Animales , Composición Corporal , Peso Corporal , Enfermedad Crónica , Contusiones/patología , Dieta Alta en Grasa , Modelos Animales de Enfermedad , Regulación hacia Abajo/genética , Masculino , Análisis de Secuencia por Matrices de Oligonucleótidos , Ratas Long-Evans , Reacción en Cadena en Tiempo Real de la Polimerasa , Reproducibilidad de los Resultados , Regulación hacia Arriba/genéticaRESUMEN
OBJECTIVE: Although women are the most common recipients of weight loss surgeries for the amelioration of the comorbidities of obesity, few studies have addressed the efficacy of these procedures with specific attention to reproductive stage. Here we ask in a rodent model of vertical sleeve gastrectomy (VSG) whether improvements to metabolic health are realized in women having received surgical menopause. Specifically we were interested in knowing whether rats made menopausal through surgical means would exhibit persistent hepatic steatosis as reported in previously pregnant, freely cycling female VSG rats or if it is resolved as reported in male VSG rats. METHODS: All the rats first received ovariectomy (OVX) and then were placed on high-fat diet before either sham or VSG surgery (Nâ=â12, 9) and then were monitored for resolution of obesity-related comorbidities. RESULTS: VSG was sufficient to reduce weight and adiposity in OVX females in comparison to obese rats (Pâ<â0.001). Glucose tolerance (Pâ<â0.05) was improved in OVX-VSG females with no change in insulin sensitivity. Both circulating (Pâ<â0.01) and hepatic triglyceride (Pâ<â0.01) levels were also reduced after VSG. Liver integrity was improved in OVX-VSG in comparison to OVX-obese as reflected by reduced aspartate aminotransferase levels (Pâ<â0.05). The ability of mitochondria to generate adenosine triphosphate was maintained, and an increase in complex IV may decrease the production of mitochondrial reactive oxygen species. CONCLUSIONS: Taken together, VSG in OVX rats experience many positive benefits including the resolution of hepatic steatosis that persists in reproductively intact female rats after VSG.
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Cirugía Bariátrica/métodos , Hígado Graso/etiología , Gastrectomía/métodos , Obesidad/complicaciones , Obesidad/cirugía , Ovariectomía , Adenosina Trifosfato/biosíntesis , Adiposidad , Alanina Transaminasa/sangre , Animales , Aspartato Aminotransferasas/sangre , Glucemia/metabolismo , Modelos Animales de Enfermedad , Hígado Graso/metabolismo , Hígado Graso/patología , Femenino , Hígado/metabolismo , Hígado/patología , Menopausia , Mitocondrias Hepáticas/metabolismo , Obesidad/metabolismo , Ratas , Ratas Long-Evans , Triglicéridos/metabolismo , Pérdida de PesoRESUMEN
Introducción: Hemos desarrollado el Método SHORT como triaje inicial prehospitalario ante incidentes con múltiples víctimas (IMV) para ser aplicado por personal no sanitario (bomberos, policía, etc.). El objetivo inicial de este método ha sido simplificar y protocolizar la labor inicial de rescate. Objetivo: Validación del Método SHORT y estudio comparativo con las escalas de gravedad más utilizadas en cuanto a discriminación de las víctimas más graves. Métodos: Se ha estudiado la eficacia de este método mediante la puesta en práctica de simulacros de IMV y talleres prácticos sobre triaje, con un total de 214 casos clínicos. En el rescate ha participado personal de extinción de incendios y salvamento y personal no sanitario de la Red de Transporte Sanitario Urgente de la Comunidad Autónoma Vasca (CAV). Se ha analizado la adecuación como primer triaje en IMV de las escalas de gravedad más utilizadas. Se han estudiado los parámetros de éstas en el contexto de los cuadros clínicos de mayor gravedad en IMV, y se han comparado, en cuanto a su capacidad para estratificar la gravedad, con los parámetros del método SHORT. Resultados: El método SHORT ha presentado una sensibilidad del 91,8% y una especificidad del 97%, en cuanto a la discriminación de víctimas graves frente al resto de víctimas. El tiempo medio de triaje por víctima ha sido de 18 segundos (rango: 19; desviación estándar: 0,25). En el estudio comparativo, el método SHORT resulta tan eficaz como el resto de escalas analizadas. Conclusiones: El método SHORT resulta eficaz y rápido para discriminar a las víctimas más graves. Es posible reflejar la gravedad de la víctima con los parámetros expresados en este método, hecho que se constata con los índices de eficacia como sensibilidad y especificidad. Debido a su sencillez de realización, resulta más adecuado que el resto de escalas estudiadas para practicarlo por personal de rescate no sanitario (AU)
Background: We have developed the SHORT Method as an initial pre-hospitalary triage procedure for multiple-victim incidents (MVI) to be applied by non-sanitary personnel (firemen, police, etc.). The initial aim of this method has been to simplify and protocolise the initial rescue operations. Aims: Validation of the SHORT method and comparative study to the most frequently used severity scales in the discriminaton of the severest victims. Methods: The effectiveness of this method has been assessed through the implementation of MVI simulations and practical triage workshops, with a total of 214 clinical cases. Participants in the rescue operations were Fire Department and Rescue personnel and non-sanitary personnel of the Urgent Ambulance Service of the Basque Autonomous Community. The adequacy of the most frequently used severity scales as initial triage in MVI has been assessed. The parameters of such scales have been examined in the context of the most severe cases in MVI and compared to those of the SHORT method in terms of their ability to stratify severity. Results: The SHORT method has evidenced 91,8% sensitivity and 97% specificity in the discrimination of severe and less severe victims. The mean triage time per victim was 18 seconds (range 19; SD 0,25). In the comparative study, the SHORT method was as effective as the remainder of the scales examined. Conclusions: The SHORT method has been shown to be effective and quick in the discrimination of the more severe victims. The parameters expressed in this method allow characterisation of the victims severity, as demonstrated by the sensitivity and specificity indices. Due to its simplicity, it is more adequate than the other scales examined for application by non-sanitary personnel (AU)