[Pharmacological treatment of obesity for Primary Care physicians]. / Tratamiento farmacológico de la obesidad para médicos de Atención Primaria.

Obesity is a disease of high prevalence in Primary Care clinics. It is associated with major comorbidities (dyslipidaemia, diabetes, hypertension) that increase morbidity and mortality, health expenditure, and reduces the quality of life of patients. Changes in lifestyle are still the pillars of the treatment of excess weight. Pharmacological treatment should be considered when there are difficulties in achieving weight loss goals. In this article, a review is presented on the currently authorised drugs for the treatment of obesity and overweight with major comorbidities.

Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE / Costs resulting from premature mortality due to cardiovascular causes: a 20-year follow-up of the DRECE study

Objetivos. Las enfermedades cardiovasculares permanecen todavía como la principal causa de muerte en España. El estudio Dieta y Riesgo de Enfermedades Cardiovasculares en España (DRECE) se basa en una cohorte representativa de la población general española en la que se analizan los hábitos nutricionales y de vida estudiando su asociación con los patrones de morbimortalidad. Hemos estimado el impacto, en términos de pérdida de productividad, de la mortalidad prematura atribuida a las enfermedades cardiovasculares. Métodos. La pérdida de productividad atribuida a mortalidad prematura se calculó desde 1991, basándose en los años de vida y de vida laboral potencialmente perdidos. Resultados. Durante el seguimiento de 20años de una cohorte de 4.779 sujetos se produjeron 225 fallecimientos (hombres, 152). El 16% de las defunciones se atribuyó a enfermedades cardiovasculares. Los costes por pérdidas de productividad por mortalidad prematura superaron los 29 millones de euros. De ellos, 4 millones de euros (14% del coste total) se debieron a causas cardiovasculares. Conclusiones. La mortalidad prematura cardiovascular en la cohorte DRECE ha supuesto un importante coste social por pérdidas de productividad laboral (AU)

Objectives. Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. Methods. The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. Results. During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. Conclusions. Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity (AU)

Costs resulting from premature mortality due to cardiovascular causes: A 20-year follow-up of the DRECE study. / Mortalidad prematura cardiovascular y sus costes: 20 años de seguimiento del estudio DRECE.

OBJECTIVES: Cardiovascular diseases are still the leading cause of death in Spain. The DRECE study (Diet and Cardiovascular Disease Risk in Spain), based on a representative cohort of the Spanish general population, analyzed nutritional habits and lifestyle and their association with morbidity and mortality patterns. We estimated the impact, in terms of loss of productivity, of premature mortality attributed to cardiovascular diseases. METHODS: The loss of productivity attributed to premature mortality was calculated from 1991, based on the potential years of life lost and the potential years of working life lost. RESULTS: During the 20-year follow-up of a cohort of 4779 patients, 225 of these patients died (men, 152). Sixteen percent of the deaths were attributed to cardiovascular disease. The costs due to lost productivity by premature mortality exceeded 29 million euros. Of these, 4 million euros (14% of the total cost) were due to cardiovascular causes. CONCLUSIONS: Premature cardiovascular mortality in the DRECE cohort represented a significant social cost due to lost productivity.

Check-ups in obese and diabetic patients: preventive medicine.

Obesity is a chronic disease associated with important additional diseases, such as DM 2, that both reduce life quality and increase morbimortality from any cause. In the Western world, obesity is directly responsible for most deaths due to associated chronic disease. Therefore, substantial effort should be directed towards adequate primary prevention campaigns and policies, as well as towards an intensive and long-term multidisciplinary treatment of obesity, in an attempt to combat this threat to the health of a large part of our population.

Medicina basada en la evidencia: nutrición en la obesidad / Evidence-based medicine: nutrition in obesity

El tratamiento dietético hipocalórico es la piedra angular del planteamiento terapéutico de la obesidad. En la mayoría de los estudios controlados la distribución de macronutrientes de la dieta no parece marcar la diferencia en términos de pérdida de peso. Así, por ejemplo, las dietas bajas en hidratos de carbono consiguen pérdidas significativas de peso frente a las dietas bajas en grasa, en períodos cortos de tiempo (6 meses), pero no hay diferencias tras un seguimiento a más largo plazo (12 meses). Existe un consenso general acerca de que una reducción energética comprendida entre 500 y 1.000 kcal diarias, respecto a la dieta habitual, consigue pérdidas promedio de 0,5 a 1 kg a la semana durante los primeros 6 meses de tratamiento, lo que representa una reducción entre el 5-10% del peso corporal, una proporción suficiente para atenuar el impacto de las comorbilidades asociadas con la obesidad. Pero los resultados a largo plazo (más de un año) con las dietas bajas en grasas son desalentadores (promedio de 0-3 kg), mientras que la seguridad de las dietas bajas en hidratos de carbono está pendiente de demostrar. En esta revisión se analizan los niveles de evidencia que diferentes tipos de dieta (incluidas las de muy bajo contenido calórico) tienen sobre el peso corporal a medio y largo plazo, poniendo de relieve que, posiblemente, los planteamientos terapéuticos de pérdida de peso deban ser diferentes de aquellos dirigidos al mantenimiento del peso perdido. Por último, cualquiera que sea el planteamiento dietético de la obesidad, no cabe duda de que el refuerzo a través de un programa estructurado de cambios en el estilo de vida y de actividad física constituye una herramienta esencial para asegurar un éxito a largo plazo (AU)

The mainstay of the therapeutic approach to obesity is the low calorie diet. In most controlled studies the distribution of micronutrients in the diet does not seem to influence weight loss. Thus, for example, low carbohydrate diets achieve significant weight loss compared with low-fat diets in short periods (6 months), but there are no differences after longer follow-up (12 months). There is general consensus that a reduction of between 500 and 1,000 kcal daily with respect to the normal diet achieves an average weight loss of 0.5 to 1 kg per week for the first 6 months of treatment, representing a reduction of 5-10% of body weight, a proportion that is sufficient to attenuate the impact of obesity-related comorbidities. However the long-term results (more than 1 year) with low-fat diets are discouraging (0-3 kg), while the safety of low carbohydrate diets remains to be demonstrated. The present review analyzes the levels of evidence for the effect of distinct types of diet (including very low calorie diets) on body weight in the medium and long term, highlighting that possibly the therapeutic approaches to weight loss should differ from the strategies used to maintain weight loss. Lastly, whatever the dietary approach to obesity, there is no doubt that reinforcement through a structured program of lifestyle changes and physical activity is an essential tool to ensure long-term success (AU)

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (II) micronutrient intake. Dieta y Riesgo de Enfermedades Cardiovasculares en España.

OBJECTIVE: To evaluate the dietary micronutrient intake in the adult Spanish population participating in the DRECE study. METHODS: The cross-sectional study was performed in two stages in 1991 and 1996 in 43 primary care clinics. One thousand two hundred people 'with cardiovascular risk' and 600 'without risk' answered a food frequency questionnaire. RESULTS: Significant increases in vitamin C, retinol, lycopenes, beta-cryptoxanthin and vitamin E intakes were found. Vitamin A, alpha-carotenoid and lutein intakes decreased. Vitamin B(12), B(6) and folic acid intakes increased in people with cardiovascular risk, whereas only the last two increased in the control group. Nearly 100% of the people consumed the recommended dietary allowances for vitamins B(12) and B(6) and >70% for folic acid. Calcium, iron, and zinc intake increased in both groups, but magnesium and selenium intake increased only in people at risk. Vitamin A, B(1) and zinc intakes have decreased, and >50% of the people do not consume the recommended dietary allowance. CONCLUSION: Antioxidant vitamins and vitamin B(12), B(6) and folic acid intakes seem to be adequate in the adult Spanish population, no significant differences appear regarding their cardiovascular risk status. Vitamin A, B(1) and zinc intakes are not appropriate.

Dietary habits and cardiovascular risk in the Spanish population: the DRECE study (I). Diet and Cardiovascular Events Risk in Spain.

BACKGROUNDS/AIMS: To investigate dietary habits and their evolution with regard to cardiovascular risk status in Spain. METHODS: Cross-sectional study performed in two phases in 1991 and 1996 in 43 primary care clinics. One thousand and two hundred people classified as 'with cardiovascular risk' and 600 'without risk' were studied. Each participant answered a food frequency questionnaire. RESULTS: The risk group did not change oil, cereals and dairy products consumption, decreased egg, legume and meat, and increased fish, fruits and vegetables intake. The control group differed in increasing dairy products and not decreasing eggs and vegetables consumption. A small decrease in energy intake happened, from 11,315. 1 to 10,941.5 kJ in the risk group (p < 0.05). Carbohydrates intake showed a not statistically significant falling trend from 41.3 to 40.6% in people at risk and 41.8 to 40.7% in those without risk. Protein intake increased in both groups up to 16.5% and fat consumption kept at around 42.9% in both groups. The decrease in saturated fat and increase in polyunsaturated fat were statistically significant in people at risk (p = 0.000). High cholesterol intakes were found. CONCLUSION: People with cardiovascular problems changed their dietary habits in a 'healthier' way than people without risk.

[Nutritional recommendations in gynecology]. / Recomendaciones nutricionales para ginecología.

In pregnant women, appropriate eating habits has a key role to play in the development of the foetus and is also related with the amount of labour at delivery, helping to avoid complications. In addition, correct nutrition is also necessary during the puerperium to encourage breast feeding and provide the new-born child with an adequate nutritional status without leading to any deficits in the mother.

[Influence of pancreatic insulin reserve on the metabolic control of type I and II diabetes mellitus]. / Influencia de la reserva pancreática de insulina sobre el control metabólico de las diabetes tipos I y II.

We have studied 22 diabetic patients, 14 type I and 8 type II, in order to determine if there is a correlation between metabolic control and pancreatic reserve of insulin. All the patients were treated with optimum doses of bolus/basal insulin. They underwent a peptide C test (at baseline and after 3 stimulus with glucagon) and every month, during 3 months, HbA1c and fructosamine were measured, with monthly self control of glycemia. Both HbA1c and fructosamine showed a statistically significant improvement during the study. In all the cases, there was a negative correlation between metabolic control and pancreatic reserve, with statistical significance for type I, especially regarding the response of peptide C to the administration of glucagon. We conclude that the preservation of a good endogenous secretion of insulin benefits the metabolic control of diabetes.