Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?

We are entering a new era in the management of adiposity-based chronic disease (ABCD) with type 2 diabetes (T2D) and related chronic kidney disease (CKD). ABCD, T2D and CKD can affect almost every major organ system and have a particularly strong impact on the incidence of cardiovascular disease (CVD) and heart failure. ABCD and the associated insulin resistance are at the root of many cardiovascular, renal and metabolic (CKM) disorders, thus an integrated therapeutic framework using weight loss (WL) as a disease-modifying intervention could simplify the therapeutic approach at different stages across the lifespan. The breakthrough of highly effective WL drugs makes achieving a WL of >10% possible, which is required for a potential T2D disease remission as well as for prevention of microvascular disease, CKD, CVD events and overall mortality. The aim of this review is to discuss the link between adiposity and CKM conditions as well as placing weight management at the centre of the holistic CKM syndrome approach with a focus on CKD. We propose the clinical translation of the available evidence into a transformative Dysfunctional Adipose Tissue Approach (DATA) for people living with ABCD, T2D and CKD. This model is based on the interplay of four essential elements (i.e. adipocentric approach and target organ protection, dysfunctional adiposity, glucose homeostasis, and lifestyle intervention and de-prescription) together with a multidisciplinary person-centred care. DATA could facilitate decision-making for all clinicians involved in the management of these individuals, and if we do this in a multidisciplinary way, we are prepared to meet the adipocentric challenge.

Características sociodemográficas, psicológicas y clínicas de una cohorte de personas transgénero de mediana y avanzada edad: importancia de la atención primaria en la asistencia a la transexualidad y diversidad de género / Socio-demographic, psychological and clinical characteristics of a cohort of middle-aged and older transgender persons: the importance of primary health care in supporting transsexuality and gender diversity. Characteristics of a cohort of older transgen

Objetivo: describir la proporción de las personas transgénero mayores de 45 años que solicitan acompañamiento médico o psicológico, así como sus características sociales, historia identitaria, presencia de factores de riesgo cardiovascular, tratamiento hormonal o quirúrgico afirmativo y comorbilidades psiquiátricas.Métodos: estudio transversal descriptivo. Se incluyeron 567 pacientes con incongruencia de género que demandaron atención por la Unidad de Identidad de Género (UIG) del Hospital Universitario Doctor Peset de Valencia en el entre 2012 y 2019 (inclusive).Resultados: un 4,2% de la muestra correspondía a personas mayores de 45 años con una mediana de edad de 52 (RIQ: 50,25-60,25) años. La gran mayoría había experimentado un sentimiento de incongruencia identitaria en la etapa prepuberal o adolescente e hizo el tránsito social durante la edad adulta. Un 25% de las mujeres transgénero se automedicaban antes de acudir a la UIG. Un 29,1% tenía antecedentes de ideación suicida y el 25% había llevado a cabo intentos suicidas. Más de la mitad presentaban al menos dos factores de riesgo cardiovascular y no recibían tratamiento farmacológico específico.Conclusiones: en nuestra muestra, existió una baja proporción de personas trans mayores de 45 años que consultaban en la UIG en comparación con el resto de las franjas etarias más jóvenes. Dicho colectivo se caracterizó por presentar altas tasas de factores de riesgo cardiovascular y comorbilidades psicológicas.(AU)

Aim: to report the proportion of transgender persons aged over 45 who requested medical or psychological care, as well as social characteristics, identity history, cardiovascular risk factors, hormonal or affirmative surgical treatment and psychiatric comorbidities.Methods: cross-sectional, descriptive study. We included 567 patients with gender incongruence who requested care at the Gender Identity Unit (UIG), at Doctor Peset University Hospital (Valencia), from 2012 to 2019.Results: a total of 4.2% of sample corresponded to persons aged over 45, with a median age of 52 [IQR 50.25-60.25]. The vast majority had experienced a feeling of identity incongruity in the prepubertal or adolescent stage and made the social transition during adulthood. A total of 25% of transgender women self-medicated before visiting the UIG; 29.1% had a history of suicidal ideation (IS) and 25% had attempted suicide. More than half presented at least two cardiovascular risk factors and did not receive specific pharmacological treatment.Conclusions: In our sample, there was a low proportion of transgender individuals over the age of 45 who sought care at the IUG compared to younger age groups. This particular group was characterized by high rates of cardiovascular risk factors and psychological comorbidities.(AU)

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. / Antecedentes de comportamientos autolesivos y autolíticos en población adolescente y adulta joven transexual, atendida en una unidad especializada en identidad de género en España.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Tendencia de la población española de búsqueda en internet sobre información relacionada con diferentes dietas / Spanish population trends in Internet searches for information on different diets

OBJETIVO: Explorar a través Google Trends las tendencias del interés de la población española sobre información relacionada con diferentes tipos de dietas, focalizadas en las más populares y con estudios de evidencia, a lo largo de los últimos 10 años. MATERIAL Y MÉTODO: Se analizaron las tendencias de búsqueda de los términos «dieta mediterránea», «dieta cetogénica», «dieta baja en grasas», «ayuno intermitente» y «dieta vegana». El volumen relativo de búsqueda (VRB) de cada término fue comparado. La dirección de la tendencia se estudió mediante la correlación de Spearman (CS). RESULTADOS: El término «dieta mediterránea» fue el más buscado, con una mediana de VRB de 16 (rango intercuartil [RI] 6; rango 8-100), aunque siguió una tendencia cronológica decreciente (CS = -0,216). Le siguieron «dieta cetogénica», con VRB de 8 (RI 9; rango 1-57); «dieta vegana», con VRB de 4 (RI 5; rango 0-16); «ayuno intermitente», con VRB de 2 (RI 5; rango 0-27), y «dieta baja en grasas», con VRB de 1,16 (RI 0; rango 0-2). El término con mejor correlación a lo largo del tiempo fue «ayuno intermitente» (CS = 0,96), seguido de «dieta cetogénica» (CS = 0,91) y «dieta vegana» (CS = 0,85). CONCLUSIÓN: En España, el interés de la población sobre la información acerca de la dieta mediterránea es mayor que para otras dietas. Sin embargo, en los últimos años se ha producido un incremento progresivo en el interés, medido como VRB, en otras dietas, como la dieta cetogénica, la dieta vegana o el ayuno intermitente, y se ha producido una reducción en el interés por la dieta mediterránea. La dieta baja en grasas no genera interés en la población española

OBJECTIVE: To use Google Trends to explore the trends of interest of the Spanish population regarding information related to different types of diets, focused on those that are popular and with evidence-based studies, over the last 10 years. MATERIAL AND METHODS: The search trends referred to the terms «Mediterranean diet», «ketogenic diet», «low fat diet», «intermittent fasting» and «vegan diet» were analyzed. The relative search volumes (RSV) of the terms were compared. The direction of the trend was studied using the Spearman's correlation coefficient (SC). RESULTS: «Mediterranean diet» was the most widely searched term, with a median RSV of 16 (interquartile range [IQR] 6; range 8-100), though it exhibited a decreasing chronological trend (SC = -0.216). It was followed by «ketogenic diet», with an RSV of 8 (IQR 9; range 1-57); «vegan diet», with an RSV of 4 (IQR 5; range 0-16); «intermittent fasting», with an RSV of 2 (IQR 5; range 0-27), and «low fat diet», with an RSV of 1.16 (IQR 0; range 0-2). The term with the best correlation over time was «intermittent fasting» (SC = 0.96), followed by «ketogenic diet» (SC = 0.91) and «vegan diet» (SC = 0.85). CONCLUSIONS: In Spain, the interest of the population in information about the Mediterranean diet is greater than for other diets. However, in recent years there has been a progressive increase in interest (measured as RSV) in other diets such as the ketogenic diet, vegan diet or intermittent fasting, and there has been a decrease in interest in the Mediterranean diet. The low fat diet does not generate interest in the Spanish population

Demanda, psicopatología, calidad de vida, autoestima y personalidad en personas transexuales adolescentes y adultas jóvenes atendidas en una Unidad de Referencia en Identidad de Género en España / Demand, psychopathology, quality of life, self-esteem and personality in adolescents and young adult transsexuals attended in a Reference Unit in Gender Identity in Spain

OBJETIVO: Evaluar en personas transexuales adolescentes y adultas jóvenes atendidas en una Unidad especializada de Identidad de Género, la evolución de la demanda, la presencia de psicopatología, autoestima, calidad de vida y personalidad. METODOLOGÍA: Estudio transversal en una cohorte de personas transexuales adolescentes y adultas jóvenes sin tratamientos previos de afirmación de género, obtenida mediante muestreo consecutivo que solicitaron atención sanitaria desde 2014 hasta 2017. La medición de las variables fue realizada mediante siete test validados: Inventario para la depresión de Beck-BDI, Cuestionario de Ansiedad Estado-Rasgo-STAI-R/E, Escala de Miedo a la Evaluación Negativa-FNE, Escala de Estrés y Evitación Social-SAD, Índice de calidad de vida-QLI-Sp, versión española, Escala de Autoestima-EAE, versión española y Cuestionario de Personalidad de Eysenck-EPI. RESULTADOS: Se analizan las variables recogidas de 190 personas, 110 hombres transexuales (Mujer-Hombre) y 80 mujeres transexuales (Hombre-Mujer), referentes a la evaluación previa al inicio de los tratamientos médicos de afirmación de género. La demanda en los últimos años ha tenido un incremento notable sobre todo en menores de edad, suponiendo el 43,45% de la misma. La ratio en hombres transexuales ha ido aumentado frente a las mujeres transexuales llegando a ser 1,3 frente a 1. El 18% presentaba depresión moderada y el 3% grave. La ansiedad estado estaba presente en el 48% de la muestra de forma moderada y en el 23% de forma severa, con distribución similar a la ansiedad rasgo (43 y 31% respectivamente). El miedo a la evaluación negativa estaba presente en el 5% de los sujetos y el 7% presentaba conductas de evitación social. La mitad de la muestra tenía baja autoestima. El 10% valoraban su calidad de vida como mala o muy mala y el 28% como regular. Un 20% puntúan alto en rasgo de neuroticismo y 21% puntuó en baja extroversión. No se encontraron diferencias significativas en ninguna de las variables estudiadas en función del género, ni cuando se compararon adolescentes (10 a 19 años) con personas adultas jóvenes (20-35 años). CONCLUSIONES: Existe un porcentaje importante de personas transexuales adolescentes y adultas jóvenes, qué al iniciar la demanda de tratamientos médicos de afirmación de género, manifiestan clínica depresiva y ansiosa y en menor medida ansiedad social. La mitad de ellas tienen baja autoestima, el 40% considera que su calidad de vida es regular o mala y la quinta parte muestra inestabilidad emocional e introversión. BREVE DESCRIPCIÓN DEL CONTENIDO: Hemos analizado la evolución de la demanda asistencial y diferentes variables de salud mental, autoestima, calidad de vida y personalidad, recogidas en los cuestionarios administrados en la evaluación inicial, previa al inicio de tratamientos médicos de afirmación de género, con el fin de detectar las necesidades de apoyo psicoterapéutico que precisa esta población para afrontar con éxito el protocolo de tratamiento médico y la adaptación social en género sentido

OBJECTIVE: To evaluate the evolution of demand, the presence of psychopathology, self-esteem, quality of life and personality in transgender adolescents and young adults attended in a specialized Unit of Gender Identity. METHODOLOGY: Cross-sectional study in a cohort of adolescent and young adult transsexuals without prior gender affirmation treatments, obtained through consecutive sampling that requested health care from 2014 to 2017. The variables were measured using seven validated tests: Inventory of Beck-BDI depression, State-Trait Anxiety Questionnaire-STAI-R / E, Scale of Fear of Negative Evaluation-FNE, Stress Scale and Avoidance Social-SAD, Quality of Life Index-QLI-Sp, Spanish version, Self-Esteem Scale-EAE, Spanish version and Eysenck-EPI Personality Questionnaire. RESULTS: The data collected from 190 people (110 female-to-male (F-M) and 80 male-to-female (M-F) are analyzed, referring to the evaluation prior to the start of medical gender affirmation treatments. Demand in recent years has had a notable increase, especially in minors, representing 43.45% of it. The ratio in transsexual men has been increasing compared to transsexual women, reaching 1.3 compared to 1. 18% had moderate depression and 3% severe. The anxiety state was present in 48% of the sample moderately and in 23% severely, with distribution similar to trait anxiety (43 and 31% respectively). The fear of negative evaluation was present in 5% of the subjects and 7% had social avoidance behaviors. Half of the sample had low self-esteem. 10% valued their quality of life as bad or very bad and 28% as regular. 20% scored high on neuroticism trait and 21% scored low extroversion. No significant differences were found in any of the variables studied according to gender, nor when adolescents (10 to 19 years old) were compared with young adults (20-35 years old). CONCLUSIONS: There is a significant percentage of adolescents and young adult transsexuals, which when they start the demand for medical gender affirmation treatments, manifest depressive and anxious clinic and to a lesser extent social anxiety. Half of them have low self-esteem, 40% consider their quality of life to be regular or bad, and a fifth show emotional instability and introversion

Spanish population trends in Internet searches for information on different diets. / Tendencia de la población española de búsqueda en internet sobre información relacionada con diferentes dietas.

OBJECTIVE: To use Google Trends to explore the trends of interest of the Spanish population regarding information related to different types of diets, focused on those that are popular and with evidence-based studies, over the last 10years. MATERIAL AND METHODS: The search trends referred to the terms «Mediterranean diet¼, «ketogenic diet¼, «low fat diet¼, «intermittent fasting¼ and «vegan diet¼ were analyzed. The relative search volumes (RSV) of the terms were compared. The direction of the trend was studied using the Spearman's correlation coefficient (SC). RESULTS: «Mediterranean diet¼ was the most widely searched term, with a median RSV of 16 (interquartile range [IQR] 6; range 8-100), though it exhibited a decreasing chronological trend (SC=-0.216). It was followed by «ketogenic diet¼, with an RSV of 8 (IQR 9; range 1-57); «vegan diet¼, with an RSV of 4 (IQR 5; range 0-16); «intermittent fasting¼, with an RSV of 2 (IQR 5; range 0-27), and «low fat diet¼, with an RSV of 1.16 (IQR 0; range 0-2). The term with the best correlation over time was «intermittent fasting¼ (SC=0.96), followed by «ketogenic diet¼ (SC=0.91) and «vegan diet¼ (SC=0.85). CONCLUSIONS: In Spain, the interest of the population in information about the Mediterranean diet is greater than for other diets. However, in recent years there has been a progressive increase in interest (measured as RSV) in other diets such as the ketogenic diet, vegan diet or intermittent fasting, and there has been a decrease in interest in the Mediterranean diet. The low fat diet does not generate interest in the Spanish population.