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1.
Wiad Lek ; 73(9 cz. 2): 1940-1943, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33148837

RESUMEN

OBJECTIVE: The aim: Is to evaluate copetin's, MRproADM's and troponin's I dynamic in patients with acute myocardial infarction depending on the degree of concomitant obesity. PATIENTS AND METHODS: Material and methods: The study included 105 patients with AMI. There were formed 2 groups: 1st group of patients with AMI and concomitant obesity (n=75), 2nd group - patients with AMI without obesity (n=30). 37 patients had obesity of the I degree, 38 patients - II degree. The groups were comparable in age and gender. Copeptin, MRproADM, troponin I were determined by enzyme immunoassay method. Data are presented as mean values and the error of the mean (M±m). Differences were considered statistically significant at p<0,05. RESULTS: Results: It was found an increased copeptin's level by 73,8 % (p<0,001) in obesity I degree and by 205,9 % in obesity II degree compared with group with isolated AMI, MRproADM - by 30,68 % (p<0,001) and 54,5 % (p<0,001) respectively. Concentration of copeptin was higher by 76 % (p<0,001) in patients with AMI and II degree obesity comparing to patients with obesity of I degree, and MRproADM - by 18,3% (p<0,001) respectively. Troponin I value fully corresponded the comparison group both in obesity of I degree and II degree (p>0,05). CONCLUSION: Conclusions: The present study provides evidence that a high activity of copeptin and MRproADM in patients with AMI and obesity of I degree with an excessive activity of a marker of vasoconstriction copeptin in conditions of moderate inadequate to the needs MRproADM functioning in patients with obesity of II degree.


Asunto(s)
Infarto del Miocardio , Troponina I , Biomarcadores , Glicopéptidos , Humanos , Infarto del Miocardio/complicaciones , Obesidad/complicaciones , Estudios Prospectivos , Vasoconstricción , Vasodilatación
3.
Med Hypotheses ; 143: 110197, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33017906

RESUMEN

Coronavirus disease 2019 (COVID-19) may have a metabolic origin given strong links with risk factors such as lipids and glucose and co-morbidities such as obesity and type 2 diabetes mellitus. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein mediates viral cellular entry via the ACE2 receptor. The cytoplasmic tail of this spike protein is heavily palmitoylated. Emerging studies suggest that SARS-CoV-2 alters lipid metabolism in the lung epithelial cells by modulating peroxisome proliferator-activated receptor alpha (PPARα), possibly contributing to lipotoxicity, inflammation and untoward respiratory effects. Disruption of this process may affect palmitoylation of SARS-CoV spike protein and thus infectivity and viral assembly. COVID-19 is also increasingly being recognized as a vascular disease, with several studies noting prominent systemic endothelial dysfunction. The pathogenesis of endothelial dysfunction may also be linked to COVID-19-mediated metabolic and inflammatory effects. Herein, exercise will be compared to fenofibrate as a possible therapeutic strategy to bolster resilience against (and help manage recovery from) COVID-19. This paper will explore the hypothesis that exercise may be a useful adjuvant in a setting of COVID-19 management/rehabilitation due to its effects on PPARα and vascular endothelial function.


Asunto(s)
Infecciones por Coronavirus/terapia , Terapia por Ejercicio/métodos , PPAR alfa/metabolismo , Neumonía Viral/terapia , Glicoproteína de la Espiga del Coronavirus/metabolismo , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/tratamiento farmacológico , Citoplasma/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Ejercicio Físico , Fenofibrato/química , Humanos , Inflamación , Metabolismo de los Lípidos , Lipoilación , Pulmón/metabolismo , Obesidad/complicaciones , Pandemias
4.
BMJ ; 371: m3109, 2020 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-33046451

RESUMEN

Hypertriglyceridemia is one of the most common lipid abnormalities encountered in clinical practice. Many monogenic disorders causing severe hypertriglyceridemia have been identified, but in most patients triglyceride elevations result from a combination of multiple genetic variations with small effects and environmental factors. Common secondary causes include obesity, uncontrolled diabetes, alcohol misuse, and various commonly used drugs. Correcting these factors and optimizing lifestyle choices, including dietary modification, is important before starting drug treatment. The goal of drug treatment is to reduce the risk of pancreatitis in patients with severe hypertriglyceridemia and cardiovascular disease in those with moderate hypertriglyceridemia. This review discusses the various genetic and acquired causes of hypertriglyceridemia, as well as current management strategies. Evidence supporting the different drug and non-drug approaches to treating hypertriglyceridemia is examined, and an easy to adopt step-by-step management strategy is presented.


Asunto(s)
Manejo de la Enfermedad , Hipertrigliceridemia/terapia , Adulto , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Femenino , Humanos , Hipertrigliceridemia/complicaciones , Hipertrigliceridemia/genética , Hipolipemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Pancreatitis/etiología , Pancreatitis/prevención & control , Factores de Riesgo , Triglicéridos/sangre
5.
Wiad Lek ; 73(8): 1637-1640, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33055325

RESUMEN

OBJECTIVE: The aim: To examine the association between polymorphisms of the IL-6 gene promoter and HF in patients with CAD and obesity. PATIENTS AND METHODS: Material and methods: 222 patients with coronary artery disease and obesity were identified. Comparison group consisted of 115 patients with coronary artery disease with normal body weight. The groups were comparable in age and sex. The exclusion group consisted of patients with severe concomitant diseases of the respiratory and digestive organs, kidneys and people with cancer. One single nucleotide polymorphisms in the interleukin-6 promoter region was analyzed. Odds ratio (OR) and 95 % confident interval (95 % CI) were calculated. RESULTS: Results: The combined course of coronary artery disease and obesity was characterized by the detection of allele C in 62 patients (27.93 %), allele G - in 160 patients (72.07 %), and genotypes CC, CG and GG - at 24 (10.81 %), 67 (30.18 %) and 131 (59.01 %) patients respectively. The results showed that the -174G allele and GG genotype in patients with coronary artery disease and obesity were associated with heart failure (OR = 2.55, 95% CI = [1.72-3.79], χ2 = 22.8; p<0.05) and (OR = 11.95, 95% CI = [3.41-41.91], χ2 = 22.5; p<0.05), whereas allele C-174 was associated with a decrease in the risk of heart failure (OR = 0.39, 95% CI = [0.26-0.58 ], χ2 = 22.75, p<0.05). CONCLUSION: Conclusions: The obtained results testify that the -174G>C polymorphism in the interleukin-6 gene is significantly associated with increased risk of heart failure in patients with coronary artery disease and obesity.


Asunto(s)
Enfermedad de la Arteria Coronaria , Insuficiencia Cardíaca , Interleucina-6 , Obesidad , Alelos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/genética , Femenino , Insuficiencia Cardíaca/genética , Humanos , Interleucina-6/genética , Masculino , Obesidad/complicaciones , Obesidad/genética
6.
Wiad Lek ; 73(8): 1690-1695, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33055335

RESUMEN

OBJECTIVE: The aim of the study was to observe the influence of dense bean extract on the intensity of apoptotic processes in the liver cells and pancreas of rats on a model of type 2 diabetes mellitus on obesity's background. PATIENTS AND METHODS: Materials and methods: The main method was to model type 2 diabetes mellitus on the background of obesity in organism of mature six-month-old male rats of the Wistar population (n = 21), weighing 150-170 g. The modelling was carried out by intraperitoneal low dose administration of streptozotocin (30 mg / kg, in citrate buffer pH = 4, 5) inside after three months period of keeping animals on a combined diet. Apoptosis in DNA samples of liver and pancreas cells was identified in duplicates using electrophoresis in a 1% agarose gel with using a 1kb DNA SibEnzyme apoptosis marker (from 10,000 to 250 nucleotides). RESULTS: Results: Only in two of the seven studied DNA samples of the pancreas of a group of rats, treated with a dense bean extract, were observed the traces of necrosis without detectable manifestations of the apoptotic process. It situates at the level of indicators of the animals' intact control group and indicates the distinct effect's presence which includes maintaining pancreas cells survival (in both endocrine and exocrine parts) if imbalance of carbohydrate and lipid metabolism take place in organism. CONCLUSION: Conclusion: Dense bean extract showed a more distinct effect than the comparison drug metformin in relation to the risk of premature loss of pancreatic cell function and the development of non-alcoholic fatty liver disease. A dense bean extract is promising for further pharmacological studies, with the aim of creating phytopreparations - «Glyphasonorm¼ tablets and «Glyfasolin¼ capsules for the correction of type 2 diabetes mellitus and its complications.


Asunto(s)
Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Animales , Apoptosis , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Masculino , Obesidad/complicaciones , Ratas , Ratas Wistar
7.
Crit Care Med ; 48(11): e1097-e1101, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33045152

RESUMEN

OBJECTIVES: To characterize the impact of obesity on disease severity in patients with coronavirus disease 2019. DESIGN: This was a retrospective cohort study designed to evaluate the association between body mass index and risk of severe disease in patients with coronavirus disease 2019. Data were abstracted from the electronic health record. The primary endpoint was a composite of intubation or death. SETTING: Two hospitals in Massachusetts (one quaternary referral center and one affiliated community hospital). PATIENTS: Consecutive patients hospitalized with confirmed coronavirus disease 2019 admitted between March 13, 2020, and April 3, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 305 patients were included in this study. We stratified patients by body mass index category: < 25 kg/m (54 patients, 18%), ≥ 25 kg/m to < 30 kg/m (124 patients, 41%), ≥ 30 kg/m to < 35 kg/m (58 patients, 19%), and ≥ 35 kg/m (69 patients, 23%). In total, 128 patients (42%) had a primary endpoint (119 patients [39%] were intubated and nine died [3%] without intubation). Sixty-five patients (51%) with body mass index greater than or equal to 30 kg/m were intubated or died. Adjusted Cox models demonstrated that body mass index greater than or equal to 30 kg/m was associated with a 2.3-fold increased risk of intubation or death (95% CI, 1.2-4.3) compared with individuals with body mass index less than 25 kg/m. Diabetes was also independently associated with risk of intubation or death (hazard ratio, 1.8; 95% CI, 1.2-2.7). Fifty-six out of 127 patients (44%) with body mass index greater than or equal to 30 kg/m had diabetes, and the combination of both diabetes and body mass index greater than or equal to 30 kg/m was associated with a 4.5-fold increased risk of intubation or death (95% CI, 2.0-10.2) compared with patients without diabetes and body mass index less than 25 kg/m. CONCLUSIONS: Among consecutive patients hospitalized with coronavirus disease 2019, obesity was an independent risk factor for intubation or death.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/mortalidad , Enfermedad Crítica/mortalidad , Intubación Intratraqueal/mortalidad , Obesidad/mortalidad , Neumonía Viral/mortalidad , Adulto , Anciano de 80 o más Años , Índice de Masa Corporal , Infecciones por Coronavirus/terapia , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Pandemias , Neumonía Viral/terapia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
8.
Wiad Lek ; 73(9 cz. 1): 1818-1823, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33099522

RESUMEN

Arthrosis as osteoarthritis is a global problem that affects more and more people and is associated with severe chronic pain, reduced mobility and, consequently, disability. The etiology of degenerative disease is complex and depends on many factors. However, its course was not fully understood. One of the factors affecting the development of arthrosis is obesity. Obesity is a growing problem. Over the past 30 years, the number of overweight people has almost doubled. In people suffering from obesity, whose body mass index is above 30kg/m2, the risk of developing degenerative changes in articular cartilage is six times higher than the risk of developing this disease in people with normal body weight. Osteoarthritis is detected when the symptoms get worse where the changes are already at some stage. Therefore, a lot of research is currently underway to find suitable biomarkers, which would indicate the potential development of degenerative changes in the future and at the same time the possibility of inhibiting their activity. One of them may be adipokines, which are synthesized by adipose tissue and affect cartilage. In obese people, adipokines may contribute to the inflammation of the low charterer, whichaccompanies both obesity and arthrosis. These compounds can be specific biomarkers to assess the degree of progression and severity of osteoarthritis. The aim: To assess the importance of obesity and adipokines produced by adipose tissue as specific markers of arthrosis.


Asunto(s)
Adipoquinas , Osteoartritis , Tejido Adiposo , Biomarcadores , Humanos , Obesidad/complicaciones
11.
Niger J Clin Pract ; 23(10): 1345-1355, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047690

RESUMEN

Background: Several studies have demonstrated an association between obesity, periodontitis, and exercise. Aims: This study aimed to investigate the effects of regular exercise on obese women with periodontal disease, using serum, saliva, and gingival crevicular fluid (GCF) samples. A before-after study design was adopted to evaluate the effects of 12 weeks of regular exercise on obese women grouped according to periodontal status, without a control group (no exercise). The study sample comprised of 15 patients without periodontitis (NP group) and 10 patients with chronic periodontitis (CP group), from whom periodontal parameters were measured and serum, saliva, and GCF samples were collected. Body mass index (BMI), anthropometric measurements, somatotype-motoric tests, and maximal oxygen consumption (VO2max) were recorded at baseline and after exercise. Subjects and Methods: Med Calc was used for statistical analysis. Results: After exercise, a significant decrease in BMI and a significant increase in VO2max were observed in both groups. A significant decrease in probing depth and clinical attachment loss, serum leptin, GCF tumor necrosis factor-α(TNF-α) and leptin, and a significant increase in GCF resistin were observed in the CP group. A significant decrease in serum TNF-α and leptin levels and a significant increase in serum resistin and GCF TNF-α, leptin, resistin, and adiponectin levels were observed in the NP group. Significant correlations between bleeding on probing and levels of interleukin-1ß and leptin in GCF were observed in the CP group. Conclusions: This study showed that regular exercise exerts different impacts with respect to clinical and biochemical aspects of periodontal and systemic conditions in obese women.


Asunto(s)
Adipoquinas/metabolismo , Periodontitis Crónica/complicaciones , Periodontitis Crónica/metabolismo , Ejercicio Físico/fisiología , Líquido del Surco Gingival/química , Obesidad/complicaciones , Saliva/química , Adipoquinas/sangre , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Periodontitis Crónica/sangre , Femenino , Humanos , Interleucina-1beta/sangre , Interleucina-1beta/metabolismo , Persona de Mediana Edad , Obesidad/sangre , Obesidad/metabolismo , Bolsa Periodontal/metabolismo , Resistina/sangre , Resistina/metabolismo , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/metabolismo
12.
JAMA ; 324(15): 1543-1556, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33079159

RESUMEN

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients. Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome. Evidence Review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence. Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome. Conclusions and Relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.


Asunto(s)
Síndrome de Down/terapia , Adulto , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/epidemiología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Comorbilidad , Complicaciones de la Diabetes/epidemiología , Síndrome de Down/complicaciones , Medicina Basada en la Evidencia , Humanos , Tamizaje Masivo , Obesidad/complicaciones
13.
PLoS Negl Trop Dis ; 14(10): e0008806, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33064734

RESUMEN

Clinical spectrum of Coronavirus Disease 2019 (COVID-19) remains unclear, especially with regard to the presence of pneumonia. We aimed to describe the clinical course and final outcomes of adult patients with laboratory-confirmed COVID-19 in the full spectrum of disease severity. We also aimed to identify potential predictive factors for COVID-19 pneumonia. We conducted a retrospective study among adult patients with laboratory-confirmed COVID-19 who were hospitalized at Bamrasnaradura Infectious Diseases Institute, Thailand, between January 8 and April 16, 2020. One-hundred-and-ninety-three patients were included. The median (IQR) age was 37.0 (29.0-53.0) years, and 58.5% were male. The median (IQR) incubation period was 5.5 (3.0-8.0) days. More than half (56%) of the patients were mild disease severity, 22% were moderate, 14% were severe, and 3% were critical. Asymptomatic infection was found in 5%. The final clinical outcomes in 189 (97.9%) were recovered and 4 (2.1%) were deceased. The incidence of pneumonia was 39%. The median (IQR) time from onset of illness to pneumonia detection was 7.0 (5.0-9.0) days. Bilateral pneumonia was more prevalent than unilateral pneumonia. In multivariable logistic regression, increasing age (OR 2.55 per 10-year increase from 30 years old; 95% CI, 1.67-3.90; p<0.001), obesity (OR 8.74; 95%CI, 2.06-37.18; p = 0.003), and higher temperature at presentation (OR 4.59 per 1°C increase from 37.2°C; 95% CI, 2.30-9.17; p<0.001) were potential predictive factors for COVID-19 pneumonia. Across the spectrum of disease severities, most patients with COVID-19 in our cohort had good final clinical outcomes. COVID-19 pneumonia was found in one-third of them. Older age, obesity, and higher fever at presentation were independent predictors of COVID-19 pneumonia.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Progresión de la Enfermedad , Neumonía Viral/diagnóstico , Adulto , Factores de Edad , Anciano , Betacoronavirus , Femenino , Fiebre/etiología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Pandemias , Pronóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Riesgo , Evaluación de Síntomas , Tailandia/epidemiología , Adulto Joven
14.
Am J Case Rep ; 21: e925586, 2020 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-33104529

RESUMEN

BACKGROUND In early 2020, severe acute respiratory syndrome-corona virus 2 caused an outbreak of a viral pneumonia that rapidly progressed to a global pandemic. Most cases presented with mild respiratory symptoms and required only supportive care with instructions to self-quarantine at home. Others had more severe symptoms that became complicated by acute respiratory distress syndrome (ARDS) and required hospitalization. CASE REPORT In this report, we present the case of a young patient in New York City who presented to our hospital with coronavirus disease 2019-induced diabetic ketoacidosis (DKA) that progressed to ARDS and subsequent death. The patient was managed for DKA on presentation with insulin protocol and acidosis management. However, it became evident that he had underlying respiratory complications, which later presented as ARDS requiring mechanical ventilation and antibiotics. CONCLUSIONS We recommend that clinicians be aware of this potentially fatal complication in all patients with pre-existing diabetes. Simultaneously, a low threshold for intubation should be advocated for patients with concurrent COVID-19 and type I diabetes mellitus since the potential for poor clinical outcomes from respiratory demise may be lessened by early respiratory intervention.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Diabetes Mellitus Tipo 1/complicaciones , Cetoacidosis Diabética/etiología , Obesidad/complicaciones , Neumonía Viral/complicaciones , Síndrome de Dificultad Respiratoria del Adulto/etiología , Infecciones por Coronavirus/epidemiología , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología , Adulto Joven
15.
Clin Obes ; 10(6): e12414, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33079448

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic is straining the healthcare system, particularly for patients with severe outcomes requiring admittance to the intensive care unit (ICU). This study investigated the potential associations of obesity and diabetes with COVID-19 severe outcomes, assessed as ICU admittance. Medical history, demographic and patient characteristics of a retrospective cohort (1158 patients) hospitalized with COVID-19 were analysed at a single centre in Kuwait. Univariate and multivariate analyses were performed to explore the associations between different variables and ICU admittance. Of 1158 hospitalized patients, 271 had diabetes, 236 had hypertension and 104 required admittance into the ICU. From patients with available measurements, 157 had body mass index (BMI) ≥25 kg/m2 . Univariate analysis showed that overweight, obesity class I and morbid obesity were associated with ICU admittance. Patients with diabetes were more likely to be admitted to the ICU. Two models for multivariate regression analysis assessed either BMI or diabetes on ICU outcomes. In the BMI model, class I and morbid obesities were associated with ICU admittance. In the diabetes model, diabetes was associated with increased ICU admittance, whereas hypertension had a protective effect on ICU admittance. In our cohort, overweight, obesity and diabetes in patients with COVID-19 were associated with ICU admittance, increasing the risk of poor outcomes.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Diabetes Mellitus/virología , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos , Obesidad/complicaciones , Neumonía Viral/complicaciones , Adulto , Betacoronavirus , Índice de Masa Corporal , Comorbilidad , Femenino , Humanos , Kuwait , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Sobrepeso/complicaciones , Pandemias , Estudios Retrospectivos , Factores de Riesgo
19.
Eur J Endocrinol ; 183(6): R167-R183, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33105105

RESUMEN

Overt hypogonadism in men adversely affects body composition and metabolic health, which generally improve upon testosterone (TS) therapy. As obese men often display lower serum TS levels, in particular when they present with the metabolic syndrome (MetS) or type 2 diabetes (T2DM), there have been claims that androgen therapy prevents or reverses obesity and improves metabolic health. This has contributed to the increase in TS prescriptions during the past two decades. In this narrative review, based on findings from larger observational studies and randomized controlled intervention trials, we evaluate whether low TS predicts or predisposes to obesity and its metabolic consequences, and whether obese men with low TS are truly hypogonadal. We further describe the mechanisms underlying the bi-directional relationships of TS levels with obesity and metabolic health, and finally assess the evidence for TS therapy in men with obesity, MetS and/or T2DM, considering efficacy, safety concerns and possible alternative approaches. It is concluded that low serum sex hormone-binding globulin and total TS levels are highly prevalent in obese men, but that only those with low free TS levels and signs or symptoms of hypogonadism should be considered androgen deficient. These alterations are reversible upon weight loss. Whether low TS is a biomarker rather than a true risk factor for metabolic disturbances remains unclear. Considering the limited number of sound TS therapy trials have shown beneficial effects, the modest amplitude of these effects, and unresolved safety issues, one cannot in the present state-of-the-art advocate TS therapy to prevent or reverse obesity-associated metabolic disturbances. Instead, the focus should remain on lifestyle measures and management of obesity-related consequences.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Terapia de Reemplazo de Hormonas/métodos , Hipogonadismo/tratamiento farmacológico , Síndrome Metabólico/tratamiento farmacológico , Obesidad/tratamiento farmacológico , Testosterona/uso terapéutico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Hipogonadismo/sangre , Hipogonadismo/complicaciones , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/complicaciones , Obesidad/sangre , Obesidad/complicaciones , Estudios Observacionales como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Globulina de Unión a Hormona Sexual/análisis , Testosterona/sangre , Resultado del Tratamiento
20.
Eur J Endocrinol ; 183(6): 669-676, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33112256

RESUMEN

Context: Obesity and cardiometabolic diseases are associated with higher long-term glucocorticoid levels, measured as scalp hair cortisol (HairF) and cortisone (HairE). Cardiometabolic diseases have also been associated with copeptin, a stable surrogate marker for the arginine-vasopressin (AVP) system. Since AVP is, together with corticotropin-releasing hormone (CRH) an important regulator of the hypothalamic-pituitary adrenal axis (HPA axis), we hypothesize that AVP contributes to chronic hypercortisolism in obesity. Objective: To investigate whether copeptin levels are associated with Higher HairF and HairE levels in obesity. Design: A cross-sectional study in 51 adults with obesity (BMI ≥30 kg/m2). Methods: Associations and interactions between copeptin, HairF, HairE, and cardiometabolic parameters were cross-sectionally analyzed. Results: Copeptin was strongly associated with BMI and waist circumference (WC) (rho = 0.364 and 0.530, P = 0.008 and <0.001, respectively), also after correction for confounders. There were no associations between copeptin and HairF or HairE on a continuous or dichotomized scale, despite correction for confounders. Conclusion: In patients with obesity, AVP seems not a major contributor to the frequently observed high cortisol levels. Other factors which stimulate the HPA axis or affect cortisol synthesis or breakdown may be more important than the influence of AVP on long-term glucocorticoid levels in obesity.


Asunto(s)
Cortisona/metabolismo , Síndrome de Cushing/etiología , Glicopéptidos/metabolismo , Hidrocortisona/metabolismo , Obesidad/metabolismo , Adulto , Arginina Vasopresina/metabolismo , Biomarcadores/metabolismo , Índice de Masa Corporal , Hormona Liberadora de Corticotropina/metabolismo , Estudios Transversales , Femenino , Glucocorticoides/metabolismo , Cabello/química , Humanos , Sistema Hipotálamo-Hipofisario/metabolismo , Masculino , Obesidad/complicaciones , Sistema Hipófiso-Suprarrenal/metabolismo
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