The pericapsular nerve group block, a highly selective blockage for intracapsular hip fractures: A case series.

Hip fracture is a very frequent clinical situation in the elderly and frail patient. The Pericapsular Nerve Group (PENG) has emerged as a highly selective block for the intracapsular hip fractures. We describe 44 patients with intracapsular hip fractures who underwent a PENG block in addition to spinal anaesthesia with. The main objective was to assess post-surgical pain control at the recovery room and after 24 h. Also, we considered the need for first of second analgesic rescue during the first 24 h after surgery. Only 10 patients presented mild pain at the recovery room. Up to 30 of them had pain after 24 h. However, 25 of these patients reported having mild pain. Only 9 patients required analgesic rescue for postoperative pain control. In conclusion, PENG block is a locoregional technique that allows good postoperative pain control and low opioid consumption during the postoperative period of intracapsular hip fractures.

Potential Association of the Oral Microbiome with Trimethylamine N-Oxide Quantification in Mexican Patients with Myocardial Infarction.

Many attempts have been proposed to evaluate the linkage between the oral-gut-liver axis and the mechanisms related to the diseases' establishment. One of them is the oral microbiota translocation into the bloodstream, liver, and gut, promoting a host dysbiosis and triggering the presence of some metabolites such as trimethylamine N-oxide (TMAO), known as a risk marker for cardiovascular disease, and especially the myocardial infarction (MI). In the present pilot study, the involvement of oral dysbiosis related to the presence of TMAO has been considered an independent component of the standard risk factors (SRs) in the development of MI, which has not been previously described in human cohorts. A positive and significant correlation of TMAO levels with Porphyromonas was identified; likewise, the increase of the genus Peptidiphaga in patients without SRs was observed. We determined that the presence of SRs does not influence the TMAO concentration in these patients. This report is the first study where the relationship between oral dysbiosis and TMAO is specified in the Mexican population. Our findings provide information on the possible contribution of the oral pathogens associated with gut dysbiosis in the development of MI, although further analysis should be performed.

Ulcerative colitis and pyoderma gangrenosum refractory to treatment successfully managed with pentoxifylline: a case report.

Introduction and importance: Pyoderma gangrenosum is an unusual inflammatory pathology, with neutrophilic dermatosis, of unknown etiology. It is associated with diseases such as bowel disease. Generally, it is treated with anti-inflammatory drugs, corticosteroids, immunosuppressants, and antibodies against tumor necrosis factor, but relapse and adverse effects are persistent. Pentoxifylline is a drug with immunoregulatory and anti-inflammatory properties. Case presentation: A 47-year-old male with a diagnosis of ulcerative colitis initially managed favorably for 7 years with mesalazine. At 3 years of treatment, he presented a sudden ulcer that affected skin and subcutaneous tissue (13×10 cm) in the lower right limb. During the last 2 years, he was treated with mesalazine and infliximab with partial results and permanent relapses. Therefore, pentoxifylline was added to his treatment. Clinical discussion: The justification for the addition of pentoxifylline is mainly its action as an inhibitor of Nuclear Factor-kappa Beta (NF-κB) transcription, which stimulates the expression of proinflammatory interleukin genes such as IL-1, IL-6, IL- 8, and TNF-α and showing immunoregulatory and antioxidant activities. Conclusion: With pentoxifylline, this lesion healed at 6 weeks without relapses after 2 years.

Neuroinflammation, Microbiota-Gut-Brain Axis, and Depression: The Vicious Circle.

Depression is the leading cause of disability worldwide, contributing to the global disease burden. From above, it is a priority to investigate models that fully explain its physiopathology to develop new treatments. In the last decade, many studies have shown that gut microbiota (GM) dysbiosis influences brain functions and participate, in association with immunity, in the pathogenesis of depression. Thereby, GM modulation could be a novel therapeutic target for depression. This review aims to evidence how the GM and the immune system influence mental illness, particularly depression. Here, we focus on the communication mechanisms between the intestine and the brain and the impact on the development of neuroinflammation contributing to the development of Major Depressive Disorder (MDD). However, most of the current findings are in animal models, suggesting the need for studies in humans. In addition, more analysis of metabolites and cytokines are needed to identify new pathophysiological mechanisms improving anti-depression treatments.

Comparison of social gradient in cardiometabolic health in Czechia and Venezuela: a cross-sectional study.

OBJECTIVES: This study compared the relationships of social determinants with cardiometabolic risk in different socioeconomic contexts: sociopolitically unstable Venezuela (VE) and stable Czechia (CZ). DESIGN: cross-sectional analysis involving two population-based studies. SETTING: Brno, Czechia and 23 cities of Venezuela. PARTICIPANTS: 25-64 years old subjects from CZ (2013-2014, n=1579, 56% females) and VE (2014-2017, n=1652, 70% females). MAIN OUTCOME MEASURES: The composite cardiometabolic risk score (CMRS) (scaled 0-8) was calculated using eight biomarkers (body mass index, waist circumference, blood glucose, systolic and diastolic blood pressure, total and high-density lipoprotein-cholesterol, triglycerides). Social characteristics included education in both countries, income in CZ and a composite measure of social position (SP) in VE. Sex stratified ordinal regression examined the social gradient in having less favourable CMRS. RESULTS: In CZ, men and women with low education and women with low income had higher odds of higher CMRS compared with those with high education and income with OR 1.45 (95% CI 1.01 to 2.21), 2.29 (95% CI 1.62 to 3.24) and 1.69 (95% CI 1.23 to 2.35). In VE, women with low education and low SP had higher odds to have higher CMRS OR 1.47 (95% CI 1.09 to 1.97) and 1.51 (95% CI 1.16 to 1.97), while men with low education and low SP had lower odds to have higher CMRS OR 0.64 (95% CI 0.41 to 1.00) and 0.61 (95% CI 0.40 to 0.97), compared with those with high education and high SP. Independently of age, sex and socioeconomic characteristics, Venezuelans had higher odds to have higher CMRS than Czechs (OR 2.70; 95% CI 2.37 to 3.08). CONCLUSIONS: The results suggest that the associations of socioeconomic status indices and cardiometabolic risk differed between CZ and VE, likely reflecting differences in the social environment among countries. Further research is needed to confirm and quantify these differences.

Contribution of Trimethylamine N-Oxide (TMAO) to Chronic Inflammatory and Degenerative Diseases.

Trimethylamine N-oxide (TMAO) is a metabolite produced by the gut microbiota and has been mainly associated with an increased incidence of cardiovascular diseases (CVDs) in humans. There are factors that affect one's TMAO level, such as diet, drugs, age, and hormones, among others. Gut dysbiosis in the host has been studied recently as a new approach to understanding chronic inflammatory and degenerative diseases, including cardiovascular diseases, metabolic diseases, and Alzheimer's disease. These disease types as well as COVID-19 are known to modulate host immunity. Diabetic and obese patients have been observed to have an increase in their level of TMAO, which has a direct correlation with CVDs. This metabolite is attributed to enhancing the inflammatory pathways through cholesterol and bile acid dysregulation, promoting foam cell formation. Additionally, TMAO activates the transcription factor NF-κB, which, in turn, triggers cytokine production. The result can be an exaggerated inflammatory response capable of inducing endoplasmic reticulum stress, which is responsible for various diseases. Due to the deleterious effects that this metabolite causes in its host, it is important to search for new therapeutic agents that allow a reduction in the TMAO levels of patients and that, thus, allow patients to be able to avoid a severe cardiovascular event. The present review discussed the synthesis of TMAO and its contribution to the pathogenesis of various inflammatory diseases.

Incidence of endophthalmitis post cataract surgery in a Tertiary Hospital of Buenos Aires.

OBJECTIVE: Acknowledging the rates of endophthalmitis after cataract surgery is very important to understand the seriousness of the disease. Until now, there is no data of this situation in Argentina. The aim of this study was to estimate the incidence of postoperative endophthalmitis after cataract surgery at a tertiary hospital, a medical facility which provides a high degree of subspecialty expertise, in Buenos Aires, Argentina. METHOD: Retrospective cohort study of adult patients who underwent cataract phacoemulsification surgery between 2006 and 2020 at Hospital Italiano de Buenos Aires, was performed. Patients with endophthalmitis diagnosis within the first 6 weeks after surgery were included. Those who underwent extracapsular surgery or combined surgeries were excluded. RESULTS: A total of 29 326 cataract surgeries were performed in ten years. The annual incidence of acute postoperative endophthalmitis after cataract surgery was 0.102% (95% CI 0.069-0.146). Thirty cases of endophthalmitis were diagnosed. The main microorganism was Pseudomonas aeruginosa (45.4%). Final visual acuity was higher than 0.3 (LogMAR) in 46.6% of the patients. CONCLUSION: The incidence of endophthalmitis after cataract surgery in this hospital is within the range reported globally. Knowing the regional incidence contributes to decide if new prophylaxis measures are necessary.

OBJETIVO: Conocer las tasas de endoftalmitis después de la cirugía de cataratas es muy importante para comprender la gravedad de la enfermedad. Hasta el momento, no hay datos de su situación en Argentina. El objetivo de este estudio fue estimar la incidencia de endoftalmitis postoperatoria tras cirugía de catarata en un hospital de tercer nivel o alta complejidad de Buenos Aires, Argentina. Método: Se realizó un estudio de cohorte retrospectivo de pacientes adultos operados de facoemulsificación de cataratas entre 2006 y 2020 en el Hospital Italiano de Buenos Aires. Se incluyeron pacientes con diagnóstico de endoftalmitis dentro de las primeras 6 semanas posteriores a la cirugía. Se excluyeron los pacientes que se sometieron a cirugía extracapsular o cirugías combinadas. RESULTADOS: En diez años se realizaron un total de 29.326 operaciones de cataratas. La incidencia anual de endoftalmitis postoperatoria aguda después de la cirugía de cataratas fue del 0.102% (IC del 95%: 0.069-0.146). Treinta casos de endoftalmitis fueron identificados. El principal microorganismo fue Pseudomonas aeruginosa (45.4%). La agudeza visual final fue superior a 0.3 (LogMAR) en el 46.6% de los pacientes. Conclusión: La incidencia de endoftalmitis después de la cirugía de cataratas en este hospital está dentro del rango reportado a nivel mundial. Conocer la incidencia regional contribuye a decidir si son necesarias nuevas medidas de profilaxis.

Risk Factors Associated with the Consumption of Sugar-Sweetened Beverages among Czech Adults: The Kardiovize Study.

High consumption of sugar-sweetened beverages (SSBs) is associated with a higher risk of cardiovascular disease (CVD). The last report on the prevalence of SSBs consumption in Czechia was 17 years ago, an updated analysis will enable the design of appropriate public health policies. This study aimed to determine the prevalence of SSBs consumption in a Czech city during 2020 and 2022, and its association with cardiometabolic biomarkers, behavioral risk factors, and socioeconomic determinants. A total of 730 participants (33 to 73 years) were assessed from a random population-based survey. SSBs consumption was evaluated using two methods: by calorie amount, with a 24 h dietary recall, and by frequency, with a food frequency questionnaire. By calorie amount, the prevalence of SSBs consumption was none: 52.5%, low: 30.0%, and moderate−high: 17.5%; by frequency was never: 16.0%, occasionally: 64.1%, and daily: 19.9%. SSBs intake was higher in men (p < 0.001) and younger participants (p = 0.001). Men consuming daily had higher waist circumference and visceral fat area compared to both occasional and never consumers. Higher SSBs consumption was associated with low household income, middle education level, and high total energy intake. In total, 20% drank SSBs daily and 17.5% of participants consumed moderate−high calorie amounts of SSBs. These results represent an increase in the prevalence of SSBs consumption in the last two decades. Public health policies should target men of younger age and people with low education and income.

Incidence of endophthalmitis post cataract surgery in a tertiary hospital of Buenos Aires / Incidencia de endoftalmitis post cirugía de catarata en un hospital de tercer nivel en Buenos Aires

Abstract Objective: Acknowledging the rates of endophthalmitis after cataract surgery is very important to understand the seriousness of the disease. Until now, there is no data of this situation in Argentina. The aim of this study was to estimate the incidence of postoperative endophthalmitis after cataract surgery at a tertiary hospital, a medical facility which provides a high degree of subspecialty expertise, in Buenos Aires, Argentina. Method: Retrospective cohort study of adult patients who underwent cataract phacoemulsification sur gery between 2006 and 2020 at Hospital Italiano de Buenos Aires, was performed. Patients with endophthalmitis diagnosis within the first 6 weeks after surgery were included. Those who underwent extracapsular surgery or combined surgeries were excluded. Results: A total of 29 326 cataract surgeries were performed in ten years. The annual incidence of acute postoperative endophthalmitis after cataract surgery was 0.102% (95% CI 0.069-0.146). Thirty cases of endophthalmitis were diagnosed. The main microorganism was Pseudomonas aeruginosa (45.4%). Final visual acuity was higher than 0.3 (LogMAR) in 46.6% of the patients. Conclusion: The incidence of endophthalmitis after cataract surgery in this hospital is within the range reported globally. Knowing the regional incidence contributes to decide if new prophylaxis measures are necessary.

Resumen Objetivo: Conocer las tasas de endoftalmitis después de la cirugía de cataratas es muy importante para comprender la gravedad de la enfermedad. Hasta el momento, no hay datos de su situación en Argentina. El objetivo de este estudio fue estimar la incidencia de endoftalmitis postoperatoria tras cirugía de catarata en un hospital de tercer nivel o alta complejidad de Buenos Aires, Argentina. Método: Se realizó un estudio de cohorte retrospectivo de pacientes adultos operados de facoemulsificación de cataratas entre 2006 y 2020 en el Hospital Italiano de Buenos Aires. Se incluyeron pacientes con diagnóstico de endoftalmitis dentro de las prime ras 6 semanas posteriores a la cirugía. Se excluyeron los pacientes que se sometieron a cirugía extracapsular o cirugías combinadas. Resultados: En diez años se realizaron un total de 29.326 operaciones de cataratas. La incidencia anual de endoftalmitis postoperatoria aguda después de la cirugía de cataratas fue del 0.102% (IC del 95%: 0.069-0.146). Treinta casos de endoftalmitis fueron identificados. El principal microorganismo fue Pseudomonas aeruginosa (45.4%). La agudeza visual final fue superior a 0.3 (LogMAR) en el 46.6% de los pacientes. Conclusión: La incidencia de endoftalmitis después de la cirugía de cataratas en este hospital está dentro del rango reportado a nivel mundial. Conocer la incidencia regional contribuye a decidir si son necesarias nuevas medidas de profilaxis.

Association of Self-Reported Depression Symptoms with Physical Activity Levels in Czechia.

Worldwide, depressive disorder is one of the leading determinants of disability-adjusted life years. Although there are benefits associated with a higher physical activity (PA) level, there is a lack of information related to this relationship, especially in countries such as Czechia, where modern approaches to mental health care only recently emerged. The present study aimed to evaluate the association between the level of depression and different PA levels following the World Health Organization (WHO) PA guidelines and according to specific symptoms that indicate depression. Multivariable-adjusted Poisson regression models were used to calculate the prevalence rate (PR) in a sample of 2123 participants (45.3% men, median 48 years). Compared to subjects with insufficient PA, moderate and high PA levels were inversely associated with continuous depression scores (PR = 0.85; 95% CI: 0.75-0.97; and PR = 0.80; 95% CI: 0.70-0.92). Depressed mood and worthlessness were the symptoms associated with moderate and high PA. Tiredness, change in appetite, and concentration problems were related to high PA. The results suggest that reaching the minimum PA target according to the guidelines seems to be effective, and this could stimulate adherence. However, more specific improvements in symptomatology will require a subsequent gradual increase in PA levels.

A gene expression signature in HER2+ breast cancer patients related to neoadjuvant chemotherapy resistance, overall survival, and disease-free survival.

Breast cancer ranks first in terms of mortality and incidence rates worldwide among women. The HER2+ molecular subtype is one of the most aggressive subtypes; its treatment includes neoadjuvant chemotherapy and the use of a HER2 antibody. Some patients develop resistance despite positive results obtained using this therapeutic strategy. OBJECTIVE: To identify prognostic markers for treatment and survival in HER2+ patients. METHODS: Patients treated with neoadjuvant chemotherapy were assigned to sensitive and resistant groups based on their treatment response. Differentially expressed genes (DEGs) were identified using RNA-seq analysis. KEGG pathway, gene ontology, and interactome analyses were performed for all DEGs. An enrichment analysis Gene set enrichment analysis was performed. All DEGs were analyzed for overall (OS) and disease-free survival (DFS). RESULTS: A total of 94 DEGs were related to treatment resistance. Survival analysis showed that 12 genes (ATF6B, DHRS13, DIRAS1, ERAL1, GRIN2B, L1CAM, IRX3, PRTFDC1, PBX2, S100B, SLC9A3R2, and TNXB) were good predictors of disease-free survival, and eight genes (GNG4, IL22RA2, MICA, S100B, SERPINF2, HLA-A, DIRAS1, and TNXB) were good predictors of overall survival (OS). CONCLUSION: We highlighted a molecular expression signature that can differentiate the treatment response, overall survival, and DFS of patients with HER2+ breast cancer.

Comparison of gastric reactance with commonly used perfusion markers in a swine hypovolemic shock model.

BACKGROUND: The gut has been hypothesized to be a protagonist tissue in multiple organ dysfunction syndrome (MODS) for the past three decades. Gastric reactance (XL) is a potential perfusion marker derived from gastric impedance spectroscopy (GIS), which is an emerging tool through which living tissue can be continuously measured to determine its pathophysiological evolution. This study aimed to compare the performance of XL [positive predictive values (PPV), negative predictive values (NPV), and area under the curve (AUC)] against commonly used perfusion markers before and during hypovolemic shock in swine subjects. METHODS: Prospective, controlled animal trial with two groups, control group (CG) N = 5 and shock (MAP ≤ 48 mmHg) group (SG) N = 16. Comparison time points were defined as T-2 (2 h before shock), T-1 (1 h before shock), T0 (shock), T1 (1 h after shock), and T2 (2 h after shock). Shock severity was assessed through blood gases, systemic and hemodynamic variables, and via histological examination for assessing inflammation-edema and detachment in the gastric mucosa. Macroscopic assessment of the gastric mucosa was defined in five levels (0-normal mucosa, 1-stippling or epithelial hemorrhage, 2-pale mucosa, 3-violet mucosa, and 4-marmoreal mucosa). Receiver Operating Characteristic (ROC) curves of perfusion markers and XL were calculated to identify optimal cutoff values and their individual ability to predict hypovolemic shock. RESULTS: Comparison among the CG and the SG showed statistically significant differences in XL measurements at T-1, T0, T1, and T2, while lactate showed statistically significant differences until T1 and T2. Statistically significant differences were detected in mucosa class (p < 0.001) and in inflammation-edema in the gastric body and the fundus (p = 0.021 and p = 0.043). The performance of the minimum XL value per subject  per event (XL_Min) was better (0.81 ≤ AUC ≤ 0.96, 0.93 ≤ PPV ≤ 1.00, 0.45 ≤ NPV ≤ 0.83) than maximum lactate value (Lac_Max) per subject per event (0.29 ≤ AUC ≤ 0.82, 0.82 ≤ PPV ≤ 0.91, 0.24 ≤ NPV ≤ 0.82). Cutoff values for XL_Min show progressive increases at each time point, while cutoff values for Lac_Max increase only at T2. CONCLUSIONS: XL proved to be an indirect and consistent marker of inadequate gastric mucosal perfusion, which shows significant and detectable changes before commonly used markers of global perfusion under the hypovolemic shock conditions outlined in this work.

Feasibility and Effectiveness of a Preventive Care Program during the Compound Humanitarian Crisis and COVID-19 Pandemic in Venezuela.

Effective preventive care programs are urgently needed during humanitarian crises, as has been especially obvious during the COVID-19 pandemic. A pragmatic trial was designed: hybridized intervention (Diabetes Prevention Program [DPP] + medical nutrition therapy + liquid diet [LD]; LD group) vs. DPP only (DPP group). The participants were adults who were overweight/obese and at high risk of type 2 diabetes mellitus (T2DM). The LD consisted of a "homemade" milk- and fruit-juice-based beverage. Pandemic restrictions delayed the program by nine months, tripled the amount of time required for screening, and reduced the total sample to 60%. Eventually, 127 participants were randomized, and 94/127 participants (74.0%) completed the first phase. Participant dropout was influenced by migration, COVID-19 symptoms, education level, and socioeconomic status. In two months, the LD group lost 2.9 kg (p < 0.001) and the DPP group, 2.2 kg (p < 0.001) (between-group p = 0.170), with improvements in their cardiometabolic risk factors. At this stage, the DPP was shown to be feasible and effective, demonstrating weight loss with the improvement of cardiometabolic risk factors in a primary setting in Venezuela, a middle-income country with a chronic humanitarian crisis, during the COVID-19 pandemic.

Higher Adherence to ERAS Society® Recommendations is Associated with Shorter Hospital Stay Without an Increase in Postoperative Complications or Readmissions in Bariatric Surgery: the Association Between Use of Enhanced Recovery After Surgery Protocols and Postoperative Complications after Bariatric Surgery (POWER 3) Multicenter Observational Study.

PURPOSE: The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery. MATERIALS AND METHODS: Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03864861.

The Combined Effects of Television Viewing and Physical Activity on Cardiometabolic Risk Factors: The Kardiovize Study.

The aim of the present study was to evaluate the association between television viewing/physical activity (TVV/PA) interactions and cardiometabolic risk in an adult European population. A total of 2155 subjects (25-64 years) (45.2% males), a random population-based sample were evaluated in Brno, Czechia. TVV was classified as low (<2 h/day), moderate (2-4), and high (≥4). PA was classified as insufficient, moderate, and high. To assess the independent association of TVV/PA categories with cardiometabolic variables, multiple linear regression was used. After adjustments, significant associations were: High TVV/insufficient PA with body mass index (BMI) (ß = 2.61, SE = 0.63), waist circumference (WC) (ß = 7.52, SE = 1.58), body fat percent (%BF) (ß = 6.24, SE = 1.02), glucose (ß = 0.25, SE = 0.12), triglycerides (ß = 0.18, SE = 0.05), and high density lipoprotein (HDL-c) (ß = -0.10, SE = 0.04); high TVV/moderate PA with BMI (ß = 1.98, SE = 0.45), WC (ß = 5.43, SE = 1.12), %BF (ß = 5.15, SE = 0.72), triglycerides (ß = 0.08, SE = 0.04), total cholesterol (ß = 0.21, SE = 0.10), low density protein (LDL-c) (ß = 0.19, SE = 0.08), and HDL-c (ß = -0.07, SE = 0.03); and moderate TVV/insufficient PA with WC (ß = 2.68, SE = 1.25), %BF (ß = 3.80, SE = 0.81), LDL-c (ß = 0.18, SE = 0.09), and HDL-c (ß = -0.07, SE = 0.03). Independent of PA levels, a higher TVV was associated with higher amounts of adipose tissue. Higher blood glucose and triglycerides were present in subjects with high TVV and insufficient PA, but not in those with high PA alone. These results affirm the independent cardiometabolic risk of sedentary routines even in subjects with high-levels of PA.

Prevalence of adiposity-based chronic disease in middle-aged adults from Czech Republic: The Kardiovize study.

AIMS/HYPOTHESIS: The need for understanding obesity as a chronic disease, its stigmatization, and the lack of actionability related to it demands a new approach. The adiposity-based chronic disease (ABCD) model is based on adiposity amount, distribution, and function, with a three stage complication-centric rather than a body mass index (BMI)-centric approach. The prevalence rates and associated risk factors are presented. METHODS: In total, 2159 participants were randomly selected from Czechia. ABCD was established as BMI ≥ 25 kg/m2 or high body fat percent, or abdominal obesity and then categorized by their adiposity-based complications: Stage 0: none; Stage 1: mild/moderate; Stage 2: severe. RESULTS: ABCD prevalence was 62.8%. Stage 0 was 2.3%; Stage 1 was 31.4%; Stage 2 was 29.1%. Comparing with other classifiers, participants in Stage 2 were more likely to have diabetes, hypertension, and metabolic syndrome than those with overweight, obesity, abdominal obesity, and increased fat mass. ABCD showed the highest sensitivity and specificity to detect participants with peripheral artery disease, increased intima media, and vascular disease. CONCLUSION/INTERPRETATION: The ABCD model provides a more sensitive approach that facilitates the early detection and stratification of participants at risk compared to traditional classifiers.

Prediction of Cardiorespiratory Fitness in Czech Adults: Normative Values and Association with Cardiometabolic Health.

Cardiorespiratory fitness (CRF) is a strong independent predictor of morbidity and mortality. However, there is no recent information about the impact of CRF on cardiometabolic risk specifically in Central and Eastern Europe, which are characterized by different biological and social determinants of health. In this cross-sectional study normative CRF values were proposed and the association between CRF and cardiometabolic outcomes was evaluated in an adult Czechian population. In 2054 participants (54.6% females), median age 48 (IQR 19 years), the CRF was predicted from a non-exercise equation. Multivariable-adjusted logistic regressions were carried out to determine the associations. Higher CRF quartiles were associated with lower prevalence of hypertension, type 2 diabetes (T2D) and dyslipidemia. Comparing subjects within the lowest CRF, we see that those within the highest CRF had decreased chances of hypertension (odds ratio (OR) = 0.36; 95% CI: 0.22-0.60); T2D (OR = 0.16; 0.05-0.47), low HDL-c (OR = 0.32; 0.17-0.60), high low-density lipoprotein (OR = 0.33; 0.21-0.53), high triglycerides (OR = 0.13; 0.07-0.81), and high cholesterol (OR = 0.44; 0.29-0.69). There was an inverse association between CRF and cardiometabolic outcomes, supporting the adoption of a non-exercise method to estimate CRF of the Czech population. Therefore, more accurate cardiometabolic studies can be performed incorporating the valuable CRF metric.

Optimal waist circumference cutoff values to predict cardiometabolic alterations in a Venezuela national representative sample. The EVESCAM study / Valores óptimos de punto de corte de circunferencia abdominal para predecir alteraciones cardiometabólicas en una muestra representativa nacional de Venezuela. El estudio EVESCAM

Abstract Objective: Waist circumference (WC) value reflects abdominal adiposity, but the amount abdominal fat that is associated to cardiometabolic risk factors varies among ethnicities. Determination of metabolic abnormalities has not undergone a WC adaptation process in Venezuela. The aim of the study was (1) to determine the optimal WC cutoff value associated with ≥2 cardiometabolic alterations and (2) incorporating this new WC cutoff, to determine the prevalence of abdominal obesity and cardiometabolic risk factors related in Venezuela. Methods: The study was national population-based, cross-sectional, and randomized sample, from 2014 to 2017. To assess performance of WC for identifying cardiometabolic alterations, receiver operating characteristics curves, area under the curve (AUC), sensitivity, specificity, and positive likelihood ratios were calculated. Results: Three thousand three hundred eighty-seven adults were evaluated with mean age of 41.2 ± 15.8 years. Using the best tradeoff between sensitivity and specificity, WC cutoffs of 90 cm in men (sensitivity = 72.4% and specificity = 66.1%) and 86 cm in women (sensitivity = 76.2% and specificity = 61.4%) were optimal for aggregation of ≥2 cardiometabolic alterations. AUC was 0.75 in men and 0.73 in women using these new cutoffs. Prevalence of abdominal obesity and metabolic syndrome was 59.6% (95 CI; 57.5-61.7) and 47.6% (95 CI; 45.2-50.0), respectively. Cardiometabolic risk factors were associated with being men, higher age, adiposity, and living in northern or western regions. Conclusion: The optimal WC values associated with cardiometabolic alterations were 90 cm in men and 86 cm in women. More than half of the Venezuelan population had abdominal obesity incorporating this new WC cutoff.

Resumen Objetivo: El valor de la circunferencia abdominal (CA) refleja la adiposidad abdominal, pero la cantidad de grasa abdominal asociada a factores de riesgo cardiometabólicos varía según la etnia. La determinación de anomalías metabólicas no se ha adaptado a la CA en Venezuela. 1) Detrerminar el valor de corte óptimo de CA asociados a ≥ 2 alteraciones cardiometabólicas. 2) Incorporando este nuevo límite de CA, determinar la prevalencia de obesidad abdominal y factores de riesgo cardiometabólicos relacionados en Venezuela. Métodos: Fue un estudio poblacional, transversal, de muestreo aleatorio de 2014 a 2017. Para evaluar el valor de CA para identificar alteraciones cardiometabólicas, se realizaron curvas características operativa del receptor y se calculó área bajo la curva (ABC), sensibilidad, especificidad y razón de similitud. Resultados: se evaluaron 3387 adultos con una edad promedio de 41.2 ± 15.8 años. Utilizando la mejor relación entre sensibilidad y especificidad, se determinó que los valores de corte de 90 cm en hombres (sensibilidad = 72.4% y especificidad = 66.1%) y 86 cm en mujeres (sensibilidad = 76.2% y especificidad = 61.4%) fueron óptimos para la agregación de ≥ 2 alteraciones cardiometabólicas. El ABC fue de 0,75 en hombres y de 0,73 en mujeres usando estos nuevos puntos de corte. La prevalencia de obesidad abdominal y síndrome metabólico fue 59.6% (95IC; 57.5 - 61.7) y 47.6% (95CI; 45.2 - 50.0), respectivamente. La presencia de factores de riesgo cardiometabólicos se asoció con ser hombre, mayor edad, adiposidad y vivir en regiones del norte o del oeste. Conclusión: Los valores óptimos de CA asociados con alteraciones cardiometabólicas fueron 90 cm en hombres y 86 cm en mujeres. Más de la mitad de la población venezolana tenía obesidad abdominal al incorporar este nuevo corte de CA.