Effects of weight stigma on BMI and inflammatory markers among people living with obesity.

OBJECTIVE: Weight stigma (WS) and prejudice are one of the most prevalent ways of discrimination among adults, comparable with rates of racial discrimination. Exposure to WS among patients with obesity (PWO) may make the adoption of healthy dietary patterns and regular physical activity even more challenging and, therefore, the achievement of weight loss. Additionally, WS could also induce physiological responses such as increased levels of inflammatory markers, due to stress exposure. METHOD: Subjects attending two obesity clinics were evaluated at baseline and after a minimum follow-up of six months. The weight Bias Internalization Scale (WBIS) and the Stigmatizing Situations Inventory (SSI) were administered to evaluate WS. Also, anthropometric and inflammatory markers, including cortisol, ferritin and C-reactive protein (CRP), were recorded at baseline. RESULTS: 79 PWO (87.3%♀, 45.5 ± 1.3 years, 35.9 ± 6.3 kg/m2) were included. At baseline, 72.2% started liraglutide as anti-obesity drug. Baseline body mass index (BMI) correlated positively with both WBIS (r = 0.23; p = 0.03) and SSI (r = 0.25; p = 0.02) scores. Mean percentual weight loss after a mean follow-up of six months was -7.28%. However, there was a negative, but not statistically significant, correlation between weight loss and both WBIS (r=-0.14; p = 0.2) and SSI (r=-0.19; p = 0.08). Regarding inflammatory markers, plasma cortisol levels at baseline correlated positively with WBIS (p = 0.005) and SSI (p = 0.02). CRP at baseline also presented a positive correlation with SSI (p = 0.03). No significant correlations were found for stigma tests and ferritin levels. DISCUSSION: As weight increases among PWO, so does stigma. Despite we did not find a significant negative association between the presence of WS and weight loss outcomes, there was an increase in inflammatory markers among PWO who experienced higher levels of WS.

Long-term chronic joint pain after sleeve gastrectomy and its influence on clinical and psychological outcomes.

INTRODUCTION: Bariatric surgery (BS) is effective in improving chronic joint pain (CJP). However, the long-term effects on this comorbidity are poorly understood. OBJECTIVES: To determine the prevalence of CJP in a sample of patients who had undergone BS with a minimum follow-up of 18 months. To determine whether or not there was any relationship between CJP and clinical or psychological outcomes after BS. MATERIAL AND METHODS: Cross-sectional study. The Lattinen index (LI) was used to evaluate CJP, using the cut-off point of 10 to define significant CJP (SCJP). RESULTS: Of the 110 subjects assessed, 31.2% (35/110) had SCJP. The patients with SCJP were older (57.4±13 vs 47.8±11.6 years; p<0.0001) and more time had elapsed since their BS (105.6±54.3 vs 78.5±39 months; p=0.023). The last BMI was higher in subjects with SCJP (35±5 vs 33.3±6.9kg/m2; p=0.05) and the percentage of patients who took significant regular exercise was lower (2.9% vs 68%; p<0.0001). Trauma problems after BS were more common in subjects with SCJP (61.8% vs 22.7%; p<0.0001). More patients with SCJP met depression criteria (47.1% vs 5.3%; p<0.0001) and/or were treated with antidepressants (38.2% vs 17.3%; p=0.003). Patients with SCJP reported fewer hours of sleep (6±1.4 vs 6.8±1.2h; p=0.003). CONCLUSIONS: SCJP is highly prevalent in patients who have had BS once they reach the weight plateau phase. There is an association between having SCJP and worse psychological and functional status, with potential detrimental metabolic effects.

Análogos de GLP1 en los pacientes con sobrepeso u obesidad durante el confinamiento / GLP1 analogues among patients with overweight or obesity during lockdown

Antecedentes y objetivosUno de los potenciales efectos negativos de un confinamiento son los cambios en los patrones dietéticos y de estilo de vida, que pueden conllevar a una ganancia de peso. El objetivo fue ver los cambios sobre los hábitos higiénico-dietéticos y de patrones de ingesta en una situación de confinamiento y el impacto sobre el peso. Asimismo, ver si el estar bajo tratamiento con análogos de GLP1 (aGLP1) modificó estos parámetros.Material y métodosSe reclutó, de forma consecutiva, a 100 pacientes con sobrepeso/obesidad que acudieron a revisión al finalizar el confinamiento. Se diseñó una entrevista estructurada para ver los cambios en los hábitos dietéticos, rutinas y ejercicio.ResultadosEl 52% de los pacientes ganaron peso durante el confinamiento. El porcentaje de sujetos con historia activa de depresión o ansiedad fue superior entre el grupo de pacientes que ganó peso. El porcentaje de pacientes que empeoraron su hiperfagia ansiosa fue superior en aquellos que ganaron peso (71,2% vs. 10,6%; p<0,0001); lo mismo ocurrió con los atracones (92% vs. 10,6%; p<0,0001) y los cravings, dulces y salados (69,2% vs. 21,3% y 69,2% vs. 14,9%; p<0,0001 y p<0,0001, respectivamente). De los 48 pacientes que no ganaron peso, 30 estaban en tratamiento con aGLP1 (61,7%). El empeoramiento de los patrones anómalos de ingesta fue inferior entre los pacientes en tratamiento con aGLP-1.ConclusionesUn confinamiento es un período vulnerable para ganar peso, especialmente en aquellos pacientes con antecedentes psicopatológicos. Los aGLP1 consiguen controlar la ingesta emocional convirtiéndolos en una opción terapéutica valiosa.

GLP1 analogues among patients with overweight or obesity during lockdown. / Análogos de GLP1 en los pacientes con sobrepeso u obesidad durante el confinamiento.

BACKGROUND AND OBJECTIVES: One of the potential negative effects of a lockdown are changes in dietary and lifestyle patterns, which can lead to weight gain. Our objective was to assess the changes on dietary habits and eating patterns in a lockdown situation and their impact on weight. We aimed to determine whether the treatment with GLP1 analogues (aGLP1) could impact on these parameters. MATERIAL AND METHODS: 100 overweight/obese patients were consecutively recruited for a review at the end of the lockdown. A structured interview was designed to see changes in dietary habits, routines and exercise. RESULTS: 52% patients gained weight during lockdown. The percentage of subjects with an active history of depression or anxiety was higher among the group of patients who gained weight. The percentage of patients who worsened their hyperphagia was higher in those who gained weight (71.2% vs. 10.6%; P<0.0001); similar results were observed with binge eating (92% vs. 10.6%; p<0.0001) and cravings, both sweet and salty (69.2% vs. 21.3% and 69.2% vs. 14.9%; p<0.0001 and p<0.0001 respectively). Of the 48 patients who did not gain weight, 30 were under aGLP1 treatment (61.7%). The worsening of abnormal eating patterns was lower among patients treated with aGLP-1. CONCLUSIONS: A lockdown is a vulnerable period to gain weight, especially in those patients with a psychopathological history. aGLP1 manage to control emotional eating, making them a valuable therapeutic option.

The coexistence of low albumin levels and obesity worsens clinical outcomes among subjects admitted for sars-cov-2 infection.

BACKGROUND AND AIMS: The clinical spectrum of the SARS-CoV-2 infection is very broad, ranging from asymptomatic infection to severe pneumonia. However, the majority of fatalities related to COVID-19 have involved old, frail and patients with comorbidities, such as obesity, groups that also have high rates of a poor nutritional status. To assess the impact on clinical outcomes of the coexistence of any degree of obesity and low albumin levels on admission among patients with COVID-19. METHODS: This is a sub-analysis of a former study where 75 patients admitted due to COVID-19 were evaluated cross-sectionally. In this analysis, patients were divided in two groups, according to the presence of obesity and albumin levels on admission lower than 3.5 g/dl. RESULTS: 11 out 75 patients evaluated (14.7%) had obesity and albumin levels lower than 3.5 g/dl. Patients with obesity and hypoalbuminemia were older than patients without these two conditions (65.3 ± 7.7 vs 54.2 ± 17 years; p = 0.01). CRP (141.4 ± 47.9 vs 70.1 ± 60.6 mg/l; p = 0.002), D-dimer (2677.3 ± 2358.3 vs 521.7 ± 480.3 ng/ml; p = 0.001), fibrinogen (765.9 ± 123.9 vs 613.5 ± 158gr/L; p = 0.007) ferritin levels (903.1 ± 493 vs 531.4 ± 418.9 mcg/l; p = 0.01) and procalcitonin (3.5 ± 0.6 vs 1.1 ± 0.7 ng/ml; p = 0.009) were significantly higher in the group with obesity and hypoalbuminemia. Among patients with low albumin and obesity, length of hospital was higher (21.9 ± 18.7 vs 10.5 ± 9.5 days; p = 0.004) and the proportion of subjects admitted to ICU was greater (81.8% vs 11.5%; p < 0.0001). However, mortality rates were comparable between the two groups (3.8% vs 0%; p = 0.5). CONCLUSIONS: The combination of obesity and hypoalbuminemia may worsen the prognosis of patients with a SARS-CoV-2 infection. Therefore, prompt identification and amelioration of nutritional status could be beneficial.

Influence of nutritional status on clinical outcomes among hospitalized patients with COVID-19.

BACKGROUND AND AIMS: Several factors that worsen the prognosis of the new coronavirus SARS-CoV-2 have been identified, such as obesity or diabetes. However, despite that nutrition may change in a lockdown situation, little is known about the influence of malnutrition among subjects hospitalized due to COVID-19. Our study aimed to assess whether the presence of malnutrition among patients admitted due to COVID-19 had any impact on clinical outcomes compared with patients with the same condition but well nourished. METHODS: 75 patients admitted to hospital due to COVID-19 were analyzed cross-sectionally. Subjective Global Assessment (SGA) was completed by phone interview. Clinical parameters included were extracted from the electronic medical record. RESULTS: According to the SGA, 27 admitted due to a COVID-19 infection had malnutrition. Patients not well nourished were older than patients with a SGA grade A (65 ± 14.1 vs 49 ± 15.1 years; p < 0.0001). Length of hospital stay among poorly nourished patients was significantly higher (18.4 ± 15.6 vs 8.5 ± 7.7 days; p = 0.001). Mortality rates and admission to ICU were greater among subjects with any degree of malnutrition compared with well-nourished patients (7.4% vs 0%; p = 0.05 and 44.4% vs 6.3%; p < 0.0001). CRP (120.9 ± 106.2 vs 60.8 ± 62.9 mg/l; p = 0.03), D-dimer (1516.9 ± 1466.9 vs 461.1 ± 353.7 ng/mL; p < 0.0001) and ferritin (847.8 ± 741.1 vs 617.8 ± 598.7mcg/l; p = 0.03) were higher in the group with malnutrition. Haemoglobin (11.6 ± 2.1 vs 13.6 ± 1.5 g/dl; p < 0.0001) and albumin 3.2 ± 0.7 vs 4.1 ± 0.5 g/dl; p < 0.0001) were lower in patients with any degree of malnutrition. CONCLUSIONS: The presence of a poor nutritional status is related to a longer stay in hospital, a greater admission in the ICU and a higher mortality.

Long-Term Prevalence of Food Addiction Among Bariatric Surgery Patients: Influence on Metabolic and Psychological Outcomes.

Background: We wanted to assess the prevalence of individuals with food addiction (FA) among bariatric surgery (BS) patients at long term and to determine if there was any relationship between FA and both clinical and psychological outcomes at the time of the evaluation. Methods: Participants were evaluated for the presence of FA with the Yale Food Addiction Scale 2.0. Results: Of 134 subjects, 32 (23.9%) included met criteria for FA. The frequency of patients with depression at the time of the evaluation was greater among subjects with FA (34.4% vs. 11.8%; P = 0.006). The score obtained with the Beck Depression Inventory at the time of the evaluation was greater among subjects with FA (14.8 ± 11.5 vs. 6 ± 6.5; P < 0.0001). The frequency of subjects with FA who had criteria for binge eating disorder at the time of the evaluation was significantly greater (56.3% vs. 20.5%; P < 0.001). Patients with FA scored higher in the Lattinen index for chronic pain at the time of the evaluation (8.7 ± 5.9 vs. 5.8 ± 5.4; P = 0.014). However, clinical outcomes were similar between the two groups. Conclusions: Routine screening for FA at long term postoperatively should be recommended to improve psychological outcomes of BS.

Costos de los egresos inoportunos de origen no médico en una clínica de alto nivel de complejidad en Colombia / The costs of nonclinical delayed discharge in a tertiary care clinic in Colombia

Resumen Objetivo: describir los pacientes con egreso inoportuno de origen no médico, sus características sociodemográficas, clínicas y estimar los costos derivados, durante el 01 de junio y el 31 de agosto de 2017, en una institución de salud de alto nivel de complejidad. Material y métodos: estudio observacional, retrospectivo. La definición operativa de egreso inoportuno correspondía a pacientes que desde el punto de vista clínico podían ser dados de alta, pero continuaban ocupando una cama por problemas no médicos. Los datos fueron tomados de las historias clínicas y para el análisis de costo, se tuvieron en cuenta el total de los costos generados por la estancia inapropiada, incluyendo el costo día de hospitalización, insumos, medicamentos y evaluaciones médicas. La perspectiva del costo fue desde el pagador. Resultados: de los 3273 egresos durante el periodo analizado, se presentaron 79 casos de egresos inoportunos (2.4%). La edad media de los pacientes fue de 49 años. El 62% eran del régimen subsidiado; 60.7% eran procedentes de otros departamentos o municipios lejanos. El total de días hospitalización perdidos por esta causa fue de 547, con una media de 6.6 días por paciente. Los servicios más afectados fueron medicina interna y cuidados paliativos. Las principales causas fueron: necesidad de tiquetes para retornar al lugar de procedencia, alta temprana por medicamentos o insumos para el egreso y necesidad de oxígeno. El costo total que se generó por egreso inoportuno fue US$83 935, con un valor promedio de US$1062.47 por paciente. Conclusión: el egreso inoportuno es un problema evidente en la atención. Las principales causas que encontramos fueron problemas sociales y traslados regionales. Además genera un gasto adicional importante de recursos materiales y económicos tanto para las instituciones como para el sistema.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1255).

Abstract Objective: to describe the sociodemographic and clinical characteristics of patients with nonclinical delayed discharge and estimate the resulting costs in a tertiary healthcare facility from June 1 to August 31, 2017. Materials and methods: a retrospective observational study. The working definition of delayed discharge was patients who, from a clinical perspective, could be discharged but who continued to occupy a bed due to nonclinical problems. The data were taken from the medical charts, and the total costs incurred by the inappropriate length of stay were used for the cost analysis, including the cost per inpatient day, supplies, medications and medical assessments, from the payer's cost perspective. Results: of the 3,273 discharges during the study period, there were 79 cases of delayed discharge (2.4%). The mean age of the patients was 49 years. Sixty-two percent had subsidized medical insurance; 60.7% came from other departments or distant towns. The total number of inpatient days lost due to this cause was 547, with a me of 6.6 days per patient. The departments which were most affected were internal medicine and palliative care. The main causes were: the need for tickets to return to their place of origin, early discharge due to medications or discharge supplies and the need for oxygen. The total cost incurred due to delayed discharge was USD 83,935, with an average of USD 1,062.47 per patient. Conclusion: delayed discharge is an evident healthcare problem. The main causes found in this study were social and regional transport issues. Delayed discharge also causes a significant additional expense in material and financial resources for both the institutions and the system.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1255).

Effects of depressive symptoms on clinical outcomes, inflammatory markers and quality of life after a significant weight loss in a bariatric surgery sample.

INTRODUCTION: Obesity is linked to a low-grade chronic systemic inflammation that improves after weight loss. Depressive disorder has been suggested to be associated with systemic inflammation up regulation. OBJECTIVE: We aimed to explore whether, after a significant weight loss, the presence of depressive symptoms was associated with differences in terms of inflammatory markers and quality of life. METHODS: Sixty patients (78.3%♀, age 46.4 ± 9.9) who underwent bariatric surgery, with a minimum follow up of 18 months, were evaluated. For the screening of depression, the Beck Depression Inventory (BDI) was administered. RESULTS: Ten subjects (16.6%) had a positive screening for depressive disorder. The percentage of patients with weight regain was greater among subjects with symptoms of depression (70% vs. 32%; p = 0.024), although no differences were seen regarding BMI prior to surgery and current BMI. Acute phase reactants were higher among subjects with symptoms of depression: platelets (319 ± 15 x 10^12/L vs. 232 ± 47 x 10 ^ 12/L; p = 0.001), erythrocyte sedimentation rate (24.7 ± 11.3 mm vs.17 ± 10 mm; p = 0.03), fibrinogen (486 ± 107 mg/dL vs. 406 ± 66 mg/dL; p = 0.003), ferritin (106 ± 180 ng/ml vs. 34 ± 44 ng/ml; p = 0.014) and ultrasensitive C-reactive protein (0.96 ± 1.84 mg/dL vs. 0.24 ± 0.26 mg/dL; p = 0.008). All domains of quality of life were significantly lower in the depressive group. CONCLUSIONS: Despite a significant weight loss, inflammatory markers are greater and quality of life lower when associated with depressive symptoms.

Effects of depressive symptoms on clinical outcomes, inflammatory markers and quality of life after a significant weight loss in a bariatric surgery sample / Efectos de los síntomas depresivos sobre los parámetros clínicos, marcadores inflamatorios y calidad de vida en una muestra bariátrica tras una pérdida de peso significativa

Introduction: Obesity is linked to a low-grade chronic systemic inflammation that improves after weight loss. Depressive disorder has been suggested to be associated with systemic inflammation up regulation. Objective: We aimed to explore whether, after a significant weight loss, the presence of depressive symptoms was associated with differences in terms of inflammatory markers and quality of life. Methods: Sixty patients (78.3%♀, age 46.4 ± 9.9) who underwent bariatric surgery, with a minimum follow up of 18 months, were evaluated. For the screening of depression, the Beck Depression Inventory (BDI) was administered. Results: Ten subjects (16.6%) had a positive screening for depressive disorder. The percentage of patients with weight regain was greater among subjects with symptoms of depression (70% vs. 32%; p = 0.024), although no differences were seen regarding BMI prior to surgery and current BMI. Acute phase reactants were higher among subjects with symptoms of depression: platelets (319 ± 15 x 10

Introducción: la obesidad se asocia a una inflamación crónica de bajo grado que mejora tras la pérdida de peso. El trastorno depresivo también se ha asociado a una inflamación sistémica. Objetivo: determinar si, tras una pérdida de peso significativa, la presencia de síntomas depresivos se asocia a diferencias en los marcadores inflamatorios y la calidad de vida. Métodos: sesenta pacientes (78,3% ♀, edad 46,4 ± 9.9) sometidos a cirugía bariátrica, con un seguimiento mínimo de 18 meses, fueron evaluados. Se autoadministró el test de depresión de Beck (BDI) para el screening de depresión. Resultados: diez sujetos (16,6%) tenían un screening positivo para depresión. El porcentaje de pacientes que ganaron peso fue superior en el grupo de pacientes con síntomas depresivos (70% vs. 32%; p = 0,024), aunque no se evidenciaron diferencias en cuanto al IMC antes de la cirugía ni al IMC actual. Los reactantes de fase aguda fueron mayores entre los sujetos con síntomas depresivos: plaquetas (319 ± 15 x 10

Postoperative grazing as a risk factor for negative outcomes after bariatric surgery.

INTRODUCTION/PURPOSE: After bariatric surgery, de novo eating patterns can develop, such as grazing. Although grazing has been associated with poorer weight loss, it has received minimal attention. We aimed to assess the influence of grazing in clinical, biochemical and psychological outcomes in a bariatric surgery sample. MATERIALS AND METHODS: Sixty patients (78.3%♀, age 46.35±9.89, months since BS 46.28±18.1) who underwent BS were evaluated cross-sectionally. Clinical, biochemical and psychological parameters were recorded. A pattern of grazing was assessed in this group of patients through interview. RESULTS: 41.7% met criteria for grazing. Mean time since BS was greater in the group with grazing (57.64±23.7months vs 38.8±26.44months; p=0.008). Although there were no differences in initial and current BMI, the percentage of patients with weight regain was greater among patients with grazing (72% vs 11.7%; p<0.0001) and the percentage of excess weight loss was lower (28.15±6.96% vs 33.35±11.9%; p=0.05). There were more difficulties in following the standardized visits according to our hospital's protocol (17.6% vs 56%; p=0.009). No significant differences were found when assessing presurgical psychiatric comorbidity among patients with a grazing pattern and individuals without this condition (68% vs 55.9%; p=0.423). When assessing quality of life only mental health was lower among patients with grazing (49.6±22.7 vs 64.2±23.3; p=0.02). CONCLUSION: Development of grazing is frequent after BS, especially when weight loss has reached a plateau. Due to its potential association with weight regain, systematic screening of grazing after BS is warranted.

Eating disorders are frequent among type 2 diabetic patients and are associated with worse metabolic and psychological outcomes: results from a cross-sectional study in primary and secondary care settings.

AIMS: Data regarding the prevalence of eating disorders (ED) and their influence on clinical outcomes among patients with type 2 diabetes (T2DM) are scarce. Our aim is to investigate the frequency of positive screening for ED, specifically binge eating disorder (BED), in a T2DM sample and analyze whether there are any differences among T2DM subjects with a positive screening for ED or BED. METHODS: Three hundred and twenty subjects with T2DM were recruited randomly. All participants were evaluated for the presence of ED by completing the "Eating Attitudes Test-26" (EAT-26). In addition, the "Questionnaire of Eating and Weight Patterns-Revised" (QEWP-R) for the screening of BED was also implemented. Sociodemographic, clinical and biochemical parameters were also recorded. RESULTS: According to EAT-26, 14 % of subjects screened positive for ED. Regarding QEWP-R, 16 % had a positive screening for ED, with BED having a frequency of 12.2 %, being the most prevalent one. There was a positive correlation between the scores obtained with the EAT-26 and the Beck Depression Inventory (p = 0.0014). Patients with BED were younger (57.5 ± 11.1 vs 63.3 ± 10.3 years; p = 0.004), with a lesser T2DM duration (8.5 ± 6.1 vs 12.1 ± 9.6 years; p = 0.002). Weight and BMI among subjects with BED were greater (89.1 ± 1.3 vs 82.4 ± 16.7 kg; p = 0.04 and 39.4 ± 10.3 vs 30.7 ± 5.5 kg/m(2); p = 0.01). The frequency of subjects with one admission related to T2DM or any other condition during the last year was higher (10 vs 3 %; p = 0.04 and 33 vs 21 %; p = 0.01). CONCLUSIONS: ED among T2DM are frequent. Due to their deleterious effect on different metabolic and psychological outcomes, they should be diagnosed promptly, especially BED.

Are subjects with criteria for adult attention-deficit/ hyperactivity disorder doing worse after bariatric surgery? A case-control study / ¿Tienen peores resultados los individuos con criterios para trastorno por déficit de atención/ hiperactividad tras la cirugía bariátrica? Estudio de casos y controles

Introduction: There is an increasing awareness of the strong associations between obesity and adult attention-deficit/hyperactivity disorder (ADHD), with high rates of ADHD (26-61%) in patients seeking weight loss. Aims: To determine the frequency of ADHD in a bariatric surgery (BS) sample and investigate whether there were any differences among clinical, analytical and psychological parameters in individuals with criteria for ADHD. Methods: Sixty patients (78.3% female, age 46.3±9.8, months since BS 46.28±18.1) who underwent BS, with a minimum follow-up of 18 months, were evaluated cross-sectionally. Initial and current BMI, eating patterns, comorbidity, socio-demographic and biochemical parameters were recorded. For the screening of ADHD, ADHD self rating scale-v1.1 was administered. Results: Nineteen individuals (31.6%) had a positive screening for ADHD. This group had higher levels of HDL-cholesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) and Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/ dl; p=0.015), and an increased consumption of lipids (42.2±7.1% vs 36.7±8.3%; p=0.019). Subjects with ADHD symptoms had more difficulties in following visits after BS (52.6% vs 24.3%; p= 0.011).We could not find any differences in achieved BMI, depressive symptoms or quality of life. Conclusions: Patients who met criteria for ADHD face significant difficulties with compliance in follow-up, but we could not find differences in major clinical outcomes. Surprisingly, these patients could have a protective lipid profile (AU)

Introducción: Hay una creciente concienciación de la fuerte asociación entre la obesidad y el trastorno por déficit de atención/hiperactividad del adulto (TDAH), con elevadas tasas de TDAH (26-61%) en los pacientes que consultan por pérdida ponderal. Objetivos: conocer la frecuencia del TDAH en una muestra de sujetos sometidos a cirugía bariátrica (CB) e investigar si existen diferencias clínicas, analíticas y psicológicas en estos sujetos. Métodos: Sesenta pacientes (78.3% mujeres, edad 46.3±9.8, meses desde la CB 46.28±18.1) sometidos a CB, con un seguimiento mínimo desde ésta de 18 meses, fueron evaluados transversalmente. Se recogieron y analizaron el IMC inicial y en el momento de la evaluación, patrones alimentarios, comorbilidades, y parámetros sociodemográficos y bioquímicos. Para el screening del TDAH se administró la versión española del 'ADHD self-rating scale v 1.1'. Resultados: Diecinueve individuos (31.6%) tenían un screening positivo para TDAH. Estos sujetos tenían niveles superiores de HDL colesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) y Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/dl; p=0.015), y un consumo mayor de lípidos en la dieta (42.2±7.1% vs 36.7±8.3%; p=0.019). Estos sujetos tenían más dificultades en seguir las visitas protocolizadas tras la CB (52.6% vs 24.3%; p= 0.011). No se evidenciaron diferencias en el IMC alcanzado, síntomas depresivos o calidad de vida. Conclusiones: Los pacientes sometidos a CB con criterios para TDAH presentan más dificultades en la adherencia al seguimiento, pero no se evidenciaron diferencias en resultados clínicos relevantes. Curiosamente, estos sujetos podrían presentar un perfil lipídico protector (AU)

Cardiovascular risk profile in Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention: impact of both interventions after 1 year of follow-up.

BACKGROUND: The aim was to compare obesity-related cardiovascular (CV) risk factors (classic and emerging) and the estimated CV risk at 10 years (calculated by REGICOR) in obese Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention at baseline and after 1 year of follow-up. METHODS: Patients submitted to bariatric surgery (n = 108) and standardized program of therapeutic changes in lifestyle (n = 90) were retrospectively included. Clinical history, physical examination, and laboratory analysis were routinely determined before weight loss intervention and at 1 year follow-up. RESULTS: Seventy-five percent of the surgery patients had a CV risk lower than 5 % and not one patient had a 10-year CV risk higher than 15 %. The percentage of patients with comorbidities (diabetes and sleep apnea syndrome) was higher in the surgery group. Seventeen of the surgery patients had no comorbidities. The improvement in CV risk profile was significant higher in the surgery group. CV risk benefit of both intervention groups was related to baseline higher CV risk, with type 2 diabetes with poor metabolic control and high cholesterol levels being the most important predictors for surgery patients. Neither body mass index nor excess of weight loss was related to CV risk improvement. CONCLUSIONS: Mediterranean patients undergoing a weight loss intervention have a low CV risk. In comparison with lifestyle intervention, surgery induces a better improvement of CV risk. This benefit is related to estimated CV risk, presence of diabetes, and cholesterol levels at baseline. These observations should be taken into account in order to optimize health resources.

Are subjects with criteria for adult attention-deficit/ hyperactivity disorder doing worse after bariatric surgery? A case-control study.

INTRODUCTION: There is an increasing awareness of the strong associations between obesity and adult attention- deficit/hyperactivity disorder (ADHD), with high rates of ADHD (26-61%) in patients seeking weight loss. AIMS: To determine the frequency of ADHD in a bariatric surgery (BS) sample and investigate whether there were any differences among clinical, analytical and psychological parameters in individuals with criteria for ADHD. METHODS: Sixty patients (78.3% female, age 46.3±9.8, months since BS 46.28±18.1) who underwent BS, with a minimum follow-up of 18 months, were evaluated cross-sectionally. Initial and current BMI, eating patterns, comorbidity, socio-demographic and biochemical parameters were recorded. For the screening of ADHD, ADHD self rating scale-v1.1 was administered. RESULTS: Nineteen individuals (31.6%) had a positive screening for ADHD. This group had higher levels of HDL-cholesterol (62.8±17.3 mg/dl vs 53.5±9.9 mg/dl; p=0.011) and Apo-A (177.7±28.4 mg/dl vs 154.9±34.7 mg/ dl; p=0.015), and an increased consumption of lipids (42.2±7.1% vs 36.7±8.3%; p=0.019). Subjects with ADHD symptoms had more difficulties in following visits after BS (52.6% vs 24.3%; p= 0.011).We could not find any differences in achieved BMI, depressive symptoms or quality of life. CONCLUSIONS: Patients who met criteria for ADHD face significant difficulties with compliance in follow-up, but we could not find differences in major clinical outcomes. Surprisingly, these patients could have a protective lipid profile.

Introducción: Hay una creciente concienciación de la fuerte asociación entre la obesidad y el trastorno por déficit de atención/hiperactividad del adulto (TDAH), con elevadas tasas de TDAH (26-61%) en los pacientes que consultan por pérdida ponderal. Objetivos: conocer la frecuencia del TDAH en una muestra de sujetos sometidos a cirugía bariátrica (CB) e investigar si existen diferencias clínicas, analíticas y psicológicas en estos sujetos. Métodos: Sesenta pacientes (78.3% mujeres, edad 46.3±9.8, meses desde la CB 46.28±18.1) sometidos a CB, con un seguimiento mínimo desde ésta de 18 meses, fueron evaluados transversalmente. Se recogieron y analizaron el IMC inicial y en el momento de la evaluación, patrones alimentarios, comorbilidades, y parámetros sociodemográficos y bioquímicos. Para el screening del TDAH se administró la versión española del "ADHD self-rating scale v 1.1". Resultados: Diecinueve individuos (31.6%) tenían un screening positivo para TDAH. Estos sujetos tenían niveles superiores de HDL colesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) y Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/dl; p=0.015), y un consumo mayor de lípidos en la dieta (42.2±7.1% vs 36.7±8.3%; p=0.019). Estos sujetos tenían más dificultades en seguir las visitas protocolizadas tras la CB (52.6% vs 24.3%; p= 0.011). No se evidenciaron diferencias en el IMC alcanzado, síntomas depresivos o calidad de vida. Conclusiones: Los pacientes sometidos a CB con criterios para TDAH presentan más dificultades en la adherencia al seguimiento, pero no se evidenciaron diferencias en resultados clínicos relevantes. Curiosamente, estos sujetos podrían presentar un perfil lipídico protector.

Funciones endocrinas del tejido adiposo

El tejido adiposo se considera en la actualidad como un órgano con función endocrina, capaz de secretar diversas sustancias que están relacionadas directamente en la aparición de la obesidad. Es la principal reserva energética del organismo y su unidad funcional es el adipocito. Se distinguen dos tipos de tejido adiposo, el blanco y el pardo o marrón; el primero, es donde tiene lugar su función endocrina y se encuentra ampliamente distribuido en el cuerpo, dividido en dos compartimientos: subcutáneo y visceral. Entre el grupo de sustancias secretadas por el tejido adiposo se encuentran moléculas implicadas en la regulación del peso corporal: leptina y adiponectina; en el sistema inmune: factor de necrosis tumoral alfa, interleuquina 1 y 6; en la función vascular: angiotensina e inhibidor del activador del plasminógeno tipo 1; en el desarrollo de la resistencia a la insulina: resistina. El conocimiento de estas sustancias abre una nueva ventana para la explicación de la génesis de la obesidad y para la efectividad en la búsqueda del tratamiento futuro.

Adipose tissue has been considered as an endocrine organ which is able to secreting several peptides directly involved with obesity. Adipose tissue is also the main body energetic storage and its functional unit is the adipocite. Two types of adipose tissue are known: white and brown adipose tissue; the first one has an endocrine function and it is widely spread in whole body including two compartments: subcutaneous and visceral. Peptides secreted by adipose tissue are involved in different systems: body weight regulation: leptin, adiponectin; immune system: alpha tumour necrosis factor, interleukin 1 and 6; vascular function: angiotensin and plasminogen activator inhibitor-l; and insulin resistance pathogenesis: resistin. The knowledge of these substances open a new door for understanding of obesity and its treatment.

Síndrome de comedor nocturno: un nuevo trastorno de la conducta alimentaria / The night eating syndrome: a new eating disorden

La anorexia y bulimia son los clásicos Trastornos de la Conducta Alimentaria, debido a las alteraciones patológicas del comportamiento de comer, como ayunos, dietas extremas o ingesta compulsivas de alimentos. El síndrome de comedor nocturno, es una entidad que cursa con estas alteraciones sumadas a variaciones en los patrones del sueño. Los estudios demuestran que a mayor Indice de Masa Corporal mayor incidencia del mismo, por lo que se está considerando la posibilidad de incluir la obesidad como un desorden de alimentación. El síndrome se caracteriza por presentar: anorexia matutina, hiperfagia nocturna e insomnio; con modificación del patrón neuroendocrino (Eje Hipófisis Pituitario Adrenal, cortisol, melatonina y leptina) el cual tiene función reguladora con ritmos circadianos propios que modulan diversas funciones metabólicas y psicológicas. La exacerbación de la sintomatología coincide con períodos de ganancia de peso y episodios de vida estresante. Los tipos de comedor nocturno son: Comedor compulsivo de tarde y noche, nocturno ansioso, por antojos y el que tiene la creencia del todo o nada sobre el comedor nocturno. El diagnostico diferencial: la bulimia, el comedor compulsivo y el desorden del sueño relacionado con la ingesta nocturna. Todo esto es relevante considerarlo en la evaluación nutricional del paciente que asiste a la consulta, ya que es bien conocido el fracaso de los tratamientos para la obesidad a corto o largo plazo. por esta razón el objetivo de la revisión es presentar las características del Síndrome del Comedor Nocturno a fin de diagnosticarlo y obtener los resultados esperados del tratamiento