Remission of type 2 diabetes mellitus after bariatric surgery - comparison between procedures.

INTRODUCTION: We aimed to assess the mid-term type 2 diabetes mellitus recovery patterns in morbidly obese patients by comparing some relevant physiological parameters of patients of bariatric surgery between two types of surgical procedures: mixed (roux-en-Y gastric bypass and biliopancreatic diversion) and restrictive (sleeve gastrectomy). MATERIAL AND METHODS: This is a prospective and observational study of co-morbid, type 2 diabetes mellitus evolution in 49 morbidly obese patients: 37 underwent mixed surgery procedures and 12 a restrictive surgery procedure. We recorded weight, height, body mass index, and glycaemic, lipid, and nutritional blood parameters, prior to procedure, as well as six and twelve months post-operatively. In addition, we tested for differences in patient recovery and investigated predictive factors in diabetes remission. RESULTS: Both glycaemic and lipid profiles diminished significantly to healthy levels by 6 and 12 months post intervention. Type 2 diabetes mellitus showed remission in more than 80% of patients of both types of surgical procedures, with no difference between them. Baseline body mass index, glycated haemoglobin, and insulin intake, among others, were shown to be valuable predictors of diabetes remission one year after the intervention. CONCLUSIONS: The choice of the type of surgical procedure did not significantly affect the remission rate of type 2 diabetes mellitus in morbidly obese patients. (Endokrynol Pol 2017; 68 (1): 18-25).

Evaluación de Nutrire(R): una herramienta on-line para realizar estudios de evaluación del estado nutricional / Evaluation of Nutrire(R): An On-Line Tool for Carrying Out Evaluation Studies to Assess Nutritional Status

Introducción: Nutrire(R) es un programa informático, fruto de tres proyectos de innovación docente de la Universidad de Granada (España), que permite la valoración del estado nutricional mediante a partir de parámetros antropométricos, dietéticos y bioquímicos. Objetivo: El objetivo de este trabajo es presentar los resultados obtenidos de la evaluación global del programa por alumnos y egresados para poder analizar sus puntos fuertes y débiles que sirvan con posterioridad para realizar las modificaciones oportunas. Material y Métodos: Se ha realizado una encuesta anónima a 128 alumnos de 3 titulaciones de grado y 1 de postgrado de la Universidad de Granada. Se incluye 6 preguntas sobre navegabilidad y diseño y 5 sobre contenidos académicos del programa. Asimismo, se han entrevistado a 20 egresados que lo han utilizado en su actividad profesional. Resultados: La puntuación media obtenida en los alumnos fue de 4,1 sobre 5. Como aspectos positivos destacan: facilidad de uso, incorporación de fotografías de alimentos para elegir el tamaño de ración/ porción. Como aspectos de mejora señalan: incorporar más fotos de alimentos, el poder instalar el programa para su uso en un ordenador. Según los egresados, el principal punto fuerte es tener reunido en un solo programa los tres aspectos de la evaluación del estado nutricional. Como puntos débiles señalan la falta de algún nutriente, como los azucares, en la base de datos nutricional. Conclusión: Nutrire(R) es un programa de fácil utilización, muy bien valorada por los alumnos y por los egresados para realizar estudios de evaluación del estado nutricional

Introduction: Nutrire(R) is a computer programme, a product of three innovation teaching projects of the University of Granada (Spain), designed to carry out the assessment of the nutritional status by anthropometric, dietetic and biochemical parameters. Objectives: The main aim of this study is to present its overall results and to analyze its strengths and weaknesses and to carry out the modifications to improve the programme. Material and Method: An anonymous survey was carried out on 128 students from three different degrees and one the Master’s degree. The survey included 6 questions on navigability and design and 5 about the academic content of the programme. Twenty post-graduates who had used the programme in their professional life were also interviewed. Results and Discussion: The average marking of the students was 4.1 out of 5. The main positive aspects which stood out were the ease of use of the computer programme, and the inclusion of photographs of foodstuffs which facilitated the choice of size of portion when evaluating a diet. Negative aspects that were commented on were the necessity to include more photos of foodstuffs, and the impossibility of using the programme without the internet. According to the post-graduates the main benefit of the programme is to have the three principal aspects of the assessment of the nutritional status. The weak points commented on are that the table showing the composition of the foodstuffs does not give information on simple sugars. Conclusion: Nutrire(R) is an easy tool to use and highly valued by both under-graduates and graduates to evaluate nutritional status

Relationship between serum concentrations of persistent organic pollutants and markers of insulin resistance in a cohort of women with a history of gestational diabetes mellitus.

The aim of the present study was to assess the relationship between serum concentrations of several persistent organic pollutants and insulin resistance markers in a cohort of women with a history of gestational diabetes mellitus. ∑POPs was computed as the sum of individual serum POP concentrations. No statistically significant associations were found between levels of any POP and fasting glucose. However, polychlorinated biphenyl (PCB) congeners 138 and 180 were positively associated with 2-h glucose levels and PCB 180 also with fasting immunoreactive insulin (IRI). We also found a positive association of p,p'- dichlorodiphenyldichloroethylene (p,p'- DDE), PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs with 2-h IRI. Serum concentrations of PCBs (138, 153, and 180), hexachlorobenzene, and ∑POPs were also positively associated with homeostasis model assessment (HOMA2-IR) levels. Moreover, p,p'- DDE, PCBs (138, 153 and 180), hexachlorobenzene, and ∑POPs were negatively associated with Insulin Sensitivity Index (ISI-gly) levels. No significant association was found between glycated hemoglobin and the concentrations of any POP. The removal of women under blood glucose lowering treatment from the models strengthened most of the associations previously found for the whole population. Our findings suggest that exposure to certain POPs is a modifiable risk factor contributing to insulin resistance.

Ingesta nutricional de migrados marroquíes en Almería: estudio comparativo en el lugar de origen y con la población española / Nutritional intake of north african migrants in Almeria: comparative study in the native place and with the spanish population

Objetivo: Analizar la ingesta de energía y nutrientes de los inmigrantes marroquíes en Almería con respecto al país de origen, Marruecos, comparando su adecuación a las ingestas dietéticas recomendadas (IDRS) y al consumo nutricional de los españoles. Metodología: Estudio epidemiológico transversal en 95 marroquíes en Almería (MA) y 30 en Marruecos (MM). Para determinar la ingesta alimentaria se ha utilizado un cuestionario de frecuencia de consumo de alimentos semanal y un recuerdo de consumo de 24 horas, con valoración de la ingesta de calorías y nutrientes mediante programa informatizado. Resultados: Los inmigrantes residentes en Almería tienen una ingesta calórica y de grasas significativamente mayor que en Marruecos (p<0.01). Presentan déficit de micronutrientes y vitamina D respecto a la IDR y al consumo de los españoles. Conclusiones: Los inmigrados marroquíes, cuando se trasladan a Almería, realizan una “dieta de transición” que se adapta mejor a las ingestas recomendadas internacionalmente y al patrón alimentario de la dieta mediterránea, con aumento del consumo de hidratos de carbono y menos grasas saturadas y proteínas de origen animal que la dieta occidental (AU)

Objectives: To compare calorie, macronutrient and micronutrient intake among Moroccan immigrants in Almeria, Spain to the intake in their country of origin (Morocco), international recommendations and intake among the host population. Methods: Cross-sectional study including 95 Moroccan in Almeria (MA) and 30 in Morocco (MM). Dietary intake was recorded by using a weekly food frequency questionnaire and a 24-recall questionnaire; intake of calories and nutrients was calculated using computer software. Results: Fat and calorie intake among immigrants residing in Almeria is significantly higher than that in Morocco (p <0.01); protein intake was the same, whereas carbohydrate intake was less (p <0.01). They present micronutrient and vitamin D deficiencies according to the RDI and to Spanish consumption patterns (p <0.01). Conclusions: When Moroccan immigrants move to Almeria, they follow a “transitional diet” which is closer to the internationally recommended intake and to the patterns of the Mediterranean diet, which has increased carbohydrates consumption and less saturated fat and animal protein consumption than that found in the Western diet (AU)

Clinical and hormonal variables related to bone mass loss in anorexia nervosa patients.

A better understanding of the prognostic factors of low bone mass in anorexia nervosa (AN) and development of effective therapeutic strategies is critical. In order to determine which clinical, biochemical, and/or hormonal parameters could be related to bone mineral density (BMD), 47 female AN patients were classified according to the WHO osteoporosis criteria at lumbar spine (LS). This was a cross-sectional study of 16 AN women with osteoporosis criteria and 31without. Control group was 25 healthy, normal-weight, age-matched women. We assessed BMD using dual-energy X-ray absorptiometry at the LS and body composition. We measured serum fasting cortisol, estradiol, insulin-like growth factor-1 (IGF-1), leptin, sex hormone-binding globulin, albumin and retinol binding protein levels. The prevalence of osteoporosis was 34% and osteopenia 19% at the LS. The AN group with osteoporosis had lower IGF-1 and estradiol levels (both p<0.001), lower serum leptin (p<0.02), and higher cortisolemia (p<0.03) levels compared with AN group without osteoporosis. The BMD and T-score at LS was inversely related to the duration of amenorrhea (p<0.02) and directly related to body mass index (BMI, p<0.002), total fat mass (p<0.03), serum IGF-1 (p<0.01), and estradiol levels (p<0.001) in AN patients. We conclude that AN women with a significant BMD loss have a high risk of developing osteoporosis. A low BMD is a consequence of hormonal alterations which include hypoestrogenism, hypoleptinemia, hypercortisolism, and decreases in IGF-1 levels, as well as a low BMI and fat mass.

Metabolismo mineral y riesgo de fracturas en la anorexia nerviosa / Bone metabolism and fracture risk in anorexia nervosa

El diagnóstico de anorexia nerviosa (AN) se hace habitualmente en la adolescencia, por lo que la osteoporosis es una complicación relevante al incidir en una etapa crítica del desarrollo esquelético. Hasta un 50% de las pacientes con AN presenta una densidad mineral ósea alterada en el momento del diagnóstico, con riesgo de fracturas precoces o en la vida adulta. Se afecta fundamentalmente el hueso trabecular y los factores de mal pronóstico son el diagnóstico tardío, la persistencia de la amenorrea y del peso bajo. Las bases actuales del tratamiento serían la ganancia de peso, la recuperación de las menstruaciones y la suplementación con calcio y vitamina D. La densitometría ósea es una prueba diagnóstica necesaria en el estudio y en el seguimiento de las pacientes. La atención primaria debe identificar y derivar de forma precoz a unidades especializadas para mejorar el pronóstico de la enfermedad (AU)

The prevalence of anorexia nervosa has increased in recent years and a large proportion of patients with this disorder have low bone density at diagnosis and, therefore, an increased risk of early and late fractures. The mechanism of bone loss in anorexia nervosa is not well understood, yet it likely includes hypogonadism, alterations of the GH-IGF-1 axis and hypercortisolism. DEXA is the most effective tool for assessing and monitoring bone density in these patients, and it is important to improve or at least stabilize bone metabolism in those with low bone mass. No agent has yet been proven to be effective in improving bone density. However, sustained weight recovery and menses besides an adequate intake of calcium and vitamin D are recommended to optimize the conditions in which bone mass accrual may occur (AU)

[Bone metabolism and fracture risk in anorexia nervosa]. / Metabolismo mineral y riesgo de fracturas en la anorexia nerviosa.

The prevalence of anorexia nervosa has increased in recent years and a large proportion of patients with this disorder have low bone density at diagnosis and, therefore, an increased risk of early and late fractures. The mechanism of bone loss in anorexia nervosa is not well understood, yet it likely includes hypogonadism, alterations of the GH-IGF-1 axis and hypercortisolism. DEXA is the most effective tool for assessing and monitoring bone density in these patients, and it is important to improve or at least stabilize bone metabolism in those with low bone mass. No agent has yet been proven to be effective in improving bone density. However, sustained weight recovery and menses besides an adequate intake of calcium and vitamin D are recommended to optimize the conditions in which bone mass accrual may occur.