Prospective analysis of the quality of Spanish health information web sites after 3 years.

OBJECTIVE: Although the Internet has become an essential source of health information, our study conducted 3 years ago provided evidence of the low quality of Spanish health web sites. The objective of the present study was to evaluate the quality of Spanish health information web sites now, and to compare these results with those obtained 3 years ago. METHODS: For the original study, the most visited health information web sites were selected through the PageRank® (Google®) system. The present study evaluated the quality of the same web sites from February to May 2013, using the method developed by Bermúdez-Tamayo et al. and HONCode® criteria. RESULTS: The mean quality of the selected web sites was low and has deteriorated since the previous evaluation, especially in regional health services and institutions' web sites. The quality of private web sites remained broadly similar. Compliance with privacy and update criteria also improved in the intervening period. CONCLUSION: The results indicate that, even in the case of health web sites, design or appearance is more relevant to developers than quality of information. It is recommended that responsible institutions should increase their efforts to eliminate low-quality health information that may further contribute to health problems.

Evaluation of the quality of the general health information webpages in Spain: influence of page source.

The Internet, regardless of whether or not it is reliable, is considered the main source of health information. However, the lay-user does not know which sources offer good quality information. The main objective of the present study, therefore, was to evaluate the quality of Spanish health-related webpages, and to determine whether the webpage source influences this quality. To this end, 36 webpages were selected through the PageRank® system. The webpages from all the Regional Health Services of Spain (19 sites) were also included. The quality evaluation, which was carried out by applying the Andalusian Health Quality Agency Test, indicated that the quality information offered by Spanish webpages is very low, since no site reached the maximum score. In addition, several important aspects, including those related with personal data management and the updating of information, were not considered by most of the evaluated pages. In summary, this work shows that quality of the health information webpages in Spain is generally low, and draws particular attention to certain responsibilities, that are not met by most evaluated webpages, including sites from the Regional Health Services.

Profile of adipose tissue gene expression in premenopausal and postmenopausal women: site-specific differences.

OBJECTIVES: Menopause increases the risk of several pathologies, probably due to enlarged levels of visceral fat. Apart from morphological and endocrine changes, a cluster of genes, still not fully defined, may be involved in these alterations. The objectives of the present study, therefore, were to analyze differences in adipose tissue gene expression between premenopausal and postmenopausal women and to ascertain whether any differences were depot specific. METHODS: Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) biopsies were taken from 7 premenopausal and 7 postmenopausal women undergoing surgery because of morbid obesity. RNA was extracted, and the overall gene expression profile was analyzed by microarray analysis. RESULTS: In general, SAT genes were overexpressed, whereas VAT genes were down-regulated in premenopausal compared with postmenopausal women. We found 724 differentially expressed genes in SAT and 327 in VAT. These differences suggest that several biological processes, such as the immune system and other metabolic processes, were altered based on menopause status. Regarding individual genes, neurexin 3, metallothionein 1E, and keratyn 7 showed the most pronounced differences. Interestingly, the expression of these genes was related to body fat distribution. CONCLUSIONS: Our results reveal that menopause influences the adipose tissue expression of many genes, especially of neurexin 3, metallothionein 1E, and keratyn 7, which are associated with the alteration of several key biological processes, such as the immune system and cell metabolism. Gene expression in adipose tissue could be used for diagnosis and the development of new therapeutic strategies against obesity and related alterations, depending on menopause status.

Circadian rhythm of clock genes in human adipose explants.

To analyze in severely obese women the circadian expression of the clock genes hPer2, hBmal1, and hCry1 in explants from subcutaneous (SAT) and visceral (VAT) adipose tissue (AT), in order to elucidate whether this circadian clockwork can oscillate accurately and independently of the suprachiasmatic nucleus (SCN) and if glucocorticoid metabolism-related genes such as glucocorticoid receptor (hGr) and 11beta-hydroxysteroid dehydrogenase 1 (h11 beta Hsd1) and the transcription factor peroxisome proliferator activated receptor gamma (hPPAR gamma) are part of the clock controlled genes. AT biopsies were obtained from morbid obese patients (BMI > or =40 kg/m(2)) (n = 7). Anthropometric variables were measured and fasting plasma lipids and lipoprotein concentrations were analyzed. In order to carry out rhythmic expression analysis, AT explants were cultured during 24 h and gene expression was performed at the following times (T): 0, 6, 12, and 18 h, with quantitative real-time PCR. Clock genes oscillated accurately and independently of the SCN in AT explants. Their intrinsic oscillatory mechanism regulated the timing of other genes such as hPPAR gamma and glucocorticoid-related genes. Circadian patterns differed between VAT and SAT. Correlation analyses between the genetic circadian oscillation and components of the metabolic syndrome (MetS) revealed that subjects with a higher sagittal diameter showed an increased circadian variability in hPer2 expression (r = 0.91; P = 0.031) and hBmal1 (r = 0.90; P = 0.040). Data demonstrate the presence of peripheral circadian oscillators in human AT independently of the central circadian control mechanism. This knowledge paves the way for a better understanding of the circadian contribution to medical conditions such as obesity and MetS.

N-6 from different sources protect from metabolic alterations to obese patients: a factor analysis.

First, to analyze the interactions among fatty acids (FAs) from diet, plasma and subcutaneous and visceral adipose tissue (AT), and second, the relationship among FAs from these different sources and obesity-related alterations in extreme obesity. We studied 20 extreme obese subjects. A food-frequency questionnaire was used to determine the FA intakes. Serum and AT (subcutaneous and visceral) FA concentrations were determined by gas chromatography. Cardiometabolic risk parameters were assessed. Principal factor analysis was performed to define specific FA factors in the metabolic alterations. We found important associations among diet, plasma, and AT FA and cardiometabolic parameters. In this regard, it is interesting to highlight the negative associations between plasma cholesterol and dietary n-3 FA. In the subcutaneous depot, as occurred in plasma, n-6 and polyunsaturated FAs (PUFA) were negatively associated with triacylglycerols (TGs). Factor analysis revealed TGs as the unique cardiovascular risk parameter appearing in the first factor (F1), together with n-6 (load factor = 0.94) and PUFA (0.91). Besides, n-3 from diet and plasma appeared in the third factor inversely related to cholesterol, low-density lipoprotein cholesterol (LDL-c), and insulin. In an opposite way, dietary and AT trans FAs and saturated FA (SFA) were associated to an increase of the metabolic risk. We have shown, for the first time, the importance of n-6 and PUFAs composition as protective factors against metabolic alterations in extreme obese subjects. These findings support current dietary recommendations to increase PUFA intakes and restrict saturated and trans FA intakes even in extreme obesity.

Role of DHEA-S on body fat distribution: gender- and depot-specific stimulation of adipose tissue lipolysis.

The objective of this work was to study the possible impact of DHEA-S on body fat distribution and the specific action of the hormone on lipolysis from visceral and subcutaneous human adipose tissue. First, a clinical evaluation was performed in 84 obese patients (29 men, 55 women), measuring serum DHEA-S, computed tomography (CT) anthropometric parameters of abdominal fat distribution. In a second experiment, subcutaneous and visceral adipose tissue samples were obtained from 20 obese patients (10 men, 10 women) and cultured in vitro under stimulation with DHEA-S to further assess a possible effect of this hormone on adipose tissue lipolysis. Serum DHEA-S was inversely and specifically associated with visceral fat area (VA) as assessed by CT in men and with waist-to-hip ratio in women. In vitro, DHEA-S increased lipolysis in women's subcutaneous adipose tissue at 2 h, while in men, the effect was evident in visceral tissue and after 24 h of treatment. In conclusion, DHEA-S contributes to gender-related differences in body fat distribution probably by a differential lipolytic action. We have demonstrated for the first time in vitro that DHEA-S stimulates lipolysis preferably in subcutaneous fat in women and in visceral fat in men.

Adiponectin, the controversial hormone.

OBJECTIVE: To discuss present knowledge about adiponectin hormone. DESIGN: Review of existing literature. SETTING AND RESULTS: Adiponectin is one of the most interesting cytokines associated with obesity, although its physiological role remains to be fully clarified. Adiponectin is a 247-amino acid protein that contains four differentiable domains. Contrary to most adipose-related cytokines, adiponectin levels are surprisingly lower in obese than in lean humans. Women have been found to have significantly higher adiponectin plasma concentrations than men. Further research is needed in order to identify new polymorphisms which contribute to explain the potential role of adiponectin in obesity and related pathologies. Considering the anti-inflammatory properties of adiponectin and the fact that it is negatively associated with adiposity, this cytokine could be one of the links between obesity and inflammation. The main mechanisms of action of adiponectin are directed to a protective role against atherogenic and insulin resistance processes. Research has revealed interesting new functions far beyond metabolism, such as immunity, cancer and bone formation. Contrary to all adipose-related proteins, adiponectin decreases with obesity. Most of the contradictory data surrounding adiponectin are related to plasma values and their relationship with body fat, gender differences and insulin resistance. There are important confounding results regarding the mechanisms of action and functions of adiponectin, especially in relation to insulin resistance and inflammation.

Two-dimensional predictive equation to classify visceral obesity in clinical practice.

OBJECTIVE: Visceral obesity assessment is not easy, and although computed tomography (CT) is an accurate tool, this technique is expensive and sometimes not suitable in clinical practice. We developed a new two-dimensional elliptical anthropometric equation to classify visceral obesity and evaluated the validity and the reliability of the new equation compared with CT. RESEARCH METHODS AND PROCEDURES: We collected anthropometric and CT data from overweight/obese subjects (n = 61, BMI = 32.4 +/- 3.7 kg/m2). A validation group of 32 subjects was also selected. An equation for the assessment of visceral obesity was developed using multiple regression analysis. Once validated, the equation was compared with previous models. Tests for accuracy included mean differences, analysis of diagnostic, R2, Snedecor's F-test, and Bland-Altman plot. RESULTS: Multiple regression analysis revealed that the sagittal and coronal diameters and the triceps skinfold were significant contributors to the model. The final equation was: visceral area (VA)/subcutaneous area (SA)predicted = 0.868 + 0.064 x sagittal diameter - 0.036 x coronal diameter - 0.022 x triceps skinfold. Patients with visceral-subcutaneous area ratio (VA/SA) > 0.42 were classified as having visceral obesity. The predictive equation was valid, showing a significant association with VA/SA assessed by CT (VA/SA(CT); r = 0.68; p < 0.0001). Paired Student's t test showed no significant differences with VA/SACT (p = 0.541). The reliability was high [F(24/60) = 2.12; p = 0.01]. DISCUSSION: The new two-dimensional and elliptical predictive equation is valid to assess visceral obesity and is more precise than previous models.