Effects of a (poly)phenol-rich supplement on anthropometric, biochemical, and inflammatory parameters in participants with morbid obesity: Study protocol for a randomised controlled trial.

Background: Morbid obesity (body mass index ≥40 kg/m2) represents a severe health risk and implies the need of urgent therapeutic action. (Poly)phenols may play a relevant role in the management of this disease modulating physiological and molecular pathways involved in energy metabolism and adiposity. The purpose of this double-blinded, placebo-controlled, randomised trial is to determine if (poly)phenol supplementation, in combination with a dietary intervention, can improve anthropometric and cardiometabolic parameters in participants with morbid obesity. Methods: Adults (n = 40) with morbid obesity, bariatric surgery candidates, will be recruited from the Bellvitge University Hospital, Spain, and randomly assigned (stratified by sex) to intervention (poly)phenol-rich supplement 1,200 mg/day + hypocaloric diet) or control group (placebo + hypocaloric diet) for 12 weeks. The primary outcome is body weight. Secondary outcomes are: other anthropometric markers and body composition measured through standardized methods and a bioimpedance analysis, cardiometabolic and inflammatory biomarkers, metabolic pathways, and gut microbiota diversity. Anthropometric parameters, dietary, physical activity and lifestyle questionnaires, blood pressure, and blood and urine samples will be collected at baseline, 6 weeks, and 12 weeks. Faecal samples will be collected at baseline and at 12 weeks. Informed consent of participants will be obtained before the start of the study. Discussion: The present study is expected to provide evidence on the effects of a combination of (poly)phenols on several well-established obesity and cardiometabolic markers, and to unravel possible underlying mechanisms by metabolomic analyses. Gut microbiota diversity will be considered as a potential future endpoint. The study will contribute to future strategies for prevention or treatment of obesity and related conditions.

El cuidado de la salud mental en primera infancia: una experiencia de detección y prevención precoz entre Pediatría y CDIAP / La cura de la salut mental a la primera infància: una experiència de detecció i prevenció precoç entre pediatria i CDIAP / Mental health care in early childhood: an experience of early detection and prevention between Paediatrics and CDIAP

Este artículo explica una experiencia de prevención en el centro de atención primaria (EAP),en colaboración con el equipo de pediatría y el centro de desarrollo y atención precoz (CDIAP) de la zona. El objetivo del proyecto es poder realizar una tarea de sensibilización, detección y prevención de posibles trastornos del desarrollo en niños de 0 a 5 años. Durante el primer año de desarrollo del proyecto se atendieron a 29 niños. Se muestra a través de una viñeta clínica cómo se interviene de manera precoz para facilitar el desarrollo del niño y la calidad del vínculo con sus cuidadores desde el contexto de la consulta pediátrica:(AU)

This article explains a prevention experience in the primary care center (EAP), in collaboration withthe paediatrics team and the development and early care center (CDIAP) of the area. The project aims to raiseawareness and detect and prevent possible developmental disorders in children from 0 to 5 years of age. Duringthe first year of the project, 29 children attended. A clinical vignette shows how to intervene early to facilitate thechild's development and the quality of the bond with their caregivers in the context of paediatric consultation.(AU)

Aquest article explica una experiència de prevenció al centre d'atenció primària (EAP) en col·laboracióamb l'equip de pediatria i el centre de desenvolupament i atenció precoç (CDIAP) de la zona. L'objectiu del projecteés poder desenvolupar una tasca de sensibilització, detecció i prevenció de possibles trastorns del desenvolupamenten nens de 0 a 5 anys. Durant el primer any de desenvolupament del projecte es va atendre 29 nens. Esmostra, a través d'una vinyeta clínica, com s'intervé de manera precoç per facilitar el desenvolupament del nen i laqualitat del vincle amb els cuidadors des del context de la consulta pediàtrica.(AU)

Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication.

PURPOSE: Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years. MATERIAL AND METHODS: Forty-five patients with mean BMI of 39.4(1.9)kg/m2 and T2DM with HbA1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. RESULTS: Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up. CONCLUSIONS: Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.

Nutritional deficiencies and bone metabolism after endobarrier in obese type 2 patients with diabetes.

Endobarrier® is a minimally invasive, reversible endoscopic treatment for obesity. It provokes malabsorption along 60 cm of the small intestine, which can contribute to the development of vitamin deficiencies and to changes in bone mineral density (BMD). To determine the prevalence of nutrient deficiencies, changes in body composition and BMD during the first year after Endobarrier® placement. Twenty-one patients with type 2 diabetes met inclusion criteria. Levels of vitamins, micro and macronutrients were assessed prior and at 1, 3 and 12 months post-operatively. DEXA was performed before and 12 months after implant. Nineteen patients completed the 12 months follow-up. Vitamin D deficiency was the most prevalent finding before Endobarrier® implant. The percentage of patients with severe deficiency decreased from 19 to 5% at 12 months after supplementation. Microcytic anaemia was initially present in 9.5% of patients and increased to 26.3% at 12 months. Low ferritin and vitamin B12 levels were observed in 14.2 and 4.8% of patients before the implant and worsened to 42 and 10.5%. Low concentrations of magnesium and phosphorus were also common but improved along the study. A significant but not clinically relevant decrease in BMD of 4.14 ± 4.0% at the femoral neck was observed at 12 months without changes in osteocalcin levels. Vitamin deficiencies are common after Endobarrier® implant. It is therefore important to screen patients prior to and at regular intervals after the implant, and to encourage adherence to diet counselling and supplementation.