Improvement of Low-Grade Inflammation in Patients with Metabolically Healthy Severe Obesity After Primary Bariatric Surgery.

INTRODUCTION: The inflammatory state that accompanies adiposity and the metabolic syndrome (MetS) is called "low-grade" inflammation. White blood cell count (WBC) has been proposed as an emerging biomarker for predicting future cardiovascular events, MetS and mortality. Bariatric surgery (BS) improves comorbidities associated with obesity and the MetS and the surgically induced weight loss is known to improve inflammatory status. OBJECTIVES: To analyze the improvement of low-grade inflammation associated to obesity in patients with metabolically healthy severe obesity (MHSO) and patients with metabolically unhealthy obesity (MUSO) (severe obesity with MetS) after primary bariatric surgery as well as the protective effect of BS against the development of MetS in patients with MHSO by reducing the WBC. MATERIALS AND METHODS: Retrospective analysis of prospectively collected data of patients undergoing laparoscopic primary BS (gastric by-pass or sleeve gastrectomy) from January 2004-December 2015. Outcomes included changing of low-grade inflammation in terms of leukocytes, neutrophils, lymphocytes, and platelets. RESULTS: Twenty-one patients with MHSO and 167 patients with MUSO underwent laparoscopic primary BS. The preoperative values of leukocyte and platelet were statistically higher in the group of patients with MHSO. In both groups, there was significant postoperative decrease of inflammatory markers. The greatest drop in WBC occurred in the second postoperative year. No patient of the group of patients with MHSO developed MetS within five postoperative years. CONCLUSIONS: Surgically induced weight loss plays an important role for improvement in chronic inflammation associated to obesity because of reduction of visceral fat mass. MHSO associates a low-grade chronic inflammatory status comparable to MUSO. The improvement or decrease of low-grade inflammation in patients with metabolically healthy severe obesity after bariatric surgery could have a protective effect against the development of MetS and medical conditions associated with severe obesity.

Malnutrition management of hospitalized patients with diabetes/hyperglycemia and COVID-19 infection.

Diabetes mellitus and/or hyperglycemia are highly prevalent medical conditions in patients hospitalized for coronavirus disease 2019 (COVID-19) and are associated with adverse outcomes. In addition, COVID-19 itself can provoke fluctuating and high glucose levels that can be difficult to manage upon hospitalization. Hospitalized patients with COVID-19 are at high risk of malnutrition due to an increase in nutritional requirements and a severe acute inflammatory response. The management of patients with diabetes/hyperglycemia and COVID-19 is challenging and requires a specific nutritional approach, the purpose of which is to fulfill the nutritional requirements while maintaining an optimal glycemic control. In this study, an expert group of nutritional endocrinologists carried out a qualitative literature review and provided recommendations based on evidence and guidelines, when available, or on their own experience. The optimal care based on these recommendations was compared with the routine bedside care as reported by a panel of physicians (mainly, endocrinologists, geriatricians, and internists) treating patients with diabetes/hyperglycemia and COVID-19 in their daily practice. Early screening and diagnosis, a diabetes-specific therapeutic approach, and a close malnutrition monitoring are essential to improve the clinical outcomes of these patients. In conclusion, the proposed recommendations are intended to provide a useful guide on the clinical management of malnutrition in patients with COVID-19 and diabetes/hyperglycemia, in order to improve their outcomes and accelerate their recovery. The comparison of the recommended optimal care with routine clinical practice could aid to identify gaps in knowledge, implementation difficulties, and areas for improvement in the management of malnutrition in this population.

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y otras patologías concurrentes (cuestiones generales) / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and concurrent pathologies (general issues)

La diabetes mellitus tipo 2 es una enfermedad muy prevalente en todo el mundo y genera una carga clínica y económica creciente debido a sus complicaciones micro- y macrovasculares. Con frecuencia, las personas con diabetes son hospitalizadas por diversas patologías. Estos pacientes tienen, por lo general, un mayor riesgo de complicaciones, de estancias prolongadas y de mortalidad. Un factor adicional que empeora el pronóstico en estos pacientes es la presencia de desnutrición, sobre todo en personas de edad avanzada.Todo ello hace que el manejo de estos pacientes sea complejo y requiera un abordaje nutricional específico, cuya finalidad sea cubrir los requerimientos nutricionales manteniendo siempre el control glucémico. La finalidad de este trabajo es generar, en base a los datos disponibles en la bibliografía y la experiencia clínica, recomendaciones consensuadas por parte de dieciocho expertos en Endocrinología y Nutrición sobre el abordaje nutricional de pacientes hospitalizados con diabetes/hiperglucemia y comparar el manejo óptimo basado en estas recomendaciones con la atención habitual a pie de cama, según un panel de médicos españoles encuestados sobre su práctica clínica diaria. En este primer artículo de este número extraordinario de la revista Nutrición Hospitalaria, se describe la metodología seguida y los resultados obtenidos sobre las cuestiones comunes para todas las patologías. (AU)

Type 2 diabetes mellitus is a highly prevalent disease worldwide, generating an increasing clinical and economic burden due to its micro- and macrovascular complications. Frequently, people with diabetes are hospitalized for various pathologies. These patients generally have higher risk of complications, prolonged hospitalizations and mortality. An additional factor that worsens the prognosis in these patients is the concurrence of malnutrition, especially in elderly people.All this makes the management of these patients challenging and requires a specific nutritional approach, whose purpose is to cover the nutritional requirements while always maintaining glycemic control. The purpose of this work is to provide, based on the evidence available in the literature and clinical experience, consensus recommendations by eighteen experts in Endocrinology and Nutrition on the nutritional approach of hospitalized patients with diabetes/hyperglycemia and compare the optimal management, based on these recommendations with bedside usual care according to a panel of Spanish doctors surveyed about their daily clinical practice. This first article of this extraordinary issue of the journal Nutrición Hospitalaria describes the methodology of the study and the results obtained regarding common issues for all pathologies. (AU)

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y fractura de cadera / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and hip fracture

La incidencia de fractura de cadera cada año es muy alta, lo que genera una importante carga asistencial y socioeconómica. Estas fracturas pueden producirse a cualquier edad, pero la gran mayoría ocurren en personas mayores de 65 años y con predominancia del sexo femenino, debido al mayor riesgo de osteoporosis tras la menopausia. La diabetes mellitus tipo 2 (DM2), aparte de alterar el metabolismo glucídico, lipídico y proteico, también causa una desregulación del calcio, fósforo y magnesio, y alteraciones del metabolismo óseo. La prevalencia de desnutrición en pacientes con fractura de cadera es también elevada, por la edad avanzada, y la misma lesión aguda generar respuestas catabólicas e inflamatorias que resultan en desnutrición relacionada con la enfermedad y sarcopenia, lo que agrava el estado clínico del paciente. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con fractura de cadera. (AU)

The yearly incidence of hip fracture is very high, which generates significant healthcare and socioeconomic burden. These fractures can occur at any age, but the vast majority occur in people over 65 years of age and predominantly in women, due to the increased risk of menopause-associated osteoporosis. Type 2 diabetes mellitus (DM2), apart from altering glucose, lipid and protein metabolisms, also causes a deregulation of calcium, phosphorus and magnesium and dysfunction in bone metabolism. The prevalence of malnutrition in patients with hip fracture is also high, due to their advanced age, and the acute injury itself provokes catabolic and inflammatory responses that result in disease-related malnutrition and sarcopenia, which aggravates the patient's clinical condition. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with hip fracture. (AU)

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y sarcopenia / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and sarcopenia

La sarcopenia se describe como una afección multidimensional que afecta negativamente a la masa muscular, la fuerza muscular y el rendimiento físico. La prevalencia de sarcopenia en personas con diabetes es muy superior a la de la población general, especialmente en individuos que presentan un estado nutricional deficiente. Tanto la sarcopenia como la desnutrición son condiciones susceptibles de intervención para mejorar el pronóstico clínico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con sarcopenia concurrente. (AU)

Sarcopenia is a multidimensional condition that negatively affects muscle mass, muscle strength, and physical performance. The prevalence of sarcopenia in people with diabetes is much higher than that of the general population, especially in individuals with poor nutritional status. Both sarcopenia and malnutrition are conditions amenable to intervention to improve clinical prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with sarcopenia. (AU)

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia e insuficiencia cardíaca / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and heart failure

La insuficiencia cardíaca (IC) es una de las principales causas de morbilidad y mortalidad entre las personas mayores, lo que la convierte en un importante problema de salud pública. Las enfermedades cardiovasculares en general, y la IC en particular, son comorbilidades frecuentes en personas con diabetes tipo 2 (DM2). La presencia de DM2 e IC se asocia con síntomas y signos clínicos más graves, y peor calidad de vida y pronóstico. Además, debido al estado hipercatabólico y los trastornos de la absorción de nutrientes, la desnutrición está presente en muchos casos de IC. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con IC. (AU)

Heart failure (HF) is one of the leading causes of morbidity and mortality among older people, making it a major public health problem. Cardiovascular diseases in general, and HF in particular, are common comorbidities in people with type 2 diabetes (DM2). The concurrence of DM2 and HF is associated with more severe clinical symptoms and signs, and poorer quality of life and prognosis. Furthermore, due to the hypercatabolic state and nutrient absorption disorders, malnutrition is present in many HF cases. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with HF. (AU)

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia en el contexto perioperatorio / Malnutrition management of hospitalized patients with diabetes/hyperglycemia in the perioperative setting

Las personas con diabetes tienen un riesgo elevado de requerir una intervención quirúrgica a lo largo de su vida y de tener complicaciones perioperatorias en caso de un control metabólico deficiente. La hospitalización representa un evento estresante que, unido a otros factores asociados a procedimientos diagnósticos y terapéuticos, conlleva un deterioro del estado nutricional de los pacientes. Se ha observado una asociación entre un estado nutricional deficiente y resultados adversos en pacientes quirúrgicos. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) en el periodo perioperatorio. (AU)

People with diabetes are at high risk of requiring surgical intervention throughout their lives, and of perioperative complications in case of poor metabolic control. Hospitalization represents a stressful event that, together with other factors associated with diagnostic and therapeutic procedures, leads to a deterioration in the nutritional status of the patients. An association between poor nutritional status and adverse outcomes in surgical patients has been observed. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) in the perioperative setting. (AU)

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y caquexia tumoral / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia

La diabetes es una comorbilidad frecuente en pacientes con cáncer, ya que comparten factores de riesgo comunes. En la enfermedad oncológica, la presencia de caquexia tumoral representa un factor de mal pronóstico, que se ve agravado por un estado nutricional deficiente. Clínicamente, la caquexia se manifiesta como una reducción significativa del peso corporal, acompañado de cambios en la composición corporal y alteraciones en el equilibrio del sistema biológico, y causa una disfunción progresiva. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con caquexia tumoral concurrente. (AU)

Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia. (AU)

Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y cirrosis hepática / Malnutrition management of hospitalized patients with diabetes/hyperglycemia and liver cirrhosis

La cirrosis hepática es una enfermedad progresiva y crónica del hígado, de etiología diversa, que se asocia frecuentemente con intolerancia a la glucosa y en algunos casos concurre con diabetes tipo 2 (DM2). La DM2 se asocia con resultados adversos en pacientes con cirrosis, incluyendo una mayor tasa de ingresos hospitalarios, una mayor prevalencia de carcinoma hepatocelular y un mayor riesgo de mortalidad. La desnutrición es otra complicación frecuente en la cirrosis, cuya prevalencia aumenta con el grado de disfunción hepática, empeorando el pronóstico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con cirrosis hepática. (AU)

Liver cirrhosis is a progressive and chronic disease of the liver, of diverse etiology, which is frequently associated with glucose intolerance and in some cases concurs with type 2 diabetes (DM2). DM2 is associated with adverse outcomes in patients with cirrhosis, including a higher rate of hospitalizations, a higher prevalence of hepatocellular carcinoma, and an increased risk of mortality. Malnutrition is another frequent complication of cirrhosis, the prevalence of which increases with the degree of liver dysfunction, worsening the prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with liver cirrhosis. (AU)