Effect of n-3 Polyunsaturated Fatty Acid Supplementation on Metabolic and Inflammatory Biomarkers in Type 2 Diabetes Mellitus Patients.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is accompanied by chronic low-grade inflammation, with an imbalance in the secretion of adipokines and, worsening insulin resistance. Supplementation with n-3 PUFA in T2DM decreases inflammatory markers, the purpose of the study was to investigate the effect of n-3 PUFA supplementation on adipokines, metabolic control, and lipid profile in T2DM Mexican adults. METHODS: In a randomized, single-blind, placebo-controlled pilot study, 54 patients with T2DM received 520 mg of DHA + EPA-enriched fish-oil (FOG) or a placebo (PG) daily. Baseline and 24-week anthropometric and biochemical measurements included glucose, insulin, glycosylated hemoglobin (Hb1Ac), leptin, adiponectin, resistin, and lipid profile; n-3 PUFA intake was calculated in g/day. RESULTS: Waist circumference and blood glucose showed significant reductions in the FOG group (p = 0.001 and p = 0.011, respectively). Hb1Ac (p = 0.009 and p = 0.004), leptin (p < 0.000 and p < 0.000), and leptin/adiponectin ratio (p < 0.000 and p < 0.000) decreased significantly in both groups after 24 weeks (FOG and PG respectively). Serum resistin (FOG p < 0.000 and PG p = 0.001), insulin (FOG p < 0.000 and PG p < 0.000), and HOMA-IR (FOG p = 0.000 and PG p < 0.000) increased significantly in both groups. FOG had an overall improvement in the lipid profile with a significant decrease in triacylgycerols (p = 0.002) and atherogenic index (p = 0.031); in contrast, the PG group had increased total cholesterol (p < 0.000), non-HDL cholesterol (p < 0.000), and atherogenic index (p = 0.017). CONCLUSIONS: We found a beneficial effect of n-3 PUFA supplementation on waist circumference, glucose, Hb1Ac, leptin, leptin/adiponectin ratio, and lipid profile, without significant changes in adiponectin, and increases in resistin, insulin, and HOMA-IR in both groups.

Diet, exercise and gut mucosal immunity.

Diet and exercise are primary strategies recommended for the control of the obesity epidemic. Considerable attention is being paid to the effect of both on the immune system. However, little research has been done on the effect of diet, nutrients or exercise on the mucosal immune system. The gastrointestinal tract (gut) is not only responsible for the entry of nutrients into the organism, but also for triggering the primary immune response to orally ingested antigens. The gut-associated lymphoid tissue contains a large amount of immune cells, disseminated all along the intestine in Peyer's patches and lamina propria. Specific nutrients or their combinations, as well as the microflora, are capable of modulating the immune system through cell activation, production of signalling molecules or gene expression. We have observed an increase in T-cells as well as a decrease in B-cells from Peyer's patches, induced by diets high in fats or carbohydrates in Balb/c mice. It has also been demonstrated that exercise modulates the immune system, where moderate levels may improve its function by increasing the proliferation of lymphocytes from various sites, including gut-associated lymphoid tissue, whereas exhaustive acute exercise may cause immunosuppression. High-fat diets combined with exercise are able to induce an increase in CD3+ lymphocytes due to increased CD8+ cells and a decrease in B-cells. Explanations and consequences of the effects of diet and exercise on the gut mucosal immunity are still being explored.

[New therapeutics alternative in severe preeclampsia]. / Nueva alternativa terapéutica en preeclampsia severa.

INTRODUCTION: Vasoconstriction is a major pathophysiologic finding in preeclampsia due to hyperactivity of the sympathetic nervous system and a consequent increase in concentration of plasmatic catecholamine. Thus, vasodilatation produced by secondary sympathetic block to lumbar epidural blockade favors control of high blood pressure in patients with severe preeclampsia. OBJECTIVE: Our objective was to evaluate whether lumbar epidural blockade with bupivacaine 0.25% decreases high blood pressure of patients with severe preeclampsia within a lapse of 6 h in comparison with customary antihypertensive treatment. MATERIAL AND METHODS: An open, randomized, controlled trial was carried out in 24 pregnant patients with 30 weeks of gestational age or more and diagnosis of severe preeclampsia who entered the Intensive Care Uni of the IMEIM Hospital of Gynecology and Obstetrics for hemodynamic stabilization and resolution of pregnancy. Group 1 (n = 12) was managed with customary antihypertensive treatment and group 2 (n = 12), with lumbar epidural blockade and bupivacaine 0.25%: 10 mg in bolus and 5 mg/h continuous epidural infusion. Patients were monitored non-invasively and with continuous clinical monitoring with MAP, SAP, and DAP during 6 h. Statistical analysis employed consisted of ANOVA measurement repeats. RESULTS: In MAP and SAP, there were no significant differences between the two groups; DAP in first and second h of treatment had significant differences between the two groups (p value of < or = 0.05). CONCLUSIONS: Lumbar epidural blockade with bupivacaine 0.25% can be used as a therapeutic alternative in high blood pressure control in patients with severe preeclampsia during the the first 6 h of hemodynamic stabilization.

[Presence of equinocyte in the preeclampsia-eclampsia syndrome. Is this a subclinical manifestation of the syndrome?]. / Presencia del equinocito en el síndrome de preeclampsia-eclampsia ¿Manifestación subclínica del síndrome?

OBJECTIVE: To determine the relationship between erythrocyte deformations and preeclampsia-eclampsia syndrome before presentation of the triad high blood pressure-edema-proteinuria. MATERIAL AND METHODS: Aleatory study. A total of 308 patients were studied without evidence of preeclampsia, with negative erythrocyte deformation smear, between 12 and 18 weeks of pregnancy. Monthly laboratory samples were performed including arterial blood pressure monitorization, weight, and periphery blood smear considered as positive with presence of 50% of morphologic changes of erythrocyte (equinocyte) deem in 10 fields, with light microscopic and oil immersion at 100X. Statistical studies were performed to determine relative risk (RR), sensitivity (S), and specificity (E), and positive and negative predictive values. RESULTS: A total of 308 patients were studied; 36 patients (100%) had a positive smear, nine (25%) had preeclampsia. Erythrocyte deformation was seen at between 22 and 26 weeks of pregnancy in all patients before onset of high blood pressure, edema, and proteinuria; of 27 patients with positive smear who did not present preeclampsia (75%), five had thrombocytopenia, of five had edema and increased weight, and 17 were normal with normal vaginal delivery. A total of 267 patients who had negative smear until the end of pregnancy (98%), five (2%) had preeclampsia (sensitivity = 64%, specificity = 90%, VP+ = 25%, VP- = 98%, RR = 13.6%). CONCLUSIONS: There is a close relationship between erythrocyte deformations with onset of preeclampsia-eclampsia syndrome prior to presentation of the triad high blood pressure-edema-proteinuria.