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1.
Surg Obes Relat Dis ; 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31813775

RESUMO

BACKGROUND: Recent works have reported that bariatric surgery has remarkable effects on the metabolome, which might be potentially associated to the metabolic improvement of this procedure in patients with obesity. Serum polyamines, metabolites derived from amino acid metabolism, have been recently related to the metabolic status in obese individuals. However, the impact of bariatric surgery on the circulating levels of polyamines remains elusive. OBJECTIVE: To evaluate the effect of bariatric surgery on serum polyamine levels and to evaluate the association of changes in these molecules with metabolic improvement in patients with morbid obesity. SETTING: Virgen de la Victoria University Hospital, Malaga, Spain. METHODS: This study included 32 morbidly obese patients (weight index ≥40 kg/m2) with metabolic syndrome, who underwent sleeve gastrectomy. Serum levels of polyamines (putrescine, spermidine, and spermine), acetylpolyamines, and polyamine-related amino acids (arginine and ornithine) were assessed at baseline and 6 months after bariatric surgery, and were analyzed in an ultraperformance liquid chromatography-mass spectrometry platform. RESULTS: Our metabolomic analysis revealed a significant rise in several metabolites related to the polyamine metabolism, such as putrescine and acetyl derivatives of spermidine and spermine in serum samples from morbidly obese patients after bariatric surgery. Changes in serum levels of both putrescine and acetylputrescine were associated to the resolution of metabolic syndrome after surgery. CONCLUSION: Our study indicates that bariatric surgery affects the serum polyamine pattern and the resolution of metabolic syndrome after bariatric surgery is associated to specific changes in the serum polyamine metabolome.

2.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 443-458, ago.-sept. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182864

RESUMO

Objetivo: El tratamiento de la diabetes tipo 2 (DM2) es complejo y su propósito es reducir la morbimortalidad, por lo que su manejo tiene que incluir: un control glucémico individualizado precoz (mediante una adecuada educación diabetológica, modificaciones del estilo de vida y tratamiento farmacológico), el control de los factores de riesgo cardiovascular (CV), la detección y tratamiento precoz de las complicaciones y la evaluación de las comorbilidades asociadas. El objetivo fue elaborar un documento para unificar los aspectos necesarios para el abordaje integral de las personas con DM2. Participantes: Miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Métodos: Se realizó una revisión de la evidencia disponible relativa a cada aspecto del manejo de la diabetes: objetivos de control glucémico, dieta y ejercicio, tratamiento farmacológico, tratamiento y control de factores de riesgo, detección de complicaciones y manejo del paciente frágil con DM2. Las recomendaciones se formularon según los grados de evidencia recogidos en los Standards of Medical Care in Diabetes 2018. Tras la formulación de las recomendaciones el documento fue consensuado por los miembros del Grupo de trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición. Conclusiones: El objetivo de este documento es proporcionar, desde el punto de vista del endocrinólogo clínico, unas recomendaciones prácticas basadas en la evidencia acerca de todos los aspectos necesarios para el abordaje integral de la DM2


Objective: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. Methods: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. Conclusions: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists


Assuntos
Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicações , Fatores de Risco , Sociedades Médicas/normas , Documentos , Índice Glicêmico , Estilo de Vida , Sociedades Médicas/organização & administração , Estratégias de eSaúde , Exercício/fisiologia
3.
Endocrinol Diabetes Nutr ; 66(7): 443-458, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30827909

RESUMO

OBJECTIVE: Treatment of type 2 diabetes mellitus (T2DM) is complex and is intended to decrease morbidity and mortality. Management should therefore include adequate diabetes education, lifestyle changes, drug treatment to achieve early blood glucose control and reduction of cardiovascular (CV) risk factors, early detection and treatment of complications, and assessment of associated comorbidities. The objective was to prepare a document including all aspects required for a comprehensive approach to T2DM. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology. METHODS: The available evidence regarding each aspect of diabetes management (blood glucose control goals, diet and exercise, drug treatment, risk factor management and control, detection of complications, and management of frail patients) was reviewed. Recommendations were formulated based on the grades of evidence stated in the 2018 Standards of Medical Care in Diabetes. Recommendations were discussed and agreed by the working group members. CONCLUSIONS: This document is intended to provide evidence-based practical recommendations for comprehensive management of T2DM by clinical endocrinologists.

4.
Obes Surg ; 29(3): 983-989, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30488259

RESUMO

BACKGROUND: Non-alcoholic steatohepatitis (NASH) is present in a high percentage of obese patients undergoing bariatric surgery. A significant proportion of patients still present NASH even after considerable weight loss and metabolic improvements after surgery. OBJECTIVE: To determine whether the changes in the serum lipidome after sleeve gastrectomy could be used to discriminate obese patients with NASH patients to those with non-alcoholic fatty liver (NAFL). METHODS: This study involved 24 patients with grade 3 obesity diagnosed with either NAFL (n = 8) or NASH (n = 16) using the non-invasive OWLiver assay. All patients suffering from NASH were re-evaluated 6 months after bariatric surgery using the OWLiver test to confirm NASH resolution. Serum lipid extracts were assessed at baseline and 6 months post surgery and were analyzed in an ultra-performance liquid chromatography/time-of-flight mass spectrometry (UPLC-TOF-MS)-based platform. RESULTS: Lipidomic analysis revealed a differential sphingomyelin profile in patients with NASH resolution after sleeve gastrectomy. Certain serum sphingomyelin species were significantly higher at baseline in NASH patients in comparison to those with NAFL. Sphingomyelin profile of subjects with NASH resolution was similar to that for obese subjects with NAFL before bariatric surgery. CONCLUSION: Our study indicates that the serum sphingomyelin levels could be related to the status of non-alcoholic fatty liver disease and that certain sphingomyelin species may be used for the follow-up of obese patients with NASH after sleeve gastrectomy.

7.
Diabetes Technol Ther ; 19(11): 633-640, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29091477

RESUMO

BACKGROUND: Blood glucose meters are reliable devices for data collection, providing electronic logs of historical data easier to interpret than handwritten logbooks. Automated tools to analyze these data are necessary to facilitate glucose pattern detection and support treatment adjustment. These tools emerge in a broad variety in a more or less nonevaluated manner. The aim of this study was to compare eDetecta, a new automated pattern detection tool, to nonautomated pattern analysis in terms of time investment, data interpretation, and clinical utility, with the overarching goal to identify early in development and implementation of tool areas of improvement and potential safety risks. METHODS: Multicenter web-based evaluation in which 37 endocrinologists were asked to assess glycemic patterns of 4 real reports (2 continuous subcutaneous insulin infusion [CSII] and 2 multiple daily injection [MDI]). Endocrinologist and eDetecta analyses were compared on time spent to analyze each report and agreement on the presence or absence of defined patterns. RESULTS: eDetecta module markedly reduced the time taken to analyze each case on the basis of the emminens eConecta reports (CSII: 18 min; MDI: 12.5), compared to the automatic eDetecta analysis. Agreement between endocrinologists and eDetecta varied depending on the patterns, with high level of agreement in patterns of glycemic variability. Further analysis of low level of agreement led to identifying areas where algorithms used could be improved to optimize trend pattern identification. CONCLUSION: eDetecta was a useful tool for glycemic pattern detection, helping clinicians to reduce time required to review emminens eConecta glycemic reports. No safety risks were identified during the study.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Automonitorização da Glicemia , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Insulina/administração & dosagem , Sistemas de Infusão de Insulina
8.
Endocrinol Diabetes Nutr ; 64 Suppl 1: 23-30, 2017 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28440762

RESUMO

Thyroid nodule detection has increased with widespread use of ultrasound, which is currently the main tool for detection, monitoring, diagnosis and, in some instances, treatment of thyroid nodules. Knowledge of ultrasound and adequate instruction on its use require a position statement by the scientific societies concerned. The working groups on thyroid cancer and ultrasound techniques of the Spanish Society of Endocrinology and Nutrition have promoted this document, based on a thorough analysis of the current literature, the results of multicenter studies and expert consensus, in order to set the requirements for the best use of ultrasound in clinical practice. The objectives include the adequate framework for use of thyroid ultrasound, the technical and legal requirements, the clinical situations in which it is recommended, the levels of knowledge and learning processes, the associated responsibility, and the establishment of a standardized reporting of results and integration into hospital information systems and endocrinology units.


Assuntos
Endocrinologia/organização & administração , Unidades Hospitalares , Doenças da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia , Acreditação/normas , Biópsia por Agulha Fina , Certificação/normas , Curadoria de Dados , Endocrinologia/legislação & jurisprudência , Endocrinologia/métodos , Segurança de Equipamentos/normas , Sistemas de Informação Hospitalar , Unidades Hospitalares/legislação & jurisprudência , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Humanos , Hiperparatireoidismo Primário/diagnóstico por imagem , Registros Médicos , Guias de Prática Clínica como Assunto , Prevalência , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Ultrassonografia/normas
9.
Endocrinol. diabetes nutr. (Ed. impr.) ; 64(supl.1): 23-30, mar. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-171738

RESUMO

La ecografía se ha convertido en un instrumento imprescindible en la asistencia a los pacientes con enfermedades tiroideas. La detección de los nódulos tiroideos se ha incrementado con el uso generalizado de la misma, siendo la herramienta principal para su detección, orientación diagnóstica, seguimiento y, en ocasiones, también terapéutica. Los Grupos de Trabajo de Cáncer de Tiroides y de Técnicas ecográficas de la Sociedad Española de Endocrinología y Nutrición han promovido este documento en el que se resumen los requisitos necesarios para la mejor práctica clínica posible con esta técnica. Los objetivos del trabajo incluyen encuadrar su utilización dentro de la especialidad, los requisitos técnicos y legales necesarios, las situaciones clínicas de su aplicación, los niveles de conocimiento y aprendizaje, la responsabilidad asociada, la comunicación estandarizada de resultados e integración en los sistemas de información hospitalarios, posicionando la técnica ecográfica dentro de la cartera de servicios en las actuales unidades de Endocrinología y Nutrición (AU)


Thyroid nodule detection has increased with widespread use of ultrasound, which is currently the main tool for detection, monitoring, diagnosis and, in some instances, treatment of thyroid nodules. Knowledge of ultrasound and adequate instruction on its use require a position statement by the scientific societies concerned. The working groups on thyroid cancer and ultrasound techniques of the Spanish Society of Endocrinology and Nutrition have promoted this document, based on a thorough analysis of the current literature, the results of multicenter studies and expert consensus, in order to set the requirements for the best use of ultrasound in clinical practice. The objectives include the adequate framework for use of thyroid ultrasound, the technical and legal requirements, the clinical situations in which it is recommended, the levels of knowledge and learning processes, the associated responsibility, and the establishment of a standardized reporting of results and integration into hospital information systems and endocrinology units (AU)


Assuntos
Humanos , Ultrassonografia , Doenças do Sistema Endócrino/diagnóstico por imagem , Estado Nutricional , Nutrição em Saúde Pública , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Glândula Tireoide/diagnóstico por imagem
10.
Med. clín (Ed. impr.) ; 147(supl.esp.1): 44-48, nov. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-163183

RESUMO

Los inhibidores del SGLT2 tienen como efecto principal una acción glucosúrica y logran revertir el efecto deletéreo del aumento de la reabsorción tubular de glucosa en las personas con diabetes mellitus tipo 2 (DM2). En términos de eficacia producen una reducción de HbA1c promedio del 0,8%, aunque si se parte de una HbA1c más elevada se pueden tener reducciones mayores. Además de los efectos glucémicos, como efectos complementarios se obtiene la reducción de peso y de presión arterial sin aumentar las hipoglucemias. Por su mecanismo de acción independiente de la insulina se pueden utilizar en monoterapia, en pacientes intolerantes a la metformina o en combinación con otros medicamentos hipoglucemiantes, incluyendo la insulina. Los efectos secundarios son pocos y los más frecuentes están relacionados con su mecanismo de acción. Destacan las infecciones genitourinarias, las más frecuentes son las micóticas. Por otro lado, su perfil cardiovascular (CV) es adecuado y queda por aclarar la aparición de cetoacidosis (CAD), en posible relación a su uso en pacientes insulinopénicos. En un ensayo clínico aleatorizado de un iSGLT2 en pacientes con diabetes mellitus tipo 2 y enfermedad CV de base, se ha podido observar que el uso de este en asociación a la terapia estándar logra enlentecer la progresión del daño renal y disminuir eventos renales relevantes, como la duplicación de los valores de creatinina sérica y el inicio de diálisis. Estos efectos, probablemente se fundamentan en sus efectos favorables sobre la hemodinámica glomerular disminuyendo la hiperfiltración, en la reducción de la toxicidad tubular de la glucosa, así como sus efectos beneficiosos sobre la glucemia, la presión arterial, el peso y la uricemia (AU)


The main effect of SGLT2 inhibitors is their glycosuric action. These drugs reverse the deleterious effect of increased glucose reabsorption by the renal tubule in persons with DM2. In terms of efficacy, SGLT2 inhibitors produce a mean HbA1c reduction of 0.8%, although higher initial HbA1c levels can show a larger decrease. In addition to these glycaemic effects, this drug class also favours weight loss and blood pressure control, without increasing hypoglycaemic episodes. Due to their insulin-independent mechanism of action, SGLT2 inhibitors can be used in monotherapy, in patients with metformin intolerance, or in combination with other glucose-lowering drugs, including insulin. These drugs have few secondary effects and most are related to their mechanism of action. The most frequent adverse effects are genitourinary infections, usually mycotic infections. SGLT2 inhibitors have an adequate cardiovascular safety profile. The development of ketoacidosis remains to be elucidated, and may be related to use in patients with insulinopenia. A randomised clinical trial of an SGLT2 inhibitor in patients with DM2 and underlying cardiovascular disease showed that its use in association with standard therapy slowed the progression of renal damage and reduced significant renal events such as doubling of serum creatinine values and initiation of dialysis. These effects are probably due to the favourable effects of SGLT2 inhibition on glomerular haemodynamics, by reducing hyperfiltration, to the reduction of glucose-induced tubular toxicity, as well as its beneficial effects on glycaemia, blood pressure, weight, and uricaemia (AU)


Assuntos
Humanos , Transportador 2 de Glucose-Sódio/antagonistas & inibidores , Transportador 2 de Glucose-Sódio/uso terapêutico , Medidas de Segurança/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Albuminúria/tratamento farmacológico , Cetose/complicações , Cetose/tratamento farmacológico , Osteoporose/complicações , Osteoporose/diagnóstico , Candidíase/complicações , Candidíase/tratamento farmacológico , Homeostase
11.
Br J Pharmacol ; 173(11): 1820-34, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26993859

RESUMO

BACKGROUND AND PURPOSE: Glucagon-like peptide-1 (GLP-1) analogues improve glycaemic control in type 2 diabetic (T2D) patients and cause weight loss in obese subjects by as yet unknown mechanisms. We recently demonstrated that the GLP-1 receptor, which is present in adipocytes and the stromal vascular fraction of human adipose tissue (AT), is up-regulated in AT of insulin-resistant morbidly obese subjects compared with healthy lean subjects. The aim of this study was to explore the effects of in vitro and in vivo administration of GLP-1 and its analogues on AT and adipocyte functions from T2D morbidly obese subjects. EXPERIMENTAL APPROACH: We analysed the effects of GLP-1 on human AT and isolated adipocytes in vitro and the effects of GLP-1 mimetics on AT of morbidly obese T2D subjects in vivo. KEY RESULTS: GLP-1 down-regulated the expression of lipogenic genes when administered during in vitro differentiation of human adipocytes from morbidly obese patients. GLP-1 also decreased the expression of adipogenic/lipogenic genes in AT explants and mature adipocytes, while increasing that of lipolytic markers and adiponectin. In 3T3-L1 adipocytes, GLP-1 decreased free cytosolic Ca2+ concentration ([Ca2+]i). GLP-1-induced responses were only partially blocked by GLP-1 receptor antagonist exendin (9­39). Moreover, administration of exenatide or liraglutide reduced adipogenic and inflammatory marker mRNA in AT of T2D obese subjects. CONCLUSIONS AND IMPLICATIONS: Our data suggest that the beneficial effects of GLP-1 are associated with changes in the adipogenic potential and ability of AT to expand, via activation of the canonical GLP-1 receptor and an additional, as yet unknown, receptor.


Assuntos
Adipócitos/efeitos dos fármacos , Diferenciação Celular/efeitos dos fármacos , Peptídeo 1 Semelhante ao Glucagon/farmacologia , Células 3T3-L1 , Adipócitos/citologia , Adipócitos/metabolismo , Animais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Exenatida , Expressão Gênica/efeitos dos fármacos , Marcadores Genéticos , Humanos , Camundongos , Obesidade Mórbida/complicações , Obesidade Mórbida/metabolismo , Obesidade Mórbida/patologia , Peptídeos/uso terapêutico , Projetos Piloto , Estudos Prospectivos , Peçonhas/uso terapêutico
12.
Med Clin (Barc) ; 147 Suppl 1: 44-48, 2016 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28760225

RESUMO

The main effect of SGLT2 inhibitors is their glycosuric action. These drugs reverse the deleterious effect of increased glucose reabsorption by the renal tubule in persons with DM2. In terms of efficacy, SGLT2 inhibitors produce a mean HbA1c reduction of 0.8%, although higher initial HbA1c levels can show a larger decrease. In addition to these glycaemic effects, this drug class also favours weight loss and blood pressure control, without increasing hypoglycaemic episodes. Due to their insulin-independent mechanism of action, SGLT2 inhibitors can be used in monotherapy, in patients with metformin intolerance, or in combination with other glucose-lowering drugs, including insulin. These drugs have few secondary effects and most are related to their mechanism of action. The most frequent adverse effects are genitourinary infections, usually mycotic infections. SGLT2 inhibitors have an adequate cardiovascular safety profile. The development of ketoacidosis remains to be elucidated, and may be related to use in patients with insulinopenia. A randomised clinical trial of an SGLT2 inhibitor in patients with DM2 and underlying cardiovascular disease showed that its use in association with standard therapy slowed the progression of renal damage and reduced significant renal events such as doubling of serum creatinine values and initiation of dialysis. These effects are probably due to the favourable effects of SGLT2 inhibition on glomerular haemodynamics, by reducing hyperfiltration, to the reduction of glucose-induced tubular toxicity, as well as its beneficial effects on glycaemia, blood pressure, weight, and uricaemia.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose , Glicemia , Glucose , Humanos , Hipoglicemiantes/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Sódio , Transportador 2 de Glucose-Sódio
13.
Endocrinol Nutr ; 62(5): e47-56, 2015 May.
Artigo em Espanhol | MEDLINE | ID: mdl-25797189

RESUMO

OBJECTIVE: To update previous recommendations developed by the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition for the evaluation and treatment of osteoporosis associated to different endocrine and nutritional diseases. PARTICIPANTS: Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition. METHODS: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date between 18 October 2011 and 30 October 2014 were included. The recommendations were discussed and approved by all members of the Working Group. CONCLUSIONS: This update summarizes the new data regarding evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions.


Assuntos
Doenças do Sistema Endócrino/complicações , Doenças Metabólicas/complicações , Minerais/metabolismo , Osteoporose/etiologia , Absorciometria de Fóton , Anorexia Nervosa/complicações , Antineoplásicos Hormonais/efeitos adversos , Densidade Óssea , Osso e Ossos/metabolismo , Neoplasias da Mama/complicações , Neoplasias da Mama/tratamento farmacológico , Complicações do Diabetes , Doenças do Sistema Endócrino/induzido quimicamente , Doenças do Sistema Endócrino/terapia , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/prevenção & controle , Humanos , Doenças Inflamatórias Intestinais/complicações , Masculino , Desnutrição/complicações , Doenças Metabólicas/terapia , Osteoporose/diagnóstico por imagem , Osteoporose/terapia , Neoplasias da Próstata/complicações , Neoplasias da Próstata/tratamento farmacológico
14.
J Clin Endocrinol Metab ; 100(4): E591-5, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25706239

RESUMO

CONTEXT: The relationship between 25-hydroxyvitamin D [25(OH)D] and obesity and type 2 diabetes is not completely understood. Vitamin D receptor (VDR) expression in adipose tissue (AT) is related to obesity and might be regulated by 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]. OBJECTIVE: To analyze serum 25(OH)D and VDR gene expression in AT according to body mass index (BMI) and glycemic status and the effect of 1,25(OH)2D3 on AT according to BMI. DESIGN AND PATIENTS: Two cohorts were studied: 1) 118 subjects classified according to their BMI (lean, overweight, obese, or morbidly obese [MO]) and their glycemic status (normoglycemic [NG] and prediabetic and diabetic [P&D]); and 2) 30 obese subjects (BMI > 30 kg/m(2)) classified as NG and P&D. VDR gene expression was analyzed during preadipocyte differentiation and in vitro stimulation with 1,25(OH)2D3 of AT explants from donors with different BMI values. SETTING: University Hospital. MAIN OUTCOME MEASURES: Serum 25(OH)D, parathyroid hormone (PTH), and AT VDR gene expression. RESULTS: 25(OH)D levels were lower in P&D than NG subjects, significantly so in the lean and MO groups (P < .05). 25(OH)D levels correlated negatively with homeostasis model of assessment for insulin resistance (HOMA-IR) (r = -0.200; P = .032) and glucose (r = -0.295; P = .001), but not with BMI. VDR gene expression was higher in MO than in the other BMI groups (P < .05). 1,25(OH)2D3 increased VDR gene expression in AT from obese patients (P < .05) but not from lean subjects. CONCLUSIONS: 25(OH)D levels are diminished in P&D compared to NG subjects, independently of BMI, and are closely related to glucose metabolism variables, suggesting that vitamin D deficiency is associated more with carbohydrate metabolism than with obesity. Moreover, AT has a different response to 1,25(OH)2D3 depending on the degree of obesity.


Assuntos
Tecido Adiposo/metabolismo , Diabetes Mellitus Tipo 2/genética , Obesidade/sangue , Obesidade/genética , Receptores de Calcitriol/genética , Vitamina D/análogos & derivados , Adulto , Idoso , Índice de Massa Corporal , Células Cultivadas , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Feminino , Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/sangue , Sobrepeso/genética , Estado Pré-Diabético/sangue , Estado Pré-Diabético/genética , Receptores de Calcitriol/metabolismo , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/genética
15.
Av. diabetol ; 28(supl.1): 27-31, jun. 2012.
Artigo em Espanhol | IBECS | ID: ibc-103783

RESUMO

El objetivo de la insulinización actual es mimetizar tanto la secreción basal como la secreción prandial de insulina. La insulina regular humana ha sido usada durante años para el control prandial de los pacientes con diabetes tipo 2 (DM2); sin embargo, su perfil nunca se ha considerado óptimo. La insulina aspart, por su perfil más fisiológico, ha venido sustituyendo el régimen prandial de los pacientes con DM2 en vez de la insulina regular; sin embargo, los beneficios no están del todo claros. Aunque la insulina aspart no ha demostrado descensos significativos en HbA1c, sí ha demostrado, aunque no de manera consistente, mejorar el perfil de glucemia posprandial y, al menos en poblaciones concretas, reducir la incidencia de hipoglucemias nocturnas y graves, lo cual cobra importancia en pacientes con alto riesgo de hipoglucemias(AU)


Current insulin therapy aims to mimic both basal and prandial physiological hormone secretion to achieve near-normal glycemia. Regular human insulin has been used for years for glycemic control in type 2 diabetes mellitus (DM-2). However, its pharmacokinetic and pharmacodynamic profiles have never been considered optimal. Due to its more physiological profile, insulin aspart has gradually been substituting regular human insulin in patients with DM-2 but there is ongoing debate concerning its efficacy and safety in these patients. Although insulin aspart has not been shown to produce significant decreases in HbA1c, some – but not all – studies have reported that this drug has beneficial effects in reducing postprandial hyperglycemia. Furthermore, at least in specific populations, insulin aspart may reduce the incidence of nocturnal hypoglycemic episodes and severe hypoglycemic episodes, a finding of importance in high-risk patients(AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insulina Aspart/uso terapêutico , Hemoglobina A Glicada , Hipoglicemia/prevenção & controle
16.
PLoS One ; 7(2): e31280, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22384010

RESUMO

OBJECTIVE: De novo lipogenesis is involved in fatty acid biosynthesis and could be involved in the regulation of the triglyceride storage capacity of adipose tissue. However, the association between lipogenic and lipolytic genes and the evolution of morbidly obese subjects after bariatric surgery remains unknown. In this prospective study we analyze the association between the improvement in the morbidly obese patients as a result of bariatric surgery and the basal expression of lipogenic and lipolytic genes. METHODS: We study 23 non diabetic morbidly obese patients who were studied before and 7 months after bariatric surgery. Also, we analyze the relative basal mRNA expression levels of lipogenic and lipolytic genes in epiploic visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT). RESULTS: When the basal acetyl-CoA carboxylase 1 (ACC1), acetyl-CoA synthetase 2 (ACSS2) and ATP citrate lyase (ACL) expression in SAT was below percentile-50, there was a greater decrease in weight (P = 0.006, P = 0.034, P = 0.026), body mass index (P = 0.008, P = 0.033, P = 0.034) and hip circumference (P = 0.033, P = 0.021, P = 0.083) after bariatric surgery. In VAT, when the basal ACSS2 expression was below percentile-50, there was a greater decrease in hip circumference (P = 0.006). After adjusting for confounding variables in logistic regression models, only the morbidly obese patients with SAT or VAT ACSS2 expression ≥ P50 before bariatric surgery had a lower percentage hip circumference loss (

Assuntos
Tecido Adiposo/fisiologia , Cirurgia Bariátrica/métodos , Lipogênese , Obesidade Mórbida/terapia , ATP Citrato (pro-S)-Liase/genética , Acetil-CoA Carboxilase/genética , Acetiltransferases/genética , Adulto , Antropometria/métodos , Feminino , Humanos , Gordura Intra-Abdominal/metabolismo , Lipólise , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/genética , RNA Mensageiro/metabolismo , Gordura Subcutânea/metabolismo , Resultado do Tratamento
17.
PLoS One ; 7(3): e33264, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22442679

RESUMO

OBJECTIVE: Zinc-α(2) glycoprotein (ZAG) stimulates lipid loss by adipocytes and may be involved in the regulation of adipose tissue metabolism. However, to date no studies have been made in the most extreme of obesity. The aims of this study are to analyze ZAG expression levels in adipose tissue from morbidly obese patients, and their relationship with lipogenic and lipolytic genes and with insulin resistance (IR). METHODS: mRNA expression levels of PPARγ, IRS-1, IRS-2, lipogenic and lipolytic genes and ZAG were quantified in visceral (VAT) and subcutaneous adipose tissue (SAT) of 25 nondiabetic morbidly obese patients, 11 with low IR and 14 with high IR. Plasma ZAG was also analyzed. RESULTS: The morbidly obese patients with low IR had a higher VAT ZAG expression as compared with the patients with high IR (p = 0.023). In the patients with low IR, the VAT ZAG expression was greater than that in SAT (p = 0.009). ZAG expression correlated between SAT and VAT (r = 0.709, p<0.001). VAT ZAG expression was mainly predicted by insulin, HOMA-IR, plasma adiponectin and expression of adiponectin and ACSS2. SAT ZAG expression was only predicted by expression of ATGL. CONCLUSIONS: ZAG could be involved in modulating lipid metabolism in adipose tissue and is associated with insulin resistance. These findings suggest that ZAG may be a useful target in obesity and related disorders, such as diabetes.


Assuntos
Regulação da Expressão Gênica , Resistência à Insulina , Gordura Intra-Abdominal/metabolismo , Lipólise , Obesidade Mórbida/metabolismo , Proteínas de Plasma Seminal/biossíntese , Gordura Subcutânea/metabolismo , Adulto , Proteínas de Arabidopsis/biossíntese , Humanos , Proteínas Substratos do Receptor de Insulina/biossíntese , Gordura Intra-Abdominal/patologia , Transferases Intramoleculares/biossíntese , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/patologia , Obesidade Mórbida/terapia , PPAR gama/biossíntese , Gordura Subcutânea/patologia
18.
Endocrinol. nutr. (Ed. impr.) ; 59(3): 174-196, mar. 2012. ilus
Artigo em Espanhol | IBECS | ID: ibc-105140

RESUMO

Objetivo Proporcionar unas recomendaciones prácticas para la evaluación y tratamiento de la osteoporosis asociada a diferentes enfermedades endocrinas y alteraciones nutricionales. Participantes Miembros del Grupo de Metabolismo Mineral de la Sociedad Española de Endocrinología y Nutrición, un metodólogo y un documentalista. Métodos Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en Medline de la evidencia disponible para cada patología usando las siguientes palabras clave asociadas al nombre de cada patología: AND osteoporosis, fractures, bone mineral density, bone markers y treatment. Se revisaron artículos escritos en inglés con fecha de inclusión hasta 18 de octubre de 2011, y cada tema fue revisado por dos personas del Grupo. Un metodólogo resolvió las diferencias que surgieron durante el proceso de revisión de bibliografía y formulación de recomendaciones. Tras la formulación de las recomendaciones estas se discutieron en una reunión conjunta del Grupo de Trabajo. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y tratamiento de la osteoporosis en las enfermedades endocrinas y nutricionales que asocian baja masa ósea o aumento del riesgo de fractura. Para cada patología, se señala el riesgo de osteoporosis y fracturas asociado, se formulan recomendaciones en cuanto a la evaluación de masa ósea y se enumeran las opciones terapéuticas que han demostrado eficacia en aumentar la densidad mineral ósea y/o reducir el riesgo de fractura (AU)


Objective To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. Participants Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. Methods Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND “osteoporosis”, “fractures”, “bone mineral density”, and “treatment”. Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts, related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. Conclusions The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed (AU)


Assuntos
Humanos , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Doenças do Sistema Endócrino/complicações , Transtornos Nutricionais/complicações , Padrões de Prática Médica , Fraturas Ósseas/prevenção & controle , Densidade Óssea/fisiologia
19.
Endocrinol Nutr ; 59(3): 174-96, 2012 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22321561

RESUMO

OBJECTIVE: To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS: The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.


Assuntos
Doenças do Sistema Endócrino/complicações , Desnutrição/complicações , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Absorciometria de Fóton , Algoritmos , Anorexia Nervosa/complicações , Anorexia Nervosa/terapia , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Complicações do Diabetes/diagnóstico , Gerenciamento Clínico , Doenças do Sistema Endócrino/tratamento farmacológico , Doenças do Sistema Endócrino/cirurgia , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Osteoporose/etiologia , Osteoporose/fisiopatologia , Nutrição Parenteral/efeitos adversos , Síndromes Pós-Gastrectomia/tratamento farmacológico , Vitamina D/uso terapêutico
20.
Menopause ; 19(2): 172-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21971209

RESUMO

OBJECTIVE: Clinical studies evaluating the role of leptin and adiponectin on bone metabolism had shown conflicting results, and data about the effect of anticatabolic drugs on these adipokines are scarce. Our aims were to determine adiponectin and leptin levels in osteoporotic postmenopausal women and their relationship with bone mass and bone turnover and to analyze changes on adiponectin and leptin levels after treatment with raloxifene or alendronate. METHODS: We selected 53 women (mean ± SD age, 63 ± 7 y) with postmenopausal osteoporosis divided into two treatment groups: raloxifene (60 mg/d; n = 20) or alendronate (70 mg/wk; n = 33) during a period of 1 year. Bone mineral density by dual-energy x-ray absorptiometry and serum levels of leptin, adiponectin, and bone turnovers markers were determined at baseline and at 1 year after treatment. RESULTS: Baseline levels of leptin were correlated to body mass index (r = 0.47; P < 0.01), waist circumference (r = 0.38, P = 0.01), and estradiol (r = 0.4, P = 0.003). Adiponectin was inversely related to bone-specific alkaline phosphatase (r = -0.41, P < 0.01) and serum crosslaps (r = -0.35; P < 0.01). There was no correlation between bone mineral density, leptin, and adiponectin. After 12 months, no changes were observed in leptin and adiponectin in the alendronate group; however, a significant increase in leptin levels (973.5 ± 637.4 pM/mL vs 1,305.7 ± 793.5 pM/mL; P = 0.031) was detected in the raloxifene group, whereas adiponectin levels showed no significant changes (P = 0.46). CONCLUSIONS: In postmenopausal women with osteoporosis, raloxifene induces a significant increase in leptin levels without significant changes in adiponectin serum levels. The antiresorptive effect of raloxifene and alendronate is not substantially influenced by changes in leptin or adiponectin levels.


Assuntos
Adiponectina/sangue , Alendronato/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Leptina/sangue , Osteoporose Pós-Menopausa/tratamento farmacológico , Cloridrato de Raloxifeno/uso terapêutico , Idoso , Alendronato/farmacologia , Índice de Massa Corporal , Densidade Óssea/efeitos dos fármacos , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/sangue , Cloridrato de Raloxifeno/farmacologia
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