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2.
Obes Surg ; 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420830

RESUMO

BACKGROUND: To compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism. METHODS: Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12 months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well as GLP-1, GLP-2, and insulin after a standard meal were determined. RESULTS: After surgery, the decrease at femoral neck (FN) was similar but at lumbar spine (LS), it was greater in the mRYGB group compared with SG and GCP - 7.29 (4.6) vs. - 0.48 (3.9) vs. - 1.2 (2.7)%, p < 0.001. Osteocalcin and alkaline phosphatase increased more after mRYGB. Bone mineral content (BMC) at the LS after surgery correlated with fasting ghrelin (r = - 0.412, p = 0.01) and AUC for GLP-1 (r = - 0.402, p = 0.017). FN BMD at 12 months correlated with post-surgical fasting glucagon (r = 0.498, p = 0.04) and insulin AUC (r = 0.384, p = 0.030) and at LS with the AUC for GLP-1 in the same time period (r = - 0.335, p = 0.049). However, in the multiple regression analysis after adjusting for age, sex, and BMI, the type of surgery (mRYGB) remained the only factor associated with BMD reduction at LS and FN. CONCLUSIONS: mRYGB induces greater deleterious effects on the bone at LS compared with SG and GCP, and gastrointestinal hormones do not play a major role in bone changes.

3.
Diabetes Care ; 42(10): 1956-1965, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375523

RESUMO

OBJECTIVE: To determine the potential use of baseline circulating succinate to predict type 2 diabetes remission after bariatric surgery. RESEARCH DESIGN AND METHODS: Forty-five obese patients with diabetes were randomly assigned to Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or laparoscopic greater curvature plication. Anthropometric parameters were evaluated, and a complete biochemical analysis including circulating serum succinate concentrations was performed at baseline and 1 year after surgery. The results were externally validated in a second cohort including 88 obese patients with diabetes assigned to RYGB or SG based on clinical criteria. RESULTS: Succinate baseline concentrations were an independent predictor of diabetes remission after bariatric surgery. Patients achieving remission after 1 year had lower levels of baseline succinate (47.8 [37.6-64.6] µmol/L vs. 64.1 [52.5-82.9] µmol/L; P = 0.018). Moreover, succinate concentrations were significantly decreased 1 year after surgery (58.9 [46.4-82.4] µmol/L vs. 46.0 [35.8-65.3] µmol/L, P = 0.005). In multivariate analysis, the best logistic regression model showed that baseline succinate (odds ratio [OR] 11.3, P = 0.031) and the type of surgery (OR 26.4, P = 0.010) were independently associated with remission. The C-statistic for this model was 0.899 (95% CI 0.809-0.989) in the derivation cohort, which significantly improved the prediction of remission compared with current available scores, and 0.729 (95% CI 0.612-0.846) in the validation cohort. Interestingly, patients had a different response to the type of surgery according to baseline succinate, with significant differences in remission rates. CONCLUSIONS: Circulating succinate is reduced after bariatric surgery. Baseline succinate levels have predictive value for diabetes remission independently of previously described presurgical factors and improve upon the current available scores to predict remission.

4.
Obes Surg ; 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31346930

RESUMO

INTRODUCTION: miRNAs are small non-coding RNAs, some of which are expressed in adipose tissues, are present in the circulation, and are regulated in obesity. Bariatric surgery (BS) has been proposed to lead to activation of brown adipose tissue, an effect that may be related to beneficial effects of BS on systemic metabolism. Here, we evaluated circulating levels of miR-92a and miR-99b, two miRNAs proposed as biomarkers of brown fat activity, in a cohort of patients with severe obesity before and after BS, and studied their potential relationship with BS-associated improvements in metabolic parameters. METHODS: Circulating levels of miR-92a and miR-99b were quantified in a cohort of 26 patients (age, 48 ± 10 years; BMI, 45 ± 7 kg/m2) before and 6 months after BS. Clinical parameters were determined at different time points and correlations among them were studied. RESULTS: Basal levels of miR-92a were significantly increased in patients with obesity relative to lean controls. Serum miR-92a levels were strongly reduced at 6 months after BS, reaching levels similar to those in controls. Serum miR-99b levels were unchanged in relation to both the obese condition and BS. Elevated levels of miR-92a were directly correlated with worsened glucose homeostasis parameters and poor BS outcome. CONCLUSIONS: Our findings show that miR-92a is elevated in conditions of obesity, and its reduction after BS correlates with metabolic improvement. Further studies would be necessary to establish miR-92a as serum biomarker and potential predictor of the BS success in improving the metabolic status of patients with obesity.

5.
Obes Surg ; 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31209830

RESUMO

INTRODUCTION/PURPOSE: The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. MATERIALS/METHODS: A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. RESULTS: A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. CONCLUSION: Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge.

6.
Clin Nutr ; 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30948220

RESUMO

BACKGROUND & AIMS: Peripheral white blood cells (PWBC) may allow for the development of obesity biomarkers. We aimed to investigate the existence of gene expression and DNA methylation changes in PWBC after a very low calorie diet (VLCD) followed by a laparoscopic sleeve gastrectomy (LSG), and its correlation with surgical outcomes. METHODS: From July 2013 to June 2014, 35 consecutive bariatric patients and 33 healthy lean volunteers were recruited. Molecular data was obtained once on the control group and at 3 different times on the LSG group: 1) at baseline; 2) after 2 weeks of VLCD, right before LSG; and 3) 6 months after LSG. The expression of 12 genes in PWBC was analyzed by quantitative real-time polymerase chain reaction: ghrelin (GHRL), visfatin (NAMPT), insulin receptor substrate 1 (IRS1), fat mass and obesity-related gene (FTO), leptin (LEP), peroxisome proliferator-activated receptor gamma (PPARG), adiponectin (ADIPOQ), fatty acid synthase (FASN), melanocortin 4 receptor (MC4R), fas cell surface death receptor (FAS), tumor necrosis factor alpha (TNF) and chemokine (C-C motif) ligand 2 (CCL2). Moreover, DNA methylation of GHRL, NAMPT and FAS promoters was analyzed in PWBC by bisulfite pyrosequencing. RESULTS: Seven genes (GHRL, NAMPT, IRS1, FTO, FAS, TNF and CCL2) had detectable expression in PWBC. FTO expression at baseline was lower in patients than in controls (p = 0.042), equalizing after LSG. In patients, FAS expression decreased after VLCD (p = 0.01) and stayed low after LSG (p = 0.015). Also, CCL2 expression decreased 50% after LSG compared to pre-surgical levels (p = 0.016). All studied CpG sites in the GHRL gene promoter followed a consistent pattern of DNA methylation/demethylation. No direct correlation between these molecular changes and surgical outcomes was found at 1-year follow-up. CONCLUSIONS: FTO expression increased and FAS and CCL2 expression decreased in PWBC after LSG. Molecular changes did not correlate with surgical outcomes.

7.
Sci Rep ; 9(1): 6274, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-31000783

RESUMO

We aimed to explore the relationship between GLP-1 receptor (GLP-1R) expression in adipose tissue (AT) and incretin secretion, glucose homeostasis and weight loss, in patients with morbid obesity and type 2 diabetes undergoing bariatric surgery. RNA was extracted from subcutaneous (SAT) and visceral (VAT) AT biopsies from 40 patients randomized to metabolic gastric bypass, sleeve gastrectomy or greater curvature plication. Biochemical parameters, fasting plasma insulin, glucagon and area under the curve (AUC) of GLP-1 following a standard meal test were determined before and 1 year after bariatric surgery. GLP-1R expression was higher in VAT than in SAT. GLP-1R expression in VAT correlated with weight (r = -0.453, p = 0.008), waist circumference (r = -0.494, p = 0.004), plasma insulin (r = -0.466, p = 0.007), and systolic blood pressure (BP) (r = -0.410, p = 0.018). At 1 year, GLP-1R expression in VAT was negatively associated with diastolic BP (r = -0.361, p = 0.039) and, following metabolic gastric bypass, with the increase of GLP-1 AUC, (R2 = 0.46, p = 0.038). Finally, GLP-1R in AT was similar independently of diabetes outcomes and was not associated with weight loss after surgery. Thus, GLP-1R expression in AT is of limited value to predict incretin response and does not play a role in metabolic outcomes after bariatric surgery.

9.
An. pediatr. (2003. Ed. impr.) ; 90(2): 79-85, feb. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-177218

RESUMO

Introducción: La prevalencia y la variabilidad de la práctica clínica en la bronquiolitis aguda la convierten en una candidata perfecta para evaluar la adecuación en el uso de recursos asistenciales. El objetivo de este estudio es comparar la utilización de recursos no recomendados para la atención de pacientes con bronquiolitis en el Servicio de Urgencias, antes y después de la instauración de un nuevo protocolo basado en las recomendaciones actuales. Métodos: Estudio retrospectivo de una muestra de pacientes diagnosticados de bronquiolitis aguda en el Servicio de Urgencias de un hospital terciario y seleccionados mediante aleatorización simple antes (diciembre de 2014) y después (diciembre de 2016) de la instauración de un nuevo protocolo. Se comparó el uso de pruebas diagnósticas y el tratamiento en ambos grupos. Resultados: Se han comparado 113 pacientes con bronquiolitis aguda atendidos en diciembre de 2014 y 128 en diciembre de 2016. Las características clínicas en ambos grupos eran similares. En el período posprotocolo se observó una disminución significativa en la utilización de salbutamol, tanto en el servicio de urgencias (33,6% vs 19,5%, p < 0,01) como al alta (46,7% vs 15,2%, p < 0,001); de adrenalina (12,4% vs 2,4%, p = 0,002) y de suero salino hipertónico nebulizado (5,3% vs 0,8%, p = 0,04). También disminuyó la solicitud de la prueba de detección rápida de VRS (40,7% vs 26,6%, p = 0,01). No se produjo un aumento en el número de ingresos o readmisiones en urgencias en las siguientes 72 horas. Conclusiones: la instauración de un nuevo protocolo de bronquiolitis aguda disminuyó la utilización de recursos no recomendados, principalmente el uso de broncodilatadores y de la prueba de detección rápida del VRS


Introduction: The prevalence and the variability of clinical practice in acute bronchiolitis make it a perfect candidate to monitor the proper use of resources. The aim of this study is to analyse the differences in the use of non-recommended resources in the management of bronchiolitis in the Emergency Department, before and after the establishment of a new protocol. Methods: A retrospective study was conducted on a sample of patients diagnosed with acute bronchiolitis in the Emergency Department of a tertiary hospital, before (December 2014) and after (December 2016) the implementation of a new protocol. A comparison was made on the use of diagnostic tests and treatments in both groups. Results: The analysis included a total of 113 patients with acute bronchiolitis examined in December 2014, and 128 patients in December 2016. The clinical characteristics in both groups were similar. In the post-protocol period, there was a significant decrease in the use of salbutamol, both in the Emergency Department (33.6% vs 19.5%, P < .01) and at discharge (46.7% vs 15.2%, P < .001); adrenaline (12.4% vs 2.4%, P = .002), and nebulised hypertonic saline solution (5.3% vs 0.8%, P = .04). Rapid respiratory syncytial virus (RSV) testing was also decreased (40.7% vs 26.6%, P = .01). This decrease was not associated with an increase in the number of admissions or re-assessments in the Emergency Department. Conclusions: The establishment of a new protocol for acute bronchiolitis decreased the use of non-recommended resources, mainly the use of bronchodilators and rapid RSV testing


Assuntos
Humanos , Pré-Escolar , Bronquiolite/diagnóstico , Protocolos/métodos , Bronquiolite/terapia , Broncodilatadores/uso terapêutico , Fatores de Risco , Oxigenoterapia/métodos , Estudos Retrospectivos
10.
Obes Surg ; 2018 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-30397876

RESUMO

CONTEXT: Information concerning the risk-benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery. METHODS: This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain. RESULTS: Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m2). All but one patient belonged to Child-Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation. CONCLUSIONS: Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis. TRIAL REGISTRATION: Controlledtrials.com Identifier: 10.1186/ISRCTN15009106.

11.
An Pediatr (Barc) ; 2018 Apr 20.
Artigo em Espanhol | MEDLINE | ID: mdl-29685831

RESUMO

INTRODUCTION: The prevalence and the variability of clinical practice in acute bronchiolitis make it a perfect candidate to monitor the proper use of resources. The aim of this study is to analyse the differences in the use of non-recommended resources in the management of bronchiolitis in the Emergency Department, before and after the establishment of a new protocol. METHODS: A retrospective study was conducted on a sample of patients diagnosed with acute bronchiolitis in the Emergency Department of a tertiary hospital, before (December 2014) and after (December 2016) the implementation of a new protocol. A comparison was made on the use of diagnostic tests and treatments in both groups. RESULTS: The analysis included a total of 113 patients with acute bronchiolitis examined in December 2014, and 128 patients in December 2016. The clinical characteristics in both groups were similar. In the post-protocol period, there was a significant decrease in the use of salbutamol, both in the Emergency Department (33.6% vs 19.5%, P<.01) and at discharge (46.7% vs 15.2%, P<.001); adrenaline (12.4% vs 2.4%, P=.002), and nebulised hypertonic saline solution (5.3% vs 0.8%, P=.04). Rapid respiratory syncytial virus (RSV) testing was also decreased (40.7% vs 26.6%, P=.01). This decrease was not associated with an increase in the number of admissions or re-assessments in the Emergency Department. CONCLUSIONS: The establishment of a new protocol for acute bronchiolitis decreased the use of non-recommended resources, mainly the use of bronchodilators and rapid RSV testing.

13.
Obes Surg ; 27(7): 1674-1682, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28161887

RESUMO

BACKGROUND: Nutritional deficiencies are common after bariatric surgery, but data are scarce after sleeve gastrectomy (SG) at long term. METHODS: We performed a prospective nutritional status evaluation before and at 2 and 5 years after SG in morbid obese patients receiving mulvitamin and mineral supplementation at a Spanish university hospital. One hundred seventy-six patients (49.3 ± 9.1 years and 46.7 ± 7.4 kg/m2) were evaluated; 51 of them were followed during 5 years. Anthropometric, compliance supplementation intake, and micronutrient evaluation were performed. RESULTS: Baseline concentrations were below normal values for 25(OH) vitamin D (73%), folic acid (16.5%), cobalamin (6.9%), pyridoxine (12%), thiamine (3.4%), and copper (0.5%). Anemia was found in 23%. In 49% of the subjects, at least one micronutrient deficiency was found at 2 years after SG. Vitamin D deficiency persisted at 2 and 5 years higher than 30% of patients. Frequencies of deficiencies for folic acid, B12, B6, and B1 vitamins decreased significantly after 2 years with normalization at 5 years. Copper deficiency increased between 1 and 2 years and it persisted at 5 years after SG. Vitamin supplementation compliance decreased progressively from the first year after surgery (94.8 to 81% at 2 years and to 53% 5 years after surgery). CONCLUSIONS: Vitamin D deficiency is the most prevalent long-term nutritional deficiency after SG. About half of patients show some micronutrient deficiency at medium long term, despite supplementation. A proactive follow-up is required to ensure a personalized and adequate supplementation in all surgically treated obese patients including those in which SG has been performed.


Assuntos
Gastrectomia/efeitos adversos , Desnutrição/diagnóstico , Obesidade Mórbida/cirurgia , Oligoelementos/sangue , Oligoelementos/deficiência , Vitaminas/sangue , Adulto , Anemia/sangue , Anemia/diagnóstico , Suplementos Nutricionais , Feminino , Humanos , Masculino , Desnutrição/etiologia , Micronutrientes/sangue , Micronutrientes/deficiência , Pessoa de Meia-Idade , Estado Nutricional , Obesidade Mórbida/sangue , Estudos Prospectivos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/etiologia
14.
Obes Facts ; 9(1): 41-51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26901345

RESUMO

BACKGROUND: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. METHODS: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. RESULTS: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases. CONCLUSIONS: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Hiperinsulinismo/etiologia , Hipoglicemia/etiologia , Adulto , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperinsulinismo/sangue , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Hipoglicemia/terapia , Incidência , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Nesidioblastose/complicações , Nesidioblastose/diagnóstico , Nesidioblastose/epidemiologia , Octreotida/uso terapêutico , Pancreatectomia , Sistema de Registros , Estudos Retrospectivos , Espanha/epidemiologia , Estômago/cirurgia
15.
Obes Surg ; 26(8): 1836-42, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26661106

RESUMO

BACKGROUND: Specific data is needed to safely expand bariatric surgery and to preserve good surgical outcomes in response to the non-stop increase in obesity prevalence worldwide. OBJECTIVE: The aims of this study are to provide an overview of the baseline characteristics, type of surgery, and 30-day postoperative morbidity and mortality in patients undergoing bariatric surgery in Spanish public hospitals, and evaluate changes throughout the 2000-2014 period. MATERIAL AND METHODS: This is a descriptive study using data from the RICIBA, a computerized multicenter and multidisciplinary registry created by the Obesity Group of the Endocrinology and Nutrition Spanish Society. Three periods according to the date of surgery were created: January 2000 to December 2004 (G1), January 2005 to December 2009 (G2), and January 2010 to December 2014 (G3). RESULTS: Data from 3843 patients were available (44.8 ± 10.5 years, a 3:1 female-to-male ratio, 46.9 ± 8.2 kg/m(2)). Throughout the 15-year period assessed, candidate patients for bariatric surgery were progressively older and less obese, with an increase in associated comorbidities and in the prevalence of men. The global trend also showed a progressive decrease in Roux-en-Y gastric bypass, the most performed bariatric procedure (75.1 % in G1, 69.3 % in G2, and 42.6 % in G3; p < 0.001), associated with a parallel increase in sleeve gastrectomy (0.8 % in G1, 18.1 % in G2, and 39.6 % in G3; p < 0.001). An overall mortality rate of 0.3 % was reported. CONCLUSIONS: Data from Spain is similar to data observed worldwide. Information recorded in the National Registries like RICIBA is necessary in order to safely expand bariatric surgery in response to increasing demand.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/tendências , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/mortalidade , Período Pós-Operatório , Prevalência , Sistema de Registros , Espanha/epidemiologia
16.
Cardiovasc Diabetol ; 14: 121, 2015 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-26382922

RESUMO

BACKGROUND: The glycoprotein YKL-40 is a new marker of early inflammation and endothelial dysfunction. Adiponectin is a collagen-like protein with anti-atherogenic and anti-inflammatory effects. Increased concentrations of both markers have been reported in patients with type 1 diabetes (T1D). AIM: To assess the possible role of YKL-40 and adiponectin as a marker of subclinical cardiovascular disease in asymptomatic patients with type 1 diabetes with no history of ischemic or macrovascular heart disease and its relationship with other classic inflammatory biomarkers. METHODS: Concentrations of YKL-40, adiponectin, IL-6, IL-1ß, TNF-α, hsCRP and homocysteine were determined in 150 T1D patients (58% men, age: 38.6 ± 8.1 years, 20.4 ± 8.1 years of evolution, BMI: 25.1 ± 3.6 kg/m(2); HbA1c 8.1 ± 2.3%, 4% smokers; 26% retinopathy, microalbuminuria 9%) and 50 controls age, sex and smoke condition matched. Subclinical atherosclerosis was assessed by a carotid ultrasonography and a computed tomography for evaluation of calcium artery calcification score (CACS). RESULTS: 82% of T1D patients and 92% of controls had a calcium score of 0. T1D patients showed a significantly higher mean common carotid artery intima media thickness (CIMT) compared to controls (0.55 ± 0.14 vs 0.48 ± 0.14 mm, p = 0.01). Concentrations of YKL-40 and adiponectin were significantly higher in T1D [42.6 (10.4-195.0) vs ±28.7 (11.0-51.2) ng/ml, p = 0.001 and 15.8 ± 9.1 vs. 12.4 ± 5.3 mg/ml, p = 0.008], with no differences when compared to other inflammatory parameters. In T1D patients no association was found between YKL-40 and adiponectin and screening test for subclinical arterial disease (neither CACS nor CIMT). A positive correlation was found between levels of YKL-40 and age and duration of disease (r = 0.28, p = 0.003; r = 0.35, p = 0.001). There were no differences in the YKL-40 in relation to the presence or absence of retinopathy or nephropathy. Levels of adiponectin were higher in patients with nephropathy (21.84 ± 8.15 vs. 14.88 ± 8.27 mg/ml, p = 0.008). CONCLUSIONS: Type 1 diabetes patients from a Mediterranean area with a longer disease evolution, although a lower degree of subclinical disease, showed significatively higher concentrations of YKL-40 and adiponectin compared with the controls. Therefore, we conclude that YKL-40 and adiponectin are early inflammatory markers in diabetic subjects even in the presence of a low atherosclerotic background.


Assuntos
Adipocinas/sangue , Adiponectina/sangue , Doenças das Artérias Carótidas/sangue , Doença da Artéria Coronariana/sangue , Diabetes Mellitus Tipo 1/sangue , Mediadores da Inflamação/sangue , Lectinas/sangue , Calcificação Vascular/sangue , Adulto , Idoso , Doenças Assintomáticas , Biomarcadores/sangue , Doenças das Artérias Carótidas/diagnóstico , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Proteína 1 Semelhante à Quitinase-3 , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Diabetes Mellitus Tipo 1/diagnóstico , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Espanha , Fatores de Tempo , Tomografia Computadorizada por Raios X , Regulação para Cima , Calcificação Vascular/diagnóstico
17.
Med. clín (Ed. impr.) ; 144(12): 560-565, jun. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-141033

RESUMO

La creciente prevalencia de obesidad y de diabetes mellitus tipo 2 (DM2) comporta un interés ascendente en la investigación de nuevos procedimientos. El tratamiento de la DM2 se ha centrado hasta ahora en compensar la insulinopenia y la resistencia a la insulina. Sin embargo, en los últimos 10 años se han abierto nuevas líneas de investigación en el tratamiento de la DM2, cuyos estudios en fase preclínica parecen prometedores. La posibilidad de usar estos fármacos de forma combinada con los disponibles hasta ahora (sensibilizadores a la insulina o insulinotropos) permitirá potenciar el efecto antidiabético y favorecer la reducción ponderal con menos efectos secundarios. El seguimiento poscomercialización nos ayudará a conocer mejor su perfil de seguridad y sus potenciales efectos sobre las lesiones de los órganos diana (AU)


The increasing prevalence of obesity and type 2 diabetes mellitus (T2DM) has led to a growing interest in the investigation of new therapies. Treatment of T2DM has focused on the insulinopenia and insulin resistance. However, in the last 10 years, new lines of research have emerged for the treatment of T2DM and preclinical studies appear promising. The possibility of using these drugs in combination with other currently available drugs will enhance the antidiabetic effect and promote weight loss with fewer side effects. The data provided by post-marketing monitoring will help us to better understand their safety profile and potential long-term effects on target organs, especially the cardiovascular risk (AU)


Assuntos
Feminino , Humanos , Masculino , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/metabolismo , Terapêutica/métodos , Terapêutica/enfermagem , Insulina/administração & dosagem , Insulina/sangue , Pesquisa Biomédica/métodos , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/patologia , Terapêutica/instrumentação , Terapêutica/normas , Insulina , Insulina/metabolismo , Pesquisa Biomédica
18.
Am J Surg ; 210(2): 340-4, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25701890

RESUMO

BACKGROUND: Predictors of weight loss (WL) or weight regain (WR) after Roux-en-Y gastric bypass (RYGBP) are not established. The aim of this study was to analyze the usefulness of some baseline peptides (leptin, insulin, and ghrelin) as biomarkers of WL and WR in morbid obese patients after RYGBP at long term. METHODS: Seventy-six morbid obese (47 women, age 41.6 ± 9.6 years, body mass index [BMI] 52.1 ± 8 kg/m(2)) patients were evaluated at baseline and at 1, 2, and 6 years after surgery. RESULTS: Excess body weight loss after 6 years was of 63.9%. Age, BMI, and studied hormones at baseline or their changes over time did not predict long-term excess body weight loss. WR greater than 10% was observed in 36.8% of patients between 2 and 6 years of follow-up, but it was not correlated with BMI, age, or baseline peptide concentrations. CONCLUSION: Measurement of ghrelin, insulin, and leptin before surgery is not useful as predictors of WL or WR at long term after RYGBP.


Assuntos
Derivação Gástrica , Grelina/sangue , Insulina/sangue , Leptina/sangue , Obesidade Mórbida/cirurgia , Ganho de Peso , Perda de Peso , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Recidiva , Fatores de Tempo
19.
Acta Diabetol ; 52(4): 773-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25572333

RESUMO

AIMS: Several studies linked vitamin D deficiency with coronary artery disease (CAD). The aim of this study was to evaluate the relationship between the concentrations of 25-hydroxyvitamin D (25OHD) and the presence of early atherosclerosis in asymptomatic Type 1 Diabetes (T1D) patients with no previous history of ischemic heart disease. METHODS: One hundred and forty-five patients with T1D (age 37.8 ± 8 years, 57 % male, all Caucasian, disease duration 20.6 ± 8.3 years, HbA1c 7.6 ± 1.4 % (60.2 ± 11.1 mmol/mol), body mass index (BMI) 25.2 ± 3.5 kg/m2, 52.4 % smokers, 23 % retinopathy, 10 % nephropathy) and 48 controls matched for age, sex, BMI and smoking habit were studied. 25OHD deficiency was defined for values ≤20 ng/mL. A sun exposure questionnaire, carotid ultrasonography to determine carotid intima-media thickness (CIMT) and the presence of atheroma plaques and cardiac computed tomography for evaluation of calcium artery calcification (CACS) were performed. RESULTS: T1D subjects showed a high proportion of 25OHD deficiency (43.2 % vs. 21.7 %, p = 0.032). Of all, 82 % of T1D patients and 92 % of controls had a calcium score of 0. CIMT was greater in patients with T1D (0.55 ± 0.14 mm vs 0.48 ± 0.15, p = 0.01) compared with controls. T1D subjects showed no differences in the results of CACS or CIMT according to the vitamin D concentrations. CONCLUSIONS: T1D patients have lower concentrations and twice more prevalence of 25OHD deficiency than controls. There was no association between 25OHD concentrations and subclinical CAD.


Assuntos
Aterosclerose/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Doenças Assintomáticas , Aterosclerose/complicações , Índice de Massa Corporal , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Masculino , Região do Mediterrâneo/epidemiologia , Pessoa de Meia-Idade , Prevalência , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/complicações
20.
Med Clin (Barc) ; 144(12): 560-5, 2015 Jun 22.
Artigo em Espanhol | MEDLINE | ID: mdl-25194974

RESUMO

The increasing prevalence of obesity and type 2 diabetes mellitus (T2DM) has led to a growing interest in the investigation of new therapies. Treatment of T2DM has focused on the insulinopenia and insulin resistance. However, in the last 10 years, new lines of research have emerged for the treatment of T2DM and preclinical studies appear promising. The possibility of using these drugs in combination with other currently available drugs will enhance the antidiabetic effect and promote weight loss with fewer side effects. The data provided by post-marketing monitoring will help us to better understand their safety profile and potential long-term effects on target organs, especially the cardiovascular risk.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Terapia de Alvo Molecular , 11-beta-Hidroxiesteroide Desidrogenase Tipo 1/antagonistas & inibidores , Fármacos Antiobesidade/efeitos adversos , Fármacos Antiobesidade/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Diacilglicerol O-Aciltransferase/antagonistas & inibidores , Dipeptidil Peptidase 4/efeitos dos fármacos , Quimioterapia Combinada , Drogas em Investigação/efeitos adversos , Drogas em Investigação/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Glucagon/agonistas , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Glucoquinase/efeitos dos fármacos , Gluconeogênese/efeitos dos fármacos , Glucose/farmacocinética , Humanos , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/classificação , Hipoglicemiantes/farmacologia , Incretinas , Resistência à Insulina , Insulina de Ação Prolongada/uso terapêutico , Obesidade/complicações , Obesidade/tratamento farmacológico , Fosfofrutoquinase-2/antagonistas & inibidores , Proteínas de Transporte de Sódio-Glucose/antagonistas & inibidores , Perda de Peso
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