Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?

We are entering a new era in the management of adiposity-based chronic disease (ABCD) with type 2 diabetes (T2D) and related chronic kidney disease (CKD). ABCD, T2D and CKD can affect almost every major organ system and have a particularly strong impact on the incidence of cardiovascular disease (CVD) and heart failure. ABCD and the associated insulin resistance are at the root of many cardiovascular, renal and metabolic (CKM) disorders, thus an integrated therapeutic framework using weight loss (WL) as a disease-modifying intervention could simplify the therapeutic approach at different stages across the lifespan. The breakthrough of highly effective WL drugs makes achieving a WL of >10% possible, which is required for a potential T2D disease remission as well as for prevention of microvascular disease, CKD, CVD events and overall mortality. The aim of this review is to discuss the link between adiposity and CKM conditions as well as placing weight management at the centre of the holistic CKM syndrome approach with a focus on CKD. We propose the clinical translation of the available evidence into a transformative Dysfunctional Adipose Tissue Approach (DATA) for people living with ABCD, T2D and CKD. This model is based on the interplay of four essential elements (i.e. adipocentric approach and target organ protection, dysfunctional adiposity, glucose homeostasis, and lifestyle intervention and de-prescription) together with a multidisciplinary person-centred care. DATA could facilitate decision-making for all clinicians involved in the management of these individuals, and if we do this in a multidisciplinary way, we are prepared to meet the adipocentric challenge.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. / Antecedentes de comportamientos autolesivos y autolíticos en población adolescente y adulta joven transexual, atendida en una unidad especializada en identidad de género en España.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Spanish population trends in Internet searches for information on different diets. / Tendencia de la población española de búsqueda en internet sobre información relacionada con diferentes dietas.

OBJECTIVE: To use Google Trends to explore the trends of interest of the Spanish population regarding information related to different types of diets, focused on those that are popular and with evidence-based studies, over the last 10years. MATERIAL AND METHODS: The search trends referred to the terms «Mediterranean diet¼, «ketogenic diet¼, «low fat diet¼, «intermittent fasting¼ and «vegan diet¼ were analyzed. The relative search volumes (RSV) of the terms were compared. The direction of the trend was studied using the Spearman's correlation coefficient (SC). RESULTS: «Mediterranean diet¼ was the most widely searched term, with a median RSV of 16 (interquartile range [IQR] 6; range 8-100), though it exhibited a decreasing chronological trend (SC=-0.216). It was followed by «ketogenic diet¼, with an RSV of 8 (IQR 9; range 1-57); «vegan diet¼, with an RSV of 4 (IQR 5; range 0-16); «intermittent fasting¼, with an RSV of 2 (IQR 5; range 0-27), and «low fat diet¼, with an RSV of 1.16 (IQR 0; range 0-2). The term with the best correlation over time was «intermittent fasting¼ (SC=0.96), followed by «ketogenic diet¼ (SC=0.91) and «vegan diet¼ (SC=0.85). CONCLUSIONS: In Spain, the interest of the population in information about the Mediterranean diet is greater than for other diets. However, in recent years there has been a progressive increase in interest (measured as RSV) in other diets such as the ketogenic diet, vegan diet or intermittent fasting, and there has been a decrease in interest in the Mediterranean diet. The low fat diet does not generate interest in the Spanish population.