[SEEDO 2007 Consensus for the evaluation of overweight and obesity and the establishment of therapeutic intervention criteria]

Plasma vitamin D and parathormone are associated with obesity and atherogenic dyslipidemia: a cross-sectional study

BACKGROUND

Low concentrations of plasma vitamin D (25(OH)D) have been associated with the development of metabolic syndrome (MetS), obesity, diabetes and cardiovascular disease. The objective of this study was to quantify the associations between 25(OH)D and parathormone (PTH) plasma levels and obesity, the presence of MetS, diabetes or atherogenic dyslipidemia (AD) in a large sample of individuals with different degrees of adiposity.

METHODS

Retrospective study of all patients who had attended the obesity clinics in a Spanish hospital between 2009 and 2011, and whose concentrations of PTH, 25(OH)D, calcium and alkaline phosphatase had been determined (n=316, 75.9% women). Individuals were categorized by degree of adiposity, presence of MetS, and other comorbidities.

RESULTS

PTH increased but 25(OH)D and calcium decreased with increasing adiposity. The prevalence of 25(OH)D deficiency or insufficiency increased with obesity (<10% when BMI<45kg/m(2), and 26% when >50). The prevalence of hyperparathyroidism increased from 12% in non-obese to 47.5% in morbidly obese individuals with BMI>50 kg/m2. Low plasma 25(OH)D and high PTH concentrations were associated with an increased risk of MetS and AD. These associations disappeared, except in the case of AD for 25(OH)D when adjusting for BMI. Regression analysis revealed that BMI and age or seasonality were independent predictors of PTH and 25(OH)D levels, respectively.

CONCLUSIONS

BMI was the variable most strongly associated with plasma 25(OH)D and PTH concentrations in our study. Low 25(OH)D and high PTH concentrations were not independently associated with an increased risk of MetS, or diabetes. Our data support a possible contribution of plasma 25(OH)D to the pathogenesis of hypertriglyceridemia and AD through inflammation.

The usefulness of densitometry as a method of assessing the nutritional status of athletes. Comparison with body mass index

The body mass index (BMI) is used to assess nutritional status. The result in athletes may be overestimated due to increase in muscle mass.

OBJECTIVE

To assess the usefulness of fat mass index (FMI) and lean mass index (LMI) determination as indicators of nutritional status and to compare the results with BMI.

MATERIAL AND METHODS

We studied 28 amateur rugby players, male. After being subjected to whole body densitometry by dual X-ray absorptiometry, we determined fat and lean body mass together with other parameters. FMI (fat in kg/height in meters(2)), LMI (lean in kg/height in meters(2)) and appendicular muscle mass index (AMMI, arms and legs musculature in kg/height in meters(2)) were calculated.

RESULTS

Using BMI, 18 players were overweight and 4 obese type I. Considering FMI, 7 of them had normal values and high LMI and AMMI, one of them changed from overweight to obese and another one from obese to overweight. Of the 6 players with normal BMI, one of them showed fat excess and another one fat defect. The results changed the assessment of nutritional status in 39% of players.

CONCLUSIONS

Although BMI is an appropriate parameter in general population for the assessment of nutritional status, in athletes should be taken into account fat and muscle body percentage and their corresponding indexes. The whole body densitometry appears to be a simple and reliable technique for this purpose.

Differential effect of oral dehydroepiandrosterone-sulphate on metabolic syndrome features in pre- and postmenopausal obese women

OBJECTIVE

To analyze the effect in obese pre- and postmenopausal women of a daily dose of 100 mg dehydroepiandrosterone-sulphate (DHEA-S) provided over a period of 3 months as replacement therapy against metabolic syndrome.

CONTEXT

Although DHEA-S appears to be effective against certain features of metabolic syndrome, its usefulness against this syndrome as a whole has not been evaluated to date.

DESIGN/PATIENTS

A randomized, double-blind placebo-controlled trial was conducted involving 61 postmenopausal women, who received DHEA-S (n = 41) or placebo (n = 20) for 3 months. The effect of DHEA-S treatment on the same postmenopausal women was compared with the effects observed in a group of premenopausal women (n = 20).

MEASUREMENTS

Anthropometric measurements were taken at the beginning and at the end of the treatment. Similarly, different parameters that define metabolic syndrome and other cardiometabolic variables were determined.

RESULTS

Dehydroepiandrosterone-sulphate replacement produced weight loss in the obese women studied. Moreover, waist circumference, glucose and systolic and diastolic blood pressure, among other metabolic syndrome parameters, improved in the postmenopausal group, who showed a significant reduction in the total metabolic syndrome score (P < 0·05). In contrast, in premenopausal women, the effect of DHEA-S was limited to obesity parameters, and no effect was observed on metabolic syndrome components. No significant changes were evident in the placebo group.

CONCLUSIONS

An oral dose of DHEA-S is useful for weight loss. In obese postmenopausal women, the hormone significantly improves plasma biochemical levels and anthropometric characteristics, leading to a better metabolic profile, which highlights the usefulness of this therapy against metabolic syndrome in this group of women.

[Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation]

OBJECTIVE

To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway.

DESIGN

A prospective, observational cohort study was carried out.

INTERVENTION

Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process.

SETTING

A polyvalent ICU.

PATIENTS

We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ).

VARIABLES OF INTEREST

ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period.

RESULTS

ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04).

CONCLUSIONS

The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.

[FESNAD-SEEDO consensus summary: evidence-based nutritional recommendations for the prevention and treatment of overweight and obesity in adults]

This paper is a summary of the Spanish Federation of Nutrition, Food and Dietetics Associations (FESNAD) and the Spanish Association for the Study of Obesity (SEEDO) consensus document on the role of diet in prevention and treatment of overweight and obesity. To prepare this document, and in order to achieve the maximum evidence level possible, a systematic review was made of all medical literature published between January 1, 1996 and January 31, 2011 (15 years). The obtained findings were catalogued by evidence level following the Scottish Intercollegiate Guidelines Network system, and recommendations were produced based on data collected. As a result, 65 evidences and 31 recommendations applicable to obese adults without any other pathological process were produced. Evidences and resulting recommendations are provided, and the most significant findings are discussed. This consensus document is intended to provide healthcare professionals with a reference tool that may help them design dietary strategies for prevention and treatment of overweight and obesity.

Dietary habits of patients with schizophrenia: a self-reported questionnaire survey

The present study was carried out to determine the dietary habits of patients with schizophrenia and the influence of these habits on the degree of obesity. The study was developed in a sample of 159 patients, who were given a self-reported questionnaire, to ascertain the influence of socio-familiar aspects, pharmacological treatment, and dietary habits. Anthropometric measurements (body mass index (BMI) and waist circumference (WC)) were also taken. Patients with schizophrenia presented unhealthy dietary habits, as indicated by the finding that 51% of the patients took no longer than 15 min to eat, 40.8% did not eat fruit daily, and 63.1% did not eat fish. Women were three times more likely to be obese than men (odds ratio (OR) = 2.91, P = 0.021). Patients classified as having unhealthy dietary habits have a 2.33-fold higher risk of obesity than patients with good dietary habits (OR = 2.33, P = 0.034). In summary, this paper highlights the fact that patients with schizophrenia have a detrimental dietary pattern that is associated with an increase in BMI and WC, with the consequent development of obesity and related metabolic alterations, regardless of the pharmacological treatment being followed. Future research directions will include exploring the need for nutritional education programmes to improve the dietary habits of such patients.

Effect of weight loss on C3 and C4 components of complement in obese patients

BACKGROUND

Circulating C3 levels are elevated in obese patients, but how this factor is affected after weight loss through diet is a question that is yet unanswered. Therefore, the aim of this study was to evaluate the effects of weight loss on lipid and hydrocarbonated metabolism parameters and on the levels of C3 and C4 components of complement in obese patients.

DESIGN

This is a longitudinal intervention study based on a 6-week very low-calorie diet (VLCD), a liquid formula of 603 kcal/day. A total of 131 middle-aged patients were distributed among grades II, III and IV of obesity. Anthropometric parameters, total cholesterol, triglycerides, high-density lipoprotein cholesterol, LDLc, apolipoproteins A-I and B-100, glucose, insulin, HOMA-IR and C3 and C4 levels were evaluated at baseline and after 6 weeks of intervention.

RESULTS

After VLCD, the moderate weight loss was accompanied by a significant reduction in C3 levels in grade III and grade IV patients (10.2% and 15.4%, respectively; P < 0.001). C4 levels were not altered. Adherence to the diet improved anthropometric parameters and was accompanied by a significant decrease in all lipid profile parameters (P < 0.001). In addition, weight loss was associated with an improvement in hydrocarbonated metabolism as shown by the decrease in glucose levels and HOMA-IR (P < 0.01).

CONCLUSIONS

Our findings show that in severely obese patients following a VLCD for 6 weeks produces reductions in factor C3, a biomarker of cardiovascular disease, and a significant improvement in some features of metabolic syndrome. In this way, the abovementioned diet may represent an effective strategy for treating obesity and related cardiovascular risk factors.

Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population

BACKGROUND

The prevalence of obesity in Spain is on the rise with the consequent increase in bariatric surgery. Studies in non-Mediterranean populations have shown that micronutrient deficits are present before surgery. However, there is no data on this topic in a Spanish population.

METHODS

We evaluated food intake and the prevalence of nutritional deficiencies in 231 obese patient (72.3% women, 45.6 ± 9.9 years, BMI 48.2 ± 7.8 kg/m(2)) candidates for bariatric surgery. Forty-six normal weight individuals with similar demographic variables except BMI were included for comparison of deficiencies.

RESULTS

In obese subjects, the mean estimated energy intake was 2,584 ± 987 kcal/day in males and 2,094 ± 669 kcal/day in females (p < 0.05). After adjusting for kilocalorie intake, carbohydrate intake was of 38.7% [CI 36.2 to 41.1] and 39.9% [CI 37.8 to 40.8] (n.s.), lipid intake was 41.9% [CI 39.6 to 44.2] and 43.0% [CI 41.7 to 44.8] (n.s.) and protein intake was 19.1% [CI 17.7 to 20.5] and 17.3% [CI 16.4 to 18.1] (n.s.) for men and women, respectively. The most prevalent deficiency was vitamin D25(OH): obese 94%, control 24%; (p < 0.0001). Above normal PTH levels were observed in 41.0% and 20.0% of obese and normal weight subjects, respectively (p < 0.0497). Increased prevalence of deficiencies in obese patients included magnesium, vitamin B6 and anaemia (p < 0.05). Other vitamin deficiencies were observed although did not reach statistical significance.

CONCLUSIONS

Nutritional deficiencies are commonly found in the Spanish obese population undergoing bariatric surgery and are significantly more prevalent than in normal weight individuals.

Abdominal obesity vs general obesity for identifying arterial stiffness, subclinical atherosclerosis and wave reflection in healthy, diabetics and hypertensive

Background

Our aim was to analyze the relationship between abdominal obesity and general obesity, with subclinical atherosclerosis, arterial stiffness and wave reflection in healthy, diabetics and hypertensive subjects.

Methods

A cross-sectional descriptive study was made of 305 individuals (diabetics 32.8%, hypertensive subjects 37.0% and healthy individuals 30.2%). Measurements: Body mass index (BMI), waist circumference (WC), body fat percentage (BFP) and waist/height ratio (WHtR). Arterial stiffness was assessed according to pulse wave velocity (PWV), intima-media thickness of the common carotid artery (C-IMT), augmentation index (central and peripheral), ankle-brachial index (ABI), and central and peripheral pulse pressure.

Results

WC and WHtR showed a positive correlation to PWV and C-IMT in the studied groups. After adjusting for age, gender, high sensitivity c-reactive protein, serum glucose and the presence of diabetes, hypertension, smoking, dyslipidemia, antidiabetic drugs, lipid-lowering drugs, and atherosclerotic plaques, it was seen that for every 0.1 point increase in WHtR, and for every cm increase in WC, the PWV increased 0.041 and 0.029 m/sec, and C-IMT increased 0.001 mm and 0.001 mm, respectively.

Conclusions

The measures of abdominal obesity (WHtR and WC) correlates better than BMI and BFP with arterial stiffness evaluated by PWV, and with subclinical atherosclerosis evaluated by C-IMT, independently of the presence of diabetes or hypertension.

Trial Registration

Clinical Trials.gov Identifier: NCT01325064

Evaluation of the usefulness of a low-calorie diet with or without bread in the treatment of overweight/obesity

BACKGROUND & AIMS

Despite the lack of scientific evidence, bread is one of the most restricted foods in popular hypocaloric diets. The aim of this study was to compare two nutrition strategies (with or without bread) designed to promote weight loss in overweight/obese women.

METHODS

A clinical, prospective and randomised study in which 122 women >18 years, BMI ≥ 25 < 40 kg/m(2) were divided into two groups: intervention group (BREAD, n = 61) and control group (NO BREAD, n = 61). Both groups received a low-calorie diet (with or without bread), nutrition education and physical activity guidelines, and were monitored for 16 weeks.

RESULTS

104 women completed the study (48.4 ± 9 years, 29.8 ± 3.5 kg/m(2)). Anthropometric and biochemical markers improved after the intervention without significant differences between groups. BREAD group significantly increased total cereal consumption (3.2 ± 1.3 to 3.7 ± 0.5 servings/day, P < 0.05) and the percentage of energy from carbohydrates (41.2 ± 6.4 vs. 45.9 ± 5.0% P < 0.001) and reduced fat (39.0 ± 6.6 vs. 32.7 ± 5.1% P < 0.001). In contrast, NO BREAD group increased the discrepancy with recommended consumption. NO BREAD group had the most dropouts (21.3% vs. 6.6%, P < 0.05).

CONCLUSION

The bread inclusion in a low-calorie diet designed for weight loss favoured a better evolution of dietetic parameters and greater compliance with the diet with fewer dropouts. Registered under ClinicalTrials.gov Identifier no. NCT01223989.

Sexual dimorphism in clock genes expression in human adipose tissue

BACKGROUND

This study was carried out to investigate whether sex-related differences exist in the adipocyte expression of clock genes from subcutaneous abdominal and visceral fat depots in severely obese patients.

METHODS

We investigated 16 morbidly obese patients, eight men and eight women (mean age 45 ± 20 years; mean BMI 46 ± 6 kg/m(2)), undergoing laparoscopic gastric bypass surgery. Biopsies were taken as paired samples [subcutaneous and visceral adipose tissue (AT)] at the beginning of the surgical process at 11:00 h in the morning. Metabolic syndrome features such as waist circumference, plasma glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were also studied. The expression of clock genes (PER2, BMAL1, and CRY1) was measured by quantitative real-time PCR, Western blot, and immunohistochemical analysis.

RESULTS

Gene expression was significantly higher in women than in men for the three genes studied in both ATs (P < 0.05). In visceral fat, these differences were more marked. (P < 0.001). Western blot analysis partially confirmed these results since statistical differences were observed for PER2 in both ATs and for CRY1 in subcutaneous adipose tissue. There were no differences in BMAL1 protein expression. Interestingly, clock gene expression level was correlated with LDL-C and HDL-C (P < 0.05). Moreover, we found significant associations with body fat mass in women and with age in men.

CONCLUSIONS

Clock genes expression is sex dependent in human adipose tissue from morbidly obese subjects and correlates to a decreased in metabolic syndrome-related traits. These preliminary results make necessary to go deep into the knowledge of the molecular basis of the sexual dimorphism in chronobiology.

Dehydroepiandrosterone-sulphate replacement improves the human plasma fatty acid profile in plasma of obese women

DHEA-S treatment is used as an anti-aging and anti-obesity hormone therapy in adults; however, it mechanisms of action are not clearly elucidated. The objective of the present work was to analyze the effect of a replacement therapy, which included a daily single oral dose of DHEA-S for three months, on the composition of human plasma fatty acids (FAs) in obese women. In the first study, a randomized, double-blind, placebo-controlled trial was conducted involving 61 postmenopausal women, who were assigned to receive 100mg/day of DHEA-S (n = 41) or placebo (n = 20) orally for 3 months. In a second study, the effect of DHEA-S treatment on postmenopausal obese women (n = 41) was compared to that in premenopausal obese women (n = 20). Blood samples were collected at the beginning and at the end of the treatment. Plasma FAs were analyzed by gas chromatography. DHEA-S treatment produced significant changes in plasma FAs of both post- and premenopausal women with a reduction of total saturated FAs (SFA) as well as an increase in n-6 polyunsaturated FA (PUFA). Particularly, in premenopausal women the DHEA-S treatment also increased the plasma n-3 PUFA percentage. Regarding estimation of desaturase activity, our data showed that Δ6-desaturase was significantly decreased in postmenopausal women after DHEA-S treatment, whereas Δ5-desaturase was increased in the premenopausal group. In conclusion, DHEA-S treatment in obese women modifies plasma FA composition towards a potentially better metabolic profile, mainly by decreasing SFA and increasing n-6 PUFA in both postmenopausal and premenopausal women.

[Cardiovascular risk factors and Primary Care: evaluation and intervention]

There is high prevalence of major cardiovascular risk factors (MCVRF) in Spain, equal or greater than the rest of the countries in Europe, with a tendency to increase, while the their control is in general sub-optimal. In the clinical setting, and in Primary Care clinics in particular, preventive activities and early detection (screening) of MCVRF that are well established by the scientific evidence should be carried out. Smoking should be tackled and treated with decisively, even more so in the context of the favourable current legislation. The measurement of risk factors makes it easy to take decisions in clinical practice, but should not be substituted for clinical judgement, given the limitation of the currently available calculation methods. The concept of overall focus on cardiovascular risks can obtain a reduction of the risk by the synergetic action on the different MCVRF in each individual case. The aim must be to reduce the probability of having a cardiovascular disease in the future, as well as the loss in quality of life, incapacity and associated mortality.

Differences in daily rhythms of wrist temperature between obese and normal-weight women: associations with metabolic syndrome features

The circadian rhythm of core body temperature is associated with widespread physiological effects. However, studies with other more practical temperature measures, such as wrist (WT) and proximal temperatures, are still scarce. The aim of this study was to investigate whether obesity is associated with differences in mean WT values or in its daily rhythmicity patterns. Daily patterns of cortisol, melatonin, and different metabolic syndrome (MetS) features were also analyzed in an attempt to clarify the potential association between chronodisruption and MetS. The study was conducted on 20 normal-weight women (age: 38 ± 11 yrs and BMI: 22 ± 2.6 kg/m(2)) and 50 obese women (age: 42 ± 10 yrs and BMI: 33.5 ± 3.2 kg/m(2)) (mean ± SEM). Skin temperature was measured over a 3-day period every 10 min with the "Thermochron iButton." Rhythmic parameters were obtained using an integrated package for time-series analysis, "Circadianware." Obese women displayed significantly lower mean WT (34.1°C ± 0.3°C) with a more flattened 24-h pattern, a lower-quality rhythm, and a higher intraday variability (IV). Particularly interesting were the marked differences between obese and normal-weight women in the secondary WT peak in the postprandial period (second-harmonic power [P2]), considered as a marker of chronodisruption and of metabolic alterations. WT rhythmicity characteristics were related to MetS features, obesity-related proteins, and circadian markers, such as melatonin. In summary, obese women displayed a lower-quality WT daily rhythm with a more flattened pattern (particularly in the postprandial period) and increased IV, which suggests a greater fragmentation of the rest/activity rhythm compared to normal-weight women. These 24-h changes were associated with higher MetS risk.

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol

Background

The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner.

Methods/Design

An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines.

Discussion

Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity.

Trials Registration

ClinicalTrials.gov (NCT01282190).

Thyroid hormone levels predict the change in body weight: a prospective study

BACKGROUND

Different studies, mostly cross-sectional, have found an association between low levels of thyroid hormones, even within the normal range, and a greater body mass index. The aim of this study was to determine the association between thyroid function and the risk for obesity.

MATERIALS AND METHODS

In this population-based prospective study, measurements were made of anthropometric parameters, thyroid hormone function and urinary iodine in a cohort of the Pizarra Study (n = 937), and repeated 6 years later (n = 784). At the second point, measurements were also made of leptin and adiponectin.

RESULTS

Among the persons who were not obese at the start of the study, the odds ratio (OR) of becoming obese for those in the fourth quartile (Q(4)) for free triiodothyronine (FT3) (versus those in Q(1)) was 2·94 (1·46-5·90) (P = 0·005). The OR of becoming obese in persons in Q(4) of FT4 (versus those in Q(1)) was 3·06 (1·23-7·43) (P = 0·01). Those persons in Q(4) of weight gain had a higher FT3 at the 6-year follow-up than those whose weight gain was in Q(1) (P < 0·001). Leptin correlated with thyrotropin (β = 0·58, P = 0·001) and the FT4 (β = -1·12, P = 0·005). Adiponectin correlated with FT3 (r = -0·24, P < 0·001). The urinary iodine correlated negatively with both the BMI (β = -0·08, P = 0·01) and the increase in weight (β = -0·08, P = 0·04).

CONCLUSIONS

The changes in the thyroid hormones could be the consequence, rather than the cause, of the increase in weight. The same pathophysiological mechanisms that induce obesity might also be modifying the thyroid hormone pattern.

Effect of the consumption of a fruit and vegetable soup with high in vitro carotenoid bioaccessibility on serum carotenoid concentrations and markers of oxidative stress in young men

AIM

To evaluate the effect of the daily intake of a fruit & vegetable soup with high in vitro bioaccessibility of carotenoids on β-carotene and lycopene serum concentrations.

METHODS

Fourteen healthy young men (24 ± 1 years) received 300 mL/day of a carrot, tomato, and broccoli soup, containing 3.9 mg β-carotene and 4 mg lycopene, for 4 weeks followed by a 4-week washout period. The serum carotenoid response and oxidative markers were analyzed after 3 and 4 weeks of soup consumption and after a 4-week washout.

RESULTS

The in vitro bioaccessibility of β-carotene and lycopene was 55 and 43%, respectively, in the soup. Serum β-carotene concentrations were significantly higher than baseline (0.33 ± 0.05 μmol/L) after 3 weeks (0.69 ± 0.06 μmol/L) and 4 weeks (0.78 ± 0.10 μmol/L) of soup consumption (P < 0.001). Serum lycopene was also significantly higher compared with baseline levels (0.26 ± 0.08-0.56 ± 0.04 μmol/L and 0.60 ± 0.04 μmol/L, after 3 and 4 weeks, respectively) (P < 0.001). Although the highest concentration of both carotenoids was found after 4 weeks, the levels were not statistically different from the levels at 3 weeks. A 4-week washout significantly decreased serum carotenoid concentrations, although only β-carotene returned to baseline. Glutathione peroxidase (GPx) increased significantly after soup supplementation compared with baseline, while superoxide dismutase was significantly lower only after 3 weeks. Glutathione reductase, lipid, protein, and DNA oxidative markers remained unchanged.

CONCLUSIONS

The soup contributed to increasing the concentration of each carotenoid by more than 100% after 3 and 4 weeks of consumption, the maximum increase being observed after 4 weeks. Oxidative markers did not show any variation except for GPx. Serum lycopene half-life was longer than that of β-carotene, which may be important for studies evaluating both carotenoids.

Cardiovascular risk assessment in hypertensive patients with tests recommended by the European Guidelines on Hypertension

Objective: To evaluate the usefulness of the diagnostic tests recommended by the European Society of Hypertension/Cardiology Guidelines (ESH-ESC 2007) in hypertensive patients classified as being at low or moderate risk, analyzing the change to high risk classification and the characteristics associated with such change.

Methods: A cross-sectional study was made in 391 patients aged between 30 and 80 years recently diagnosed with arterial hypertension in the Primary Care setting. The criteria of the 2007 ESH-ESC Guidelines were followed for the evaluation of risk factors, subclinical organ damage, cardiovascular disease and cardiovascular risk. In addition to the routine tests, echocardiography, carotid ultrasound, albumin/creatinine ratio, estimated glomerular filtration rate, ankle-brachial index, pulse wave velocity and retinography were used. We established four levels of testing performed for risk classification.

Results: Using the routine tests to evaluate risk (level 1), 218 (55.8%) patients were classified as being at high risk. Of the 173 patients classified as presenting low or moderate risk, the ankle-brachial index, albumin/creatinine ratio and glomerular filtration rate were determined (level 2), and 18 patients (10.4%) were classified as being at high risk. With echocardiography and carotid ultrasound (level 3), another 16 patients (10%) were raised to high risk. Finally, with pulse wave velocity and retinography (level 4), 10 additional patients (5%) were classified as presenting high risk. Patients with increased blood pressure, advanced age and women showed a 4.28-fold (95%CI: 2.01–9.16), 3.54-fold (95%CI: 1.61–7.77) and 1.36-fold (95%CI: 0.62–3.00) higher probability of being reclassified to high cardiovascular risk, respectively.

Conclusions: With the non-routine tests, 25.4% of the low or moderate risk patients were reclassified as presenting high risk.

Increased plasma soluble endoglin levels as an indicator of cardiovascular alterations in hypertensive and diabetic patients

BACKGROUND

Endoglin is involved in the regulation of endothelial function, but there are no studies concerning its relation with hypertension- and diabetes-associated pathologies. Thus, we studied the relationship between plasma levels of soluble endoglin and cardiovascular alterations associated with hypertension and diabetes.

METHODS

We analyzed 288 patients: 64 with type 2 diabetes, 159 with hypertension and 65 healthy patients. We assessed the relationship of soluble endoglin plasma levels measured by enzyme-linked immunosorbent assay with basal glycemia, glycosylated hemoglobin, blood pressure, endothelial dysfunction (assessed by pressure wave velocity), hypertensive retinopathy (by Keith-Wagener classification), left ventricular hypertrophy (by Cornell and Sokolow indexes), cardiovascular risk and target organ (heart, vascular, kidney) damage.

RESULTS

There are significant correlations between endoglin and glycemia, systolic blood pressure, pulse pressure, pressure wave velocity and electrocardiographically assessed left ventricular hypertrophy. Endoglin levels were significantly higher in patients with diabetes who had nondipper and extreme dipper circadian blood pressure patterns than in dipper circadian patterns, in patients with hypertension and diabetes who had riser pattern than in the other patients, and in patients with diabetes but not hypertension who had extreme dipper pattern than in dipper, nondipper and riser groups. There was also a significant correlation between plasma-soluble endoglin and lower levels of systolic night-day ratio. Higher endoglin levels were found in patients with diabetes who had retinopathy, in patients with diabetes who had a high probability of 10-year cardiovascular risk, and in patients with diabetes and hypertension who had three or more damaged target organs (heart, vessels, kidney) than in those with no organs affected.

CONCLUSIONS

This study shows that endoglin is an indicator of hypertension- and diabetes-associated vascular pathologies as endothelial dysfunction and cardiovascular damage.

[Prevalence of overweight and obesity in adults in an urban health area]

OBJECTIVE

To estimate prevalence of overweight and obesity in adults and to identify those individuals at high cardiovascular risk (subjects with type 2 diabetes or hypertension) in whom a nurse intervention might be beneficial in terms of life-style changes and reduction in body weight.

METHOD

A cross-sectional study on 2270 adults (18-80 years-old) from an urban Primary Health Care Centre. Medical history, social and demographic data, physical examination and blood tests were collected.

RESULTS

The mean body mass index was 26.9±5.1kg/m(2) and was found to be higher in men. Thirty-eight percent of subjects were overweight and 22% were obese. Although the prevalence of obesity was identical in both sexes, women had higher prevalences of type ii and iii obesity than men, but overweight was more frequent in men. Among those older than fifty years-old, 84% were overweight or obese. One-hundred and fifty-six (7%) subjects had type 2 diabetes and 707 (31%) had hypertension, and 111 (5%) subjects with both diabetes and hypertension. BMI was higher (P<0.001) in patients who suffered from, hypertension (29.7±5.2), diabetes (28.5±4.6), and diabetes and hypertension (31.4±5.3), than in those who did not suffer from these diseases (25.4±4.3).

CONCLUSIONS

Obesity and overweight is highly prevalent in the population studied and is higher in patients with diabetes and hypertension.

Chronobiological aspects of nutrition, metabolic syndrome and obesity

The present review starts from the classical physiological and nutritional studies related with food intake control, digestion, transport and absorption of nutrients. It continues with studies related with the metabolism of adipose tissue, and finish with modern experiments in genetics and molecular biology - all from a fresh, chronobiological point of view. Obesity will be explained as a fault in the circadian system, as pathology associated with "chronodisruption". The main gaps in chronobiological research related to obesity will be also identified and chronobiological-based therapies will be proposed in order to allow the resetting of the circadian rhythm among obese subjects.

Fruit and vegetable consumption and proinflammatory gene expression from peripheral blood mononuclear cells in young adults: a translational study

BACKGROUND

Fruits and vegetables are important sources of fiber and nutrients with a recognized antioxidant capacity, which could have beneficial effects on the proinflammatory status as well as some metabolic syndrome and cardiovascular disease features. The current study assessed the potential relationships of fruit and vegetable consumption with the plasma concentrations and mRNA expression values of some proinflammatory markers in young adults.

METHODS

One-hundred and twenty healthy subjects (50 men/70 women; 20.8 +/- 2.6 y; 22.3 +/- 2.8 kg/m2) were enrolled. Experimental determinations included anthropometry, blood pressure and lifestyle features as well as blood biochemical and inflammatory measurements. The mRNA was isolated from peripheral blood mononuclear cells (PBMC) and the gene expression concerning selected inflammatory markers was assessed by quantitative real-time PCR. Nutritional intakes were estimated by a validated semi-quantitative food-frequency questionnaire.

RESULTS

The highest tertile of energy-adjusted fruit and vegetable consumption (>660 g/d) was associated with lower plasma concentrations of C-reactive protein (CRP) and homocysteine and with lower ICAM1, IL1R1, IL6, TNFalpha and NFkappaB1 gene expression in PBMC (P for trend < 0.05), independently of gender, age, energy intake, physical activity, smoking, body mass index, systolic blood pressure and circulating non-esterified fatty acids. In addition, plasma CRP, homocysteine and TNFalpha concentrations and ICAM1, TNFalpha and NFkappaB1 gene expression in PBMC showed a descending trend as increased fiber intake (>19.5 g/d) from fruits and vegetables (P for trend < 0.05). Furthermore, the participants within the higher tertile (>11.8 mmol/d) of dietary total antioxidant capacity showed lower plasma CRP and mRNA values of ICAM1, IL1R1, IL6, TNFalpha and NFkappaB1 genes (P for trend < 0.05). The inverse association between fruit and vegetable consumption and study proinflammatory markers followed the same trend and remained statistically significant, after the inclusion of other foods/nutrients in the linear regression models.

CONCLUSION

A higher fruit and vegetable consumption was independently associated not only with reduced CRP and homocysteine concentrations but also with a lower mRNA expression in PBMC of some relevant proinflammatory markers in healthy young adults.

[Abnormalities of bone metabolism in bariatric surgery]

Obesity is an ever-increasing disease in our environment, and a major risk factor for the development of other chronic diseases that increase morbidity and mortality. Bariatric surgery is an effective treatment for obesity, since it not only allows a significant and sustained loss of weight, but also an important reduction of its co-morbidities. However, this treatment is not free of complications, since along with weight loss, frequent nutritional and metabolic deficiencies have been described. These complications are particularly frequent when mixed surgical procedures with a restrictive and malabsortive component such as Roux-en-Y gastric bypass and biliopancreatic diversion are performed. The nutritional deficiencies observed include, to a greater or lesser extent, malabsorption of fat and liposoluble vitamins, as well as other micronutrients such as calcium. As a result, disorders of bone mineral metabolism with skeletal manifestations that include bone mass reduction, increased bone turnover and defective bone mineralization may develop.

Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol

Background

Diabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk.

The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome.

Methods/Design

Design: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up.

Setting: The study will be carried out in the urban primary care setting.

Study population: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included.

Measurements: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for diabetes, arterial hypertension and hyperlipidemia will be registered, together with antiplatelet drugs.

Discussion

The results of this study will help to know and quantify the prognostic value of central arterial pressure and pulse wave velocity in relation to the evolution of the subclinical target organ damage markers and the possible incidence of cardiovascular events in patients with type 2 diabetes mellitus.

Trial Registration

ClinicalTrials.gov Identifier: NCT01065155