[Commitment of Asunción. A call to action]

Introduction

The Latin American Federation of Nutritional Therapy, Clinical Nutrition, and Metabolism - FELANPE, was founded in 1988. It brings together interdisciplinary societies and associations in Clinical Nutrition and Nutritional Therapy from Latin America and the Caribbean, as well as Spain and Portugal. Currently, it comprises representations from 18 countries. The objectives of the Federation are described, taking into account the assumed commitment. This is an observational cross-sectional, multicenter study that included 132 hospitals with more than 100 beds, of high complexity, both state-owned and private, from 14 countries in Latin America that are members of FELANPE. The study assessed hospital characteristics, implementation of nutritional assessment, nutritional diagnosis of patients, the team responsible for nutritional therapy, nutritional therapy (oral, enteral, and parenteral), monitoring, and nutritional follow-up. For this purpose, a digital questionnaire and an explanatory video were designed and validated to ensure the quality of the collected data. Validation was carried out through a pilot study conducted in Paraguay, approved by the Ethics Committee for Research at the Faculty of Medical Sciences of the National University of Asunción. The current research has the approval of the Research Ethics Committee of the Faculty of Chemical Sciences of the National University of Asunción and the Ethics Committee of FELANPE. The results presented at the XVIII Latin American Congress of FELANPE in Asunción, Paraguay, on October 12, 2023, serve as a basis for characterizing the implementation of Parenteral and Enteral Nutritional Therapy (medical nutritional therapy) in hospitals in Latin America and are used as technical support for the present Asunción Commitment.

[Intermittent fasting and human metabolic health]

Intermittent fasting (IF) has gained increasing scientific and general attention. Most studied forms of IF include alternate-day fasting, modified alternate-day fasting, and time-restricted eating (TRE). Several cardiometabolic effects of IF have been described in animal models and, to a lesser extent, in humans. This review analyzes the impact of IF on weight loss, glucose metabolism, blood pressure, and lipid profile in humans. A literature search was conducted in the Pubmed/Medline, Scopus, and Google Scholar databases. Controlled observational or interventional studies in humans, published between January 2000 and June 2021, were included. Studies comparing IF versus religious fasting were not included. Most studies indicate that the different types of IF have significant benefits on body composition, inducing weight loss and reducing fat mass. Changes in cardiometabolic parameters show more divergent results. In general, a decrease in fasting glucose and insulin levels is observed, together with an improved lipid profile associated with cardiovascular risk. High heterogeneity in study designs was observed, particularly in studies with TRE, small sample sizes, and short-term interventions. Current evidence shows that IF confers a range of cardiometabolic benefits in humans. Weight loss, improvement of glucose homeostasis and lipid profile, are observed in the three types of IF protocols evaluated.

Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition diagnosis of malnutrition

The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus-based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual-energy x-ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic- and sex-specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.

Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition

The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus-based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual-energy x-ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic- and sex-specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.

New insights of tricuspid regurgitation: a large-scale prospective cohort study

AIMS

To evaluate the burden of tricuspid regurgitation (TR) in a large cohort, determine the right ventricle involvement of patients with TR and determine the characteristics of isolated TR.

METHODS AND RESULTS

Prospective study where consecutive patients undergoing an echocardiographic study in 10 centres were included. All studies with significant TR (at least moderate) were selected. We considered that patients with one of pulmonary systolic hypertension >50 mmHg, left ventricular ejection fraction <35%, New York Heart Association III-IV, or older than 85 years, had a high surgical risk. A total of 35 088 echocardiograms were performed. Significant TR was detected in 6% of studies. Moderate TR was found in 69.6%, severe in 25.5%, massive in 3.9%, and torrential in 1.0% of patients. Right ventricle was dilated in 81.7% of patients with massive/torrential TR, in 55.9% with severe TR, and in 29.3% with moderate TR (P < 0.001). Primary TR was present in 7.4% of patients whereas secondary TR was present in 92.6%. Mitral or aortic valve disease was the most common aetiology (54.6%), following by isolated TR (16%). Up to 51.9% of patients with severe, massive, or torrential primary TR and 57% of patients with severe, massive, or torrential secondary TR had a high surgical risk.

CONCLUSION

Significant TR is a prevalent condition and a high proportion of these patients have an indication for valve intervention. More than a half of patients with severe, massive, or torrential TR had a high surgical risk. Massive/torrential TR may have implications regarding selection and monitoring patients for percutaneous treatment.

Zinc absorption and zinc status are reduced after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women with severe obesity studied prospectively over 24 postoperative months

BACKGROUND

Roux-en-Y gastric bypass (RYGBP) is known to reduce zinc absorption; the effects of vertical sleeve gastrectomy (SG) and its long-term implications on zinc absorption have not yet been studied.

OBJECTIVE

The aim was to evaluate the effects of SG and RYGBP on zinc absorption and zinc status in premenopausal women with severe obesity up to 24 mo after surgery.

METHODS

Twenty-six premenopausal women undergoing SG [BMI (in kg/m2): 37.3 ± 3.2] and 32 undergoing RYGBP (BMI: 42.0 ± 4.2) were studied. A series of anthropometric, dietary, and zinc status parameters (plasma and hair zinc), and the size of the exchangeable zinc pool (EZP), as well as percentage zinc absorption from a standardized dose using a stable isotope methodology were evaluated in the patients before the surgical procedure and at 12 and 24 mo after SG or RYGBP. SG patients received 15 mg and RYGBP received 25 mg of supplemental Zn/d.

RESULTS

In premenopausal women, zinc absorption was decreased by 71.9% and 52.0% in SG and RYGBP, respectively, 24 mo postsurgery, compared with initial values. According to 2-factor repeated-measures ANOVA, time effect was significant (P = <0.0001), but not time × group interaction (P = 0.470). Plasma zinc below the cutoff point of 70 µg/dL increased from 0 to 15.4% and 38.1% in SG and RYGBP, respectively. Mean EZP was significantly reduced 24 mo after surgery, although no time × group interactions were observed. Hair zinc did not change across time or between groups.

CONCLUSIONS

Both SG and RYGBP have profound effects on zinc absorption capacity, which are not compensated for after 24 mo. Although zinc absorption reduction was similar in both types of surgeries, plasma zinc was more affected in RYGBP than SG, despite greater zinc supplementation in RYGBP.This trial was registered at http://www.isrctn.com as ISRCTN31937503.

Nutrition competencies for undergraduate medical education: Results of an international interdisciplinary consensus

BACKGROUND

The gap between the nutrition education provided to medical students and the nutrition competencies and attitudes needed for physicians to provide adequate nutrition care is a global concern. There is no universally accepted benchmark on nutrition competencies for doctors. The objective of this study was to establish, by expert consensus, the objectives of undergraduate nutrition medial education, the nutrition core competencies, and strategies for curriculum development in medical nutrition education.

METHODS

We administered a Delphi survey to systematically gather the opinion of a panel of Latin American experts in nutrition. The survey questionnaire was constructed considering scientific literature by using a 5-point Likert scale. Consensus was defined as >70% agreement on the importance of an item (Likert scale 4 and 5).

RESULTS

A four-round Delphi survey was conducted for this research. In the second, third, and fourth rounds, we validated a total of 130 competencies by consensus, which were distributed into four different thematic areas: (1) basic nutrition concepts, (2) public nutrition and nutrition prevention throughout the life cycle, (3) nutrition status and disease, and (4) nutrition care process.

CONCLUSION

The curricula for general physician education in medical school must include health promotion, prevention, and treatment of diseases related to nutrition. This goal can be reached by integrating ≤130 competencies into four different fundamental areas.

[Equations to estimate body composition using bioelectrical impedance in Chilean adults]

BACKGROUND

Equations for the evaluation of fat-free mass (FFM) and fat mass (FM) with Bioelectrical impedance analysis (BIA) were formulated in Caucasian populations. International recommendations suggest that population-specific equations should be formulated.

AIM

To validate an equation previously formulated in Chileans adults and compare it to a new equation generated on an independent sample.

MATERIAL AND METHODS

In 108 adult volunteers aged 38.1±14.1 years (44% males), with a body mass index (BMI) of 25.1± 4.1 kg/m2, body composition was measured by BIA (Bodystat) and dual X-ray absorptiometry (DXA: Lunar Prodigy). Body composition estimated using Schifferli equation and BIA were compared with DEXA, by the Bland-Altman method and simple linear regression.

RESULTS

FFM and FM measured by DXA were 45.2 ± 9.8 kg and 29.6 ± 11.7 % respectively. Resistance was 467.7 ± 76.3 ohm. Schifferli equation and BIA significantly overestimated FFM by 7.3 and 7.4 kg, respectively. The error was higher for high levels of FFM (slope β < 1, p < 0.01). Both equations underestimated FM measured by DXA (averages of 7.5 and 7.8%, respectively, p < 0.01), without a differential bias for Schifferli equation, but with a bias in low levels of FM measured with BIA (slope β < 1, p < 0.01). Estimation biases could be eliminated using the regression coefficients.

CONCLUSIONS

Both equations behave similarly and have biases, although less with Schifferli. Statistically correcting for biases, the new adjusted equations provide clinically valid estimates of FFM and FM. Equations should not only be population-specific, but also device-specific.

Fatty acid desaturation in red blood cell membranes of patients with type 2 diabetes is improved by zinc supplementation

BACKGROUND/OBJECTIVE

Membrane flexibility can be a determining factor in pathophysiological mechanisms of type 2 diabetes (T2D). As a cofactor of delta-5 desaturase (D5D) and delta-6 desaturase (D6D), and gene expression regulator, zinc may play a role modulating membrane flexibility by increasing membrane polyunsaturated fatty acids (PUFA) abundance. The objective of this study was to evaluate the effect of a 24-month zinc supplementation (30 mg elemental zinc) on membrane fatty acid composition in patients with T2D.

SUBJECTS/METHODS

Sixty patients with T2D were evaluated. Thirty were randomly assigned to the zinc supplemented group and thirty to the placebo group. Fatty acid composition in red blood cell (RBC) membranes was determined by gas chromatography. Expression of gene encoding for D5D (FADS1), and D6D (FADS2) were evaluated in peripheral blood mononuclear cells by real-time polymerase chain reaction.

RESULTS

After 24 months of supplementation, a greater abundance of docosapentaenoic acid (C22:5 n-3), arachidonic acid (C20:4 n-6), adrenic acid (C22:4 n-6), and total n-6 PUFA was found (p = 0.001, p = 0.007, p = 0.033, p = 0.048, respectively). The unsaturated fatty acids/saturated fatty acids ratio, and unsaturation index was increased in the zinc supplemented group at month 24 (p = 0.003 and p  = 0.000, respectively). FADS1 gene was upregulated in the zinc group in relation to placebo at month 12 (p = 0.020).

CONCLUSIONS

Supplementation with 30 mg/d elemental zinc during 24 months in patients with T2D had an effect on the composition of RBC membranes increasing PUFA abundance and in turn, improving membrane flexibility. This effect may be mediated by induction of D5D gene expression.

Is Isolated tricuspid regurgitation different from functional tricuspid regurgitation?

Introduction

Isolated tricuspid regurgitation (TR) prevalence is increasing in the last decades. Its presence is associated with a worse prognosis when EROA is &gt;40 mm2. Because of high surgery risk and increasing incidence, isolated TR is a challenge in modern cardiology.

Purpose

To evaluate the prevalence and characteristics of isolated TR compared to other TR aetiologies in a large cohort of patients.

Methods

Prospective study where consecutive patients undergoing an echocardiographic study within a three-month period were included. All studies with at least moderate TR were selected. Isolated TR was defined as TR with no likely pulmonary hypertension (&gt;50 mmHg), no overt TR cause (no intrinsic tricuspid disease, LVEF ≥50%, no pacemaker/defibrillator wire across the tricuspid, no other significant valve disease, no disease that may cause TR, no congenital or pericardial heart disease); and no previous valve surgery. Patients with isolated TR and other aetiologies were compared.

Results

2121 patients with at least moderate TR were included. Isolated TR was found in 398 patients (18.8%). Basal characteristics are shown in table 1. Patients with isolated TR did not have a higher prevalence of AF (47.5% vs. 48.6% p=0.362). Isolated TR was less severe (20.5% vs. 32.1% of patients with severe TR; p&lt;0.001) and less symptomatic (NYHA ≥ II in 27.8% of patients vs. 69.3%; p&lt;0.001).

After selecting patients with at least severe TR, patients with isolated TR were also less symptomatic (NYHA≥II in 47.8% of patients vs. 70.7%; p&lt;0.001) and they had better RV function (TAPSE &lt;17 mm in 13.4% vs. 35.6%; p=0.001).

We found that patients with isolated severe TR had a larger tricuspid annulus diameter (25.4±0.8 mm/m2 vs. 24.0±0.3 mm/m2; p=0.047).

Conclusions

In this large prospective study, isolated TR is present in 18.8% of significant TR. Isolated TR was less severe, was associated with less RV dilatation (but with larger tricuspid annulus diameter) and patients had a better functional class compared to other TR aetiologies.

Differeces in NYHA and RV function

Funding Acknowledgement

Type of funding source: None

Lessons Learned in Nutrition Therapy in Patients With Severe COVID-19

The coronavirus disease 2019 (COVID‐19) pandemic has reached worldwide, and until a vaccine is found, it will continue to cause significant morbidity and mortality. The clinical presentation of COVID‐19 ranges from that of being asymptomatic to developing a fatal illness characterized by multiple organ involvement. Approximately 20% of the patients will require hospitalization; one‐quarter of hospitalized patients will develop severe COVID‐19 requiring admission to the intensive care unit, most frequently, with acute respiratory failure. An ongoing effort is being made to identify the patients that will develop severe COVID‐19. Overall, patients present with 3 different phenotypes of nutrition risk: (1) the frail older patient, (2) the patient with severe ongoing chronic illness, and (3) the patient with severe and morbid obesity. These 3 phenotypes represent different nutrition risks and diverse nutrition interventions. This article explores the different potential approaches to nutrition intervention in patients with COVID‐19, evaluating, in this process, the challenges faced in the implementation of guidelines written by different societies.

Coupling air temperature records and gravimetric data to interpret ventilation patterns in a Mediterranean karstic system (Nerja-Pintada caves, southern Spain)

Microclimate and geophysical studies are commonly applied to the characterization of karst systems although they are usually used separately. The main purpose of this manuscript is to show how the analysis of the data from both these research methods is a useful tool in the characterization of karst systems and we present the analysis of a specific case study: the Nerja- Pintada caves system. The joint analysis of the Nerja Cave and external air data (mainly temperatures) and the pre-existing gravimetric data of its surroundings (residual gravity anomaly map) have allowed us: 1) to postulate the existence of an unknown great cavity located near to the Nerja Cave and with direct influence in its ventilation and 2) to propose a new model of the Nerja-Pintada caves ventilation based on the changing connection between a "main cavity" system (Nerja Cave), with basically a transmissive function of airflows and an "annex cavities" sub-system, with different functioning as far as the airflow is concerned: transmissive in the case of Pintada Cave and capacitive in the case of the geophysically-located cave.

P906 Are all severe Tricuspid Regurgitation the same?

Introduction

Tricuspid regurgitation (TR) importance is growing in the last years. Its presence is associated with a worse prognosis. A new severity classification has been published, adding massive and torrential to the classical TR classification. However, both clinical profile of the patients as well as right chambers morphologic and functional changes have not been described compared to the severe TR patients.

Methods

Consecutive patients undergoing an echocardiographic study in 9 Spanish hospitals within a three-month period with at least moderate TR were prospectively included. All studies with severe TR were selected for analysis. TR assessment was performed as recommended by the European Association of Cardiovascular Imaging. TR severity grades was performed according to Hanh & Zamorano new published classification. Two cohorts were made: patients with severe TR and patients with massive or torrential TR.

Results

A total of 644 patients with severe or bigger TR were analysed. Severe TR was present in 540 (84%), massive was present in 83 (13%) and torrential in 21 (3%) Baseline characteristics of the study population are shown in table 1.

No differences were found in NYHA class or atrial fibrillation incidence between groups. Pacemaker was more frequent in massive/torrential group (30% vs 19%; 0,014).

Patients with massive/torrential TR presented worst RV remodelling data:

-RV was dilated (RV telediastolic basal diameter &gt;42mm) in 84.2% of patients with massive/torrential TR vs 57% of patients with severe TR (p &lt; 0.001).

-Right atrium was bigger in patients with massive/torrential TR (21 ± 0.8 cm2/m2 vs 17.2 ± 0,3 cm2/m2; p &lt; 0.001)

-Tricuspid annulus diameter was bigger between massive/torrential TR patients (26.7 ± 0.6 cm/m2 vs 23.6 ± 0.3 cm/m2; p &gt; 0.001).

No significant differences in prevalence of RV function (TAPSE &lt; 17 mm) were noted 39% vs 33%, p = 0,273.

Conclusions

In this large multicentre cohort of patients, the presence of massive/torrential TR seems to be associated with a differential RV and RA remodelling, reflecting the greater volume overload seen in these patients. Further studies are needed to define prognosis implication of our findings and its role in clinical decision making.

Table 1 Variable Severe (n = 540) Massive/Torrential (n = 104) Body mass index 26,6 (±0,3) 26.4(±0,6) 0.350 Woman 336 (62%) 69 (66%) 0.438 Atrial firilation 298(55%) 61(59%) 0.514 Age (years) 76,5 (±0,5) 77,5(±1,1) 0.209

A comparison of body composition assessment methods in climbers: Which is better?

Objective

To compare body composition estimations of field estimation methods: Durnin & Womersley anthropometry (DW-ANT), bioelectrical impedance analysis (BIA) and Deborah-Kerr anthropometry (DK-ANT) against dual-energy X-ray absorptiometry (DXA) in a male Chilean sport climbing sample.

Methods

30 adult male climbers of different performance levels participated in the study. A DXA scan (Lunar Prodigy^®) was used to determine fat mass, lean mass and total bone mineral content (BMC). Total muscle mass (MM, kg) was estimated through a validated prediction model. DW-ANT and BIA (“non-athletes” and “athletes” equations) were used to determinate fat mass percentage (FM %), while DK-ANT was utilized to estimate MM and BMC.

Results

A significant (p<0.01) inter-method difference was observed for all methods analyzed. When compared to DXA, DW-ANT and BIA underestimated FM% and DK-ANT overestimated MM and BMC (All p<0.01). The inter-method differences was lower for DW-ANT.

Discussion

We found that body composition estimation in climbers is highly method dependent. If DXA is not available, DW-ANT for FM% has a lower bias of estimation than BIA in young male Chilean climbers. For MM and BMC, further studies are needed to compare and estimate the DK-ANT bias level. For both methods, correction equations for specific climbing population should be considered.

Targeted next-generation sequencing of circulating-tumor DNA for tracking minimal residual disease in localized colon cancer

BACKGROUND

A high percentage of patients diagnosed with localized colon cancer (CC) will relapse after curative treatment. Although pathological staging currently guides our treatment decisions, there are no biomarkers determining minimal residual disease (MRD) and patients are at risk of being undertreated or even overtreated with chemotherapy in this setting. Circulating-tumor DNA (ctDNA) can to be a useful tool to better detect risk of relapse.

PATIENTS AND METHODS

One hundred and fifty patients diagnosed with localized CC were prospectively enrolled in our study. Tumor tissue from those patients was sequenced by a custom-targeted next-generation sequencing (NGS) panel to characterize somatic mutations. A minimum variant allele frequency (VAF) of 5% was applied for variant filtering. Orthogonal droplet digital PCR (ddPCR) validation was carried out. We selected known variants with higher VAF to track ctDNA in the plasma samples by ddPCR.

RESULTS

NGS found known pathological mutations in 132 (88%) primary tumors. ddPCR showed high concordance with NGS (r = 0.77) for VAF in primary tumors. Detection of ctDNA after surgery and in serial plasma samples during follow-up were associated with poorer disease-free survival (DFS) [hazard ratio (HR), 17.56; log-rank P = 0.0014 and HR, 11.33; log-rank P = 0.0001, respectively]. Tracking at least two variants in plasma increased the ability to identify MRD to 87.5%. ctDNA was the only significantly independent predictor of DFS in multivariable analysis. In patients treated with adjuvant chemotherapy, presence of ctDNA after therapy was associated with early relapse (HR 10.02; log-rank P < 0.0001). Detection of ctDNA at follow-up preceded radiological recurrence with a median lead time of 11.5 months.

CONCLUSIONS

Plasma postoperative ctDNA detected MRD and identified patients at high risk of relapse in localized CC. Mutation tracking with more than one variant in serial plasma samples improved our accuracy in predicting MRD.

Nutritional Effects of Zinc on Metabolic Syndrome and Type 2 Diabetes: Mechanisms and Main Findings in Human Studies

Zinc (Zn) plays crucial roles in mammalian metabolism. There is increasing interest about the potential beneficial effects of Zn on the prevention or treatment of non-communicable diseases. This review critically analyzes the information related to the role of Zn on the metabolic syndrome (MetS) as well as type 2 diabetes (T2D), and summarizes the biological basis of these potential effects of Zn. There are several mechanisms by which Zn may help to prevent the development or progression of MetS and T2D, respectively. Zn is involved in both insulin secretion and action in peripheral tissues. Specifically, Zn has insulin-mimetic properties that increase the activity of the insulin signaling pathway. Zn modulates long-chain polyunsaturated fatty acids levels through its action on the absorption of essential fatty acids in the intestine and its subsequent desaturation. Zn is also involved in both the assembly of chylomicrons and lipoproteins as well as their clearance, and thus, plays a role in lipolysis regulation. Finally, Zn has been found to play a role in redox metabolism, and in turn, on blood pressure. The evidence related to the association between Zn status and occurrence of MetS is inconsistent. Although there are several studies reporting an inverse relationship between Zn status or dietary Zn intake and MetS prevalence, others found a direct relationship between Zn status and MetS prevalence. Intervention studies also provide confusing information about this issue, making it hard to reach firm conclusions. Zn as part of the treatment for patients with T2D has been shown to have positive responses in terms of glucose control outcomes, but only among those with Zn deficiency.

Association between zinc nutritional status and glycemic control in individuals with well-controlled type-2 diabetes

BACKGROUND/OBJECTIVE

Interest in healthy properties of food and nutrients as co-adjuvant in type-2 diabetes therapy has increased in recent years. Zinc supplementation trials have shown improvements in glycemic control in these patients, although it seems dependent on zinc status of the individuals. The objective of this study was to evaluate the relationship between zinc nutritional status and glucose homeostasis in patients with type-2 diabetes.

SUBJECTS/METHODS

Eighty patients with well controlled type-2 diabetes were recruited and clinical, anthropometric and dietary evaluations were performed. One week after, insulin sensitivity and beta cell function were assessed by a modified Frequently Sampled Intravenous Glucose Tolerance Test. Zinc status was assessed by plasma zinc and the size of rapidly Exchangeable Zinc Pool (EZP); zinc intake was also determined. Glucagon concentration was evaluated in a subsample of 36 patients.

RESULTS

Patients presented a normal zinc status although zinc intake was lower than recommended. Overall, no associations were observed between zinc status and glycemic control markers. Nevertheless, positive correlations were observed between EZP and fasting insulin concentration (ρ = 0.393, p = 0.021) and HOMA-IR (ρ = 0.386, p = 0.024) in women, and between plasma zinc concentration and HbA1c (ρ = 0.342, p = 0.020) in men.

CONCLUSIONS

No significant associations were found between zinc status and glycemic control parameters in patients with well-controlled type 2 diabetes and normal zinc status, although low-degree gender-dependent associations were observed. Further research is required to assess the role of zinc status in zinc deficient patients.

Zinc Supplementation Does Not Affect Glucagon Response to Intravenous Glucose and Insulin Infusion in Patients with Well-Controlled Type 2 Diabetes

Glucagon dysregulation is an essential component in the pathophysiology of type 2 diabetes. Studies in vitro and in animal models have shown that zinc co-secreted with insulin suppresses glucagon secretion. Zinc supplementation improves blood glucose control in patients with type 2 diabetes, although there is little information about how zinc supplementation may affect glucagon secretion. The objective of this study was to evaluate the effect of 1-year zinc supplementation on fasting plasma glucagon concentration and in response to intravenous glucose and insulin infusion in patients with type 2 diabetes. A cross-sectional study was performed after 1-year of intervention with 30 mg/day zinc supplementation or a placebo on 28 patients with type 2 diabetes. Demographic, anthropometric, and biochemical parameters were determined. Fasting plasma glucagon and in response to intravenous glucose and insulin infusion were evaluated. Patients of both placebo and supplemented groups presented a well control of diabetes, with mean values of fasting blood glucose and glycated hemoglobin within the therapeutic goals established by ADA. No significant differences were observed in plasma glucagon concentration, glucagon/glucose ratio or glucagon/insulin ratio fasting, after glucose or after insulin infusions between placebo and supplemented groups. No significant effects of glucose or insulin infusions were observed on plasma glucagon concentration. One-year zinc supplementation did not affect fasting plasma glucagon nor response to intravenous glucose or insulin infusion in well-controlled type 2 diabetes patients with an adequate zinc status.

Highlighting the importance of transitional ventilation regimes in the management of Mediterranean show caves (Nerja-Pintada system, southern Spain)

This study shows the utilization of the air CO₂ exhaled by a very high number of visitors in the Nerja Cave as both a tracer and an additional tool to precisely evaluate the air circulation through the entire karst system, which includes non-touristic passages, originally free of anthropogenic CO₂. The analysis of the temporal - spatial evolution of the CO₂ content and other monitoring data measured from January 2015 to December 2016 in the Nerja-Pintada system, including air microbiological controls, has allowed us to define a new general ventilation model, of great interest for the conservation of the subterranean environment. During the annual cycle four different ventilation regimes and two ventilation modes (UAF-mode and DAF-mode) exist which determine the significance of the anthropogenic impact within the caves. During the winter regime, the strong ventilation regime and the airflow directions from the lowest to the highest entrance (UAF-mode) contribute to the rapid elimination of anthropogenic CO₂, and this affects the whole karstic system. During the summer regime the DAF-mode ventilation (with airflows from the highest to the lowest entrances) is activated. Although the number of visitors is maximum and the natural ventilation of the karstic system is the lowest of the annual cycle, the anthropogenic impact only affects the Tourist Galleries. The transitional ventilation regimes -spring and autumn- are the most complex of the annual cycle, with changing air-flow directions (from UAF-mode to DAF-mode and vice versa) at diurnal and poly diurnal scale, which conditions the range of the anthropogenic impact in each sector of the karst system. The activation of the DAF-mode has been observed when the temperature difference between the external and air cave is higher than 5°C.

TIOMAX: A Spanish Multicenter Registry of the real-world use of the TItanium OptiMAX® biostent: TIOMAX: Registro Español Multicéntrico Del Biostent De Titanio OptiMAX® En La Vida Real

OBJECTIVES

To compare the safety and efficacy of the new cobalt-chromium bioactive stent Titan Optimax^® (Hexacath, France) with its predecessor, Titan-2^® .

BACKGROUND

The TIOMAX registry includes 784 patients who underwent percutaneous coronary intervention with these stents in 21 Spanish hospitals.

METHODS

Analysis of all patients in the registry without exclusion criteria, candidates for revascularization (March-2013/July-2014). Initially 273 patients received Titan-2^® , and the next 511 received the Optimax^® after its launch.

RESULTS

Mean age was 65.8 ± 13.0 (78.1% men); 49.2% were STEACS patients (n = 322), 29.8% NSTEACS, and 27.3% had stable angina or silent ischemia. Most STEACS patients (76.4% of n = 322) were treated <24 hr after developing symptoms. All-cause death (D), cardiac death (CD), acute myocardial infarction (AMI), and stent thrombosis (ST) at 1 month were 1.1, 0.8, 0.1, and 0.5%, respectively, with no significant differences between groups. At 1 year, the death rate was 5.5% for Titan-2 vs. 4.1% for Optimax^® , CD was 1.8% for both groups, ST 1.1 vs. 0.6%, new AMI 3.3 vs. 2.5% and target lesion revascularization (TLR) 3.7 vs. 2.9%. The primary endpoint of the composite event (CE) of D/AMI/TLR/ST occurred in 10.3% vs. 7.6% (p = 0.211). Patients with STEACS (N = 322: Titan-2/Optimax: 103/209) had better outcomes for secondary events, device-oriented failure CD/AMI/TLR (7.8% vs. 5.0%; p = 0.330), and non-fatal CE of AMI/ST/TLR (7.8% vs. 2.7%, p = 0.039).

CONCLUSIONS

The Titan Optimax retains the efficacy and safety of Titan 2. It appears to perform better in the subgroup of STEACS patients, by reducing the non-fatal CE of AMI/ST/TLR.

Calcium absorption may be affected after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women: a 2-y prospective study

Background

Although Roux-en-Y gastric bypass (RYGBP) is known to reduce calcium absorption (CA), the effects of vertical sleeve gastrectomy (SG) and its long-term implications on CA have not yet been studied.

Objective

The aim of this study was to evaluate changes in CA and its relation with modifications of bone mineral density (BMD), intakes of calcium and vitamin D, vitamin D status, and parathyroid hormone (PTH) concentrations ≤24 mo after SG and RYGBP, respectively.

Design

Twenty-six premenopausal women undergoing SG [mean ± SD body mass index (BMI; kg/m2): 37.3 ± 3.2; age: 34.2 ± 10.2 y] and 32 undergoing RYGBP (BMI: 42.0 ± 4.2; age: 37.3 ± 8.1 y) were studied at baseline (presurgery) and followed up at 12 and 24 mo after surgery. BMD, bone alkaline phosphatase activity, and serum PTH, 25-hydroxyvitamin D [25(OH)D], calcium, magnesium, and phosphorus concentrations were determined. Food and supplement intakes were recorded. CA was measured by using a dual stable isotope method.

Results

In premenopausal women, CA was significantly reduced from 36.5% ± 2.0% preoperatively to 21.0% ± 2.3% and 18.8% ± 3.4% at 12 and 24 mo post-SG surgery, respectively. CA also decreased significantly from 41.5% ± 2.8% preoperatively to 27.9% ± 3.8% and 18.5% ± 2.2% 12 and 24 mo after RYGBP, respectively. No difference was found between type of surgery (time × group interaction, P = 0.60). Considering both groups combined, 56.6% of the variance in CA at the 12-mo but not at the 24-mo follow-up was explained by serum PTH and 25(OH)D concentrations, together with vitamin D and calcium intakes.

Conclusions

CA was similarly reduced in both SG and RYGBP compared with baseline, and it was not associated with changes in BMD or body weight loss. This reduction in CA could be explained only partially by calcium intake increase. This trial is registered at http://www.isrctn.com as ISRCTN31937503.

[Effect of meal frequency and carbohydrate intake on the metabolic control of patients with type 2 diabetes mellitus]

BACKGROUND

Increasing meal frequency is commonly used in the clinical practice as part of the nutritional treatment of patients with type 2 Diabetes Mellitus (DM2), although its effect on metabolic control parameters is controversial.

AIM

To evaluate the association of energy intake, meal frequency, and amount of carbohydrates with fasting plasma glucose and glycosylated hemoglobin in a group of patients with DM2 without insulin therapy.

MATERIAL AND METHODS

Dietary intake was evaluated in 60 subjects with DM2 through three-day food records. The meal frequency was estimated establishing the main meal times considering snacks.

RESULTS

Meal frequency was 4.7 ± 1.1 times per day. There was a positive association between glycosylated and fasting blood glucose levels (p <0.01). Meal frequency was associated with energy intake (p <0.01). When meal frequency, available carbohydrates and energy intake, body mass index and fasting plasma glucose were analyzed in a multiple linear regression model, fasting blood glucose was the variable that best predicted changes in glycosylated hemoglobin (45.5%). Meal frequency had no association with glycosylated hemoglobin.

CONCLUSIONS

Meal frequency showed no association with metabolic control parameters in DM2 patients.

Expression of MYD88 in Adipose Tissue of Obese People: Is There Some Role in the Development of Metabolic Syndrome?

BACKGROUND

The mechanism leading to the development of metabolic complications in obese individuals is not fully understood. Thus, the objective of this study was to examine differences in insulin resistance, inflammation, cytokine and adipokine levels, and expression of selected genes across obese individuals with different number of metabolic syndrome (MetS) components.

METHODS

Forty obese individuals who underwent bariatric surgery, divided in three groups based on the number of components of MetS, in addition to abdominal obesity (0, 1, and 2-3 additional components), were studied. Levels of inflammatory proteins, insulin resistance, cytokines, adipokines, and gene expression in subcutaneous (SAT) and visceral adipose tissue (VAT) were compared.

RESULTS

There was a significantly higher expression of MYD88 in SAT among those with more components of MetS (P = 0.008). In SAT, but not in VAT, MYD88 expression was significantly correlated with toll-like receptor 4 expression (r = 0.7, P < 0.05). Expression of adipsin in SAT was also associated with the presence of more components of MetS, but with borderline statistical significance (P = 0.05). There were no significant differences in insulin resistance, inflammation, and cytokine and adipokine levels by the number of components of MetS.

CONCLUSIONS

Our study suggests that MYD88 expression in SAT of obese subjects could be associated with the development of components of MetS.

Does Zinc Really "Metal" with Diabetes? The Epidemiologic Evidence

Zinc (Zn) is important in a number of processes related to insulin secretion and insulin activity in peripheral tissues, making this element an interesting potential co-adjuvant in the treatment of patients with type 2 diabetes (T2D). This issue has been matter of interest in recent years. The available evidence is analyzed in this review. Information from epidemiologic studies evaluating the relationship between Zn and T2D is inconsistent. Furthermore, few studies examined the association between Zn status and insulin action and/or glucose homeostasis. In terms of usefulness of Zn as a preventive agent for T2D development, information is insufficient to reach firm conclusions. Results from Zn supplementation trials found some positive effects only in those with initial sub normal Zn status in a significant proportion of individuals. In conclusion, the effect of Zn on patients with type 2 diabetes is still an open question, and better study designs are needed to clarify the real impact and characteristics of the Zn-diabetes interaction.

Micronutrient Deficiencies in Morbidly Obese Women Prior to Bariatric Surgery

BACKGROUND

Although morbid obesity is related to excess of energy and macronutrient intake, it does not rule out the presence of micronutrient deficiencies. The aim of this study was to evaluate food intake and the prevalence of micronutrient deficiencies in a group of morbidly obese women seeking bariatric surgery.

METHODS

A total of 103 morbidly obese women were studied prior to bariatric surgery. Anthropometry and body composition (dual-energy X-ray absorptiometry, DEXA) were performed on all subjects. Energy and nutrient intake was determined by food frequency questionnaire. Blood tests to assess micronutrients status, including plasma iron, ferritin, transferrin, zinc, copper, calcium, phosphorus, hemoglobin, hematocrit, mean corpuscular volume (MCV), and hair zinc, were performed. Folic acid, vitamin B12, vitamin D, and parathyroid hormone (PTH) were also assessed in 66 subjects.

RESULTS

Mean energy intake was 2801 ± 970 kcal/day. Carbohydrate, protein, and lipid intake represented 55 ± 9.1, 13.9 ± 3.3, and 32.5 ± 8.2% of total energy intake, respectively. Iron, calcium, and vitamin D intake was below the recommended dietary allowance. The prevalence of nutritional deficiencies were as follows: plasma iron 12.6%, ferritin 8.7%, transferrin 14.6%, plasma zinc 2.9%, calcium 3.3%, phosphorus 2.3%, hemoglobin 7.7%, hematocrit 13.6%, MCV 6.8%, and hair zinc 15.7%. In the subsample, 10.6% had a vitamin B12 deficiency, 71.7% showed low concentrations of vitamin D, and 66% had high PTH levels. No folic acid or copper deficiencies were detected.

CONCLUSIONS

Despite high daily energy intake and adequate macronutrient distribution, morbidly obese Chilean women seeking bariatric surgery present with deficient intake of some micronutrients and a high prevalence of micronutrient deficiencies.

Mechanisms of long-term weight regain in patients undergoing sleeve gastrectomy

OBJECTIVES

Weight regain after bariatric surgery may be associated with behavioral, metabolic, or mechanical factors alone or in combination. The aim of this study was to investigate which factors are related to weight regain in the long-term after sleeve gastrectomy (SG).

METHODS

A retrospective case-control study with 40 patients undergoing SG (32 women, 8 men; age 42.9 ± 10.7 y; preoperative body mass index 35 ± 2.8 kg/m(2)), was performed. Patients were grouped according percentile->50% (cases) or <50% (controls)-of weight regain (%WR cutoff: 25% of weight loss). Weight history, anthropometry, glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), thyroid-stimulating hormone, resting energy expenditure, body composition, dietary survey, psychological test, and physical activity were recorded. Residual gastric capacity was estimated using a radiologic method. RESULTS (MEDIAN [P25-P75]): The evaluation was conducted 38.5 mo (34-41 mo) after SG. Percent weight regain ranged from 2.7% to 129.2% (25.4% [13-37.1]). Patients in the higher %WR group had a greater residual gastric volume (252.7 ± 108.4 versus 148.5 ± 25.3; P < 0.05) and the estimated volume was significantly correlated with %WR (r = 0.673; P = 0.023). Significantly higher body mass index (P = 0.001), resting energy expenditure (P = 0.04), fasting insulin (P = 0.01), and HOMA-IR (P = 0.02) were observed in the higher %WR group. A higher fat intake and a trend toward higher total energy intake were observed in the group with greater %WR. Clinical or borderline levels of anxiety were more frequently observed in the higher %WR group (70% versus 30%; P = 0.01).

CONCLUSIONS

Results from the present study demonstrated that the most important factor associated with long-term weight regain after SG was residual gastric volume. Additional prospective studies with larger numbers of patients are necessary to confirm our results.

[IMPACT OF DIETARY FATTY ACIDS ON LIPID PROFILE, INSULIN SENSITIVITY AND FUNCTIONALITY OF PANCREATIC β CELLS IN TYPE 2 DIABETIC SUBJECTS]

INTRODUCTION

the quality of fats could influence the metabolic control of patients with Type 2 Diabetes Mellitus (DM2).

OBJECTIVES

to determine the relationship between intake and quality of dietary fatty acids to lipid profile, metabolic control, functionality of pancreatic cells and insulin sensivity in subjects with DM2.

METHODS

we studied 54 subjects with DM2, anthropometric measurements were performed, body composition and dietary lipid intake, saturated fatty acids (SFA), trans, monounsaturated, polyunsaturated, omega 3, omega 6 and dietary cholesterol. Laboratory parameters related to their metabolic control were determined (fasting blood glucose, glycated hemoglobin, and lipid profile). The insulin secretion and insulin sensitivity was determined with the insulin-modified intravenous glucose tolerance test according to the Bergman's minimal model.

RESULTS

28 men and 26 women were studied (BMI of 29.5 ± 3.7 kg/m2; age 55.6 ± 6.8 y.), 48% had LDL-C < 100 mg/dL, 12.9% of men c-HDL > 40 mg/dL and 7.4% of women c-HDL > 50 mg/dL. 32% consumed > 10% of AGS and > 300 mg/day of dietary cholesterol. The SFA intake and percentage of calories from fat (G%) were significantly associated with insulin resistance and fasting plasma glucose concentration. The G% predicted 84% variability on c-VLDL.

CONCLUSIONS

in patients with DM2 a greater intake of fat and saturated fatty acids it associated with greater fasting glycemia and insulin resistance.

Changes in bone mineral density after sleeve gastrectomy or gastric bypass: relationships with variations in vitamin D, ghrelin, and adiponectin levels

BACKGROUND

A major long-term concern after gastric bypass (GBP) is the risk of osteoporosis; however, little is known about this complication in patients undergoing sleeve gastrectomy (SG).

OBJECTIVE

To evaluate changes in bone mineral density (BMD) after GBP and SG, and its relationship with changes in vitamin D, parathyroid hormone (PTH), ghrelin, and adiponectin.

METHODS

Twenty-three women undergoing GBP (BMI 42.0 ± 4.2 kg/m2; 37.3 ± 8.1 years) and 20 undergoing SG (BMI 37.3 ± 3.2 kg/m2; 34.2 ± 10.2 years) were studied before and 6 and 12 months after surgery. BMD was measured by dual-energy X-ray absorptiometry. Plasma PTH, 25-hydroxyvitamin D (25-OHD), ghrelin, and adiponectin concentrations were determined. Food as well as calcium and vitamin D supplement intake was recorded.

RESULTS

Excess weight loss (mean ± SE), adjusted by baseline excess weight, was 79.1±3.8% and 74.9 ± 4.1% 1 year after GBP and SG, respectively (p = 0.481). Significant reduction in BMD for total body (TB), lumbar spine (LS), and femoral neck (FN) was observed after GBP. In the SG group, reduction in BMD was significant only for TB. Adjusted by baseline BMD, the difference between change in BMD for GBP vs. SG was not significant for TB, LS, or FN. Percent reduction in ghrelin concentration was a main factor related to total BMD loss (GBP group) and LS BMD loss (GBP and SG groups).

CONCLUSIONS

One year after gastric bypass, bone mineral density was significantly affected, mainly at the femoral neck. Decreases in bone mineral density were more dramatic among patients who had greater baseline BMD and greater reduction in ghrelin concentrations.

[Second Consensus of the Chilean Society of Endocrinology and Diabetes about insulin resistance]

Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.

Synthesis and Characterization of New Palladium(II) Complexes with Ligands Derived from Furan-2-carbaldehyde and Benzaldehyde Thiosemicarbazone and their in vitro Cytotoxic Activities against Various Human Tumor Cell Lines

With the ligands 4-phenyl-1-(furan-2-carbaldehyde)thiosemicarbazone, HTSC1, (1), 4-phenyl-1- (5´-phenyl-furan-2-carbaldehyde)thiosemicarbazone, HTSC2 (2), o-methoxy-benzaldehydethiosemicarbazone, HTSC3 (3), and o-cyano-benzaldehydethiosemicarbazone, HTSC4 (4), the corresponding palladium(II) complexes, Pd(TSC1)2 (5), Pd(TSC2)2 (6), Pd(TSC3)2 (7), and Pd(TSC4)2 (8) were synthesized and characterized by elemental analysis and spectroscopic techniques. The crystal structure of Pd(TSC3)2 (7) was determined by single-crystal X-ray diffraction. Complex 7 shows a squareplanar geometry, where two deprotonated ligands are coordinated to the PdII center through the nitrogen and sulfur atoms in a trans arrangement. In vitro antitumor studies against different human tumor cell lines have revealed that the palladium(II) complexes 5- 8 are more cytotoxic (IC50 values in the range of 0.21 - 3.79 μM) than their corresponding ligands (1 - 4) (> 60 μM). These results indicate that the antiproliferative activity is enhanced when thiosemicarbazone ligands are coordinated to the metal. Among the studied palladium(II) complexes, 8 exhibits high antitumor activity on K562 chronic myelogenous leukemia cells with a low value of the inhibitory concentration (IC50 = 0.21 μM).

Differences in body composition and resting energy expenditure in childhood in preterm children born with very low birth weight

BACKGROUND

Rapid early ponderal growth is associated with adverse metabolic risks in young adults born at term.

AIM

To determine whether there are differences in body composition, resting energy expenditure (REE) and metabolic variables between preterm children born with very low birth weight (VLBW) either appropriate (AGA) or small (SGA) for gestational age and whether these differences are related to an early period of weight gain.

METHODS

67 VLBW preterm (40 AGA, 27 SGA). Body composition by DEXA, REE by indirect calorimetry and blood sampling at age 6.7 ± 0.5 years.

RESULTS

VLBW SGA children were lighter, shorter, had a lower waist and hip circumference, HDL cholesterol and lipid oxidation rates than their AGA counterparts (adjusted for age, sex and BMI). Birth weight correlated negatively with total body and trunk fat mass. In a multivariate linear regression analysis, we found a positive association between weight gain in the first 3 months of life and total and trunk fat at age 6 years and a reciprocal association with REE at age 6 years. In contrast, the weight gain rate at 6-9 months of life was associated with higher REE and lipid oxidation rates at 6 years. A higher weight gain rate at 9-12 months was associated with a higher lean mass at 6 years.

CONCLUSION

An early fast-pace weight gain in VLBW infants may have detrimental consequences for metabolic health later on.

[Evolution of the intake and nutritional status of zinc, iron and copper in women undergoing bariatric surgery until the second year after surgery]

INTRODUCTION

Bariatric surgery allows a significant reduction in weight and improvement of comorbidities associated with obesity in the long term, but it can also adversely affect the nutritional status of some micronutrients.

OBJECTIVES

To evaluate changes in intake and parameters of nutritional status of zinc, iron and copper in patients undergoing Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG), until the second postoperative year.

METHODS

We prospectively studied 45 women undergoing GBP or SG (mean age 35.2 ± 8.4 years, mean BMI 39.8 ± 4.0 kg/m²), every 6 months We measured intake and status indications nutritional zinc, iron and copper, and annually evaluated body composition. The contribution of minerals through supplements represented twice the recommended intake for a healthy woman in patients undergoing GT and three times for GBP.

RESULTS

20 women underwent GBP and 25 SG. In both groups there was a significant reduction in weight and body fat percentage, which was maintained until the second postoperative year. Women who have had a greater commitment GBP nutritional status of zinc, iron and copper, that patients undergoing SG.

CONCLUSIONS

Gastric bypass Roux-Y produces a greater commitment of nutritional status of zinc, iron and copper sleeve gastrectomy. It should evaluate whether administration of supplementation fractional improve the absorption of these nutrients.

Synthesis and Characterization of New Palladium(II) Thiosemicarbazone Complexes and Their Cytotoxic Activity against Various Human Tumor Cell Lines

The palladium(II) bis-chelate complexes of the type [Pd(TSC(1-5))2] (6-10), with their corresponding ligands 4-phenyl-1-(acetone)-thiosemicarbazone, HTSC(1) (1), 4-phenyl-1-(2'-chloro-benzaldehyde)-thiosemicarbazone, HTSC(2) (2), 4-phenyl-1-(3'-hydroxy-benzaldehyde)-thiosemicarbazone, HTSC(3) (3), 4-phenyl-1-(2'-naphthaldehyde)-thiosemicarbazone, HTSC(4) (4), and 4-phenyl-1-(1'-nitro-2'-naphthaldehyde)-thiosemicarbazone, HTSC(5) (5), were synthesized and characterized by elemental analysis and spectroscopic techniques (IR and (1)H- and (13)C-NMR). The molecular structure of HTSC(3), HTSC(4), and [Pd(TSC(1))2] (6) have been determined by single crystal X-ray crystallography. Complex 6 shows a square planar geometry with two deprotonated ligands coordinated to Pd(II) through the azomethine nitrogen and thione sulfur atoms in a cis arrangement. The in vitro cytotoxic activity measurements indicate that the palladium(II) complexes (IC50 = 0.01-9.87 μM) exhibited higher antiproliferative activity than their free ligands (IC50 = 23.48-70.86 and >250 μM) against different types of human tumor cell lines. Among all the studied palladium(II) complexes, the [Pd(TSC(3))2] (8) complex exhibited high antitumor activity on the DU145 prostate carcinoma and K562 chronic myelogenous leukemia cells, with low values of the inhibitory concentration (0.01 and 0.02 μM, resp.).

Zinc as a potential coadjuvant in therapy for type 2 diabetes

BACKGROUND

Type 2 diabetes is highly prevalent in populations having high rates of overweight and obesity. It is a chronic condition responsible for long-term severe dysfunction of several organs, including the kidneys, heart, blood vessels, and eyes. Although there are a number of pharmacologic products in the market to treat insulin resistance and impaired insulin secretion--the most prominent features of this disease--interventions directed at preserving the integrity and function of beta-cells in the long term are less available. The use of some nutrients with important cellular protective roles that may lead to a preservation of beta-cells has not been fully tested; among these, zinc may be an interesting candidate.

OBJECTIVE

To assess the potential of zinc supplementation as coadjuvant to diabetes therapy.

METHODS

This article reviews the available information on the use of zinc as part of diabetes therapy.

RESULTS

Cellular and animal models provide information on the insulin mimetic action of zinc, as well as its role as a regulator of oxidative stress, inflammation, apoptosis, and insulin secretion. Zinc supplementation studies in humans are limited, although some positive effects have been reported; mainly, a modest but significant reduction in fasting glucose and a trend to decreased glycated hemoglobin (HbA1c).

CONCLUSIONS

Zinc supplementation may have beneficial effects on glycemic control. Nevertheless, among the studies considered, the vast majority lasted for 6 months or less, suggesting the importance of conducting long-duration studies given the characteristics of type 2 diabetes as a chronic disease.

[Bone mineral density and adequacy of dietary pattern of patients with chronic kidney disease in hemodialysis]

BACKGROUND

In chronic kidney disease (CKD) patients, malnutrition is common with loss of muscle mass and decreased bone mineral density (BMD), increasing the risk of morbidity.

OBJECTIVE

To compare body composition, bone mineral density (BMD) and bone mineral content (BMC) between CKD patients and healthy subjects, and relate these parameters with energy, macronutrients and micronutrients intake.

METHODS

Body composition was assessed 30 haemodialysis patients and compared with 28 healthy volunteers with DEXA. In patients, three 24 hours records of dietary intake were filled.

RESULTS

A significantly lower BMD (p < 0.01) and BMC (p < 0.0) were found in CKD patients. There was a trend for patients to have lower fat free mass (FFM) than controls (p = 0.06). In men, differences in BMD and BMC lost significance when adjusting for fat mass FM (%) and FFM (kg). In CKD, 34.5% and 27.6% of patients had an adequate intake of energy and protein, respectively. However, it was observed a deficit of energy and protein intake in 31.0% and 44.8% of patients, respectively. No significant correlation was found in CKD patients between macronutrient and calcium intake and BMD or BMC.

CONCLUSIONS

CKD have lower BMD and BMC than healthy volunteers. These differences lost significance in men, after adjusting for body composition parameters. A poor dietary adequacy was found in most patients with CKD, but no association was observed between these variables and body composition or bone mineral density.

[Endocrinometabolic disorders in chronic obstructive pulmonary disease]

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is characterized by the presence of chronic airflow obstruction and associated endocrinometabolic disorders, which usually worsen the clinic and prognostic of the patients. Therefore, in-depth knowledge of these prevalent disorders in patients with COPD is relevant to develop preventive measures and early detection.

PURPOSE

To analyze the prevalence of endocrinometabolic diseases that occur in COPD subjects and their related risk factors.

METHODS

We carried out a bibliographic search of the bibliographic resources of the last 10 years, including PubMed, Scopus and ScienceDirect databases. Words used were: "endocrine metabolic disorders AND COPD", "endocrine disorders AND COPD" and "metabolic disorders AND COPD". The bibliographical analysis was made in two steps. During the first phase, we excluded those articles in which the title or their content did not correspond with the objective settled; during the second phase, we deleted all the references duplicated in both databases. Finally, 17 articles after full-text critical appraisal were maintained.

RESULTS

After reviewing the articles, we found a significant relationship between diabetes mellitus, metabolic syndrome, obesity, osteoporosis, hypogonadism and COPD. Different authors have reported a higher prevalence of these comorbidities, influencing the development of COPD.

CONCLUSIONS

Due to the high prevalence and association with COPD, these comorbidities have to be considered by the health professionals related to the COPD patients. Better understanding of the endocrinometabolic disorders related to COPD can influence the treatment and the outcome of patients.

Heme- and nonheme-iron absorption and iron status 12 mo after sleeve gastrectomy and Roux-en-Y gastric bypass in morbidly obese women

BACKGROUND

The effect of bariatric surgery on iron absorption is only partially known.

OBJECTIVE

The objective was to study the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) on heme- and nonheme-iron absorption and iron status.

DESIGN

Fifty-eight menstruating women were enrolled in this prospective study [mean (±SD) age: 35.9 ± 9.1 y; weight: 101.7 ± 13.5 kg; BMI (in kg/m²): 39.9 ± 4.4]. Anthropometric, body-composition, dietary, and hematologic indexes and heme- and nonheme-iron absorption-using a standardized meal containing 3 mg Fe-were determined before and 12 mo after surgery. Forty-three subjects completed the 12-mo follow-up. Iron supplements were strictly controlled.

RESULTS

Heme-iron absorption was 23.9% before and 6.2% 12 mo after surgery (P < 0.0001). Nonheme-iron absorption decreased from 11.1% to 4.7% (P < 0.0001). No differences were observed by type of surgery. Iron intakes from all sources of supplements were 27.9 ± 6.2 mg/d in the SG group and 63.2 ± 21.1 mg/d in the RYGBP group (P < 0.001). Serum ferritin and total-body iron decreased more after RYGBP than after SG.

CONCLUSIONS

Iron (heme and nonheme) absorption is markedly reduced after SG and RYGBP. The magnitude of the decrease in heme-iron absorption is greater than that of nonheme iron. The amounts suggested as iron supplements may need to be increased to effectively prevent iron-status impairment.