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Study Group Of Hyperglycemia In Parenteral Nutrition Nutrition Area Of The Spanish Society Of Endocrinology And Nutrition Seen, Olveira G, Tapia MJ, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar MD, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García MC, García-Manzanares Á, Botella-Romero F, Quílez-Toboso RP, Cabrerizo L, Matía P, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Petrina E, Manjón L, Diéguez M, Carrera MJ, Vila-Bundo A, Urgelés JR, Aragón-Valera C, Sánchez-Vilar O, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, del Olmo D, Pereira JL, Tous MC. Prevalence of diabetes, prediabetes, and stress hyperglycemia: insulin therapy and metabolic control in patients on total parenteral nutrition (prospective multicenter study). Endocr Pract 2016; 21:59-67. [PMID: 25148810 DOI: 10.4158/ep13441.or] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The prevalence of carbohydrate metabolism disorders in patients who receive total parenteral nutrition (TPN) is not well known. These disorders can affect the treatment, metabolic control, and prognosis of affected patients. The aims of this study were to determine the prevalence in noncritically ill patients on TPN of diabetes, prediabetes, and stress hyperglycemia; the factors affecting hyperglycemia during TPN; and the insulin therapy provided and the metabolic control achieved. METHODS We undertook a prospective multicenter study involving 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included, and data were collected on demographic, clinical, and laboratory variables (glycated hemoglobin, C-reactive protein [CRP], capillary blood glucose) as well as insulin treatment. RESULTS The study included 605 patients. Before initiation of TPN, the prevalence of known diabetes was 17.4%, unknown diabetes 4.3%, stress hyperglycemia 7.1%, and prediabetes 27.8%. During TPN therapy, 50.9% of patients had at least one capillary blood glucose of >180 mg/dL. Predisposing factors were age, levels of CRP and glycated hemoglobin, the presence of diabetes, infectious complications, the number of grams of carbohydrates infused, and the administration of glucose-elevating drugs. Most (71.6%) patients were treated with insulin. The mean capillary blood glucose levels during TPN were: known diabetes (178.6 ± 46.5 mg/dL), unknown diabetes (173.9 ± 51.9), prediabetes (136.0 ± 25.4), stress hyperglycemia (146.0 ± 29.3), and normal (123.2 ± 19.9) (P<.001). CONCLUSION The prevalence of carbohydrate metabolism disorders is very high in noncritically ill patients on TPN. These disorders affect insulin treatment and the degree of metabolic control achieved.
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Affiliation(s)
| | - Gabriel Olveira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/Universidad de Málaga, Malaga, Spain CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain
| | - María J Tapia
- Unidad de Gestión Clínica de Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/Universidad de Málaga, Malaga, Spain
| | - Julia Ocón
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Carmen Cabrejas-Gómez
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | - Josefina Olivares
- Endocrinology and Nutrition Service, Hospital Son Llàtzer (Palma de Mallorca), Spain
| | - María C Conde-García
- Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain
| | - Álvaro García-Manzanares
- Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain
| | | | - Rosa P Quílez-Toboso
- Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Spain
| | - Lucio Cabrerizo
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Matía
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
| | - Luisa Chicharro
- Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Rosa Burgos
- Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Pedro Pujante
- Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mercedes Ferrer
- Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana Zugasti
- Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain
| | - Estrella Petrina
- Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain
| | - Laura Manjón
- Endocrinology and Nutrition Service, Hospital de Cabueñes. Gijón, Asturias, Spain
| | - Marta Diéguez
- Endocrinology and Nutrition Service, Hospital de Cabueñes. Gijón, Asturias, Spain
| | - María J Carrera
- Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain
| | - Anna Vila-Bundo
- Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain
| | - Juan R Urgelés
- Endocrinology and Nutrition Service, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Olga Sánchez-Vilar
- Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain
| | - Irene Bretón
- Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar García-Peris
- Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Araceli Muñoz-Garach
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Efren Márquez
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Dolores del Olmo
- Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - José Luis Pereira
- Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - María C Tous
- Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain
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Sánchez-Pernaute A, Rubio MÁ, Cabrerizo L, Ramos-Levi A, Pérez-Aguirre E, Torres A. Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients. Surg Obes Relat Dis 2015; 11:1092-8. [PMID: 26048517 DOI: 10.1016/j.soard.2015.01.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/22/2015] [Accepted: 01/29/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric operations achieve a high remission rate of type 2 diabetes in patients with morbid obesity. Malabsorptive operations usually are followed by a higher rate of metabolic improvement, though complications and secondary effects of these operations are usually higher. OBJECTIVES Analyze the results of a simplified duodenal switch, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) on patients with obesity and type 2 diabetes mellitus (T2 DM). SETTING University Hospital, Madrid, Spain. METHODS Ninety-seven T2 DM patients with a mean body mass index (BMI) of 44.3 kg/m(2) were included. Mean preoperative glycated hemoglobin was 7.6%, and mean duration of the disease was 8.5 years. Forty patients were under insulin treatment. SADI-S was completed with a sleeve gastrectomy performed over a 54 French bougie and a 200 cm common limb in 28 cases and 250 cm in 69. RESULTS Follow up was possible for 86 patients (95.5%) in the first postoperative year, 74 (92.5%) in the second, 66 (91.6%) in the third, 46 (86.7%) in the fourth and 25 out of 32 (78%) in the fifht postoperative year. Mean glycemia and glycated hemoglobin decreased immediately. Control of the disease, with HbA1c below 6%, was obtained in 70 to 84% in the long term, depending on the initial antidiabetic therapy. Most patients abandoned antidiabetic therapy after the operation. Absolute remission rate was higher for patients under oral therapy than for those under initial insulin therapy, 92.5% versus 47% in the first postoperative year, 96.4% versus 56% in the third and 75% versus 38.4% in the fifth. A short diabetes history and no need for insulin were related to a higher remission rate. Three patients had to be reoperated for recurrent hypoproteinemia. CONCLUSION SADI-S is an effective therapeutic option for obese patients with diabetes mellitus.
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Affiliation(s)
| | | | - Lucio Cabrerizo
- Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana Ramos-Levi
- Department of Endocrinology, Hospital "La Princesa," Madrid, Spain
| | | | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain
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Tapia MJ, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar MD, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García MC, García-Manzanares Á, Botella-Romero F, Quílez-Toboso RP, Cabrerizo L, Rubio MA, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Petrina E, Manjón L, Diéguez M, Carrera MJ, Vila-Bundo A, Urgelés JR, Aragón-Valera C, Sánchez-Vilar O, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, del Olmo D, Pereira JL, Tous MC, Olveira G. Nutrition-related risk indexes and long-term mortality in noncritically ill inpatients who receive total parenteral nutrition (prospective multicenter study). Clin Nutr 2014; 34:962-7. [PMID: 25466952 DOI: 10.1016/j.clnu.2014.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/15/2014] [Accepted: 10/24/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. AIMS The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). METHODS This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. RESULTS Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (<2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization). CONCLUSIONS The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization.
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Affiliation(s)
| | - María José Tapia
- UGC Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/ Universidad de Málaga, Malaga, Spain
| | - Julia Ocón
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Carmen Cabrejas-Gómez
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | - Josefina Olivares
- Endocrinology and Nutrition, Hospital Son Llàtzer (Palma de Mallorca), Spain
| | - Ma Carmen Conde-García
- Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain
| | - Álvaro García-Manzanares
- Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain
| | | | - Rosa P Quílez-Toboso
- Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Spain
| | - Lucio Cabrerizo
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
| | - Luisa Chicharro
- Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Rosa Burgos
- Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Pedro Pujante
- Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mercedes Ferrer
- Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana Zugasti
- Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain
| | - Estrella Petrina
- Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain
| | - Laura Manjón
- Endocrinology and Nutrition Service, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Marta Diéguez
- Endocrinology and Nutrition Service, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Ma José Carrera
- Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain
| | - Anna Vila-Bundo
- Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain
| | - Juan Ramón Urgelés
- Endocrinology and Nutrition Service, Hospital Universitario Son Dureta, Palma de Mallorca, Spain
| | | | - Olga Sánchez-Vilar
- Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain
| | - Irene Bretón
- Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar García-Peris
- Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Araceli Muñoz-Garach
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Efren Márquez
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Dolores del Olmo
- Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - José Luis Pereira
- Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - María C Tous
- Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Gabriel Olveira
- UGC Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/ Universidad de Málaga, Malaga, Spain; CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain.
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Ramos-Leví AM, Matía P, Cabrerizo L, Barabash A, Torrejón MJ, Sánchez-Pernaute A, Torres AJ, Rubio MA. C-peptide levels predict type 2 diabetes remission after bariatric surgery. NUTR HOSP 2014; 28:1599-603. [PMID: 24160222 DOI: 10.3305/nh.2013.28.5.6554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND C-peptide (Cp) serves as a surrogate of pancreatic beta-cell reserve. This study evaluates the clinical significance of basal Cp as a predictor of type 2 diabetes (T2D) remission after bariatric surgery (BS). RESEARCH DESIGN AND METHODS Retrospective study of 22 patients with BMI > 35 kg/m² and T2D who underwent BS. Evaluation of anthropometric and glucose metabolism parameters before BS and at one-year follow-up. Analysis of patients with T2D remission (HbA1c < 6%, fasting glucose (FG) < 100 mg/dl, absence of pharmacologic treatment) and preoperative characteristics associated (logistic binary regression model). ROC curve to estimate an optimal Cp value to predict T2D remission. RESULTS Preoperativeley (mean ± SD): age 53.3 ± 9.4 years, BMI 42.9 ± 6.8 kg/m², T2D duration 6.9 ± 5.2 years, FG 159.6 ± 56.6 mg/dL, HbA1c 7.5 ± 1.1%, Cp 4.0 ± 2.0 (median 3.8, range 0.1-8.9) ng/mL. At one year follow-up, remission of T2D in 12 cases (54.5%). Preoperative Cp correlated with 12-month HbA1c (r = -0.519, p = 0.013). Preoperative Cp was higher in those who achieved remission: 5.0 ± 1.7 vs 3.0 ± 1.7 ng/ml, p = 0,013. A Cp concentration > 3.75 ng/mL provided a clinically useful cut-off for prediction of T2D remission. T2D remission rates were different according to median preoperative Cp: 27.3% if Cp < 3.8 ng/mL and 81.7% if Cp > 3.8 ng/mL (p = 0.010). CONCLUSIONS Patients with elevated preoperative Cp levels achieve higher rates of T2D remission one year after BS. A Cp concentration > 3.75 ng/mL seems clinically useful.
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Affiliation(s)
- Ana M Ramos-Leví
- Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. IdISSC. Madrid
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Ramos-Levi AM, Matia P, Cabrerizo L, Barabash A, Sanchez-Pernaute A, Calle-Pascual AL, Torres AJ, Rubio MA. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes 2014; 6:472-7. [PMID: 24433454 DOI: 10.1111/1753-0407.12127] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/28/2013] [Accepted: 01/09/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) remission may be achieved after bariatric surgery (BS), but rates vary according to patients' baseline characteristics. The present study evaluates the relevance of several preoperative factors and develops statistical models to predict T2D remission 1 year after BS. METHODS We retrospectively studied 141 patients (57.4% women), with a preoperative diagnosis of T2D, who underwent BS in a single center (2006-2011). Anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up were recorded. Remission of T2D was defined according to consensus criteria: HbA1c <6%, fasting glucose (FG) <100 mg/dL, absence of pharmacologic treatment. The influence of several preoperative factors was explored and different statistical models to predict T2D remission were elaborated using logistic regression analysis. RESULTS Three preoperative characteristics considered individually were identified as the most powerful predictors of T2D remission: C-peptide (R2 = 0.249; odds ratio [OR] 1.652, 95% confidence interval [CI] 1.181-2.309; P = 0.003), T2D duration (R2 = 0.197; OR 0.869, 95% CI 0.808-0.935; P < 0.001), and previous insulin therapy (R2 = 0.165; OR 4.670, 95% CI 2.257-9.665; P < 0.001). High C-peptide levels, a shorter duration of T2D, and the absence of insulin therapy favored remission. Different multivariate logistic regression models were designed. When considering sex, T2D duration, and insulin treatment, remission was correctly predicted in 72.4% of cases. The model that included age, FG and C-peptide levels resulted in 83.7% correct classifications. When sex, FG, C-peptide, insulin treatment, and percentage weight loss were considered, correct classification of T2D remission was achieved in 95.9% of cases. CONCLUSION Preoperative characteristics determine T2D remission rates after BS to different extents. The use of statistical models may help clinicians reliably predict T2D remission rates after BS.
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Affiliation(s)
- Ana M Ramos-Levi
- Department of Endocrinology and Nutrition, La Princesa University Hospital, La Princesa Investigation Institute, Madrid, Spain
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Cuesta M, Pelaz L, Pérez C, Torrejón MJ, Cabrerizo L, Matía P, Pérez-Ferre N, Sánchez-Pernaute A, Torres A, Rubio MA. Fat-soluble vitamin deficiencies after bariatric surgery could be misleading if they are not appropriately adjusted. NUTR HOSP 2014; 30:118-23. [PMID: 25137270 DOI: 10.3305/nh.2014.30.1.7471] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the differences in frequency of fat-soluble vitamin deficiencies if we adjust their levels by its main carriers in plasma in patients undergoing Biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB). RESEARCH METHODS & PROCEDURES We recruited 178 patients who underwent RYGB (n = 116 patients) and BPD (n = 62 patients) in a single centre. Basal data information and one-year after surgery included: anthropometric measurements, fat-soluble vitamins A, E and D, retinol binding protein (RBP) and total cholesterol as carriers of vitamin A and E respectively. Continuous data were compared using T-Student and proportions using chisquare test. RESULTS There was a vitamin D deficiency of 96% of all patients, 10% vitamin A deficiency and 1.2% vitamin E deficiency prior to surgery. One year after surgery, 33% of patients were vitamin A deficient but the frequency reduced to 19% when we adjusted by RBP. We found a vitamin E deficiency frequency of 0% in RYGB and 4.8% in DBP one year after surgery. However, when we adjusted the serum levels to total cholesterol, we found an increased frequency of 8.7% in RYGB group for vitamin E deficiency and 21.4% in DBP (p = 0.04). CONCLUSION We have found a different frequency of deficit for fat-soluble vitamin both in BPD and RYGB once we have adjusted for its main carriers. This is clinically relevant to prevent from overexposure and toxicity. We suggest that carrier molecules should be routinely requested when we assess fat-soluble vitamin status in patients who undergo malabsorptive procedures.
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Affiliation(s)
- Martín Cuesta
- Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Laura Pelaz
- Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Celia Pérez
- Department of Family Medicine. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - M José Torrejón
- Department of Clinical Analysis. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Lucio Cabrerizo
- Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Pilar Matía
- Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Natalia Pérez-Ferre
- Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Andrés Sánchez-Pernaute
- Department of Surgery. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Antonio Torres
- Department of Surgery. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
| | - Miguel A Rubio
- Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain..
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Ramos-Levi A, Sanchez-Pernaute A, Matia P, Cabrerizo L, Barabash A, Hernandez C, Calle-Pascual A, Torres A, Rubio M. Diagnosis of diabetes remission after bariatic surgery may be jeopardized by remission criteria and previous hypoglycemic treatment. Obes Surg 2014; 23:1520-6. [PMID: 23702908 DOI: 10.1007/s11695-013-0995-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Controversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients' baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin therapy (IT). METHODS We performed a retrospective study from a cohort of 657 BS from a single center (2006-2011), of which 141 (57.4 % women) had T2D. We evaluated anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. T2D remission was defined according to 2009 consensus criteria: HbA1c <6%, fasting glucose (FG) <100 mg/dL, and absence of pharmacologic treatment. We analyzed diabetes remission according to previous treatment. RESULTS Preoperative characteristic were (mean ± SD): age 53.9 ± 9.8 years, BMI 43.7 ± 5.6 kg/m2, T2D duration 7.4 ± 7.6 years, FG 160.0 ± 54.6 mg/dL, HbA1c 7.6 ± 1.6%. Fifty-six (39.7%) individuals had IT. At 1-year follow-up, 74 patients (52.5%) had diabetes remission. Percentage weight loss (%WL) and percentage excess weight loss (%EWL) were associated to remission (35.5 ± 8.1 vs. 30.2 ± 9.5 %, p = 0.001; 73.6 ± 18.4 vs. 66.3 ± 22.8%, p = 0.037, respectively). Duration of diabetes, age, and female sex were associated to nonremission: 10.3 ± 9.4 vs. 4.7 ± 3.8 years, p < 0.001; 55.1 ± 9.3 vs. 51.2 ± 9.9 years, p = 0.017; 58.9 vs. 33.3%, p = 0.004, respectively. Prior treatment revealed differences in remission rates: 67.1 % in case of oral therapy (OT) vs. 30.4% in IT, p < 0.001. OR for T2D remission in patients with previous IT, compared to those with only OT, were 0.157-0.327 (p < 0.05), adjusting by different models. CONCLUSIONS Consensus criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission.
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Affiliation(s)
- Ana Ramos-Levi
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense, C/ Prof. Martin Lagos s/n., Madrid, 28040, Spain,
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Tapia M, Olveira G, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar M, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García M, García-Manzanares Á, Botella-Romero F, Quílez-Toboso R, Cabrerizo L, Matía P, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Manjón L, Diéguez M, Carrera M, Vila-Bundo A, Urgelés J, Aragón-Valera C, Rovira A, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, Del Olmo D, Pereira J, Tous M. PP005-SUN PREVALENCE AND PREDICTORS OF HYPOGLYCEMIA DURING TOTAL PARENTERAL NUTRITION IN NONCRITICALLY ILL INPATIENTS. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Olveira G, Tapia MJ, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar MD, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García MC, García-Manzanares Á, Botella-Romero F, Quílez-Toboso RP, Cabrerizo L, Rubio MA, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Manjón L, Diéguez M, Carrera MJ, Vila-Bundo A, Urgelés JR, Aragón-Valera C, Rovira A, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, Del Olmo D, Pereira JL, Tous MC. The Subjective Global Assessment Predicts In-Hospital Mortality Better than Other Nutrition-Related Risk Indexes in Noncritically Ill Inpatients Who Receive Total Parenteral Nutrition in Spain (Prospective Multicenter Study). J Acad Nutr Diet 2013; 113:1209-18. [DOI: 10.1016/j.jand.2013.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/23/2013] [Indexed: 01/04/2023]
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Olveira G, Tapia MJ, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar MD, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García MDC, García-Manzanares A, Botella-Romero F, Quílez-Toboso RP, Cabrerizo L, Matia P, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Prieto J, Diéguez M, Carrera MJ, Vila-Bundo A, Urgelés JR, Aragón-Valera C, Rovira A, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, Del Olmo D, Pereira JL, Tous MC. Parenteral nutrition-associated hyperglycemia in non-critically ill inpatients increases the risk of in-hospital mortality (multicenter study). Diabetes Care 2013; 36:1061-6. [PMID: 23223407 PMCID: PMC3631871 DOI: 10.2337/dc12-1379] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients. RESEARCH DESIGN AND METHODS This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality. RESULTS The study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels <140 mg/dL (95% CI 1.47-21.4 mg/dL) after adjusting for age, sex, nutritional state, presence of diabetes or hyperglycemia before starting TPN, diagnosis, prior comorbidity, carbohydrates infused, use of steroid therapy, SD of blood glucose level, insulin units supplied, infectious complications, albumin, C-reactive protein, and HbA1c levels. CONCLUSIONS Hyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality.
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López-Pantoja JL, Cabranes JA, Sanchez-Quintero S, Velao M, Sanz M, Torres-Pardo B, Ancín I, Cabrerizo L, Rubio MA, Lopez-Ibor JJ, Barabash A. Personality profiles between obese and control subjects assessed with five standardized personality scales. Actas Esp Psiquiatr 2012; 40:266-274. [PMID: 23076609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/01/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIM Psychopathology may exert influence on developing and maintaining obesity. Studies of personality traits or psychopathology of personality in obesity are scarce and contradictory. The aim of this study was to compare personality profiles between obese and normal-weight subjects and to determine the most useful tool to detect differences, considering that psychological assessment and psychotherapeutical support should be included within the overall management of these patients.* METHOD We examined 55 obese subjects (mean BMI=43kg/ m2) and 66 controls (mean BMI =21.7kg/m2). We used the personality assessment tools: MCMI-II, TCI-R, EPQ-A, BIS-111 and SSS. Factorial multivariate analysis of variance was applied; with factors BMI, Gender and Age as a covariate. RESULTS Significant differences between groups were more marked in the clinical syndrome scales of MCMI-II, particularly in Major-Depression, Thought-Disorder, Anxiety, Somatoform and Alcohol-Dependence. Among obese, women scored higher than men in all scales but not significantly. We have found significant differences in normal personality dimensions between both groups in TCI-R. Obese showed higher scores in Harm Avoidance, and lower in Novelty Seeking, Persistence and Self-transcendence. The remaining tests have not been useful for differentiating personality traits between both groups. CONCLUSION Obese subjects showed different personality profiles than control subjects. The most useful scales for determining these differences might be those designed to assess pathological personality such as MCMI-II. Less important would be those intended to measure normal personality traits, such as TCI-R and EPQ-A.
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Affiliation(s)
- José L López-Pantoja
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos Madrid, España
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12
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Sánchez-Pernaute A, Rubio MÁ, Pérez Aguirre E, Barabash A, Cabrerizo L, Torres A. Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients. Surg Obes Relat Dis 2012; 9:731-5. [PMID: 22963820 DOI: 10.1016/j.soard.2012.07.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 06/26/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single-anastomosis duodenoileal bypass with sleeve gastrectomy is a simplified 1-loop duodenal switch with a 200-250 common channel. Our objective was to analyze the weight loss and metabolic results of the technique on a series of 100 consecutively operated patients at a tertiary center university hospital. METHODS A total of 100 patients consecutively underwent surgery. The criteria of inclusion were morbid obesity or metabolic disease. In the first 50 cases, the common/efferent limb measured 200 cm. The length was changed to 250 cm to reduce the hypoproteinemia rate. RESULTS No mortality and no severe complications developed. The mean excess weight loss was >95% maintained during the follow-up period. More than 90% of the patients experimented complete remission of type 2 diabetes mellitus. Two conversions to a standard duodenal switch with a longer alimentary channel were required because of recurrent hypoproteinemia. Hypertension was controlled in 98% of the patients, with a 58% remission rate. The mean number of bowel movements was 2.5/d. CONCLUSION Single-anastomosis duodenoileal bypass with sleeve gastrectomy is a simplified duodenal switch procedure that is safe and quicker to perform and offers good results for the treatment of both morbid obesity and its metabolic complications.
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Lecumberri E, Krekshi W, Matía P, Hermida C, de la Torre NG, Cabrerizo L, Rubio MÁ. Effectiveness and safety of air-filled balloon Heliosphere BAG® in 82 consecutive obese patients. Obes Surg 2012; 21:1508-12. [PMID: 21221835 DOI: 10.1007/s11695-010-0314-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intragastric balloon is a widely used technique to treat obesity that is considered to be more efficient than conservative treatment before bariatric surgery. To describe air-filled balloon (Heliosphere BAG®) effectiveness [absolute weight loss, body mass index (BMI) loss, percentage of body weight loss (BWL), percentage of excess weight loss (EWL)] and complications 6 months after its insertion. METHODS Eighty-four consecutive intragastric balloons were placed endoscopically. Individualized nutritional counseling was given. The follow-up was carried out in an endocrinology outpatient clinic. Due to the weight or height data missed in two cases, only 82 patients were included in this report, 63 women with a mean age 39 years (SD, 11.1); mean BMI, 39.1 kg/m(2) (SD, 5.8). The median follow-up was 182 days. RESULTS The mean weight loss and BMI loss were 14.5 kg (SD, 8.2); and 5.3 kg/m(2) (SD, 2.8), respectively (for difference, p < 0.001). The mean percentage of BWL was 13.4% (SD, 7.0). Of the sample, 70.4% achieved a percentage of BWL >10%. The percentage of EWL reached 33.2% (SD, 19.2). After adjusting by sex and initial BMI, absolute weight loss (p = 0.033), BMI loss (p = 0.034), percentage of BWL (p = 0.034), and percentage of EWL (p = 0.034) were inversely related to age. Absolute weight loss and BMI loss were greater in higher initial BMI, but the percentage of EWL was lower. Two spontaneous deflations occurred (3%), but only one surgical early removal (1.2%) was required. Nausea and vomiting developed in 7.4% of the patients during the first week. CONCLUSIONS Air-filled Heliosphere BAG® has been effective in achieving a relevant loss of body weight.
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Affiliation(s)
- Edurne Lecumberri
- Endocrinology and Nutrition Department, Fundación Jiménez Díaz-Capio, Avda. Reyes Católicos n 2, Madrid, Spain.
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Iglesias Rosado C, Villarino Marín AL, Martínez JA, Cabrerizo L, Gargallo M, Lorenzo H, Quiles J, Planas M, Polanco I, Romero de Ávila D, Russolillo J, Farré R, Moreno Villares JM, Riobó P, Salas-Salvadó J. [Importance of water in the hydration of the Spanish population: FESNAD 2010 document]. NUTR HOSP 2011. [PMID: 21519727 DOI: 10.3305/nh.2011.26.1.5167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
For any healthy individual, thirst is an appropriate sign to drink water, except for babies, sportsmen, and most of ill and elderly people. In these instances, it is convenient to schedule appropriate times to drink water since great demands and the physiological mechanisms that determine thirst in these situations may condition water unbalances with important consequences for health and the physical and intellectual performance. The human body has a number of mechanisms that allow keeping constant the water content by adjusting intakes and wastes. Water balance is determined by intake (consumed water, beverages, and water contained in foods) and wastes (urine, stools, the skin, and expired air from the lungs). Failure of these mechanisms and subsequent impairments in water balance may produce severe disarrangements that may threaten somebody's life. In the present document, we analyze the evidences regarding the factors conditioning water needs in the different life stages and physiological situations, as well as the consequences of water unbalance under different situations. A proper hydration may be achieved by feeding and the use of water and other liquids. Although water is the beverage by excellence and represents the ideal way of restoring the losses and get hydrated, we should be aware that, from the very beginning, we have sought other liquid sources with hydration properties. In the last decades we have increased the consumption of different beverages, with a proliferation of sugar-containing beverages. Since excessive sugar consumption has been related to obesity and other chronic conditions, it is evident that the use of these caloric beverages should be rationalized, especially in children. In this document all the considerations regarding hydration are presented and different recommendations are exposed.
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Miralles-García JM, de Pablos-Velasco P, Cabrerizo L, Pérez M, López-Gómez V. Prevalence of distal diabetic polyneuropathy using quantitative sensory methods in a population with diabetes of more than 10 years' disease duration. ACTA ACUST UNITED AC 2010; 57:414-20. [PMID: 20638348 DOI: 10.1016/j.endonu.2010.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/23/2010] [Accepted: 05/10/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Results of studies on the prevalence of distal diabetic polyneuropathy (DPN) are contradictory. Conventional methods used for the diagnosis of DPN in clinical practice have limited effectiveness. The present study aimed to assess the prevalence of DPN in a population with long-standing diabetes (more than 10 years disease duration) by measuring vibratory, thermal and tactile sensitivities with quantitative sensory devices, as well as their relationship with associated clinical risk factors. PATIENTS AND METHODS A total of 1011 diabetic patients were evaluated in a multicenter, cross-sectional, observational study. The three sensitivities were assessed by ultrabiothesiometer, aesthesiometer and thermoskin devices, respectively. The prevalence of neuropathic pain was validated by the DN4 questionnaire. RESULTS Of the 1011 cases included, 400 (39.6%) met the diagnostic criteria of DPN, while no DPN was found in the remaining 611 (60.4%). Of the 400 patients with DPN, 253 (63.2%) showed clinical manifestations, while 147 (36.8%) were diagnosed as subclinical DPN. The prevalence of DPN increased with disease duration. There was a progressive loss of the three sensitivities with increased disease duration, particularly thermal and vibratory sensitivities. This loss was statistically significant for the latter two sensitivities. Among patients with clinical DPN, 84.2% had painful neuropathic symptoms. The prevalence of DPN was positively related to micro- and macroangiopathic complications and with dyslipidemia. CONCLUSION This study reveals a high degree of underdiagnosis of DPN, most likely due to the asymptomatic nature of the disease in a considerable proportion of patients. Our observations provide evidence of the usefulness of specific equipment for quantitative and objective assessment of polyneuropathy.
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Cuervo M, Corbalán M, Baladía E, Cabrerizo L, Formiguera X, Iglesias C, Lorenzo H, Polanco I, Quiles J, Romero de Avila MD, Russolillo G, Villarino A, Alfredo Martínez J. [Comparison of dietary reference intakes (DRI) between different countries of the European Union, The United States and the World Health Organization]. NUTR HOSP 2009; 24:384-414. [PMID: 19721919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 05/15/2009] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND In Spain, there are some organizations and scientific societies that have edited reference values of recommended nutrient intake, but whose data does not always agree in terms of format and content. AIMS To review the definitions, data and methodology that other countries or groups of countries have followed to obtain and document their own reference values in order to offer basic information to facilitate the establishment of the best reference values for the Spanish population. FIELD: Review of the available information in different countries (or groups of countries) from the European Union, the United States and World Health Organization. The analysed data concerned to healthy populations. CONCLUSIONS Reference intakes differ among the examined countries according to population groups, included nutrients, methodology and frequency of published reviews. However, most of the countries define major concepts in the same way, although with different names in each country. On the other hand, most of the studied cases represent only a scientific organization in charge of the publication and update of the values of dietary reference intakes, but not in Spain. In that context, it looks convenient to reach a consensus among all Spanish organizations and scientific societies that are involved in this task, in order to establish an acceptable reference values.
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Affiliation(s)
- M Cuervo
- Instituto de Ciencias de la Alimentación, Universidad de Navarra, Spain
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Velasco MV, Casanova I, Sanchez-Pernaute A, Pérez-Aguirre E, Torres A, Puerta J, Cabrerizo L, Rubio MA. Unusual Late-Onset Wernicke’s Encephalopathy Following Vertical Banded Gastroplasty. Obes Surg 2009; 19:937-40. [DOI: 10.1007/s11695-009-9841-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 04/01/2009] [Indexed: 11/29/2022]
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García de Lorenzo A, Alvarez J, Burgos R, Cabrerizo L, Farrer K, García Almeida JM, García Luna PP, García Peris P, Llano JD, Planas M, Piñeiro G. [Management models in clinical nutrition: weaknesses and strengths]. NUTR HOSP 2009; 24:135-137. [PMID: 19593481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Accepted: 01/07/2009] [Indexed: 05/28/2023] Open
Abstract
At the 6th Abbott-SENPE Debate Forum a multidisciplinary and multiprofessional discussion was established in order to seek for the model or the models of clinical management most appropriate for Clinical Nutrition and Dietetics Units (CNAD) in Spain. The weaknesses and strengths as well as opportunities for the current systems were assessed concluding that a certain degree of disparity was observed not only due to regional differences but also to different hospital types. It was proposed, from SENPE, the creation of a working group helping to standardize the models and promote the culture of Integral Control and Change Management.
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Tinahones FJ, Rubio MA, Garrido-Sánchez L, Ruiz C, Gordillo E, Cabrerizo L, Cardona F. Green tea reduces LDL oxidability and improves vascular function. J Am Coll Nutr 2008; 27:209-13. [PMID: 18689551 DOI: 10.1080/07315724.2008.10719692] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Several different epidemiological studies have examined the association between the consumption of tea and coronary heart disease. Some, though not all, support the view that tea or flavonoids reduce the risk of cardiovascular heart disease. The aim of this study was to determine the short-to medium-term effect of a green tea extract on vascular function and lipid peroxidation as compared with placebo. METHODS The study was undertaken with 14 healthy women, none of whom were receiving any medical treatment. Measurements were made of antibodies and immune complexes by ELISA, endothelial dependent vascular function by Doppler ultrasound, and the concentration of oxidized LDL by TBARS. RESULTS The mean diameter of the brachial artery following the post-compression hyperaemia phase rose significantly (p < 0.0001) after treatment with green tea extract. Flow-mediated brachial artery vasodilation ranged from 5.68% for the placebo phase to 11.98% after the green tea extract (p = 0.02). The consumption of green tea extract was associated with a significant 37.4% reduction in the concentration of oxidized LDL (TBARS) (p = 0.017). The levels of anti-oxidized LDL IgM antibodies fell significantly after treatment (p = 0.002). CONCLUSION This study found that consumption of green tea extract by women for five weeks produced modifications in vascular function and an important decrease in serum oxidizability.
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Affiliation(s)
- F J Tinahones
- Servicio de Endocrinología, Hospital Clinico Virgen de la Victoria de Málaga, Spain.
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García de la Torre N, Rubio MA, Bordiú E, Cabrerizo L, Aparicio E, Hernández C, Sánchez-Pernaute A, Díez-Valladares L, Torres AJ, Puente M, Charro AL. Effects of weight loss after bariatric surgery for morbid obesity on vascular endothelial growth factor-A, adipocytokines, and insulin. J Clin Endocrinol Metab 2008; 93:4276-81. [PMID: 18713823 DOI: 10.1210/jc.2007-1370] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adipocytes regulate blood vessel formation, and in turn endothelial cells promote preadipocyte differentiation through the expression of proangiogenic factors, such as vascular endothelial growth factor (VEGF)-A. Some adipocytokines and hormones also have an effect on vascular development. OBJECTIVES Our objectives were to analyze the relationship between weight and circulating VEGF-A in morbidly obese subjects before and after bariatric surgery, and investigate the relationship between circulating VEGF-A and certain adipocytokines and hormones regulating adipocytes. METHODS A total of 45 morbidly obese women and nine lean females were included in the study. Patients underwent bariatric surgery: vertical banded gastroplasty (n=17), gastric bypass (n=17), and biliopancreatic diversion (n=11). Serum samples for VEGF-A, adiponectin, leptin, ghrelin, and insulin were obtained preoperatively and 9-12 months after surgery. RESULTS Obese patients showed significantly higher VEGF-A levels than controls (306.3+/-170.3 vs. 187.6+/-91.9 pg/ml; P=0.04), decreasing to 246.1+/-160.4 after surgery (P<0.001), with no differences among surgical procedures. In controls there was an inverse correlation between VEGF-A and ghrelin (r=-0.85; P<.01), but not in obese patients. Leptin and insulin concentrations were increased in obese patients, with a significant decrease shown after weight loss with surgery. Conversely, adiponectin concentrations were lower in obese patients, with a significant increase shown after weight loss with surgery. Ghrelin was higher in controls than obese patients, decreasing after gastric bypass and biliopancreatic diversion, but not after vertical banded gastroplasty. CONCLUSION Serum VEGF-A levels are significantly higher in obese patients than in lean controls, decreasing after weight loss with bariatric surgery, behaving similarly to other hormones related to adipose mass like leptin and insulin.
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Affiliation(s)
- Nuria García de la Torre
- Department of Endocrinology, Hospital Clínico Universitario San Carlos, Martín Lagos s/n, 28040 Madrid, Spain.
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Duran A, Runkle I, Matía P, de Miguel MP, Garrido S, Cervera E, Fernandez MD, Torres P, Lillo T, Martin P, Cabrerizo L, de la Torre NG, Calle JR, Ibarra J, Charro AL, Calle-Pascual AL. Family physician and endocrinologist coordination as the basis for diabetes care in clinical practice. BMC Endocr Disord 2008; 8:9. [PMID: 18671870 PMCID: PMC2518542 DOI: 10.1186/1472-6823-8-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 07/31/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To estimate the proportion of diabetic patients (DPts) with peripheral vascular disease treated at a primary health care site after an endocrinologist-based intervention, who meet ATP III and Steno targets of metabolic control, as well as to compare the outcome with the results of the patients treated by endocrinologists. METHODS A controlled, prospective over 30-months period study was conducted in area 7 of Madrid. One hundred twenty six eligible diabetic patients diagnosed as having peripheral vascular disease between January 2003 and June 2004 were included in the study. After a treatment period of three months by the Diabetes team at St Carlos Hospital, 63 patients were randomly assigned to continue their follow up by diabetes team (Group A) and other 63 to be treated by the family physicians (FP) at primary care level with continuous diabetes team coordination (Group B). 57 DPts from Group A and 59 from Group B, completed the 30 months follow-up period. At baseline both groups were similar in age, weight, time from diagnosis and metabolic control. The main outcomes of this study were the proportion of patients meeting ATP III and Steno goals for HbA1c (%), Cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood pressure, albumine-to-creatinine excretion ratio (ACR), body mass index (BMI), waist circumference (WC), anti-aggregation treatment and smoking status. RESULTS At the end of the follow up, no differences were found between the groups. More than 37% of diabetic patients assigned to be treated by FP achieved a HbA1c < 6.5%, more than 50% a ACR < 30 mg/g, and more than 80% reached low risk values for cholesterol, LDL cholesterol, triglycerides, diastolic blood pressure and were anti-aggregated, and 12% remained smokers. In contrast, less than 45% achieved a systolic blood pressure < 130 mm Hg, less than 12% had a BMI < 25 Kg.m-2 (versus 23% in group A; p < 0.05) and 49%/30% (men/women) had a waist circumference of low risk. CONCLUSION Improvements in metabolic control among diabetic patients with peripheral vascular disease treated at a primary health care setting is possible, reaching similar results to the patients treated at a specialized level. Despite such an improvement, body weight control remains more than poor in both levels, mainly at primary care level. General practitioner and endocrinologist coordination care may be important to enhance diabetes management in primary care settings. TRIAL REGISTRATION Clinical Trial number ISRCTN75037597.
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Affiliation(s)
- Alejandra Duran
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Isabelle Runkle
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Matía
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Maria P de Miguel
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Sofia Garrido
- Unidad de Formación e Investigación de Atención Primaria, Área 7, Madrid, Spain
| | - Emilio Cervera
- Unidad de Formación e Investigación de Atención Primaria, Área 7, Madrid, Spain
| | - Maria D Fernandez
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Torres
- Dirección Médica, coordinación atención primaria-especializada, Hospital Clínico San Carlos, Madrid, Spain
| | - Tomas Lillo
- Dirección Médica, coordinación atención primaria-especializada, Hospital Clínico San Carlos, Madrid, Spain
| | - Patricia Martin
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Lucio Cabrerizo
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Jose R Calle
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Jose Ibarra
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Aniceto L Charro
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
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Sánchez-Pernaute A, Rubio Herrera MA, Pérez-Aguirre E, García Pérez JC, Cabrerizo L, Díez Valladares L, Fernández C, Talavera P, Torres A. Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy: proposed technique. Obes Surg 2007; 17:1614-8. [PMID: 18040751 DOI: 10.1007/s11695-007-9287-8] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 07/22/2007] [Indexed: 12/19/2022]
Abstract
Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy is a new bariatric technique based on the biliopancreatic diversion with duodenal switch in which after the sleeve gastrectomy, the duodenum is anastomosed to the ileum in a Billroth-II fashion. A 200-cm common channel-alimentary limb is devised. Anticipating an appropriate weight loss, at least similar to that obtained after gastric bypass, theoretical benefits for operated patients are a shorter operative time, the performance of only one anastomosis, and no mesentery opening. A prospective trial is now being conducted to find out the results of the procedure and to compare them to those obtained with gastric bypass and standard duodenal switch.
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Affiliation(s)
- Andrés Sánchez-Pernaute
- Department of Surgery, Hospital Clínico San Carlos, Servicio de Cirugía 2, 7a planta, ala Norte, c/Martín Lago s/n, Madrid 28040, Spain.
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Sánchez-Pernaute A, Pérez-Aguirre E, Talavera P, Robin A, Díez-Valladares L, Cabrerizo L, Rubio MA, Méndez R, Santos E, Torres A. Mucocele of the gastric tube after conversion of vertical banded gastroplasty to duodenal switch: not just a radiological image. Obes Surg 2006; 16:524-7. [PMID: 16608621 DOI: 10.1381/096089206776327198] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present two patients who underwent a duodenal switch operation after a failed vertical banded gastroplasty. Both patients had a complicated postoperative course because of an abdominal infection, and both presented the radiological image of a gastric fundus mucocele in the part of the fundus excluded between two staple-lines. Although initially considered as a radiological image with no clinical significance, the presentation of the second case with the same abdominal complication led us to contemplate the possibility of a connection between the gastric mucocele and the postoperative infection.
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Affiliation(s)
- Andrés Sánchez-Pernaute
- Department of Surgery III, Hospital Clínico San Carlos, c/Martin Lago s/n, 28040 Madrid, Spain.
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Rubio JA, Rubio MA, Cabrerizo L, Burdaspal P, Carretero R, Gómez-Gerique JA, Montoya MT, Maestro ML, Sanz MT, Fernández C. Effects of pork vs veal consumption on serum lipids in healthy subjects. NUTR HOSP 2006; 21:75-83. [PMID: 16562817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
AIMS To analyse the influence of lean pork (P) and veal (V) consumption on the lipid profile of healthy subjects within the framework of a healthy diet comprising low levels of total fat (TF), saturated fatty acids (SFA) and cholesterol. DESIGN Double-crossover, randomized and controlled trial SUBJECTS 44 healthy individuals (22 male and 22 female), recruited voluntarily from the University Complutense of Madrid. The weight and lipid profiles of these volunteers were normal and their dietary patterns were typical for people in our area. INTERVENTIONS The study comprised 4 phases: stabilisation phase (5 weeks), the participants followed their normal diet; second phase (6 weeks), half of the subjects, were randomised to lean pork or veal consumption, 150 g per day, for their main meal of the day; washout period (5 weeks) and final phase, which was the second phase of intervention (6 weeks). During the intervention stages, only the main meal of the day was taken in the Hospital. The rest of the subjects' diets consisted of different fortnightly menus designed in accordance with the recommendations of the Spanish Society of Arteriosclerosis (SEA). RESULTS After both stages of intervention had been completed, there was a mean reduction of 5.5% in low-density lipoprotein cholesterol. However, after each intervention there were no significant differences between those who had consumed P, 2.62 (0.55) mmol/L and those who had consumed V, 2.71 (0.47) mmol/L. No differences were observed in any of the other parameters between those who had consumed P and those who had consumed V. CONCLUSIONS Lean pork and veal produces similar effects on the lipid profiles of healthy subjects. Its consumption, as part of the saturated fat and cholesterol-controlled diet, could therefore be included in food guidelines, both for normal and therapeutic diets.
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Affiliation(s)
- J A Rubio
- Department of Endocrinology and Nutrition, Príncipe de Asturias University Hospita, Madrid, España.
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León-Sanz M, García-Luna PP, Sanz-París A, Gómez-Candela C, Casimiro C, Chamorro J, Pereira-Cunill JL, Martin-Palmero A, Trallero R, Martínez J, Ordóñez FJ, García-Peris P, Camarero E, Gómez-Enterría P, Cabrerizo L, Perez-de-la-Cruz A, Sánchez C, García-de-Lorenzo A, Rodríguez N, Usán L. Glycemic and lipid control in hospitalized type 2 diabetic patients: evaluation of 2 enteral nutrition formulas (low carbohydrate-high monounsaturated fat vs high carbohydrate). JPEN J Parenter Enteral Nutr 2005; 29:21-9. [PMID: 15715270 DOI: 10.1177/014860710502900121] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Type 2 diabetic patients may need enteral nutrition support as part of their treatment. The objective was to compare glycemic and lipid control in hospitalized patients with type 2 diabetes requiring feeding via nasogastric tube using enteral feedings with either a highcarbohydrate or a high-monounsaturated-fat content. METHODS This trial included type 2 diabetes patients admitted to the hospital for neurologic disorders or head and neck cancer surgery who received either a low-carbohydrate-high-mono-unsaturated-fat (Glucerna) or a high-carbohydrate diet (Precitene Diabet). Glycemic and lipid control was determined weekly. Safety and gastrointestinal tolerance were also assessed. RESULTS A total of 104 patients were randomized and 63 were evaluable according to preestablished protocol criteria. Median duration of therapy was 13 days in both groups. Mean glucose was significantly increased at 7 days of treatment (p = .006) in the Precitene arm, with no significant variations in the Glucerna arm. Mean weekly blood triglycerides levels in the Precitene arm were increased without reaching statistical significance, whereas patients in the Glucerna arm showed a stable trend. Patients in the Precitene arm showed a significantly higher incidence of diarrhea than patients in Glucerna arm (p = .008), whereas the incidence of nausea was smaller in the Precitene arm than in the Glucerna arm (p = .03). CONCLUSIONS An enteral formula with lower carbohydrate and higher monounsaturated fat (Glucerna) has a neutral effect on glycemic control and lipid metabolism in type 2 diabetic patients compared with a high-carbohydrate and a lower-fat formula (Precitene Diabet).
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Rojas-Marcos PM, Rubio MA, Kreskshi WI, Cabrerizo L, Sánchez-Pernaute A. Severe Hypocalcemia following Total Thyroidectomy after Biliopancreatic Diversion. Obes Surg 2005; 15:431-4. [PMID: 15826482 DOI: 10.1381/0960892053576712] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients undergoing malabsoprtive operations for bariatric surgery are prone to disturbances of bone metabolism, but this does not commonly lead to clinical symptoms. We present a morbidly obese patient who had undergone the biliopancreatic diversion of Larrad, and presented clinical symptoms of severe hypocalcemia and tetany after total thyroidectomy. Very high doses of i.v. calcium and calcitriol and 10 days of hospitalization were required to control the symptoms and correct plasma levels. The physiological aspects that contribute to this situation are discussed.
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Affiliation(s)
- P Martin Rojas-Marcos
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Madrid, Spain.
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Affiliation(s)
- Fidel Toldrá
- Instituto de Agroquimica y Tecnologia de Alimentos (CSIC), PO Box 73, 46100 Burjassot, Valencia, Spain
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Rubio M, Moreno C, Cabrerizo L. Guías para el tratamiento de las dislipemias en el adulto: Adult Treatment Panel III (ATP-III). ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1575-0922(04)74614-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alvarez Bartolomé M, Borque M, Martinez-Sarmiento J, Aparicio E, Hernández C, Cabrerizo L, Fernández-Represa JA. Peptide YY secretion in morbidly obese patients before and after vertical banded gastroplasty. Obes Surg 2002; 12:324-7. [PMID: 12082881 DOI: 10.1381/096089202321088084] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Peptide YY (PYY) secretion pattern was assessed in morbidly obese (MO) patients before and after vertical banded gastroplasty (VBG). METHODS 12 MO patients (10 women, 2 men) age 29-62 years, BMI 50.7 +/- 9.6 kg/m2, treated with a VBG were studied. Before surgery, blood samples were taken in basal conditions of fasting and 10, 15, 20, 30 and 60 min after the ingestion of a semiliquid test meal. This was repeated in the same patients 6 and 12 months after VBG. Blood samples were also taken from 6 healthy non-obese subjects as controls. PYY plasma concentration was measured by radioimmunoassay with I125. RESULTS There were statistically significant differences between the preoperative PYY concentration in MO patients compared to controls. After a VBG, PYY concentration varied significantly compared to the preoperative levels. There was no significant difference between the PYY concentrations in the MO patients after VBG and the controls. CONCLUSION PYY concentration is lower in MO patients compared with non-obese. After VBG, PYY concentration gradually rises to the control levels.
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Ballesteros MD, Rubio MA, Redondo MJ, Cabrerizo L, Romeo S, Alonso JL, Nieto YL, Ayala F, Martín M. [Parenteral nutrition of patients under intensive chemotherapy: comparative study of two lipid emulsions]. NUTR HOSP 1998; 13:177-80. [PMID: 9780749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Neoplastic patients receiving intensive chemotherapy often need total parenteral nutrition (TPN), with lipid emulsions based on long-chain triglycerides (LCT) or medium-chain triglycerides (MCT). Potential benefits of MCT include easier metabolism and limited storage. Our present investigation was performed to define if there is any real clinical advantage of any of these lipid emulsions in this group of patients. Fifty-one patients receiving the LCT emulsion and sixty of them receiving the MCT-LCT one were evaluated retrospectively. TPN with 40% of non-protein kilocalories as fat was administered during a mean time of 11.5 days. No differences in total cholesterol, albumin, prealbumin, transferrin, bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase and transaminases were found between both groups, neither in nitrogen balances. In conclusion, in a group of neoplastic patients receiving intensive chemotherapy, we did not found any advantage of TPN with LCT or MCT-LCT either in nutritional laboratory parameters or in liver function.
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Affiliation(s)
- M D Ballesteros
- Servicios de Endocrinología y Nutrición y Oncología Médica, Hospital Universitario San Carlos, Madrid, España
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Oliván B, Tejerina E, Rodríguez-Coira A, Rubio MA, Cabrerizo L, Romeo S. [Consumption of fish fats: effect on plasma lipids]. Rev Clin Esp 1988; 183:452-4. [PMID: 3238097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Calle Pascual AL, Bordiu E, Romeo S, Cabrerizo L, Marañes JP. [Diets with a high carbohydrate content and with fiber supplements in diabetes mellitus. I. Effect on blood sugar control]. Med Clin (Barc) 1984; 83:271-5. [PMID: 6092794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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