El sobrepeso y la obesidad como un problema de salud / Overweight and obesity as an universal health problem

Se destaca al sobrepeso y obesidad como el principal condicionante actual de patología crónica no transmisible. Se identifican y discuten las principales comorbilidades asociadas al sobrepeso y obesidad, analizando las evidencias que las apoyan. Se destaca el rol de la adiposidad en la etiopatogenia del síndrome metabólico y en forma muy especial de la DM. Se analiza la asociación entre indicadores de masa corporal y tejido adiposo y tasas de mortalidad, destacando un significativo incremento de la mortalidad a medida que la masa corporal o grasa se incrementa. Se destacan los rangos asociados a la menor mortalidad, nadires que fundamentan los rangos de peso normal. Se discute en forma separada la asociación entre sobrepeso yobesidad en la infancia y adolescencia y salud, en especial su posible rol en la incidencia de patologías crónicas al alcanzar la adultez.

The article highlights overweight and obesity as the main factor in some current chronic diseases. Also it identifies and discusses major co-morbidities associated with overweight and obesity, analyzing the evidence that support them. The role of adiposity in the pathogenesis of metabolic syndrome especially in the development of mellitus diabetes 2 is discussed. We analyze the association between indicators of body mass and adipose tissue and mortality, highlighting a significant increase in mortality as the fat body mass increases and shows the range associated with lower mortality, basing the normal weight ranges. Will be discussing separately the association between overweight and obesity in childhood and adolescence health, especially its possible role in the incidence of chronic diseases that will develop at adulthood.

Hipercolesterolemia familiar heterocigota: diagnóstico molecular y terapia combinada. Caso clínico / Molecular diagnosis and combined lipid lowering therapy of heterozygous familial hypercholesterolemia: Report of one case

Heterozygous familial hypercholesterolemia affects one every 400 individuals, is caused by mutations in the LDL receptor gene and is associated with premature coronary artery disease. Nowadays, LDL cholesterol can be efficiently reduced with the new therapies to reduce blood lipids. We report a female patient who consulted in 1975, when she was 46 years old, for severe hypercholesterolemia. In 2003, a sample of leukocyte DNA was obtained and the uncommon 1705 + 1G >A mutation of the LDL receptor gene was detected. No mutations in the apolipoprotein B gene were found. The patient was treated successfully with simvastatin 80 mg/day and ezetimibe 10 mg/day and LDL cholesterol levels were reduced below 200 mg/dl.

Terapia hipolepemiante intensiva en el manejo del riesgo cardiovascular ateroesclerótico / Intensive cholesterol lowering therapy to reduce cardiovascular risk

Primary and secondary prevention trials have clearly demonstrated that lowering serum cholesterol levels with statins reduces the incidence of cardiovascular events. Recent studies plus post hoc analysis of previous clinical trials show that risk reduction is proportional to the magnitude of LDL cholesterol lowering. Therefore, new recommendations of the National Cholesterol Education Program (USA) have defined a category of patients with very high cardiovascular risk, who should achieve serum LDL cholesterol levels below 70 mg/dl. This proposal will require new and more efficient pharmacologic strategies to attain the increasingly strict therapeutic goals for LDL cholesterol. This article reviews the clinical studies that support the use of intensive lipid lowering therapy to reduce cardiovascular risk. An effective reduction of serum cholesterol can be obtained using statins in high doses or a combination of hypolipidemic drugs with different mechanisms of action.

El colesterol HDL: ¿un nuevo objetivo terapéutico en el manejo de las dislipidemias y la ateroesclerosis? / HDL cholesterol: A new target in the treatment of lipid disorders and atherosclerosis?

Low plasma HDL cholesterol levels are an independent risk factor for atherosclerotic cardiovascular disease. During the past years, the study of HDL has been stimulated by the discovery of novel genes and proteins, which have provided new insights into the molecular and cellular mechanisms involved in HDL metabolism. In addition, recent clinical studies focused on treating low HDL as primary objective in high cardiovascular risk patients have been very encouraging. Furthermore, new drugs for raising HDL cholesterol are under development. This article reviews the recent progress in the HDL field and its important implications for the pathophysiology and treatment of atherosclerosis. In the near future, we expect that new drugs with specific and beneficial effects on HDL metabolism and the associated cardiovascular risk should improve the current approach to this disease with high burden on health systems and society.

Sensibilidad a la insulina: ausencia de diferencias sexuales al expresarla en función de la masa magra / Insulin sensitivity: absence of sexual differences when expressed as a function of lean body mass

The hyperinsulinemic, euglycemic clamp techinque was used to test the hypothesis that - when expressed per kiligram of lean body mass - there is a sex-difference in peripheral insulin-mediated glucose disposal (M), as proposed in the literature. Lean body mass wass assessed with tetrapolar bioelectric impedance analysis. We studied 15 normal subjects (volunteers with normal glucose tolerance and body mass indices between 20-25 Kg/m2) of both sexes, 9 women and 6 men, of age-groups, 20-30 year-old and 40-50 year-old. Men and women were similarly aged (33.3 ñ 3.8 and 33.3 ñ 3.8 years, respectively). body mass indices were similar in both sexes (22.5 ñ 0.6 in women and 23.6 ñ 0.7 in men, NS) but percentages of fat mass were not (294 ñ 1.2 in women and 20.6 ñ 1.6 in men, p < 0.001). As no difference in M (mg of glucose metabolized per kilogram of body weight per minute) between age-groups was found (6.4 ñ 0.8 snf 6.8 ñ 1.2 mg/Kg/min, Ns) the data from these 2 age-groups were pooled. When M values obtained in both sexes were compared no differences were found (7.1 ñ 1.5 mg/Kg/min in women and 6.3 ñ 0.6 in men, NS). Similarly, when M was expressed in function of the prevailing insulin levels attained during steady-state, M/l, no differences were disclosed (8.98 ñ 2 mg/Kg/min/µIU insulin in women and 7.8 ñ 1.2 in men, NS). When M was expressed per kilogram of lean body mass, Mmm, the values were similar in both sexes (8.99 ñ 1.86 m/kg lean body mass/min in women and 8.94 ñ 0.8 in men, NS). Finally, another maneuver commonly used to normalize MJ in function of metabolic size, expresing it per square meter of body surface, Ma, failed to disclose a sex-differnce (225.5 ñ 20.6 mg/m2/min in women and 263.5 ñ 52.8 in men, NS). We conclude that no sex-difference exists in M when expressed per kilogram of lean body mass, thus contradicting previous data published elsewhere

Efecto del bloqueo androgénico periférico sobre las lipoproteinas plasmáticas en pacientes hirsutas / Effect of peripheral androgenic blockade upon plasma lipoproteins in female patients with hirsutism

We studied the effect of flutamide, a peripheral androgenic blocking agent, 500 mg daily for days in 7 non ovalating patients with hirsutism. Totañl and HDL cholestero, triglycerides, testosterone and dehydroepiandrosterone sulphate (S-DHEA) plasma levels were measured in patients and in 6 non ovulating control women of similar age and weight. Only basal HDL levels were lower in patients than in controls (40.2 ñ 1.6 vs 51.4 weight Only basal HDL levels were lower in patients than in controls (40.2 ñ 1.6 vs 51.4 ñ 3.3mg/dl, p < 0.01). A decrease in S-DHEA levels was observed after flutamide in patients with hirsutism (3.2 ñ 0.4 to 2.1 ñ 0.4, p < 0.01) which may be attributed to the lowering of cortisol clearance induced by the drug. total testosterone and plasma lipoproteins reamined stable. Thus, peripheral androgenic blockade does not modify the decreased levels of HDL cholesterol in non ovulating patients with hirsutim

Alcohol y factores de riesgo de cardiopatía coronaria: estudio en 571 hombres / Alcohol and risk factors for coronary heart disease: a study in 571 males

In 571 health professional males we correlated alcohol consumption with serum total cholesterol (C), HDL-C, triglycerides, blood sugarm cigarette consumption, body mass index and arterial blood pressure. An autstanding finding was a positive independent, correlation of alcohol consumption and serum HDL-C levels (r0.22, p<0.0001). Univariate analysis showed correlation of alcohol consumption woth body mass index, blood pressure and total serum C, however this was dependent on age and/or body mass. No correlation was found between alcohol consumption and blood sugar or TG levels. Alcohol consumption did not identify a group of subjects with high risk factors. Consumption of more than 10 cigarettes per day decreased the strenght of the association between elevated HDL levels and alcohol consumption. We conclude that a moderate intake of alcohol is associated to increased serum HDL levels with no significant change of other coronary risk factors

Colesteramina en el tratamiento de la hipercolesterolemia: experiencia en 11 casos / Cholestyramine therapy for severe hypercholesterolemia: results in 11 patients

Bile acid sequestrant resing are considered agents of choice in the therapy of hypercholesterolemia non responsive to diet treatment. We evaluated the effects of cholestyramine, 12 g per day during 4 weeks, in 11 adult patients with severe hypercholesterolemia. Total cholesterol decreased fom 414 ñ 112 to 302 ñ 140 mg/dl (28%), LDL cholesterol from 330 ñ 122 to 226 ñ 143 (33%) and Apo B lipoprotein from 141 ñ 31 to 115 ñ 34 mg/dl (18%), p < 0.01. HDL cholesterol including fractions HSL2 and HDL3, Apo A1 and Triglyceride levels were not modified. No significant side effects on gastrointestinal function were observed. Thus, we confirm that cholestyramine is an effective therapy for severe hypercholesterolemia