Beneficial changes on plasma apolipoproteins A and B, high density lipoproteins and oxidized low density lipoproteins in obese women after bariatric surgery: comparison between gastric bypass and sleeve gastrectomy.

BACKGROUND: The beneficial effects in lipid profiles after obesity surgery might be associated with the decrease in cardiovascular risk. However, direct comparison between different surgical techniques has not been extensively performed. METHODS: In the present study we compare 20 obese women submitted to laparoscopic Roux en Y gastric bypass (RYGB) with 20 women submitted to sleeve gastrectomy (SG). Twenty control women matched for age and baseline cardiovascular risk were also included. Both patients and controls were followed up for 1 year after surgery or conventional treatment with diet and exercise, respectively. Lipid profiles were measured at baseline, 6 and 12 months later. Carotid intima-media thickness was measured by ultrasonography at baseline and at the end of the study. RESULTS: Women submitted to bariatric surgery showed a decrease in total cholesterol, triglycerides, oxidized-LDL and ApoB, and an increase in HDL and ApoA concentrations that occurred regardless of the surgical procedure. LDL concentrations, however, decreased only after RYGB whereas Lp(a) showed no changes. We did not observe any correlation between the changes in serum lipid concentrations and those in carotid intima-media thickness. CONCLUSIONS: Sleeve gastrectomy and gastric bypass induce a similar beneficial effect on serum lipids in women with high cardiovascular risk 1 year after surgery.

Carga de la enfermedad atribuible al hipotiroidismo subclínico en la población española / Burden of illness attributable to subclinical hypothyroidism in the Spanish population

Introducción. El hipotiroidismo subclínico (HS) se ha asociado a enfermedades cardiovasculares, pero se desconoce la pérdida de salud que conlleva. Hemos evaluado la carga de enfermedad del HS en España. Pacientes y métodos. A partir de la prevalencia del HS en España obtenida de estudios internacionales, se llevó a cabo un modelo teórico que calculó los años de vida ajustados por discapacidad (AVAD), los años de vida perdidos (AVP), y las pérdidas de salud por discapacidad (AVD) asociados al HS. Las prevalencias de los factores de riesgo, el riesgo de mortalidad coronaria, y de episodios coronarios asociados al HS se obtuvieron de una revisión de la literatura. El análisis se llevó a cabo según la metodología de la Organización Mundial de la Salud, utilizando fuentes oficiales españolas (registro de altas hospitalarias: conjunto mínimo básico de datos [CMBD], registro de mortalidad hospitalaria, etc.). Resultados. En España hay aproximadamente 2.767.124 personas con HS (1.949.820 con niveles de TSH entre 4,5 y 6,9mUI/l [70,5%], 538.988 con TSH entre 7 y 9,9mUI/l [19,5%], y 278.317 con TSH entre 10 y 19,9mUI/l [10%]). Estas personas con HS podrían sufrir 12.608 episodios cardiacos y 1.388 muertes cardiacas anuales, lo que representa 30.550 AVAD (13.124 AVP y 17.426 AVD). El HS puede representar entre el 1,6 y el 7,3% de los AVAD cardiovasculares. Conclusión. El HS es una condición silente que determina una enorme carga de enfermedad. La valoración del HS, al menos en los pacientes pertenecientes a grupos de riesgo, podría ser coste-efectiva (AU)

Introduction. Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. Patients and methods. Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. Results. In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. Conclusion. SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective (AU)

Burden of illness attributable to subclinical hypothyroidism in the Spanish population.

INTRODUCTION: Subclinical hypothyroidism (SH) has been associated recently to cardiovascular diseases. However, the loss of health it entails remains unknown. This study has assessed the burden of illness attributable to SH in Spain. PATIENTS AND METHODS: Based on the Spanish prevalence data found in international studies, a theoretical model was developed to estimate the Disability Adjusted Life Years (DALYs), Years of Life Lost (YLL) and Years Lost due to Disability (YLD) associated with SH. Prevalence of risk factors, coronary mortality risk and coronary event risk associated with SH were obtained from a review of the literature. An analysis was conducted according to the World Health Organization methodology approach for these studies, using official Spanish sources (hospital discharge records, minimum basic data set [MBDS], inpatient mortality records, etc. RESULTS: In Spain, approximately 2,767,124 people have SH, specifically 1,949,820 with levels of TSH between 4.5 and 6.9mIU/l (70.5%), 538,988 with levels between 7 and 9.9mIU/l (19.5%), and 278,317 between 10 and 19.9mIU/l (10%). These subjects suffer approximately 12,608 cardiac events and 1,388 deaths a year attributed to their SH. This represents 30,550 DALYs (13,124 YLL and 17,426 YLD). Between 1.6 and 7.3% of cardiovascular DALYs can be attributed to SH. CONCLUSION: SH is a silent disease which considerably increases the burden of disease. Evaluation of SH, at least in patients belonging to risk groups, could be cost-effective.

Circulating free testosterone in obese men after bariatric surgery increases in parallel with insulin sensitivity.

BACKGROUND AND AIM: Male hypogonadism has been linked to obesity and diabetes. We aimed to study the association of changes in insulin sensitivity and testosterone levels in severe obese patients submitted to bariatric surgery. SUBJECTS AND METHODS: Prospective intervention study with twenty consecutive patients who underwent bariatric surgery studied before and after significant weight loss. Serum testosterone, SHBG, fasting glucose, and insulin were measured among others. Free testosterone was calculated with the Vermeulen formula and insulin sensitivity with the homeostatic model assessment (HOMA). RESULTS: At baseline, thirteen patients had low total testosterone levels, whereas eight of these patients also had free testosterone levels below the reference range obtained from the control group. After bariatric surgery total testosterone, SHBG, and free testosterone significantly increased and achieved normal values in all evaluated patients. Insulin sensitivity improved in all of them. Multivariate linear regression showed that changes in fasting glucose (ß=-1.868, p=0.001), insulin (ß=-3.782, p=0.001), weight (ß=-0.622, p=0.002), and SHBG (ß=-0.635, p=0.022) were associated with changes in free testosterone (adjusted R2=0.936, F=26.613, p=0.001). When insulin resistance calculated by HOMA was in the model instead of insulin and glucose, it also was associated (ß=-3.488, p=0.008) with free testosterone (adjusted R2=0.821, F=11.111, p=0.005). CONCLUSIONS: Circulating tes tos terone in obese men increases after bariatric surgery in parallel with an improvement in insulin sensitivity.

[Percutaneous gastrostomy complicated with abdominal wall hematoma; severe anemia secondary to percutaneous endoscopic gastrostomy]. / Gastrostomía percutánea complicada con hematoma de pared abdominal; anemización severa secundaria a gastrostomía endoscópica percutánea.

Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review.

Gastrostomía percutánea complicada con hematoma de pared abdominal; anemización severa secundaria a gastrostomía endoscópica percutánea / Percutaneous gastrostomy complicated with abdominal wall hematoma; severe anemia secondary to percutaneous endoscopic gastrostomy

Introducción: La Gastrostomía Percutánea Endoscópica (PEG), es un método seguro y efectivo que ofrece claras ventajas respecto a la alimentación por sonda naso-gástrica para conseguir una nutrición adecuada en pacientes con problemas de deglución, pero que mantienen intacto el sistema digestivo. Sin embargo, a pesar de ser considerada una técnica segura no está exenta de complicaciones graves. Presentamos una paciente con disfagia que tras la práctica de la gastrostomía endoscópica percutánea desarrolla una anemización severa con gran hematoma subcutáneo, dado lo excepcional del caso y revisamos la literatura (AU)

Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review (AU)

Chylous ascytes secondary to acute pancreatitis: a case report and review of literature.

Chylous ascites is an uncommon finding which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is usually caused by a chronic disruption of the lymphatic system. The present report is one of the rare cases in the literature of chylous ascites secondary to idiopathic acute pancreatitis, which showed a complete resolution with a combination of low fat enteral nutrition with MCT and somatostatin analogs.

[Influence of weight loss in the clinical evolution, metabolic and psychological of the patients with overweight or obesity]. / Influencia de la pérdida de peso en la evolución clínica, metabólica y psicológica de los pacientes con sobrepeso u obesidad.

INTRODUCTION AND OBJECTIVE: The clinical evolution and psychological well-being of patients with overweight or obesity is still a matter of controversy. The aim of this study is to know the impact of the loss of weight on the evolution of the alterations both clinical and metabolic as psychological in patients with overweight or obesity. PATIENTS AND METHOD: We studied a cohort of 192 patients randomly chosen. All of them were characterized clinically and biochemically. Autoadministered questionnaires were used which were already validated in the Spanish population:the General Health Questionnaire (GHQ-28), and bulimia subescale, the Eating Disorder Inventary (EDI). For the statistical analysis using the statistical program SPSS 15.0. Data are expressed as mean (standard deviation). RESULTS: The weight loss was 3.77 (4.85) kilograms, equivalent to a 3.8 (4.86)% of the total weight, the diameter of the waist was reduced by 3.78 (5.89) centimeters, systolic blood pressure was reduced by 3.36 (15.61) mmHg and diastolic in 2.15 (11.26) mmHg. We also found a decreased significantly of glucose levels 7.37(21.23) mg/dl, insulin levels 2.773 (8.749) IU/ml, HOMA-IR index 0.925 (2.728), triglycerides 12.59 (82.95) mg/dl and uric acid 0.172 (1.13) mg/dl. The basal score of the GHQ-28 was pathological in 44,8% of the studied patients, and after six months of treatment, it improved in 20,8% of the patients (p < 0,001). The EDI bulimia subscale score at the beginning of the treatment was 1,02 (SD 1,91), improving after six months of treatment to 0,65 (SD 1,49) p < 0,002. CONCLUSION: The decrease in weight improves not only clinical parameters and biochemical cardiovascular risk and insulin resistance, but also improves the scale score Goldberg, with higher impact on those with worse baseline GHQ-28 scores.

Serum concentrations of osteocalcin, procollagen type 1 N-terminal propeptide and beta-CrossLaps in obese subjects with varying degrees of glucose tolerance.

AIMS: To evaluate serum levels of osteocalcin (OC), procollagen type 1 N-terminal propeptide (P1PN) and beta-CrossLaps (beta-CTx) in obese subjects and their relationship with glucose metabolism parameters. SUBJECTS: Sixty-four obese patients classified according to their glucose tolerance. DESIGN: Case-control study. MEASUREMENTS: A 75-g oral glucose tolerance test was performed with determinations of glucose and insulin between 0 and 120 min. Serum concentrations of OC, P1PN and beta-CTx were quantified in baseline samples. RESULTS: Patients with type 2 diabetes (T2D, n = 24) exhibited OC serum levels (2·6 ± 1·0 nm) significantly lower than those found in subjects with normal glucose tolerance (NGT, n = 20, 3·9 ± 1·5 nm, P < 0·01). We found no significant differences in P1NP and beta-CTX levels among patients with NGT, prediabetes and T2D. Multiple regression analysis showed that serum OC concentration, but not P1NP or beta-CTx levels, was independently related to 2-h plasma glucose. CONCLUSION: Obese patients with T2D showed significantly reduced levels of OC in comparison with patients with lower degrees of glucose tolerance derangement. Our results also suggest that OC was the only bone marker independently related to the degree of glucose metabolism derangement in these patients.

Taurine and glucose metabolism: a review.

INTRODUCTION: Taurine has probed to be involved in a wide range of biological processes and to provide several different important health benefits. Its effects have been revealed to be exerted mainly through its antioxidant and anti-inflammatory effects, among other mechanisms. OBJECTIVES AND METHODS: The present review is aimed to provide a solid body of evidence regarding the beneficial effects of taurine in the context of diabetes and its complications, with an special focus on the cardiovascular health impairments so frequently associated to this disease, so that data from this updated systematic review of the literature, may constitute a base to back up future clinical and epidemiological studies, on the possibilities of taurine supplementation as a useful tool for both prevention and treatment of diabetes complications. CONCLUSIONS: We consider results from the different experimental, in vitro studies as well as some clinical ones reviewed, to provide sufficient evidence as to constitute a solid base to back up future clinical and epidemiological studies on the usefulness of taurine supplementation both in the prevention and treatment of diabetes and its complications.

Severe ketoacidosis secondary to starvation in a frutarian patient.

The present paper presents the first clinical case of a patient suffering from Frutarianism a new "Eating disorder" and severe Ketoacidosis. The life-style feed strictly only on fruits (not even other vegetables, since plant death is necessary previous consumption).This behavioural alteration frequently leads to starvation and the subsequent Ketoacidosis due to starvation.

Meal replacement with a low-calorie diet formula in weight loss maintenance after weight loss induction with diet alone.

BACKGROUND/OBJECTIVES: Weight loss in obesity can reduce morbidity and mortality and benefits persist as long as weight loss is maintained. Weight maintenance is difficult in the long term and new strategies need to be developed to achieve this goal. We aimed to evaluate the efficacy of substituting a low-calorie diet formula for a meal in a weight loss program during the maintenance phase. METHODS: Randomized paralleled clinical trial including 62 adult patients with at least a 5% weight loss with diet alone for 6 months, randomized to two groups: daily replacement of one meal with a low-calorie diet formula, or dieting alone for another 6 months (weight maintenance phase). RESULTS: Weight maintenance or further weight loss occurred in 83.9% of patients in the intervention group, whereas only in 58.1% in the control group (P=0.025). As a whole, patients in the intervention group lost a further 3.2+/-3.7% of initial weight compared with a 1.3+/-3.6% in the control group (P=0.030). Body fat mass diminished in both groups, with no differences between them (1.6+/-3.5 vs 1.0+/-9.3 kg, respectively, P=0.239), and the same happened with free fat mass (0.9+/-3.3 vs 0.4+/-6.7 kg, respectively, P=0.471). A multivariate logistic regression analysis (R (2)=0.114, P=0.023) retained only the intervention as a predictor of the achievement of weight maintenance with an odds ratio (95% confidence interval) of 3.756 (1.138-12.391). CONCLUSIONS: Substitution of a low-calorie diet formula for a meal is an effective measure for weight loss maintenance compared with dieting alone.

Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion.

Secondary hyperparathyroidism (SH) is a frequent metabolic complication of bariatric surgery. Around 70%of patients who undergo biliopancreatic diversion (BPD) have this complication in the long term. The aim of this study was to evaluate the relative influence of vitamin D deficiency and calcium malabsorption in the development of SH in patients who underwent BPD. We reviewed the mean values of PTH throughout the post-operative follow-up and of related biochemical data (25-hydroxyvitamin D, calcium, magnesium) of 121 patients who underwent BPD at our institute from November 1996 to November 2004 (mean follow-up 66 months). Mean PTH correlated negatively with mean 25-hydroxyvitamin D (r=-0.27, p=0.003) and with urinary calcium(r=-0.19, p=0.047), and positively with age (r=0.22, p=0.018). However, a high mean PTH was found in 48.7% patients with mean 25-hydroxyvitamin D >or=30 ng/ml and in 80.0% patients with mean 25-hydroxyvitamin D between 20 and 30 ng/ml. The mean PTH was normal in 5 patients without calcium supplements at present, and progressively increased in parallel to the calcium dose in the rest of patients, although mean 25-hydroxyvitamin D levels were not related to the calcium dose. Our data suggest that individual differences in active and/or passive calcium absorption determine intractable SH after BPD in around half of the patients who have normal levels of 25-hydroxyvitamin D and in 80% of patients with 25-hydroxyvitamin D levels between 20 and 30 ng/ml after BPD, worsening with age.

[Importance of artificial nutrition in the resolution and etiologic diagnosis of severe chronic diarrhea: a propos of a case]. / Importancia de la nutrición artificial en la resolución y diagnóstico etiológico de diarrea crónica severa: a propósito de un caso.

We present a case of severe chronic diarrhea requiring parenteral nutritional support to both cover the nutritional needs and allow for intestinal rest for later adaptation to enteral nutrition, altogether allowing for the etiologic diagnosis and disease healing.

[Poisonings by oral antidiabetic drugs in Spain. Analysis and evolution during 13 years (1991-2003)]. / Intoxicaciones por antidiabéticos orales en España. Análisis y evolución a lo largo de 13 años (1991-2003).

INTRODUCTION: The prevalence of diabetes type 2 increases and increased in the next years. The pharmacology treatment of the diabetes type 2 is the oral antidiabetic oral drugs. The objective of our study is to know the existence and evolution of the poisonings by oral antidiabetics in Spain. We have studied the poisonings registered by oral antidiabetics in the National System of information toxicological, centre of national reference for acute poisonings in our country, during period 1991-2003. RESULTS: The total number of poisonings was of 309 subjects, being more frequent in women 52.9% versus 47.1% in men. The clinical poisonings were classified in asymptomatic 13.9%, low symptoms 49.5% moderate serious 31.3% serious 5.1%. The pharmacologic group with greater number of poisonings was of sulfonilurea 66.5%, within this group the glyburide one. In the last years poisonings with but of a drug appear appearing in the 2002 poisoning by triple therapy (sulfonilurea-metformin and alpha-glucosidase inhibitor). It is important to emphasize the absence of mortality and the modification of prescription increase of cases of metformin and diminution of alpha-glucosidase inhibitor. In our study we emphasized the greater one I number of poisonings in group of suckling babies and children with respect to the adults. Everything shows the importance of the correct prescription and use of the oral antidiabetics.

[Probesci strategy: a cheaper therapeutic approach for obese patients]. / Estrategia probesci: un abordaje terapéutico de menor coste para el paciente obeso.

Obesity has become epidemic in Western countries. From clinical practice, obestity may be considered as a disease characterized by an excess of body fat mass, but patients usually demonstrate different responses to the same therapeutic strategy. It could be possible that the latter may be a consecuence of different pathophysiological factors among obese patients. Therefore, a detailed and thorough phenotyping of patients may enable clinitians to establish groups of patients that may respond in a homogeneous and effective way to a specific treatment for obesity. However, this type of approach can be especially time-consuming and may increase costs. In this study we describe the "PROBESCI" strategy, which is a novel system of studying the obese patient at the first visit, performed in groups of patients, aimed to the collection and analysis of data in order to categorize phenotypic profiles which may achive homogeneous responses to a specific therapy. We also analyze the costs of this new strategy compared to those of an individual consultation, showing a decrease of 58% for the first visit, and of 21% of the total costs throughout treatment.

Estrategia probesci: un abordaje terapéutico de menor coste para el paciente obeso / Probesci strategy: a cheaper therapeutic approach for obese patients

Desde la experiencia clínica todas las evidencias hacen suponer que la obesidad, epidemia que amenaza la Salud Pública de los países más ricos de la Tierra, se presenta como un síndrome que abarca distintas enfermedades, todas ellas con un rasgo común, el exceso de grasa corporal, pero con respuestas clínicas claramente diferenciadas ante la misma estrategia terapéutica. Si las respuestas son tan heterogéneas es que la etiopatogenia también lo es, por lo que un estudio fenotípico exhaustivo ayudaría a establecer grupos clínicos que presumiblemente tendrían una respuesta más homogénea ante el mismo tratamiento. En este caso el abordaje y manejo terapéutico de los distintos grupos clínicos permitiría diversificar el tratamiento y posiblemente, mejorar su efectividad. El gran inconveniente para llevar a la práctica un estudio fenotípico exhaustivo es el elevado coste, por el consumo de tiempos recursos humanos que exige, lo que es con frecuencia inviable. En este estudio se describe la "estrategia PROBESCI" como un sistema organizativo de estudio y recogida de datos que sistematiza, estandariza y caracteriza la información constituyendo la base para la consiguiente clasificación y establecimiento de perfiles fenotípicos dentro de la obesidad. Es una nueva modalidad de consulta inicial en grupo, de valoración del paciente obeso, que ha demostrado su viabilidad. Se estudian los costes de esta nueva modalidad, comparándolos con los de la consulta clásica y se demuestra que supone un gran ahorro, ya que disminuye un 58% los costes de la consulta inicial y un 21% los costes totales del tratamiento (AU)

Obesity has become epidemic in Western countries. From clinical practice, obestity may be considered as a disease characterized by an excess of body fat mass, but patients usually demonstrate different responses to the same therapeutic strategy. It could be possible that the latter may be a consequence of different pathophysiological factors among obese patients. Therefore, a detailed and thorough phenotyping of patients may enable clinitians to establish groups of patients that may respond in a homogeneous and effective way to a specific treatment for obesity. However, this type of approach can be especially time-consuming and may increase costs. In this study we describe the "PROBESCI" strategy, which is a novel system of studying the obese patient at the first visit, performed in groups of patients, aimed to the collection and analysis of data in order to categorize phenotypic profiles which may achive homogeneous responses to a specific therapy. We also analyze the costs of this new strategy compared to those of an individual consultation, showing a decrease of 58% for the first visit, and of 21% of the total costs throughout treatment (AU)

[Eucaloric substitution of medium chain triglycerides for dietary long chain fatty acids improves body composition and lipid profile in a patient with human immunodeficiency virus lipodystrophy]. / La sustitución eucalórica de triglicéridos de cadena larga por triglicéridos de cadena media mejora la composición corporal y el perfil lipídico en un paciente con lipodistrofia asociada al virus de la inmunodeficiencia humana.

BACKGROUND: Lipodystrophy is a frequent disorder among patients with human immunodeficiency virus (HIV) infection, characterized by a loss of adipose tissue from the extremities, gluteal region and face, with excess fat in the neck and abdominal region. Metabolic abnormalities such as hyperlipidaemia and diabetes mellitus frequently coexist, posing these patients to an increased cardiovascular risk. Drug therapy may improve some of these metabolic disturbances, but to date there are no treatments for lipodystrophy with proven benefit. CASE REPORT: A 42-year-old man with HIV lipodystrophy was started on a standard low caloric diet with <30% of total fat and <10% of saturated fat, together with rosiglitazone 8 mg daily. After five months of treatment, given that lipodystrophic features and dyslipidaemia were still present in our patient, we tried to further improve therapeutic results by eucaloric substitution of medium chain triglycerides for dietary long chain fatty acids. Three months later, a dramatic change in body composition was shown with an increase in lean mass and a decrease in fat mass, together with an improvement in lipid profile. CONCLUSION: Eucaloric substitution of medium chain triglycerides for dietary long chain fatty acids may produce therapeutic benefits in HIV lipodystrophy.