Does FMI Correlate Better than BMI with the Occurrence of Metabolic Changes in Obese Patients? Study Based on 2007 Consecutive Mexican Patients.

BACKGROUND: The body mass index (BMI) is the most commonly used anthropometric indicator. However, it does not discern among the different body components. The body fat content, expressed as fat mass index (FMI), is an accurate way to estimate adiposity. Since most metabolic diseases are associated with excess fat tissue, our aims were to comparatively analyze the frequency of associated metabolic abnormalities in patients with different obesity degrees based on BMI and FMI and to determine the best cut-off value of both indicators to predict metabolic abnormalities. METHODS: From a cohort of 2007 patients, BMI and FMI were calculated using DXA. Individuals were classified into the different obesity degrees according to the reference ranges from the World Health Organization (WHO) and the National Health and Nutrition Examination Survey (NHANES). A comparative analysis between BMI, FMI, and their correlation to the presence of metabolic alterations was performed. RESULTS: BMI underestimated the degree of obesity when compared with FMI. Spearman's rank-order correlation for both indexes resulted in very high coefficients (rho Spearman's = 0.857; p = 0.0001). The prevalence of metabolic alterations increased as BMI and FMI also increased. Despite the high positive statistical correlation between BMI and FMI, it was seen that some comorbidities were more specifically related to one particular index. CONCLUSIONS: There were no significant differences between the BMI and the FMI for predicting the degree of obesity. Likewise, there were no significant differences between them for the prediction of metabolic alterations.

Continuous glucose monitoring in the management of patients after gastric bypass

Summary: In patients with gastric bypass (GB), high glucose variability (GV) and hypoglycemia have been demonstrated, which could impact the metabolic status and eating behavior. We describe the glucose patterns determined through continuous glucose monitoring (CGM) in two patients with >5 years follow-up after GB and significant weight recovery, who reported hypoglycemic symptoms that interfered with daily activities, and their response to a nutritional and psycho-educative prescription. Case 1: A 40-year-old woman without pre-surgical type 2 diabetes (T2DM) and normal HbA1c, in whom CGM showed high GV and hypoglycemic episodes that did not correlate with the time of hypoglycemic symptoms. Her GV reduced after prescription of a diet with low glycemic index and modification of meal patterns. Case 2: A 48-year-old male with pre-surgical diagnosis of T2DM and current normal HbA1c, reported skipping meals. The CGM showed high GV, 15% of time in hypoglycemia and hyperglycemic spikes. After prescription of a low glycemic index diet, his GV increased and time in hypoglycemia decreased. Through the detailed self-monitoring needed for CGM, we discovered severe anxiety symptoms, consumption of simple carbohydrates and lack of meal structure. He was referred for more intensive psychological counseling. In conclusion, CGM can detect disorders in glucose homeostasis derived both from the mechanisms of bariatric surgery, as well as the patient's behaviors and mental health, improving decision-making during follow-up. Learning Points: High glycemic variability is frequent in patients operated with gastric bypass. Diverse eating patterns, such as prolonged fasting and simple carbohydrate ingestion, and mental health disorders, including anxiety, can promote and be confused with worsened hypoglycemia. CGM requires a detailed record of food ingested that can be accompanied by associated factors (circumstances, eating patterns, emotional symptoms). This allows the detection of particular behaviors and amount of dietary simple carbohydrates to guide recommendations provided within clinical care of these patients.

[Association of inflammatory cytokines with bone turnover markers in type 1 diabetes]. / Asociación de citocinas inflamatorias con marcadores de recambio óseo en diabetes tipo 1.

BACKGROUND: Diabetes mellitus (DM) adversely affects the skeleton and the physiological mechanisms implicated have not been explained sufficiently. Thus, the objective was to identify inflammatory cytokines (IL-1, IL-6 and TNF-alpha) in patients with T1DM and their association with markers of bone formation (sPINP) and markers of bone resorption (sCTX). METHODS: We studied 62 patients of 18 years of age or more with T1DM. We determined the values of HbA1c, vitamin D, inflammatory cytokines, as well as those of markers of bone formation and of markers of bone resorption. RESULTS: 49 patients were female with a mean age of 33.5 years. We found values of HbA1c > 7.5 in 83 %, vitamin D of 16 ng/mL. In patients with HbA1c >7.5 we found a positive correlation between TNF-alpha and sCTX (r = 0.43, p = 0.05), IL-6 and sCTX (r = 0.48, p = 0.037). With a model of simple linear regression between IL-6 and sCTX, it was found a beta coefficient of 23.8 with a p = 0.030 (95 % CI = 2-45.6), ie.: for every unit increase in IL-6 there is a sCTX increase of 23.8 pg/mL. CONCLUSIONS: We found a positive association between TNF-alpha and IL-6 with the marker of bone resorption (sCTX) in the group of patients with HbA1c > 7.5. The loss of metabolic control was associated with TNF-alpha and IL-6.

Introducción: la diabetes mellitus afecta de una manera adversa al esqueleto y esos mecanismos fisiopatológicos continúan sin entenderse completamente. Por lo tanto, el objetivo de este estudio es identificar citocinas inflamatorias (IL-1, IL-6 y TNFα) en pacientes con DM1 y su asociación con marcadores de formación (sPINP) y resorción (sCTX) óseas. Métodos: Se estudiaron 62 pacientes con DM1, mayores de 18 años. Se determinaron los valores de la HbA1c, la vitamina D, las citocinas inflamatorias, así como los de los marcadores de formación y resorción óseas. Resultados: 49 pacientes fueron del sexo femenino con una edad media de 33.5 años, HbA1c > 7.5 en 83%, vitamina D 16 ng/mL. En los pacientes con HbA1c > 7.5 hubo correlación positiva entre el TNFa y sCTX (r = 0.43, p = 0.05), IL-6 y sCTX (r = 0.48, p = 0.037). Posterior a un modelo de regresión lineal simple entre el sCTX y la IL-6 se encontró un coeficiente beta de 23.8, p = 0.030 (IC 2-45.6), es decir, por cada unidad de elevación de IL-6 hay un incremento de sCTX de 23.8 pg/mL. Conclusiones: encontramos una asociación positiva entre TNF-alfa e IL-6 con el marcador de resorción ósea (sCTX) en pacientes con HbA1c > 7.5 %. El descontrol metabólico se asoció con la elevación de citocinas inflamatorias TNF-alfa e IL-6.