Biomarcadores sanguíneos, de orina y conductas autolesivas e intentos de suicidio repetidos en los adolescentes / Blood and urine biomarkers and repeated self-injurious behaviors and suicide attempts in adolescents

Hay evidencia parcial de que los niveles elevados de la β-endorfina sanguínea se asocian a la adicción suicida en los adultos, pero apenas hay datos sobre los adolescentes. La β-endorfina sanguínea, con un importante papel en los mecanismos de gestión de las adicciones, puede inducir euforia y felicidad, recompensar y reforzar el comportamiento suicida. Para probar si los grandes repetidores de intentos de suicidio (5 o más intentos de suicidio) y de conductas autolesivas (20 o más episodios de autolesiones) tienen unos niveles de biomarcadores más elevados, se selecciona una muestra de 43 pacientes de entre 12 y 17 años que acuden al Servicio de Urgencias Psiquiátricas en el Hospital Universitario Puerta de Hierro Majadahonda. Diez presentan 5 o más intentos de suicidio, 35 presentan 20 o más episodios autolesivos y 10 presentan ambas características, y la mayoría de los adolescentes cumplían criterios de adicción para autolesiones y suicidio. Los resultados sugieren que todos los pacientes que presentaban adicción al suicidio también presentaban adicción a la autolesión. Los niveles de ACTH, cortisol y β-endorfina sanguíneos y de cortisol en orina fueron muy elevados, pero no diferenciaban a los grandes repetidores del resto de adolescentes. (AU)

There is partial evidence that elevated levels of blood β-endorphin are associated with suicidal addiction in adults, but hardly any data on adolescents. Blood β-endorphin, with an important role in addiction management mechanisms, can induce euphoria and happiness, reward and reinforce suicidal behavior. To test whether high repeaters of suicide attempts (5 or more suicide attempts) and self-injurious behaviors (20 or more episodes of self-injury) have higher biomarker levels, a sample of 43 patients aged 12-17 years attending the Psychiatric Emergency Department at the Hospital Universitario Puerta de Hierro Majadahonda is recruited. Ten present 5 or more suicide attempts, 35 present 20 or more self-injurious episodes and 10 present both characteristics, and most of the adolescents meet addiction criteria for self-injury and suicide. The results suggest that all patients with addiction to suicide also had addiction to self-injury. Blood ACTH, cortisol and β-endorphin and urine cortisol levels were very elevated, but did not differentiate heavy repeaters from the rest of the adolescents. (AU)

Association between biomarkers of iron status and cardiometabolic risk in Spanish children aged 9-10 years. The ELOIN study.

The relationship between iron metabolism and cardiometabolic risk factors has been scarcely studied in children, and the results are controversial. The objective of this study was to evaluate the association between iron parameters and lipid, glycemic and blood pressure alterations in the pediatric population. This was a cross-sectional study of 1954 children between 9 and 10 years of age in Madrid (Spain), participants in a longitudinal study of childhood obesity. Iron metabolism parameters, i.e., serum iron (Is), ferritin (Fs), transferrin (Tf) and transferrin saturation (STf) and lipid, glycemic and blood pressure profiles were evaluated. Odds ratios (ORs) were estimated using logistic regression models adjusted for sociodemographic characteristics, diet, physical activity, C-reactive protein and body mass index. Compared with the participants in the low Is and STf tertiles, those in the upper tertiles had a lower risk of low HDL-Chol (OR: 0.34; 95%CI: 0.17; 0.67) and OR: 0.44 (95%CI: 0.23; 0.84), respectively, and children in the upper Fs tertile had an OR of 2.07 (95%CI: 1.16; 3.68) for low HDL-Chol. Children in the highest Is and STf tertiles had a lower risk of prediabetes [OR: 0.63 (95%CI: 0.41; 0.97) and OR: 0.53 (95%CI: 0.34; 0.82)] and insulin resistance (IR) (OR: 0.37; 95%CI: 0.22; 0.64), and those in the upper Tf tertile had a higher risk of IR (OR: 1.90; 95%CI: 1.16; 3.12). An increased risk of hypertension was found only in children in the upper Fs tertile (OR: 1.46; 95%CI: 1.01; 2.13). CONCLUSIONS: Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population, with a variable direction and magnitude depending on the indicators used. WHAT IS KNOWN: • Iron metabolism is related to important cardiometabolic alterations such as metabolic syndrome and its components. • Association between biomarkers of iron status and cardiometabolic risk have been less explored in children. WHAT IS NEW: • Biomarkers of iron metabolism are associated with cardiometabolic alterations in the pediatric population. • Iron parameters in the pediatric population could be of great help to detect and prevent cardiometabolic abnormalities early.

Biosignature of self-injury behaviors in adolescence: Role of ß-endorphin in an acute inpatient unit.

Self-injurious behavior (SIB) (either non-suicidal self-injury, NSSI; or suicide attempts, SA) is a common reason for adolescent psychiatric emergency hospitalizations. Altered basal serum ß-endorphin (BE) levels have been reported in adults with a history of SIB, but information is lacking in adolescents. We analyzed the psychoclinical profile and serum BE level of 39 adolescents admitted to the acute unit at a hospital in Spain due to SIB. The Mean (SD) serum BE level was high (190.53 ± 74.83). Regarding time sequence, the onset age of NSSI and SA were related (p < 0.001). The older the onset age of NSSI, the shorter the transition between NSSI and the onset of SA behavior (p = 0.05), but this difference does not lead the variation of BE (p = 0.81). Patients diagnosed with depression had lower serum BE levels than adolescents with other diagnoses (p = 0.03). Although adolescents who seem to be addicted to SIB had higher levels of BE, this finding was not statistically significant. The relationship between serum BE levels and SIB in adolescents requires further investigation.

Changes in obesity and iron deficiency between 4 and 9 years of age. Longitudinal study of childhood obesity (ELOIN).

BACKGROUND: Recent studies revealed that children who are overweight have a higher risk of iron deficiency, although the etiology of this relationship remains unclear. The aim of the study was to evaluate the association between changes in obesity status between 4 and 9 years of age and iron deficiency. SUBJECTS: This population-based cohort study included 1347 children from the ELOIN study, conducted in Madrid, Spain. Follow-up with physical examinations and a computer-assisted telephone interview were carried out at 4, 6 and 9 years of age, and a blood test was performed at 9 years. METHODS: Changes in obesity were estimated based on body mass index and waist circumference, according to the persistence or variation in obesity rates at 4, 6 and 9 years and were classified as follows: (1) Stable without obesity; (2) Remitting obesity at 9 years; (3) Incident obesity or relapse at 9 years; and (4) Stable with obesity. Iron deficiency was defined as transferrin saturation value below 16%. Odds ratios (ORs) for iron deficiency were estimated according to obesity status using logistic regression and adjusted for confounding variables, including C-reactive protein (CRP). RESULTS: The prevalence of iron deficiency in the stable general obesity (GO) and abdominal obesity (AO) groups was 38.2% and 41.2%, versus 23.6% and 23.4% in the stable without obesity groups, respectively. The ORs for iron deficiency were 1.85 (95% CI: 1.03-3.32) in the stable GO group and 2.34 (95% CI: 1.29-4.24) in the stable AO group. This association disappeared when CRP was included in the analysis. CONCLUSIONS: An extended state of obesity during the first stages of life is associated with iron deficiency, and this association may be mediated by CRP. Prevention and early detection of obesity in children should be a priority to avoid a double burden of malnutrition.

Influence of Galactooligosaccharides on the Positive Effect of Plant Sterol-Enriched Beverages on Cardiovascular Risk and Sterol Colon Metabolism.

In the present study, the impact of galactooligosaccharide (GOS) addition to a plant sterol (PS)-enriched beverage on the hypocholesterolemic effect and on the bioavailability and colonic metabolization of sterols was evaluated. A crossover trial was undertaken in postmenopausal women who intook a PS-enriched (2 g PS/day) or PS-GOS-enriched beverage (2 g PS/day and 4.3 g GOS/day) for 6 weeks. The presence of GOS did not modify the hypocholesterolemic effect of the PS-enriched beverage (total- and low-density lipoprotein-cholesterol reductions) or sterol bioavailability (increments of serum markers of dietary PS intake and of cholesterol synthesis). The consumption of both beverages led to an increase of sterol and metabolite excretion (with the exception of coprostanol, which decreased) and to slight changes in women's capacities for sterol conversion, regardless of the GOS presence. This study demonstrates the suitability of simultaneous enrichment with PS and GOS in milk-based fruit beverages, considering their hypocholesterolemic effect.

Biochemical Validation of a Self-Administered Food Frequency Questionnaire to Assess Diet Using Carotenoids and Vitamins E and D in Male Adolescents in Spain.

Reliable tools to evaluate diet are needed, particularly in life periods such as adolescence in which a rapid rate of growth and development occurs. We assessed the biochemical validity of a self-administered food frequency questionnaire (FFQ) in a sample of Spanish male adolescents using carotenoids and vitamin E and D data. We analyzed data from 122 male adolescents aged 15-17 years of the INMA-Granada birth cohort study. Adolescents answered a 104-item FFQ and provided a non-fasting blood sample. Mean daily nutrient intakes and serum concentration were estimated for main carotenoids (lutein-zeaxanthin, ß-cryptoxanthin, lycopene, α-carotene and ß-carotene), vitamins E and D and also for fruit and vegetable intake. Pearson correlation coefficients (r) and the percentage of agreement (same or adjacent quintiles) between serum vitamin concentrations and energy-adjusted intakes were estimated. Statistically significant correlation coefficients were observed for the total carotenoids (r = 0.40) and specific carotenoids, with the highest correlation observed for lutein-zeaxanthin (r = 0.42) and the lowest for ß-carotene (0.23). The correlation coefficient between fruit and vegetable intake and serum carotenoids was 0.29 (higher for vegetable intake, r = 0.33 than for fruit intake, r = 0.19). Low correlations were observed for vitamin E and D. The average percentage of agreement for carotenoids was 55.8%, and lower for vitamin E and D (50% and 41%, respectively). The FFQ may be an acceptable tool for dietary assessment among male adolescents in Spain.

IL-6 and Other Biomarkers associated with Poor Prognosis in a Cohort of Hospitalized Patients with COVID-19 in Madrid.

OBJECTIVES: There are several published works on the prognostic value of biomarkers in relation to the severity or fatal outcome of coronavirus disease 2019 (COVID-19). In Spain, the second European country in incidence of the disease at the time of data collection, there are few studies that include both laboratory parameters and clinical parameters. Our aim is to study the relationship of a wide series of biomarkers with admission to intensive care and death in a hospital in the Autonomous Community of Madrid (Spain), with special attention to IL-6 due to its role in the systemic inflammatory response associated with a worse prognosis of the disease. METHODS: Data were collected from 546 hospitalized patients with COVID-19. All of them had IL-6 results, in addition to other biochemical and haematological parameters. The difference of the medians for the selected parameters between the groups (ICU vs non-ICU, dead vs survivors) was studied using a Mann-Whitney analysis. The independent variables that predicted death were studied using a Cox proportional hazard regression model. RESULTS: Higher age and blood concentrations of ALT, creatinine, CK, cTnI, LDH, NT-proBNP, CRP, IL-6, leucocyte count and D-dimer together with lower blood concentrations of albumin and lymphocyte count were associated with mortality in univariate analysis. Age, LDH, IL-6 and lymphocyte count remained associated with death in multivariate analysis. CONCLUSIONS: Age, LDH, IL-6 and lymphocyte count, as independent predictors of death, could be used to establish more aggressive therapies in COVID-19 patients.

Serum ß-endorphin levels are associated with addiction to suicidal behavior: A pilot study.

The literature provides partial support for the hypothesis that some suicide attempters develop a behavioral addiction to suicidal behavior (SB). We hypothesized that major suicide repeaters (MR) (≥5 lifetime suicide attempts) are addicted to suicide attempts as measured by modified DSM-IV criteria for substance dependence. In this cross-sectional study with 13 psychiatric controls (PC), 55 non-major suicide attempters (NMR), and 9 MR we found that MR are characterized by emotional abuse and neglect, as well as higher scores on the Personality and Life Event scale (short version). The levels of 8 AM serum ACTH, cortisol and ß-endorphin were elevated in all three groups. Serum ß-endorphin (pg/mL) was particularly high in PC diagnosed with schizophrenia 220.34 (±56.30). The level of 8 AM serum ß-endorphin rose with increased numbers of criteria met for addiction to SB from 130.31 (±88.16) (≥ 3 criteria met for addiction to SB) to 174.84 (±114.93) (≥ 6 criteria met for addiction to SB) whereas serum ACTH and cortisol did not change. SB addicts (≥ 6 criteria) displayed higher serum ß-endorphin concentrations than non-addicts (174.84 ± 114.93 vs. 116.93 ± 61.70, FET p = 0.09). The present study brings some support to the addictive hypothesis of SB. Our results delineate ß-endorphin as a promising biomarker of SB addiction, and offer a good basis for future studies that test whether buprenorphine can be used to prevent repetitive suicide attempts, non-suicidal-self-injury (NSSI), and the development of an addiction to SB.

Comentarios sobre «Hipercarotinemia tras cirugía bariátrica» / Comments on «Hipercarotinemia after bariatric surgery»

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Comparison of methods for circulating cell-free DNA isolation using blood from cancer patients: impact on biomarker testing.

BACKGROUND: The implementation of liquid biopsy for biomarker testing and response to treatment monitoring in cancer patients would presumable increase laboratory throughput, requiring the development of automated methods for circulating free DNA (cfDNA) isolation. METHODS: The present study compares the MagNA Pure Compact (MPC) Nucleic Acid Isolation Kit I and Maxwell® RSC (MR) ccfDNA Plasma Kit and the later with QIAamp Circulating Nucleid Acid (QCNA) Kit using 57 plasma samples from cancer patients. cfDNA concentration was measured using the Qubit fluorometer. DNA fragments lengt were assessed using the Agilent 2100 Bioanalyzer. Circulating tumor DNA (ctDNA) was quantified by digital PCR (dPCR). RESULTS: Firstly, we observed that MPC method significantly extracted less cfDNA than MR (P<0.0001). However, there were no significant differences in extraction yields of QCNA and MR kits. cfDNA isolation yield was also associated with tumor stage but not with tumor location. Secondly, an oligonucleosomal DNA ladder pattern was observed in 88% of the samples and significant differences in the recovery of mono-, di- and tri-nucleosomes DNA fragments were observed between MPC and MR methodologies. Finally, tumor mutation quantification on cfDNA was performed on 38 paired samples using digital PCR. Mutant allele fractions (MAFs) between paired samples were not significantly different. CONCLUSIONS: Methods for isolation of cfDNA can affect DNA yield and molecular weight fractions recovery. These observations should be taken into account for cfDNA analysis in routine clinical practice.

Bioavailability of ß-cryptoxanthin in the presence of phytosterols: in vitro and in vivo studies.

Bioactive compounds are used in the design and development of new food products with potential health benefits, although little is known regarding their bioavailability and interactions. This study assessed the stability, in vitro bioaccessibility, and human bioavailability of ß-cryptoxanthin from ß-cryptoxanthin-rich drinks with and without added phytosterols developed for this purpose. The developed drinks showed no difference in the content of ß-cryptoxanthin, and they were stable over 6 months. In vitro, hydrolysis of ß-cryptoxanthin esters and the amount of free ß-cryptoxanthin at duodenal and micellar phases were similar regardless of the presence of phytosterols. In the human study, the daily intake provoked significant increments of ß-cryptoxanthin in serum regardless of the type of the drink. In conclusion, in vitro and in vivo human studies have shown that the bioavailability of ß-cryptoxanthin is not significantly affected by the presence of phytosterols when they are simultaneously supplied in a drink.

Time-course changes in bone turnover markers and fat-soluble vitamins after obesity surgery.

BACKGROUND: The available evidence indicates a progressive increase in the incidence and severity of the deficiency of certain vitamins and related clinical conditions (i.e., metabolic bone disease). Because of the potential role of fat-soluble vitamins and carotenoids in bone metabolism, our aim was to assess the time-course changes of fat-soluble vitamins and serum markers of bone metabolism in candidates for obesity surgery and following two bariatric procedures. METHODS: Sixty-five candidates for bariatric surgery and 150 serum samples after obesity surgery (i.e., Roux-en-Y gastric bypass, n = 85; biliopancreatic diversion, n = 65) were consecutively analyzed over a period of more than 2 years. Retinol, α- and γ-tocopherol, 25-OH-vitamin D3, ß-cryptoxanthin, and ß-carotene were analyzed by high-performance liquid chromatography. Calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), osteocalcin, beta-crosslaps, and N-terminal peptide of procollagen I (P1NP) were determined using commercial kits. RESULTS: Retinol, ß-cryptoxanthin, ß-carotene, and α- and γ-tocopherol levels were significantly lower in post-surgery samples while osteocalcin, b-crosslaps, and P1NP were significantly increased. Along the time and regardless of the surgical procedure, P1NP, b-crosslaps, and osteocalcin increased during the first 12-24 months but declined afterward. 25-OH-vitamin D increased during the first 12 months and tended to decrease afterward while iPTH remained constant or decreased but increased after 1 year in both groups. Vitamin A remained constant but α- and γ-tocopherol, ß-cryptoxanthin, and ß-carotene decreased in both groups. CONCLUSIONS: In addition to the nutritional assessment, regular monitoring of bone markers seems necessary in these patients and the early introduction of preventive strategies (i.e., the use of antiresorptive agents) should be evaluated.

Prevalencia de diabetes mellitus y factores de riesgo cardiovascular en la población adulta de la Comunidad de Madrid: estudio PREDIMERC / Prevalence of diabetes mellitus and cardiovascular risk factors in the adult population of the autonomous region of Madrid (Spain): the PREDIMERC study

ObjetivoDeterminar la prevalencia de diabetes y los principales factores de riesgo cardiovascular en la población adulta de la Comunidad de Madrid.Material y métodoEstudio transversal de base poblacional en el año 2007. Se seleccionó una muestra aleatoria representativa de la población de 30–74 años, con un tamaño muestral fijo para cada estrato de edad, ponderando los resultados según la estructura por edad de la Comunidad de Madrid. Se realizó una encuesta telefónica. Posteriormente, en el centro de salud se efectuó la exploración física y la extracción de sangre en ayunas para determinar la glucemia, el colesterol y las fracciones lipídicas.ResultadosSe incluyeron 2.268 personas con una edad media de 48,3 años; el 52% eran mujeres. La tasa de respuesta fue del 56,4%. El 8,1% (intervalo de confianza del 95% [IC95%]: 7,0–8,9) de la población presenta diabetes y el 5,9% (IC95%: 4,8–6,1) una glucemia basal alterada. El 29,3% (IC95%: 27,3–31,5) tiene hipertensión arterial y el 23,3% (IC 95%: 21,4–25,2) hipercolesterolemia. El 22,8% (IC95%: 20,8–25,0) presenta sobrepeso de grado II, el 21,7% (IC95%: 19,8–23,6) obesidad y el 23,9% (IC95%: 21,8–26,1) obesidad abdominal. El 85,5% (IC95%: 83,1–87,1) eran sedentarios en tiempo libre y el 28,4% (IC95%: 26,3–30,3) fumadores.ConclusionesLa prevalencia de diabetes mellitus en la Comunidad de Madrid se sitúa en una posición intermedia con respecto a otras comunidades autónomas. Los principales factores de riesgo cardiovascular tienen una elevada prevalencia. El sobrepeso de grado II y la obesidad, que afectan a 4,5 de cada 10 adultos, representan una prioridad de intervención en la prevención de la diabetes y la enfermedad cardiovascular(AU)

ObjectiveTo describe the prevalence of diabetes and major cardiovascular risk factors in the adult population of the autonomous region of Madrid (Spain).Material and methodA population-based cross-sectional study was carried out in 2007. A random sample of the population aged 30–74 years old was selected. A fixed sample size per age stratum was assigned, weighted by the real age-specific distribution of the population of the autonomous region of Madrid. An epidemiological survey was conducted by telephone. Subsequently, physical examination was performed and a fasting blood sample was taken in the health center for glucose, cholesterol and lipid fraction determinations.ResultsWe included 2268 people with a mean age of 48.3 years old (52% women). The response rate was 56.4%. Diabetes was found in 8.1% (95%CI: 7.0–8.9) of the adult population and impaired fasting glucose was found in 5.9% (95%CI: 4.8–6.1). The prevalence of risk factors was as follows: hypertension in 29.3% (95%CI: 27.3–31.5), hypercholesterolemia in 23.3% (95%CI: 21.8–26.1), overweight grade II in 22.8% (20.8–25.0), obesity in 21.7% (95%CI: 19.8–23.6), and central obesity in 23.9% (95%CI: 21.8–26.1). A total of 85.5% (95%CI: 83.1–87.1) were sedentary in their leisure time and 28.4% (95%CI: 26.3–30.3) were smokers.ConclusionsThe prevalence of diabetes in the autonomous region of Madrid is intermediate in relation to other regions of Spain. Cardiovascular risk factors are highly prevalent, and are higher in men than in women. Overweight and obesity, affecting 4.5 out of every 10 adults, should be considered a priority for health interventions in cardiovascular disease prevention(AU)

[Prevalence of diabetes mellitus and cardiovascular risk factors in the adult population of the autonomous region of Madrid (Spain): the PREDIMERC study]. / Prevalencia de diabetes mellitus y factores de riesgo cardiovascular en la población adulta de la Comunidad de Madrid: estudio PREDIMERC.

OBJECTIVE: To describe the prevalence of diabetes and major cardiovascular risk factors in the adult population of the autonomous region of Madrid (Spain). MATERIAL AND METHOD: A population-based cross-sectional study was carried out in 2007. A random sample of the population aged 30-74 years old was selected. A fixed sample size per age stratum was assigned, weighted by the real age-specific distribution of the population of the autonomous region of Madrid. An epidemiological survey was conducted by telephone. Subsequently, physical examination was performed and a fasting blood sample was taken in the health center for glucose, cholesterol and lipid fraction determinations. RESULTS: We included 2268 people with a mean age of 48.3 years old (52% women). The response rate was 56.4%. Diabetes was found in 8.1% (95%CI: 7.0-8.9) of the adult population and impaired fasting glucose was found in 5.9% (95%CI: 4.8-6.1). The prevalence of risk factors was as follows: hypertension in 29.3% (95%CI: 27.3-31.5), hypercholesterolemia in 23.3% (95%CI: 21.8-26.1), overweight grade II in 22.8% (20.8-25.0), obesity in 21.7% (95%CI: 19.8-23.6), and central obesity in 23.9% (95%CI: 21.8-26.1). A total of 85.5% (95%CI: 83.1-87.1) were sedentary in their leisure time and 28.4% (95%CI: 26.3-30.3) were smokers. CONCLUSIONS: The prevalence of diabetes in the autonomous region of Madrid is intermediate in relation to other regions of Spain. Cardiovascular risk factors are highly prevalent, and are higher in men than in women. Overweight and obesity, affecting 4.5 out of every 10 adults, should be considered a priority for health interventions in cardiovascular disease prevention.