Factores asociados a la hepatoxicidad por fármacos

En el hígado, tras la ingesta de medicamentos, debemos tener en cuenta dos posibles acontecimientos; por un lado, la hepatotoxicidad directa del fármaco y, por otro, la ingesta del mismo por parte de un paciente afectado de una hepatopatía. El presente artículo se ocupa de la primera circunstancia y, más en concreto, intenta ofrecer una respuesta a la siguiente pregunta: ¿qué condiciones son las que predisponen a que un paciente sufra una lesión hepática por medicamentos? La respuesta aportada por este trabajo es doble. Por un lado, existen factores que dependen de la naturaleza química propia del medicamento en cuestión y, por otro, factores dependientes del paciente. Entre ellos podemos mencionar la edad, el sexo, los factores hormonales, algunas circunstancias nutricionales, hepatopatías previas, ingestión de alcohol, interacciones virales y factores genéticos.La gran complejidad del metabolismo hepático de los fármacos determina que, de todos los factores mencionados, se dé un especial énfasis al que concierne a los mecanismos genéticos, cuyas alteraciones pueden explicar una gran parte de las lesiones hepatotóxicas. (AU)

Obesidad y aparato digestivo

La obesidad es una enfermedad muy frecuente que repercute de forma importante sobre la salud del ser humano.Su prevalencia es elevada en la población española y la tendencia estimada para el futuro es de que siga in crescendo, de tal suerte que algunos autores se atreven ya a denominarla como la epidemia del siglo XXI. El aparato digestivo no se salva de sus consecuencias nocivas. Las repercusiones anatómicas y funcionales que sobre él genera esta enfermedad son múltiples. Aparte de las más conocidas (mayor riesgo de colelitiasis, esteatosis, etc) en este artículo nos ocupamos del estudio de otras que se han evidenciado recientemente. Entre ellas son de destacar el elevado riesgo de padecer estos pacientes un adenocarcinoma esofágico y, aunque de forma no tan llamativa, otra neoplasia cuya incidencia en la población general está en gran aumento, como es el cáncer colorrectal. Las pancreatitis agudas son más frecuentes y más severas en los enfermos obesos. En los obesos también es posible el desarrollo de una cirrosis hepática como último escalón evolutivo desde una esteatohepatitis no alcohólica, y su existencia puede representar un factor patogénico relevante en la génesis de la fibrosis hepática en los enfermos con hepatitis C (AU)

[Implication of calcium deficiency in the progress of periodontal diseases and osteoporosis]. / Implicación de la deficiencia en calcio en el progreso de la enfermedad periodontal y de la osteoporosis.

Several authors have established a relationship between osteoporosis and periodontal disease. The ageing process is associated with a loss of both oral and total bone mass. It has been shown that a reduction of bone mineralization aggravates pathological periodontal changes, resulting in less support for the teeth. The present study investigates the nutritional influences that may condition the appearance of both pathological process. Insufficient dietary calcium and a reduction in the calcium: phosphorous ratio may favour the appearance of both these conditions by promoting bone reabsorption. Bone loss affects the following in descending order: jaw bones (especially alveolar bone), cranial bones, ribs, vertebrae and long bones. Alveolar bone which has the highest rate of renewal, is affected first and consequently is the most severely affected in the long term. The role of calcium in the etiology of osteoporosis is a controversial issue. Nevertheless, its implication has been proven in numerous investigations. The effect of adequate calcium intake on dental health has formed the basis of several recent studies. These investigations have demonstrated that increased calcium intake improves the suffering of inflammatory processes and tooth mobility in patients suffering from gingivitis with haemorrhaging. Based on the results of studies which link dietary calcium and phosphorous to the risk of osteoporosis and periodontal disease, and bearing in mind that in a large proportion of the Spanish population calcium intake is below that recommended, there is a need for a general improvement of the diet. It may be of special interest to increase the calcium intake of patients suffering periodontal disease. It may also help in the prevention of osteoporosis.

[Underestimation of energy intake in a group of young female university students of Madrid]. / Infravaloración de la ingesta energética en un colectivo de jóvenes universitarias de Madrid.

The validity of estimates of energy intake in a group of young women, and the influence of body mass index (BMI) and concern over bodyweight on such estimates, were determined with the aid of a food record intake. The study subjects were a group of female university students between 20 and 32 years of age. Participants maintained a steady weight over the month-long experimental period. Their energy intake was, therefore, very similar to their theoretical energy expenditure. Discrepancies between intake and expenditure data can be used as an indicator of the degree of over or underestimation of intake. 29.7% of subjects had a BMI < 20 kg/m2, 5.5% showed BMIs of > 25 kg/m2, and none exceeded the lower limit of obesity (BMI > 30 kg/m2). Of those with BMI < 20 kg/m2, no significant differences were seen between intake and expenditure (-2.3%). However, those with BMI > or = 20 kg/m2 showed discrepancies of 10.4%. In those with BMI > 25 kg/m2, this figure rose to 22.2% Concern over bodyweight, and the amount of weight that subjects wished to lose, increased with BMI (r = 0.72). However, even some subjects with BMI < 20 kg/m2 showed a desire to lose some weight (2.1 +/- 1 kg). A tendency was seen for subjects with BMI > or = 20 kg/m2 to underestimate their food intake. This became more obvious with increasing BMI (r = 0.36). This could mean that obese women habitually underestimate food intake; a factor that could invalidate many dietetic studies published to date. In the present group, when BMI did not exceed 24 kg/m2, mean underestimation was 4.8%. However, subjects with BMIs > or = 24 kg/m2 underestimated their intakes by 20.4%. Concern over bodyweight (assessed as kg a subject wished to lose) did not change the observed increase in underestimation with rising BMI. Anxiety, therefore, probably parallels true weight and BMI.

Differences in diet and food habits between patients with gallstones and controls.

OBJECTIVE: To compare the food, energy, macronutrient and micronutrient intake of patients with gallstones to those of a control group of similar demographic characteristics. DESIGN: Patient-control study. SUBJECTS: 54 gallstone patients and 46 control subjects. METHODS: Two 24-hour dietary recalls and a "food frequency intake" questionnaire were obtained from patients and controls. In both groups, the presence/absence of gallstones was confirmed by ultrasonography. Participants answered a questionnaire on their physical activity patterns. RESULTS: Gallstone patients consumed less food per day (g/day) and less fish and fruits than did control subjects. They also showed greater intakes of cereals, oils, sugars and meats than did control subjects and ate fewer meals per day, tending to omit evening snacks and more substantial evening meals. Further, patients spent less time walking and slept more than did control subjects. They also experienced fluctuations in body weight with greater frequency. Patients consumed more total calories (energy) and fats (especially monounsaturated fatty acids and saturated fatty acids), and less fiber, folate and magnesium than did control subjects. Women with gallstones were shown to have significantly higher intakes of total fats, monounsaturated fatty acids, saturated fatty acids and cholesterol, and significantly lower intakes of fiber, folate, magnesium, calcium and vitamin C than control women. For all vitamins and minerals studied, patients showed a greater percentage of intakes below those recommended. CONCLUSIONS: Dietary intervention might provide a method of avoiding the recurrence of gallstones as well as a method of prevention control subjects.

Associations between obesity, breakfast-time food habits and intake of energy and nutrients in a group of elderly Madrid residents.

OBJECTIVE: The objective of this study was to gain more knowledge about the breakfast habits of different groups of elderly people and to investigate the differences in breakfast habits between overweight and normal weight elderly subjects. METHODS: A study was made of the food preferences, dietary habits and the intake of energy and nutrients at breakfast in a group of 122 elderly Spanish people (65 men and 57 women) aged 75.7+/-8.7 years. Study participants were divided into two groups: overweight and obese subjects (O) with a body mass index (BMI)>or=25 kg/m2 (58% of the population), and normal weight subjects (NW) with a BMI<25 kg/m2 (42% of the population). The members of each group were further divided into subgroups according to age (>or=80 years of age (Y) and

Differences in breakfast habits between institutionalized and independent elderly Spanish people.

An investigation was made into the breakfast habits of 150 elderly people between 65 and 95 years of age. The food intake of 58 institutionalized subjects was followed by means of "precise individual weighing of food". The food intake of 92 subjects living independently was followed using a prospective method involving the keeping of a "weighed food record". For all subjects the study lasted 5 consecutive days including a Sunday. Institutionalized subjects spent more time at breakfast (p < 0.01 in women) and the food they consumed was more varied, both in terms of number of foods (p < 0.001) and food groups (p < 0.001). Their breakfasts included more fruit (P < 0.001), fibre (P < 0.05 in women) and vitamin A (P < 0.01) than those of independent subjects, 7% of whom took no breakfast at all with a further 8% consuming only a glass of milk or fruit juice. 62.7% of independent and 43.1% of institutionalized subjects consumed an inadequate breakfast (i.e. their breakfasts provided less than 20% of their energy expenditure). The breakfasts of institutionalized subjects contained a greater percentage of their total daily intake of carbohydrates (P < 0.001 in women), fibre (P < 0.01 in women), thiamine (p < 0.05 in women), vitamin B12 (p < 0.05 in women, p < 0.001 in men), vitamin D (p < 0.01 in women) and magnesium (p < 0.05 in women). Given the importance of breakfast in the maintenance of a satisfactory nutritive condition, these results suggest that both qualitative and quantitative improvements of elderly people's breakfasts are required. Residing at an old people's home seems to improve the quality of breakfast consumed, especially for elderly women.

Dietary assessment of a group of elderly Spanish people.

The dietary patterns of 60 elderly from Spain (37 women and 23 men) were examined by analysis of the food, energy and nutrient intake during 5 days. The caloric profile was somewhat unbalanced, since the percentage of total energy intake from proteins and lipids was above the recommended limit whereas the proportion of energy derived from carbohydrates was slightly deficient. The degree of underreporting derived by subtracting predicted total daily energy expenditure from self-reported energy intake obtained from a diet control during 5 days is 120 kcal/day in men and 334 kcal/day in women. More than 50% of the population showed intakes of pyridoxine, folates, vitamin A (only in men), vitamin D, vitamin E. zinc, magnesium and iron (only in women) lower than those recommended. Although it is likely that the real intakes of these micronutrients are higher than the levels measured considering the underreporting, the obtained results show the existence of a risk of deficiency of several nutrients. An increase in the energy intake of the group with a parallel increase in physical activity with a view to avoiding weight gain may be of use in improving the nutritional status of the group. This measure, together with increased consumption of vegetables and milk products especially, may lead to a striking reduction in illness, a finding that is of considerable clinical and public health importance.

[Energy balance and caloric profile in the elderly obese or in those with overweight compared to those of normal weight]. / Balance energético y perfil calórico en ancianos obesos o con sobrepeso en comparación con los de peso normal.

BACKGROUND: Elderly obese people have higher morbidity and mortality rates than those of normal weight and thus deeper knowledge of the problem of obesity is required in order to establish measures for prevention and correction. The aim of this study was to analyze the differences in the energetic ingestion and caloric profile in the diets of elderly patients based on their body mass index (BMI). METHODS: A collective of 127 elderly patients (44 institutionalized and 83 not) from 65 to 89 years of age were studied being grouped as: overweight-obese elderly (BMI > 25 kg/m2) and normal weight elderly patients (BMI < 25 kg/m2). The ingestion of energy and caloric profile of their diets was calculated in both groups by the "precise individual weight" method (in the institutionalized patients) and by the "register of food consumption" (in non institutionalized patients). The data of energetic ingestion were validated by comparison with the energy spent calculated on the basis of weight, age, and the daily activities of each patient. RESULTS: No significant differences were found between the energetic ingestion of overweight and obese elderly persons and those of normal weight, although the former had a more unbalanced caloric profile, with greater protein contribution and lesser carbohydrate contribution to total calories. It was also found that overweight and obese elderly patients underevaluate their energetic ingestion more than those of normal weight. CONCLUSIONS: The main difference observed between overweight-obese elderly patients with respect to those of normal weight was in the composition of their diets more than in the total energetic consumption.

Parental death from cardiovascular disease and dietary habits in an elderly group.

The present study examines the influence of parental history of death from cardiovascular disease on dietary habits and nutritional status of a group of seventy-two Spanish elderly. Those with at least one parent who had died of cardiovascular disease (43.1% of the cases) had higher diastolic blood pressure (P < 0.05) and nutrient intakes less favourable from the cardiovascular risk point of view than those whose parents died of other causes. Descendants whose parents died of cardiovascular disease had higher total fat, animal fat, saturated fatty acids, myristic acid and palmitic acid intakes and a lower monounsaturated fatty acids:saturated fatty acids value than descendants of those who died from other causes (all P < 0.05).