Increased resting energy expenditure by fat-free mass in children and teenagers with constitutional leanness.

BACKGROUND/OBJECTIVES: To compare the resting energy expenditure (REE) and the REE/Fat-free-mass (FFM) quotient in children with constitutional leanness (CL) and children with normal body weight, and to describe the within-family clustering of CL. SUBJECTS/METHODS: We have studied 18 children and teenagers with CL, 10 girls and 8 boys, and 18 gender and age matched normal controls, with the same pubertal stage. All were recruited from the outpatient pediatric clinic nutrition unit. None of the children with CL showed symptoms of chronic illness, they had normal laboratory results, they had a normal caloric food intake, and they did not agree with the DSM-IV-TR criteria for anorexia nervosa. We describe the body mass index (BMI) of children and their parents. The children were classified according to Cole's recently published BMI cut-offs for thinness: under 18.5 points in CL group, stable at least in the last year, and between 18.5 and 25 cutt-offs in the control group. The body composition was calculated by anthropometric methods (skinfold thickness measurements). In addition REE was measured using fasting indirect calorimetry. RESULTS: The CL group had a higher mean percentage of FFM, and a mean FM significantly less, relative to controls (p < 0.001). The average absolute REE was significantly lower in the CL group (1,106.55 ± 240.72 kcal) than the control group (1,353.33 ± 270.01 kcal/dia) (p < 0.01). However, the REE adjusted for FFM showed a mean significantly greater in the CL group (41.39 ± 2.26 kcal/kg FFM) (Mean confidence interval (CI) 95 %: 40.33-42.45) than the controls (37.37 ± 3.06 kcal/kg FFM) (Mean CI 95 %: 35.93-38.81) (p < 0.001). Finally, in the family study, the mean BMI of fathers of CL group was significantly lower (p < 0.01), but there were not any differences in the mean BMI of mothers. Among parents with BMI known, 8 of 35 parents of CL group had an BMI lower 18.5, and only 2 of 36 parents in the control group (p < 0.05). CONCLUSIONS: This increased energy expenditure-to-FFM ratio differentiates between CL and controls. These metabolic differences are probably genetically determined.

Increased resting energy expenditure by fat-free mass in children and teenagers with constitutional leanness / Incremento del gasto energético en reposo por masa libre de grasa en niños y adolescentes con delgadez constitucional

Background/objectives: To compare the resting energy expenditure (REE) and the REE/Fat-free-mass (FFM) quotient in children with constitutional leanness (CL) and children with normal body weight, and to describe the within-family clustering of CL. Subjects/methods: We have studied 18 children and teenagers with CL, 10 girls and 8 boys, and 18 gender and age matched normal controls, with the same pubertal stage. All were recruited from the outpatient pediatric clinic nutrition unit. None of the children with CL showed symptoms of chronic illness, they had normal laboratory results, they had a normal caloric food intake, and they did not agree with the DSM-IV-TR criteria for anorexia nervosa. We describe the body mass index (BMI) of children and their parents. The children were classified according to Cole's recently published BMI cut-offs for thinness: under 18.5 points in CL group, stable at least in the last year, and between 18.5 and 25 cutt-offs in the control group. The body composition was calculated by anthropometric methods (skinfold thickness measurements). In addition REE was measured using fasting indirect calorimetry. Results: The CL group had a higher mean percentage of FFM, and a mean FM significantly less, relative to controls (p < 0.001). The average absolute REE was significantly lower in the CL group (1,106.55 ± 240.72 kcal) than the control group (1,353.33 ± 270.01 kcal/dia) (p < 0.01). However, the REE adjusted for FFM showed a mean significantly greater in the CL group (41.39 ± 2.26 kcal/kg FFM) (Mean confidence interval (CI) 95 %: 40.33-42.45) than the controls (37.37 ± 3.06 kcal/kg FFM) (Mean CI 95 %: 35.93-38.81) (p < 0.001). Finally, in the family study, the mean BMI of fathers of CL group was significantly lower (p < 0.01), but there were not any differences in the mean BMI of mothers. Among parents with BMI known, 8 of 35 parents of CL group had an BMI lower 18.5, and only 2 of 36 parents in the control group (p < 0.05). Conclusions: This increased energy expenditure-to-FFM ratio differentiates between CL and controls. These metabolic differences are probably genetically determined (AU)

Objetivos: Comparar el gasto energético en reposo (GER) y el cociente GER/masa libre de grasa (MLG) entre niños con delgadez constitucional (CL) y niños con peso normal, y describir la agregación familiar de la DC. Material y métodos: Hemos estudiados 18 niños y adolescentes con DC, 10 niñas y 8 niños, y 18 controles pareados con aquellos por edad, sexo y mismo estadio puberal. Todos fueron captados en la consulta externa de la Unidad de Nutrición clinica infantil. Ninguno de los niños con DC mostraba sintomas de enfermedad crónica, todos presentaban hallazgos de laboratorio normales, tuvieron una ingesta calórica normal, y no cumplieron en ningún caso criterios de anorexia nerviosa según la DSM-IV-TR. Se describe el indice de masa corporal (IMC) de los niños y de sus padres. Los niños fueron clasificados según los puntos de corte de IMC para definición de delgadez recientemente publicados por Cole: inferior al punto 18.5 en el grupo de DC, estable durante al menos un año, y entre los puntos de corte 18.5 y 25 en el grupo control. La composición corporal fue calculada por métodos antropométricos (medida de pliegues cutáneos). Además, el GER fue determinado mediante calorimetria indirecta en ayunas. Resultados: El grupo de DC tuvo un porcentaje de MLG medio mayor, y una masa grasa (MG) media significativamente menor, en relación con los controles (p < 0,001). El GER absoluto medio fue significativamente más bajo en el grupo con DC (1.106,5 ± 240,72 kcal) que en el grupo control (1.353,3 ± 270,01 kcal/dia) (p < 0,01). Sin embargo, el GER ajustado por MLG mostró una media significativamente mayor en el grupo de DC (41,39 ± 2,26 kcal/kg MLG) (Intervalo de confianza (IC) de la media al 95%: 40,33-42,45) que en los controles (37,37 ± 3.06 kcal/kg MLG) (CI 95%: 35,93-38,81) (p < 0,001). Finalmente, en el estudio familiar, el IMC medio de los padres del grupo con DC fue significativamente más bajo (p < 0,01), pero no hubo ninguna diferencia entre el IMC de las madres. Entre los padres con IMC conocido, 8/35 padres del grupo con DC presentaron un IMC menor de 18,5, por sólo 2/36 padres del grupo control (p < 0.05). Conclusiones: El incremento en el GER por MLG diferencia niños con DC de controles. Estas diferencias metabólicas podrían estar determinadas genéticamente (AU)

[Nutrition and bone health in children]. / Nutrición infantil y salud ósea.

Adequate nutrient intake is an important component of maintaining bone health, and should be encouraged in all age groups. Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine and hip. Osteoporosis is a global public health problem which currently affects a great proportion of women and men, and is increasing in significance as the population of the world both grows in size and lives longer. Bone loss does not have any symptoms, and often the first sign of having osteoporosis is a fracture. Studies in children and adolescents have shown that calcium and Vitamin D supplements seems to enhance the rate of bone mineral acquisition, and can play a role in osteoporosis prevention. In this paper we review some of the more important questions about this condition, its pathogenesis, diagnosis, and prevention.

Nutrición infantil y salud ósea / Nutrition and bone health in children

Mantener un adecuado estado nutricional en todas las etapas de la vida es decisivo para lograr un metabolismo óseo que favorezca la salud. La osteoporosis se caracteriza por una alteración en la cantidad y calidad de la mineralización ósea, lo que origina una fragilidad del esqueleto con riesgo aumentado de fracturas, especialmente vertebrales y de cadera. Es un problema público a nivel mundial, que afecta a una proporción elevada de hombres y mujeres, y que se desarrolla de forma asintomática hasta que se manifiesta de forma imprevista y causa una fractura del esqueleto. Estudios en niños han demostrado que el desarrollo de osteoporosis en la edad adulta puede verse condicionada por el estado nutricional durante la infancia, especialmente en lo referente a los aportes de calcio y vitamina D. No obstante, existen aún muchas cuestiones abiertas, tanto en lo referente a su patogenia y diagnóstico como a su tratamiento; algunas de éstas se revisan en este trabajo (AU)

Adequate nutrient intake is an important component of maintaining bone health, and should be encouraged in all age groups. Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine and hip. Osteoporosis is a global public health problem which currently affects a great proportion of women and men, and is increasing in significance as the population of the world both grows in size and lives longer. Bone loss does not have any symptoms, and often the first sign of having osteoporosis is a fracture. Studies in children and adolescents have shown that calcium and Vitamin D supplements seems to enhance the rate of bone mineral acquisition, and can play a role in osteoporosis prevention. In this paper we review some of the more important questions about this condition, its pathogenesis, diagnosis, and prevention (AU)

Ingesta de calcio y fósforo en ausencia de leche / Calcioum and phsphorus intake in absence of milk

La leche es un alimento de elevada calidad nutricional dado su baja densidad energética y su alto contenido en nutrientes. Dentro de éstos es preciso destacar que la leche es la única fuente dietética de lactosa y una de las principales de calcio y fósforo. Durante los primeros meses de la vida puede cubrir todas las necesidades nutricionales del niño pero su importancia dentro de la alimentación va disminuyendo progresivamente con la edad. Precisamente uno de los motivos de que los adolescentes dejen de tomar leche es su identificación como alimento infantil. En otras ocasiones e trata de aversiones e intolerancias de diverso tipo que obligan a sustituir la leche (y en ocasiones los productos lácteos) por otros alimentos. La mineralización ósea evidencia un balance positivo durante la infancia, hasta alcanzar su máximo (pico de masa ósea) unos años después de terminar el crecimiento. Existen al menos 3 períodos críticos para la aposición del calcio y fósforo: el último trimestre del embarazo, los tres primeros años de vida y la pubertad. La recomendaciones de ingesta se ajustan a los cambios fisiológicos en la mineralización ósea aunque son del tipo AI (ingestas adecuadas9, ya que aún no hay datos suficientes para asegurar científicamente (RDA) los requerimientos a cada edad (AU)

Milk is a nourishment having elevated nutritional quality given its low energy density high nutrient content. Within these, it is necessary to stress that milk is the only dietary source of lactose and one of the principal ones of calcium and phosphorus. During the first months of life, it can cover all of the nutritional needs of the infant, but its importance within the diet progressively decreases with age. One of the reasons that adolescents stop drinking milk is precisely its identification as a food for children. On other occasions, it is an aversion and intolerance to different types that make it necessary to substitute the milk (and sometime the lactic products) with other nutrients. Bone mineralization shows a positive balance during childhood, until it reaches its maximum 8bone mass peak) a few years after growth ends. There are at least 3 critical periods for calcium and phosphorus apposition: The last three months of pregnancy, the first three years of life and puberty. Intake recommendations are adjusted to they are type AI (adequate intake), since sufficient data is still lacking to scientifically assure (RDA) the requirements at each age (AU)

Gasto energetic y obesidad / Energy output and obesity

Se efectúa un trabajo de revisión sobre el gasto energético, sus componentes y métodos de valoración del mismo, centrado en la aplicación de todos estos conceptos sobre la obesidad infantil y la juvenil. La parte teórica inicial del trabajo está orientada a la comprensión adecuada del estudio efectuado en una población de 70 niños y adolescentes obesos que se describe en una segunda parte. El gasto calórico en reposo (GER) fue determinado por calorimetría indirecta y por las ecuaciones clásicas de estimación del gasto, generando el dato del gasto energético total (GET), tras determinar el factor de actividad física (FA). Se analizan de forma combinada los datos relativos a la ingesta calórica, mediante encuesta de tres días no consecutivos incluyendo un festivo y los datos del cociente respiratorio (CI) y la oxidación de sustratos (AU)

We present and energy expenditure review, its components and mechanism of evaluation focused on infantile and juvenile obesity. The initial theorical part is oriented to the correct comprehension of the study made in an population of obese children and adolescents (range 8-18 years) that we describe in the second part. Initial nutritional assessment included anthropometrics and bioimpedance. The resting energy expenditure (REE) was measured by indirect calorimetry and by the classics equations’ for the estimation of energy expenditure, giving rise to the total energy expenditure value (TEE) taking into account the physical activity (PA). We perform a multivariate analysis of the caloric intake estimated by, a three non consecutive day including a holiday, intake surveys the respiratory quotient (RQ) and the substrate oxidation (AU)

Los alimentos funcionales a la luz de la normativa europea / Functional foods in light of the European regulation

No disponible

[Childhood obesity. Recommendations of the Nutrition Committee of the Spanish Association of Pediatrics. Part II. Diagnosis. Comorbidities. Treatment]. / Obesidad Infantil. Recomendaciones del Comité de Nutrición de la Asociación Española de Pediatría. Parte II. Diagnóstico. Comorbilidades. Tratamiento.

The present article reviews the diagnostic criteria for pediatric obesity and its comorbidities. Treatment is also reviewed, including promotion of physical activity, and dietetic, pharmacologic and surgical treatment.

Obesidad Infantil. Recomendaciones del Comité de Nutrición de la Asociación Española de Pediatría. Parte II. Diagnóstico. Comorbilidades. Tratamiento / Childhood obesity. Recommendations of the Nutrition Committee of the Spanish Association of Pediatrics. Part II. Diagnosis. Comorbidities. Treatment

En el presente artículo se revisan los criterios actuales para el diagnóstico de la obesidad y de sus comorbilidades en la edad pediátrica, así como el tratamiento en todas sus vertientes: dietético, ejercicio físico, farmacológico y quirúrgico

The present article reviews the diagnostic criteria for pediatric obesity and its comorbidities. Treatment is also reviewed, including promotion of physical activity, and dietetic, pharmacologic and surgical treatment

Valoración del estado nutricional del obeso: estimación de la masas grasa / Assessment of nutritional status of the obese: stimulation of the fat mass

No disponible

Differential efficacy of treatment with acetylcholinesterase inhibitors in patients with mild and moderate Alzheimer's disease over a 6-month period.

There are various anticholinesterase inhibitors (AChEIs) for the symptomatic treatment of mild to moderate Alzheimer's disease (AD). All AChEIs have shown greater efficacy than placebo in randomized, double-blind, parallel-group clinical trials. No differential studies have yet been made of the efficacy between all AChEIs. The study aims to determine the differential efficacy of the AChEIs with respect to a historical sample of patients with AD that were not treated with AChEIs. An open-label, prospective, observational study with a retrospective control group was undertaken to examine the evolution of the cognitive function over a 6-month period. The patients were assessed with the Mini-Mental State Examination (MMSE) at study entry and at 6 months. A general linear model was applied for repeated measurements with the MMSE score as the dependent variable, treatment type as an independent variable and the severity of the deterioration, age and the MMSE baseline score as covariables. Of the sample of 147 patients, 40 initiated treatment with donepezil, 32 with galantamine, 30 with rivastigmine and 45 were part of a historical sample of the memory clinic patients between 1991 and 1996 that had not been treated with AChEIs. The average age was 73.7 years (SD = 6.9; range = 52-86), 67.3% were women, 78.2% of the cases were mild and the MMSE baseline score was 18.1 points (range = 11-27). No significant intergroup differences were observed in these variables. The average doses of donepezil, galantamine and rivastigmine were 5.87 mg/day (SD = 1.92), 14.81 mg/day (SD = 6.25) and 6.41 mg/day (SD = 1.82), respectively. At 6 months, the difference in the MMSE score with respect to the untreated group was 1.6 points for donepezil (95% CI 0.79-2.37; p < 0.001), 0.99 points for galantamine (95% CI 0.14-1.85; p = 0.01) and 0.90 points for rivastigmine (95% CI 0.05-1.74; p = 0.03). No significant differences were observed in the efficacy among the groups treated with AChEIs (p > 0.05). Treatment with AChEIs significantly delays the global cognitive impairment associated with AD for at least 6 months. Our study found no significant differences in efficacy between donepezil, galantamine and rivastigmine. Further studies in the context of daily clinical practice will determine the clinical significance of the changes observed. An important variability of the response to the treatment was observed in treated patients.

Bloqueo posterior del plexo lumbar para analgesia postoperatoria de artroplastias de cadera / Posterior lumbar plexus block for analgesia after hip arthroplasty

OBJETIVOS: Se estudió la calidad analgésica, con carácter descriptivo, en el postoperatorio precoz, del bloqueo posterior del plexo lumbar en el compartimento del psoas, localizado mediante neuroestimulación y con punción única, según la técnica de Chayen, a nivel paramedial L4, en pacientes sometidos a artroplastias de cadera no cementadas, realizadas bajo anestesia subaracnoidea con bupivacaína 0,5%. MATERIAL y MÉTODOS: Se analizó en 20 pacientes la intensidad del dolor según la escala visual analógica (EVA) cada hora durante las primeras 12 horas y cada 2 horas las siguientes 12 horas, el consumo de analgésico antiinflamatorio no esteroideo de rescate (AINE) si el dolor fue superior a 3 en la EVA, y el de morfina si la analgesia era insuficiente, y una valoración por el enfermo de la analgesia recibida según una escala de valoración verbal así como las complicaciones de la técnica. RESULTADOS: Las puntuaciones en la EVA se mantuvieron por debajo de 3 las primeras 11 horas, ascendiendo progresivamente hasta un máximo de 4,7 a las 24 horas. Durante las primeras 12 horas sólo 5 pacientes (25 %) necesitaron alguna dosis de AINE y ninguno morfina. En las segundas 12 horas 16 pacientes (80%) precisaron una media de 1,6 dosis de AINE, y en 3 (15%) fue necesario administrar morfina por dolor refractario o mayor de 5. En la encuesta de valoración verbal únicamente el 10% refería haber padecido un dolor intenso durante el tiempo de postoperatorio estudiado, mientras que para el 90% el dolor fue leve o moderado. CONCLUSIONES: El bloqueo posterior del plexo lumbar, con punción única, tiene efectividad analgésica durante las primeras 12 horas de postoperatorio, asociado a la anestesia espinal. Su utilización de forma continua mediante catéter podría proporcionar unas mejores condiciones analgésicas que las observadas (AU)

OBJETIVES: To describe early postoperative analgesic quality from a posterior lumbar plexus block in the psoas compartment, located by neurostimulation. We used a single paramedial puncture at L4, following Chayen's approach, in patients undergoing uncemented hip arthroplasty under subarachnoid anesthesia with 0,5% bupivacaine. MATERIAL AND METHODS: Twenty patients were enrolIed. We studied pain intensity on a visual analogical (VAS) scale every hour for the first 12 hours and every 2 hours for the next 12. The need for rescue analgesia, specifically non-steroidal anti-inflammatory drugs (NSAIDs) if pain was over 3 on the VAS and for morphine if analgesia was still insufficient. The patients assessed quality of analgesia received on a verbal scaIe. Complications were also noted. RESULTS: VAS scores were under 3 throughout the first 11 hours, gradually rising to 4,7 at 24 h. Only 5 patients (2%) needed NSAIDs in the first 12 hours and none needed morphine. Sixteen patients (80%) needed a mean 1,6 doses of NSAIDs and 3 (15%) needed morphine for persistent pain or for pain greater than 5 on the VAS. On the verbal sea le, only 10% reported experiencing intense pain during the postoperative period, whereas 90% said they had experienced mild or moderate pain. CONCLUSIONS: A posterior lumbar plexus block using a single shot gives effective analgesia in the first 12 hours after surgery performed with spinal anesthesia. Continuous infusion through a catheter may provide better analgesia than that observed in this study (AU)

[Posterior block of lumbar plexus for postoperative analgesia after hip arthroplasty]. / Bloqueo posterior del plexo lumbar para analgesia postoperatoria de artroplastias de cadera.

OBJECTIVES: To describe early postoperative analgesic quality from a posterior lumbar plexus block in the psoas compartment, located by neurostimulation. We used a single paramedial puncture at L4, following Chayen's approach, in patients undergoing uncemented hip arthroplasty under subarachnoid anesthesia with 0.5% bupivacaine. MATERIAL AND METHODS: Twenty patients were enrolled. We studied pain intensity on a visual analogical (VAS) scale every hour for the first 12 hours and every 2 hours for the next 12. The need for rescue analgesia, specifically non-steroidal anti-inflammatory drugs (NSAIDs) if pain was over 3 on the VAS and for morphine if analgesia was still insufficient. The patients assessed quality of analgesia received on a verbal scale. Complications were also noted. RESULTS: VAS scores were under 3 throughout the first 11 hours, gradually rising to 4.7 at 24 h. Only 5 patients (2%) needed NSAIDs in the first 12 hours and non needed morphine. Sixteen patients (80%) needed a mean 1.6 doses of NSAIDs and 3 (15%) needed morphine for persistent pain or for pain greater than 5 on the VAS. On the verbal scale, only 10% reported experiencing intense pain during the postoperative period, whereas 90% said they had experienced mild or moderate pain. CONCLUSIONS: A posterior lumbar plexus block using a single shot gives effective analgesia in the first 12 hours after surgery performed with spinal anesthesia. Continuous infusion through a catheter may provide better analgesia than that observed in this study.

[The tumor necrosis factor system and leptin in coeliac disease]. / Sistema factor de necrosis tumoral y leptina en la enfermedad celíaca.

OBJECTIVE: Patients with coeliac disease (CD) present anorexia and malnutrition. Leptin is a significant anorexigenic factor, with a close relationship to the body mass index. The aims of this study were to asses serum leptin levels in CD and their possible influence on appetite, as well as to compare and relate leptin with tumor necrosis factor (TNF) activity, which has similar functions. METHODS: Leptin and TNF receptor-1 (TNFr-1) were measured by enzyme-linked immunosorbent assay. Sixty-five serum samples from patients with CD (28 boys and 37 girls) were analyzed. In all patients, small bowel biopsy and anti-endomysium determination were performed simultaneously. Twenty-nine patients presented active CD and 36 were in remission. RESULTS: Leptin concentrations were reduced in active CD (p = 0.002). In patients in remission, leptin was related to the body mass index (p = 0.001), but this correlation was not found during the active phase of the disease. Contrary to normal differences between sexes, in active CD leptin levels were similar in boys and girls. TNFr-1 was found in all serum samples and levels were statistically higher in patients with active CD (p = 0.0003), suggesting that the TNF system is activated in this disease. CONCLUSIONS: Leptin concentrations were reduced in active CD, but we did not find the usual positive correlation with body mass index and higher concentrations in girls. These results suggest that leptin does not contribute to anorexia and failure to thrive in patients with CD; in contrast, the TNF system might be involved.

Sistema factor de necrosis tumoral y leptina en la enfermedad celíaca / The tumor necrosis factor system and leptin in coeliac disease

Objetivo: Los enfermos celíacos presentan malnutrición y una gran anorexia. La leptina es un importante factor anorexígeno estrechamente relacionado con el índice de masa corporal (IMC). El objetivo fue estudiar la leptina sérica en la enfermedad celíaca y su posible acción sobre el apetito, compararla y relacionarla con el factor de necrosis tumoral (TNF), que tiene funciones similares. Métodos: La leptina y el receptor I de TNF (TNF-R-I) se midieron mediante enzimoinmunoanálisis (ELISA). Se analizaron 65 sueros de enfermos celíacos (28 varones y 37 mujeres). En todos los casos se practicó simultáneamente biopsia intestinal y se determinaron anticuerpos antiendomisio. Estaban en actividad 29 casos y 36 en remisión. Resultados: Los valores de leptina estaban disminuidos en la fase de actividad de la enfermedad celíaca (p 0,002), lo que no apoya su participación sobre la anorexia y la desnutrición del paciente celíaco. Durante la remisión de la enfermedad celíaca la leptina se relaciona con el IMC (p 0,001), pero en la fase activa se rompe esta relación habitual. En la fase aguda también se rompe la diferencia entre sexos, y son similares los valores en varones y mujeres. El TNF-R-I se detectó en todos los sueros y mostró una elevación significativa durante la fase aguda (p 0,0003) lo que parece indicar una activación del sistema TNF en la enfermedad celíaca. Conclusiones: La leptina está disminuida durante la fase activa de la enfermedad, y se pierde su habitual correlación con el IMC y el sexo femenino. Los resultados señalan que no participa en la anorexia y la desnutrición de la enfermedad celíaca y, sin embargo, sí podría hacerlo el sistema TNF (AU)

Valor de los marcadores serológicos en el diagnóstico de la enfermedad celíaca. Propuesta de un protocolo / Value of serological markers in the diagnosis of celiac disease. A proposed guidelinebackground

OBJETIVO: La alta frecuencia de casos atípicos de enfermedad celíaca y de formas con pobre sintomatología ha potenciado la búsqueda de marcadores analíticos que apoyen la indicación de la biopsia intestinal. Las pruebas más extendidas son la determinación de anticuerpos antigliadina de clase IgG e IgA (AAGIgG y AAGIgA) y antiendomisio (AEmIgA). MÉTODOS: Se presenta la experiencia de 10 años, estudiando AAG en 1.075 sueros de pacientes con enfermedad celíaca y AEmIgA en 534. Los marcadores séricos se compararon a la biopsia intestinal en 152 casos en los que se realizaron simultáneamente. RESULTADOS: En los casos con atrofia intestinal grave fue la alta sensibilidad de los AAGIgG (91 por ciento) y de los AEmIgA (94 por ciento), quienes además mostraron el valor predictivo positivo (88 por ciento) y negativo (97 por ciento) más altos. Un título positivo de AEmIgA coincidió con una biopsia alterada al 100 por ciento de los casos. Los AEmIgA fueron también el marcador más eficaz para el control de la dieta sin gluten. Sin embargo, en los casos con atrofia parcial de la mucosa intestinal ningún marcador fue lo bastante indicativo. CONCLUSIÓN: Los AEmIgA son el mejor marcador serológico de enfermedad celíaca. A la luz de los resultados y según la prevalencia estimada de esta enfermedad, se proponen protocolos de utilización de los marcadores serológicos para el diagnóstico de los síndromes malabsortivos, para estudios de poblaciones de bajo y alto riesgo de enfermedad celíaca y para el seguimiento de los pacientes diagnosticados (AU)

[Value of serological markers in the diagnosis of celiac disease. A proposed protocol]. / Valor de los marcadores serológicos en el diagnóstico de la enfermedad celíaca. Propuesta de un protocolo.

AIM: In recent years, the high frequency of atypical cases of celiac disease (CD) and of forms of this disease with minor symptoms has prompted the search for analytical markers that may support indications for intestinal biopsy. The commonest tests are those for serum class IgG and IgA antigliadin antibodies (IgG-AGA, IgA-AGA) and IgA antiendomysial antibodies (IgA-EmA). METHODS: We report our 10 year experience of studying AGA in 1,075 serum samples from patients with CD and IgA-EmA in 534 samples. The serological markers were compared with 152 intestinal biopsies performed simultaneously with the other tests. RESULTS: In patients with severe intestinal atrophy the sensitivity of IgA-AGA (91%) and IgA-EmA (94%) was high. IgA-EmA and the latter showed the highest positive (88%) and negative (97%) predictive values. In all patients, IgA-EmA positivity coincided with alterations in the biopsy. Determination of IgA-EmA was also the most efficient marker for monitoring the gluten free diet phase. However, in patients in whom minimal histological changes were found in the intestinal mucosa, none of the markers was sufficiently accurate. RESULTS: IgA- EmA antibodies are the most accurate serological marker of CD. In view of these results and the estimated prevalence of the disease, protocols for the use of serological markers are proposed for the differential diagnosis of malabsorption symptoms, for use in patients at low and high risk of CD and for the followup of those with a diagnosis of CD.

[Resting energy expenditure in cystic fibrosis]. / Gasto energético en reposo en fibrosis quística.

OBJECTIVE: Study of Resting Energy Expenditure (REE) by indirect calorimetry in patients with Cystic Fibrosis (CF), with the aim of determine its possible increase and its relationship with nutritional clinic and analitic parameters. PATIENTS AND METHODS: Measurement of REE in 18 patients (11 female) with CF, without acute pulmonary exacerbation. Their age was between 5 years 3 months and 21 years 7 months. REE was expressed as kcal/day and as percentage of the predictive education of World Health Organization (WHO) for calculation of REE in function of gender, age and weight. It was also determined complete anthropometry and body composition derived (Siri), bioelectrical impedance, pulmonary function (FEV1 and FVC), chest X-ray (Score Chrispin) and blood sample (leucocits, VSG, IgM, vitamin A, C, E and serum lipids). RESULTS: The mean REE was 1280 +/- 246 kcal/day. There was strong correlation with fat free mass (anthropometry) (r: 0.92; p < 0.0001) and with ratio height 2/resistance by bioelectric impedance (r: 0.89; p < 0.0001). If expressed as percentage of WHO education, REE was 104.2 +/- 9.8%. In chronic infected by Pseudomona sp. was 106.8 +/- 11.5% and 101.0 +/- 6.6 in no infected patients. REE was 102.9 +/- 6.4% in prepubertal subjects, 102.2 +/- 10.8% in pubertal, and 108.6 +/- 12.1 in postpubertal subjects. There was no significative correlation with nutritional status, but it was reported significative correlation with severity of pulmonary disease (FEV1: r: -0.58; p < 0.05. Score Chrispin: r: 0.62; p < 0.005). There was also significative correlation with ratio vitamin E/cholesterol (r: -0.60; p < 0.05), but not with another analitic parameters. CONCLUSIONS: REE is strong correlated with fat free mass in patients with CF. The increased REE values over normal ones is related with severity of pulmonary disease. The decrease of ratio Vitamin E/cholesterol is also related with increase of REE.