[Effect of gastric bypass on the cardiovascular risk and quality of life in morbid obese patients]. / Efecto del bypass gástrico sobre el riesgo cardiovascular y la calidad de vida en pacientes con obesidad mórbida.

OBJECTIVES: To determine the prevalence of major comorbidities of morbidity obese patients and to evaluate the gastric bypass effect on the weight status, cardiovascular risk and quality of life in these patients. METHODS: The evolution of weight, comorbidity, 10- year follow-up of cardiovascular risk (estimated by the Framingham risk score) and quality of life using the test BAROS (Bariatric Analysis and Reporting Outcome System) was analyzed in 162 patients with morbid obesity before and 2 years after gastric bypass. RESULTS: Body mass index (BMI) was reduced from 51.12 ± 7.22 to 29.94 ± 4.86 kg/m2 (72.85% loss of excess weight). Hypertension (HT), dyslipidemia and type 2 diabetes mellitus (T2DM) were resolved in 71.93%, 91.38% and 82.93% respectively (p < 0.001). Cardiovascular risk greater than 10% was reduced from 25.91% to 4.32% (p < 0.001). According to BAROS scale, surgery was positive in 95% of cases. CONCLUSIONS: Gastric bypass is very effective in weight loss; benefits in comorbidities, cardiovascular risk and quality of life.

Objetivos: Determinar la prevalencia de las principales comorbilidades asociadas a la obesidad mórbida y evaluar el efecto del bypass gástrico sobre el estado ponderal, riesgo cardiovascular y calidad de vida en estos pacientes. Métodos: Estudio descriptivo con medidas del cambio intrasujeto (antes-después) en una muestra de 162 pacientes de los resultados del bypass gástrico sobre la evolución ponderal, comorbilidades asociadas, riesgo cardiovascular a 10 años (estimado mediante las tablas de Framingham) y calidad de vida mediante el test BAROS (Bariatric Analysis and Reporting Outcome System). Resultados: El índice de masa corporal (IMC) se reduce de 51,12 ± 7,22 kg/m2 a 29,94 ± 4,86 kg/m2 (72,85% de sobrepeso perdido) y se resuelven la hipertensión arterial (HTA), la dislipemia y la diabetes mellitus tipo 2 (DMT2) en el 71,93%, 91,38% y 82,93% respectivamente (p < 0,001). El riesgo cardiovascular mayor del 10% se reduce del 25,91% al 4,32% (p < 0,001). Según la escala BAROS, el resultado de la cirugía fue favorable en el 95% de los casos. Conclusiones: La cirugía bariátrica mediante bypass gástrico demuestra ser muy efectiva para la reducción ponderal y comorbilidades asociadas, mejorando notablemente la calidad de vida.

Efecto del bypass gástrico sobre el riesgo cardiovascular y la calidad de vida en pacientes con obesidad mórbida / Effect of gastric bypass on the cardiovascular risk and quality of life in morbid obese patients

Objetivos: Determinar la prevalencia de las principales comorbilidades asociadas a la obesidad mórbida y evaluar el efecto del bypass gástrico sobre el estado ponderal, riesgo cardiovascular y calidad de vida en estospacientes. Métodos: Estudio descriptivo con medidas del cambio intrasujeto (antes-después) en una muestra de 162 pacientes de los resultados del bypass gástrico sobre la evolución ponderal, comorbilidades asociadas, riesgo cardiovascular a 10 años (estimado mediante las tablas de Framingham) y calidad de vida mediante el test BAROS (Bariatric Analysis and Reporting Outcome System).Resultados: El índice de masa corporal (IMC) se reduce de 51,12 ± 7,22 kg/m2 a 29,94 ± 4,86 kg/m2 (72,85% de sobrepeso perdido) y se resuelven la hipertensión arterial(HTA), la dislipemia y la diabetes mellitus tipo 2 (DMT2)en el 71,93%, 91,38% y 82,93% respectivamente (p <0,001). El riesgo cardiovascular mayor del 10% se reduce del 25,91% al 4,32% (p < 0,001). Según la escala BAROS, el resultado de la cirugía fue favorable en el 95% de los casos. Conclusiones: La cirugía bariátrica mediante bypass gástrico demuestra ser muy efectiva para la reducción ponderal y comorbilidades asociadas, mejorando notablemente la calidad de vida (AU)

Objectives: To determine the prevalence of majorcomorbidities of morbidity obese patients and to evaluate the gastric bypass effect on the weight status, cardiovascular risk and quality of life in these patients. Methods: The evolution of weight, comorbidity, 10-year follow-up of cardiovascular risk (estimated by the Framingham risk score) and quality of life using the test B AROS (Bariatric Analysis and Reporting Outcome System) was analyzed in 162 patients with morbid obesity before and 2 years after gastric bypass. Results: Body mass index (BMI) was reduced from 51.12± 7.22 to 29.94 ± 4.86 kg/m2 (72.85% loss of excess weight).Hypertension (HT), dyslipidemia and type 2 diabetes mellitus (T2DM) were resolved in 71.93%, 91.38% and82.93% respectively (p < 0.001). Cardiovascular risk greater than 10% was reduced from 25.91% to 4.32% (p< 0.001). According to BAROS scale, surgery was positive in 95% of cases. Conclusions: Gastric bypass is very effective in weightless; benefits in comorbidities, cardiovascular risk and quality of life (AU)

Cytokine profile, metabolic syndrome and cardiovascular disease risk in women with late-onset gestational diabetes mellitus.

Inflammation is an important component of the metabolic syndrome (MetS) which could be the link between the metabolic and the cardiovascular consequences of this condition. Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for MetS and an inflammation component has been described in this disease. The aim of the study was to evaluate the relationships between cytokine concentrations, components of MetS and cardiovascular risk markers in women with late-onset GDM. Women (n=63) with late-onset GDM and 63 controls were enrolled. Clinical variables, and obstetrics and perinatal outcomes were recorded. Relationships between cytokines (TNF-α, leptin, IL6, adiponectin) and endothelial injury markers (VCAM, ICAM and selectine) were analyzed. Control vs. patient data indicated: pre-gestational body mass index (BMI) 23.46±3.73 vs. 26.97±5.07kg/m(2) (p=0.001); TNF-α 2.2±0.8 vs. 3.1±1.5pg/mL (p=0.002); leptin 18714.78±8859.08 vs. 27365.79±16209.67pg/mL (p=0.001); adiponectin 162.42±34.19 vs. 141.54±41.33ng/mL (p=0.04). Multivariate analyses showed that adiponectin had a protective effect (OR=0.9; p=0.02) and BMI carried a significant risk (OR=8.4; p=0.01) for GDM. No differences were found in endothelial injury markers. In conclusion, the cytokine profile in women with late-onset GDM is characterized by high concentrations of TNF-α and leptin and low adiponectin. This profile is related, in large extent, to an increased pregravid BMI which, potentially, may be linked to the future development of both metabolic and cardiovascular disease.

Evaluación de la calidad asistencial en pacientes con diabetes tipo 2 del Área Sanitaria Cádiz-San Fernando / Evaluation of the quality of care of type 2 diabetic patients from the Health Area 2 Cádiz-San Fernando

Objetivo: Evaluar la calidad de la prestación de atención sanitaria al paciente con diabetes tipo 2 en un área básica de salud. Pacientes y métodos: Estudio observacional descriptivo de una muestra de 517 pacientes con diabetes tipo 2 conocida (intervalo de confianza 95%, nivel de riesgo alfa 0,05) atendidos en Atención Primaria y Endocrinología del área básica de salud Cádiz-San Fernando (228.000 habitantes). Se evalúa la calidad de la atención sanitaria aplicando los criterios de calidad propuestos por el Grupo Europeo de la Federación Internacional de Diabetes. Resultados: Se estudian 517 pacientes con diabetes tipo 2de 63,4 ± 12 años de edad media (59,4% mujeres) y 9,7 ± 8 años de evolución conocida de la diabetes. A pesar de la elevada prevalencia de factores de riesgo cardiovascular (HTA: 58%, dislipemia53%, obesidad: 40%, tabaquismo activo: 19%) y complicaciones crónicas de la diabetes (retinopatía 29%, nefropatía: 20%). El grado de cumplimiento en la realización de autoanálisis de glucemia capilar (35%), exploración anual de los pies (44%), determinación anual de albuminuria (47%) y de un perfil lipídico completo(51%) y participación en actividades educacionales (53%) fue insuficiente. Sin embargo, el porcentaje de determinación anual dehemoglobina glicosilada fue aceptable (81%).Conclusiones: Los pacientes con diabetes tipo 2 del área Cádiz-San Fernando presentan una elevada prevalencia de comorbilidades y complicaciones crónicas, evidenciándose la necesidad de mejora en el cumplimiento de las recomendaciones básicas para el cuidado y control de la enfermedad

Objective: The objective of our study was to evaluate the quality of health care in patients with type 2 in a health care area. Patients and methods: Observational descriptive study of a sample of 517 type 2 diabetes patients (confidence interval at 95% and sensibility at 5%) attended by Primary Care and Endocrinology of a Cádiz-San Fernando health care area (228,000 inhabitants). The quality of health care was evaluated applying the Guidelines of Diabetes Care of European Diabetes Policy Group of International Diabetes Federation. Results: A total of 517 patients with type 2 diabetes, with a mean age of 63.4 ± 12 years (59.4% women) and a mean period of disease evolution of 9.7 ± 8 years were assessed. Despite of great prevalence of cardiovascular risk factors (58% hypertension, 53% dislipemia, 40% obesity, 19% smoker) and chronic diabetes complications (29% retinopathy, 20% nephropathy), it was observed inadequate percentages in self-monitoring of blood glucose (35%), foot examination (44%) and yearly measure of urinary albumin excretion (47%) and blood lipid profile (51%) and patient education programme participation (53%). However, it was observed an adequate percentage of patients with at least one glycated haemoglobin determination at year (81%). Conclusion: Type 2 diabetes patients of Cádiz-San Fernando health care area present a great prevalence of comorbidities and chronic diabetes complications. It is necessary to improve the implementation of diabetes basic care recommendations and control of illness