Sarcopenia, neuropatía periférica y enfermedad arterial periférica en pacientes con diabetes mellitus sometidos a hemodiálisis / Sarcopenia, peripheral neuropathy, and peripheral arterial disease in patients with diabetes mellitus under hemodialysis

Resumen Introducción: La sarcopenia se caracteriza por pérdida de fuerza y masa muscular. Los pacientes con diabetes mellitus que se encuentran bajo tratamiento en hemodiálisis tienen disminución de actividad física y cambios en su ingestión alimentaria, lo que propicia también la presencia de sarcopenia; por otro lado, la neuropatía periférica y enfermedad arterial periférica aparecen comúnmente como complicaciones crónicas de la diabetes mellitus. Material y métodos: Se realizó un estudio transversal, observacional, en pacientes con diabetes mellitus y hemodiálisis. Para la evaluación de la sarcopenia se midió fuerza muscular, rendimiento físico y cantidad de masa muscular. Se midió fuerza muscular con dinamómetro, mientras que el rendimiento físico se evaluó con el tiempo en segundos de marcha con cronómetro, la cantidad de músculo de obtuvo utilizando una báscula con bioimpedancia. Se consideró sarcopenia severa cuando existía baja fuerza y cantidad muscular además de bajo rendimiento físico. La neuropatía periférica se evaluó explorando la sensibilidad a la presión y el tacto con el monofilamento de Semmes-Weinstein y sensibilidad profunda con un diapasón de 128 Hz. El índice tobillo-brazo fue la medición tomada para la clasificación de enfermedad arterial periférica. Resultados: El análisis final se realizó con 33 pacientes. Con un tiempo en hemodiálisis de 3,57 ± 2,56 años. La prevalencia de sarcopenia severa y sarcopenia fue de 90,8% y la de pre-sarcopenia de 9% del total de los pacientes; por otro lado, se encontró al 78,1% los pacientes con pérdida de la sensibilidad profunda, mientras que el porcentaje de los pacientes con pérdida de la sensibilidad a la presión y al tacto fue de 54,5%. Se encontró correlación entre los parámetros de sarcopenia y el tiempo de evolución de la insuficiencia renal y la edad. Conclusión: La sarcopenia se presenta, en sus diferentes etapas, en prácticamente todos los pacientes con diabetes mellitus sometidos a hemodiálisis; existe relación con la edad del paciente y el tiempo de hemodiálisis.

Abstract Introduction: Sarcopenia is characterized by loss of strength and muscle mass. Patients with diabetes mellitus who are under hemodialysis treatment show decreased physical activity and changes in their food intake, which also leads to the presence of sarcopenia. On the other hand, peripheral neuropathy and peripheral arterial disease commonly appear as chronic complications of diabetes mellitus. Methods: A cross-sectional, observational study was carried out in diabetes mellitus patients on hemodialysis. For the assessment of sarcopenia, muscle strength, physical performance and muscle mass percentage were measured. Muscle strength was calculated with a dynamometer, while physical performance was evaluated in seconds by means of a walk test with a stopwatch; muscle mass percentage was obtained using a scale with bioelectrical impedance. Sarcopenia was considered severe when there was low muscle strength and percentage in addition to low physical performance. Peripheral neuropathy was assessed by exploring touch and pressure sensibility with the Semmes-Weinstein monofilament test and deep sensibility with a 128 Hz tuning fork. The ankle-brachial index was the measurement taken for the peripheral arterial disease classification. Results: The final analysis was performed with 33 patients, whose time on hemodialysis was 3.57 ± 2.56 years. The prevalence of severe sarcopenia and sarcopenia was 90.8% and that of pre-sarcopenia was 9% of all patients. On the other hand, 78.1% were found to be patients with loss of deep sensibility, while the percentage of patients with loss of sensibility to pressure and touch was 54.5%. A correlation was found between the sarcopenia parameters and the time of evolution of renal failure and age. Conclusion: Sarcopenia occurs, in its different stages, in practically all diabetes mellitus patients undergoing hemodialysis; there is a relationship with the patient's age and hemodialysis time.

Risk and lifestyle factors associated to chronic kidney disease. / Factores de riesgo y de estilo de vida asociados a enfermedad renal crónica.

Lifestyle has a determining influence on the progression of a chronic kidney disease (CKD), which starts with some kidney damage, that can remain and progress by the influence of risk factors and accumulate subsequent injury of kidney damage throughout life. It is more common in adults and frequently remains hidden from routine analysis, but if it can be detected early, treatment and healthy lifestyle can be applied, which would allow stopping or lengthening the progress of kidney damage, in order to avoid the need of a renal transplant or dialysis. The objective of this work was to show the possible lifestyles to apply, such as visits to the doctor, not smoking, have intense to moderate physical activity, consume enough vegetables and fruits, avoid diets high in carbohydrates and lipids. To carry out this review, it was obtained literature from databases between 1980 and 2017, freely accessible, using keywords like "chronic kidney disease (CKD)", "lifestyle" and "risk factors", and its equivalents in Spanish.

El estilo de vida tiene una influencia determinante en el avance de la enfermedad renal crónica (ERC), la cual inicia con algún daño renal que puede permanecer y progresar por la acción de factores de riesgo, además de que pueden agregarse lesiones renales a lo largo de la vida. Es más común en personas adultas y frecuentemente permanece oculta a los análisis habituales, pero si logra detectarse de manera temprana puede atenderse con el fin de aplicar estilos de vida saludables que permitan detener o alargar el avance del daño renal, para evitar o retardar la necesidad de diálisis o de trasplante. El objetivo de este trabajo es dar a conocer los posibles estilos de vida que se deben implementar, como las visitas al médico, no fumar, tener actividad de intensa a moderada, consumir suficientes vegetales y frutas, y evitar dietas altas en hidratos de carbono y lípidos. Para llevar a cabo la revisión se obtuvo literatura de bases de datos entre 1980 y 2017, de libre acceso, utilizando las palabras clave en inglés "chronic kidney disease (CKD)", "lifestyle" y "risk factors", y sus equivalentes en español.

Association of Irisin Serum Concentration and Muscle Strength in Normal-Weight and Overweight Young Women.

Background: Irisin is a muscle-contraction-induced myokine. In previous studies, it has been related to exercise type, fitness and physical activity; however, evidence is not consistent. Thus, the aim of this study was to research the association between health-related fitness and irisin in young women. Methods: The study was designed as a prospective cross-sectional one. Young, healthy, nonsmoking women were enlisted. The sample comprised 40 overweight (OW) and 40 normal-weight (NW) individuals. The average age was 18.63 ± 0.63 and 18.78 ± 0.73 years, respectively. Components of health-related fitness, metabolic parameters, serum irisin and body composition were analyzed. Results: Statistically significant differences were found in physical tests between NW and OW groups for one-leg standing, hand grip strength, vertical jump, modified push-up, fitness index and maximal oxygen uptake (VO2MAX). There were no differences in concentrations of serum irisin between the groups. We found a positive correlation between irisin and hand grip strength (r = 0.374, p = 0.023). In a multivariate analysis adjusted by body fat, a significant association between irisin and hand grip strength was observed in OW group (ß = 0.380, p = 0.026); as well, a positive association between irisin and one-leg standing test in NW group (ß = 0.311, p = 0.044) was found. Conclusions: According to our findings, hand grip strength could be linked to irisin concentration in overweight young women.

Enzymatic activity induction of GST-family isoenzymes from pesticide mixture used in floriculture.

Glutathione S-transferases (GSTs) comprise a number of genes that codify for a group of isoenzymes that participate in phase II xenobiotic detoxification by means of conjugation with glutathione, producing hydrosoluble compounds. It has been demonstrated that some pesticides are substrates for GST isoenzymes. Floriculture is one of the main economic activities in the municipalities of Villa Guerrero and Atlacomulco; pesticides, applied as mixtures, are intensively used in this activity. In this study, total GST enzymatic activity and glutathione S-transferases theta 1 (GSTT1) enzymatic activity were calculated for a group of floriculture workers exposed to pesticides and for an unexposed group. The former comprised 169 floriculture workers, while the latter, 96 students. The value of the median GST enzymatic activity in the exposed group was 0.560 and 0.169 µmol/min/mL in the unexposed individuals. GSTT1 activity was 1.234 µmol/min/mL in the exposed group and 0.221 µmol/min/mL in the unexposed group. Mann-Whitney U test showed a significant difference between these groups, for both total GST and GSTT1, p < 0.001. Our results show that exposure to pesticides increases the activities of total GST and GSTT1 enzymes.

[Effect of exercise on the serum concentrations of leptin and adiponectin in adolescents with risk factors of developing diabetes]. / Efecto del ejercicio en la concentración sérica de leptina y adiponectina en adolescentes con factores de riesgo de DM.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is an increasing health issue. Physical activity (PA) in early stages is a preventive measure in the development of degenerative diseases. It has been documented the association between exercise and leptin and adiponectin concentrations. The objective was to evaluate the effect of a physical activity program (PAP) on serum leptin and adiponectin in teenagers with risk factors for developing T2DM. METHODS: Experimental-longitudinal study. Teenagers (men and women), with T2DM risk factors, aged 14 to 16 years, participated in a PAP for three months, five days a week, 45 minutes each day. Before and after the program, all anthropometric variables, incluiding leptin and adiponectin, were evaluated. RESULTS: 22 adolescents participated in the PAP and they were compared with 22 adolescents from the control group (who did not participate in the PAP). There was a reduction in the serum concentration of leptin in the intervention group (baseline 23 ± 13; after the PAP 14 ± 8, p > 0.0001), compared with the control group (baseline 18 ± 13, three months follow-up 20 ± 14, p < 0.520). Also, the adiponectin concentration increased (baseline 10 ± 3, after the PAP 13 ± 4.0, p > 0.014), compared with the control group (baseline 11 ± 3, 13 ± 4.0 after the PAP p > 0.032). CONCLUSIONS: This study support the efficacy of an aerobic exercise intervention on metabolic markers of adolescents with risk factors for developing diabetes.

INTRODUCCIÓN: la diabetes mellitus tipo 2 (DM2) es un problema de salud cada vez más preocupante. El ejercicio en etapas tempranas es una medida preventiva en el desarrollo de enfermedades crónico-degenerativas. Se ha postulado la asociación entre el ejercicio con las concentraciones de leptina y adiponectina. El objetivo fue evaluar el efecto de un programa de actividad física (AF) sobre la concentración sérica de leptina y adiponectina en adolescentes con factores de riesgo para el desarrollo de DM2. Métodos: estudio de tipo experimental-longitudinal. Participaron en un programa de AF durante tres meses adolescentes de 14 a 16 años, con factores de riesgo para el desarrollo de diabetes, cinco días a la semana, durante 45 minutos. Antes y después del programa, se evaluó la respuesta de leptina y adiponectina. RESULTADOS: participaron 22 adolescentes en el programa y se compararon con 22 adolescentes del grupo control. Las cifras de leptina disminuyeron en el grupo de intervención: basal 23 ± 13, después del programa 14 ± 8, p < 0.001; grupo control: basal 18 ± 13, seguimiento a tres meses 20 ± 14, p < 0.520. Asimismo, incrementaron las cifras de adiponectina: basal 10 ± 3, después del programa 13 ± 4.0, p < 0.014; grupo control: basal 11 ± 3, post ejercicio 13 ± 4.0, p < 0.032. CONCLUSIONES: nuestros resultados apoyan la eficacia de una intervención con ejercicio aeróbico sobre las características en un grupo minoritario de adolescentes con factores de riesgo para desarrollar diabetes.

Dietary patterns associated with body mass index (BMI) and lifestyle in Mexican adolescents.

BACKGROUND: The objetive in this study is to determine the relationship between dietary patterns, BMI, type 2 diabetes mellitus family history (T2DMFH) and some lifestyle variables such as smoking and skipping breakfast in a Mexican adolescent population. METHODS: Cross-sectional, observational, analytical study.Subjetcts: 14-16 years old male and female adolescents (n 373). A previously validated food frequency questionnaire (FFQ) was used and dietary patterns were derived using principal component analysis (PCA). Scores for dietary patterns were categorized by tertiles. RESULTS: Three major dietary patterns that explained 47 % of variance were found: westernized, high in protein/fat and prudent pattern. Subjects at the highest tertile of prudent pattern had lower BMI. And was also associated with less T2DMFH and less smoking habit when compared with the lowest tertile. We found a positive correlation between BMI and high scores for westernized and high in protein/fat pattern CONCLUSIONS: Dietary patterns of adolescents are a public health concern because there is a direct association between inadequate diet at this early age and obesity.

The adiponectin/leptin ratio is a useful tool to evaluate the metabolic status in an obstetrical intensive care unit.

INTRODUCTION: Critically ill patients, including obstetrical patients, face undernutrition but a reliable and cost effective study to assess their nutritional state is still missing. Our main objective was to analyze serum leptin and adiponectin concentrations in puerperal women attended in an Obstetrical Intensive Care Unit (OICU) in order to evaluate their potential role as nutritional metabolic parameter. METHODS: This was a descriptive, clinical, longitudinal and comparative study. We evaluated the anthropometric variables, clinical laboratories, daily calories and adiponectin and leptin serum levels of 16 puerperal women attended at the OICU of the Materno Perinatal Hospital "Mónica Pretelini" (HMPMP). RESULTS: For all women there was a negative correlation with Spearman test between leptin the day of discharge from the obstetrical intensive care unit and the days of stay -0.632 (p = 0.011). Considering an adiponectin/leptin ratio, the media in the first day was of 0.3 (0.07-13.6) and in the day of discharge it was of 2.4 (0.1-24.6) in overweight women. The same values for obese women were of 0.3 (0.2-0.4) and 0.5 (0.3-1.2). CONCLUSION: After an average of six days of hospitalization, leptin showed a decrement in women attended at the OICU. As expected, adiponectin increased in both groups. The adiponectin/ leptin ratio could be a useful metabolic parameter.