[Trends in the characteristics of patients treated with nutritional supplements in the Northern Area of Gran Canaria in the period 2016 -2021]. / Tendencias en las características de los pacientes tratados con suplementos nutricionales en el Área Norte de Gran Canaria en el periodo 2016 -2021.

AIM: assess the prescription of oral nutritional supplements (ONS) in the Northern Area of Gran Canaria in the period 2016-2021. MATERIALS AND METHODS: based on electronic prescription data, the first ONS prescription during 2016-2021 was analyzed considering age, gender, nutritional requirements (NR), body mass index (BMI), percentage of weight loss (%WL), albumin and number of prescribed ONS per patient. RESULTS: 10,595 prescriptions were identified corresponding to 6661 patients with the following characteristics: 46.3 % men, mean age 72.84 ± 15.93 years, BMI 20.60 ± 3.98 kg/m2, %WL 11.89 ± 8.32 %; albumin 3.08 ± 0.63 g/dl. The most frequent etiologies of DRE were: neoplasms 42.6 %; degenerative processes of the CNS 28.9 %; stroke 3.9 %; short intestine 6.9 %, and inflammatory bowel disease (IBD) 5.5 %. The percentages of NR covered by the prescribed ONS were: 100 % in 8.9 % of cases, 50 % in 36.9 %, and 25 % in 54.2 %; 40.4 % of patients received 1 unit of ONS daily, 36.3 % took 2 units of ONS, and 23 % received > 3 units of ONS per day. Greater NR were associated with a greater number of ONS (p < 0.001), but 40.8 % of patients who needed to cover > 50 % of NR received only one unit of ONS. CONCLUSION: a significant percentage of patients with DRM do not receive a number of ONS according to their NR.

Treatment of hypertension with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and resting metabolic rate: A cross-sectional study.

Hypertension in obese and overweight patients is associated with an elevated resting metabolic rate (RMR). The aim of this study was to determine whether RMR is reduced in hypertensive patients treated with angiotensin-converting enzyme inhibitors (ACEI) and blockers (ARB). The RMR was determined by indirect calorimetry in 174 volunteers; 93 (46.5 %) were hypertensive, of which 16 men and 13 women were treated with ACEI/ARB, while 30 men and 19 women with untreated hypertension served as a control group. Treated and untreated hypertensives had similar age, BMI, physical activity, and cardiorespiratory fitness. The RMR normalized to the lean body mass (LBM) was 15% higher in the untreated than ACEI/ARB-treated hypertensive women (p = .003). After accounting for LBM, whole-body fat mass, age, the double product (heart rate x systolic blood pressure), and the distance walked per day, the RMR was 2.9% lower in the patients taking ACEI/ARB (p = .26, treatment x sex interaction p = .005). LBM, age, and the double product explained 78% of the variability in RMR (R2  = 0.78, p < .001). In contrast, fat mass, the distance walked per day, and total T4 or TSH did not add predictive power to the model. Compared to men, a greater RMR per kg of LBM was observed in untreated hypertensive overweight and obese women, while this sex difference was not observed in patients treated with ACEI or ARBs. In conclusion, our results indicate that elevated RMR per kg of LBM may be normalized by antagonizing the renin-angiotensin system.

Resting metabolic rate is increased in hypertensive patients with overweight or obesity: Potential mechanisms.

The purpose of this investigation was to determine whether differences in body composition, pharmacological treatment, and physical activity explain the increased resting metabolic rate (RMR) and impaired insulin sensitivity in hypertension. Resting blood pressure, RMR (indirect calorimetry), body composition (dual-energy X-ray absorptiometry), physical activity (accelerometry), maximal oxygen uptake (VO2 max) (ergospirometry), and insulin sensitivity (Matsuda index) were measured in 174 patients (88 men and 86 women; 20-68 years) with overweight or obesity. Hypertension (HTA) was present in 51 men (58%) and 42 women (49%) (p = .29). RMR was 6.9% higher in hypertensives than normotensives (1777 ± 386 and 1663 ± 383 kcal d-1 , p = .044). The double product (systolic blood pressure × heart rate) was 18% higher in hypertensive than normotensive patients (p < .001). The observed differences in absolute RMR were non-significant after adjusting for total lean mass and total fat mass (estimated means: 1702 kcal d-1 , CI: 1656-1750; and 1660 kcal d-1 , CI: 1611-1710 kcal d-1 , for the hypertensive and normotensive groups, respectively, p = .19, HTA × sex interaction p = .37). Lean mass, the double product, and age were the variables with the higher predictive value of RMR in hypertensive patients. Insulin sensitivity was lower in hypertensive than in normotensive patients, but these differences disappeared after accounting for physical activity and VO2max . In summary, hypertension is associated with increased RMR and reduced insulin sensitivity. The increased RMR is explained by an elevated myocardial oxygen consumption due to an increased resting double product, combined with differences in body composition between hypertensive and normotensive subjects.

Ultrasonographic Size of the Thenar Muscles of the Nondominant Hand Correlates with Total Body Lean Mass in Healthy Subjects.

RATIONALE AND OBJECTIVES: Sarcopenia is associated with adverse outcomes in clinical situations such as elderly population, in-hospital setting and oncologic patients. However, no direct measurement of muscular mass is routinely available for clinicians. The aim of this study was to assess the correlation between thenar musculature of the nondominant hand evaluated by ultrasound and body fat-free mass. MATERIALS AND METHODS: In this one-center, cross-sectional, observational study, the width and depth of thenar muscles of both hands was assessed by ultrasonography. Nondominant hand musculature was taken as reference as a better estimator of total body muscular mass. These data were compared to body composition by bioimpedance analysis and dual-energy X-ray absorptiometry (DXA), hand grip strength, arm muscular area and physical activity (with International Physical Activity Questionnaire ). Statistical correlation was determined for each parameter. RESULTS: We obtained ultrasonographic measurements, International Physical Activity Questionnaire and hand grip strength from 83 subjects, whereas bioimpedance was performed in 64 subjects and DXA in 29 subjects. The strongest correlations were found between longitudinal thenar depth vs fat-free mass index (fat-free mass in DXA [kg]/height2 [m]) (r = 0.63, p < 0.001, 95%CI 0.34-0.81), longitudinal depth and hand dynamometry (r = 0.72, p < 0.001, 95%CI 0.59-0.81), longitudinal depth and DXA fat-free total mass (r = 0.76, p < 0.001, 95%CI 0.54-0.88), transversal thenar depth vs fat-free mass index (r = 0.67, p < 0.001, 95%CI 0.41-0.83), transversal width and DXA fat-free total mass (r = 0.62, p < 0.001, 95%CI 0.33-0.8), transversal depth and DXA nonfat total mass (r = 0.81, p < 0.001, 95%CI 0.63-0.91). CONCLUSION: Ultrasonographic examination of the nondominant thenar musculature is a fast and simple way of assessing total body fat-free mass, showing a good correlation with body composition measured by bioimpedance analysis and DXA, hand grip strength and arm muscular area.

Resting Energy Expenditure and Body Composition in Overweight Men and Women Living in a Temperate Climate.

This study aimed to determine whether the measured resting energy expenditure (REE) in overweight and obese patients living in a temperate climate is lower than the predicted REE; and to ascertain which equation should be used in patients living in a temperate climate. REE (indirect calorimetry) and body composition (DXA) were measured in 174 patients (88 men and 86 women; 20-68 years old) with overweight or obesity (BMI 27-45 kg m-2). All volunteers were residents in Gran Canaria (monthly temperatures: 18-24 °C). REE was lower than predicted by most equations in our population. Age and BMI were similar in both sexes. In the whole population, the equations of Mifflin, Henry and Rees, Livingston and Owen, had similar levels of accuracy (non-significant bias of 0.7%, 1.1%, 0.6%, and -2.2%, respectively). The best equation to predict resting energy expenditure in overweight and moderately obese men and women living in a temperate climate all year round is the Mifflin equation. In men, the equations by Henry and Rees, Livingston, and by Owen had predictive accuracies comparable to that of Mifflin. The body composition-based equation of Johnston was slightly more accurate than Mifflin's in men. In women, none of the body composition-based equations outperformed Mifflin's.

Pancreatic beta cell function is preserved in the short term in patients with type 2 diabetes undergoing non-urgent surgery.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a progressive condition influenced by many factors. Surgery usually produces hyperglycemia in the postoperative period, which leads to adverse clinical outcomes. Possible consequences of surgery on beta cell reserve have not been explored. The aim of this study was to assess the effect of surgery on the beta cell function of patients with T2DM undergoing non-urgent surgery. METHODS: We performed a prospective observational study on the population of patients with T2DM scheduled for surgery in a tertiary level hospital. After adequate wash-out periods for antidiabetic medications, two blood samples were collected: one fasting and the other one six minutes after an intravenous stimulation with glucagon. Glucose, insulin and C-peptide concentrations were measured. This determination was repeated about a month after surgery. RESULTS: We included 42 patients with the following characteristics: 47.6% males, average HbA1c 7%, average time from T2DM diagnosis 7.3 years and average age 62.1 years. Intravenous glucagon produced a significant increase in C-peptide after six minutes in both the presurgical (C-peptide values: basal 2.97 ng/mL; after glucagon 5.53 ng/mL) and the postsurgical (C-peptide values: basal 3.12 ng/mL; after glucagon 5.67 ng/mL) periods (mean difference 2.56 ng/mL and 2.55 ng/mL respectively, P<0.001). However, C-peptide increase after glucagon was not different between the presurgical and the postsurgical periods (2.56 ng/mL vs. 2.55 ng/mL, P>0.05). CONCLUSIONS: The pancreatic beta reserve of patients with T2DM was not affected a month after the non-urgent surgery. The direct measurement of pancreatic function by dynamic assessment with glucagon did not change, nor did we find alterations in the indirect calculation of insulin secretion using the HOMA-B. None of these parameters reached statistical significance. Non-urgent surgical procedures included in our study are safe for patients with short lasting, properly controlled T2DM, from the point of view of glucose metabolism assessed by pancreatic insulin secretion. We can consider non-urgent surgical procedures safe from the point of view of the preservation of the pancreatic reserve in patients with T2DM. A sharp deterioration of metabolic control is not expectable in the short term for these patients, which represent a large proportion of the population undergoing surgery in modern hospitals.

Effects of manidipine and its combination with an ACE inhibitor on insulin sensitivity and metabolic, inflammatory and prothrombotic markers in hypertensive patients with metabolic syndrome: the MARCADOR study.

BACKGROUND AND OBJECTIVE: Metabolic syndrome is common in patients with hypertension and increases the risk of developing diabetes mellitus. The objective of this study (the MARCADOR study) was to compare the effects of manidipine 20 mg with the extemporary combination of manidipine 10 mg/lisinopril 10 mg, amlodipine 10 mg and telmisartan 80 mg on insulin sensitivity, as well as metabolic, inflammatory and prothrombotic markers, in hypertensive non-diabetic patients with metabolic syndrome. METHODS: This study had a prospective, randomized, open-label, blinded endpoint (PROBE) design. A total of 120 patients aged 35-75 years with stage I-II essential hypertension (systolic blood pressure [BP] 140-179 mmHg, diastolic BP 90-109 mmHg) and metabolic syndrome were recruited from general practitioner clinics in Northern Gran Canaria Island, Spain and randomized to receive amlodipine 10 mg (n = 30), telmisartan 80 mg (n = 30), manidipine 20 mg (n = 30) or (low-dose) manidipine 10 mg/lisinopril 10 mg (n = 30), all administered once daily. At baseline and after 14 weeks of treatment, BP, insulin sensitivity, lipid profile, and albumin and metanephrin excretion as well as several other metabolic, inflammatory, prothrombotic and growth/adhesion markers were measured. The primary endpoint was the change in insulin sensitivity. RESULTS: A total of 115 patients completed the study. All treatments significantly lowered BP from baseline. Compared with amlodipine, manidipine had significantly superior effects (p < 0.05) on insulin resistance (-26.5% vs -3.0%), albumin/creatinine ratio (-28.2% vs -3.6%), low-density lipoprotein (LDL) cholesterol (-6.8% vs +1.7%), and several other metabolic, inflammatory and prothrombotic markers. Manidipine was associated with a slightly greater increase in insulin sensitivity than manidipine/lisinopril, but manidipine/lisinopril was significantly more effective than manidipine and telmisartan for improving a number of metabolic, inflammatory, prothrombotic and growth/adhesion markers. Amlodipine was associated with a significantly greater incidence of adverse effects compared with telmisartan, manidipine and manidipine/lisinopril (26.7% vs 3.3%, 3.3% and 13.3%, respectively). CONCLUSION: In patients with hypertension and metabolic syndrome, manidipine, both alone and in combination with the ACE inhibitor lisinopril, is significantly superior to amlodipine for improving insulin sensitivity as well as several metabolic, inflammatory and prothrombotic markers. Furthermore, the combination of manidipine and lisinopril appears to have greater efficacy than manidipine alone and telmisartan with respect to the improvement of metabolic, inflammatory and prothrombotic markers.

Seguridad y tolerabilidad de los antidiabéticos orales en el tratamiento de la diabetes mellitus tipo 2 / Safety and tolerability of oral antidiabetes drugs in the treatment of type 2 diabetes mellitus

El tratamiento de la diabetes mellitus tipo 2 requiere de un control global de los múltiples factores de riesgo que suelen asociarse en estos pacientes. Entre ellos, la disminución de la tasa de hipoglucemias y el tratamiento de la obesidad, especialmente de predominio central, son muy importantes. Por este motivo, dentro de los variados enfoques fisiopatológicos para mejorar el control glucémico que no incluyen la insulina, los fármacos que no producen aumento en la tasa de hipoglucemias ni aumento de peso tienen un atractivo añadido. Así, los nuevos antidiabéticos orales basados en potenciar el efecto incretínico destacan por ser capaces de producir pérdidas moderadas de masa corporal. Además, la seguridad es un factor que hay que tener en cuenta en pacientes que estarán expuestos a estos fármacos durante décadas no sólo por evitar efectos adversos graves, lo cual es fundamental, sino también para tratar de garantizar el cumplimiento terapéutico a largo plazo (AU)

The treatment of type 2 diabetes mellitus requires overall control of the multiple risk factors usually found in these patients. Amongst these, avoidance of hypoglycemia and treatment of obesity, especially central obesity, is of utmost importance. Consequently, among the various physiopathological approaches to improve glycemic control that do not include insulin, drugs that are not associated with increased risk of hypoglycaemia or increase weight are of special interest. Hence, the new incretin-based oral antidiabetes drugs are of great relevance, given their weight neutrality and very low risk of hypoglycaemia. Safety is clearly a factor to be considered in patients who will be exposed to these drugs for decades, not only to avoid severe adverse effects –which is essential– but also to guarantee long-term compliance (AU)

[Safety and tolerability of oral antidiabetes drugs in the treatment of type 2 diabetes mellitus]. / Seguridad y tolerabilidad de los antidiabéticos orales en el tratamiento de la diabetes mellitus tipo 2.

The treatment of type 2 diabetes mellitus requires overall control of the multiple risk factors usually found in these patients. Amongst these, avoidance of hypoglycemia and treatment of obesity, especially central obesity, is of utmost importance. Consequently, among the various physiopathological approaches to improve glycemic control that do not include insulin, drugs that are not associated with increased risk of hypoglycaemia or increase weight are of special interest. Hence, the new incretin-based oral antidiabetes drugs are of great relevance, given their weight neutrality and very low risk of hypoglycaemia. Safety is clearly a factor to be considered in patients who will be exposed to these drugs for decades, not only to avoid severe adverse effects--which is essential--but also to guarantee long-term compliance.