Estimación de grasa corporal según ecuación CUN-BAE e IMC y riesgo de mortalidad por sexos en la cohorte del Estudio Asturias / Estimation of body fat mass using the CUN-BAE index and mortality risk by sex in the Asturias Study cohort

Introducción y objetivos: Conocemos que el exceso de grasa corporal (GC) se asocia con factores de riesgo cardiovascular, algunos tipos de cáncer y otras causas principales de muerte. Se ha definido un nuevo método antropométrico: el índice CUN-BAE (Clínica Universidad de Navarra-Estimador de Adiposidad Corporal), que se basa en el IMC, el sexo y la edad. Hemos utilizado IMC y CUN-BAE para evaluar su contribución en la asociación con mortalidad en la cohorte del Estudio Asturias. Material y métodos: El Estudio Asturias se trata de un estudio de cohortes que incluyó a 1.034 individuos de 30-75 años de edad que participaron en la primera fase del estudio (1998-1999), realizando encuesta, exploración física y sobrecarga oral de glucosa. Se registraron los fallecimientos en la cohorte tras 18 años de seguimiento. Resultados: 204 personas fallecieron: 93 mujeres y 111 varones (16,6% de las mujeres y 23,5% de los varones). Valores basales tanto de IMC como de %GC determinantes de obesidad (> 30 kg/m2 para IMC; > 25% en hombres y > 35% en mujeres para CUN-BAE) fueron mayoritarios en los datos de individuos fallecidos. Tras ajuste por DM2, HTA, ECV y tabaco, el riesgo de mortalidad por todas las causas y cardiovascular es significativamente mayor según se incrementa el CUN-BAE, sobre todo en mujeres. Conclusiones: La ecuación CUN-BAE es una herramienta útil en mujeres para detectar las que van a presentar un mayor riesgo de mortalidad, independientemente de factores de riesgo

Introduction and objectives: In epidemiological studies, excess body fat (BF) has been associated with cardiometabolic risk factors, some types of cancer, and other causes of death. A new anthropometric method has been defined: The CUN-BAE index (University of Navarra Clinic-Body Fat Estimator), which is based on BMI, sex, and age. BMI and CUN-BAE index were used to assess their contribution to mortality risk from any cause in the Asturias Study cohort. Material and methods: The Asturias study is a cohort study including 1.034 individuals aged 30-75 years who participated in the first study phase (1998-1999). The study included a clinical survey, physical examination, and an oral glucose tolerance test. Vital status was determined in the cohort after 18years of follow-up. Results: Two hundred and four subjects died: 93 females and 111 males (16.6% and 23.5% respectively men). Baseline values of both BMI and %BF suggesting obesity (BMI > 30 kg/m2 and CUN-BAE > 25% in males and >35% in females) were found in most subjects. After adjusting for T2DM, HBP, CVD, and tobacco, the risk of all-cause and cardiovascular mortality was significantly higher as CUN-BAE increased, especially in females. Conclusions: The CUN-BAE equation is a useful tool, especially in females, to detect those who will have a greater risk of mortality, regardless of cardiovascular risk factors

Estimation of body fat mass using the CUN-BAE index and mortality risk by sex in the Asturias Study cohort. / Estimación de grasa corporal según ecuación CUN-BAE e IMC y riesgo de mortalidad por sexos en la cohorte del Estudio Asturias.

INTRODUCTION AND OBJECTIVES: In epidemiological studies, excess body fat (BF) has been associated with cardiometabolic risk factors, some types of cancer, and other causes of death. A new anthropometric method has been defined: The CUN-BAE index (University of Navarra Clinic-Body Fat Estimator), which is based on BMI, sex, and age. BMI and CUN-BAE index were used to assess their contribution to mortality risk from any cause in the Asturias Study cohort. MATERIAL AND METHODS: The Asturias study is a cohort study including 1.034 individuals aged 30-75years who participated in the first study phase (1998-1999). The study included a clinical survey, physical examination, and an oral glucose tolerance test. Vital status was determined in the cohort after 18years of follow-up. RESULTS: Two hundred and four subjects died: 93 females and 111 males (16.6% and 23.5% respectively men). Baseline values of both BMI and %BF suggesting obesity (BMI>30kg/m2 and CUN-BAE >25% in males and >35% in females) were found in most subjects. After adjusting for T2DM, HBP, CVD, and tobacco, the risk of all-cause and cardiovascular mortality was significantly higher as CUN-BAE increased, especially in females. CONCLUSIONS: The CUN-BAE equation is a useful tool, especially in females, to detect those who will have a greater risk of mortality, regardless of cardiovascular risk factors.

Association of ADIPOR2 with liver function tests in type 2 diabetic subjects.

OBJECTIVE: Adiponectin protects against liver dysfunction in insulin-resistant states such as obesity and type 2 diabetes (T2DM), but the role of adiponectin receptors in this disorder is largely unknown. We studied whether common single-nucleotide polymorphisms (SNPs) in ADIPOR1 and ADIPOR2 are associated with liver function tests (LFTs) in human subjects with various degrees of insulin resistance. METHODS AND PROCEDURES: Serum alanine (ALT) and aspartate (AST) aminotransferases, homeostasis model assessment of insulin resistance (HOMA-IR), -8503 G/A (rs6666089) and +5843 C/T (rs1342387) SNPs in ADIPOR1, -64,241 T/G (rs1029629) and +33447 C/T (rs1044471) SNPs in ADIPOR2 were assessed in 700 white subjects from a population-based study. RESULTS: In nondiabetic subjects, the at-risk alleles for the common -64,241 T/G and +33447 C/T SNPs in ADIPOR2 were associated with increased circulating adiponectin (P < 0.05 to P < 0.005), but not with LFT. Conversely, in T2DM subjects (who are at risk for liver dysfunction), the same alleles were associated with increased serum ALT and AST (P < 0.05 to P < 0.0001), but not with circulating adiponectin. No significant associations with these parameters were evident for the common -8503 G/A and +5843 C/T SNPs in ADIPOR1. In a replication study, the -64,241 T/G and +33447 C/T SNPs in ADIPOR2 were associated with ALT and AST (P < 0.05 to P < 0.0001) in pooled obese and T2DM subjects. DISCUSSION: Common SNPs in ADIPOR2 are associated with LFT in T2DM subjects, which suggests a possible role of this receptor in liver dysfunction associated with insulin resistance.

[Unilateral adrenal hemorrhage and hypertensive crisis in a patient with antiplatelet treatment]. / Hemorragia suprarrenal unilateral asociada a crisis hipertensiva en un paciente antiagregado.

OBJECTIVE: We report a case of non-traumatic adrenal hemorrhage in a man with antiplatelet treatment. METHODS: The patient was admitted to the Critical Care Unit because of a non-controlled hypertensive crisis. Pheochromocytoma was analytically excluded. The patient underwent a delayed adrenalectomy. RESULTS: Pathologic study of the specimen showed a wide hemorrhagic necrosis. CONCLUSIONS: Association of high blood pressure and adrenal hemorrhage is not pathognomonic of pheochromocytoma.

Hemorragia suprarrenal unilateral asociada a crisis hipertensiva en un paciente antiagregado / Unilateral adrenal hemorrhage and hypertensive crisis in a patient with antiplatelet treatment

Objetivo: Presentación de un caso de hemorragia suprarrenal no traumática en un paciente antiagregado. Métodos: El paciente fue ingresado en la Unidad de Cuidados Intensivos por una crisis hipertensiva no controlada. Se descartó analíticamente la existencia de un feocromocitoma y se practicó una suprarrenalectomía diferida. Resultados: El examen histológico de la glándula mostró una extensa necrosis hemorrágica. Conclusiones: La asociación de hipertensión arterial y hemorragia suprarrenal no es diagnóstica de feocromocitoma (AU)

Objective: We report a case of non-traumatic adrenal hemorrhage in a man with antiplatelet treatment. Methods: The patient was admitted to the Critical Care Unit because of a non-controlled hypertensive crisis. Pheochromocytoma was analytically excluded. The patient underwent a delayed adrenalectomy. Results: Pathologic study of the specimen showed a wide hemorrhagic necrosis. Conclusions: Association of high blood pressure and adrenal hemorrhage is not pathognomonic of pheochromocytoma (AU)

An alternatively spliced soluble TNF-alpha receptor is associated with metabolic disorders: a replication study.

In a previous study, we identified a biologically active form of tumor necrosis factor-alpha receptor 2 (sTNFR2) produced by differential splicing (DS-TNFR2) which antagonized TNF-alpha biological activity. Obesity, insulin resistance and type 2 diabetes are linked to increased TNF-alpha action. We hypothesized that subjects with detectable DS-TNFR2 would be protected from developing obesity and related metabolic disorders. Thus, we investigated if circulating DS-TNFR2 concentration was associated with components of the so-called metabolic syndrome among 269 consecutive subjects from the general population. DS-TNFR2 was measured using a monoclonal antibody against an epitope present in TNFR2 (first 14 residues of the juxtamembrane region) but predicted to be absent in soluble proteolytic cleavage-produced TNFR2. Plasma DS-TNFR2 concentration was significantly decreased among patients with glucose intolerance or type 2 diabetes mellitus (p=0.026). DS-TNFR2 tended to be associated with fasting and post-load glucose (both r=-0.11, p=0.054), and with diastolic blood pressure in men (r=-0.16, p=0.07). Serum DS-TNFR2 concentration was significantly associated with LDL cholesterol (r=-0.28, p=0.002), uric acid (r=-0.13, p=0.04) and with blood glycated hemoglobin (r=-0.13, p=0.04). DS-TNFR2 declined with increased number of components of the metabolic syndrome (p=0.03). Those subjects with 2 or more components had significantly decreased circulating DS-TNFR2 levels (0.96+/-2.2 versus 1.7+/-3.2, p=0.033). In summary, the circulating concentration of DS-TNFR2 seems to be inversely linked to metabolic disorders, hinting at a possible anti-inflammatory role.

[Adrenal incidentaloma associated to elevated urinary normethanephrine in a patient with high blood pressure]. / Incidentaloma suprarrenal asociado a normetanefrina urinaria elevada en un paciente hipertenso.

OBJECTIVES: To report one case of adrenal incidentaloma and to review the sensitivity and specificity of urine methanephrines in the diagnosis of pheochromocytoma. METHODS: We report the case of a patient with high blood pressure and a left adrenal incidentaloma. Surgical excision of the mass was indicated after elevated urine methanephrine. RESULTS: Pathologic study of the nodule established the diagnosis of cortical adenoma. CONCLUSIONS: The elevation of urine normethanephrine is a non-specific parameter for the diagnosis of pheochromocytoma.

Adiponectin is independently associated with glycosylated haemoglobin.

BACKGROUND: In humans, adiponectin has been demonstrated to circulate in inverse proportion to the degree of insulin resistance. OBJECTIVE: To investigate the association between adiponectin and glycosylated haemoglobin (HbA1c) in a population-based study. DESIGN AND METHODS: Two hundred and ninety-seven individuals aged 30-75 years were enrolled in a cross-sectional study. They included patients with type 2 (non-insulin-dependent) diabetes mellitus and stable, good metabolic control (n=32) and individuals with glucose intolerance (n=54). Adiponectin was measured using a sandwich enzyme-linked immunosorbent assay (intra-assay and interassay coefficients of variation 3.3 and 7.4% respectively). RESULTS: Adiponectin correlated with age (r=0.161; P=0.006), body mass index (r=-0.197; P=0.001), diastolic blood pressure (r=-0.181; P=0.005), fasting glucose and HbA1c (r=-0.251 and r=-0.22 respectively; P<0.0001), high-density lipoprotein cholesterol (r=0.442; P<0.001) and serum triglycerides (r=-362; P<0.001). In multiple regression analysis, sex, age, fasting and post-load glucose, and adiponectin independently contributed to 40% of the variance in HbA1c. Among individuals with normal glucose tolerance, fasting glucose (P=0.0033), post-load glucose (P=0.0015), age (P=0.001) and adiponectin (P=0.0083) independently contributed to 21% of the variance in HbA1c. CONCLUSION: Adiponectin is significantly associated with altered glucose metabolism and independently contributes to the variance of HbA1c in a population-based manner.

[Clinical and genetic study of a 46, XX man with occult mosaicism ]. / Estudio clínico y genético de un varón 46,XX con mosaicismo oculto.

OBJECTIVE: To describe a 46,XX male with a hidden mosaicism. METHOD: Clinical, hormonal and genetic findings are presented. RESULTS: The patient was a normal phenotypic male with a bilateral testicular volume of 10 ml. Hypergonadotropic hypogonadism (elevated serum concentrations of FSH and LH, and normal serum concentration of testosterone) without gynecomastia was found. Final karyotype was a 46,XX/47,XX + mar mosaic, with 3% of studied cells containing an abnormal SRY positive Y chromosome. CONCLUSION: XX males karyotype must include a great number of metaphases in order to ascertain a definitive genetic diagnosis.

Estudio clínico y genético de un varón 46,XX con mosaicismo oculto / Clinical and genetic study of a 46 XX male with occult mosaicism

OBJETIVO: Descripción de un varón 46,XX con mosaicismo oculto. MÉTODO: Presentación de sus características clínicas, hormonales y genéticas. RESULTADOS: El fenotipo del paciente era masculino normal, con un volumen testicular bilateral de 10 ml. Se objetivó un y 18 meses . Otros tras objetivar fístula postbiopsia realizan embolización si es sintomática y si no, realizan eco-doppler color durante 3-6 meses tras los cuales llevan a cabo la embolización si no muestra tendencia a desaparecer espontáneamente (11).Hay que resaltar que cuanto más selectiva sea la embolización menos probabilidad de infartos en áreas sanas se producirán .Así mismo hemos de considerar dos tipos de complicaciones derivadas de este procedimiento, la primera de ellas hace referencia al síndrome postembolización (3, 7) que consiste en dolor lumbar, fiebre, hipertensión arterial transitoria además de sepsis y tromboembolismo pulmonar (TEP) (estos últimos ocurren con una frecuencia <2 por ciento) ya que son consecuencia directa de la embolización y tienen un carácter transitorio. La otra complicación es la derivada directamente de la embolización arterial selectiva ocurriendo a veces infarto segmentario y TEP debido al agente embolígeno utilizado (4).Si tras la embolización no se resuelve la fístula, la excisión de la misma, la ligadura de los vasos venosos así como la nefrectomía parcial o total (dependiendo sobre todo de la localización, tamaño y accesibilidad de la lesión) pueden ser opciones terapéuticas válidas (AU)