Early blood pressure alterations are associated with pro-inflammatory markers in type 1 diabetes mellitus.

The aim of this study was to evaluate the relationship between early blood pressure (BP) changes (detected using ambulatory BP monitoring; ABPM) with different markers of inflammation and endothelial dysfunction in patients with type 1 diabetes mellitus (T1DM). The study design was observational cross-sectional in 85 T1DM patients, clinically normotensive and with normo-albuminuria. We analyzed the relationships between ABPM-measured BP alterations over 24 h with the inflammatory cytokines (interleukin-6 (IL-6), tumor necrosis factor-α and vascular endothelial growth factor (VEGF)) and the markers of endothelial damage (vascular adhesion molecule, intercellular adhesion molecule and plasminogen activator inhibitor-1 (PAI)). Despite being recorded as normotensive, 27 (31.8%) subjects presented with an average of pathological BP. VEGF levels were significantly elevated in the patients with an altered mean diurnal values compared with normotensives (112.33 (72.87-213.53) pg ml-1 vs 71.03 (37.71-107.92) pg ml-1; P=0.007). Further, VEGF levels correlated significantly with the parameters of diurnal BP and of 24 h values. IL-6 concentration was a risk factor in the patients with hypertension (OR=1.406; P=0.027). There were no modifications in the levels of markers of endothelial damage. Summarizing, there is an increase in pro-inflammatory cytokines, but not the endothelial adhesion molecules, in early stages of arterial hypertension in patients with T1DM.

[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.

[Micronutrients in bariatric surgery]. / Micronutrientes en cirugía bariátrica.

The morbid obesity is a chronic disease with increasing prevalence and that associates an important morbility and mortality. The bariatric surgery is the most effective treatment to secure a weight reduction maintained in the time and a diminution in the rates of complications associated to the obesity. The overweight and the obesity are risk factors for the deficit of several micronutrients like vitamins B1, B6, C, folic acid and D, minerals like the iron and trace elements like zinc, generally by dietetic deficit. In spite of it, at the moment a consensus don't exist about the monitoring of micronutrients in the preoperative one, although it seems reasonable in view of his considerable prevalence. The bariatric surgery can bring about deficit of micronutrients or to intensify previous deficiencies, as much by limitation of the ingestion like by the maldigestión and malabsorption in the malabsortives techniques, being the parallel risk to the ponderal loss. It is precise to monitor of by life the different micronutrients, mainly after the malabsortives surgical techniques. The use of a polivitamínic complex of systematic form is recommended and in the cases in which he is insufficient, it will be precise to use specific suplementación.

Alterations in arterial pressure in patients with Type 1 diabetes are associated with long-term poor metabolic control and a more atherogenic lipid profile.

AIM: To determine the prevalence of alterations in blood pressure (BP) in patients with Type 1 diabetes who are normoalbuminuric and normotensive; and to evaluate the association with genetic, clinical and metabolic factors. MATERIAL/ METHODS: Normoalbuminuric, normotensive Type 1 diabetic patients (no.=85) had their ambulatory blood pressure monitoring (ABPM) performed over 24 h, together with measurement of HbA1c and lipid profile, polymorphisms of the ACE gene, non-midriatic retinography, and the "historical HbA1c" calculated (mean of all the determinations available on the patient). RESULTS: Of the 85 patients, a mean of 18.8% had pathologic values of BP over the 24 h, 31.8% during active periods and 22.4% during rest periods; in 42% there was a non-dipper pattern in BP. The patients with alterations of BP had higher body mass index (BMI), higher levels of glycemia and of triglycerides, and decreased levels of HDL cholesterol. The "historical HbA1c" was significantly higher in the patients with the non-dipper pattern (8.6 ± 1.4% vs 7.9 ± 1.4%; p=0.046). Pulse pressure was directly associated with male gender (p=0.006) and with BMI (p=0.001). No differences were detected in the distribution of the polymorphisms of the ACE gene as a function of the BP alterations. CONCLUSIONS: An elevated number normoalbuminuric, normotensive, Type 1 diabetic patients have alterations in BP detected with ABPM over 24 h, and these are associated with a greater BMI, poor long-term metabolic control and a more atherogenic lipid profile.