Ana Ortola

A Mediterranean diet with additional extra virgin olive oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St. Carlos GDM prevention study

Background Gestational diabetes mellitus (GDM) prevalence is increasing and becoming a major public health concern. Whether a Mediterranean diet can help prevent GDM in unselected pregnant women has yet to be studied. Methods We conducted a prospective, randomized controlled trial to evaluate the incidence of GDM with two different dietary models. All consecutive normoglycemic (<92 mg/dL) pregnant women at 8–12 gestational weeks (GW) were assigned to Intervention Group (IG, n = 500): MedDiet supplemented with extra virgin olive oil (EVOO) and pistachios; or Control Group (CG, n = 500): standard diet with limited fat intake. Primary outcome was to assess the effect of the intervention on GDM incidence at 24–28 GW. Gestational weight gain (GWG), pregnancy-induced hypertension, caesarean section (CS), preterm delivery, perineal trauma, small and large for gestational age (SGA and LGA) and admissions to neonatal intensive care unit were also assessed. Analysis was by intention-to-treat. Results A total of 874 women completed the study (440/434, CG/IG). According to nutritional questionnaires and biomarker analysis, women in the IG had a good adherence to the intervention. 177/874 women were diagnosed with GDM, 103/440 (23.4%) in CG and 74/434(17.1%) in IG, p = 0.012. The crude relative risk (RR) for GDM was 0.73 (95% CI: 0.56–0.95; p = 0.020) IG vs CG and persisted after adjusted multivariable analysis, 0.75(95% CI: 0.57–0.98; p = 0.039). IG had also significantly reduced rates of insulin-treated GDM, prematurity, GWG at 24–28 and 36–38 GW, emergency CS, perineal trauma, and SGA and LGA newborns (all p<0.05). Conclusions An early nutritional intervention with a supplemented MedDiet reduces the incidence of GDM and improves several maternal and neonatal outcomes.

Gestational diabetes mellitus treatment reduces obesity-induced adverse pregnancy and neonatal outcomes: the St. Carlos gestational study

Background Obesity and gestational diabetes mellitus (GDM) increase the morbidity of the mother and newborn, which could increase further should they coexist. We aimed to determine the risk of adverse pregnancy and neonatal outcomes associated with excess weight (EW), and within this group identify potential differences between those with and without GDM. Methods We carried out a post-hoc analysis of the St. Carlos Gestational Study which included 3312 pregnant women, arranged in 3 groups: normal-weight women (NWw) (2398/72.4%), overweight women (OWw) (649/19.6%) and obese women (OBw) (265/8%). OWw and OBw were grouped as EW women (EWw). We analyzed variables related to adverse pregnancy and neonatal outcomes. Results The relative risk (95% CI) for GDM was 1.82 (1.47 to 2.25; p<0.0001) for OWw, and 3.26 (2.45 to 4.35; p<0.0001) in OBw. Univariate analysis showed associations of EW to higher rates of prematurity, birth weight >90th centile, newborns admitted to neonatal intensive care unit (NICU), instrumental delivery and cesarean delivery (all p<0.005). Multivariate analysis, adjusted for parity and ethnicity, showed that EW increased the risk of prematurity, admission to NICU, cesarean and instrumental delivery, especially in EWw without GDM. NWw with GDM had a significantly lower risk of admission to NICU and cesarean delivery, compared with NWw without GDM. Conclusions EW is detrimental for pregnancy and neonatal outcomes, and treatment of GDM contributes to lowering the risk in EWw and NWw. Applying the same lifestyle changes to all pregnant women, independent of their weight or GDM condition, could improve these outcomes.

The role of the variant in adiponectin gene rs266729 on weight loss and cardiovascular risk factors after a hypocaloric diet with Mediterranean pattern

OBJECTIVES The role of ADIPOQ gene variants on weight loss after a dietary intervention remain unclear. The aim of this study was to analyze the effects of rs266729 of the ADIPOQ gene on cardiovascular risk factors and adiposity parameters after adherence to a Mediterranean-type hypocaloric diet. METHOD Eighty-three obese patients were studied before and after 12 wk on a Mediterranean-type hypocaloric diet. Anthropometric parameters and biochemical profiles were measured. The variant of ADIPOQ gene rs266729 was assessed at basal time by polymerase chain reaction at real time. RESULTS Two genotype groups were realized (CC versus CG + GG). The final genotype distribution was 48 patients CC (57.8%), 30 patients CG (36.2%) and 5 patients GG (6%). After dietary intervention with a moderate calorie restriction and in both genotypes, body mass index (BMI), weight, fat mass, systolic blood pressure, and waist circumference decreased. After dietary intervention and in non-G allele carriers (CC versus CG+ GG), glucose (δ: -6.2 ± 1.1 versus -2.9 ± 1.2 mg/dL; P = 0.02), total cholesterol (δ:-15.2 ± 3.1 versus -3.4 ± 2 mg/dL; P = 0.02), low-density lipoprotein cholesterol (δ, -14.9 ± 3.1 versus -4.9 ± 1.2 mg/dL; P = 0.01), insulin levels (δ, -4± 0.6 versus 0.7 ± 0.3 UI/L;P = 0.01), homeostasis model assessment for insulin resistance (δ, -1.6 ± 0.4 versus -0.2 ± 0.4 units; P = 0.01), and adiponectin (δ, -10.4 ± 3.1 versus -1.3 ± 1.0 ng/dL; P = 0.01) improved. CONCLUSION After weight loss, the CC genotype of ADIPOQ gene variant (rs266729) is associated with increases in adiponectin levels and decreases of low-density lipoprotein cholesterol, insulin and homeostasis model assessment for insulin resistance after weight loss.

Hyponatremia in patients receiving parenteral nutrition: the importance of correcting serum sodium for total proteins. The role of the composition of parenteral nutrition in the development of hyponatremia

Background/objectivesHyponatremia is the most common electrolyte disorder, and is associated with high-morbimortality rates. The true prevalence of hyponatremia in patients on parenteral nutrition (PN) is unknown, and the relationship between PN composition and development of hyponatremia has yet to be studied. Hypoproteinemia, a common finding in patients receiving PN, induces an overestimation of serum sodium (SNa) levels, when using indirect electrolyte methodology. Thus, SNa should be corrected for serum total protein levels (TP).The objective was to accurately determine the prevalence of hyponatremia (indirect SNa corrected for PT) and evaluate the relationship between the composition of PN and the development of hyponatremia.Subjects/methodsMedical records of 222 hospitalized patients receiving total PN during a 7-month period were reviewed. Composition of PN, indirect SNa-mmol/l-, and SNa corrected for TP (SNa-TP)-mmol/l-, both upon initiation and during PN administration, were analyzed.ResultsHyponatremia (SNa < 135 mmol/l) was present in 81% of subjects when SNa was corrected for TP, vs. 43% without correction (p = 0.001). In total 64% of patients that were eunatremic upon initiation of PN developed hyponatremia during PN administration, as detected by SNa-TP, vs. 28% as detected by uncorrected SNa (p < 0.001). There were no significant differences in volume, osmolarity, sodium or total osmols administered in PN between patients who developed hyponatremia and those who remained eunatremic.ConclusionsA majority of patients receiving PN present hyponatremia, when indirect SNa levels are corrected for TP. The development of hyponatremia during PN is not related to the composition of the PN.

The association of SNP276G>T at adiponectin gene with insulin resistance and circulating adiponectin in response to two different hypocaloric diets

BACKGROUND Several adiponectin gene (ADIPOQ) single nucleotide polymorphisms (SNPS) have been related with adiponectin levels and risk for obesity. OBJECTIVE The aim of our study was to analyze the effect of rs1501299 ADIPOQ gene polymorphism and dietary intake on total adiponectin levels and insulin resistance after two hypocaloric diets in obese subjects. MATERIAL AND METHODS A Caucasian population of 284 obese patients was enrolled in a randomized clinical trial with two hypocaloric diets (I: moderate carbohydrates vs II: low fat). Before and after 12 weeks on each hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were realized. The statistical analysis was performed for the combined GT and TT as a group (mutant) and GG as second group (wild) (dominant model). RESULTS The genotype distribution was 149 GG, 124 GT and 21 TT. With caloric restriction strategies, body weight, body mass index (BMI), fat mass, waist circumference, systolic blood pressure, total LDL cholesterol, LDL cholesterol and leptin levels decreased. Only in subjects with GG genotype, diet I and II decreased fasting insulin levels, HOMA-IR and adiponectin levels. The improvement was similar with both diets; insulin concentrations (Diet I: -4.7 ± 1.4 mUI/L vs. Diet II: -5.9 ± 1.9 mUI/L: p = .76), HOMA-IR (Diet I: -1.4 ± 0.6 units vs. Diet II: -2.0 ± 0.7 units: p = .56) and adiponectin levels (Diet I: -10.2 ± 3.4 ng/dl vs. Diet II: -14.0 ± 2.9 ng/dl: p = .33). CONCLUSION The GG genotype of ADIPOQ gene variant (rs1501299) is associated with an increase in adiponectin levels and a decrease of insulin and HOMA-IR after weight loss.

Estudio de tolerancia y aceptación de una fórmula enteral con alta densidad energética en pacientes de una unidad de coronarias

Objective: The aim of our study was to evaluate the tolerance of enteral formula with high energetic density in patients hospitalized in a coronary care unit requering enteral support for at least five days. Methods: Opened, non-comparative, nonrandomized, descriptive study, evaluating the tolerance of enteral formula with high energy density in patients admitted to a coronary care unit. Results: 31 patients were included with a mean age of 67.32 ± 13.8 years, 66.7% were male. The average prescribed final volume Nutrison Energy® was 928.5 ± 278.5 mL/day (range: 800-1,500 mL/day). The average duration of enteral nutrition was 11.2 ± 3.2 days. The average calorie intake was 1,392 ± 417 cal/day, with 169.9 ± 50.9 g/day of carbohydrates, 53.8 ± 16.1 g/day of fat and 55.7 ± 16.9 g/day of protein. After administration there was a significant increased levels of transferrin. A total of 3 patients had an episode of diarrhea (9.7%). The number of patients experiencing at least one episode of gastric residue was 5 (16.1%) not forced in any way to withdra wing enteral nutrition, forcing in 2 patients to diminish the nutritional intake volume for 24 hours. During nutritional support, in only 3 patients it was required to decrease the volume made the previous day energy formula. With regard to vomiting, in 1 patient this situation (3.2%) was verified. No patient in the study presented any digestive complications associated with the administration of the enteral nutrition formula. Finally, no adverse events related to the administered formulation were recorded. Conclusions: The results show that enteral formula with high energy density is a well-tolerated formula with a very low frequency of gastrointestinal symptoms, which favors compliance.

Biochemical, Anthropometric and Lifestyle Factors Related with Weight Maintenance after Weight Loss Secondary to a Hypocaloric Mediterranean Diet

Background/Aims: The aim of our study was to evaluate the influence of lifestyle factors and molecular biomarkers on the maintenance of the weight lost after a hypocaloric Mediterranean diet. Design: After 3 months on a diet, patients (n = 335) remained with no controlled diet during 3 years and they were revaluated. Results: Using linear regression, in the group of responders, we detected that a positive weight loss at 3 months, serum levels of leptin at 3 months, and each 30 min per week of physical activity were associated with weight loss maintenance. In the model with reduced weight (RW) as dependent variable, a positive weight loss at 3 months was associated with 2.4% RW (95% CI 1.31–8.11; p = 0.015), each unit of serum leptin levels at 3 months with –0.44% RW (95% CI –0.59 to –0.020; p = 0.007), each basal unit homeostasis model assessment for insulin resistance (HOMA-IR) level with –2.32% (95% CI –13.01 to –0.17; p = 0.040), and each 30 min per week of physical activity with 1.58% RW (95% CI 1.08–2.94; p = 0.020). Conclusion: Obese subjects who are on maintenance weight loss after a dietary intervention appear to have a better initial response during the 3 months intervention, more physical activity at 3 years, and lower basal HOMA-IR and leptin after weight loss than those who regain weight.

The dual burden of tuberculosis and diabetes in hospitalized Spanish patients

A total of 25,367 patients with TBC were identified; 9.2% of them had also a diagnosis of DM2 (Figure 1). Patients with DM 2 had a higher mortality than non-DM patients (7.7 % vs 4.8 %; p<0.01) (Figure 2). Hypoglycaemia was registered in 150 cases, also associated with higher mortality. The dual burden of Tuberculosis (TBC) and Diabetes Mellitus (DM) has attracted much attention in the past decade. Patients with Type 2 Diabetes have a higher risk of developing pulmonary tuberculosis. Moreover, DM comorbidity in pulmonary TB is associated with poor treatment outcomes. Patients admitted to Internal Medicine Departments are an ideal setting to analyze the prognostic roll of DM on TBC clinical course.