Antonio Dorado

Serum phospholipid fatty acid profile and dietary intake in an adult Mediterranean population with cystic fibrosis

The relative importance of the usual diet in serum phospholipids in subjects with cystic fibrosis (CF) has been poorly studied. To compare the fatty acid profile in serum phospholipids from adult CF subjects with that of healthy subjects, and determine the role of the normal diet in this profile, we studied thirty-seven adult CF subjects with stable pulmonary disease and thirty-seven healthy controls matched for age, sex and nutritional status. A dietary questionnaire was obtained, anthropometric data were recorded, and the fatty acid profile measured by GLC. Compared with the controls, the percentages of myristic, palmitoleic and stearic acids and total MUFA were significantly higher in the CF group, and DHA, linoleic acid, total PUFA and n-6 fatty acids were significantly lower in the CF group. The CF subjects with worse pulmonary function and with pancreatic insufficiency had significantly lower levels of linoleic and n-6 fatty acids. The total energy intake was significantly higher in the CF subjects, although the energy distribution in the CF subjects and the controls was not different for the carbohydrates, lipids and proteins. No differences were detected in fat intake for MUFA (51 (SD 4) v. 52 (SD 4) %) or saturated fatty acids (33.5 (SD 5) v. 31.2 (SD 3.8) %), but the PUFA were slightly lower in the CF subjects (15.4 (SD 4.5) v. 17.4 (SD 4.2) %; P=0.02). The usual dietary intake of fatty acids by adult CF subjects does not appear to explain the difference in the fatty acid profile compared with controls. This suggests an abnormal fatty acid metabolism in CF subjects.

Validez y fiabilidad del Cuestionario Respiratorio de St. George en población adulta con fibrosis quística

Objetivo: Estudiar la percepcion de la calidad de vida (CV) en una poblacion adulta con fibrosis quistica (FQ) y valorar la validez del Cuestionario Respiratorio St. George (SGRQ) en estos pacientes. Pacientes y metodos: Hemos estudiado a 37 personas adultas con FQ, estables desde el punto de vista respiratorio y nutricional. Se realizo una valoracion de la gravedad de la enfermedad mediante espirometria y los sistemas NIH (National Institutes of Health) modificado y Bhalla, asi como una valoracion nutricional mediante la medicion del peso, la talla, el indice de masa corporal, impedanciometria bioelectrica y parametros analiticos. Se estimo la percepcion de la CV mediante el SGRQ. Resultados: Las personas con FQ tienen mayores puntuaciones (peor CV) que la poblacion general y que los afectados de enfermedad pulmonar obstructiva cronica (EPOC). El coeficiente alfa de Cronbach de la puntuacion total fue de 0,864. Las mujeres con FQ presentan puntuaciones mas altas que los varones, aunque sin alcanzar la significacion estadistica. Se observa una gradacion de las puntuaciones (de forma estadisticamente significativa) en funcion de la gravedad de la afectacion pulmonar (a mayor gravedad, peor CV). Se han encontrado relaciones positivas, estadisticamente significativas, entre las dimensiones del SGRQ y la edad, el indice de masa corporal y el porcentaje de masa grasa, y negativas con el NIH modificado, el Bhalla, el volumen espiratorio forzado en el primer segundo (expresado en porcentaje) y las concentraciones de cinc y somatomedina C. Conclusiones: Los adultos con FQ tienen peor percepcion de la CV que la poblacion general y que los afectados de EPOC. El SGRQ es valido para analizar la CV relacionada con la salud de las personas adultas con FQ, ya que discrimina muy bien entre los distintos grados de gravedad de la funcion pulmonar y presenta una adecuada consistencia interna.

Validación de la versión española del cuestionario revisado de calidad de vida para fibrosis quística en adolescentes y adultos (CFQR 14+ Spain)

BACKGROUND The aim of this study was to assess the validity and reliability of the Spanish version of the revised disease-specific health related quality of life questionnaire for adolescents and adults with cystic fibrosis (CFQR 14+ Spain). METHODS A total of 43 cystic fibrosis (CF) patients completed the CFQR 14+ Spain. Forced expiratory volume in 1 second, in percentage of predicted - FEV(1) (%)-, number of respiratory exacerbations, 6-minute walk test, Bhalla score (based on computerized tomography of the chest), fat-free mass index, body mass index (BMI), faecal fat and St Georges Respiratory Questionnaire were included as measurements of health status. RESULTS Ten out of the twelve scales had alpha coefficients above 0.70. Test-retest correlations (Spearman) ranged from 0.49 to 0.95 and they were significant in all scales. Intraclass correlations ranged from 0.47 to 0.95 (ten out of the twelve scales were >0.70) forty out of the fifty ítems have correlations between items and scale above 0.70. All the CFQR+14 scales, except the digestive symptoms scale, discriminated significantly between patients with mild, moderate and severe disease (according to FEV(1) (%)). Other respiratory parameters also discriminated significantly between patients with mild-moderate and severe disease. Only some scales discriminated significantly between nourished and malnourished patients. All of the scales met standards for floor effects (<15% of the responders with the lowest score) but not for ceiling effects (only five out of the twelve). CONCLUSION The Spanish CFQR14+ (Spain) is a reliable and valid instrument for measuring the health-related quality of life in Spanish adolescents and adults with CF, though with the exception of a few of its subscales.

Cellular and plasma oxidative stress biomarkers are raised in adults with bronchiectasis

BACKGROUND & AIMS Oxidative stress is believed to play an important role in the pathophysiology of bronchiectasis. The aims of this study were to evaluate the oxidative stress status in bronchiectasis patients. METHODS This cross-sectional study included 90 clinically stable adults with bronchiectasis of any aetiology (36 with cystic fibrosis [CF] and 54 without CF) plus 50 healthy controls. Plasma and serum oxidative stress biomarkers were measured using commercial kits. Cellular oxidative stress biomarkers in white blood cells (mitochondrial membrane potential, intracellular glutathione, superoxide anion and hydrogen peroxide) were analyzed by flow cytometry. RESULTS Compared with the control group, the catalase activity and lipid peroxidation (TBARs and 8-isoprostanes) were significantly increased in the patient group and the total antioxidant capacity and the activity of superoxide dismutase were decreased. Intracellular superoxide anion and hydrogen peroxide were significantly elevated in the patients versus the controls in total leukocytes, lymphocytes, monocytes and neutrophils. Compared to the controls, the mitochondrial membrane potential was significantly lower in neutrophils and intracellular glutathione in monocytes. No significant differences were observed between CF and non-CF bronchiectasis patients in the oxidative stress biomarkers studied. CONCLUSIONS Biomarkers of oxidative stress, both in plasma and intracellular were raised in patients with bronchiectasis compared with controls. No differences were seen in the CF patients compared with the others.

Markers for the Validation of Reported Dietary Intake in Adults with Cystic Fibrosis

OBJECTIVE To identify different markers in order to validate the assessment of dietary intake in adults with cystic fibrosis (CF). DESIGN Cross-sectional survey. SETTING Tertiary care. SUBJECTS We assessed 37 adults with CF whose nutritional and respiratory condition was stable and 37 healthy adults, matched for age, sex, and nutritional status. INTERVENTIONS A consecutive, 7-day, prospective dietary survey was given to all the participants. Anthropometric variables were measured and a fasting blood sample was drawn to measure the composition of the serum phospholipid fatty acids by gas chromatography. We also measured fecal fat and nitrogen at 72 hours and 24-hour urine nitrogen. RESULTS The ratio of energy intake to basal metabolic rate expenditure was significantly greater in the patients (2.1+/-0.4) than the controls (1.79+/-0.4) and the percentage of patients with the ratio of energy intake to basal metabolic rate lower than 1.55 was 24% in the controls (n=9) vs 8% in the patients (n=3). Fecal nitrogen correlated significantly with total energy and the intake of carbohydrates, lipids, and proteins. In the patients, total dietary energy and fat and protein intake correlated positively with fecal fat. The protein and fat intake and fecal nitrogen and fat correlated significantly with urine nitrogen. In the controls, significant correlations were seen between different parameters of intake and the percentage of certain serum phospholipid fatty acids. These correlations in the patients were either absent or less marked. CONCLUSIONS Use in persons with CF of the energy intake to basal metabolic rate ratio, measurement of fecal fat and nitrogen at 72 hours and of urine nitrogen may be useful to validate dietary surveys. The serum phospholipid fatty acid profile, however, may be less useful for this purpose in these patients.

Validation of the Spanish Version of the Revised Cystic Fibrosis Quality of Life Questionnaire in Adolescents and Adults (CFQR 14+ Spain)

a b s t r a c t Background: The aim of this study was to assess the validity and reliability of the Spanish version of the revised disease-specific health related quality of life questionnaire for adolescents and adults with cystic fibrosis (CFQR 14+ Spain). Patients and methods: A total of 43 cystic fibrosis (CF) patients completed the CFQR 14+ Spain. Forced expiratory volume in 1 second, in percentage of predicted - FEV1 (%) -, number of respiratory exacerbations, 6-minute walk test, Bhalla score (based on computerized tomography of the chest), fat-free mass index, body mass index (BMI), faecal fat and St Georges Respiratory Questionnaire were included as measurements of health status. Results: Ten out of the twelve scales had alpha coefficients above 0.70. Test-retest correlations (Spearman) ranged from 0.49 to 0.95 and they were significant in all scales. Intraclass correlations ranged from 0.47 to 0.95 (ten out of the twelve scales were >0.70) forty out of the fifty items have correlations between items and scale above 0.70. All the CFQR 14+ scales, except the digestive symptoms scale, discriminated significantly between patients with mild, moderate and severe disease (according to FEV1 (%)). Other respiratory parameters also discriminated significantly between patients with mild-moderate and severe disease. Only some scales discriminated significantly between nourished and malnourished patients. All of the scales met standards for floor effects (<15% of the responders with the lowest score) but not for ceiling effects (only five out of the twelve). Conclusion: The Spanish CFQR 14+ (Spain) is a reliable and valid instrument for measuring the health-related quality of life in Spanish adolescents and adults with CF, though with the exception of a few of its subscales.

Oral supplement enriched in HMB combined with pulmonary rehabilitation improves body composition and health related quality of life in patients with bronchiectasis (Prospective, Randomised Study)

BACKGROUND & AIMS Pulmonary Rehabilitation (PR) is recommended for bronchiectasis but there is no data about its effect on body composition. The aim of this study is to assess the effect of Pulmonary Rehabilitation (PR) for 12 weeks in normally-nourished non-cystic-fibrosis bronchiectasis patients compared with the effect of PR plus a hyperproteic oral nutritional supplement enriched with beta-hydroxy-beta-methylbutyrate (HMB) on body composition, muscle strength, quality of life and serum biomarkers. METHODS single center randomized controlled trial, parallel treatment design: Participants were randomly assigned to receive PR for 12 weeks or PR plus ONS (PRONS) (one can per day). Outcome assessments were performed at baseline, 12 weeks and 24 weeks: body composition (Dual-energy X-Ray Absorptiometry (DEXA), mid-arm muscle circumference (MAMC), phase angle by Bio-impedance), health related quality of life (Spanish QOL-B-V3.0, Physical Functioning Scale), handgrip strength, diet questionnaire, and plasma levels of prealbumin, myostatin and somatomedin-c. RESULTS Thirty patients were randomized (15 per group) without differences in clinical and respiratory variables. In the PRONS group bone mineral density (BMD), mean and maximum handgrip dynamometry, MAMC, QOLB and prealbumin were significantly increased from baseline at 12 and 24 weeks and Fat free Mass (FFM) and FFM index, at 12 weeks. In the PR group only mean handgrip dynamometry and prealbumin were significantly increased at 12 and 24 weeks. In both groups plasma myostatin was reduced at 12 weeks (without significant differences). CONCLUSION The addition of a hyperproteic ONS enriched with HMB to Pulmonary Rehabilitation could improve body composition, BMD, muscle strength and health related quality of life in bronchiectasis patients. Clinical Trials Number NCT02048397.

Mediterranean diet is associated on symptoms of depression and anxiety in patients with bronchiectasis

BACKGROUND The aim was to measure symptoms of depression and anxiety in patients with bronchiectasis and evaluate their relationship with a Mediterranean diet. METHODS This cross-sectional study recruited patients with bronchiectasis at four Spanish centers. Patients completed the hospital anxiety and depression scale (HADS) and the Mediterranean diet questionnaire (PREDIMED). Demographic, health and outcome data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥11). RESULTS Of the 205 participants recruited, 37 (18.0%) had elevated anxiety-related scores and 26 (12.7%) had elevated depression-related scores (HADS≥11). Increased symptoms of depression were significantly associated with being unemployed, a lower education, older age, comorbidity, major dyspnea, worse quality of life (QOL) and a lower PREDIMED score. Increased symptoms of anxiety were significantly associated with more exacerbations, worse QOL and a lower PREDIMED score. Regression analyses indicated that, after adjustment, QOL and the PREDIMED score predicted elevated symptoms of depression and QOL predicted elevated symptoms of anxiety. CONCLUSIONS The prevalence of elevated symptoms of depression and anxiety is high in patients with bronchiectasis and greater adherence to a Mediterranean diet is associated with a lower likelihood of having these symptoms, particularly for depression.

Inflammation and Oxidation Biomarkers in Patients with Cystic Fibrosis: The Influence of Azithromycin

OBJECTIVE In addition to their antibiotic effect, macrolides appear to modulate the inflammatory response in cystic fibrosis (CF) and could influence oxidative stress. The objective of this study was to assess oxidation biomarkers and levels of inflammation and to determine whether there is an association between these parameters and the intake of macrolides. MATERIALS AND METHODS The subjects included in this cross-sectional study were, on the one hand, clinically stable patients with CF and, on the other, healthy controls. The following serum and plasma inflammatory and oxidative stress biomarkers were measured: interleukin-6 (IL-6), reactive C protein (RCP), tumor necrosis alpha (TNF-α), glutathione peroxidase (GPx), total antioxidant capacity (TAC), catalase (CAT), and superoxide dismutase (SOD), together with markers of lipid peroxidation (8-isoprostanes and thiobarbituric acid reactive substances [TBARS]). Clinical, anthropometric, lung function, radiological, and analytical variables (albumin, prealbumin, vitamins, and zinc) were also recorded. RESULTS We studied 36 adults with CF and 41 controls. No differences were observed in age, gender, or anthropometric variables. The patients had significantly higher levels of IL-6, TNF-α, RCP, TBARS, and isoprostanes, and lower levels of SOD than the controls. Twenty-three of the patients were treated with azithromycin, and they had more severe clinical and radiological parameters than those who were not but nevertheless presented significantly lower levels of TNF-α. No differences were observed in the markers of oxidation. CONCLUSION Inflammation and oxidation biomarkers were increased in patients with CF compared with controls. The use of azithromycin was associated with reduced TNF-α levels and did not influence oxidation parameters.