Armando Aguirre-Jaime

Sedentary Lifestyle: Physical Activity Duration Versus Percentage of Energy Expenditure

INTRODUCTION AND OBJECTIVES To compare different definitions of a sedentary lifestyle and to determine which is the most appropriate for demonstrating its relationship with the metabolic syndrome and other cardiovascular risk factors. METHODS A cross-sectional study of 5814 individuals was carried out. Comparisons were made between two definitions of a sedentary lifestyle: one based on active energy expenditure being less than 10% of total energy expenditure, and the other, on performing less than 25-30 minutes of physical activity per day. Reported levels of physical activity, anthropometric measurements, and biochemical markers of cardiovascular risk were recorded. The associations between a sedentary lifestyle and metabolic syndrome and other risk factors were adjusted for gender, age and tobacco use. RESULTS The prevalence of a sedentary lifestyle was higher in women (70%) than in men (45-60%, according to the definition used). The definitions based on physical activity duration and on energy expenditure were equally useful: there were direct associations between a sedentary lifestyle and metabolic syndrome, body mass index, abdominal and pelvic circumferences, systolic blood pressure, heart rate, apolipoprotein B, and triglycerides, and inverse associations with high-density lipoprotein cholesterol and paraoxonase activity, which demonstrated the greatest percentage difference between sedentary and active individuals. An incidental finding was that both definitions of a sedentary lifestyle were more strongly associated with the metabolic syndrome as defined by International Diabetes Federation criteria than by Adult Treatment Panel III criteria. CONCLUSIONS Given that it is relatively easy to determine whether a patient performs less than 25 minutes of physical activity per day, use of this definition of a sedentary lifestyle is recommended for clinical practice. The serum paraoxonase activity level could provide a useful marker for studying sedentary lifestyles.

Microalbuminuria and Hypoxemia in Patients with Chronic Obstructive Pulmonary Disease

RATIONALE Microalbuminuria (MAB), a marker of endovascular dysfunction, is a predictor of cardiovascular events and all-cause mortality in the general population. There is evidence of vascular dysfunction in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES To assess the prevalence and relationship of MAB with clinical and physiological parameters in stable patients with COPD. METHODS We measured urinary albumin rate (urinary albumin to creatinine ratio: UACR), smoking history, arterial blood pressure, gas exchange, body mass index, lung function, BODE index (body mass index, airflow obstruction, dyspnea, exercise performance), and comorbidity index in 129 patients with stable COPD and 51 smokers with normal spirometry without known cardiovascular disease. MAB levels were compared between groups. A multivariate analysis was performed to determine the best determinants of MAB levels. MEASUREMENTS AND MAIN RESULTS MAB was higher in patients with COPD than in control smokers (8 [5th-95th percentile (P₅₋₉₅), 2.9-113] vs. 4.2 [P₅₋₉₅, 1.8-22.7] mg/g, P < 0.001]). The difference remained significant even after using the standard pathologic threshold (MAB, 30-299 mg/g in women and 20-299 mg/g in men; 24% in patients with COPD vs. 6% in control smokers; P = 0.005). In patients with COPD, there was a negative correlation between Pa(O₂) and MAB (r = -0.40, P < 0.001). Using multivariate analysis, MAB was only associated with the Pa(O₂) (relative risk, 0.934; 95% confidence interval, 0.880-0.992; P < 0.001) and with the systolic arterial blood pressure (relative risk, 1.034; 95% confidence interval, 1.011-1.057; P = 0.003). CONCLUSIONS MAB is frequent in patients with COPD and is associated with hypoxemia independent of other cardiovascular risk factors. Further studies are necessary to investigate whether MAB could be an early simple biomarker of cardiovascular compromise in patients with COPD.

Association of IL-6 gene polymorphisms and COPD in a Spanish Population

Interleukin-6 (IL-6) is a potential mediator of systemic effects of Chronic Obstructive Pulmonary Disease (COPD). In the present case-control study we investigated the association of promoter polymorphisms of this gene and COPD in a cohort of 191 patients, smokers without COPD (n=75) and a healthy control population (n=296). Besides spirometry, exercise capacity (6MWD, 6 min walking distance) and body mass index (BMI) were measured in COPD patients. Genotyping of the IL-6 polymorphisms at positions -174, -572 and -597 was performed. The -597G/A and -174G/C polymorphisms were not associated with the disease. However, the -572G/C polymorphism was significantly associated with COPD susceptibility under a dominant model of inheritance. The frequency of the genotypes containing the C allele was significantly lower in the COPD cases (9.9%) compared with the healthy control group (16.9%) and smokers (23.1%), (OR=0.46, p=0.032 and OR=0.28, p=0.012, respectively). The GCG (-597/-572/-174) haplotype was significantly associated with the disease (OR=0.37, p=0.022, COPD cases vs. healthy subjects and OR=0.17, p=0.011, COPD cases vs. smokers). Moreover, a borderline association was also found for the -572G allele and hypoxemia (PaO(2)<60 mmHg) (p=0.05). Our data suggest that the IL-6 -572C allele may confer a diminished risk of developing COPD.

Sedentarismo: tiempo de ocio activo frente a porcentaje del gasto energético

Introduccion y objetivos Comparar 2 definiciones diferentes de sedentarismo y averiguar cual es mas efectiva para detectar su relacion con el sindrome metabolico (SM) y otros factores de riesgo cardiovascular. Metodos Estudio transversal de 5.814 individuos. Se compara el concepto de sedentarismo basado en consumir activamente menos del 10% del gasto energetico total con el concepto basado en no realizar al menos 25-30 min diarios de ocio activo. Se analizan la actividad fisica declarada, la antropometria y los marcadores bioquimicos de riesgo cardiovascular. La relacion del sedentarismo con el SM y los marcadores de riesgo se ajusto por el sexo, la edad y el tabaquismo. Resultados La prevalencia de sedentarismo en mujeres (70%) fue superior a la de los varones (un 45-60%, segun el concepto empleado). El tiempo de ocio mostro la misma efectividad que la energia consumida: el sedentarismo se asocio directamente con el SM, el indice de masa corporal, las cinturas abdominal y pelvica, la presion arterial sistolica, la frecuencia cardiaca, la apolipoproteina B y los trigliceridos, e inversamente con el colesterol unido a lipoproteinas de alta densidad (cHDL) y la actividad de la paraoxonasa (esta presento el mayor porcentaje de variacion entre sedentarios y activos). Como resultado collateral se obtuvo que la definicion de SM propuesta por la Federacion Internacional de Diabetes se asocia con mayor fuerza que la del ATP-III a cualquier concepto de sedentarismo. Conclusiones Dada su mayor facilidad de obtencion, en la practica clinica es recomendable el uso del concepto de sedentarismo basado en averiguar si el paciente realiza al menos 25 min diarios de ocio activo. La actividad de la paraoxonasa es un marcador de interes para el estudio del sedentarismo.

Morphine-Methadone Opioid Rotation in Cancer Patients: Analysis of Dose Ratio Predicting Factors

The dose ratio that is effective when switching opioid therapy from morphine to methadone in cancer patients varies widely. There are no conclusive data explaining the source of this variability. We analyzed 54 cancer patients undergoing opioid rotation to clarify those factors that influenced the morphine/methadone dose ratio (MMEDR) at Day 10 after the switch. Reasons for switching were uncontrolled pain (10 patients) or side effects (with or without pain, 44 patients). Initial MMEDR was 5:1 or 10:1 (82% or 18% of patients, respectively). Multivariate regression analysis was used to identify the demographic, cancer-related, and treatment-related variables that were potential predictors of MMEDR. Median previous morphine dose for the entire sample was 220 mg/day (range: 30-1000 mg/day). The stable MMEDR median was 5:1 (range: 2:1-15:1). In the univariate analysis, reasons for opioid rotation, age, and previous morphine doses were associated with MMEDR. Multiple linear regression analysis showed that only the reason for switching (pain vs. side effects; P<0.001) and previous morphine doses (lower vs. upper to 300 mg/day; P<0.001) were associated with MMEDR. From this analysis, the MMEDRs for patients rotated for side effects at 300 mg/day or more or less than 300 mg/day of morphine were 9.1:1 or 5.6:1, respectively, and the MMEDRs for those switched for pain at 300 mg/day or more or less than 300 mg/day of morphine were 4.9:1 or 3:1, respectively. Both the reasons for opioid rotation and previous morphine doses are predictive factors and should be used to select the MMEDR more accurately.

Estimación del riesgo coronario en la población de Canarias aplicando la ecuación de Framingham

Fundamento y objetivo: La mortalidad por cardiopatia isquemica en Canarias se situa entre las mas altas de Espana. Dada la ausencia de tablas de riesgo coronario especificas para la poblacion del archipielago, este estudio las elabora y compara a la poblacion canaria con la de Gerona, cuya prevalencia y tablas de riesgo se han publicado previamente. Sujetos y metodo: Estudio transversal de 4.915 sujetos, de entre 25 y 74 anos de edad, incluidos en la cohorte CDC de Canarias. Se les efectuo una entrevista personal, ademas de exploracion fisica y extraccion de sangre, para estimar las prevalencias estandarizadas de tabaquismo, sobrepeso, obesidad, diabetes e hipertension arterial. Con ellas se calibro la ecuacion derivada de la cohorte de Framingham y se elaboraron las tablas de riesgo coronario. Resultados: La prevalencia bruta de obesidad fue del 30% (intervalo de confianza [IC] del 95%, 28,7-31,3), la de sobrepeso del 39% (IC del 95%, 37,6-40,4), la de tabaquismo del 26% (IC del 95%, 24,8-27,2), la de hipertension arterial del 40% (IC del 95%, 38,6-41,4) y la de diabetes mellitus del 12% (IC del 95%, 11,1-12,9). Comparada con la estimada en Gerona, la prevalencia de casi todos estos factores de riesgo es desfavorable a la poblacion de las islas desde las edades mas jovenes hasta las mas avanzadas. En promedio, el riesgo coronario calibrado en Canarias es un 89% mas alto (un 94% en varones y un 87% en mujeres), lo cual se corresponde con la distancia entre ambas poblaciones en las estadisticas nacionales de mortalidad. Conclusiones: La elevada prevalencia de obesidad y otros factores en la poblacion canaria genera importantes riesgos coronarios y explica su posicion en las estadisticas de mortalidad por cardiopatia isquemica. El uso de tablas calibradas como las que aqui presentamos puede ser de ayuda para intensificar la prevencion cardiovascular.

Impaired fasting glucose, ancestry and waist-to-height ratio: main predictors of incident diagnosed diabetes in the Canary Islands.

Diabet. Med. 29, 399–403 (2012)

Validación de un cuestionario de frecuencia de consumo de alimentos adaptado para el estudio y seguimiento de la población adulta de las Islas Canarias

Background: The registering of eating habits requires a valid and reliable method. The purpose of this study is to validate the food intake frequency questionnaire, CDC-FFQ, which is an adaptation of another questionnaire, in order to assess the nutrition of the adult population of the Canary Islands. Methods: The CDC-FFQ questionnaire was given to 1,067 individuals taken from the general population (GP) and to 106 university students, aged 19 to 30. The second group was surveyed also in three 24-hour follow-ups. The nutrients were compared according to the CDC-FFQ in the GP and university students. The correlations were estimated between the CDC-FFQ and the follow-ups for nutrients and groups of foods and the concordance of the intakes of nutrients and groups of foods in the extreme quintiles, for the university students. Results: The mean values between nutrients of the CDC-FFQ between the GP, university students and the general population with university studies showed no significant differences except for vitamin B12 (p=0.004) and vitamin D (p=0.005). Correlations between the CDC-FFQ and the mean of the three follow-ups were obtained in the 0.202-0.601 range between nutrients adjusted by calories consumed in the case of the university students. By groups of foods, the correlations ranged between 0.243-0.542 for the CDC-FFQ and the follow-ups. The concordance of nutrients ranged between 39% and 100% and for groups of foods, between 41% and 100%. Conclusions: The CDC-FFQ questionnaire is valid for classifying the subjects in the relative ranges of their level of intake of foods and nutrients and, therefore, it could be useful in epidemiological studies with a diet assessment in the adult population of the Canary Islands.

Serum Resistin and Polymorphisms of Androgen Receptor CAGn and GGNn and Aromatase TTTAn

There is evidence that androgens are regulators of insulin resistance (IR), and may be involved in the regulation of resistin, a cytokine that has been related with IR. Earlier studies found that androgen receptor length polymorphisms CAGn and GGNn and the aromatase polymorphism TTTAn may influence receptor or enzyme activity and serum concentrations of androgens. This study was designed to determine whether polymorphism length was related to serum resistin concentration and to other variables related with IR. In 1,580 persons chosen randomly from the general population of the Canary Islands (Spain), we measured polymorphism length, waist circumference, waist/hip ratio, BMI, and serum glucose concentration. In smaller subgroups, we also measured C‐peptide (n = 677), resistin (n = 583), and leptin concentration (n = 754) and estimated IR (homeostasis model assessment‐IR (HOMA2‐IR)). In men, polymorphism length correlated with resistin concentration (CAGn, r = 0.13, P = 0.031; TTTAn, r = 0.15, P = 0.005; GGNn, r = −0.15, P = 0.026), and the correlations were confirmed in multivariate regression models. The length of CAGn and TTTAn correlated inversely with C‐peptide (r = −0.13, P = 0.016 and r = −0.21, P < 0.001, respectively) and with estimated IR (r = −0.12, P = 0.032 and r = −0.19, P = 0.001, respectively). In men, length of the CAGn, GGNn, and TTTAn was associated with serum resistin concentration. These results support the hypothesis that androgens may be involved in the regulation of resistin. Resistin may be a link between IR and androgens.

TNFA-863 polymorphism is associated with a reduced risk of Chronic Obstructive Pulmonary Disease: A replication study

BackgroundTNF-α mediated inflammation is thought to play a key role in the respiratory and systemic features of Chronic Obstructive Pulmonary Disease. The aim of the present study was to replicate and extend recent findings in Taiwanese and Caucasian populations of associations between COPD susceptibility and variants of the TNFA gene in a Spanish cohort.MethodsThe 3 reported SNPs were complemented with nine tag single nucleotide polymorphisms (SNP) of the TNFA and LTA genes and genotyped in 724 individuals (202 COPD patients, 90 smokers without COPD and 432 healthy controls). Pulmonary function parameters and serum inflammatory markers were also measured in COPD patients.ResultsThe TNFA rs1800630 (-863C/A) SNP was associated with a lower COPD susceptibility (ORadj = 0.50, 95% CI = 0.33-0.77, p = 0.001). The -863A allele was also associated with less severe forms of the disease (GOLD stages I and II) (ORadj = 0.303, 95%CI = 0.14-0.65, p = 0.014) and with lower scores of the BODE index (< 2) (ORadj = 0.40, 95%CI = 0.17-0.94, p = 0.037). Moreover, the -863A carrier genotype was associated with a better FEV1 percent predicted (p = 0.004) and a lower BODE index (p = 0.003) over a 2 yrs follow-up period. None of the TNFA or LTA gene variants correlated with the serum inflammatory markers in COPD patients (p > 0.05).ConclusionsWe replicated the previously reported association between the TNFA -863 SNP and COPD. TNFA -863A allele may confer a protective effect to the susceptibility to the disease in the Spanish population.