B. de la Fuente

Double blind randomized clinical trial controlled by placebo with an alpha linoleic acid and prebiotic enriched cookie on risk cardiovascular factor in obese patients

INTRODUCTION Inulin and FOS are prebiotics with potential benefit in cardiovascular risk factors. Alpha linolenic acid (ALA) is the metabolic precursor of the long chain n-3 fatty acid eicosapentaenoic acid (20: 5n-3), this fatty acid has anti-inflammatory properties. The aim of our study was to evaluate the response of the cardiovascular risk profile in obese patients after inclusion in the diet of an ALA, FOS and inulin enriched-cookie. MATERIAL AND METHODS 36 patients were randomized in both branches: group I (inulin, FOS and ALA enriched cookie) Gullon SL(®) and group II (control cookie). Previous and after 1 month of the treatment, a nutritional and biochemical study was realized. RESULTS 15 patients finished the procotol in each group. In group I, a significantly increase in soluble fiber (2.3 ± 0.8 g/day vs 7.7 ± 0.8 g/day: p < 0.05) and ALA (0.6 ± 0.5 g/day vs 3.8 ± 0.5 g/day; p < 0.05) intakes was detected. In this group a significant decrease of total cholesterol (238.1 ± 45.3 mg/dl vs 210.5 ± 38.1 mg/dl: p < 0.05), LDL cholesterol (153.6 ± 23.2 mg/dl vs 127.1 ± 27.9 mg/dl: p < 0.05) and C reactive protein (6.6 ± 1.4 mg/dl vs 4.4+7-1.8 mg/dl: p < 0.05) was reached in males. Anthropometric parameters did not change in both groups. The increase in soluble fiber and ALA dietary intakes did not produce any gastrointestinal adverse effect. CONCLUSION The increase of 2 grams per day of inulin, 3.1 grams per day of FOS and 3.2 grams per day of alpha linolenic (ALA) dietary intakes from an enriched-cookie, improved total cholesterol, LDL cholesterol and C reactive protein levels in obese males. As far as we know, this is the first study that has evaluated the effect on risk factors of an ALA enriched cookies.

Relation of resistin levels with cardiovascular risk factors, insulin resistance and inflammation in naive diabetes obese patients

BACKGROUND The aim of the present study was to explore the relationship of resistin levels with cardiovascular risk factors, insulin resistance and inflammation in naïve diabetic patients. SUBJECTS A population of 66 naïve diabetic patients with obesity was analyzed. A complete nutritional and biochemical evaluation was performed. RESULTS The mean age 56.9+/-11.6 years and the mean BMI was 37.8+/-6.3. Patients were divided in two groups by median resistin value (3.3ng/ml), group I (patients with the low values, average value 2.5+/-0.5) and group II (patients with the high values, average value 4.8+/-1.8). Patients in the group I had lower waist circumference, total cholesterol, LDL-cholesterol and C-reactive protein than patients in group II. Correlation analysis showed a significant correlation among resistin levels and the independent variables; BMI (r=0.26; p<0.05), waist circumference (r=0.38; p<0.05), fat mass (r=0.28; p<0.05), LDL-cholesterol (r=0.3; p<0.05), C-reactive protein (r=0.28; p<0.05). In the multivariate analysis, resistin concentration increase 0.024ng/ml (CI 95%: 0.006-0.42) for each mg/dl of C-reactive protein. CONCLUSION Circulating resistins are associated with C-reactive protein in an independent way in naïve diabetic patients.

Experience over 12 years with home enteral nutrition in a healthcare area of Spain

BACKGROUND The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study the outcome, as well as the clinical and epidemiological characteristics, of these patients. The present study aimed to analyse the incidence and characteristics of a cohort of patients on home enteral nutrition (HEN) over 12 years. MATERIALS AND METHODS A prospective observational study was performed between January 1999 and December 2010. All adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. RESULTS The incidence of HEN ranged between 9.52 per 100, 000 inhabitants in 2001 to 30.0 per 100,000 inhabitants in 2009. HEN was administered orally in 472 patients (68.28%) (group 1), and through a nasogastric tube in 168 patients (24.30%), a percutaneous enteral gastrostomy tube in 47 patients (6.80%) and a jejunostomy in four patients (0.60%) (group 2; 219 patients). During the course of HEN, 31 patients had diarrhoea (4.5%), 17 patients had constipation and 12 patients had nausea. The mean (SD) duration of HEN was 159.9 (97) days. In multivariable analysis, an independent factor associated with death was age (hazard ratio = 1.03; 95% confidence interval - 1.01-1.05), adjusted by sex, route and diagnosis. CONCLUSIONS HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.

Double blind randomized clinical trial controlled by placebo with a FOS enriched cookie on saciety and cardiovascular risk factors in obese patients

INTRODUCTION It is essential to determine which snack foods are most affective for appetite control. The objective of the current study was to assess the responses of two different cookies on satiety and cardiovascular risk factors. MATERIAL AND METHODS 38 patients were randomized: group I (FOS enriched cookie, n=19) and group II (control cookie, n=19). Previous and after 1 month , the subjects rated their feelings of satiety/hunger with a test meal of 5 cookies. RESULTS After the test meal, the basal area under curve of the first hunger/satiety score was higher with satiety cookie than with control cookie, the data after 1 month of treatment was higher with satiety cookie than with control cookie, too. The score was higher than the fasting level for 20 minutes with satiety cookie and for 40 minutes with the same cookie, too. In satiety group, these scores (20 min and 40 min) were higher than control group before and after 1 month of treatment. The results were in the same way with the 100 mm 5-point visual satiety scale. Cardiovascular risk factors and dietary intake remained unchanged after dietary intervention. CONCLUSION A FOS enriched cookie produced greater ratings of satiety than a control cookie, without effects on cardiovascular risk factors or dietary intakes.

Roles of G1359A polymorphism of the cannabinoid receptor gene (CNR1) on weight loss and adipocytokines after a hypocaloric diet

BACKGROUND A intragenic biallelic polymorphism (1359 G/A) of the CB1 gene resulting in the substitution of the G to A at nucleotide position 1359 in codon 435 (Thr), was reported as a common polymorphism in Caucasian populations. Intervention studies with this polymorphism have not been realized. OBJECTIVE We decided to investigate the role of the polymorphism (G1359A) of CB1 receptor gene on adipocytokines response and weight loss secondary to a lifestyle modification (Mediterranean hypocaloric diet and exercise) in obese patients. DESIGN A population of 94 patients with obesity was analyzed. Before and after 3 months on a hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were performed. The statistical analysis was performed for the combined G1359A and A1359A as a group and wild type G1359G as second group, with a dominant model. RESULTS Forty seven patients (50%) had the genotype G1359G (wild type group) and 47 (50%) patients G1359A (41 patients, 43.6%) or A1359A (6 patients, 6.4%) (mutant type group) had the genotype. In wild and mutant type groups, weight, body mass index, fat mass, waist circumference and systolic blood pressure decreased. In mutant type group, resistin (4.15 ± 1.7 ng/ml vs. 3.90 ± 2.1 ng/ml: P < 0.05), leptin (78.4 ± 69 ng/ml vs 66.2 ± 32 ng/ml: P < 0.05) and IL-6 (1.40 ± 1.9 pg/ml vs 0.81 ± 1.5 pg/ml: P < 0.05) levels decreased after dietary treatment. CONCLUSION The novel finding of this study is the association of the mutant allele (A1359) with a decrease of resistin, leptin and interleukin-6 secondary to weight loss.

Allelic frequency of G380A polymorphism of tumor necrosis factor alpha gene and relation with cardiovascular risk factors and adipocytokines in obese patients

BACKGROUND The aim of our study was to investigate the allelic frequency of the G308A polymorphism in the TNF alpha gene and the influence of G308A this polymorphism on cardiovascular risk factors and adipokine levels in obese patients. DESIGN A population of 834 obesity patients was analyzed. A nutritional evaluation and a blood analysis were performed. The statistical analysis was performed for the combined G308A and A308A as mutant group and type G308G as wild group. RESULTS A total of 630 patients (181 males/449 females) (75.5%) had the genotype G308/G308 (wild genotype group) with an average age of 43.5 ± 14.8 years, 188 patients (61 males/127 females) (22.5%) had the genotype G308/A308 (mutant genotype group-heterozygote) and 16 patients (5 males/11 females) (1.9%) with an average age of 44.5 ± 14.2 years had the genotype A308/A308 (mutant group-homorozygote) with an average age of 44.3 ± 11.4 years, without statistical differences in the mean age or sex distribution. Genotypes G308/A308 and A308/A308 was designed (mutant genotype group) as a dominant model. Allelic frequency of the A substitucion -308 was 13.19%. Anthropometric, adipokines, insulin resistance, lipid levels ad dietary intake were similar in both genotypes. CONCLUSION In conclusion, allelic frequency of G308A polymorphism is is in accordance with allelic frequencies observed in other populations. Carries of A308 allele have the same anthropometric and metabolic profile than wild type carriers.

Effect of a hypocaloric diet with a commertial formula in weight loss and quality of life in obese patients with chronic osteoarthritis

BACKGROUND The aim of our study was to evaluate in patients with obesity and chronic osteoarthritis the impact on quality of life and metabolic control of a dietary intervention with a hypocaloric commercial formula. METHODS A sample of 55 obese patients with chronic osteoarthritis was enrolled. The study consisted of a 12-week weight reduction program where the participants received an oral diet replaced with 2 bricks of Optisource Plus®. RESULTS In order to assess the effect of weight loss on different parameters, patients were divided in two groups by the median of weight loss percentage (9%); group 1 (< 9%) and group 2 (> 9%). In group 2, patients showed an improvement in total SF-36 score (4.0 ± 6.1 points), physical function domain of SF 36 (1.8 ± 3.4 points), role physical domain of SF 36 (0.6 ± 1.6 points) and vitality domain of SF 36 (2.7 ± 4.6 points) improved. Total score of WOMAC test (- 8.2 ± 15.0 points), function domain of WOMAC test (- 6.5 ± 10.6 points) and stiffness domain of WOMAC test (-0.7 ± 2.1 points) improved, too. CONCLUSION The effect on metabolic response, functionality and quality of life was better in patients with a percentage of weight loss > 9% than patients with a lower weight loss.

Clinical effects of a hypercaloric and hyperproteic oral suplemment enhanced with w3 fatty acids and dietary fiber in postsurgical ambulatory head and neck cancer patients

BACKGROUND Patients with head and neck cancer undergoing surgery have a high risk of nutritional complications. OBJECTIVE The aim of our study was to investigate the influence of a hypercaloric and hyperproteic oral supplement enriched with w3 FATTY ACIDS and fiber in clinical parameters in head and neck tumor postsurgical ambulatory patients with or without radiotherapy. DESIGN A population of 37 ambulatory postsurgical patients with oral and laryngeal cancer was enrolled. At Hospital discharge postsurgical head and neck cancer patients were asked to consume two units per day of a hypercaloric and hyperproteic oral supplement for a twelve week period. RESULTS The mean age was 63.8+/-7.1 years (16 female/ 21 males). Duration of supplementation was 98.1±19.1 days. A significant increase of albumin and transferrin levels was observed, in total group and in patients undergoing radiotherapy and without it. No differences were detected in weight and other anthropometric parameters in total group and in patients with radiotherapy during the protocol. Nevertheless, patients without radiotherapy showed a significant improvement of BMI; weight, fat free mass and fat mass. CONCLUSIONS An omega 3 and fiber enriched formula improved seric protein levels in ambulatory postoperative head and neck cancer patients. Improvement of weight, fat mass and fat free mass was observed in patients whom not received radiotherapy during the follow up.

Polymorphism of neuropeptide Y gene rs16147 modifies the response to a hypocaloric diet on cardiovascular risk biomarkers and adipokines.

BACKGROUND The main genetic variant described in NPY gene is rs16147 (G-399A) and it is located within the promoter region upstream of the gene for neropeptide Y (NPY). We evaluate the effects of the rs16147 NPY gene polymorphism on metabolic changes secondary to weight loss after 3 months of a hypocaloric diet in adult obese patients. METHODS A population of 82 obese patients was analysed in an interventional design of one arm. Before and after 3 months on a hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were performed. The statistical analysis was performed for combined GA and AA as a group (minor allele group) and GG as second group (major allele group) (dominant model). RESULTS In A allele carriers, the mean (SD) decrease in weight was -2.8 (2.2) kg [decrease in non A allele carriers -2.6 (1.1) kg, P > 0.05), body mass index was -1.2 (0.6) kg m-2 [decrease in non A allele carriers -1.1 (0.8) kg m-2 , P > 0.05], fat mass was -1.7 (1.4) kg [decrease in non A allele carriers -1.9 (1.3) kg, P > 0.05], waist circumference was -5.5 (3.4) cm [decrease in non A allele carriers -3.7 (4.1) cm, P = 0.006], C-reactive protein (CRP) was -0.7 (0.6) mg dL-1 [decrease in non A allele carriers -0.1 (0.3) mg dL-1 , P = 0.02], insulin was -1.5 (0.4) mUI L-1 [decrease in non A allele carriers -0.8 (2.0) mUI L-1 , P = 0.001] and homeostasis model assessment-insulin resistance (HOMA-IR) was -0.4 (0.5) [decrease in non A allele carriers -0.2 (0.1), P = 0.005]. interleukin (IL)-6 changes were significant in A allele carriers [-0.7 (0.2) pg mL-1 ] versus non A allele carriers [-0.1 (0.3) pg mL-1 ] (P = 0.01). CONCLUSIONS We found that the rs164147 genotype affected the reduction of waist circumference, HOMA-IR, insulin, CRP and IL-6 levels in response to weight loss diet in obese subjects.

Effects of C358A polymorphism of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH) on weight loss, adipocytokines levels, and insulin resistance after a high polyunsaturated fat diet in obese patients

Background and aims: The C385A polymorphism of FAAH gene (rs324420C>A) has been associated with obesity. We investigate the role of this polymorphism on anthropometric and insulin resistance responses to a high polyunsaturated fat hypocaloric diet. Methods: Obese individuals (no.=99) were assessed at baseline and after 3 months of a high polyunsaturated fat hypocaloric diet. Results: Seventy-one patients (71.7%) had the genotype C385C and 28 (28.3%) patients had the C385A (26 patients, 26.3%) or A358A (2 patients, 2.0%) (A allele carriers group) genotype. In A allele carriers and after dietary intervention, total cholesterol (−16.3±37.4 mg/dl) and LDL-cholesterol (−12.9±6.5 mg/dl) levels decreased. In subjects with C385C genotype, the decreases were significant in total cholesterol (−12.3±27.4 mg/dl), LDL-cholesterol (−7.5±20.5 mg/dl), insulin (−2.2±6.2 mUI/l), and homeostasis model assessment of insulin resistance (HOMA-R) (−0.79±1.15 units) levels. The weight loss was similar in both genotype groups (−4.1 ±3.8 kg vs −4.2±3.2 kg). Only leptin levels had a significant similar decrease in both genotypes. Conclusion: Subjects with C385C genotype of the FAAH showed an improvement on insulin and HOMA-R levels with a high polyunsaturated fat hypocaloric diet after weight loss during 3 months.