Diego Bellido

Lipoprotein(a) and other lipoproteins in hypothyroid patients before and after thyroid replacement therapy

AIMS To analyse the influence of thyroid hormones on serum lipoprotein(a) (Lp(a)) concentration and other lipid parameters, and hence potentially on coronary artery disease (CAD) risk. METHODS Thirty-six patients with hypothyroidism and 165 age-matched control euthyroid subjects were evaluated in a cross- sectional study, determining thyroid function tests and fasting serum lipids and lipoproteins. In a follow-up study for those hypothyroid patients the same determinations were repeated after normalization of thyroid state by levothyroxine (L-T(4)) replacement therapy. Patients needing other treatments were excluded. At baseline, patients with hypothyroidism had significantly higher levels of Lp(a), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (apo) A-I and apo B, and a higher TC/high-density lipoprotein cholesterol (HDL-C) ratio than control subjects. RESULTS Severity of the hypothyroid state, expressed by serum thyroid-stimulating hormone, was correlated with serum levels of Lp(a), LDL-C, and TC (r= 0.64, 0.52, 0.49, P= 0.005, P= 0.033, P= 0. 048, respectively). The pretreatment Lp(a) levels were also correlated with those of posttreatment Lp(a)(r= 0.68, P= 0.002). All patients, who presented basal Lp(a) levels higher than 30 mg/dl, showed a decrease in Lp(a) concentrations by L-T(4)therapy, and these normalized in eight cases (22.2%). Euthyroid state gave rise to a significant reduction of serum Lp(a) by 32.3%, of LDL-C by 22. 8%, of TC by 17%, of apo A-I by 9.6%, and of apo B by 9.3%. After L-T(4)therapy, CAD risk, expressed as TC/HDL-C ratio, decreased by 19.9%. CONCLUSIONS These results show that hypothyroidism is associated not only with elevated serum levels of LDL-C but also with elevated serum Lp(a) concentrations. Lp(a) levels may be at least partially modulated by thyroid hormone-dependent mechanisms, thus increasing the risk of developing premature atherosclerosis in hypothyroid state, that might be reduced by L-T(4)therapy.

Body composition changes after very low-calorie-ketogenic diet in obesity evaluated by three standardized methods

Context: Common concerns when using low-calorie diets as a treatment for obesity are the reduction in fat-free mass, mostly muscular mass, that occurs together with the fat mass (FM) loss, and determining the best methodologies to evaluate body composition changes. Objective: This study aimed to evaluate the very-low-calorie ketogenic (VLCK) diet-induced changes in body composition of obese patients and to compare 3 different methodologies used to evaluate those changes. Design: Twenty obese patients followed a VLCK diet for 4 months. Body composition assessment was performed by dual-energy X-ray absorptiometry (DXA), multifrequency bioelectrical impedance (MF-BIA), and air displacement plethysmography (ADP) techniques. Muscular strength was also assessed. Measurements were performed at 4 points matched with the ketotic phases (basal, maximum ketosis, ketosis declining, and out of ketosis). Results: After 4 months the VLCK diet induced a −20.2 ± 4.5 kg weight loss, at expenses of reductions in fat mass (FM) of −16.5 ± 5.1 kg (DXA), −18.2 ± 5.8 kg (MF-BIA), and −17.7 ± 9.9 kg (ADP). A substantial decrease was also observed in the visceral FM. The mild but marked reduction in fat-free mass occurred at maximum ketosis, primarily as a result of changes in total body water, and was recovered thereafter. No changes in muscle strength were observed. A strong correlation was evidenced between the 3 methods of assessing body composition. Conclusion: The VLCK diet-induced weight loss was mainly at the expense of FM and visceral mass; muscle mass and strength were preserved. Of the 3 body composition techniques used, the MF-BIA method seems more convenient in the clinical setting.

Plasma FGF21 levels in obese patients undergoing energy-restricted diets or bariatric surgery: a marker of metabolic stress?

Background:Fibroblast growth factor 21 (FGF21) has been suggested to be an endocrine signal of nutritional status and an active regulator of metabolism. However, there is no agreement on the effect of weight-loss therapies on circulating levels of FGF21 in humans.Objective:To assess FGF21 circulating levels in adiposity excess and after different weight-loss strategies prescribed in five different groups from four independent centers.Subjects and methods:Body composition, ketosis, insulin sensitivity and FGF21 were evaluated in 181 excess body weight and 14 normal-weight subjects. From the excess body weight patients, two independent groups (discovery cohort; n=20 and validation cohort; n=28) undertook a very low-calorie ketogenic (VLCK) diet, a third group followed a low-calorie (LC) diet (n=84) and other two groups underwent bariatric surgery (discovery cohort; n=24 and validation cohort; n=25). The follow-up was 4 to 6 or 12 months, respectively.Results:FGF21 levels were higher in excess body weight patients than in normal-weight subjects. The energy-restriction therapy to lose weight induced a significant decrease, with respect to baseline, in circulating levels of FGF21 (VLCK: −62.5 pg ml−1 or −14.8 pg ml−1 and LC diet: −67.9 pg ml−1). There were no differences in FGF21 levels between both energy-restriction treatments. On the contrary, after bariatric surgery morbidly obese patients showed a significant increase in FGF21, especially 1 month after surgery (148.8 pg ml−1 higher than baseline). The FGF21 differential changes occur concomitantly with a non-induced ketosis situation (0.66±0.56 mm) in bariatric surgery, and an improvement in adiposity and insulin sensitivity induced by the three therapies.Conclusions:FGF21 levels were reduced after energy-restricted treatments and severely increased after bariatric surgery, independently of the weight reduction magnitude, insulin sensitivity or ketosis. Therefore, FGF21 appears to be a marker of severe nutritional stress.

Índices antropométricos estimadores de la distribución adiposa abdominal y capacidad discriminante para el síndrome metabólico en población española

INTRODUCTION The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36±14.63 years, and a body mass index (BMI) of 32.76±6.81kg/m(2). Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m(2), and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS An AUC of 0.724 (95%CI: 0.706 to 0.742), P<.001, was obtained for CC, 0.709 (95%CI: 0.691 to 0.728), P<.001 for ICA with height in m(2), and 0.729 (95%CI: 0.711 to 0.747), P<.001 for ICA with height in cm, and for the BMI it was 0.680 (95%CI 0.661-0.699), P<.001. CONCLUSIONS Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI.

Intensification of basal insulin therapy with Lixisenatide in patients with type 2 diabetes in a real-world setting: the BASAL-LIXI Study

Highlights • Adding lixisenatide to basal insulin was effective for uncontrolled type 2 diabetes.• Glycemic control improved and body weight lowered during 24 weeks of treatment.• These benefits were achieved with a low risk of hypoglycemia in clinical practice.• These findings in the clinical practice setting support those of clinical trials.

Prevención, diagnóstico y tratamiento de la obesidad. Posicionamiento de la Sociedad Española para el Estudio de la Obesidad de 2016 ☆

Albert Lecube a,∗,1, Susana Monereob,1, Miguel Ángel Rubio c, Purificación Martínez-de-Icayad, Amelia Martíe, Javier Salvador f, Lluís Masmiquel g, Alberto Godayh, Diego Bellido i, Empar Lurbe j, José Manuel García-Almeida k, Francisco José Tinahones l, Pedro Pablo García-Lunam, Enrique Palacion, Manuel Gargallo ñ, Irene Bretónb, Salvador Morales-Condeo, Assumpta Caixàsp, Edelmiro Menéndezq, Manel Puig-Domingo r, Felipe F. Casanueva s

Prevention, diagnosis, and treatment of obesity. 2016 position statement of the Spanish Society for the Study of Obesity.

Albert Lecube a,∗,1, Susana Monereob,1, Miguel Ángel Rubio c, Purificación Martínez-de-Icayad, Amelia Martíe, Javier Salvador f, Lluís Masmiquel g, Alberto Godayh, Diego Bellido i, Empar Lurbe j, José Manuel García-Almeida k, Francisco José Tinahones l, Pedro Pablo García-Lunam, Enrique Palacion, Manuel Gargallo ñ, Irene Bretónb, Salvador Morales-Condeo, Assumpta Caixàsp, Edelmiro Menéndezq, Manel Puig-Domingo r, Felipe F. Casanueva s

OriginalÍndices antropométricos estimadores de la distribución adiposa abdominal y capacidad discriminante para el síndrome metabólico en población españolaAnthropometric measures of central abdominal fat and discriminant capacity for metabolic syndrome in a Spanish population

INTRODUCTION The metabolic syndrome (MS) carries an increased risk of cardiovascular disease and diabetes mellitus. Insulin resistance is probably the mechanism underlying the changes detected in lipid and carbohydrate metabolism in these patients, who have, as a common anthropometric feature, a predominantly increased abdominal fat distribution. PATIENTS AND METHODS A total of 3316 patients were studied, of whom 63.40% were female and 36.60 male, with a mean age of 42.36±14.63 years, and a body mass index (BMI) of 32.76±6.81kg/m(2). Weight, height and waist circumference (CC) were measured using standard techniques. The waist/height (ICA) was calculated using two indicators, expressed as waist in cm divided by height in m(2), and as waist divided by height, both in cm. The prevalence of metabolic syndrome in the sample was 33.70%. In order to assess the predictive ability of BMI, ICA and CC to detect the existence of MS, receiver operating curves (ROC) were constructed and the areas under the curve (AUC) calculated for each anthropometric parameter. RESULTS An AUC of 0.724 (95%CI: 0.706 to 0.742), P<.001, was obtained for CC, 0.709 (95%CI: 0.691 to 0.728), P<.001 for ICA with height in m(2), and 0.729 (95%CI: 0.711 to 0.747), P<.001 for ICA with height in cm, and for the BMI it was 0.680 (95%CI 0.661-0.699), P<.001. CONCLUSIONS Anthropometric indices that assess abdominal fat distribution have a better predictive capacity for detecting MS, compared to total adiposity indicators such as BMI.

Tratamiento nutricional del paciente con enfermedad inflamatoria intestinal

Teniendo en cuenta la multitud de factores que pueden estar implicados en la mala situacion nutricional de estos pacientes y su elevada prevalencia, la ASPEN (Asociacion Americana de Nutricion Parenteral y Enteral) establece, con un grado de recomendacion B, que se deberia realizar un cribado nutricional a todos los pacientes con enfermedad inflamatoria intestinal (EII). En primer lugar, tenemos que pensar que no existe una unica dieta oral para el paciente con EII, e incluso puede ser necesario utilizar soporte artificial. Para pacientes con EII en los que este indicado el soporte nutricional avanzado, se deberia utilizar la nutricion enteral (NE) de eleccion, y la nutricion parenteral en los pacientes con contraindicacion absoluta de NE o que no la toleren. Con respecto a la formula a utilizar, no hay diferencias entre las dietas elementales y las polimericas; (61% frente 65% respectivamente). Las dietas polimericas convencionales, con un contenido bajo en sacarosa y sin lactosa, deberian ser empleadas de primera eleccion en estos pacientes. Se ha planteado la posibilidad de utilizar la NE como tratamiento primario; los metaanalisis en la enfermedad de Crohn muestran una tasa de remision con esteroides del 80% frente a una tasa de remision de la NE del 60%; sin embargo, hay mejora en la tasa de remision en los pacientes con NE (superior al 20%) frente a placebo. En estos momentos hay resultados prometedores al anadir probioticos o fibra o modificando la cantidad y la calidad de las grasas de estas dietas.

High risk haemostasis patterns in overweight patients with type 2 diabetes mellitus

Background Some studies have shown that diabetic patients had hypercoagulability. Objective To compare the haemostasis pattern between overweight diabetic patients and control subjects. Design Twenty three overweight patients of our Diabetes Unit chosen at random (16 males/7 females) with type 2 diabetes mellitus were enrolled. The clinical characteristics of these patients were: age of 61.3 ± 12.3 years, body mass index (BMI) 27.2 ± 3.9 kg/m2 and duration of diabetes 8.4 ± 6.7 years. A group of twenty three voluntary controls chosen at random (blood donors) (15 males/8 females) without diabetes were studied. The clinical characteristics of this group were: age 62 ± 13 years and BMI 27.6 ± 3.1 kg/m2. All patients (diabetics and controls) underwent the following examinations; plasminogen activator inhibitor type 1(PAI-1), thrombin/antithrombin III complex (TAT), tissue plasminogen activator (t-PA), von Willebrand antigen (vW), protein C (PC), protein S (PS), thrombomodulin (TH), activated VII factor, D dimer (DD), plasminantiplasmin (PAP), and prothrombin activation fragment F1+2 (F12). Haemostasis parameters were compared in both groups and within the diabetic subjects in the subgroups with and without micro and macroangiopathy. In both groups, correlation analysis was performed between haemostasis and clinical parameters. Results Overweight diabetics patients showed an increment in procoagulant parameters (F12 1.38 ± 0.4 vs 1.21 ± 0.25 nmol/l, p Conclusion Hypercoagulable state is present in diabetic patients which with present knowledge, can be viewed as a risk factor for chronic complications.