E. Romero

Nutritional treatment for acquired immunodeficiency virus infection using an enterotropic peptide-based formula enriched with n-3 fatty acids: a randomized prospective trial.

Objective: Dietary counseling and intervention based on application of conventional criteria have been ineffective in preventing the progressive weight loss associated with HIV infection. The aim of the study was to compare the progression of clinical and nutritional indicators during nutritional supplementation with or without an enterotropic peptide-based formula enriched with n-3 fatty acids.Design: Randomized trial.Setting: Tertiary care.Subjects: Ninety-one patients were screened for the study. Twenty-three did not meet the inclusion criteria, therefore 74 patients were randomized. Of these, 38 were randomized to group I (standard formula) and 36 were randomized to group II supplementation (enterotropic peptide-based formula enriched with n-3 fatty acids).Interventions: Group I received standard enteral formula and group II received a enterotropic peptide-based enteral formula. The volume was the same (3 cans/day, 236 ml per can). In both groups enteral supplementation were recommended in conjunction with a registered dietitian under a dietary counseling program based on standard nutrition principles. Patients received a prospective serial assessment of nutrition status, nutritional intake with 24 h written food records, GI symptoms, immune function, anthropometric status and intercurrent health events including infections and hospitalization. These determinations were performed at baseline and at 3 months.Results: Treatment with both supplements resulted in a significant and sustained increase in weight (3.2% in group I and 3.1% in group II); this increase was mostly due to fat mass (12.8% in group I) and (7.5% in group II). Total body water and fat free-mass remained unchanged. CD4 counts remained stable in group I, while a significant increase was detected in group II (576±403 vs 642±394 cells/mm3; P<0.05). After the 3 month period CD4 counts remained higher in group II. Hospitalization events (infections) were also followed during the 3 month period. Group II had fewer hospitalizations than group I, but no statistical differences were found.Conclusions: Oral nutritional supplements for a 3 month period were well tolerated and resulted in body weight gain in HIV-infected patients. Supplement-enriched formula, with peptides and n-3 fatty acids, increased CD4 count.European Journal of Clinical Nutrition (2001) 55, 1048–1052

Isolated ACTH deficiency.

Isolated ACTH is a rare cause of secondary adrenocortical insufficiency. The diagnosis is made by the demonstration of low cortisol production with low plasma ACTH, absent adrenal responses to stimulation for pituitary or hypothalamus with intact adrenal response to exogenous ACTH, and normal secretory indices of other pituitary hormones. We conclude that the diagnosis of this condition may be difficult due to the varied clinical presentation and etiologies.

Prediction Equation of Resting Energy Expenditure in an Adult Spanish Population of Obese Adult Population

Objective: The aim of our study was to evaluate the accuracy of the equations to estimate REE in obese patents and develop a new equation in our obese population. Subjects and Methods: A population of 200 obesity outpatients was analyzed in a prospective way. The following variables were specifically recorded: age, weight, body mass index (BMI), waist circumference, and waist-to-hip ratio. Basal glucose, insulin, and TSH (thyroid-stimulating hormone) were measured. An indirect calorimetry and a tetrapolar electrical bioimpedance were performed. REE measured by indirect calorimetry was compared with REE obtained by prediction equations to obese or nonobese patients. Results: The mean age was 44.8 ± 16.81 years and the mean BMI 34.4 ± 5.3. Indirect calorimetry showed that, as compared to women, men had higher resting energy expenditure (REE) (1,998.1 ± 432 vs. 1,663.9 ± 349 kcal/day; p < 0.05) and oxygen consumption (284.6 ± 67.7 vs. 238.6 ± 54.3 ml/min; p < 0.05). Correlation analysis among REE obtained by indirect calorimetry and REE predicted by prediction equations showed the next data; Berstein’s equation (r = 0.65; p < 0.05), Harris Benedict’s equation (r = 0.58; p < 0.05), Owen’s equation (r = 0.56; p < 0.05), Ireton’s equation (r = 0.58; p < 0.05) and WHO’s equation (r = 0.57; p < 0.05). Both the Berstein’s and the Ireton’s equations overpredicted REE and showed nonsignificant mean differences form measured REE. The Owen’s, WHO’s, and Harris Benedict’s equations underpredicted REE. Our male prediction equation was REE = 58.6 + (6.1×weight (kg)) + (1,023.7×height (m)) – (9.5×age). The female model was REE = 1,272.5 + (9.8×weight (kg)) – (61.6×height (m)) – (8.2×age). Our prediction equations showed a nonsignificant difference with REE measured (–3.7 kcal/day) with a significant correlation coefficient (r = 0.67; p < 0.05). Conclusion: Previously developed prediction equations overestimated and underestimated REE measured. WHO equation developed in normal weight individuals provided the closest values. The two new equations (male and female equations) developed in our study had a good accuracy.

Effect on quality of life with a new insulin injection device in elderly patients with diabetes mellitus type 2

OBJECTIVE The aim was to investigate the efficacy, safety, and satisfaction of a new insulin injection device in elderly subjects with type 2 diabetes on suboptimal glycemic control with two doses of insulin NPH alone. RESEARCH DESIGN AND METHODS This study was a prospective no-blind study performed. We selected 25 patients (13 men and 12 women) with type 2 diabetes, only treated with two doses of NPH insulin (injection pen device) for more than 6 months, who did not achieved optimal glycemic control. Additional inclusion criterion was age 55 to 75 years (mean 65.6+/-8.6). All subjects were required to be able to comply with the protocol and carry out home blood glucose monitoring. RESULTS HbA1c decreased significantly from 7.8% to 7.6% (P<.05) (2.6% decreased from baseline), and breakfast and lunch preprandial glucose controls decreased significantly. Significant decrease was detected in breakfast and dinner postprandial glucose level. Taken the patients as a whole, insulin dose change significantly (29.8+/-10.9 to 28+/-10.8 Ul/day; P<.05). The number of hypoglycemic events during the 3-month treatment was similar than before treatment with Innolet (2.3+/-3.9 to 1.4+/-2.6 events; ns). The summary results indicated significantly improvement satisfaction questionnaire before 23.9+/-9 points and after 34.5+/-6.5 insulin injection device (P<.05). CONCLUSION Innolet improved glycemic control and satisfaction in a group of elderly patients with diabetes mellitus type 2 previously treated with pen devices.

Beneficial effects of liraglutide on adipocytokines, insulin sensitivity parameters and cardiovascular risk biomarkers in patients with Type 2 diabetes: A prospective study

AIMS To evaluate the effects of liraglutide after 14 weeks of treatment on serum adipokines, insulin resistance index and cardiovascular risk biomarkers in overweight or obese T2DM patients unable to achieve glycemic control with metformin alone or in association with a sulfonylurea in daily clinical practice. METHODS Prospective study in 59 consecutive overweight or obese (BMI≥25kg/m(2)) T2DM patients unable to achieve glycemic control (HbA1c>7%, 53mmol/mol) with metformin alone or in association with sulfonylurea that require initiation of liraglutide in progressive dose increase up to 1.8mg/day subcutaneously. Weight, body composition, blood pressure, glucose, HbA1c, C-peptide, insulin, plasma lipids, adipokines (leptin, adiponectin, resistin and visfatin) as well as cardiovascular biomarkers (IL-6 and TNF-a) levels were measured fasting at baseline and 14 weeks after liraglutide initiation. RESULTS 14 weeks of liraglutide treatment significantly reduced HbA1c, BMI and total body fat mass by 0.9%, 1.4kg/m(2) and 0.5% respectively. Statistically significant lower insulin resistance and higher insulin secretion was found by HOMA-IR 8.4 (1.6) vs 4.6 (0.9)molmIU/L(2) and HOMA-B 48.2 (9.0) vs 87.6 (16.3)μIU/mmol. Statistically significantly higher levels of visfatin 6.3 (2.1) vs 6.8 (2.1)ng/ml and resistin 3.6 (2.0) vs 4.3 (2.3)ng/ml were also observed after treatment. Baseline visfatin was negatively correlated with basal fasting plasma glucose r=-0.360 (p<0.05). CONCLUSIONS Liraglutide treatment for 14 weeks in daily clinical practice led to reduction of BMI and improvement of glucose control and insulin sensitivity and resistance parameters. Additionally, circulating levels of adipokines and pro-inflammatory factors could play an important role in GLP-1 treatment response.

Effects of Dietary Intake and Life Style on Bone Density in Patients with Diabetes mellitus Type 2

Objective: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. Design: Cross-sectional study. Setting: Tertiary care hospital. Participants: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. Results: A total of 21.7% of patients had osteoporosis (T score <2.5 SD). Patients were overweight with a high BMI and a medium glucose control. Patients with osteoporosis were older than those without osteoporosis (67.8 ± 6.9 vs. 62.1 ± 9.2 years; p < 0.05). Significant differences were detected between patients without and with osteoporosis in calcium intake (1,219.37 ± 387 vs. 839 ± 251 mg/day; p < 0.05) and zinc intake (9.23 ± 3.5 vs. 13.3 ± 6.9 mg/day; p < 0.05), respectively. No differences were detected in other dietary dairy intakes. In correlation analysis age (r = –0.23; p < 0.05) and BMI (r = 0.48; p < 0.05) was correlated with BMD. In univariate analysis with dicotomic variables, only exercise was positive associated with osteoporotic status (87.5% exercise habit in patients without osteoporosis and 25% exercise habit in patients with osteoporosis; p < 0.05). In a logistic model with the dependent variable (osteoporosis), remained in the final model dietary dairy intake of calcium and zinc, BMI, age and exercise. Exercise, calcium intake and BMI were protective factors. Zinc intake, and age were risk factors. Conclusions: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population.

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.

Serum visfatin concentrations are related to dietary intake in obese patients.

Background: Changes in dietary intake such as underfeeding, overfeeding, as well as exercise have important effects on adipose tissue metabolism. We conducted a cross-sectional study of associations between nutrient intake and serum visfatin concentrations in a group of obese patients. Subjects: A population of 231 obese subjects was analyzed in a cross-sectional study. Biochemical analysis (basal glucose, C-reactive protein, insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, blood and insulin resistance), anthropometric evaluation (weight and bioimpedance) and assessment of dietary intake were carried out. Results: The mean age was 41.8 ± 14.2 years, and the mean body mass index was 35.4 ± 5.3 among the 63 male (27.3%) and 168 female (72.7%) patients. Patients were divided into 3 groups by visfatin tertile values: group 1, <16.06 ng/ml; group 2, between 16.06 and 60.55 ng/ml; group 3, >60.55 ng/ml. Patients in group 3 had lower intakes of energy, carbohydrates, total fat, monounsaturated fat, polyunsaturated fat, saturated fat, total cholesterol and proteins than group 1. Patients in group 2 had lower intakes of energy, total fat, monounsaturated fat, saturated fat, total cholesterol and proteins than group 1. In the adjusted multivariate analysis, only monounsaturated fat intake remained as an independent predictor of visfatin levels. Visfatin concentration decreased by –3.69 ng/ml (95% CI –0.43 to –7.01) for each gram of monounsaturated fat intake. Conclusion: Monounsaturated fatty acid consumption was found to be modestly inversely associated with visfatin levels in a group of obese patients.

Role of Genetic Variation in the Cannabinoid Receptor Gene (CNR1) (G1359A Polymorphism) on Weight Loss and Cardiovascular Risk Factors After Liraglutide Treatment in Obese Patients With Diabetes Mellitus Type 2

Background A polymorphism (1359 G/A) of the cannabinoid receptor 1 (CNR1) gene was reported as a common polymorphism (rs1049353) with potential implications in weight loss. We decide to investigate the role of this polymorphism on metabolic changes and weight loss secondary to treatment with liraglutide. Methods A population of 86 patients with diabetes mellitus type 2 and obesity, unable to achieve glycemic control (hemoglobine glycate A1c >7%) with metformin alone or associated to sulfonylurea, who require initiation of liraglutide treatment in progressive dose to 1.8 mg/d subcutaneously, was analyzed. Results Fifty-one patients (59.3%) had the genotype G1359G, and 35 patients (40.7%) had G1359A (28 patients, 32.6%) or A1359A (7 patients, 8.1%) (A allele carriers). In patients with both genotypes, basal glucose, HbA1c, body mass index, weight, fat mass, waist circumference, and systolic blood pressures decreased. In patients with G1359G genotype, total cholesterol and low-density lipoprotein cholesterol decreased, and in patients with A allele, homeostasis model assessment for insulin resistance decreased, too. Conclusions There is an association of the A allele with an improvement of insulin resistance secondary to weight loss after liraglutide treatment in obese patients with diabetes mellitus type 2. Noncarriers of A allele showed an improvement in cholesterol levels after weight loss.

C358A missense polymorphism of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH) and insulin resistance in patients with diabetes mellitus type 2.

BACKGROUND The polymorphism 385 C/A of FAAH has been associated with overweight and obesity. The aim of our study was to investigate the relationship of polymorphism (cDNA 385 C-->A) of FAAH gene on obesity parameters in patients with diabetes mellitus type 2. DESIGN A population of 70 patients with diabetes mellitus type 2 was analyzed. An anthropometric and biochemical nutritional assessment was performed. The statistical analysis was performed for the combined C358A and A358A as a group and wild type C358C as second group. RESULTS Fifty-five patients (78.7%) had genotype C358C (wild type group) and 15 (21.3%) patients C358A (14 patients, 20.6%) or A358A (1 patient, 0.7%) (mutant group). BMI (38.9+/-6.4 vs. 39.2+/-5.7, p<0.05), weight (96.8+/-17.6kg vs. 102.5+/-16.8kg, p<0.05), fat mass (42.1+/-16.1kg. vs. 46.9+/-11.1kg, p<0.05), waist circumference (115.9+/-12.8cm vs. 121.3+/-12.8cm, p<0.05), insulin (22.5+/-18.8mUI/L vs. 33.9+/-17.1UI/L, p<0.05) and TNF-alpha (6.1+/-3.4pg/mL vs. 8.4+/-3.2pg/mL, p<0.05) were higher in mutant type group than wild type. Adiponectin levels (33.3+/-20.8ng/mL vs. 22.3+/-10.8ng/mL, p<0.05) were higher in wild type group than mutant type group. CONCLUSION There is an association of the mutant type group A358C and A358A of FAAH with a worse cardiovascular profile (weight, body mass index, waist circumference, insulin,TNF-alpha and adiponectin levels) than wild type group.