Juan José Arrizabalaga

Recomendaciones y algoritmo de tratamiento del sobrepeso y la obesidad en personas adultas

Entre 1996 y 1999 se publicaron las primeras revisiones sistemáticas sobre la eficacia de diferentes intervenciones para el tratamiento del exceso de peso (sobrepeso y obesidad), momento en el que también se publicaron, en lengua inglesa, las 2 guías de práctica clínica (GPC) existentes para el abordaje clínico basado en la evidencia del sobrepeso y de la obesidad1,2. La GPC más reciente data de 1998, fue elaborada por el Panel de Expertos del Instituto Nacional del Corazón, el Pulmón y la Sangre de EE.UU. y alcanzó una gran difusión3. Desde entonces se ha acumulado gran cantidad de información científica, especialmente en aspectos relacionados con el tratamiento farmacológico y con el tratamiento quirúrgico para la reducción y el mantenimiento del peso corporal, información que posibilita la elaboración de una GPC actualizada sobre diagnóstico, valoración clínica y tratamiento del sobrepeso y de la obesidad en personas adultas.

Evolución del estado de nutrición de yodo en los escolares de la Comunidad Autónoma del País Vasco

BACKGROUND An epidemiologic survey showed in 1992 iodine deficiency and endemic goiter in schoolchildren from the Basque Country. OBJECTIVES (1) To determine the percentage of homes of schoolchildren where iodized salt (IS) is used; (2) to assess iodine nutrition status in schoolchildren and to compare the data collected to those available from previous epidemiological studies. DESIGN AND METHODS A cross-sectional study in 720 randomly selected schoolchildren. Urinary iodine concentration (UIC) was measured using high-performance liquid chromatography(HPLC) with electrochemical detection. RESULTS IS was used at 53.0% of the homes (95% confidence interval [CI], 49.2-56.7%). Median UIC has increased by 226%, from 65 μg/L in 1992 to 147 μg/L (percentile [P], P(25), 99 μg/L; P(75), 233 μg/L) today. Both schoolchildren consuming IS and those using unfortified salt at their homes had UICs corresponding to adequate iodine intakes (165 and 132 μg/L respectively). UICs experienced great seasonal fluctuations, being 55% higher during the November-February period than in June-September period (191 μg/L vs 123 μg/L; p<0.001) CONCLUSIONS Schoolchildren from the Basque Country have normalized their iodine nutrition status. The strong seasonal pattern of UICs suggests that consumption of milk and iodine-rich dairy products coming from cows feed iodized fodder is one of the most significant factors involved in the increase in iodine intake since 1992.

Concentración de yodo en la leche ultrapasteurizada de vaca. Aplicaciones en la práctica clínica y en la nutrición comunitaria

BACKGROUND AND OBJECTIVE Changes to dairy cow feeding have made milk a very important food source of iodine in several European countries and in USA. We aimed to measure the iodine content in ultra-high temperature (UHT) milk, the most widely consumed milk in Spain and in the south-west of Europe. MATERIAL AND METHODS Every month, throughout 2008, UHT milk samples of commercial brands available in Vitoria-Gasteiz (Basque Country, Spain) were collected and their iodine content was determined using high-performance liquid chromatography, according to official method 992.22 of the Association of Official Analytical Chemists International. RESULTS The average (SD) iodide content and median (P25-P75) of standard UHT milk samples (n=489) were 197.6 (58.1) and 190 (159-235) μg/L, respectively. There were no significant differences between the iodide content in whole, semi-skimmed and skimmed milk (P=.219). The average iodide concentration and median in organic UHT milk (n=12) were 56.4 (8.6) and 55 (50.5-61.5) μg/L, figures that are much lower than those found in standard milk (P<.0001). CONCLUSIONS Standard UHT milk available in our food-retailing outlets constitutes a very important source of iodine. One glass of standard UHT milk (200-250mL) provides an average amount of 50μg of iodine. This amount represents around 50% of the iodine intake recommended during childhood or 20% of the iodine intake recommended for pregnant and lactating women.

Tratamiento quirúrgico de la obesidad: recomendaciones prácticas basadas en la evidencia

La obesidad morbida es, habitualmente, refractaria a los tratamientos convencionales, por lo que la modificacion de habitos dieteticos y de actividad fisica y/o el uso de farmacos consiguen perdidas de peso parciales con habitual recuperacion posterior. La cirugia bariatrica constituye una opcion terapeutica para los casos de obesidad con elevado indice de masa corporal (IMC) asociada a comorbilidades, con buenos resultados a corto y largo plazo. El Grupo de Trabajo sobre Obesidad de la Sociedad Espanola de Endocrinologia y Nutricion (GOSEEN) ha elaborado un documento con recomendaciones practicas basadas en la evidencia para el tratamiento quirurgico de la obesidad. La revision se estructura en 3 partes. En la primera se definen los conceptos de obesidad y comorbilidades asociadas, los tratamientos medicos y sus resultados, las indicaciones y contraindicaciones para el tratamiento quirurgico con los criterios de seleccion de los pacientes, el manejo pre y perioperatorio y la valoracion de grupos especiales, como adolescentes y personas de edad avanzada. En la segunda parte se describen las distintas tecnicas quirurgicas, las vias de acceso y los resultados comparativos, las complicaciones tanto a corto como a largo plazo, la repercusion de la perdida ponderal sobre las comorbilidades y los criterios para evaluar la efectividad de la cirugia. En la tercera parte se desarrolla el seguimiento postoperatorio, el control dietetico en fases tempranas y mas tardias tras la cirugia, y el calendario de control medico y analitico con la suplementacion de los distintos macro y micronutrientes en funcion de la tecnica quirurgica empleada. Se incluye un apartado final sobre gestacion y cirugia bariatrica, asi como tablas y graficos complementarios al texto desarrollado. La cirugia bariatrica sigue siendo un tratamiento discutido para la obesidad, pero los resultados en la correccion del exceso ponderal con mejoria en las patologias asociadas y en la calidad de vida confirman que puede ser el tratamiento de eleccion en pacientes seleccionados, con la tecnica quirurgica apropiada y con un correcto control pre y postoperatorio.

Estrategia terapéutica del exceso de peso en el adolescente y en su familia

In the natural history of type 2 diabetes, pancreatic insulin secretion is progressively depleted and metabolic control worsens. Treatment of these patients usually starts with diet and exercise, with subsequent use of oral glucose-lowering drugs, finally ending with insulin therapy to achieve good metabolic control. When there is still endogenous insulin secretion, the combination of insulin and oral glucose-lowering drugs is usually preferred, using a once-daily long-acting insulin analog, premixed insulin, or NPH insulin. When the patient no longer has any endogenous insulin secretion, or when good metabolic control cannot be achieved with a once-daily regimen, treatment with several insulin doses is required. This treatment consists of a basal-bolus regimen or several doses of premixed insulin. The choice between the 2 types of treatment should be based on the patient’s individual characteristics.

Causas del desarrollo de exceso de peso en el adolescente

In the natural history of type 2 diabetes, pancreatic insulin secretion is progressively depleted and metabolic control worsens. Treatment of these patients usually starts with diet and exercise, with subsequent use of oral glucose-lowering drugs, finally ending with insulin therapy to achieve good metabolic control. When there is still endogenous insulin secretion, the combination of insulin and oral glucose-lowering drugs is usually preferred, using a once-daily long-acting insulin analog, premixed insulin, or NPH insulin. When the patient no longer has any endogenous insulin secretion, or when good metabolic control cannot be achieved with a once-daily regimen, treatment with several insulin doses is required. This treatment consists of a basal-bolus regimen or several doses of premixed insulin. The choice between the 2 types of treatment should be based on the patient’s individual characteristics.

Comorbilidades del exceso ponderal en el adolescente

In the natural history of type 2 diabetes, pancreatic insulin secretion is progressively depleted and metabolic control worsens. Treatment of these patients usually starts with diet and exercise, with subsequent use of oral glucose-lowering drugs, finally ending with insulin therapy to achieve good metabolic control. When there is still endogenous insulin secretion, the combination of insulin and oral glucose-lowering drugs is usually preferred, using a once-daily long-acting insulin analog, premixed insulin, or NPH insulin. When the patient no longer has any endogenous insulin secretion, or when good metabolic control cannot be achieved with a once-daily regimen, treatment with several insulin doses is required. This treatment consists of a basal-bolus regimen or several doses of premixed insulin. The choice between the 2 types of treatment should be based on the patient’s individual characteristics.

Introducción, definición y medida del exceso de peso en adolescentes

In the natural history of type 2 diabetes, pancreatic insulin secretion is progressively depleted and metabolic control worsens. Treatment of these patients usually starts with diet and exercise, with subsequent use of oral glucose-lowering drugs, finally ending with insulin therapy to achieve good metabolic control. When there is still endogenous insulin secretion, the combination of insulin and oral glucose-lowering drugs is usually preferred, using a once-daily long-acting insulin analog, premixed insulin, or NPH insulin. When the patient no longer has any endogenous insulin secretion, or when good metabolic control cannot be achieved with a once-daily regimen, treatment with several insulin doses is required. This treatment consists of a basal-bolus regimen or several doses of premixed insulin. The choice between the 2 types of treatment should be based on the patient’s individual characteristics.

Manejo nutricional de la enfermedad inflamatoria intestinal

El manejo nutricional de la enfermedad inflamatoria intestinal (EII) incluye: 1) la vigilancia del estado nutricional, debido al elevado riesgo de desnutricion asociado a la colitis ulcerosa (CU) y, especialmente, a la enfermedad de Crohn (EC); 2) el tratamiento dietetico y el nutricional, para mantener o restaurar el estado nutricional, y 3) el tratamiento primario de la EC activa mediante nutricion enteral (NE). El tratamiento con glucocorticoides es mas efectivo que la NE en la EC activa, pero en los ninos y adolescentes puede estar justificado el uso de NE como tratamiento primario, especialmente en los que presentan retraso del crecimiento. El tratamiento con NE tambien esta indicado en los casos de EC en los que existe contraindicacion, ineficacia o intolerancia a los tratamientos farmacologicos. La evidencia disponible sobre la eficacia de los prebioticos, acidos grasos de cadena corta, probioticos, aceites de pescados, antioxidantes y TGF-β para el control de la inflamacion intestinal es limitada y resulta insuficiente para recomendar su utilizacion para el tratamiento primario de la EII. El aporte reducido de microparticulas podria desempenar un papel en el control de la actividad en la EC.

Prevalencia de sobrepeso y obesidad en la adolescencia

In the natural history of type 2 diabetes, pancreatic insulin secretion is progressively depleted and metabolic control worsens. Treatment of these patients usually starts with diet and exercise, with subsequent use of oral glucose-lowering drugs, finally ending with insulin therapy to achieve good metabolic control. When there is still endogenous insulin secretion, the combination of insulin and oral glucose-lowering drugs is usually preferred, using a once-daily long-acting insulin analog, premixed insulin, or NPH insulin. When the patient no longer has any endogenous insulin secretion, or when good metabolic control cannot be achieved with a once-daily regimen, treatment with several insulin doses is required. This treatment consists of a basal-bolus regimen or several doses of premixed insulin. The choice between the 2 types of treatment should be based on the patient’s individual characteristics.