M. Gonzalez Sagrado

Nutritional Assessment: Predictive Variables at Hospital Admission Related with Length of Stay

Background: Studies indicate that 40–50% of hospitalized patients show malnutrition, a variable that is associated with length of stay and morbidity. The aim of our study was to detect nutritional parameters, which could have an influence on length of stay in hospitalized patients. Material and Methods: All patients with a nutritional evaluation at hospital admission were elegible for inclusion. A total of 1,088 patients were studied from January 1999 to December 2003. Length of stay (LOS) data was obtained from the patient hospital record after the patient was discharged. All patients received instruction in 24-hour written food record keeping. Albumin, prealbumin, transferrin, glucose levels and total lymphocytes, were measured in all patients. Weight, body mass index, tricipital skinfold, midarm muscle circumference and midarm muscle area were assessed in a standard way. Weight loss in the previous 3 months was recorded. Results: A total of 1,088 patients were enrolled, mean age 61.8 ± 17 years, weight 64.2 ± 15 kg and BMI 23.9 ± 4.6, with a weight loss 4.15 ± 9.6 kg. The sex distribution of patients was 65.2% male and 34.8% females. Distribution of diagnosis showed leukemia and lymphoma (11.5%), solid cancer (37.4%), infections (3.5%), neurological disease (13.6%), respiratory tract disease (8.8%), and miscellaneous group (25.3%). Length of stay was 29.45 ± 25.13 days. In whole group, the correlation analysis among length of stay (days) and predictive parameters showed a positive association between albumin and length of stay (r = –0.2; p < 0.05). In the multivariant analysis with a dependent variable (length of stay (days)) and independent variables with an association in univariant analysis adjusted by age and sex, only albumin remained as an independent predictor in the model (F = 8.8; p < 0.05), with an increase of 6.2 days (95% CI: 3.5–8.9) with each decrease of 1 g/dl of albumin. Conclusion: The serum albumin levels are a good marker of LOS, a decrease in admission levels produces an increase in LOS.

Effects of a low-fat versus a low-carbohydrate diet on adipocytokines in obese adults.

Background and Aims: There are few studies addressing the effect of weight loss on circulating levels of adipocytokines. The aim of our study was to determine whether different diets would have different weight loss effects and to examine the changes in adipocytokine levels. Methods: A population of 90 obesity non-diabetic outpatients was analyzed in a prospective way. The patients were randomly allocated to two groups: (a) diet I (low-fat diet), and (b) diet II (low-carbohydrate diet). At baseline and after 3 months on the diet, adipocytokines were evaluated. Results: 43 patients were randomized to group I and 47 patients to diet group II. No differences were detected between weight loss in either group (3.3 ± 0.51 vs. 4.4 ± 0.6 kg; n.s.). In group I, a significant decrease in leptin levels was found. In group II, leptin and C-reactive protein (CRP) levels also decreased. The decrease in leptin levels was lower with diet I than II (16.4 vs. 22.8%; p < 0.05). Conclusion: The serum leptin concentration decreased due to the 3-month intervention with low-fat and low-carbohydrate diets, without changes in other adipocytokines. The decrease in leptin and CRP levels were higher with a low-carbohydrate diet than a low-fat diet.

Influence of ALA54THR Polymorphism of Fatty Acid Binding Protein 2 on Lifestyle Modification Response in Obese Subjects

Background/Aim: It has been found that the expression of fatty acid binding protein 2 (FABP2) mRNA is under dietary control. A G-to-A transition at codon 54 of FABP2 results in an amino acid substitution (from Ala 54 to Thr 54). This polymorphism was associated with high insulin resistance and high fasting insulin concentrations. The aim of our study was to investigate the influence of Thr54 polymorphism in the FABP2 protein on the response to a lifestyle modification (Mediterranean hypocaloric diet and exercise) in obese patients. Methods: A population of 69 obese (body mass index >30) nondiabetic outpatients was analyzed in a prospective way. Before and after 3 months of the lifestyle modification program, indirect calorimetry, tetrapolar electrical bioimpedance measurement, blood pressure recording, serial assessment of the nutritional intake (3 days of written food records), and biochemical analysis were performed. The lifestyle modification program consisted of a hypocaloric diet (1,520 kcal; 52% carbohydrates, 25% lipids, and 23% proteins). The exercise program consisted of aerobic exercise for at least three times/week (60 min each). Statistical analysis was performed for combined Ala54/Thr54 and Thr54/Thr54 as a mutant group and wild-type Ala54/Ala54 as second group. Results: The mean age was 45.5 ± 16.7 years, the mean body mass index was 34.1 ± 5.1, and there were 14 males (20.3%) and 55 females (79.7%) with a weight loss of 3.17 ± 3.5 kg (3.5%). Thirty-seven patients (53.6%) had the genotype Ala54/Ala54 (wild-type group) and 32 (46.4%) patients either the genotype Ala54/Thr54 (26 patients, 30.2%) or the genotype Thr54/Thr54 (6 patients, 16.2%). The percentage of responders (weight loss) was similar in both groups (89.2 vs. 90.6%). In the wild-type group, body mass index, weight, fat mass, low-density lipoprotein cholesterol level, and waist circumference decreased, whereas the VO2 (oxygen consumption) increased. In the mutant group, glucose, body mass index, weight, waist circumference, and systolic blood pressure decreased, and VO2 increased. No differences were detected between basal values in both groups. Only the leptin levels showed a significant decrease in the wild-type group (23.85%; p < 0.05), with no statistically significant difference in the mutant group (2.59%; NS). Resistin, tumor necrosis factor alpha, interleukin 6, insulin, and C-reactive protein remained without changes in both groups. Conclusions: Weight loss is associated with different changes, depending on the FABP2 genotype. Carriers of the Thr54 allele have a different response than wild-type obese subjects, with a significant decrease of systolic blood pressure and glucose levels in Thr54 carriers and a significant decrease in fat mass, low-density lipoprotein cholesterol, and leptin in wild-type patients.

Relation of resistin levels with cardiovascular risk factors and insulin resistance in non-diabetes obese patients

BACKGROUND The aim of the present study was to explore the relationship of resistin levels with these above mentioned factors. SUBJECTS A population of 213 obese was analyzed. A complete nutritional and biochemical evaluation was performed. RESULTS The mean age was 45.1+16.7 years, the mean BMI was 35.6+5.7. Higher weight, fat mass, fat free mass, waist to hip ratio, RMR, insulin and HOMA levels were observed in men than women. In all group, the analysis with a dependent variable (resistin) showed that fat mass remained in the model (F=2.48; p<0.05), with an increase of 0.033 ng/ml (CI 95%: 0.011-0.055) with each 1 kg of fat mass and a decrease of -0.29 ng/ml (CI 95%: -0.53, -0.01) with each mmHg of diastolic blood pressure. In a second model (only women) (resistin), fat mass remained in the model (F=6.06; p<0.05), with an increase of 0.037 ng/ml (CI 95%: 0.015, 0.06) with each kg of fat mass and a decrease of -0.032 ng/ml (CI 95%: -0.054, -0.01) with each mmHg of diastolic blood pressure. The third multivariate analysis (only men) did not show any relation among resistin levels and other parameters. CONCLUSION Resistin levels are related with different cardiovascular risk and anthropometric parameters, without relation with insulin resistance. A sex interaction has been observed.

Decreased basal levels of glucagon-like peptide-1 after weight loss in obese subjects.

Objective: Basal glucagon-like peptide-1 (GLP-1) concentrations seem to be attenuated in obese subjects, although statistical significance is unclear. Only a few studies have investigated the effect of weight reduction on GLP-1 concentrations and have found unclear results. The aim of the present study was to determine whether subjects who lose weight on a hypocaloric diet experience the same change in circulating GLP-1 levels as subjects who do not lose weight. Material and Methods: A population of 99 obese nondiabetic outpatients was analyzed in a prospective way. Weight and blood pressure were determined. Basal glucose, C-reactive protein, insulin, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and basal GLP-1 blood levels were measured before and after 3 months of hypocaloric diet. Bipolar impedance examination was performed in all patients to assess body composition. The lifestyle modification program consisted of a hypocaloric diet (1,520 kcal, 52% carbohydrates, 25% lipids and 23% proteins). The exercise program consisted of aerobic exercise for at least 3 times per week (60 min each). Results: Ninety-nine patients (20 male/79 female) gave informed consent and were enrolled in the study. Fourteen patients (2 male/12 female) did not lose weight (group I: weight increase of 2 ± 1.1 kg, NS) and 75 patients (18 male/67 female) lost weight (group II, weight loss of 4 ± 1.6 kg, p < 0.05). Weight, body mass index, fat mass, waist circumference, insulin, HOMA, LDL cholesterol, triglycerides and systolic blood pressure improved in group II, without significant statistical changes in group I. In group I, basal GLP-1 levels remained unchanged (7.4 ± 3.1 vs. 7.15 ± 3.6 ng/ml, NS). In group II, GLP-1 levels decreased significantly (8.4%, 6.88 ± 2.5 vs. 6.3 ± 2.4 ng/ml, p < 0.05). In the multivariate analysis with a dependent variable (levels of GLP-1 after hypocaloric diet adjusted by age and sex), only insulin levels remained as an independent predictor in the model (F = 5.9; p < 0.05), with an increase of 0.6 ng/ml (CI 95%: 0.1–1.1) in GLP-1 concentrations with each 1-mIU/ml increase of insulin. Conclusion: Hypocaloric diet decreased GLP-1 levels in patients with weight loss with a significant improvement in anthropometric parameters and cardiovascular risk factors. Nevertheless, patients without weight loss after dietary treatment exhibited unchanged GLP-1 levels. Basal insulin correlates with basal GLP-1.

Mini Nutritional Assessment (MNA) como método de evaluación nutricional en pacientes hospitalizados

OBJECTIVE: The objective of the study was to identified the prevalence of malnutrition in come patients with MNA (Mini Nutritional Assessment) test as a clinical tool. METHODS: A total of 145 patients were studied in Hospital del Rio Hortega (Valladolid), from mars of 2000 till may of 2002. In all patients a MNA test, an anthropometric and biochemical evaluation were performed. RESULTS: Mean age was 57.44 +/- 18.06 years, weight 63.5 +/- 13.7 kg and body mass index 23.4 +/- 4.9 kg/m2. The studied population were 48.6% haematological tumours and other tumours, opposite to the rest of the patients who were presenting cerebro-vascular accidents 2.1%, respiratory problems or infections 16.8%, renal failure 3.5% and neurological diseases or processes of dementia in minor proportion 2.9%. Patients were divided in two groups, malnutrition MNA < 17 (n = 99) (group I) and risk of malnutrition MNA = 17 (n = 43) (group II). The malnutrition prevalence was 68.2% (group I) and risk of malnutrition 29.6% (group II) with test MNA. In biochemical evaluation the malnutrition group I had low levels of albumin (2.9 +/- 0.7 g/dl vs 3.41 +/- 2.71 g/dl; p < 0.05), prealbumin (14.9 +/- 6.2 g/dl vs 17.6 +/- 8.1 g/dl; p < 0.05) and transferrin (152.2 +/- 54.9 g/dl vs 189.9 +/- 32.6 g/dl; p < 0.05. Arm muscular circumference and arm circumference had values under average in patients with malnutrition. On having analyzed the different paragraphs of the test MNA between both groups, it was observed since in the group of undernourished patients the punctuation he was below the average in all the paragraphs. CONCLUSIONS: The risk of malnutrition in hospital was frequent, detected by MNA test.

Influence of Ala54Thr polymorphism of fatty acid-binding protein 2 on weight loss and insulin levels secondary to two hypocaloric diets: A randomized clinical trial

OBJECTIVE A transition G to A at codon 54 of FABP2 was associated with high insulin resistance and different dietary response. The aim of our study was to investigate the influence of this polymorphism on weight loss and metabolic changes secondary to two hypocaloric diets. SUBJECTS AND METHODS A sample of 204 obesity patients was analyzed. Before and after 2 months of hypocaloric diet, a nutritional evaluation was performed. Patients were randomly allocated to diet I (low-fat diet) or II (low carbohydrate diet). RESULTS With diet Type I and in the wild group (Ala54/Ala54), BMI, weight, fat mass, waist circumference, waist to hip ratio, systolic and diastolic blood pressures, total cholesterol, triglyceride and insulin levels decreased. In the mutant group (Ala54/Thr54 and Thr54/Thr54), BMI, weight, waist circumference and fat mass decreased. In the wild group with diet Type II, the same parameters that group I decreased and glucose levels, too. In the mutant group, BMI, weight, waist circumference and fat mass decreased. Only leptin levels have a significant decrease in the wild group with both diets (diet I: 30.7%; p<0.05 and diet II: 15.85%; p<0.05). CONCLUSION Similar weight loss is associated with different changes, depending on the FABP genotype with both diets. Weight loss is associated with a more deep decrease in serum leptin concentration with low-fat diet.

Relation of Trp64Arg polymorphism of beta 3-adrenergic receptor gene to adipocytokines and fat distribution in obese patients.

Background/Aim: Obesity has multiple causes and is determined by the interaction between genetic and environmental factors. A genetic factor is a (Trp64Arg) missense mutation in the beta 3-adrenergic receptor. The aim of our study was to investigate the influence of Trp64Arg polymorphism in the beta 3-adrenergic receptor gene on weight, adipocytokines, insulin resistance, and fat distribution in obese patients. Methods: A population of 217 nondiabetic obese Caucasian outpatients was analyzed. Indirect calorimetry and tetrapolar bioimpedance results, blood pressure, nutritional intake with 3-day food records, and biochemical parameters were evaluated. The genotype of beta 3-adrenergic receptor gene polymorphism (Trp64Arg) was studied. Results: The mean age of the patients was 44.3 ± 16.4 years, and the mean body mass index was 35.2 ± 5.2. One hundred and eighty-six patients (52 males and 134 females; 85.8%) had the genotype Trp64/Trp64 (wild-type group), and 31 patients (11 males and 20 females; 14.2%) had the genotype Trp64/Arg64 (mutant group). In the mutant group, body mass index, weight, fat mass, waist-to-hip ratio, waist circumference, and C-reactive protein levels were higher than in the wild-type group. The adipocytokine levels were similar in both groups. Conclusion: The patients of the mutant group (Trp64/Arg64) had higher body mass index, weight, waist circumference, fat mass, waist-to-hip ratio, and C-reactive protein values than those of the wild-type group.

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.

Influence of Lys656Asn polymorphism of leptin receptor gene on leptin response secondary to two hypocaloric diets: a randomized clinical trial.

Background: Human obesity is characterized by high levels of leptin, and it has been suggested that obese patients may be leptin-resistant. Objective: The aim of our study was to investigate the influence of Lys656Asn polymorphism in the LEPR gene on leptin response secondary to a low fat versus a low carbohydrate diet in obese patients. Design: A population of 78 obesity patients was enrolled. Before and after 2 months of two diets, a nutritional evaluation was performed. Results: 52 patients had genotype Lys656/Lys656 (wild group) and 26 patients Lys656/Asn656 or Asn656/Asn656 (mutant group). In the low fat and wild groups, BMI, weight, fat mass, glucose, total cholesterol, triglyceride, insulin, and blood pressure decreased. In mutant type (MT), BMI, weight and fat mass decreased. In wild type (WT) with low carbohydrate diet, BMI, weight, fat mass, waist circumference, waist-to-hip ratio, total cholesterol, and blood pressures decreased. In MT, BMI, weight and fat mass decreased. Only leptin concentrations have a significant decrease in WT with both diets (diet I: 30.3%; p < 0.05) and (diet II: 15.5%; p < 0.05). Conclusion: In WT patients, the changes in serum leptin concentration due to 2 months’ intervention with low fat are higher than with a low carbohydrate diet.