Manuel Moreno

Adiponectin levels, cardiometabolic risk factors and markers of subclinical atherosclerosis in children

BACKGROUND Low levels of adiponectin have been associated with metabolic risk factors (RF) and cardiac disease. Minimal data is available about the relationship between adiponectin and subclinical atherosclerosis. OBJECTIVES To determine the relationship of adiponectin to cardiometabolic RF, C-reactive protein (CRP), anthropometric parameters of obesity, and subclinical atherosclerosis in children. METHODS Cross-sectional study in 103 children. We determined body mass index (BMI), waist circumference, percent fat mass, systolic and diastolic blood pressures, fasting lipid profile, glycemia and insulinemia, and CRP. Subclinical atherosclerosis was determined by carotid intima-media thickness (IMT) and flow-mediated dilation of the brachial artery (FMD). RESULTS Mean age of the group was 12.4+/-1.9 years (47% girls; 20.4% prepubertal; 45 eutrophic, 23 overweight and 35 obese). Adiponectin levels were not statistically significantly different in eutrophic children versus obese+overweight: 17.7+/-5.6 and 15.9+/-5.3 microg/mL, respectively. Adiponectin levels in boys were no different from those in girls. Adiponectin correlated significantly with age, BMI, zBMI, waist circumference, systolic and diastolic blood pressures, HDL, insulinemia, and HOMA index. No statistically significant association with adiponectin was found for CRP, FMD or IMT. After adjusting by sex, pubertal status, and degree of obesity, the adiponectin levels associated significantly with HDL cholesterol and the HOMA index (r(2)=0.34, p<0.0001). CONCLUSIONS Adiponectin levels were inversely correlated with anthropometric parameters of obesity and insulin resistance and directly correlated with HDL levels. However, no relationship with subclinical atherosclerosis was demonstrated in this study.

Influencia de la obesidad en los costos en salud y en el ausentismo laboral de causa médica en una cohorte de trabajadores

Background: The health associated costs of obesity can represent between 2% and 9% of the total health costs of a given country. Aim: To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers. Patients and wethods: Prospective study of 4.673 men, employees of a mining company, aged 49 ± 7 years that were followed for 24 ± 11 months. Total health care cost and days of sick leave were recordedfor each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables. Results: Mean annual health care costs for obese workers were 17% higher (p CI 1.2 to 2.0), hypertension (OR 1,34, 95%> CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95%o CI 1.1 to 2.1). Conclusions: Obesity increases significantly health care costs and absenteeism

Tratamiento farmacológico o quirúrgico del paciente con sobrepeso u obesidad

This is an updated review of the available treatments for obesity, which can be used when lifestyles modifications fail. Using the available information and the experience of the members of this advisory group, a recommendation is given about the most useful treatments, according to the severity of obesity and its complications. With regards to pharmacological treatments, only sibutramine and orlistat are approved on a worldwide basis for the treatment of obesity. These medications achieve a 10% higher weight reduction than lifestyles modification. A third medication, rimonobant, is also more effective than lifestyles modifications, but it was withdrawn due to psychological safety issues. The indications for surgical treatment and a brief description of the available techniques, success rates and complications are outlined. Finally, the need to have followed up protocols for patients and the formation of multidisciplinary treatment teams is underscored.

Diagnóstico, evaluación y tratamiento no farmacológico del paciente con sobrepeso u obesidad

The risk of complications of obesity is proportional to body mass index and is higher in severe or morbid obesities and when abdominal or visceral fat is predominant. In Chile the prevalence of obesity is increasing. According to the World Health Organization, obese subjects must reduce at least a 5% of their weight to reduce the risk of complications. Although this amount of reduction is seldom achieved with non pharmacological treatments, better results are obtained with multidisciplinary/ approaches that include a medical, psychosocial and laboratory assessment, to determine obesity level and different factors involved and the associated complications. In a second stage, goals of treatment are set and a personalized treatment is designed including dietary changes and physical activity. The aim is to obtain perdurable lifestyles modifications.

Effect of Westernization of Nutritional Habits on Obesity Prevalence in Latin America

Key Points Nutritional habits of Latin Americans show a trend toward a Western-type diet. There is a clear tendency of increased consumption of fats, saturated fats, and animal proteins and of decreased consumption of fruits and vegetables in the diet. Prevalence of obesity is high in many countries of the region in all age groups, with a clear tendency to increase. Prevention programs should be implemented from childhood, with a strong political backing and the involvement of the community. Recommendations on objectives and goals to increase nutrition education and promote exercise in the population are proposed.

AB0437 Complications of The Minimally Invasive Biopsy of The Minor Salivary Gland

Background The diagnosis of Sjogren Syndrome (SS), requires fulfillment of the American- European classification criteria, which include the obligatory presence of antibodies or a compatible histology. Numerous labial salivary gland biopsy techniques have been described, with variations in the size and shape of incision, as well as the need for suturing. Nowadays, the tendency is to use less invasive techniques Objectives To evaluate the frequency of complications of the minimally invasive biopsy of minor salivary glands Methods Transversal study of 159 biopsies of the minor salivary gland. Inclusion Criteria: patients with dry syndrome. Biopsy technique: anesthesia with ultracain and epinephrine, vertical incision (≤5 mm) of the internal surface of the lower lip using a scalpel and whitout suture, followed by the application of a gauze with topical procoagulant for 30 minutes. Variables studied: 1) clinical: age, sex, presence and duration of the symptoms; 2) diagnostic: Schirmer test, salivary scintigraphy, ANA, RF, anti-SSA and anti-SSB. 3) biopsy complications: a) immediate: bleeding and lipothymia; b) acute (<1 month): dysesthesia, hematoma, swelling, infection, pain, speaking and eating difficulties, scarring disorders (granuloma, keloid) and c) chronic (>1 month): dysesthesia, scarring disorders (granuloma, keloid), 4) histological: a) degree of atrophy: absent, light, moderate and severe b) Chisholm-Mason scale (I-IV) Results The characteristics of the sample group were; age 59.9 ±12.43 years, 91% women, 88% xerostomia, 89% xerophthalmia for a period of 49±37 months, 45% positive salivary scintigraphy, 54% positive Schirmer, 54% ANA, RF 22%, anti-SSA and anti-SSB of 28% and 6.2%, respectively. The complications were: immediate (n=16; 8%): bleeding (n=13; 81%), lipothymia (n=3; 18%); b) acute (n=93; 58%): dysesthesia (n=2; 1.2%) for a period of 2.5±0.7 days, hematomas (n=23; 14%)) for a period of 4±2.5 days, swelling (n=69; 43%) for a period of 3±2.4 days, infection (0%), 37% pain (26% mild, 9% moderate, 2% severe) for a period of 3±2.5 days, speaking difficulties (n=13;8.1%) for a period of 3±3.6 days, eating difficulties (n=20; 12%) for a period of 2.3±2.8 days and granuloma (n=10; 6.2%); c) chronic (n=4; 2.5%): dysesthesia (0%) and granuloma (n=4; 2.5%) without clinical repercussion. Material for histology was obtained in 92.5%. The development of chronic complications (granuloma) was not related to the presence of acute complications except temporal dysesthesia (18% vs 1%; p<0.001). Also chronic complications was not related to the degree of histological atrophy or age, but a tendency was observed in younger patients (49±4.5 vs 60±12.4; p<0.09) Conclusions The minimally invasive biopsy of the minor salivary gland is a technique which is easy to carry out and complications are rare. Moreover, it also offers success rates to obtain material which are similar to those of other techniques. Given the ease of the technique and the fact that complications are rare, it is worth evaluating its incorporation into those centres where it is not being used and it should be performed by rheumatologists. Disclosure of Interest None declared

FRI0322 Diagnostic Utility of The Minimally Invasive Biopsy of The Minor Salivary Gland

Background Sjögrens syndrome (SS) is a disease with a wide spectrum of clinical manifestations which can make diagnosis difficult. Due to difficult diagnosis the Americo-European classification criteria (AECC) are used. The positivity of antibodies or histology are essential to comply with these criteria, forcing in certain situations, especially in cases with negative immunology, to carry out a lip biopsy. Objectives To evaluate the diagnostic utility of the minimally invasive biopsy of the minor salivary gland. Methods Transversal study of 159 biopsies of the minor salivary gland. Inclusion Criteria: patients with dry syndrome. Biopsy Technique: vertical incision (≤5 mm) of the internal surface of the lower lip whithout suturing. Variables studied: 1) Clinical: age, sex, presence and duration of the symptoms. 2) Diagnostic: The necessary examinations were performed to fulfill the AECC: Schirmer, salivary scintigraphy, ANA, RF, Ab-SSA and Ab-SSB. 3) Histological: a) degree of atrophy: absent, mild, moderate and severe; b) Chisholm-Mason scale (I-IV) considering as positive biopsy grade III or IV; c) degree of lymphocyte infiltration: absent, mild, moderate, severe; d) histological patterns: normal, nonspecific chronic sialadenitis (NSCS), sclerosing chronic sialadenitis (SCS), focal lymphocytic sialadenitis (FLS) Results The characteristics of the sample group were; age 59.9 ±12.43 years, 91% women, 88% xerostomia, 89% xerophthalmia for a period of 49±37 months, 45% positive salivary scintigraphy, 54% positive Schirmer, 54% AAN, RF 22%, Ab-Ro and Ab-La of 28% and 6.2% respectively. Appropriate material was obtained for histological study in 92.5%, being more frequent in older patients (60 ± 53 vs 12.2 ± 12.8; p<0.05). Analyzing the data after the biopsy, 16% (n=22) of patients met diagnostic criteria. Depending on the number of previous classificatory criteria 22% and 26% of patients met 3 and 4 criteria, respectively, were diagnosed of SS. Glandular atrophy was observed in 65% (n=95) with the following distribution: mild 38%, moderate 23%, severe 4%. The histological degree of atrophy was related to patient age (r =0.38; p<0.0001). Chisholm-Mason scale classified biopsies as normal (n=22; 15%), grade I (n=73; 50%), grade II (n=15; 10%), grade III (n=22; 15%) and grade IV (n=15; 10%), being biopsies positive in 25%. The most frequent histopathological pattern was NSCS (n=83; 57%), followed by FLS (n=37; 25%), normal (n=22; 15%) and SCS (n=5; 3%). Lymphocytic sialadenitis was observed in 85% (n=125; 47% mild, moderate 18%, severe 20%) but only 25% (n=37) presented the focal lymphocytic infiltration characteristic of SS. The positive biopsy was related to the positivity of Ab-Ro (40% vs. 22%; p<0.0352), Ab -La (10% vs 1%, p<0.0002), RF (35% vs. 18%; p<0.03) and ANA (70% vs 46%;. p<0.01) There was no difference between age and the different histological patterns, but SCS was more likely in patients with more advanced age Conclusions The minimally invasive biopsy of the minor salivary gland, could be currently considered essential for the diagnosis of SS, especially in patients who meet ≥3 criteria. Disclosure of Interest None declared

Nutritional Habits and Obesity in Latin America: An Analysis of the Region

The stigma of undernutrition has been prevalent for hundreds of years in the world. More recently, obesity has become a major public health issue, present in developed and developing countries, even in those that show a high prevalence of undernutrion. In Latin America obesity is present in all countries and its prevalence varies according to their socioeconomic status. Although food habits vary in different sub-areas the traditional diets in the region have changed in the last decades to one characterized by a consumption of high fat foods, simple carbohydrates, sweetened beverages and salt. In addition, physical inactivity in children is increasing due to a combination of lack of appropiate facilities, sedentary habits and safety concerns. Although some programs to increase physycal activity have been succesful, those targeted to modify food habits have not. It is necessary to implement educational programs to improve the diet and increase physical activity in all countries of the region. This can only be accomplished with the participation of all actors involved including the community, school systems, government and food industry.