Marta Bueno

Fasting plasma peptide YY concentrations are increased in patients with major depression who associate weight loss

Background: Many patients with major depression refer a decreased appetite and weight loss among their symptoms. Peptide YY (PYY) and ghrelin belong to the family of peptides of the gut-brain axis implicated in the regulation of appetite and energy metabolism. PYY stimulates a powerful central satiety response and ghrelin increases food intake and weight gain. Brain-derived neurotrophic factor (BDNF) also contributes to the central control of food intake as an anorexigenic factor. Aim: To study fasting plasma total and acylated ghrelin, plasma PYY and serum BDNF levels in patients with major depression with weight loss as one of their symptoms and compare them with matched healthy controls. Subjects and methods: Fifteen adult patients, 9 male and 6 female, with recent diagnosis of major depression, and 16 healthy adult subjects, matched by age and anthropometric parameters were studied. All depressed patients referred weight loss and were not under antidepressant therapy. Fasting total PYY, total ghrelin and acylated ghrelin and BDNF were determined. Results: Fasting total PYY was higher in patients than controls (2.01 ±0.09 vs 1.29±0.16 pmol/l). There were no differences in fasting total ghrelin, acylated ghrelin or BDNF levels. Conclusions: Major depressed patients, with weight loss at diagnosis, showed higher fasting plasma PYY levels that could contribute to their reduced appetite.

Fibromialgia y trastornos de la conducta alimentaria en la obesidad mórbida

La prevalencia en España de la obesidad es del 22,9% en adultos, y del 0,6% en el caso de la obesidad mórbida (OM). Por otro lado, el sobrepeso y la obesidad son muy comunes en personas con fibromialgia, con una prevalencia que oscila del 32 al 50%. Algunos datos recientes sugieren que el exceso de peso empeora la sintomatología propia de la fibromialgia, llegando a demostrar que el exceso de peso está negativamente relacionado con la calidad de vida y positivamente relacionado con el dolor. Además, se ha observado que un índice de masa corporal (IMC) elevado se correlaciona con niveles superiores de dolor y fatiga en las personas con fibromialgia, lo que puede suponer una condición comórbida agravante al afectar negativamente a la calidad de vida y la consecuente disfuncionalidad física. Para explicar esta relación entre obesidad y fibromialgia se han propuesto una serie de mecanismos, entre los que destacan la actividad física reducida, las alteraciones del sueño o problemas de depresión, así como la disfunción de la glándula tiroidea o del eje somatotropo. Entre las opciones terapéuticas para los sujetos con OM está la cirugía bariátrica (CB), cuyos beneficios médicos y psicológicos se han demostrado previamente en numerosos trabajos. Dado el aumento de la incidencia de personas con OM candidatos a CB con fibromialgia nos propusimos evaluar si la presencia de fibromialgia se acompañaba de diferencias en el perfil sociodemográfico, en las características de la conducta alimentaria y en el grado de ansiedad en estos pacientes. Entre enero de 2012 y diciembre de 2013 reclutamos de forma consecutiva a 40 mujeres candidatas a cirugía bariátrica, 10 de las cuales tenían el diagnóstico de fibromialgia (25%). No identificamos varones obesos con fibromialgia, por lo que estos no fueron incluidos en el estudio. Recogimos variables sociodemográficas (edad, estado civil, número de hijos, grado de discapacidad, consumo de tóxicos, antecedentes en salud mental y tratamiento psicofarmacológico), y variables relacionadas con la OM (época de inicio de la obesidad, antecedentes familiares de OM, resultado de la evaluación psicológica e intervención quirúrgica realizada). Se administraron los siguientes cuestionarios para evaluar la conducta alimentaria y el nivel de ansiedad: Inventario de Trastornos de la Conducta Alimentaria (EDI-2) y Cuestionario de Ansiedad Estado/Rasgo (STAI-II). El EDI-2 es un instrumento psicométrico adecuado, tanto para evaluar las características psicológicas de la anorexia y bulimia como para hacer un cribado para la identificación de personas con alto riesgo de trastornos de la ingesta. Además, su uso está aprobado en numerosos protocolos de evaluación para estos pacientes candidatos a CB. El grupo de mujeres con OM y sin fibromialgia (n = 30) tenía un IMC de 44,8 ± 7,0 (media y desviación estándar), y en el caso del grupo de mujeres con OM y fibromialgia (n = 10), su IMC era de 43,4 ± 4,2 (p = 0,559). En el análisis de resultados no observamos diferencias estadísticamente significativas en ninguna de las variables recogidas, ni en las sociodemográficas ni en las relacionadas con la obesidad, como tampoco en el nivel de ansiedad ni en el patrón de alteraciones de la conducta alimentaria. Los resultados nos hacen pensar que la fibromialgia, a pesar de tratarse de una enfermedad crónica que genera una elevada disfuncionalidad física, social y cognitiva en las personas no obesas, no implica per se cambios en el perfil sociodemográfico ni psicológico de los pacientes con OM candidatos a CB, ni tampoco un mayor riesgo de desarrollar trastornos de la conducta alimentaria en estos pacientes. Es posible que la discapacidad física y la baja autoestima asociadas frecuentemente con la obesidad neutralicen aspectos de la salud directamente relacionados con la fibromialgia, como el dolor y la fatiga. Dicho de otra manera, la obesidad en general, y especialmente la obesidad mórbida, podría resultar en un factor agravante de la fibromialgia. Una de las limitaciones de este trabajo es que únicamente se han recogido datos basales, previos a la cirugía bariátrica. En este caso, otro aspecto a considerar es qué ocurre con estos pacientes tras la pérdida ponderal alcanzada con la CB. Si bien se ha comunicado una clara mejoría de la sintomatología asociada a la fibromialgia con la pérdida ponderal obtenida mediante CB, nos surge la siguiente pregunta: ¿va a suponer la persistencia de la fibromialgia un peor pronóstico a medio o largo plazo en aspectos tan importantes como el exceso de peso perdido, el incremento de la calidad de vida conseguida con la pérdida ponderal, o el mantenimiento a largo plazo del peso perdido? Y, por consiguiente, quizás podamos aprender si el abordaje terapéutico de la fibromialgia en las mujeres intervenidas debe diferir del que habitualmente se realiza en esta enfermedad.Prevalence rates of obesity and morbid obesity (MO) in Spanish adults are 22.9% and 0.6%, respectively. On the other hand, overweight and obesity are very common in people with fibromyalgia, with a prevalence ranging from 32% to 50%. Some recent data suggest that excess weight worsens the symptoms of fibromyalgia, and has even been shown to be negatively related to quality of life and positively related to pain. It has also been noted that high body mass index (BMI) correlates to greater pain and fatigue levels in people with fibromyalgia, which may represent an aggravating comorbid condition by negatively affecting quality of life, with a resultant physical dysfunction. A number of mechanisms have been proposed to explain this relationship between obesity and fibromyalgia, including reduced physical activity, sleep disturbances, or depression problems, as well as dysfunction of the thyroid gland or the somatotropic axis. Therapeutic options for subjects with MO include bariatric surgery (BS), whose medical and psychological benefits have been previously shown in multiple studies. Because of the increasing number of people with MO who are candidates for BS with fibromyalgia, our aim was to assess whether the presence of fibromyalgia was associated with differences in sociodemographic profile, eating behavior characteristics, and the degree of anxiety in these patients. From January 2012 to December 2013, 40 women who were candidates for bariatric surgery, of whom 10 (25%) were diagnosed with fibromyalgia, were consecutively recruited. Obese males with fibromyalgia were not identified, and no male was therefore recruited into the study. Sociodemographic variables (age, marital status, number of children, degree of disability, use of drugs, mental health history, and treatment with psychoactive drugs) and variables related to MO (time of start of obesity, family history of MO, result of psychological evaluation, and surgery performed) were collected. The following questionnaires were administered to assess eating behavior and degree of anxiety: the Eating Disorder Inventory (EDI-2) and the State-Trait Anxiety Questionnaire (STAI-II). EDI-2 is an adequate psychometric instrument both for assessing the psychological characteristics of anorexia and bulimia and for screening to identify people at a high risk of eating disorders. Moreover, its use is approved in many protocols for assessing patient candidates for BS. The group of women with MO and no fibromyalgia (n = 30) had a BMI of 44.8 ± 7.0 (mean and standard deviation), while

Autosomal dominant hypercholesterolemia in Catalonia: Correspondence between clinical-biochemical and genetic diagnostics in 967 patients studied in a multicenter clinical setting

BACKGROUND Autosomal dominant hypercholesterolemia (ADH) is associated with mutations in the low-density lipoprotein (LDL) receptor (LDLR), apolipoprotein B (APOB), and proprotein convertase subtilisin/kexin 9 (PCSK9) genes, and it is estimated to be greatly underdiagnosed. The most cost-effective strategy for increasing ADH diagnosis is a cascade screening from mutation-positive probands. OBJECTIVE The objective of this study was to evaluate the results from 2008 to 2016 of ADH genetic analysis performed in our clinical laboratory, serving most lipid units of Catalonia, a Spanish region with approximately 7.5 million inhabitants. METHODS After the application of the Dutch Lipid Clinic Network (DLCN) clinical diagnostic score for ADH, this information and blood or saliva from 23 different lipid clinic units were investigated in our laboratory. DNA was screened for mutations in LDLR, APOB, and PCSK9, using the DNA-array LIPOchip, the next-generation sequencing SEQPRO LIPO RS platform, and multiplex ligation-dependent probe amplification (MLPA). The Simon Broome Register Group (SBRG) criteria was calculated and analyzed for comparative purposes. RESULTS A total of 967 unrelated samples were analyzed. From this, 158 pathogenic variants were detected in 356 patients. The main components of the DLCN criteria associated with the presence of mutation were plasma LDL cholesterol (LDLc), age, and the presence of tendinous xanthomata. The contribution of family history to the diagnosis was lower than in other studies. DLCN and SBRG were similarly useful for predicting the presence of mutation. CONCLUSION In a real clinical practice, multicenter setting in Catalonia, the percentage of positive genetic diagnosis in patients potentially affected by ADH was 38.6%. The DLCN showed a relatively low capacity to predict mutation detection but a higher one for ruling out mutation.

Productos finales de glicación avanzada en la obesidad mórbida y tras la cirugía bariátrica: cuando la memoria glucémica empieza a fallar

BACKGROUND AND OBJECTIVE Advanced glycation end-products (AGEs) are a marker of metabolic memory. Their levels increases when oxidative stress, inflammation, or chronic hyperglycemia exists. The role of morbid obesity in AGE levels, and the impact of bariatric surgery on them are unknown. PATIENTS AND METHOD An observational study with three sex- and age-matched cohorts: 52 patients with obesity, 46 patients undergoing bariatric surgery in the last 5 years, and 46 control subjects. AGE were measured using skin autofluorescence (SAF) in the forearm with an AGE Reader™ (DiagnOptics Technologies, Groningen, The Netherlands). Presence of metabolic syndrome was assessed. RESULTS Patients with morbid obesity had higher SAF levels (2.14±0.65AU) than non-obese subjects (1.81±0.22AU; P<.001), which was mainly attributed to obese subjects with metabolic syndrome (2.44±0.67 vs. 1.86±0.51AU; P<.001). After bariatric surgery, SAF continued to be high (2.18±0.40AU), and greater as compared to the non-obese population (P<.001). A multivariate analysis showed that age and presence of metabolic syndrome (but not sex or body mass index) were independently associated to SAF (R2=0.320). CONCLUSION SAF is increased in patients with morbid obesity and metabolic syndrome, mainly because of the existence of type 2 diabetes mellitus. In the first 5 years following bariatric surgery, weight loss and metabolic improvement are not associated with a parallel decrease in subcutaneous AGE levels.

Exenatida diaria y semanal: perfil clínico de dos formulaciones pioneras en la modulación incretínica

GLP-1 receptors agonists have been a substantial change in treatment of type 2 diabetes mellitus, and its weekly administration has broken pre-established schemes. Daily exenatide is administered every 12 hours (BID) subcutaneously, while weekly exenatide is administered once a week. Both molecules share a common mechanism of action but have differential effects on basal and postprandial glucose. We review the major clinical trials with both exenatide BID and weekly exenatide. It can be concluded that exenatide BID shows a hypoglycemic effect similar to other treatments for type 2 DM but adding significant weight loss with low incidence of hypoglycemia. Weekly exenatide decreases HbA1c similar to liraglutide but larger than exenatide BID, both glargine and biphasic insulin, sitagliptin, and pioglitazone, maintaining weight loss and adding to gastrointestinal intolerance the induration at the injection site as a side effect.GLP-1 receptors agonists have been a substantial change in treatment of type 2 diabetes mellitus, and its weekly administration has broken pre-established schemes. Daily exenatide is administered every 12 hours (BID) subcutaneously, while weekly exenatide is administered once a week. Both molecules share a common mechanism of action but have differential effects on basal and postprandial glucose. We review the major clinical trials with both exenatide BID and weekly exenatide. It can be concluded that exenatide BID shows a hypoglycemic effect similar to other treatments for type 2 DM but adding significant weight loss with low incidence of hypoglycemia. Weekly exenatide decreases HbA1c similar to liraglutide but larger than exenatide BID, both glargine and biphasic insulin, sitagliptin, and pioglitazone, maintaining weight loss and adding to gastrointestinal intolerance the induration at the injection site as a side effect.