Xavier Formiguera

Prevention of overweight and obesity: a Spanish approach

BACKGROUND Obesity is considered a major public health issue in most developed countries nowadays. This paper provides an overview of current population data available in Spain and the approach to develop preventive strategies in the country. METHODS Review of population data available is based on individually measured weight and height as well as determinants. On this basis, the approach used in the country to develop preventive strategies is discussed. RESULTS According to the DORICA study, the prevalence of obesity (BMI >or=30 kg m-2) is 15.5% in Spanish adults aged 25-60 years (13.2% in men and 17.5% in women). Obesity rates are higher among women aged 45 years and older, low social class, living in semi-urban places. Population estimates for the prevalence of obesity in Spanish children and young people based on the enKid study are 13.9% for the whole group. In this study, overweight and obesity is related to absence of breastfeeding, low consumption of fruit and vegetables, high consumption of cakes, buns, softdrinks and butchery products, low physical activity levels and a positive association with time spent watching TV. In 2005, the Spanish Ministry of Health jointly with the Spanish Agency for Food Safety and Nutrition launched the multifaceted NAOS strategy for nutrition, physical activity and the prevention of obesity. The important role of the family and the school setting as well as the responsibility of the Health Administration and Pediatric Care in the prevention of obesity is highlighted in the document. The need for environmental actions is recognised. The PERSEO programme, a multicomponent school-based intervention project is part of the strategy currently in place. CONCLUSION Obesity is a public health issue in Spain. A national multifaceted strategy was launched to counteract the problem. Environmental and policy actions are a priority. Young children and their families are among the main target groups.

Increased Exercise Capacity after Surgically Induced Weight Loss in Morbid Obesity

Objective: To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity (MO).

Relationship of abdominal obesity with cardiovascular disease, diabetes and hyperlipidaemia in Spain

Objectives  To evaluate the relevance of obesity and abdominal obesity in the prevalence of cardiovascular disease (CVD), diabetes mellitus, hyperlipidaemia and hypertension in primary care patients and to ascertain whether waist circumference (WC) measurement should be included in routine clinical practice in addition to body mass index (BMI).

Hipertensión arterial y política de salud en España

José R. Banegas a,b, , Albert Jovell , Benjamı́n Abarca , Manuel Aguilar Diosdado , Luis Aguilera , Pedro Aranda , Vicente Bertoméu , Pedro Capilla , Pedro Conthe , Fernando De Álvaro , Antonio Fernández-Pro , Xavier Formiguera , Jesús Frı́as , Lucı́a Guerrero , José L. Llisterri , José M. Lobos , Juan F. Macı́as , Ángel L. Martı́n De Francisco , Jesús Millán , Juan C. Morales , Vicente Palomo , Alex Roca-Cusachs , Javier Román , Carlos Sanchis , Antonio Sarriá , Julián Segura , Álex De La Sierra , Luis Verde , Julio Zarco n y Luis M. Ruilope a,u a Asociación de la Sociedad Española de Hipertensión y Liga Española para la Lucha contra la Hipertensión Arterial b Universidad Autónoma de Madrid, CIBERESP (CIBER de Epidemiologı́a y Salud Pública), Madrid c Foro Español de Pacientes d Sociedad Española de Medicina General e Sociedad Española de Diabetes f Sociedad Española de Medicina de Familia y Comunitaria g Sociedad Española de Cardiologı́a h Consejo General de Colegios Oficiales de Farmacéuticos i Sociedad Española de Medicina Interna j Sociedad Española de Nefrologı́a en el Comité Español Interdisciplinario para la Prevención Cardiovascular k Sociedad Española para el Estudio de la Obesidad l Departamento de Farmacologı́a y Terapéutica, Universidad Autónoma de Madrid, Madrid m Asociación de Enfermerı́a de Hipertensión y Riesgo Cardiovascular (EHRICA) n Sociedad Española de Médicos de Atención Primaria o Comité Español Interdisciplinar de Prevención Cardiovascular (CEIP) p Sociedad Española de Geriatrı́a y Gerontologı́a q Sociedad Española de Nefrologı́a r Sociedad Española de Arteriosclerosis s Sociedad Española de Farmacéuticos de Atención Primaria t Ibermutuamur-Corporación Mutua-Proyectos Sanitarios u Agencia de Evaluación de Tecnologı́as Sanitarias. Instituto de Salud Carlos III, Madrid v Asociación para la Prevención del Riesgo Cardiovascular (PRECAR) x Sociedad Española de Directivos de Atención Primaria, España

Función cardiopulmonar y capacidad de ejercicio en pacientes con obesidad mórbida

Introduction and objectives. The effect of obesity on cardiac function is still under discussion. The objective of this study was to assess cardiopulmonary capacity in morbidly obese patients. Patients and method. A symptom-limited cardiopulmonary exercise stress test was carried out in 31 morbidly obese patients (BMI 50 ± 9 kg/m 2 ) and 30 normal controls (BMI 24 ± 2 kg/m 2 ). Cardiovascular function was evaluated using the oxygen pulse (oxygen uptake/heart rate). Results. There were no differences in age, sex and height between both groups. During the effort the obese subjects presented greater oxygen uptake, heart rate, systolic arterial pressure and minute ventilation and shorter test duration than control group (14 ± 3 vs 27 ± 4 min; p < 0.001). Oxygen pulse values were higher in obese patients. However, after oxygen uptake indexation by fat free mass, these differences disappeared, suggesting a similar cardiovascular function. At the end of the exercise, the control group reached 96% of their age-predicted maximal heart rate and their respiratory exchange ratio was 1 ± 0.2. Obese patients only reached 86% and 0.87 ± 0.2, respectively. Conclusions. Due to their need of more energy output to move total body mass morbidly obese patients have a reduced exercise capacity. They finish the test having done a submaximal exercise. However, during this effort they show a normal cardiopulmonar capacity.

Short-term effects of a hypocaloric diet on nitrogen excretion in morbid obese women.

Objective: To determine whether the daily pattern of urine excretion of N wastes is affected by obesity and very low-calorie diets (VLCD).Design: The plasma amino acid, urea and other energy parameters, as well as the urinary excretion of total nitrogen, urea and creatinine were studied in obese and normal-weight women. The obese womens data were obtained under hospital basal controlled conditions (8.1 MJ/day) and after 3 days of VLCD diet (1.9 MJ/day) controls were studied only once (5.8 MJ/day). The hourly excretion patterns of total N, urea and creatinine were determined from the composition of each bladder voiding.Subjects: Twenty morbidly obese and 10 age-matched normal-weight control women.Results: Plasma amino acid levels were higher in obese women, which showed a limited ability to metabolize amino acid hydrocarbon skeletons. Neither differences in the patterns between groups nor total 24 h values for urine volume were found. Total N and urea excretion diminished under VLCD diet. Hourly creatinine excretion showed a flat pattern and was higher in obese women than in the controls, VLCD diet diminished the amount of creatinine excreted in 24 h.Conclusions: The early change in energy availability that the creatinine excretion figures reflect may result from the energy conservation mechanisms induced in response to energy restriction. The early onset of this effect (3 days, and the extent of decrease (∼19%) also suggest that the impact of VLCD on the muscle energy budget of the obese is more marked than usually assumed.Sponsorship: Grants FIS-94/0034, BIO98-0316 and 2FD97-0233 of the Government of Spain.European Journal of Clinical Nutrition (2001) 55, 186–191

Analytical performance and clinical usefulness of two binding assays for growth hormone binding protein (GHBP) measurement: high performance liquid chromatography (HPLC)-gel filtration and dextran-coated charcoal adsorption

We compared two binding assays for growth hormone binding protein (GHBP) measurements, which differ in the method of bound and free GH separation: HPLC-gel filtration or dextran coated-charcoal adsorption (DCC). Two pools of sera (high and medium GHBP activity) were used for quality-control assessment. Moreover, 62 samples from 34 children and 28 adults with different nutritional status were studied. Total, between- and intra-iodination coefficients of variation (CVs) from the two methods were not different. Although percentage binding measured in the pool sera significantly differed, the concentrations assessed by Scatchard plot were comparable. Results obtained by the two methods in the 62 sera were significantly correlated (r = 0.77, P < 0.001). With both methods GHBP activity correlated with chronological age and body mass index (BMI) and differed among groups with different nutritional status. Although HPLC and DCC separation methods for GHBP measurement differ in their practicability, our study demonstrates that performance and the clinical usefulness of the two methods are comparable.

Increased leptin production in vivo and insulin cleavage by the omental adipose tissue of morbidly obese patients

The aim of this investigation was to assess the insulin cleavage capacity in obese humans. Increased insulin degradation by visceral adipose tissue has previously been demonstrated in obese rats and could be interpreted as a physiological response to hyperinsulinaemia. The recent characterization of leptin receptors in pancreatic β cells, liver and muscle suggests that leptin may influence insulin function and metabolism. Our study focuses on the possible relationship between leptin secretion and adipose tissue insulin‐degrading capacity.

Dimetilarginina asimétrica como marcador de riesgo cardiovascular

La dimetilarginina asimetrica (ADMA) es un inhibidor competitivo del grupo enzimatico oxido nitrico (NO) sintetasa, que cataliza la conversion del aminoacido L-arginina en L-citrulina y NO. Esta competencia se debe a la estrecha similitud entre la composicion quimica de la L-arginina y la molecula de ADMA (2 grupos metilos en el grupo aminoterminal de la L-arginina). Concentraciones elevadas de ADMA pueden bloquear la sintesis de NO, molecula antiaterogena endogena por excelencia, debido a su funcion reguladora del endotelio vascular. Las disminuciones del NO favorecen la disfuncion endotelial causada por factores de riesgo cardiovascular, inflamaciones o alteraciones metabolicas. Se han publicado estudios clinicos prospectivos que senalan que la ADMA es un nuevo marcador de riesgo cardiovascular capaz de predecir de forma independiente nuevos eventos. Mas recientemente se han descrito variaciones intraindividuales de la ADMA en personas sanas que inducen a seguir investigando sobre el valor diagnostico y pronostico de este potencial y novedoso marcador de riesgo cardiovascular.

URINARY FREE CORTISOL EXCRETION PATTERN IN MORBID OBESE WOMEN

The urinary excretion of free cortisol in a group of 10 control and 20 morbidly obese women was measured in all bladder voidings during 24 h. The data from obese women were measured under Hospital basal controlled conditions and after 3 days of very low calorie diet (VLCD, 1.9 MJ/d). The hourly cortisol excretion pattern was determined for each woman, and means of each group were computed in order to obtain a 24 h excretion pattern. In controls, the highest excretion rate was in the morning (8–9 h) and the lowest at 21–22 h. In basal conditions, the obese showed a similar but flatter pattern; the highest peak was also in the morning (9–10 h), but the lowest rate was between 21 and 24 h. The VLCD diet flattened the pattern even more, in a way that no clear peak was observed from the early morning until the afternoon; however, the nadir coincided with that found in basal conditions. These patterns resulted in significant differences between VLCD, basal diet and control. The amount of free cortisol excreted was 93.0 ± 6.9 nmol/day in controls, 70.1 ± 4.7 nmol/day in obese under basal conditions and 62.6 ± 3.0 nmol/day when subjected to VLCD. The results presented are consistent with a lower overall cortisol secretion in the morbid obese women, which also show a narrower margin of variation in cortisol secretion than non-obese controls. The data also show the significant influence of dietary energy on the pattern of cortisol excretion in obese women.