Hábitos alimentarios en estudiantes universitarios: Universidad de Castilla-La Mancha. Estudio piloto en la Universidad Virtual de Túnez

Con el objeto de estudiar los hábitos alimentarios de los estudiantes universitarios del campus de Albacete de la Universidad de Castilla-La Mancha, y de realizar un estudio piloto en la Universidad Virtual de Túnez que sirva de ayuda en el futuro a uno similar en la misma, se ha desarrollado este trabajo. Participaron 80 y 284 estudiantes en los estudios de la UCLM y 54 en la UVT. La recogida de datos se ha efectuado mediante la cumplimentación de un cuestionario para obtener información general y de recordatorios de 24 horas que permitieron la posterior evaluación del consumo alimentario, siendo ambos auto-administrados. La calidad global de la dieta fue medida mediante los índices de alimentación saludable, de adherencia a dieta mediterránea y el patrón alimentario griego. El cuestionario general recogió información referida a diferentes aspectos demográficos, antropométricos y de estilo de vida que pudieran tener alguna influencia sobre la calidad de la dieta de la población de estudio, teniendo en cuanta los distintos contextos de ambas universidades. En ambas universidades se recogió edad, género, peso, estatura, tipo de residencia durante el curso, seguimiento de dietas especiales, número y tipo de comidas diarias, consumo de edulcorantes artificiales, consumo de suplementos dietéticos. Para el caso tunecino se recogieron, además, procedencia, tipo de comida consumida a diario y festivos, regularidad en los horarios, y disponibilidad de electrodomésticos. También se recogió información sobre actividad física y hábito tabáquico en ambos casos. Entre las fortalezas del trabajo se destaca el hecho de la capacidad de la población de estudio para entender instrucciones, y de disponer de una memoria óptima, no se excluye ningún alimento y la población es homogénea en el caso de la UCLM. Además del diseño trasversal, la principales limitaciones se relacionan con el objeto de valorar la ingesta alimentaria, debido tanto al instrumento de medida como a la variabilidad de la dieta. El recordatorio es especialmente sensible a subestimar la ingesta. Más del 96% de los participantes de la UCLM necesitan cambios que conduzcan a hábitos más saludables, reflejando una adherencia media-baja a la dieta mediterránea. Las principales desviaciones respecto a patrón de dieta mediterránea son la baja ingesta de verduras y fruta, y el elevado consumo de carne y productos lácteos. Siendo alta la ingesta de grasas saturadas, azúcares y proteína. El único factor analizado que mostró influencia en la calidad de la dieta de los estudiantes fue el género. En el caso de la UVT, los participantes mostraron ser bastante sedentarios, con hábitos alimentarios saludables respecto a la distribución, horarios, tipo, variedad y número de comidas, presentando sobrepeso u obesidad casi el 50% de los individuos estudiados

Treatment With Simvastatin and Rifaximin Restores the Plasma Metabolomic Profile in Patients With Decompensated Cirrhosis

Patients with decompensated cirrhosis, particularly those with acute-on-chronic liver failure (ACLF), show profound alterations in plasma metabolomics. The aim of this study was to investigate the effect of treatment with simvastatin and rifaximin on plasma metabolites of patients with decompensated cirrhosis, specifically on compounds characteristic of the ACLF plasma metabolomic profile. Two cohorts of patients were investigated. The first was a descriptive cohort of patients with decompensated cirrhosis (n = 42), with and without ACLF. The second was an intervention cohort from the LIVERHOPE-SAFETY randomized, double-blind, placebo-controlled trial treated with simvastatin 20 mg/day plus rifaximin 1,200 mg/day (n = 12) or matching placebo (n = 13) for 3 months. Plasma samples were analyzed using ultrahigh performance liquid chromatography–tandem mass spectroscopy for plasma metabolomics characterization. ACLF was characterized by intense proteolysis and lipid alterations, specifically in pathways associated with inflammation and mitochondrial dysfunction, such as the tryptophan–kynurenine and carnitine beta-oxidation pathways. An ACLF-specific signature was identified. Treatment with simvastatin and rifaximin was associated with changes in 161 of 985 metabolites in comparison to treatment with placebo. A remarkable reduction in levels of metabolites from the tryptophan–kynurenine and carnitine pathways was found. Notably, 18 of the 32 metabolites of the ACLF signature were affected by the treatment. Conclusion: Treatment with simvastatin and rifaximin modulates some of the pathways that appear to be key in ACLF development. This study unveils some of the mechanisms involved in the effects of treatment with simvastatin and rifaximin in decompensated cirrhosis and sets the stage for the use of metabolomics to investigate new targeted therapies in cirrhosis to prevent ACLF development

Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study

BACKGROUND: Liver cirrhosis is a major cause of death worldwide. Cirrhosis develops after a long asymptomatic period of fibrosis progression, with the diagnosis frequently occurring late, when major complications or cancer develop. Few reliable tools exist for timely identification of individuals at risk of cirrhosis to allow for early intervention. We aimed to develop a novel score to identify individuals at risk for future liver-related outcomes. METHODS: We derived the LiverRisk score from an international prospective cohort of individuals from six countries without known liver disease from the general population, who underwent liver fibrosis assessment by transient elastography. The score included age, sex, and six standard laboratory variables. We created four groups: minimal risk, low risk, medium risk, and high risk according to selected cutoff values of the LiverRisk score (6, 10, and 15). The model's discriminatory accuracy and calibration were externally validated in two prospective cohorts from the general population. Moreover, we ascertained the prognostic value of the score in the prediction of liver-related outcomes in participants without known liver disease with median follow-up of 12 years (UK Biobank cohort). FINDINGS: We included 14 726 participants: 6357 (43·2%) in the derivation cohort, 4370 (29·7%) in the first external validation cohort, and 3999 (27·2%) in the second external validation cohort. The score accurately predicted liver stiffness in the development and external validation cohorts, and was superior to conventional serum biomarkers of fibrosis, as measured by area under the receiver-operating characteristics curve (AUC; 0·83 [95% CI [0·78–0·89]) versus the fibrosis-4 index (FIB-4; 0·68 [0·61–0·75] at 10 kPa). The score was effective in identifying individuals at risk of liver-related mortality, liver-related hospitalisation, and liver cancer, thereby allowing stratification to different risk groups for liver-related outcomes. The hazard ratio for liver-related mortality in the high-risk group was 471 (95% CI 347–641) compared with the minimal risk group, and the overall AUC of the score in predicting 10-year liver-related mortality was 0·90 (0·88–0·91) versus 0.84 (0·82–0·86) for FIB-4. INTERPRETATION: The LiverRisk score, based on simple parameters, predicted liver fibrosis and future development of liver-related outcomes in the general population. The score might allow for stratification of individuals according to liver risk and thus guide preventive care. FUNDING: European Commission under the H20/20 programme; Fondo de Investigación Sanitaria de Salud; Instituto de Salud Carlos III; Spanish Ministry of Economy, Industry, and Competitiveness; the European Regional Development Fund; and the German Ministry of Education and Research (BMBF)