Cambios en las hormonas reguladoras de la ingesta, microbiota intestinal y metabolismo hidrocarbonado, antes y después del tratamiento antibiótico erradicador en pacientes con Helicobacter pylori positivo.

Introducción. La creciente prevalencia de las enfermedades metabólicas conlleva una investigación continua de su etiopatogenia. Existen trabajos controvertidos sobre la infección por H. pylori y sus posibles efectos metabólicos y sobre las hormonas reguladoras de la ingesta. Además, los estudios más recientes publicados apuntan a la microbiota, y concretamente sus alteraciones en composición y biodiversidad, como piezas fundamentales en el desarrollo de estos trastornos metabólicos, especialmente en la DM2 y la obesidad. Objetivos. Evaluación de cambios endocrino-metabólicos y de la microbiota intestinal antes y después del tratamiento antibiótico erradicador en pacientes infectados por H. pylori. Material y métodos. Estudio prospectivo casos-control con medidas de cambio intrasujeto, de 40 pacientes no diabéticos infectados por H. pylori (test en heces positivo) y tratados con la triple terapia (Amoxicilina, Claritromicina y Omeprazol) y 20 controles no diabéticos y con test H. pylori en heces negativo. Analizamos variables clínicas, analíticas (perfil glucémico, lipídico, PCR) y hormonas reguladoras de la ingesta (ghrelina y GLP-1) basales y tras una SOG; así como composición de la microbiota intestinal y registro dietético de 7 días. Exploramos los cambios experimentados a los 2 meses post-tratamiento antibiótico erradicador. Resultados. La comunidad microbiana intestinal de pacientes infectados por H. pylori es diferente respecto a individuos sanos. La erradicación de la infección por H. pylori mejora el metabolismo hidrocarbonado y lipídico, reduce el área bajo la curva de ghrelina tras la sobrecarga oral de glucosa sobre todo en sujetos obesos e incrementa los niveles de GLP-1 sobre todo en sujetos no obesos. Tras el tratamiento antibiótico erradicador, el descenso de HbA1c se relaciona con cambios en la comunidad de Bacteroides fragillis y Megamonas; los cambios en el área bajo la curva de glucosa se relacionan con cambios en la familia Rikenellaceae y el género Butyricimonas; y los cambios en el perfil lipídico con cambios en los géneros Veillonella respecto al LDL-c y Desulfovibrio respecto del HDL-c. El uso de tratamiento antibiótico de amplio espectro reduce la abundancia de la comunidad microbiana intestinal y su diversidad. Conclusiones. El tratamiento antibiótico erradicador de la infección por H. pylori modifica la microbiota intestinal y la producción de determinadas incretinas tras la ingesta, relacionándose estas modificaciones con cambios favorables en el metabolismo hidrocarbonado y lipídico. Los cambios en la microbiota inducidos por el uso de antibióticos de amplio espectro persisten al menos 2 meses después de finalizado el tratamiento

Obesity-related glomerulopathy: Current approaches and future perspectives

Obesity-related glomerulopathy (ORG) is a silent comorbidity which is increasing inincidence as the obesity epidemic escalates. ORG is associated with serious healthconsequences including chronic kidney disease, end-stage renal disease (ESRD), andincreased mortality. Although the pathogenic mechanisms involved in the develop-ment of ORG are not fully understood, glomerular hemodynamic changes, renin-angiotensin-aldosterone system (RAAS) overactivation, insulin-resistance, inflamma-tion and ectopic lipid accumulation seem to play a major role. Despite albuminuriabeing commonly used for the non-invasive evaluation of ORG, promising biomarkersof early kidney injury that are emerging, as well as new approaches with proteomicsand metabolomics, might permit an earlier diagnosis of this disease. In addition, theassessment of ectopic kidney fat by renal imaging could be a useful tool to detectand evaluate the progression of ORG. Weight loss interventions appear to be effec-tive in ORG, although large-scale trials are needed. RAAS blockade has a ren-oprotective effect in patients with ORG, but even so, a significant proportion ofpatients with ORG will eventually progress to ESRD despite therapeutic efforts. It isnoteworthy that certain antidiabetic agents such as sodium-glucose cotransporter2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) couldbe useful in the treatment of ORG through different pleiotropic effects. In this article,we review current approaches and future perspectives in the care and treatmentof ORGInstitute of Health“Carlos III”(ISCIII), Grant/Award Numbers: JR 19/00054, CM 17/00169,PI20/01559; Funding for open access charge: Universidad de Málaga / CBU

Rectus Femoris Muscle and Phase Angle as Prognostic Factor for 12-Month Mortality in a Longitudinal Cohort of Patients with Cancer (AnyVida Trial)

Background: Cancer-related malnutrition is still unrecognized and undertreated in clinical practice. The morphofunctional assessment of disease-related malnutrition (DRM) is a new approach that focuses on evaluating changes in body composition and function. The aim of this study is to evaluate the prognostic value of classic and emerging assessment of malnutrition at 12-months survival in cancer patients. Methods. We conducted a prospective study on cancer outpatients. Bioelectrical impedance with phase angle (PhA), nutritional ultrasound by rectus femoris cross-sectional area (RFCSA), hand grip strength, and “Timed Up and Go Test” (TUG) were evaluated as predictors of mortality. Results. Fifty-seven patients were included. The non-survivors had lower PhA values than the survivors (4.7° vs. 5.4°; p < 0.001), and we had the same results with RFCSA 2.98 cm2/m2 vs. 4.27 cm2/m2 (p = 0.03). Cut-off points were identified using the ROC (receiver operating characteristic) curves for PhA (≤5.6° cancer patients, ≤5.9° men, ≤5.3° women), RFCSA (≤4.47 cm2/m2 cancer patients, ≤4.47° men, ≤2.73° women) and rectus femoris-Y-axis (RF-Y-axis; ≤1.3 cm cancer patients, ≤1.06 men, ≤1 women). In multivariate logistic regression analysis, we found that high PhA was significantly associated with a lower mortality hazard ratio (HR: 0.42 95% CI: 0.21–0.84, p = 0.014). Likewise, high RFCSA was associated with a decrease in mortality risk in the crude model (HR: 0.61 95% CI: 0.39–0.96, p = 0.031). This trend was also maintained in the adjusted models by the confounding variables. Conclusions. Low PhA and RFCSA values are significant independent predictors of mortality in cancer patients. These cut-off points are clinical data that can be used for nutritional assessment and the prediction of clinical outcomes.This study is part of a Ph.D. Program in Biomedicine, Translational Research, and New Health Technologies in the Faculty of Medicine of the University of Málaga in Spain. The Andalusian Public Foundation for Biomedical Research in Malaga (FIMABIS) covered the publication cost. This study was also supported by the Juan Rodés program from Instituto de Salud Carlos III (JR20-00040 to MM-V), the Juan de la Cierva program from the Ministerio de Ciencia e Innovación (IJCI-2017-33065 to CG-R) and the Miguel Servet Type I program from the Instituto de Salud Carlos III cofounded by the Fondo Europeo de Desarrollo Regional (CP16/00163 to IM-I). In addition, this study was supported by the “Centros de Investigación Biomédica en Red” (CIBERobn) of the Instituto de Salud Carlos III (ISCIII) (CB06/03/0018), and research grants from the ISCIII (PI18/01160; PI21/01677) and co-financed by the European Regional Development Fund (ERDF). Partial funding for open access charge: Universidad de Málag

Predictors of Sarcopenia in Outpatients with Post-Critical SARS-CoV2 Disease. Nutritional Ultrasound of Rectus Femoris Muscle, a Potential Tool

Background and Objectives: The loss of muscle mass in post-critical COVID-19 outpatients is difficult to assess due to the limitations of techniques and the high prevalence of obesity. Ultrasound is an emerging technique for evaluating body composition. The aim is to evaluate sarcopenia and its risk factors, determining ultrasound usefulness as a potential tool for this purpose according to established techniques, such as the bioimpedance vector analysis (BIVA), handgrip strength, and timed up-and-go test. Methods: This is a transversal study of 30 post-critical COVID-19 outpatients. We evaluated nutritional status by ultrasound (Rectus Femoris-cross-sectional-area (RF-CSA), thickness, and subcutaneous-adipose-tissue), BIVA, handgrip strength, timed up-and-go test, and clinical variables during admission. Results: According to The European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity (ESPEN&EASO) Consensus for Sarcopenic and Obesity, in terms of excess fat mass and decreased lean mass, the prevalence of class-1 sarcopenic obesity was 23.4% (n = 7), and class-2 sarcopenic obesity was 33.3% (n = 10) in our study. A total of 46.7% (n = 14) of patients had a handgrip strength below the 10th percentile, and 30% (n = 9) achieved a time greater than 10s in the timed up-and-go test. There were strong correlations between the different techniques that evaluated the morphological (BIVA, Ultrasound) and functional measurements of muscle. Intensive care unit stay, mechanical ventilation, and age all conditioned the presence of sarcopenia in COVID-19 outpatients (R2 = 0.488, p = 0.002). Predictive models for sarcopenic diagnosis based on a skeletal muscle index estimation were established by RF-CSA (R2 0.792, standard error of estimate (SEE) 1.10, p < 0.001), muscle-thickness (R2 0.774, SEE 1.14, p < 0.001), and handgrip strength (R2 0.856, SEE 0.92, p < 0.001). RF-CSA/weight of 5.3 cm2/kg × 100 (...)I.C.-P. was the recipient of a postdoctoral grant (Río Hortega CM 17/00169) and is now the recipient of a postdoctoral grant (Juan Rodes JR 19/00054) from the Instituto de Salud Carlos III and co-funded by Fondo Europeo de Desarrollo Regional-FEDER. Partial funding for open access charge: Universidad de Málag

Phase angle and COVID-19: a systematic review with meta-analysis

Phase angle (PhA) has been identified as a poor prognostic factor in patients with COVID-19. This study aimed to achieve a systematic review, where we discussed the potential role of PhA value as a prognostic marker of adverse clinical outcomes such as mortality and complication in hospitalized with SARS-CoV2 infection and established the strength of recommendations for use. A systematic literature review with meta-analysis was done in the main electronic databases from 2020 to January 2023. The selected articles had to investigate adverse consequences of the COVID-19 population and raw bioimpedance parameters such as PhA and published in peer-reviewed journals. GRADE tools regarded the quality of the methodology. The review protocol was registered in PROSPERO. Only eight studies, 483 studies, were eligible for the analysis. In general, differences in PhA were seen between the comparative study groups. Patients with a low PhA experienced poor outcomes. A low PhA was associated with a significantly increased mortality risk [RR: 2.44; 95% CI (1.20–4.99), p = 0.01; I2 = 79% (p = 0.0008)] and higher complications risk [OR: 3.47, 95% CI (1.16 – 10.37), p = 0.03; I2 = 82% (p = 0.004)] in COVID-19 patients. Our analysis showed four evidence-based recommendations on the prognostic value of PhA with two strong recommendations, one of moderate and another of low-moderate quality, for predicting mortality and complications, respectively. We recommend using PhA as a prognostic marker for mortality and complications in this population. Although the results are promising, future studies must identify the PhA cut-off to guide therapeutic decisions more precisely.Funding for open access publishing: Universidad Málaga/CBUA. I.C.-P. was the recipient of a postdoctoral grant (Río Hortega CM 17/00169) and is now the recipient of a postdoctoral grant (Juan Rodes JR 19/00054) from the Instituto de Salud Carlos III and co-funded by Fondo Europeo de Desarrollo Regional-FEDER. Funding for open access charge: Universidad de Málaga / CBU

Dairy product consumption and changes in cognitive performance: two-year analysis of the PREDIMED-Plus Cohort

Scope: Dairy consumption has been suggested to impact cognition; however, evidence is limited and inconsistent. This study aims to longitudinally assess the association between dairy consumption with cognitive changes in an older Spanish population at high cardiovascular disease risk. Methods and results: Four thousand six hundred sixty eight participants aged 55–75 years, completed a validated food frequency questionnaire at baseline and a neuropsychological battery of tests at baseline and 2-year follow-up. Multivariable linear regression models are used, scaled by 100 (i.e., the units of β correspond to 1 SD/100), to assess associations between baseline tertile daily consumption and 2-year changes in cognitive performance. Participants in the highest tertile of total milk and whole-fat milk consumption have a greater decline in global cognitive function (β: –4.71, 95% CI: –8.74 to –0.69, p-trend = 0.020 and β: –6.64, 95% CI: –10.81 to –2.47, p-trend = 0.002, respectively) compared to those in the lowest tertile. No associations are observed between low fat milk, yogurt, cheese or fermented dairy consumption, and changes in cognitive performance. Conclusion:Results suggest there are no clear prospective associations between consumption of most commonly consumed dairy products and cognition, although there may be an association with a greater rate of cognitive decline over a 2-year period in older adults at high cardiovascular disease risk for whole-fat milk

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach

Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9&ndash;89.3) vs. 73.7% (73.2&ndash;82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59&ndash;0.75) vs. 0.54 (0.48&ndash;0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459&ndash;6.032, p &lt; 0.001) for hydration and 2.528 (95%CI, 1.664&ndash;3.843, p &lt; 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906&ndash;10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375&ndash;2.520, p &lt; 0.001). Hydration &gt; 76.15% or ECW/TBW &gt; 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (&gt;76.15%) and ECW/TBW (&gt;0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care

Metabolic and Endocrine Consequences of Bariatric Surgery.

Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health

Does Metabolically Healthy Obesity Exist?

The relationship between obesity and other metabolic diseases have been deeply studied. However, there are clinical inconsistencies, exceptions to the paradigm of “more fat means more metabolic disease”, and the subjects in this condition are referred to as metabolically healthy obese (MHO).They have long-standing obesity and morbid obesity but can be considered healthy despite their high degree of obesity. We describe the variable definitions of MHO, the underlying mechanisms that can explain the existence of this phenotype caused by greater adipose tissue inflammation or the different capacity for adipose tissue expansion and functionality apart from other unknown mechanisms. We analyze whether these subjects improve after an intervention (traditional lifestyle recommendations or bariatric surgery) or if they stay healthy as the years pass. MHO is common among the obese population and constitutes a unique subset of characteristics that reduce metabolic and cardiovascular risk factors despite the presence of excessive fat mass. The protective factors that grant a healthier profile to individuals with MHO are being elucidated