Obesity as a chronic disease: current approach

En 1926 Don Gregorio Marañón publicaba en su libro Gordos y flacos la siguiente reflexión: “la palabra gordo resume multitud de conceptos de herencia, de costumbres, de carácter, de modalidades de la sensibilidad y de la inteligencia”1. Años antes, en 1760, el fisiólogo Malcom Flemyng había escrito: “no todas las personas corpulentas son grandes comedoras, ni todas las delgadas comen poco. Con frecuencia es al contrario. Un voraz apetito es causa de corpulencia, no como única causa y no es condición sine qua non de llegar a serlo”2. Siguiendo esta línea de pensamiento, que reconoce la multiplicidad de factores responsables de la obesidad, no cabe mantener una visión simplista entendiéndola como resultado de la glotonería y la falta de voluntad, ya que esta forma de percibirla, supone una barrera importante para su tratamiento. La obesidad debe ser entendida como una enfermedad crónica, igual que la diabetes o la hipertensión; es más, una enfermedad responsable de muchas otras enfermedades, pues es difícil encontrar una patología que no sea más prevalente en el paciente obeso, ni una patología cuya condición no empeore con la aparición de una obesidad3. De hecho, en 2013 la American Medical Association (AMA), reconoció la obesidad como una enfermedad4. La AMA defendió su acción como una forma de legitimar la obesidad, mejorar su tratamiento y facilitar su cobertura sanitaria. Con esta visión de la enfermedad, se revisa el concepto y clasificación de la obesidad, su epidemiología, sus causas y consecuencias y, finalmente, las posibilidades de tratamiento.In 1926, Gregorio Marañón published in his book “Gordos y Flacos” the following reflection: “the word fatso summarizes many concepts of inheritance, customs, character, modalities of sensitivity and intelligence”1. Many years ago, in 1760, the physiologist Malcolm Flemyng had written: “Not that all corpulent persons are great eaters; or all thin persons spare feeders. We daily see instances of the contrary. Tho’ a voracious appetite be one cause of Corpulency, it is not the only cause; and very often not even the conditio sine qua non thereof”2. Following this way of thinking, which recognizes the multiplicity of factors responsible for obesity, it is not possible to maintain a simplistic vision, understanding it as a result of gluttony and lack of will, since this way of perceiving it represents an important barrier to its treatment. Obesity should be understood as a chronic disease, just like diabetes or hypertension; furthermore, a disease responsible for many other diseases, because it is difficult to find a pathology that is not more prevalent in the obese patient, nor a pathology whose condition does not get worse with the appearance of obesity3. In fact, in 2013 the American Medical Association (AMA) recognized obesity as a disease4. The AMA defended its action as a way to legitimize obesity, improve its treatment and facilitate its health coverage. With this approach as a disease, we review the concept and classification of obesity, its epidemiology, its causes and consequences and, finally, the possibilities of treatment

Jocs amb informació incompleta: jocs bayesians i subhastes

Treballs Finals de Grau de Matemàtiques, Facultat de Matemàtiques, Universitat de Barcelona, Any: 2022, Director: Josep Vives i Santa Eulàlia[en] In this work we introduce the sealed-bid auction theory, and we compute its equilibrium when values are private and affiliated. Then we compare the seller’s expected revenue of first and second price auctions under different scenarios. Finally, we simulate an auction and check that the Revenue equivalence holds when values are uniformly distributed on [0,1]

Dibuix de 2

Treballs Finals de Grau de Belles arts. Facultat de Belles Arts. Universitat de Barcelona, Curs: 2017-2018, Tutor: Córdoba Benedicto, Jaime de[cat] Aquest projecte es desenvolupa en l’àmbit del dibuix, faig una recerca de la problemàtica en la composició d’obra, cercant la representació del vincle de l’amor en el dibuix contemporani. També busco resoldre el conflicte en l’àmbit expositiu i desenvolupar quelcom que expressi i generi una reacció en l’espectador. Hi ha un projecte personal de recerca a nivell gràfic: el tractament de les textures, la taca, l’ombra, els ritmes, la composició, la llum... Donar forma a tots aquests coneixements que he anat adquirint al llarg de la carrera en una sèrie de tres peces, amb el pretext de la parella, amb el qual puc treballar la composició de dos elements i la introspecció en la intimitat d’aquests subjectes.[eng] This project is developed in the field of drawing, I have researched the problems in my artworks’ composition, analysing the representation of love in contemporary drawing. Additionally, I will resolve the issues that arise at the expositional level, developing expressive pieces of art, intended to provoke a reaction amongst the public. This project features extensive research into graphic design: the treatment of textures, stains, shadows, rhythms, composition and lighting. I aim to apply the knowledge I acquired throughout my career, giving shape to a set of three artworks, revolving around couples and seeking to portray the beauty of intimacy between lovers

El dibujo, la emoción del proyecto

[ES] En la Historia de la representación gràfica aplicada a la construcción, el dibujo aparece como el mecanismo intelectual por el que el creador o proyectista puede imaginar los espacios y los sistemas constructivos de lo que, con posterioridad, acabará  constituyendo una obra ejecutada en su dimesión real. La técnica del dibujo ha permitido a lo largo de los siglos una definición progresivamente más precisa de las estrategias y tecnologías de la construcción, así como en cada momento ha reflejado la sensibilidad, la capacidad tecnológica, la economía y el estilo de la época. Por lo tanto, desde los trazados clásicos, pasando por la documentación de los esquemas constructivos, especialmente desde la época gótica, podemos reconocer en los dibujos la creatividad y habilidad de los constructores de espacios e infraestructuras.Pla I Masmiquel, A. (2009). El dibujo, la emoción del proyecto. EGE Revista de Expresión Gráfica en la Edificación. 0(6):61-70. https://doi.org/10.4995/ege.2009.12517OJS61700

Impact of COVID-19 lockdown on non-alcoholic fatty liver disease and insulin resistance in adults: a before and after pandemic lockdown longitudinal study

Background: Non-alcoholic fatty liver disease is a chronic disease caused by the accumulation of fat in the liver related to overweight and obesity, insulin resistance, hyperglycemia, and high levels of triglycerides and leads to an increased cardiovascular risk. It is considered a global pandemic, coinciding with the pandemic in 2020 caused by the 'coronavirus disease 2019' (COVID-19). Due to COVID-19, the population was placed under lockdown. The aim of our study was to evaluate how these unhealthy lifestyle modifications influenced the appearance of metabolic alterations and the increase in non-alcoholic fatty liver disease. Methods: A prospective study was carried out on 6236 workers in a Spanish population between March 2019 and March 2021. Results: Differences in the mean values of anthropometric and clinical parameters before and after lockdown were revealed. There was a statistically significant worsening in non-alcoholic fatty liver disease (NAFLD) and in the insulin resistance scales, with increased body weight, BMI, cholesterol levels with higher LDL levels, and glucose and a reduction in HDL levels. Conclusions: Lockdown caused a worsening of cardiovascular risk factors due to an increase in liver fat estimation scales and an increased risk of presenting with NAFLD and changes in insulin resistance. Keywords: COVID-19; insulin resistance; non-alcoholic fatty liver disease

Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Epidemiologia; ComparacióCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Epidemiología; ComparaciónCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Epidemiology; ComparisonA description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection.Objective: We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. Methods: This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020.Results: The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike.This work was supported by grants from the European Union ERDF funds (Network for Prevention and Health Promotion in Primary Care, RedIAPP–CARDIOCAT; RD16/0007/0004) and from the Agency for Management of University and Research Grants (AGAUR; 2017-SGR 1146). We thank Eric Tornabell for his technical support. We also thank all health care professionals for their ceaseless work to care for COVID-19 patients in this pandemic

Characteristics of patients with type 2 diabetes mellitus newly treated with GLP-1 receptor agonists (CHADIG Study): a cross-sectional multicentre study in Spain

Objective: Several glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1Ra) have been made recently available in Spain for type 2 diabetes mellitus (DM2) treatment. There are no published data on the clinical and sociodemographic profile of patients initiating treatment with GLP-1Ra in Spain. Our objective was to understand these patients' characteristics in a real-world clinical practice setting. Design: Cross-sectional observational study. Setting: Spanish specialist outpatient clinics. Participants: 403 adults with DM2 initiating GLP-1Ra treatment were included. Primary and secondary outcome measures: Sociodemographic and DM2-related clinical data, including treatment at and after GLP-1Ra initiation and comorbidities, were collected. Results: Evaluable patients (n=403; 50.9% female) were included ( July 2013 to March 2014) at 24 centres by 53 specialists (47 endocrinology, 6 internal medicine), with the following profile (value±SD): age (58.3±10.4 years), diabetes duration (9.9±7 years), body mass index (BMI; 36.2±5.5) and glycated haemoglobin (HbA1c; 8.4±1.4%); 14% had HbA1c≤7%. Previous antidiabetic treatment: 53.8% only oral antidiabetic drugs (OADs), 5.2% insulin and 40% insulin and OAD; of those receiving OAD, 35% single drug, 38.2% 2 drugs and 24% 3 drugs. Concomitant to GLP-1Ra, 55.3% were only on OAD, 36.2% on insulin and OAD, and 7.2% only on insulin. Of those receiving OAD, the GLP-1Ra was mainly associated with 1 drug (65%) or 2 drugs (31.8%). GLP-1Ra are frequently added to existing antidiabetic drugs, with dipeptidyl peptidase-4 inhibitors being the OAD most frequently switched (45% receiving 1 before starting GLP-1Ra, only 2.7% receiving it concomitantly). Conclusions: In Spain, GLP-1Ra therapy is usually started in combination with OADs or OADs and insulin. These drugs are used in relatively young patients often not reaching therapeutic goals with other treatment combinations, roughly a decade after diagnosis and with a relatively high BMI. The latter could be explaine

GDF15 and ACE2 stratify COVID-19 patients according to severity while ACE2 mutations increase infection susceptibility

Coronavirus disease 19 (COVID-19) is a persistent global pandemic with a very heterogeneous disease presentation ranging from a mild disease to dismal prognosis. Early detection of sensitivity and severity of COVID-19 is essential for the development of new treatments. In the present study, we measured the levels of circulating growth differentiation factor 15 (GDF15) and angiotensin-converting enzyme 2 (ACE2) in plasma of severity-stratified COVID-19 patients and uninfected control patients and characterized the in vitro effects and cohort frequency of ACE2 SNPs. Our results show that while circulating GDF15 and ACE2 stratify COVID-19 patients according to disease severity, ACE2 missense SNPs constitute a risk factor linked to infection susceptibility

Standardized incidence ratios and risk factors for cancer in patients with systemic sclerosis: Data from the Spanish Scleroderma Registry (RESCLE)

Aim: Patients with systemic sclerosis (SSc) are at increased risk of cancer, a growing cause of non-SSc-related death among these patients. We analyzed the increased cancer risk among Spanish patients with SSc using standardized incidence ratios (SIRs) and identified independent cancer risk factors in this population. Material and methods: Spanish Scleroderma Registry data were analyzed to determine the demographic characteristics of patients with SSc, and logistic regression was used to identify cancer risk factors. SIRs with 95% confidence intervals (CIs) relative to the general Spanish population were calculated. Results: Of 1930 patients with SSc, 206 had cancer, most commonly breast, lung, hematological, and colorectal cancers. Patients with SSc had increased risks of overall cancer (SIR 1.48, 95% CI 1.36-1.60; P < 0.001), and of lung (SIR 2.22, 95% CI 1.77-2.73; P < 0.001), breast (SIR 1.31, 95% CI 1.10-1.54; P = 0.003), and hematological (SIR 2.03, 95% CI 1.52-2.62; P < 0.001) cancers. Cancer was associated with older age at SSc onset (odds ratio [OR] 1.22, 95% CI 1.01-1.03; P < 0.001), the presence of primary biliary cholangitis (OR 2.35, 95% CI 1.18-4.68; P = 0.015) and forced vital capacity <70% (OR 1.8, 95% CI 1.24-2.70; P = 0.002). The presence of anticentromere antibodies lowered the risk of cancer (OR 0.66, 95% CI 0.45-0.97; P = 0.036). Conclusions: Spanish patients with SSc had an increased cancer risk compared with the general population. Some characteristics, including specific autoantibodies, may be related to this increased risk