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

Obesidad: visión actual de una enfermedad crónica

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” . 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” . 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 obesity . In fact, in 2013 the American Medical Association (AMA) recognized obesity as a disease . 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 thEn 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” . 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” . 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 obesidad . De hecho, en 2013 la American Medical Association (AMA), reconoció la obesidad como una enfermedad . 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

Ensayo clínico, controlado con placebo, triple ciego, para evaluar la eficacia de una heparina de bajo peso molecular (bemiparina) en el tratamiento de las úlceras tórpidas del pie diabético, en atención primaria

Objetivos. Establecer el grado de eficacia del tratamiento con bemiparina durante 3 meses en la mejoría de las úlceras tórpidas del pie diabético. Secundariamente se evalúa la seguridad de la bemiparina, la calidad de vida y se compara la evolución de la retinopatía y nefropatía frente a placebo. Diseño. Ensayo clínico fase III de evaluación de eficacia y seguridad en una nueva indicación de un fármaco ya comercializado, paralelo de dos grupos, aleatorizado, triple ciego y controlado con placebo. Emplazamiento. Centros de atención primaria de Mallorca (España). Participantes. Un total de 42 pacientes por grupo, mayores de 18 años, con diabetes mellitus (DM) tipo 1 o 2, de más de 3 años de evolución, y una o más úlceras de grado 1 y 2 de la clasificación de Wagner, distal a la rodilla, que no ha curado en 3 meses de atención sanitaria. Asignación aleatoria por bloques de cuatro. Intervenciones. El fármaco experimental es la bemiparina (heparina de bajo peso molecular), en inyección subcutánea, 3.500 U/día los 10 primeros días y 2.500 U/día hasta los 90 días. Como fármaco de control se utilizó suero fisiológico en inyección subcutánea en volumen similar para su enmascaramiento. Mediciones principales. Se define como «efecto» una reducción en, al menos, un 50% en el área de su superficie y/o variación favorable del estadio en un grado entre el control al iniciar el tratamiento y a los 3 meses. Otras mediciones incluyen proteinuria, retinografías y calidad de vida (SF-36). Se llevó a cabo un análisis de eficacia por principio de intención de tratar

Impact Of Covid-19 lockdown on anthropometric variables, blood pressure, and glucose and lipid profile in healthy adults: a before and after pandemic lockdown longitudinal study

Abstract: In December 2019, 27 cases of pneumonia were reported in Wuhan. In 2020, the caus- 15 ative agent was identified as a virus called SARS-CoV-2. The disease was called 'coronavirus dis- 16 ease 2019' (COVID-19) and was determined a Public Health Emergency. The main measures taken 17 included a state of lockdown. The aim of this study was to assess how the unhealthy lifestyles that 18 ensued influenced different parameters. 19 A prospective study was carried out on 6236 workers in a Spanish population between March 20 2019 and March 2021. Anthropometric, clinical, and analytical measurements were performed, 21 revealing differences in the mean values of anthropometric and clinical parameters before and 22 after lockdown due to the pandemic: increased body weight (41.1 ± 9.9 - 43.1 ± 9.9), BMI 23 (25.1 ± 4.7 - 25.9 ± 4.7), and percentage of body fat(24.5 ± 9.1 - 26.9 ± 8.8); higher total 24 cholesterol levels, with a statistically significantincrease in LDL levels and a reduction in HDL; and 25 worse glucose levels (90.5 ± 16.4 - 95.4 ± 15.8). Lockdown can be concluded to have had a 26 negative effect on health parameters in both sexes in all age ranges, causing a worsening of car- 27 diovascular risk factor

Impact of COVID-19 Lockdown on Anthropometric Variables, Blood Pressure, and Glucose and Lipid Profile in Healthy Adults: A before and after Pandemic Lockdown Longitudinal Study

[eng] In December 2019, 27 cases of pneumonia were reported in Wuhan. In 2020, the causative agent was identified as a virus called SARS-CoV-2. The disease was called "coronavirus disease 2019" (COVID-19) and was determined as a Public Health Emergency. The main measures taken to cope with this included a state of lockdown. The aim of this study was to assess how the unhealthy lifestyles that ensued influenced different parameters. A prospective study was carried out on 6236 workers in a Spanish population between March 2019 and March 2021. Anthropometric, clinical, and analytical measurements were performed, revealing differences in the mean values of anthropometric and clinical parameters before and after lockdown due to the pandemic, namely increased body weight (41.1 ± 9.9-43.1 ± 9.9), BMI (25.1 ± 4.7-25.9 ± 4.7), and percentage of body fat (24.5 ± 9.1-26.9 ± 8.8); higher total cholesterol levels, with a statistically significant increase in LDL levels and a reduction in HDL; and worse glucose levels (90.5 ± 16.4-95.4 ± 15.8). Lockdown can be concluded to have had a negative effect on health parameters in both sexes in all age ranges, causing a worsening of cardiovascular risk factors