Obesitat metabòlicament sana, mite o realitat?

Obesitat sana; Paradoxa; Malaties cardiovascularsHealthy obesity; Paradox; Cardiovascular diseasesObesidad sana; Paradoja; Enfermedades cardiovascularesComunicació presentada sobre la paradoxa al voltant de l'obesitat com a estat saludable i la seva percepció real

Hipotermia terapéutica en el neonato con encefalopatía hipóxico-isquémica.

En los países desarrollados, la asfixia periparto afecta a entre 3 y 5 neonatos por cada 1000 nacidos vivos. La consecuente encefalopatía hipóxico isquémica (EHI) moderada o severa es la principal causa en el mundo de muerte, morbilidad neurológica grave y convulsiones en el recién nacido a término, y es responsable de aproximadamente un 20% de los casos de parálisis cerebral en la niñez. En España es una entidad poco frecuente, con una incidencia de, aproximadamente, 0,5 por cada 1000 nacidos vivos. La evidencia actual muestra que la hipotermia terapéutica es un método eficaz y seguro en la encefalopatía hipóxico-isquémica. Bajando 3-4 ºC la temperatura cerebral (ya sea mediante enfriamiento cerebral selectivo o corporal total) se reducen la mortalidad y la discapacidad mayor en los supervivientes. Para obtener dichos beneficios es necesario que el enfriamiento se produzca en las primeras seis horas de vida, y una vez alcanzada la temperatura diana, ha de mantenerse durante setenta y dos horas para iniciar después un recalentamiento lento que ha de durar entre seis y doce horas. La aplicación práctica de esta terapia, desde el estricto control de los ensayos clínicos, ha hecho que aparezcan diversos interrogantes en lo que respecta al reconocimiento precoz de la encefalopatía, criterios de inclusión y exclusión, hipotermia durante el transporte, modalidades y efectos secundarios de la hipotermia, entre otros. Esta revisión pretende ser una puesta al día sobre conceptos útiles en el tratamiento mediante hipotermia de la encefalopatía hipóxico-isquémica. Entidad huérfana de intervenciones terapéuticas específicas durante todo el siglo XX, siendo tratada hasta ahora mediante terapia de soporte en cuidados intensivos. Al objeto de aportar una visión práctica, presentaré un caso clínico que pretende reflejar el manejo del neonato con encefalopatía hipóxico-isquémica grave al que se decide aplicar el tratamiento mediante hipotermia

Assessing motivational stages and processes of change for weight management around bariatric surgery: a multicenter study

[Abstract] Introduction/purpose: The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. Materials/methods: A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. Results: A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. Conclusion: Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge

A Clinical-Genetic Score for Predicting Weight Loss after Bariatric Surgery: The OBEGEN Study

Genética; Obesidad; Pérdida de pesoGenetics; Obesity; Weight lossGenètica; Obesitat; Pèrdua de pesAround 30% of the patients that undergo bariatric surgery (BS) do not reach an appropriate weight loss. The OBEGEN study aimed to assess the added value of genetic testing to clinical variables in predicting weight loss after BS. A multicenter, retrospective, longitudinal, and observational study including 416 patients who underwent BS was conducted (Clinical.Trials.gov- NCT02405949). 50 single nucleotide polymorphisms (SNPs) from 39 genes were examined. Receiver Operating Characteristic (ROC) curve analysis were used to calculate sensitivity and specificity. Satisfactory response to BS was defined as at nadir excess weight loss >50%. A good predictive model of response [area under ROC of 0.845 (95% CI 0.805–0.880), p < 0.001; sensitivity 90.1%, specificity 65.5%] was obtained by combining three clinical variables (age, type of surgery, presence diabetes) and nine SNPs located in ADIPOQ, MC4R, IL6, PPARG, INSIG2, CNR1, ELOVL6, PLIN1 and BDNF genes. This predictive model showed a significant higher area under ROC than the clinical score (p = 0.0186). The OBEGEN study shows the key role of combining clinical variables with genetic testing to increase the predictability of the weight loss response after BS. This finding will permit us to implement a personalized medicine which will be associated with a more cost-effective clinical practice.This research was supported by grants from the “Pla Estratègic de Recerca i Innovació en Salut” (PERIS) 2016–2020 (SLT002/16/00497), the Instituto de Salud Carlos III (PI PI18/00964), Fondos FEDER “Una manera de hacer Europa”), and Menarini España. CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) is an initiative of the Instituto Carlos III

Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry

Background: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. Methods: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. Results: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases. Conclusions: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure

Role of adipose tissue GLP-1R expression in metabolic improvement after bariatric surgery in patients with type 2 diabetes

We aimed to explore the relationship between GLP-1 receptor (GLP-1R) expression in adipose tissue (AT) and incretin secretion, glucose homeostasis and weight loss, in patients with morbid obesity and type 2 diabetes undergoing bariatric surgery. RNA was extracted from subcutaneous (SAT) and visceral (VAT) AT biopsies from 40 patients randomized to metabolic gastric bypass, sleeve gastrectomy or greater curvature plication. Biochemical parameters, fasting plasma insulin, glucagon and area under the curve (AUC) of GLP-1 following a standard meal test were determined before and 1 year after bariatric surgery. GLP-1R expression was higher in VAT than in SAT. GLP-1R expression in VAT correlated with weight (r = -0.453, p = 0.008), waist circumference (r = -0.494, p = 0.004), plasma insulin (r = -0.466, p = 0.007), and systolic blood pressure (BP) (r = -0.410, p = 0.018). At 1 year, GLP-1R expression in VAT was negatively associated with diastolic BP (r = -0.361, p = 0.039) and, following metabolic gastric bypass, with the increase of GLP-1 AUC, (R-2 = 0.46, p = 0.038). Finally, GLP-1R in AT was similar independently of diabetes outcomes and was not associated with weight loss after surgery. Thus, GLP-1R expression in AT is of limited value to predict incretin response and does not play a role in metabolic outcomes after bariatric surgery