Mesa Redonda sobre Interacciones Fármaco-nutrientes. RANF 15 de marzo de 2018

El pasado quince de marzo tuvo lugar una sesión científica titulada Relevancia Clínica de las interacciones de los Alimentos en la Farmacoterapia en la que actuaron como ponentes D. Mariano Madurga Sanz y el Dr. D. José Manuel Martínez Sesmero

La obesidad un grave problema de Salud Pública

Obesity is a complex and multifactorial chronic disease where, several genetic, metabolic, hormonal, social, cultural factors are at work. Their interaction induces a energy intake and expenditure unbalance, originating significant increase in the body fat and weight. In fact a high proportion of adults and relevant of children are already obese in many countries. In this chapter the different classes of obesity are defined, as well as the adequate methods and ranges to be applied in its diagnosis and evaluation. Current mapping of obesity, as well as its negative clinical implications and associations with most prevalent chronic diseases (e.g. Metabolic syndrome) are discussed. According to some estimates the cost of obesity in some countries may represent up to 12% of health cost. The analysis of factors involved in such pandemic origin suggests that rapid and deep social changes have occurred clearly affecting lifestyle and eating habits. Some relevant policies and strategies as the Spanish NAOS born to arrest such growing epidemic are discussed. The analysis of the factors involved in its origin have led to recognize the importance of creating supportive environments for healthier food choices and physical activities in order to guarantee more adequate and healthier lifestyles.La obesidad es una enfermedad multifactorial en la que confluyen múltiples factores de tipo genético, metabólico, hormonal, social, cultural, que de forma coordinada e interactiva originan un desbalance entre el ingreso y el gasto energético, que deja de responder a ajustes corporales, desencadenado a largo plazo una ganancia significativa de la masa grasa y del peso. De hecho en bastantes países del mundo existe una elevadísima proporción de adultos y niños con obesidad. En este capítulo se definen los diferentes tipos de obesidad y los métodos y medidas más adecuados para su evaluación y diagnóstico. Se comenta el mapa actual de la obesidad en el mundo y en España y las consecuencias clínicas de la obesidad en el adulto y en el niño, analizando la contribución del sobrepeso/obesidad a las enfermedades crónicas más prevalentes, con especial mención del Síndrome metabólico. El análisis de los factores implicados señala que el coste de la obesidad puede representar hasta el 12% del gasto sanitario en algunos países. Se señala que la pandemia actual de obesidad ha coincidido con profundos cambios en la población que atañen tanto a la actividad física como a los hábitos alimentarios. Se analizan y comentan algunas de las acciones y estrategias desarrolladas para combatir tal epidemia, destacando entre ellas la estrategia NAOS en España. En estas acciones se ha reconocido la importancia de crear ambientes favorables para potenciar las opciones alimentarias y de actividad física más saludables que garanticen configurar hábitos de vida más correctos

Interacciones adversas de alimentos y medicamentos: tipos, su identificación y actualización

In this publication some central aspects to consider about interactions between food or nutrients and drugs are reviewed. In the clinical investigation of a new drug the possible interactions with food, both physicochemicals and pharmacokinetics (in absorption, metabolic pathways, transport and excretion) and pharmacodynamic (in particular those relevant due to the severity of their effects) should be studied. Its evidence must be collected and described in the drug information (technical data sheets and leaflet). It is essential that any patient in treatment with any of the drugs in which food interactions have been observed receives accurate information on the type of food whose consumption should be avoided or reduced. The healthcare pharmacist must provide this information, reinforced by the Doctor Prescriber and contained in the leaflets of the respective medicinal products. Therefore, any effort to avoid adverse interactions will be futile if a fatal episode is not avoided. Oral intake of medicines mouth should be recommended for ingestion with water, in a generous amount (a glass of 200mL). Ingestion with milk or fruit juices should not be recommended, except for the physician's express indication, depending on the type of medication.Knowledge of food interactions with drugs should be supplemented with pharmacovigilance activities. Thus, the attentive action of the health professional, in general, and the pharmacist and nurse, in particular, should allow identifying new interactions with food, and avoiding the already known ones, since they are the professionals closest to the patient.En esta publicación se revisan aspectos centrales a considerar sobre los diferentes tipos de interacciones entre alimentos y/o nutrientes y fármacos. En la investigación clínica de un nuevo medicamento se deben estudiar las posibles interacciones con alimentos tanto fisicoquímicas como farmacocinéticas (en la absorción, vías metabólicas, transporte y excreción) y farmacodinámicas, en particular aquellas más relevantes por la gravedad de sus efectos. Sus evidencias deben recogerse y describirse en la información del medicamento (fichas técnicas y prospecto).Es fundamental que todo paciente en tratamiento con alguno de los fármacos en los que se hayan observado interaccionescon alimentos reciba información precisa sobre aquellos alimentos que debe evitar/reducir consumir. El farmacéutico asistencial debe proporcionar esta información, reforzando la trasmitida por el médico prescriptor y la contenida en los prospectos de los medicamentos respectivos. Por ello, todo esfuerzo que se haga para evitar las interacciones adversas será inútil si no se consigue evitar un episodio fatal. En las tomas de medicamentos por vía oral debe recomendarse su ingestión con agua, en cantidad generosa (un vaso de 200mL). No se debe recomendar la ingestión con leche o con zumos de frutas, excepto indicación expresa del médico, según el tipo de medicamento.El conocimiento de las interacciones de alimentos con medicamentos se debe complementar con las actividades de farmacovigilancia. Así, la atenta actuación del profesional sanitario, en general, y del farmacéutico y enfermero, en particular, debe permitir identificar nuevas interacciones con alimentos y evitar las ya conocidas, ya que son los profesionales más cercanos al paciente

Metode i važnost ispitivanja oksidacije biljnih ulja, masti i lipoproteina pomoću lipaze pankreasa i arilesteraze

Fats and oils as major dietary components are involved in the development of chronic diseases. In this paper the physiological relevance and some methodological aspects related to the determination of two enzymes enrolled in metabolism of fat – pancreatic lipase and arylesterase – are discussed. Pancreatic lipase has been extensively used to study the triacylglycerol fatty acid composition and the in vitro digestion of oils and fats. The action of this enzyme may be coupled to analytical methods as GC, HPLC, HPSEC, TLC- -FID, etc. as a useful tool for understanding the composition and digestion of thermal oxidized oils. Pancreatic lipase hydrolysis occurs in the water/oil interface, and it presents a behaviour that seems to be Michaelian, in which the apparent Km and the apparent Vmax of the enzymatic process depend more on the type of oil tested than on the degree of alteration. The kinetic behaviour of pancreatic lipase towards thermally oxidized oils also depends on the presence of natural tensioactive compounds present in the oil and surfactants formed during the frying. Arylesterase is an HDL binding enzyme that inhibits LDL oxidation. Low serum concentration of this enzyme has been related to increased cardiovascular disease risk. In this paper the most widely used methods for the determination of arylesterase activity are commented on. The importance of intrinsic factors (e.g. substrates, cofactors) participating in the enzyme reaction is also discussed. Moreover, several suggestions about further researches on the influence of extrinsic factors (e.g. diet, oxidative stress) upon the enzyme activity are proposed.Masti i ulja, kao glavni sastojci prehrane, uzrok su razvoja nekih kroničnih bolesti. U radu su ispitivani fiziološka važnost i neke metode određivanja dvaju enzima koji sudjeluju u metabolizmu masti, i to lipaze pankreasa i arilesteraze. Lipaza pankreasa vrlo se često koristila u ispitivanju sastava masnih kiselina u triacilglicerolima i u in vitro digestiji ulja i masti. Djelovanje tog enzima može se povezati s analitičkim metodama kao što su GC, HPLC, HPSEC i TLC-FID kako bi se utvrdio sastav i digestija toplinski oksidiranih ulja. Hidrolitsko djelovanje lipaze pankreasa provodi se na granici faza voda/ulje, te se čini da se pokorava Michaelis-Mentenovoj kinetici, u kojoj prividne Km i Vmax vrijednosti enzimskog procesa više ovise o vrsti ispitivanog ulja nego o stupnju hidrolize. Kinetika lipaze pankreasa prema toplinski oksidiranim uljima ovisi također o prisutnosti prirodnih tenzioaktivnih spojeva u ulju i o površinski aktivnim spojevima nastalim tijekom prženja. Arilesteraza je enzim koji veže HDL i time inhibira oksidaciju LDL. Mala koncentracija tog enzima u serumu povezana je s povećanim rizikom kardiovaskularnih bolesti. U radu su prikazane najčešće primijenjeni postupci za određivanje aktivnosti arilesteraze. Ujedno je razmotrena važnost unutarnjih faktora (npr. supstrata, kofaktora) koji sudjeluju u enzimskoj reakciji. Nadalje, predložena su daljnja istraživanja o utjecaju vanjskih faktora (npr. dijeta, oksidativni stres) na aktivnost enzima

Arilesterasa. Aspectos metodológicos y funcionales de una enzima clave en la enfermedad cardiovascular. Parte I

Cardiovascular diseases (CVD) are the first cause of death in developed countries and it is estimated that by 2010 they will also be the leading cause of death in developing countries. Epidemiologic studies have demonstrated that reduction of total serum cholesterol decreases prevalence and death rates associated with ischemic cardiopathy and CVD. Furthermore, a high concentration of LDL is considered a risk factor, while high levels of HDL are thought to be a protective factor. Many authors have suggested that HDL-bound PON1 enzyme may confer the protective effects to HDL. PON1 is an enzyme with several in vitro activities: paraoxonase, arylesterase, and lactonase. It has been reported that PON1 inhibits LDL and HDL peroxidation, as well as it facilitates the cholesterol reverse transport, helping to inhibit the development of atherosclerosis. Its native substrates, its in vivo mechanism of action and its molecular targets in the human body are still unknown. Nevertheless, calorimetric and spectrophotometric methods, very often employed but reaching to low very precise and sensible results, to determine its arylesterase activity have been developed. In this paper several aspects of this enzyme such as the mechanism of action, the regulation by substrates, genes and diet, are reviewed. Moreover, we present a method that uses a serum mimetic buffer that permits to obtain more precise and reproductible results of the arylesterase activity in humans and mice. Furthermore the relationship between PON1 polymorphisms and arylesterase activity is also tested in subjects at increased CVD-risk.Key Words: Arylesterase, atherosclerosis, oxidized-LDL, human serum mimetic, polymorphisms.Las enfermedades cardiovasculares (ECV) suponen la primera causa de muerte en los países desarrollados y se ha estimado que en el año 2010 también liderarán las causas de muerte en los países en vías de desarrollo. Numerosos estudios epidemiológicos han confirmado la relación entre colesterolemia y ECV, postulándose que el descenso de los niveles séricos de colesterol produce una disminución de la incidencia y la prevalencia de muerte por cardiopatía isquémica y ECV. Además se ha demostrado que la concentración elevada de lipoproteínas de baja densidad (LDL) es un factor de riesgo, mientras que la de lipoproteínas de alta densidad (HDL) es un factor protector frente a la ECV. Muchos autores han sugerido que esta acción beneficiosa de las HDL se debe a que unida a su molécula existe una enzima denominada paraoxonasa (PON1). La PON1 es un enzima que presenta varias actividades in vitro: paraoxonasa, arilesterasa, y lactonasa. Parece inhibir la oxidación tanto de las LDL como de las HDL y facilitar el transporte reverso del colesterol, disminuyendo así el riesgo de aterosclerosis. Su mecanismo de acción, propiedades catalíticas y sustratos naturales aun se desconocen. Se han desarrollado algunos métodos espectrofotométricos y calorimétricos para determinar su actividad arilesterasa que aunque muy utilizados no son muy sensibles y los resultados obtenidos no son muy reproducibles. En este trabajo se revisan muchos aspectos centrales referentes a esta enzima: mecanismos de acción, regulación por diferentes sustratos y mecanismos genéticos y dieta. Además se presenta un método que utilizando como tampón un mimético de suero permite obtener resultados más fiables y reproducibles de actividad arilesterasa en humanos y ratones. Por otra parte se detectan posibles efectos de los polimorfismos sobre los valores basales de actividad arilesterasa en individuos con riesgo cardiovascular incrementado.Palabras clave: arilesterasa, aterosclerosis, LDL-oxidada, mimético de suero humano, polimorfismos

Arilesterasa. Aspectos metodológicos y funcionales de una enzima clave en la enfermedad cardiovascular. Parte II

Cardiovascular diseases (CVD) are the first cause of death in developed countries and it is estimated that by 2010 they will also be the leading cause of death in developing countries. Epidemiologic studies have demonstrated that reduction of total serum cholesterol decreases prevalence and death rates associated with ischemic cardiopathy and CVD. Furthermore, a high concentration of LDL is considered a risk factor, while high levels of HDL are thought to be a protective factor. Many authors have suggested that HDL-bound PON1 enzyme may confer the protective effects to HDL. PON1 is an enzyme with several in vitro activities: paraoxonase, arylesterase, and lactonase. It has been reported that PON1 inhibits LDL and HDL peroxidation, as well as it facilitates the cholesterol reverse transport, helping to inhibit the development of atherosclerosis. Its native substrates, its in vivo mechanism of action and its molecular targets in the human body are still unknown. Nevertheless, calorimetric and spectrophotometric methods, very often employed but reaching to low very precise and sensible results, to determine its arylesterase activity have been developed. In this paper several aspects of this enzyme such as the mechanism of action, the regulation by substrates, genes and diet, are reviewed. Moreover, we present a method that uses a serum mimetic buffer that permits to obtain more precise and reproductible results of the arylesterase activity in humans and mice. Furthermore the relationship between PON1 polymorphisms and arylesterase activity is also tested in subjects at increased CVD-risk.Key Words: Arylesterase, atherosclerosis, oxidized-LDL, human serum mimetic, polymorphisms.Las enfermedades cardiovasculares (ECV) suponen la primera causa de muerte en los países desarrollados y se ha estimado que en el año 2010 también liderarán las causas de muerte en los países en vías de desarrollo. Numerosos estudios epidemiológicos han confirmado la relación entre colesterolemia y ECV, postulándose que el descenso de los niveles séricos de colesterol produce una disminución de la incidencia y la prevalencia de muerte por cardiopatía isquémica y ECV. Además se ha demostrado que la concentración elevada de lipoproteínas de baja densidad (LDL) es un factor de riesgo, mientras que la de lipoproteínas de alta densidad (HDL) es un factor protector frente a la ECV. Muchos autores han sugerido que esta acción beneficiosa de las HDL se debe a que unida a su molécula existe una enzima denominada paraoxonasa (PON1). La PON1 es un enzima que presenta varias actividades in vitro: paraoxonasa, arilesterasa, y lactonasa. Parece inhibir la oxidación tanto de las LDL como de las HDL y facilitar el transporte reverso del colesterol, disminuyendo así el riesgo de aterosclerosis. Su mecanismo de acción, propiedades catalíticas y sustratos naturales aun se desconocen. Se han desarrollado algunos métodos espectrofotométricos y calorimétricos para determinar su actividad arilesterasa que aunque muy utilizados no son muy sensibles y los resultados obtenidos no son muy reproducibles. En este trabajo se revisan muchos aspectos centrales referentes a esta enzima: mecanismos de acción, regulación por diferentes sustratos y mecanismos genéticos y dieta. Además se presenta un método que utilizando como tampón un mimético de suero permite obtener resultados más fiables y reproducibles de actividad arilesterasa en humanos y ratones. Por otra parte se detectan posibles efectos de los polimorfismos sobre los valores basales de actividad arilesterasa en individuos con riesgo cardiovascular incrementado.Palabras clave: arilesterasa, aterosclerosis, LDL-oxidada, mimético de suero humano, polimorfismos

XVII Curso Internacional Inmunonutrición en la Salud y el Bienestar

Resúmenes de las conferencias habidas en el XVII Curso Internacional en la Salud y el Bienestar celebrado en Madrid

Whole Alga, Algal Extracts, and Compounds as Ingredients of Functional Foods: Composition and Action Mechanism Relationships in the Prevention and Treatment of Type-2 Diabetes Mellitus

Type-2 diabetes mellitus (T2DM) is a major systemic disease which involves impaired pancreatic function and currently affects half a billion people worldwide. Diet is considered the cornerstone to reduce incidence and prevalence of this disease. Algae contains fiber, polyphenols, ω-3 PUFAs, and bioactive molecules with potential antidiabetic activity. This review delves into the applications of algae and their components in T2DM, as well as to ascertain the mechanism involved (e.g., glucose absorption, lipids metabolism, antioxidant properties, etc.). PubMed, and Google Scholar databases were used. Papers in which whole alga, algal extracts, or their isolated compounds were studied in in vitro conditions, T2DM experimental models, and humans were selected and discussed. This review also focuses on meat matrices or protein concentrate-based products in which different types of alga were included, aimed to modulate carbohydrate digestion and absorption, blood glucose, gastrointestinal neurohormones secretion, glycosylation products, and insulin resistance. As microbiota dysbiosis in T2DM and metabolic alterations in different organs are related, the review also delves on the effects of several bioactive algal compounds on the colon/microbiota-liver-pancreas-brain axis. As the responses to therapeutic diets vary dramatically among individuals due to genetic components, it seems a priority to identify major gene polymorphisms affecting potential positive effects of algal compounds on T2DM treatment.Depto. de Farmacología, Farmacognosia y BotánicaFac. de FarmaciaTRUESpanish Ministry of Education, Culture and Sports (FPU15/02759). Adrián Macho-González received a predoctoral fellowshippu