Obesidad y alteraciones metabólicas: Factores genéticos y ambientales en población mediterránea española.

RESUMEN INTRODUCCIÓN: La obesidad es una enfermedad metabólica crónica que se define como un exceso de grasa corporal, que suele ir acompañado de un peso superior al considerado como normal para una persona con la misma talla, edad y sexo. La etiología de este síndrome es heterogénea, multifactorial y compleja, caracterizada por el aumento de tejido adiposo, influida por factores metabólicos, fisiológicos, genéticos, celulares, moleculares, culturales y sociales. HIPÓTESIS Y OBJETIVOS: La obesidad es una enfermedad multifactorial, resultado de la interacción entre la susceptibilidad genética y de factores ambientales, entre los cuales la dieta, el ejercicio físico, el estrés, los acontecimientos vitales, así como el consumo de tabaco, de alcohol y de otras drogas, desempeñan un papel fundamental. Además, el exceso de peso actúa como un importante factor etiológico de dislipemias, hipertensión, hiperuricemia y diabetes, fenotipos que confieren un mayor riesgo en las enfermedades cardiovasculares. Conocer la prevalencia de obesidad y sobrepeso en la población general de la Comunidad Valenciana, y analizar las variables del estilo de vida asociadas a la misma. Estimar la contribución genética y ambiental al índice de masa corporal y a las alteraciones del metabolismo lipídico en la población general y en una muestra de obesos de origen hospitalario de la Comunidad Valenciana. MATERIAL Y MÉTODOS: Estudio transversal en una muestra aleatoria de pacientes que acuden al Centro de Salud de Paiporta y al Hospital General de Valencia, en aquellos que de forma voluntaria aceptaron participar en éste. Se les realizaron análisis bioquímicos, genéticos, toma de medidas antropométricas, de tensión arterial y finalmente se les administró un cuestionario sobre datos sociodemográficos, hábitos dietéticos, encuesta alimentaria, antecedentes personales y familiares, ejercicio físico, y otras variables del estilo de vida. Posteriormente se creó una base de datos con el paquete estadístico SPSS, donde se recogieron todas las variables incluidas en el cuestionario, así como las variables analíticas obtenidas, para su análisis estadístico. RESULTADOS: Existe una alta prevalencia, mayor en mujeres, de sobrepeso y obesidad en la población de Atención Primaria de la Comunidad Valenciana. Este exceso de peso corporal se asocia con otras variables del metabolismo lipídico e hidrocarbonado, tensión arterial y otros factores de riesgo cardiovascular. Al estudiar la relación entre los polimorfismos genéticos en los genes candidatos seleccionados, se han obtenido varias asociaciones estadísticamente significativas con las distintas variables antropométricas, con el metabolismo lipídico, con la ingestión de alimentos y hábitos dietéticos, así como con enfermedades relacionadas con la obesidad. Se hallaron interacciones gen-gen entre los polimorfismos analizados entre los genes de la APOE y CETP, leptina y receptor de la leptina, y lipoproteinlipasa y receptor beta 3 adrenérgico. CONCLUSIONES: Existe una gran complejidad de las múltiples contribuciones genéticas y ambientales en la etiología de la obesidad y parámetros relacionados, que es necesario seguir estudiando y analizando desde la integración genómica y ambiental para obtener un mejor conocimiento que posibilite una mayor individualización en la prevención y tratamiento. __________________________________________________________________________________________________INTRODUCTION: Obesity is a chronic metabolic disease with a weight excess. This syndrome is due to some heterogeneous, multifactorial and complex causes. It is characterized by an increased fat tissue and it is influenced by metabolics, physiologicals, genetics, cellular, molecular, cultural and socials factors. HYPOTHESIS AND OBJECTIVES: Obesity is a multifactorial disorder which is the result of the interaction between genetics and environmental factors like diet, physical activity, stress, or smoke, alcohol and drugs consumption. Weight gain is related to lipid disorders, hypertension, diabetes and an increased cardiovascular risk. The aim of this study is to investigate the obesity and overweight prevalence in the general population from the Comunidad Valenciana analizing the associated lifestyle factors, and to estimate the genetic and environmental contribution to the body mass index and to the lipid metabolism in this general population and in an obese group of a hospital population from the Comunidad Valenciana. MATERIAL AND METHODS: A cross-sectional study has been carried out in patients who were consecutively referred to the Primary Care Center of Paiporta and the General Hospital of Valencia. Anthropometrical parameters were measured. Demographic, lifestyle, anthropometric, biochemical and clinical variables were obtained. DNA was extracted and some polymorphisms were determined. Statistical analyses including logistic regression and means comparison were carried out by means of SPSS statistical program. Multivariate regression models with interaction terms were applied to test gene-gene interactions. RESULTS: There is a high prevalence of overweight and obesity in the Primary Care population from Comunidad Valenciana. Excess weight was associated with increased lipid and glucose concentrations, hypertension and others cardiovascular risk factors. Statistically significant associations were found between some polymorphisms with anthropometrics measures, lipid concentrations, food habits and diseases related to obesity. We observed gene-gene interactions between APOE and CETP, leptin and leptin receptor, lipoproteinlipase and beta 3 adrenergic receptor. CONCLUSION: Obesity is produced by the action of complex environmental and genetic factors. It is necessary to study and to analyse this disease from an integration model of the genomic and environmental factors to obtain a better knowledge which can be tailored to an individual prevention and treatment

Papel del médico de familia en el diagnóstico concomitante de mieloma y amiloidosis primaria en una misma paciente. Caso clínico

Multiple Myeloma is a myeloproliferative disorder of plasma cells, which may be complicated with secondary amyloidosis. We report a 48 year old woman consulting to primary care for weight loss and malaise. An initial laboratory study revealed a hypogammaglobulinemia with a monoclonal component and lambda light chains. These results motivated her derivation to hematology: her serum calcium was 11.8 mg/dl, immunofluorescence showed a monoclonal component of lambda chains and urine Bence-Jones protein was positive. A bone marrow biopsy confirmed plasma cell infiltration. A Congo-red stain of a rectal biopsy was positive. The patient was treated with thalidomide, bortezomid and dexamethasone

Quality of dietary fat intake and body weight and obesity in a Mediterranean population: Secondary analyses within the PREDIMED trial

A moderately high-fat Mediterranean diet does not promote weight gain. This study aimed to investigate the association between dietary intake of specific types of fat and obesity and body weight. A prospective cohort study was performed using data of 6942 participants in the PREDIMED trial, with yearly repeated validated food-frequency questionnaires, and anthropometric outcomes (median follow-up: 4.8 years). The effects of replacing dietary fat subtypes for one another, proteins or carbohydrates were estimated using generalized estimating equations substitution models. Replacement of 5% energy from saturated fatty acids (SFA) with monounsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA) resulted in weight changes of −0.38 kg (95% Confidece Iinterval (CI): −0.69, −0.07), and −0.51 kg (95% CI: −0.81, −0.20), respectively. Replacing proteins with MUFA or PUFA decreased the odds of becoming obese. Estimates for the daily substitution of one portion of red meat with white meat, oily fish or white fish showed weight changes up to −0.87 kg. Increasing the intake of unsaturated fatty acids at the expense of SFA, proteins, and carbohydrates showed beneficial effects on body weight and obesity. It may therefore be desirable to encourage high-quality fat diets like the Mediterranean diet instead of restricting total fat intake