Comparación de la utilidad de dos dietas hipocalóricas equilibradas con inclusión versus exclusión de pan en el tratamiento de pacientes con sobrepeso y obesidad

Tesis doctoral inédita realizada en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 9 de Diciembre de 2010

Importancia del equilibrio del índice omega-6/omega-3 en el mantenimiento de un buen estado de salud: recomendaciones nutricionales

The modification of dietary patterns has led to a change in fatty acid consumption, with an increase in the consumption of -6 fatty acids and a markerd reduction in the consumption of -3 fatty acids. This in turn has given rise to an imbalance in the -6/ -3 ratio, which is now very different from the original 1:1 ratio of humans in the past. Given the involvement of -6 and -3 essential fatty acids in disease processes, the present article examines changes in dietary patterns that have led to the present reduction in the consumption of -3 essential fatty acids, and to study the importance of the -6/ -3 balance in maintaining good health. In addition, an assesement is made of the established recommendations for preventing a poor intake of -3 essential fatty acids, and the possible options for compensating the lack of these fatty acids in the dietLa modificación de los hábitos alimentarios ha llevado a un cambio en el consumo de ácidos grasos, con una aumento de los ácidos grasos -6 y una marcada reducción en el consumo de los ácidos grasos -3. Esto a su vez ha dado lugar a un desequilibrio en la relación -6/ -3, muy diferente de la proporción original 1:1 que tenían los seres humanos en el pasado. Dada la importancia de la relación entre los ácidos grasos esenciales -6 y -3 en el desarrollo de diferentes enfermedades, en el presente artículo se examinan los cambios en los hábitos alimentarios que han llevado a la reducción en el consumo de ácidos grasos esenciales -3, y se estudia la importancia de este equilibrio en el mantenimiento de la salud. Además, se realiza una evaluación de las recomendaciones establecidas para prevenir una deficiencia en la ingesta de ácidos grasos esenciales -3, y las posibles opciones para compensar la falta de esos ácidos grasos en la diet

Efficacy evaluation of an oral powder supplement enriched with eicosapentaenoic acid in cancer patients

Introducción: El efecto beneficioso del ácido eicosapentaenoico en pacientes con cáncer está ampliamente descrito sobre todo en lo que respecta a su rol en la caquexia tumoral. Objetivo: Evaluar la eficacia de la administración de un nuevo suplemento oral en polvo con adición de este componente frente a un suplemento líquido estándar en un grupo de pacientes oncológicos. Pacientes y métodos: 61 adultos mayores de 18 años de ambos sexos con cáncer, fueron aleatorizados en dos grupos para recibir durante un mes 600 kcal extras añadidas a su alimentación; uno a través de un suplemento oral en polvo con 1,5 g de ácido eicosapentaenoico/día (RSI) y el otro con un producto líquido estándar (RE). Tanto al inicio como al final del estudio se realizaron las siguientes medidas: valoración global subjetiva generada por el paciente (VGS-gp), parámetros antropométricos (Pliegues, circunferencia del brazo y bioimpedancia), dietéticos (registro alimentario de 72 horas), bioquímicos e inflamatorios (bioquímica básica, citoquinas, prealbúmina y PCR). La calidad de vida fue valorada mediante el cuestionario SF-36. Así mismo se emplearon escalas de percepción sensorial, tolerancia de los productos y motivación y saciedad al comer durante el estudio. Resultados: Finalizaron el estudio 40 pacientes. Tras la intervención ambos grupos mantuvieron sus parámetros antropométricos y aumentaron significativamente la prealbúmina (RSI 16,11 ± 5,66 mg/dl vs 19.81 ± 6.75 mg/dl p < 0,05 y RE 16.55 ± 6.13 mg/dl vs 19.03 ± 5.47 mg/dl p < 0,05). El grupo RSI disminuyó significativamente los valores de interferón gamma (INF- ) (0,99 ± 0,95 vs 0,65 ± 0,92 pg/ml, p < 0,05). Sin embargo, el grupo RE los aumentó al final del estudio (1,62 ± 1,27 vs 2,2 ± 3,19 pg/ml, p < 0,05). No se encontraron diferencias significativas en la sensación de hambre, apetito, saciedad y capacidad de ingesta tras la intervención en ambos grupos. Las puntuaciones del SF-36 mejoraron en ambos grupos. Conclusión: La suplementación durante un mes de un producto en polvo enriquecido con 1,5 g de EPA en una población de pacientes con cáncer, modula positivamente ciertos parámetros inflamatorios. Este producto podría ser una opción nueva a tener en cuenta que podría sumarse a las estrategias de intervención para el tratamiento nutricional del paciente oncológico.Background and objectives: The beneficial effect of eicosapentaenoic acid in cancer patients is widely described especially in relation to its role in tumour cachexia. The aim of the study was to evaluate the efficacy of administration of a new oral powder supplement enriched with eicosapentaenoic acid compared to a standard liquid supplement in cancer patients. Patients and methods: A total of 61cancer patients, aged more than 18 years, were randomized to receive during a month a bonus of 600 kcal/ day to their regular diet with an oral powder supplement enriched with eicosapentaenoic acid (1.5 g) (RSI) or with a standard liquid supplement (RE). The following data were collected at baseline and after one month: the Patient-Generated Subjective Global Assessment (pg-SGA), anthropometric measurements (skin folds, circumferences and bioimpedance), dietary parameters (3-day food record), biochemical and inflammatory parameters (basic biochemistry, cytokines, prealbumin and Reactive C Protein). Quality of life was evaluated using the SF-36 questionnaire. At the end, scales were used to asses sensory perception, tolerance and satiety induced by the products and motivation to eat. Results: 40 patients completed the study. After intervention, anthropometric parameters do not change and prealbumin values increased significantly in both groups (RSI 16.11 ± 5.66 mg/dl vs. 19.81 ± 6.75 mg/dl p < 0.05 and RE 6.13 ± 16.55 mg/dl vs. 19.03 ± 5.47 mg / dl p < 0.05). RSI group significantly decreased interferon gamma (INF- ) values (0.99 ± 0.95 vs. 0.65 ± 0.92 pg/ml, p < 0.05). In contrast, RE group increased INF- after intervention (1.62 ± 1 27 vs. 2.2 ± 3.19 pg/ml, p < 0.05). There were no significant differences in hunger, appetite, satiety and intake capacity in both groups. The SF-36 scores improved in both groups. Conclusions: Supplementation based on an oral powder formula enriched with 1.5g EPA during one month in cancer patients improved certain inflammatory parameters. This product may be a novel and valuable option to be added to the nutritional intervention strategies used for cancer patients.Este estudio fue financiado por Nestlé Health Care Nutrition SA pero no tuvo intervención en el desarrollo del diseño del estudio, la recolección de los datos, el análisis estadístico, la interpretación de los resultados, la redacción ni publicación de este artícul

Estudio piloto sobre el efecto de la suplementación con ádico fólico en la mejor de los niveles de homocisteína, función cognitiva y estado depresivo en trastornos de la conducta alimentaria

Background & aims: Several authors have reported low folate intake in patients with eating disorders (ED). This vitamin plays an essential role in synthesis reactions for neurotransmitters and structural elements of neurons, and therefore its deficiency has been associated with the presence of different disorders linked to mental function. The aim of this study was to determine the effect of folic acid supplementation on homocysteine levels and the cognitive and depressive status of a group of patients with eating disorders with low folate intake. Subjects/methods: The study was designed as a randomised, prospective clinical trial, which included 24 participants assigned to two treatment groups for six months: supplemented group (SG) (10 mg/day of folic acid [ACFOL®]) and a placebo group (PG). Both groups maintained their medical, dietary and psychological treatment. At baseline and end of the intervention, anthropometric, dietary and biochemical parameters (plasma homocysteine [Hcy], serum and red blood cell folate) were recorded. Cognitive and depressive status questionnaires were administered (Stroop Test, Trail Making Test and Beck Depression Inventory). Results: Twenty-two patients completed the study (SG: 12, PG: 10, mean age: 24.2 ± 8.8 years, BMI 18.9 ± 3.5 kg/m2). The SG significantly increased their serum and red blood cell folate levels and lowered Hcy levels (9.4 ± 2.4 μmol/l vs. 7.5 ± 1.7 μmol/l, P < 0.01). The SG also significantly improved most of their test scores for cognitive and depressive status. The PG showed no significant changes in any of the evaluated variables. Conclusions: The results show that folic acid supplementation may be used as another tool within the comprehensive and multidisciplinary treatment applied to patients with EDIntroducción y objetivo: Diferentes autores han reportado una baja ingesta de ácido fólico en pacientes con Trastornos de la Conducta Alimentaria (TCA). Esta vitamina desempeña un papel esencial en las reacciones de síntesis de neurotransmisores y elementos estructurales de las neuronas y, por lo tanto, su deficiencia se ha asociado con la presencia de diferentes trastornos relacionados con la función mental. El objetivo de este estudio fue determinar el efecto de la suplementación con ácido fólico sobre los niveles de homocisteína y sobre marcadores de función cognitiva y depresión en un grupo de pacientes con TCA con baja ingesta de ácido fólico. Sujetos y métodos: Estudio clínico randomizado y prospectivo en el que se incluyeron 24 pacientes asignados a dos grupos de tratamiento durante un período de 6 meses: grupo suplementado (SG) (10 mg/día de ácido fólico [ACFOL®]) y grupo placebo (PG). Ambos grupos mantuvieron su tratamiento médico, dietético y psicológico. Al inicio del estudio y tras la intervención se evaluaron parámetros antropométricos, dietéticos y bioquímicos (homocisteína plasmática [Hcy], folato sérico y eritrocitario). Como marcadores de función cognitiva y depresión se administraron diferentes cuestionarios (Test de Stroop, Trail Making Test, BDI: Cuestionario de percepción de función cognitiva). Resultados: Completaron el estudio 22 pacientes (SG: 12, PG: 10, edad media: 24,2 ± 8,8 años, IMC 18,9 ± 3,5 kg/m2). El grupo SG incrementó de forma significativa sus niveles de folato sérico y eritrocitario y redujo el de homocisteína (9,4 ± 2,4 μmol/l vs. 7,5 ± 1,7 μmol/l, P < 0,01). Además, el grupo SG también mejoró significativamente las puntuaciones de los test de función cognitiva y depresión. En el grupo PG, en cambio, no se observaron cambios significativos en ninguna de las variables evaluadas. Conclusiones: Los resultados obtenidos demuestran que la suplementación con ácido fólico podría emplearse como una herramienta más dentro del complejo y multidisciplinario tratamiento que requieren estos paciente

Effect of different exercise modalities plus a hypocaloric diet on inflammation markers in overweight patients

Summary Background & aims Inflammation markers (IM) have been associated with the development of chronic diseases. This study compares the effects on IM of three exercise programs combined with a hypocaloric diet. Methods 119 overweight participants (73 women, 46 men) aged 18–50 years were randomised into four treatment groups: strength training (S; n = 30), endurance training (E; n = 30), combined S + E (SE; n = 30), and a diet and physical activity recommendations group (D; n = 29). Energy intake, anthropometric variables (AV), training variables (VO2peak, strength index, dynamometric strength index [DSI]) and plasma IM were recorded at baseline and after 22 weeks of treatment. Results 84 participants completed the study. At 22 weeks, all groups showed a significantly reduced energy intake (P < 0.001) and improved AV (P < 0.001). VO2peak significantly increased in all groups (P < 0.01). DSI increased in the exercise groups only (P < 0.05). Plasma leptin fell significantly (P < 0.001) in the S and E groups, but not significantly in the SE group (P = 0.029) (no significant differences between these groups). Tumour necrosis factor-α (TNF-α), and C-reactive protein (CRP) concentrations decreased in all groups when examined together, but not when examined separately. No significant differences were seen in interleukin-6 (IL-6). Conclusions Combining strength or endurance training with a hypocaloric diet improved AV and reduced plasma leptin concentrations. No differences were seen between groups in terms of TNF-α, IL-6 or CRP reduction. This trial was registered at clinical trials.gov as NCT01116856. http://clinicaltrials.gov/

The Q223R polymorphism of the leptin receptor gene as a predictor of weight gain in childhood obesity and the identification of possible factors involved

Childhood rapid weight gain during development has been postulated as a predictor of obesity. The objective of this study was to investigate the effect of single nucleotide polymorphisms (SNPs) on the annual weight gain and height growth, as well as identifying possible lifestyle factors involved. (2) Methods: As part of the GENYAL study, 221 children (6–8 years old) of Madrid (Spain) were enrolled. A total of 11 SNPs associated with high childhood body mass indexes (BMIs) were assessed. Anthropometric measurements, dietary and physical activity data, were collected in 2017 and 2018. Bonferroni-corrected linear models were used to fit the data. (3) Results: A significant association between the Q223R LEPR and the weight growth was found, showing a different behavior between GA and GG genotypes (p = 0.001). Regarding lifestyle factors, an interaction between Q223R genotypes and total active weekly hours/week to predict the weight growth (kg/year) was observed (p = 0.023). In all the genotypes, a beneficial effect against rapid weight growth was observed, but the effect size of the interaction was much more significant in homozygous (GG) minor homozygous (β = −0.61 (−0.95, −0.26) versus heterozygous (AG) and wild-type homozygous (AA) genotypes (β = −0.07 (−0.24, 0.09) and β = −0.12 (−0.32, 0.08), respectively). (4) Conclusions: These results may contribute to more personalized recommendations to prevent childhood obesit

Hormonal an inflammatory biomarkers in a group of overweight and obese women

Introducción y Objetivos: Recientemente se ha descubierto que la obesidad es una patología caracterizada por un estado crónico de inflamación leve. El objetivo de este estudio fue describir la situación hormonal e inflamatoria de un colectivo de mujeres con sobrepeso/obesidad. Pacientes y métodos: se incluyeron mujeres > 18 años, con IMC ≥ 25 < 40 kg/m2. Se recogieron datos socio-sanitarios, presión arterial, parámetros antropométricos, de actividad física, estudio bioquímico, hormonal e inflamatorio para determinar la situación hormonal e inflamatoria de un colectivo de mujeres antes del inicio de un tratamiento para el control de peso corporal. Resultados: participaron 104 mujeres con edad media de 48,4 ± 9 años y un IMC de 29,8 ± 3,5 kg/m2. Un 48% de las mujeres estudiadas se encontraba en etapa de menopausia. Un 8,9% presentó hiperinsulinemia. El valor medio obtenido de grhelina fue 38,8 ± 33,6 pg/ml, no se encontró correlación entre sus concentraciones y las variables antropométricas y bioquímicas estudiadas. Los valores medios de PCR, leptina, adiponectina, resistina, IL 6, IL 10 y PAI 1 fueron 3,0 ± 2,7 mg/dl, 36,3 ± 19,5 ng/ml, 8,3 ± 4,5 μg/ml, 24,3 ± 23,2 ng/ml, 51,6 ± 93,6 pg/ml, 10,0 ± 34,2 pg/ml y 22,3 ± 30,6 ng/ml, respectivamente. Estas concentraciones correlacionaron significativamente con diferentes variables antropométricas y bioquímicas, sin embargo, estas correlaciones fueron débiles. Variables como la edad y presencia o no de menopausia o la práctica de actividad física de forma regular no influyeron en los valores medios obtenidos. Las pacientes con obesidad tuvieron valores medios significativamente más elevados que aquellas con sobrepeso, aunque sólo en el caso de la resistina y PAI 1. Conclusión: El grupo de mujeres estudiadas presentó cifras de adipoquinas alteradas en relación a otros estudios realizados en población con situación nutricional normal. Esto pone en evidencia la situación inflamatoria presente en estos pacientes y los valores obtenidos pueden contribuir a establecer unos rangos normalizados de estos marcadores para el colectivo de personas con sobrepeso y obesidadBackground and objectives: The aim of this study was to describe the hormonal and inflammatory status of a group of overweight/obese women. Patients and methods: The sample studied was a crosssectional cohort of women > 18 years of age, BMI ≥ 25 < 40 kg/m2, prior to starting a weight control program. Data collected were: demographic characteristics, blood pressure, anthropometric parameters, physical activity data, and biochemical, hormonal and inflammatory biomarkers. Results: The study involved 104 women with a mean age of 48.4 ± 9 years and a BMI of 29.8 ± 3.5 kg/m2. Some 48% of the women studied were in menopause. Some 8.9% had hyperinsulinemia. The mean ghrelin value was 38.8 ± 33.6 pg/ml; there was no correlation between ghrelin levels and anthropometric and biochemical variables. CRP, leptin, adiponectin, resistin, IL6, IL10, and PAI1 were 3.0 ± 2.7 mg/dl, 36.3 ± 19.5 ng/ml, 8.3 ± 4.5 mg/ml, 24.3 ± 23.2 ng/ml, 51.6 ± 93.6 pg/ml, 10.0 ± 34.2 pg/ml and 22.3 ± 30.6 ng/ml, respectively. Obese patients had significantly higher mean values of resistin and PAI 1 than those who were overweight. These levels correlated significantly with anthropometric and biochemical variables; however, the correlations were weak. Age, menopause or the regular practice of physical activity had no effect on mean values. Conclusions: The group of women studied had altered inflammatory biomarkers in relation to people of normal weight. The study shows the inflammatory status of overweight/ obese individuals, and the values obtained may help to establish standard ranges for these markersEste trabajo ha sido posible gracias a un proyecto de investigación obtenido por concurso y subvencionado por la campaña “Pan cada día” promovida por el Comité Científico del Pan y el Incerhpan (Interprofesional Agroalimentaria de la cadena Cereales-Harina- Pan

Polymorphism of CLOCK gene rs3749474 as a modulator of the circadian evening carbohydrate intake impact on nutritional status in an adult sample

The aim of this study was to evaluate the distribution of energy intake and macronutrients consumption throughout the day, and how its effect on nutritional status can be modulated by the presence of the rs3749474 polymorphism of the CLOCK gene in the Cantoblanco Platform for Nutritional Genomics (“GENYAL Platform”). This cross-sectional study was carried out on 898 volunteers between 18 and 69 years old (65.5% women). Anthropometric measurements, social issues and health, dietary, biochemical, genetic, and physical activity data were collected. Subsequently, 21 statistical interaction models were designed to predict the body mass index (BMI) considering seven dietary variables analyzed by three genetic models (adjusted by age, sex, and physical activity). The average BMI was 26.9 ± 4.65 kg/m2, 62.14% presented an excess weight (BMI > 25 kg/m2). A significant interaction was observed between the presence of the rs3749474 polymorphism and the evening carbohydrate intake (% of the total daily energy intake [%TEI]) (adjusted p = 0.046), when predicting the BMI. Participants carrying TT/CT genotype showed a positive association between the evening carbohydrate intake (%TEI) and BMI (β = 0.3379, 95% CI = (0.1689,0.5080)) and (β = 0.1529, 95% CI = (−0.0164,0.3227)), respectively, whereas the wild type allele (CC) showed a negative association (β = −0.0321, 95% CI = (−0.1505,0.0862)). No significant interaction with the remaining model variables was identified. New dietary strategies may be implemented to schedule the circadian distribution of macronutrients according to the genotyp

Polymorphic appetite effects on waist circumference depend on rs3749474 CLOCK gene variant

Chronobiological aspects controlled by CLOCK genes may influence obesity incidence. Although there are studies that show an association between the expression of these genes and energy intake, waist circumference or abdominal obesity phenotypes, interactions with appetite have been insufficiently investigated in relation to chrononutrition. The objective was to identify interactions between CLOCK genetic variants involved in appetite status. A total of 442 subjects (329 women, 113 men; aged 18 to 65 years) were recruited. Anthropometric, dietary and lifestyle data were collected by trained nutritionists. Participants were classified according to their appetite feelings with a Likert scale. Multiple linear regression models were used to examine associations of the type genotype x appetite status on adiposity-related variables. p values were corrected by the Bonferroni method. A significant influence was found concerning the effects of appetite on waist circumference with respect to rs3749474 CLOCK polymorphism (p < 0.001). An additive model analysis (adjusted by age, gender, exercise and energy intake) showed that risk allele carriers, increased the waist circumference around 14 cm (β = 14.1, CI = 6.3–22.0) by each increment in the level of appetite. The effects of appetite on waist circumference may be partly modulated by the rs3749474 CLOCK polymorphism

Tolerability and Safety of a Nutritional Supplement with Potential as Adjuvant in Colorectal Cancer Therapy: A Randomized Trial in Healthy Volunteers

Bioactive supplements display relevant therapeutic properties when properly applied according to validated molecular effects. Our previous research efforts established the basis to develop a dietary supplement based on a Rosmarinus officinalis supercritical extract. This was enriched in phenolic diterpenes (RE) with proven properties against signaling pathways involved in colon tumorigenesis, and shark liver oil rich in alkylglycerols (AKG) as a bioactive lipid vehicle to improve RE bioavailability and synergize with the potential therapeutic action of the extract. Herein, we have investigated the tolerability and safety of the supplement and the biological and molecular effects from an immuno-nutritional perspective. Sixty healthy volunteers participated in a six week, double-blind, randomized parallel pilot study with two study arms: RE-AKG capsules (CR) and control capsules (CC). Mean age (±SD) of volunteers was 28.32 (±11.39) and 27.5 (±9.04) for the control and the study groups, respectively. Safety of the CR product consumption was confirmed by analyzing liver profile, vital constants, and oxidation markers (LDLox in blood and isoprostanes and thromboxanes in urine). The following were monitored: (1) the phenotyping of plasmatic leukocytes and the ex vivo response of lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMCs); (2) expression of genes associated with immune-modulation, inflammation, oxidative stress, lipid metabolism, and tumorigenesis; and (3) the correlation of selected genetic variants (SNPs) with the differential responses among individuals. The lack of adverse effects on liver profile and oxidation markers, together with adequate tolerability and safe immunological adaptations, provide high-quality information for the potential use of CR as co-adjuvant of therapeutic strategies against colorectal cancer