Profile of free fatty acids (FFA) in serum of young Colombians with obesity and metabolic syndrome

ABSTRACT: Obesity produces greater circulation of free fatty acids (FFA). In adults, the FFA composition changes in states of obesity; in adolescents, the results are contradictory. This study compare the FFA profile of obese youth with and without Metabolic Syndrome (MetS) and explore the association between FFA and metabolic alterations of obesity and MetS. A cross–sectional study with 96 young people between 10 and 18 years old was divided into three groups: 1) obese youth with MetS, 2) obese youth without MetS; and 3) adequate weight (AW), matched according to age, gender, pubertal maturation and socioeconomic stratum. The nutri- tional status was classified according to the body–mass index (BMI), according to the World Health Organization 2007 (WHO, 2007); the waist circumference (WC), adiposity, lipid profile, highly–sensitive reactive C protein (hsRCP), glucose, insulin and insulin resistance (IR), according to the homeostatic model assessment (HOMA Calculator Version 2.2.2). The FFA serum concentration was determined by gas chromatography. Both obese groups had higher adiposity, inflamation (hsRCP), FFA totals and frequency palmitoleic–16:In7, compared to AW. The obese with MetS presented more metabolic alterations, a greater amount of dihomo–γ–linolenic (DHGL-20:3n6) and a 20:3n6/18:2n6 relation, indicative of increased activity of Δ6 desaturase (D6D). The FFA totals, palmitoleic–16:1n7, DHGL–20:3n6, D6D activity and hsRCP significantly correlated with variables of adiposity, IR and triglicerides. The results in obese with MetS corroborate the association among central obesity, inflammation and increased lipolysis in visceral adipose tissue and metabolic alterations.RESUMEN: La obesidad se relaciona con mayor concentración de ácidos grasos libres (AGL) circulantes. En adultos obesos el perfil de AGL difiere comparado con individuos de peso adecuado, en adolescentes los resultados son contradictorios. El objetivo fue comparar el perfil de AGL de jóvenes obesos con y sin Síndrome Metabólico (SM) y explorar la asociación entre estos AGL con las alteraciones metabólicas propias de la obesidad y el SM. Estudio transversal, con 96 jóvenes entre 10 y 18 años divididos en 3 grupos: 1) obesos con SM, 2) obesos sin SM y 3) peso adecuado (PA), pareados uno a uno por edad, sexo, maduración puberal y estrato socioeconómico. El estado nutricional se clasificó según el índice de masa corporal (IMC) en obesos (IMC>p98) y Peso Adecuado (PA) (IMC p15-p85) según OMS/2007, se evaluó circunferencia de cintura, adiposidad, perfil lipídico, proteína C reactiva ultra sensible (PCRhs), glucemia, insulina y resistencia a la insulina (RI) según homeostatic model assessment (HOMA). La concentración sérica de AGL se determinó mediante cromatografía gaseosa. Ambos grupos de obesos presentaron mayor adiposidad, inflamación, AGL totales y frecuencia de palmitoléico-16:1n7 comparados con PA. Los obesos con SM presentaron más alteraciones metabólicas, mayor cantidad de dihomo-γ-linolénico (DHGL-20:3n6) y relación 20:3n6/18:2n6 indicativa de mayor actividad de Δ6 desaturasa (D6D). Los AGL totales, palmitoléico-16:1n7, DHGL-20:3n6, actividad D6D y PCRhs correlacionaron significativamente con variables de adiposidad, RI y triglicéridos. Los resultados en obesos con SM permiten asociar la obesidad central con inflamación, lipolisis aumentada en el tejido adiposo visceral y alteraciones metabólicas

Descripción Manejo de la hiperglicemia en un hospital de primer nivel de atención

Objective: Describe the treatment in a first-level hospital of patients who consulted the emergency department for hyperglycemia, the previous management and its probable relationship with new hyperglycemia.   Materials and methods: Observational cross-sectional study with a one-year follow-up in patients over 18 years of age with hyperglycemia who consulted in the emergency department between September-2016 and August-2017. The medical records were reviewed and sociodemographic, clinical, and pharmacological variables were established. Descriptive statistics, X2 and binary logistic regression models (P <0.05) were used. Results: There were 86 patients with hyperglycemia (mean age 52.1 ± 14.93 years). It was found that in 58.1% of cases there was a previous diagnosis of diabetes mellitus; 87.2% were treated with crystalline insulin and 47.0% of the patients consulted again for a hyperglycemic crisis in the six months after discharge. Conclusion: There is a high proportion of patients with non-ketonic, non-hyperosmolar hyperglycemia who were unaware of having diabetes mellitus. In addition, almost half of the patients consult again for a hyperglycemic attack in the following six months after discharge.Objetivo: Describir el tratamiento en un hospital de primer nivel de pacientes que consultaron el servicio de urgencias por hiperglucemia, el manejo previo y su probable relación con nuevas hiperglucemias. Materiales y métodos: Estudio observacional de corte transversal con seguimiento de un año en pacientes mayores de 18 años con hiperglucemia que consultaron en el servicio de urgencias entre septiembre-2016 y agosto-2017. Se revisaron las historias clínicas y se establecieron variables sociodemográficas, clínicas, y farmacológicas. Se empleó estadística descriptiva, X2 y modelos de regresión logística binaria (P<0.05).   Resultados: Se presentaron 86 pacientes con hiperglucemia (edad media de 52.1±14.93 años).  Se encontró que en el  58,1% de casos había un  diagnóstico previo  de diabetes mellitus; 87,2% fueron tratados con insulina cristalina y el 47,0% de los pacientes consultaron nuevamente por una crisis de hiperglucemia en los seis meses posteriores al egreso.   Conclusión: Existe  alta proporción de pacientes con hiperglucemias no cetónicas, no hiperosmolares que desconocían presentar diabetes mellitus. Además, casi la mitad de los pacientes consultan nuevamente por crisis de  hiperglucemia  en los siguientes seis meses después del alta

Descripción Manejo de la hiperglicemia en un hospital de primer nivel de atención

Objective: Describe the treatment in a first-level hospital of patients who consulted the emergency department for hyperglycemia, the previous management and its probable relationship with new hyperglycemia.   Materials and methods: Observational cross-sectional study with a one-year follow-up in patients over 18 years of age with hyperglycemia who consulted in the emergency department between September-2016 and August-2017. The medical records were reviewed and sociodemographic, clinical, and pharmacological variables were established. Descriptive statistics, X2 and binary logistic regression models (P <0.05) were used. Results: There were 86 patients with hyperglycemia (mean age 52.1 ± 14.93 years). It was found that in 58.1% of cases there was a previous diagnosis of diabetes mellitus; 87.2% were treated with crystalline insulin and 47.0% of the patients consulted again for a hyperglycemic crisis in the six months after discharge. Conclusion: There is a high proportion of patients with non-ketonic, non-hyperosmolar hyperglycemia who were unaware of having diabetes mellitus. In addition, almost half of the patients consult again for a hyperglycemic attack in the following six months after discharge.Objetivo: Describir el tratamiento en un hospital de primer nivel de pacientes que consultaron el servicio de urgencias por hiperglucemia, el manejo previo y su probable relación con nuevas hiperglucemias. Materiales y métodos: Estudio observacional de corte transversal con seguimiento de un año en pacientes mayores de 18 años con hiperglucemia que consultaron en el servicio de urgencias entre septiembre-2016 y agosto-2017. Se revisaron las historias clínicas y se establecieron variables sociodemográficas, clínicas, y farmacológicas. Se empleó estadística descriptiva, X2 y modelos de regresión logística binaria (P<0.05).   Resultados: Se presentaron 86 pacientes con hiperglucemia (edad media de 52.1±14.93 años).  Se encontró que en el  58,1% de casos había un  diagnóstico previo  de diabetes mellitus; 87,2% fueron tratados con insulina cristalina y el 47,0% de los pacientes consultaron nuevamente por una crisis de hiperglucemia en los seis meses posteriores al egreso.   Conclusión: Existe  alta proporción de pacientes con hiperglucemias no cetónicas, no hiperosmolares que desconocían presentar diabetes mellitus. Además, casi la mitad de los pacientes consultan nuevamente por crisis de  hiperglucemia  en los siguientes seis meses después del alta

Descripción Manejo de la hiperglicemia en un hospital de primer nivel de atención

Objective: Describe the treatment in a first-level hospital of patients who consulted the emergency department for hyperglycemia, the previous management and its probable relationship with new hyperglycemia.   Materials and methods: Observational cross-sectional study with a one-year follow-up in patients over 18 years of age with hyperglycemia who consulted in the emergency department between September-2016 and August-2017. The medical records were reviewed and sociodemographic, clinical, and pharmacological variables were established. Descriptive statistics, X2 and binary logistic regression models (P <0.05) were used. Results: There were 86 patients with hyperglycemia (mean age 52.1 ± 14.93 years). It was found that in 58.1% of cases there was a previous diagnosis of diabetes mellitus; 87.2% were treated with crystalline insulin and 47.0% of the patients consulted again for a hyperglycemic crisis in the six months after discharge. Conclusion: There is a high proportion of patients with non-ketonic, non-hyperosmolar hyperglycemia who were unaware of having diabetes mellitus. In addition, almost half of the patients consult again for a hyperglycemic attack in the following six months after discharge.Objetivo: Describir el tratamiento en un hospital de primer nivel de pacientes que consultaron el servicio de urgencias por hiperglucemia, el manejo previo y su probable relación con nuevas hiperglucemias. Materiales y métodos: Estudio observacional de corte transversal con seguimiento de un año en pacientes mayores de 18 años con hiperglucemia que consultaron en el servicio de urgencias entre septiembre-2016 y agosto-2017. Se revisaron las historias clínicas y se establecieron variables sociodemográficas, clínicas, y farmacológicas. Se empleó estadística descriptiva, X2 y modelos de regresión logística binaria (P<0.05).   Resultados: Se presentaron 86 pacientes con hiperglucemia (edad media de 52.1±14.93 años).  Se encontró que en el  58,1% de casos había un  diagnóstico previo  de diabetes mellitus; 87,2% fueron tratados con insulina cristalina y el 47,0% de los pacientes consultaron nuevamente por una crisis de hiperglucemia en los seis meses posteriores al egreso.   Conclusión: Existe  alta proporción de pacientes con hiperglucemias no cetónicas, no hiperosmolares que desconocían presentar diabetes mellitus. Además, casi la mitad de los pacientes consultan nuevamente por crisis de  hiperglucemia  en los siguientes seis meses después del alta

Profile of free fatty acids and fractions of phospholipids, cholesterol esters and triglycerides in serum of obese youth with and without metabolic syndrome

ABSTRACT: The study evaluated the profile of circulating fatty acids (FA) in obese youth with and without metabolic syndrome (MetS) to determine its association with nutritional status, lifestyle and metabolic variables. A cross sectional study was conducted in 96 young people, divided into three groups: obese with MetS (OBMS), obese (OB) and appropriate weight (AW). FA profiles were quantified by gas chromatography; waist circumference (WC), fat folds, lipid profile, high-sensitivity C-reactive protein, glucose, insulin, the homeostasis model assessment (HOMA index), food intake and physical activity (PA) were assessed. The OBMS group had significantly greater total free fatty acids (FFAs), palmitic-16:0 in triglyceride (TG), palmitoleic-16:1n-7 in TG and phospholipid (PL); in the OB group, these FAs were higher than in the AW group. Dihomo-gamma-linolenic (DHGL-20:3n-6) was higher in the OBMS than the AW in PL and FFAs. Linoleic-18:2n-6 in TG and PL had the lowest proportion in the OBMS group. WC, PA, total FFA, linoleic-18:2n-6 in TG and DHGL-20:3n-6 in FFAs explained 62% of the HOMA value. The OB group presented some higher proportions of FA and biochemical values than the AW group. The OBMS had proportions of some FA in the TG, PL and FFA fractions that correlated with disturbances of MetS

Abdominal obesity and low physical activity are associated with insulin resistance in overweight adolescents: a cross-sectional study

ABSTRACT: Background: Previous studies have assessed the metabolic changes and lifestyles associated with overweight adolescents. However, these associations are unclear amongst overweight adolescents who have already developed insulin resistance. This study assessed the associations between insulin resistance and anthropometric, metabolic, inflammatory, food consumption, and physical activity variables amongst overweight adolescents. Methods: This cross-sectional study divided adolescents (n = 120) between 10 and 18 years old into 3 groups: an overweight group with insulin resistance (O + IR), an overweight group without insulin resistance (O-IR), and a normal-weight control group (NW). Adolescents were matched across groups based on age, sex, pubertal maturation, and socioeconomic strata. Anthropometric, biochemical, physical activity, and food consumption variables were assessed. Insulin resistance was assessed using homeostatic model assessment (HOMA Calculator Version 2.2.2 from ©Diabetes Trials Unit, University of Oxford), and overweight status was assessed using body mass index according to World Health Organization (2007) references. A chi-square test was used to compare categorical variables. ANOVAs or Kruskal-Wallis tests were used for continuous variables. Multiple linear regression models were used to calculate the probability of the occurrence of insulin resistance based on the independent variables. Results: The risk of insulin resistance amongst overweight adolescents increases significantly when they reach a waist circumference > p95 (OR = 1.9, CIs = 1.3-2.7, p = 0.013) and watch 3 or more hours/day of television (OR = 1.7, CIs = 0.98-2.8, p = 0.033). Overweight status and insulin resistance were associated with higher levels of inflammation (hsCRP ≥1 mg/L) and cardiovascular risk according to arterial indices. With each cm increase in waist circumference, the HOMA index increased by 0.082; with each metabolic equivalent (MET) unit increase in physical activity, the HOMA index decreased by 0.026. Conclusions: Sedentary behaviour and a waist circumference > p90 amongst overweight adolescents were associated with insulin resistance, lipid profile alterations, and higher inflammatory states. A screening that includes body mass index, in waist circumference, and physical activity evaluations of adolescents might enable the early detection of these alterations

Profile of Free Fatty Acids and Fractions of Phospholipids, Cholesterol Esters and Triglycerides in Serum of Obese Youth with and without Metabolic Syndrome

The study evaluated the profile of circulating fatty acids (FA) in obese youth with and without metabolic syndrome (MetS) to determine its association with nutritional status, lifestyle and metabolic variables. A cross-sectional study was conducted in 96 young people, divided into three groups: obese with MetS (OBMS), obese (OB) and appropriate weight (AW). FA profiles were quantified by gas chromatography; waist circumference (WC), fat folds, lipid profile, high-sensitivity C-reactive protein, glucose, insulin, the homeostasis model assessment (HOMA index), food intake and physical activity (PA) were assessed. The OBMS group had significantly greater total free fatty acids (FFAs), palmitic-16:0 in triglyceride (TG), palmitoleic-16:1n-7 in TG and phospholipid (PL); in the OB group, these FAs were higher than in the AW group. Dihomo-gamma-linolenic (DHGL-20:3n-6) was higher in the OBMS than the AW in PL and FFAs. Linoleic-18:2n-6 in TG and PL had the lowest proportion in the OBMS group. WC, PA, total FFA, linoleic-18:2n-6 in TG and DHGL-20:3n-6 in FFAs explained 62% of the HOMA value. The OB group presented some higher proportions of FA and biochemical values than the AW group. The OBMS had proportions of some FA in the TG, PL and FFA fractions that correlated with disturbances of MetS

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable