Punto de corte de espesor de tejido adiposo epicárdico para predecir síndrome metabólico en población venezolana

ObjectiveTo define an echocardiographically-assessed cut-off point for epicardial adipose tissue (EAT) thickness associated to metabolic syndrome (MS) components in Venezuelan subjects.MethodsFifty-two subjects aged 20-65 years diagnosed with MS according to International Diabetes Federation criteria and 45 sex- and age-matched controls were selected. Blood glucose and plasma lipids were tested; EAT thickness and left ventricular mass were measured by echocardiography.ResultsNo significant age and sex differences were found between the two groups. Body weight, body mass index, waist circumference, and systolic and diastolic blood pressure were significantly higher (P = .0001) in the MS group. This group showed significantly higher levels of fasting blood glucose (P = .0001), total cholesterol (P = .002), LDL-C (P = .007), non-HDL-C (P = .0001), triglycerides (P = .0001), Tg-HDL-C ratio (P = .0001), and lower HDL-C levels (P = .0001) as compared to the control group. EAT thickness (P = .0001) and left ventricular mass (P = .017) were significantly higher in the MS group. The ROC curve showed an AUC of 0.852 (P = .0001) with a power of the test of 0.99. A 5-mm EAT thickness showed a sensitivity of 84.62% (95% CI: 71.9-93.1) and a specificity of 71.11% (95% CI: 55.7-83.6) for predicting MS. The odds ratio of this population for experiencing MS due to an EAT ≥ 5 mm was 8.25 (95% CI: 3.15-21.56; P = .0001).ConclusionAn EAT value ≥ 5 mm has good sensitivity and specificity for predicting MS in the Venezuelan population.     

Efecto metabólico del ejercicio físico regular en la población sana

AimTo assess the effect of moderate regular aerobic physical activity not associated to body weight changes on insulin resistance and the associated metabolic changes in general population.Sujects and methodsA cross-sectional, observational study in an adult population (n=101 sujects aged 30-70 years) with no personal history of disease and with stable weight in the three months prior to the study. The group with regular exercise performed 30-60 minutes of moderate regular physical exercise 5 days per week (7.5-15 hours MET per week), while a control group performed no regular physical excersice and had a sedentary lifestyle. Subjects were age- and sex-matched. Lipids, lipoproteins, and HOMA index were measured using standard methods.ResultsThe group with regular physical activity consisted of 48 subjects (21 male/27 female), while the group with no regular physical activity included 53 subjects (31 male/22 female). No significant differences were found between the groups in age, sex, BMI, waist circunference, and blood presure. Significant differences were found between the groups in fasting serum triglyceride, HDL-C, and apoB levels. Fasting plasma insulin levels (12.1 ± 4.13 vs 14.9 ± 4.8 mU/L, P= .004) and HOMA index (2.8 ± 1.1 vs 3.5±4.1, P= .001) were significantly lower in the group with regular physical activity as compared to the sedentary group. Prevalence rates of metabolic syndrome were 20.7% and 45.8% (P=.01) in the regular physical activity and sedentary groups respectively.ConclusionModerate regular physical activity is associated to higher insulin sensitivity, an improved lipid profile, and a decrease in components of metabolic syndrome with no change in weight or BMI.     

Modulación antioxidante y antiinflamatoria del ejercicio físico durante el envejecimiento

Aging is characterised by a gradual loss of the functional reserve. This, along with the fostering of sedentary habits and the increase in risk factors, causes a deterioration of antioxidant defences and an increase of the circulatory levels of inflammatory and oxidative markers, boosting a low-rate chronic inflammation, defined as inflamm-aging. This phenomenon is present in the aetiopathology of chronic diseases, as well as in cognitive deterioration cases associated with aging. The objective of this review is to describe the modulation of antioxidant and anti-inflammatory effects of physical exercise of moderate intensity and volume in the elderly. Evidence of its effectiveness as a non-pharmacological resource is presented, which decreases some deleterious effects of aging. This is mainly due to its neuroprotective action, the increase in circulating anti-inflammatory markers, and the improvement of antioxidant defence derived from its practice.     

Hígado graso no alcohólico y su asociación con variables clínicas y bioquímicas en niños y adolescentes obesos: efecto de un año de intervención en el estilo de vida

ObjectiveTo study the frequency of non-alcoholic fatty liver disease (NAFLD), its relationship to clinical and biochemical variables, and the effect 12-month's lifestyle intervention in obese children and adolescents.MethodsThirty-six obese patients aged 7 to 18 years, 42% female and 58% male, 72.2% prepubertal and 27.8% pubertal, were selected. Anthropometric measurements and glucose, insulin (baseline and after a glucose load), lipid profile, C-reactive protein, and aminotransferase tests were performed before and 12 months after dietary and physical activity intervention. Liver ultrasound was performed to determine the presence of NAFLD.ResultsNAFLD was found in 66.7% (n = 24), and was mild in 30.6%, moderate in 27.8%, and severe in 8.3%. Subjects with NAFLD had higher body mass index (BMI, p = 0.007), waist (p = 0.005), fat area (p = 0.002), basal insulin (p = 0.01), and HOMA-IR (p = 0.008) values and lower QUICKI (p = 0.02) values than those with no NAFLD. After intervention, physical activity increased (p = 0.0001) and calorie intake remained unchanged. NAFLD disappeared in 9 patients (37.5%, p = 0.02) and disease severity decreased in 3 patients (12.5%). In addition, BMI Z-score (p = 0.005), fat area (p = 0.0001), basal insulin (p < 0.05), insulin resistance (p < 0.005), lipid profile (p < 0.03), and transaminases decreased. Weight loss was the main variable accounting for NAFLD improvement.ConclusionThis group of obese children and adolescents showed a high frequency of NAFLD. The lifestyle intervention with weight reduction is effective for the treatment of NAFLD.     

Grado de control metabólico en una población diabética atendida en servicios de endocrinología

ObjectiveTo determine the degree of control of cardiovascular risk factors (CVRF) in a sample of patients with diabetes mellitus (DM) attending Endocrinology and Nutrition Departments in Spain.Material and methodsAn epidemiological, cross-sectional, multicenter and observational study involving 41 Departments of Endocrinology and Nutrition in Spain. Each department selected patients with DM with over 10 years of evolution, which were treated in outpatient settings. Demographic, anthropometric, clinical and biochemical data, including medication, were collected for each participant.Results1159 patients who met the inclusion criteria were recruited. 52% of the participants were patients with type 2 DM. The mean duration of DM was 19.6 years. A proportion of 37%, 44%, 27.6% and 25.5% had good control of their blood pressure (BP), low density cholesterol (LDLc), lipids and glucose, respectively, and only 4.3% did well in all factors evaluated. The percentage of poorly controlled BP was four times higher in type 2 than in type 1 DM. Obesity, low cultural level and aggregation of cardiovascular risk factors were associated with poorer control.ConclusionsThe degree of control of CVRF in diabetic patients with long disease duration is insufficient.     

Anemia: ¿cuál es su relación con el síndrome de fragilidad en el anciano?

Anaemia is often unexpectedly found, or in a context of investigations into a chest pain, dyspnoea, or weakness. This disorder can be considered an indicator of health status in elderly patients, and has been related to the frailty syndrome. A systematic review was conducted on the studies published in PubMed and Google Scholar databases in the period from January 1999 to May 2019. The search was limited to those studies published regarding anaemia and its relationship to the frailty syndrome. Anaemia seems to be part of the immunosenescence process that can explain frailty syndrome in association with other metabolism, endocrine, and inflammatory disorders. It was unable to be determined if anaemia is responsible for frailty or a result of it.     

Guía para el diagnóstico y tratamiento de la insuficiencia suprarrenal en el adulto

Adrenal insufficiency (AI) is a disease characterized by a deficient production or action of glucocorticoids, with or without deficiency in mineralcorticoids and/or adrenal androgens. It can result from disease intrinsic to the adrenal cortex (primary AI), from pituitary diseases that hamper the release of corticotropin (secondary AI) or from hypothalamic disorders that impair the secretion of the corticotropin-releasing hormone (tertiary AI).It is a disease with a low prevalence but its impact on the affected individual is very high as it can be life-threathening if not treated or lead to health problems if inadequately treated. However, currently there are no specific guidelines for the management of this disease. Therefore, at the proposal of the Spanish Society of Endocrinology and Nutrition (SEEN) board, a task-force under the Neuroendocrinology Knowledge Area of the SEEN was established, with the mandate of updating the diagnosis and treatment of AI. In fulfilment of this mandate the task-force has elaborated the present guide that, based on a comprehensive review of literature, is intended to provide an answer to questions related to the management of this disease. It is, therefore, an essentially practical document, mainly aimed at guiding the health professionals involved in the care of IA patients.     

Revision crítica de la investigación y de la literatura micológica en el uruguay en el período 1946–1956

Sans résumé