Sarcopenic obesity (SO) is defined as a combination of low strength and muscle mass along with excess adiposity. Our study aimed to determine the prevalence of sarcopenic obesity in candidates for ...bariatric surgery, according to ESPEN/EASO criteria using bioimpedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA).
Retrospective study of adult patients (18–60 years) candidates for bariatric surgery (BMI ≥40 kg/m2 or ≥35 kg/m2 with associated complications). Adiposity was assessed by the percentage of fat mass by DXA, according to Gallagher's cut-off points. Muscle strength was measured by hand grip according to Sánchez-Torralvo, Dodds, and <-2SD cut-off points of healthy reference population. Muscle mass was determined by DXA (ALM/weight according to Batsis) and by BIA (SMM/weight according to Janssen and according to reference population). In addition, the agreement of the different diagnostic methods of sarcopenic obesity was analyzed.
A total of 124 subjects were included in the study, with 71.8 % being women. The overall mean age was 42.6 (SD 8.9) years. SO prevalence was found to be 13 %–22 % applying BIA with the SMM/weight equation according to Janssen, 14 %–23 % utilizing BIA with the SMM/weight equation according to the reference population, and 13 %–23 % employing DXA with the ALM/weight equation following Batsis criteria, depending on the specific hand grip strength cut-off points used. In general, we found good or very good concordances with the different diagnostic methods (with kappa values between 0.6 and 0.97).
The prevalence of SO according to ESPEN/EASO criteria in candidates for bariatric surgery was 13 %–23 % based on the diagnostic method and cut-off points used.
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Introduction
COVID‐19 has a wide spectrum of clinical severity and there is evidence that SARS‐Cov2 affects several organs and systems. Among the organs affected since the beginning of the pandemic, ...the relationship between SARS‐CoV‐2 infection and thyroid involvement has been demonstrated. Novel and highly effective messenger RNA and DNA‐based vaccines have been rapidly developed to decrease SARS‐CoV‐2 morbidity and mortality. Early after mass vaccinations, cases of thyroid dysfunction mainly including episodes of subacute thyroiditis, began to be reported like adverse effects. The objective of this study is to determine the impact of the pandemic, both due to SARS‐CoV2 infections and vaccinations, on the incidence of Graves' disease (GD).
Methods
Cross‐sectional, observational study comparing incidence of GD in adult population (over 18 years) before (2017–2019) and after (2020–2021) Covid‐19 pandemic. Only patients with new cases of GD, no relapsed diseases, were included. SARS‐CoV‐2 diagnosis was based on nucleic acid amplification tests on nasopharyngeal swabs or measurement of class M and class G antibodies to SARS‐CoV‐2 by highly specific assays. Data on incidence and vaccination related to SARS‐CoV‐2 infection were obtained from the public records from Castilla y León autonomous regional government.
Results
A total of 180 subjects were diagnosed and treated for GD during the study period. We observed a notable increase in expected GD cases in 2021 compared to 2017–19. The number of GD cases was higher in the second (Q2) quarter. Among 2021 GD cases, 42/66 patients (63.6%) had been vaccinated in the 90 days before symptom onset, but none of them in the first quarter of the year. A total of 97.7% were women with a mean age of 48.9 (SD 15.6) years. On average they were diagnosed 19.9 (SD 17.6) days after receiving the vaccine. A total of 7/42 (16.67%) had another previously diagnosed autoimmune disease and 11/42 (26.19%) were smokers.
Discussion
Our results show a notable increase in the incidence of GD during the year 2021, specially in women with a history of smoking. Hyper activation of the immune system induced by SARS‐CoV2 and by the recently released SARS‐COV‐2 vaccines has been highlighted in recent months. To assess whether this observed increase in the incidence of GD is sustained in the coming years or has simply been a precipitous trigger for individuals who were already predisposed to develop the disease, future studies will be needed.
Central adrenal insufficiency (AI) due to isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) has been recently associated with immune checkpoint inhibitor (ICI) therapy. Our aim was to ...analyze the prevalence, clinical characteristics, and therapeutic outcomes in cancer patients with IAD induced by ICI therapy. A retrospective and multicenter study was performed. From a total of 4447 cancer patients treated with ICI antibodies, 37 (0.8%) (23 men (62.2%), mean age 64.7 ± 8.3 years (range 46-79 years)) were diagnosed with IAD. The tumor most frequently related to IAD was lung cancer (n = 20, 54.1%), followed by melanoma (n = 8, 21.6%). The most common ICI antibody inhibitors reported were nivolumab (n = 18, 48.6%), pembrolizumab (n = 16, 43.2%), and ipilimumab (n = 8, 21.6%). About half of the patients (n = 19, 51.4%) had other immune-related adverse events, mainly endocrine adverse effects (n = 10, 27.0%). IAD was diagnosed at a median time of 7.0 months (IQR, 5-12) after starting immunotherapy. The main reported symptom at presentation was fatigue (97.3%), followed by anorexia (81.8%) and general malaise (81.1%). Mean follow-up time since IAD diagnosis was 15.2 ± 12.5 months (range 0.3-55 months). At last visit, all patients continued with hormonal deficiency of ACTH. Median overall survival since IAD diagnosis was 6.0 months. In conclusion, IAD is a rare but a well-established complication associated with ICI therapy in cancer patients. It develops around 7 months after starting the treatment, mainly anti-PD1 antibodies. Recovery of the corticotropic axis function should not be expected.
Introduction
Obesity is a chronic disease associated with other comorbidities, including atherogenic dyslipidemia (AD). Bariatric surgery (BS) has shown to reduce cardiovascular risk (CVR) by ...achieving a significant weight reduction and improving the lipid profile. Different surgical techniques may have a different effect on the lipoprotein profile.
Purpose
To evaluate the lipid profile at 3 years after BS according to the surgical technique used and to determine which variables predict variation in the lipid profile at 3 years after BS.
Methods
Retrospective observational study of 206 patients who underwent BS between 2010 and 2019. We analyzed the variation of lipid parameters in the 3 years of follow-up according to the surgical technique, including a group analysis of patients according to whether they had dyslipidemia and whether they were treated or untreated and determined which variables predict variation in the lipid profile at 3 years after BS.
Results
There was a significant increase in high-density lipoprotein cholesterol (HDL-c) with sleeve gastrectomy (SG) and a significant decrease in total cholesterol (TC), LDL-cholesterol (LDL-c), non-HDL, and LDL/non-HDL with biliopancreatic diversion (BPD). Variables predicting lipid profile variation were surgical technique and pre-surgery lipoprotein level.
Conclusions
Malabsorptive techniques achieve a greater decrease in TC and LDL-c throughout follow-up and could also improve residual cardiovascular risk (non-HDL and LDL/non-HDL). The type of surgical technique and the presurgery lipid profile predict variation after 3 years of BS.
Graphical abstract
Obesity is a challenge for bioelectrical impedance analysis (BIA) estimations of skeletal muscle and fat mass (FM), and none of the equations used for appendicular lean mass (ALM) have been developed ...for people with obesity. By using different equations and proposing a new equation, this study aimed to assess the estimation of FM and ALM using BIA compared with dual-energy x-ray absorptiometry (DXA) as a reference method in a cohort of people with severe obesity.
This cross-sectional study compared a multifrequency BIA (TANITA MC-780A) versus DXA for body composition assessment in adult patients with severe obesity (body mass index BMI of >35 kg/m2). Comparisons between measured (DXA) and predicted (BIA) data for FM and ALM were performed using the original proprietary equations of the device and the equations proposed by Kyle, Sergi, and Yamada. Bland-Altman plots were drawn to evaluate the agreement between DXA and BIA, calculating bias and limits of agreement (LOA). Reliability was analyzed using intraclass correlation coefficient (ICC). Stepwise multiple regression analysis was used to derive a new equation to predict ALM in patients with obesity and was validated in a subsample of our cohort.
In this study, 115 patients (72.4% women) with severe obesity (mean BMI of 46.1 5.2 kg/m2) were included (mean age 43.5 8.6 y). FMDXA was 61.4 (10.1) kg, FMBIA was 57.9 (10.3) kg, and ICC was 0.925 (P < 0.001). Bias was –3.4 (4.4) kg (–5.2%), and LOA was –14.0, +7.3 kg. Using the proprietary equations, ALMDXA was 21.8 (4.7) kg and ALMBIA was 29.0 (6.8) kg with an ICC 0.868, bias +7.3 (4.0) kg (+34.1%) and LOA –0.5, +15.1. When applying other equations for ALM, the ICC for Sergi, et al. was 0.880, the ICC for Kyle, et al. was 0.891, and the best ICC estimation for Yamada, et al. was 0.914 (P < 0.001). Bias was +2.8 (2.8), +4.1 (2.9), and +2.7 (2.8) kg, respectively. The best-fitting regression equation to predict ALMDXA in our population derived from a development cohort (n = 77) was: ALM = 13.861 + (0.259 x H2/Z) – (0.085 x age) – (3.983 x sex 0 = men; 1 = women). When applied to our validation cohort (n = 38), the ICC was 0.864, and the bias was the lowest compared with the rest of the equations +0.3 (+0.5) kg (+2.7%) LOA –5.4, +6.0 kg.
BIA using multifrequency BIA in people with obesity is reliable enough for the estimation of FM, with good correlation and low bias to DXA. Regarding the estimation of ALM, BIA showed a good correlation with DXA, although it overestimated ALM, especially when proprietary equations were used. The use of equations developed using the same device improved the prediction, and our new equation showed a low bias for ALM.
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•The reliability of bioelectrical impedance analysis for body composition in people with obesity is controversial.•Compared with dual-energy x-ray absorptiometry in 115 people with severe obesity, multifrequency bioelectrical impedance analysis is reliable enough for the estimation of fat mass, with good correlation (intraclass correlation coefficient 0.925) and low bias (–5.2%).•Regarding the estimation of appendicular lean mass, bioelectrical impedance analysis showed a good correlation with dual-energy x-ray absorptiometry, although it overestimated appendicular lean mass when proprietary equations were used.•Equations developed using the same device improved prediction, and a new equation showed a low bias for appendicular lean mass (+2.7%).
Nutrición enteral en síndrome de intestino corto Ariadel Cobo, Diana; Pereira Cunill, José Luis; Socas Macías, María ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
12/2015, Letnik:
32, Številka:
6
Journal Article
Odprti dostop
Lo más característico del presente caso es el manejo nutricional del paciente, que ha logrado evitar la utilización de nutrición parenteral total de forma prolongada y sus posibles complicaciones, ...mediante la administración de una nutrición enteral a través de una sonda yeyunal en el extremo distal de una ileostomía en un paciente con intestino corto severo. Se trata de un hombre de 34 años de edad, con antecedentes de colecistectomía complicada con peritonitis postquirúrgica y dehiscencia, que a los dos años desarrolló un cuadro de obstrucción de intestino delgado, por lo que se realizó devolvulación de intestino delgado que se complicó con dos fugas intestinales en diferentes tiempos; tras la segunda fuga se realizó yeyunostomía lateral en doble cañón de escopeta a nivel de la dehiscencia; presentó altos débitos por el asa aferente de la yeyunostomía terminal; durante el ingreso se insertó una sonda de poliuretano para alimentación enteral por asa eferente de la yeyunostomía. Recibió nutrición enteral por sonda yeyunal colada en el asa eferente con disminución del débito de yeyunostomía proximal terminal y ganancia de peso con posterior reconstrucción del tránsito intestinal.
Background
Bariatric surgery (BS) is a very effective treatment regarding body weight loss but might affect food tolerance and energy and protein intake. The aim of this study was to compare three BS ...techniques (biliopancreactic diversion (BPD), gastric bypass (GB), and sleeve gastrectomy (SG)) and their effect on food tolerance.
Methods
Prospective study conducted between April 2016 and April 2019. Visits included were 1 before and 6, 12, and 24 months after BS. Food tolerance test (FTT), 24-h recall, and bioelectrical impedance (TANITA MC780) were performed at all visits.
Results
Sixty-six patients were included (74.2% women). FTT showed a better self-perception of the intake after surgery in BPD at 6 months (
p
= 0.013), and at 12 months (
p
= 0.006). BPD had a better tolerance of 8 food groups at 6 months (red meat
p
= 0.017, white meat
p
= 0.026, salad
p
= 0.017, bread
p
< 0.001, rice
p
= 0.047, pasta
p
= 0.014, fish
p
= 0.027) and at 12 months, but only red meat (
p
= 0.002), bread (
p
< 0.001), rice (
p
= 0.025), and pasta (
p
= 0.025) remained statistically different. Twenty-four months after surgery, only the red meat food group (
p
= 0.007) showed differences. BPD had the lowest incidence of vomiting at 6 months (
p
< 0.001), 12 months (
p
= 0.008), and 24 months (
p
= 0.002). The total score of FTT was better in BPD at 6 months 25.6 (SD 1.5),
p
< 0.001, 12 months 25.6 (SD 2.4),
p
< 0.001, and 24 months 25.7 (SD 1.3),
p
= 0.001. BPD showed the best intake in energy and proteins at 6 months 1214.8 (SD 342.4) kcal and 67.1 (SD 18.4) g and 12 months 1199.6 (SD 289.7) kcal and 73.5 (SD 24.3) g. % FML was higher in GB both at 6 and 12 months being statistically different (
p
< 0.050).
Conclusion
Biliopancreatic diversion appears to be the technique with a better food tolerance and protein and energy intake in the first year of follow-up after BS.
Graphical Abstract
Assessment of low muscle mass and strength in a control population González Arnáiz, Elena; Ballesteros Pomar, María D; Pintor de la Maza, Begoña ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2023-Feb-15, Letnik:
40, Številka:
1
Journal Article
Odprti dostop
Background and aims: low muscle mass (LMM) conditions the nutritional status of an individual and has implications for quality of life and prognosis. The aim of this study was to evaluate body ...composition and determine normal values in the diagnosis of LMM in a control group of healthy individuals. Methods: a cross-sectional study of healthy volunteers aged 18 to 45 years with body mass index (BMI) < 30 kg/m2. A descriptive study was performed including demographic, clinical, anthropometric, and body composition variables (by bioimpedance, TANITA MC 780 MA; TANITA, Tokyo, Japan), stratified by age, sex and BMI. Values corresponding to -1/-2 standard deviations (SD) were determined to consider low muscle mass/function. Results: we included 67 patients, 71,60 % women, with a median age of 28.29 (IQR 4.05) years. Males presented higher weight, BMI, fat-free mass (FFM), muscle mass (MM), appendicular lean mass (ALM), appendicular lean mass index (ALMI), and dynamometry values when compared to females. The -1/-2 SD values of the various muscle parameters were determined according to sex. Conclusion: this study determined normal LMM values in healthy and young people, and the most commonly used indexes to express it, which will allow the diagnosis of LMM in disease-related situations using the corresponding -2 DS value.
Valoración de la baja masa y fuerza muscular en una población de control González Arnáiz, Elena; Ballesteros Pomar, María Dolores; Pintor de la Maza, Begoña ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
02/2023, Letnik:
40, Številka:
1
Journal Article
Odprti dostop
Resumen Introducción y objetivos: la baja masa muscular (BMM) condiciona el estado nutricional de un individuo y tiene implicaciones en la calidad y el pronóstico de vida. El objetivo de este trabajo ...fue evaluar la composición corporal y determinar los valores de normalidad en el diagnóstico de BMM en un grupo de control de individuos sanos. Material y método: estudio transversal de voluntarios sanos con edades entre 18 y 45 años, con un índice de masa corporal (IMC) < 30 kg/m2. Se realizó un estudio descriptivo incluyendo variables demográficas, clínicas, antropométricas y de composición corporal (mediante bioimpedancia, TANITA MC 780 MA; TANITA, Tokio, Japón), con estratificación por edad, sexo e IMC. Se determinaron los valores correspondientes a -1/-2 desviaciones estándar (DE) para considerar una baja masa/función muscular. Resultados: se incluyeron 67 pacientes, el 71,60 % mujeres, con una mediana de edad de 28,29 (RIC: 4,05) años. Los varones presentan mayor peso, IMC, masa libre de grasa (MLG), masa muscular (MM), masa muscular apendicular (MMA), índice de masa muscular apendicular (IMMA) y dinamometría con respecto a las mujeres. Se determinaron los valores de -1/-2 DE de los distintos parámetros musculares en función del sexo. Conclusiones: este estudio determina los valores normales de BMM en una población sana y joven de nuestro medio, y los índices más empleados para expresarla, lo que permitirá diagnosticar la BMM en situaciones patológicas empleando el valor correspondiente a -2 DE.
A clinical case of bullous pemphigoid induced by vildagliptin González Arnáiz, Elena; Olmos Nieva, Claudia; Ariadel Cobo, Diana ...
Endocrinología, diabetes y nutrición.,
November 2020, 2020-Nov, 2020-11-00, Letnik:
67, Številka:
9
Journal Article
