Eficacia de la melatonina en insomnio primario en el adulto mayor: revisión sistemática de la literatura

Introducción: La melatonina, una sustancia cronobiótica endógena, es cada vez más empleada para el manejo de los problemas del sueño en adultos mayores por su aparente eficacia y buen perfil de eventos adversos. En este sentido, se intentó evaluar la eficacia de la melatonina en el tratamiento del insomnio primario en el adulto mayor (≥55 años) comparado con benzodiacepinas, zopiclona y placebo a la luz de la evidencia disponible en los últimos cinco años. Métodos: Revisión sistemática de la literatura. Resultados: En comparación con placebo, al parecer la melatonina mejora la calidad y los hábitos de sueño, no así la latencia de inicio de sueño en mediciones subjetivas ni objetivas (polisomnografía); a diferencia de otros medicamentos hipnóticos, no altera la arquitectura del sueño ni genera síntomas diurnos. Conclusiones: No se encontró evidencia que soporte el uso de melatonina en adultos mayores de 55 años para la reducción de la latencia de sueño, aumento del tiempo total de sueño, mejoría de la eficiencia del sueño, disminución de despertares nocturnos o mejoría de la calidad de sueño. Es necesario adelantar más estudios en comparación con placebo y otros medicamentos.

Percepción de calidad de vida relacionada con la salud en pacientes con síndrome de apnea e hipoapnea obstructiva del sueño

El objetivo de esta investigación es describir la calidad de vida y la calidad del sueño en los pacientes con diagnóstico de Síndrome de Apnea Hipoapnea del sueño, mediante el uso de un grupo de cuestionarios para obtener datos demográficos, la evaluación del grado de somnolencia diurna percibida, la percepción de la calidad del sueño y la percepción de la calidad de vida relacionada con la salud con encuestas en sus respectivas versiones validadas para Colombia.

Índice de adiposidad corporal como predictor de obesidad y de síndrome metabólico en adultos de Bogotá, Colombia

Recientemente, Bergman et al. desarrollaron el índice de adiposidad corporal (IAC), como un marcador de obesidad por exceso de grasa corporal en la práctica clínica. En este estudio se evaluó la validez del IAC como marcador de obesidad por exceso de adiposidad, además de examinar la capacidad predictiva del IAC con componentes e índices metabólicos asociados al SM en adultos de Bogotá, Colombia.

Percentiles de circunferencia de cintura en escolares de Bogotá, Colombia Estudio FUPRECOL

Objetivo: Determinar la distribución por percentiles de la circunferencia de cintura en una población escolar de Bogotá, Colombia, pertenecientes al estudio FUPRECOL. Métodos: Estudio transversal, realizado en 3.005 niños y 2.916 adolescentes de entre 9 y 17,9 años de edad, de Bogotá, Colombia. Se tomaron medidas de peso, talla, circunferencia de cintura, circunferencia de cadera y estado de maduración sexual por auto-reporte. Se calcularon los percentiles (P3, P10, P25, P50, P75, P90 y P97) y curvas centiles según sexo y edad. Se realizó una comparación entre los valores de la circunferencia de cintura observados con estándares internacionales. Resultados: De la población general (n=5.921), el 57,0% eran chicas (promedio de edad 12,7±2,3 años). En la mayoría de los grupos etáreos la circunferencia de cintura de las chicas fue inferior a la de los chicos. El aumento entre el P50-P97 de la circunferencia de cintura , por edad, fue mínimo de 15,7 cm en chicos de 9-9.9 años y de 16,0 cm en las chicas de 11-11.9 años. Al comparar los resultados de este estudio, por grupos de edad y sexo, con trabajos internacionales de niños y adolescentes, el P50 fue inferior al reportado en Perú e Inglaterra a excepción de los trabajos de la India, Venezuela (Mérida), Estados Unidos y España. Conclusiones: Se presentan percentiles de la circunferencia de cintura según edad y sexo que podrán ser usados de referencia en la evaluación del estado nutricional y en la predicción del riesgo cardiovascular desde edades tempranas.

Análisis de supervivencia en pacientes con prótesis valvular biológica, Fundación Cardioinfantil-Instituto de Cardiología, Colombia, 2005-2013

Introducción: A partir de la década de los cincuenta el manejo de la enfermedad valvular presenta cambios significativos cuando se incorporan los reemplazos valvulares tanto mecánicos como biológicos dentro de las opciones de tratamiento quirúrgico (1). Las válvulas biológicas se desarrollaron como una alternativa que buscaba evitar los problemas relacionados con la anticoagulación y con la idea de utilizar un tejido que se comportara hemodinámicamente como el nativo. Este estudio está enfocado en establecer la sobrevida global y la libertad de reoperación de la válvula de los pacientes sometidos a reemplazo valvular aórtico y mitral biológicos en la Fundación Cardioinfantil - IC a 1, 3, 5 y 10 años. Materiales y métodos: Estudio de cohorte retrospectiva de supervivencia de pacientes sometidos a reemplazo valvular aórtico y/o mitral biológico intervenidos en la Fundación Cardioinfantil entre 2005 y 2013. Resultados: Se obtuvieron 919 pacientes incluidos en el análisis general y 876 (95,3%) pacientes con seguimiento efectivo para el análisis de sobrevida. La edad promedio fue 64años. La sobrevida a 1, 3, 5 y 10 años fue 95%,90%,85% y 69% respectivamente. El seguimiento efectivo para el desenlace reoperación fue del 55% y se encontró una libertad de reoperación del 99%, 96%, 93% y 81% a los 1, 3, 5 y 10 años. No hubo diferencias significativas entre la localización de la válvula ni en el tipo de válvula aortica empleada. Conclusiones: La sobrevida de los pacientes que son llevados a reemplazo valvular biológico en este estudio es comparable a grandes cohortes internacionales. La sobrevida de los pacientes llevados a reemplazo valvular con prótesis biológicas en posición mitral y aortica fue similar a 1, 3, 5 y 10 años.

Incidencia y factores asociados a infecciones bacterianas en el primer mes postrasplante hepático en la Fundación Cardioinfantil

Introducción: El trasplante hepático ortotópico es la colocación de un nuevo hígado en la misma ubicación del explantado. El objetivo es prolongar la duración y la calidad de vida en pacientes con enfermedades hepáticas terminales. Sin embargo, las infecciones bacterianas son una complicación en los pacientes receptores del trasplante, comprometiendo el éxito del procedimiento. El objetivo fue determinar los factores asociados a infecciones bacterianas en el primer mes tras realizada la intervención y describir las características demográficas de esa población. De 332 trasplantes realizados, que 262 cumplieron criterios para el análisis. Métodos: Se realizó un estudio observacional analítico de casos y controles anidado en una cohorte, en mayores de 18 años, receptores de trasplante hepático primario, de la FCI-IC de 2005 a 2014; excluyendo trasplante combinado hígado riñón, retrasplantes o fallecidos por causa diferente a la infecciosa durante el primer mes. Resultados: Se encontró que la ventilación mecánica por más de 1 día, el catéter venoso central mayor de 3 días son los principales factores de riesgo para infecciones bacterianas. La albúmina mayor de 2,6gr/dl se asoció a menor infección. Los agentes etiológicos predominantes fueron gérmenes gram negativos como E. coli, K. pneumonia y E. cloacae. Mientras que bacteremia, infección urinaria y peritonitis fueron las infecciones más frecuentes. La incidencia de infección bacteriana en esta población fue 24%. Discusión: Se recomienda por tanto extubación antes de 24 horas, uso de catéter central menor de 3 días y limitar el uso del catéter vesical.

Nous factors inflamatoris de la diabetis tipus 2: SP-D, SP-A, a-Defensives i visfatina

La DM 2 és una malaltia multifactorial i multigènica. Aquest fet condueix a l'estudi de molts gens i proteïnes susceptibles d'estar implicades amb la DM 2. Algunes d'aquestes proteïnes i gens estan associats a un estat lleu d'inflamació crònica, la qual pot desencadenar la síndrome metabòlica (SRI) i DM 2. Moltes d'aquestes proteïnes poden usar-se com a possibles marcadors de malaltia cardiovascular, resistència a la insulina i futura DM 2. Aquest treball presenta quatre proteïnes i la seva relació amb la SRI i la DM 2. L'SP-D i l'SP-A s'estudien per la relació que hi ha entre la disminució de la funció pulmonar i la resistència a la insulina i pel fet de ser moduladores de la inflamació. Les α-defensines s'estudien perquè també són moduladores de la inflamació i per una possible relació amb l'arteriosclerosi i el colesterol LDL. La visfatina s'estudia per la possible associació amb la insulinosecreció.

Lipid metabolism in women

Differences in whole-body lipid metabolism between men and women are indicated by lower-body fat accumulation in women but more marked accumulation of fat in the intra-abdominal visceral fat depots of men. Circulating blood lipid concentrations also show gender-related differences. These differences are most marked in premenopausal women, in whom total cholesterol, LDL-cholesterol and triacylglycerol concentrations are lower and HDL-cholesterol concentration is higher than in men. Tendency to accumulate body fat in intra-abdominal fat stores is linked to increased risk of CVD, metabolic syndrome, diabetes and other insulin-resistant states. Differential regional regulation of adipose tissue lipolysis and lipogenesis must underlie gender-related differences in the tendency to accumulate fat in specific fat depots. However, empirical data to support current hypotheses remain limited at the present time because of the demanding and specialist nature of the methods used to study adipose tissue metabolism in human subjects. In vitro and in vivo data show greater lipolytic sensitivity of abdominal subcutaneous fat and lesser lipolytic sensitivity of femoral and gluteal subcutaneous fat in women than in men. These differences appear to be due to fewer inhibitory alpha adrenergic receptors in abdominal regions and greater a adrenergic receptors in gluteal and femoral regions in women than in men. There do not appear to be major gender-related differences in rates of fatty acid uptake (lipogenesis) in different subcutaneous adipose tissue regions. In visceral fat rates of both lipolysis and lipogenesis appear to be greater in men than in women; higher rates of lipolysis may be due to fewer alpha adrenergic receptors in this fat depot in men. Fatty acid uptake into this depot in the postprandial period is approximately 7-fold higher in men than in women. Triacylglycerol concentrations appear to be a stronger cardiovascular risk factor in women than in men, with particular implications for cardiovascular risk in diabetic women. The increased triacylglycerol concentrations observed in women taking hormone-replacement therapy (HRT) may explain the paradoxical findings of increased rates of CVD in women taking HRT that have been reported from recent primary and secondary prevention trials of HRT.

The role of animal nutrition in improving the nutritive value of animal-derived foods in relation to chronic disease

Foods derived from animals are an important source of nutrients in the diet; for example, milk and meat together provide about 60 and 55% of the dietary intake of Ca and protein respectively in the UK. However, certain aspects of some animal-derived foods, particularly their fat and saturated fatty acid (SFA) contents, have led to concerns that these foods substantially contribute to the risk of CVD, the metabolic syndrome and other chronic diseases. In most parts of Europe dairy products are the greatest single dietary source of SFA. The fatty acid composition of various animal-derived foods is, however, not constant and can, in many cases, be enhanced by animal nutrition. In particular, milk fat with reduced concentrations of the C12-16 SFA and an increased concentration of 18:1 MUFA is achievable, although enrichment with very-long-chain n-3 PUFA is much less efficient. However, there is now evidence that some animal-derived foods (notably milk products) contain compounds that may actively promote long-term health, and research is urgently required to fully characterise the benefits associated with the consumption of these compounds and to understand how the levels in natural foods can be enhanced. It is also vital that the beneficial effects are not inadvertently destroyed in the process of reducing the concentrations of SFA. In the future the role of animal nutrition in creating foods closer to the optimum composition for long-term human health is likely to become increasingly important, but production of such foods on a scale that will substantially affect national diets will require political and financial incentives and great changes in the animal production industry.

Foods derived from animals: the impact of animal nutrition on their nutritive value and ability to sustain long-term health

Foods derived from domestic animals are a significant source of nutrients in the UK diet. However, certain aspects of some animal-derived foods, notably levels of saturated fatty acids, have given rise to concerns that these foods may contribute to the risk of cardiovascular disease, the metabolic syndrome and other conditions. However, the composition of the many animal-derived foods is not constant and can often be enhanced by manipulating the nutrition of the animal. This paper reviews these possibilities with particular attention to lipids, and draws attention to the fact that milk in particular, contains a number of compounds which may, for example, exert anti-carcinogenic effects. It is clear that the role of animal nutrition in creating foods closer to the optimum composition for long-term human health will not only be more relevant in the future, but will be vital in attempts to improve the health of the human population.

Successful manipulation of the quality and quantity of fat and carbohydrate consumed by free-living individuals using a food exchange model

Our objective in this study was to develop and implement an effective intervention strategy to manipulate the amount and composition of dietary fat and carbohydrate (CHO) in free-living individuals in the RISCK study. The study was a randomized, controlled dietary intervention study that was conducted in 720 participants identified as higher risk for or with metabolic syndrome. All followed a 4-wk run-in reference diet [high saturated fatty acids (SF)/high glycemic index (GI)]. Volunteers were randomized to continue this diet for a further 24 wk or to I of 4 isoenergetic prescriptions [high monounsaturated fatty acids (MUFA)/high GI; high MUFA/low GI; low fat (LF)/high GI; and LF/low GI]. We developed a food exchange model to implement each diet. Dietary records and plasma phospholipid fatty acids were used to assess the effectiveness of the intervention strategy. Reported fat intake from the LF diets was significantly reduced to 28% of energy (%E) compared with 38% E from the HM and LF diets. SF intake was successfully decreased in the HM and LF diets was similar to 10% E compared with 17% E in the reference diet (P = 0.001). Dietary MUFA in the HIM diets was similar to 17% E, significantly higher than in the reference (12% E) and LF diets (10% E) (P = 0.001). Changes in plasma phospholipid fatty acids provided further evidence for the successful manipulation of fat intake. The GI of the HGI and LGI arms differed by similar to 9 points (P = 0.001). The food exchange model provided an effective dietary strategy for the design and implementation across multiple sites of 5 experimental diets with specific targets for the proportion of fat and CHO. J. Nutr. 139: 1534-1540, 2009.

Lack of association between central adiposity and lipaemia in UK Sikh men

OBJECTIVE: To determine whether the positive statistical associations between measures of total and regional adiposity and measures of glucose, insulin and triacylglycerol ( TAG) metabolism reported in Caucasian men, are also observed in UK Sikhs. DESIGN: A matched cross-sectional study in which each volunteer provided a blood sample after a 12-h overnight fast and had anthropometric measurements taken. SUBJECTS: A total of 55 healthy Caucasian and 55 healthy UK Sikh men were recruited. The Caucasian and Sikh men were matched for age ( 48.7 +/- 10.9 and 48.3 +/- 10.0 y, respectively) and body mass index (BMI) ( 26.1 +/- 2.8 and 26.3 +/- 3.2 kg/m(2), respectively). MEASUREMENTS: Anthropometric measurements were performed to assess total and regional fat depots. The concentrations of plasma total cholesterol, high-density cholesterol (HDL- C), low-density cholesterol (LDL-C) and small dense LDL (LDL3), TAG, glucose, fasting insulin (ins) and nonesterified fatty acids (NEFA) were analysed in fasted plasma. Surrogate measures of insulin resistance (HOMA-IR) and insulin sensitivity (RQUICKI) were calculated from insulin and glucose (HOMA-IR) and insulin, glucose and NEFA ( RQUICKI) measurements. RESULTS: The Sikh men had significantly higher body fat, with the sum of the four skinfold measurements (Ssk) ( P = 0.0001) and subscapular skinfold value (P = 0.009) higher compared with the Caucasian men. The Sikh volunteers also had characteristics of the metabolic syndrome: lower HDL-C (P = 0.07), higher TAG (P = 0.004), higher % LDL3 (P = 0.0001) and insulin resistance (P = 0.05). Both ethnic groups demonstrated positive correlations between insulin and waist circumference (Caucasian: r = 0.661, P = 0.0001; Sikh: r = 0.477, P = 0.0001). The Caucasian men also demonstrated significant positive correlations between central adiposity (r = 0.275, P = 0.04), other measures of adiposity (BMI and suprailiac skinfold) and plasma TAG, whereas the Sikh men showed no correlation for central adiposity (r = 0.019, ns) and TAG with a trend to a negative relationship between other measures ( Ssk and suprailiac) which reached near significance for subscapular skinfold and TAG (r = - 0.246, P = 0.007). The expected positive association between insulin and TAG was observed in the Caucasian men (r = 0.318, P = 0.04) but not in the Sikh men (r = 0.011, ns). CONCLUSIONS: In the Caucasian men, the expected positive association between plasma TAG and centralized body fat was observed. However, a lack of association between centralized, or any other measure of adiposity, and plasma TAG was observed in the matched Sikh men, although both ethnic groups showed the positive association between centralized body fat and insulin resistance, which was less strong for Sikhs. These findings in the Sikh men were not consistent with the hypothesis that there is a clear causal relationship between body fat and its distribution, insulin resistance, and lipid abnormalities associated with the metabolic syndrome, in this ethnic group.

Symposium on 'nutrition interventions in high-risk groups' - CVD risk in South Asians: the importance of defining adiposity and influence of dietary polyunsaturated fat

The prevalence of the metabolic syndrome (MetS), CVD and type 2 diabetes (T2D) is known to be higher in populations from the Indian subcontinent compared with the general UK population. While identification of this increased risk is crucial to allow for effective treatment, there is controversy over the applicability of diagnostic criteria, and particularly measures of adiposity in ethnic minorities. Diagnostic cut-offs for BMI and waist circumference have been largely derived from predominantly white Caucasian populations and, therefore, have been inappropriate and not transferable to Asian groups. Many Asian populations, particularly South Asians, have a higher total and central adiposity for a similar body weight compared with matched Caucasians and greater CVD risk associated with a lower BMI. Although the causes of CVD and T2D are multi-factorial, diet is thought to make a substantial contribution to the development of these diseases. Low dietary intakes and tissue levels of long-chain (LC) n-3 PUFA in South Asian populations have been linked to high-risk abnormalities in the MetS. Conversely, increasing the dietary intake of LC n-3 PUFA in South Asians has proved an effective strategy for correcting such abnormalities as dyslipidaemia in the MetS. Appropriate diagnostic criteria that include a modified definition of adiposity must be in place to facilitate the early detection and thus targeted treatment of increased risk in ethnic minorities.

Are definitions of adiposity appropriate for identification of cardiovascular disease risk in South Asian populations?

South Asian populations living in the UK have a high prevalence of the metabolic syndrome, cardiovascular disease (CVD) and type 2 diabetes which impacts greatly on the morbidity and mortality of this ethnic group. The identification of ‘at risk’ individuals is essential to initiate reventative treatment. However, this is considerably hindered by the lack of appropriate cut-off values for anthropometric measures. CVD risk is significantly higher at a lower body mass index (BMI) in many Asian groups compared with Caucasians and adiposity (particularly central deposition) is higher at similar BMI levels. The definition of adiposity in Asians needs to be firmly established and appropriate lower BMI and waist circumference cut-offs implemented in ethnic subpopulations to facilitate appropriate treatment strategies.

Increased n-6 polyunsaturated fatty acids do not attenuate the effects of long-chain n-3 polyunsaturated fatty acids on insulin sensitivity or triacylglycerol reduction in Indian Asians

Background: Indian Asians in Western countries have a higher rate of coronary artery disease than do the indigenous white populations, and this higher rate may be influenced by a dietary imbalance of n-6 and n-3 polyunsaturated fatty acids (PUFAs). Objective: The objective of the study was to test the hypothesis that a high background dietary intake of n-6 PUFA attenuates the effects of fish-oil supplementation on insulin sensitivity and associated blood lipids of the metabolic syndrome. Design: Twenty-nine Indian Asian men were recruited to participate in a 12-wk dietary intervention trial. Volunteers were randomly assigned to receive either a moderate or a high n-6 PUFA diet featuring modified oils and spreads over a 6-wk period. After this 6-wk period, both groups were supplemented with 4.0 g fish oil/d (2.5 g eicosapentaenoic acid + docosahexaenoic acid) for an additional 6 wk in combination with the dietary treatment. Volunteers participated in a postprandial study and an insulin sensitivity test after the 6-wk dietary intervention and again after the fish-oil supplementation period. Results: There was no significant time X treatment interaction for blood lipids or insulin action after dietary intervention with the moderate or high n-6 PUFA diets in combination with fish oil. After the 6-wk period of fish oil supplementation, fasting and postprandial plasma triacylglycerol concentrations decreased significantly. Conclusion: The background dietary n-6 PUFA concentration did not modulate the effect of fish-oil supplementation on blood lipids or measures of insulin sensitivity in this ethnic group.