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Oleocanthal and oleacein are olive oil phenolic compounds with well known anti-inflammatory and anti-oxidant properties. The main evidence, however, is provided by experimental studies. Few human clinical trials have examined the health benefits of olive oils rich in these polyphenols. Our aim was to assess the health properties of rich oleocanthal and oleacein extra virgin olive oil (EVOO), compared to those of common olive oil (OO), in people with prediabetes and obesity. This was a randomised, double-blind, crossover trial done in people aged 40-65 years with obesity (BMI 30-40 kg/m2) and prediabetes (HbA1c 5.7-6.4%). The intervention consisted in substituting for 1 month the oil used for food, both raw and cooked, by EVOO or OO. No hypocaloric diet or changes in physical activity were recommended. The primary outcome was the inflammatory status. Secondary outcomes were the oxidative status, body weight, metabolic status and lipid profile. An ANCOVA model adjusted for age, sex and treatment administration sequence was used for the statistical analysis. 91 patients were enrolled (33 men and 58 women) and finished the trial. A decrease in interferon-γ was observed after EVOO treatment, reaching inter-treatment differences (P=0.041). Total antioxidant status increased and lipid and organic hydroperoxides decreased after EVOO treatment, the changes reaching significance compared to OO treatment (P

Las actividades humanas son ahora tan penetrantes y profundas que están alterando la estabilidad de la tierra en formas que amenazan al sistema de soporte vital del que depende la humanidad. El campo del diseño ha contribuido a la creación de problemas socio ecológicos tan complejos, pero también se está adaptando como fuente de soluciones. El Design Thinking y la Eco-Innovación son herramientas con un enfoque que podría ayudar a crear tales soluciones y contribuir al desarrollo sostenible estratégico. A medida que la creatividad y el enfoque del diseñador se convierten en una necesidad para resolver problemas para los negocios en un mundo cada vez más complejo, es más importante la eco-innovación en los negocios que se espera que crezca más y más, pero respetando el entorno medioambiental.

• Human T-cell lymphotropic virus type 1 (HTLV-1) is a globally-spread virus. It is estimated that there are about 5–10 million infected people in the world. HTLV is endemic in Chile, with higher seroprevalence among indigenous people. However, little is known about HTLV-1 genetic diversity, its introduction and dispersion in this country. To gain insights into these issues, a phylogenetic dating analysis was conducted based on Chilean and closed related long terminal repeat sequences. The time tree reconstruction showed that the introduction of HTLV-1aA occurred several times in Chile. It was hypothesized that these introductions took place at least in two different historical moments: (i) during the ancient human migrations and (ii) during/after the European colonization of South America. The present study contributes toward understanding the evolutionary history of HTLV-1 in Chile and South America.

Background: Anxiety and depression are common in patients with cancer. The aim of this study is to determine the prevalence of anxiety and depression symptoms in colorectal cancer (CRC) patients awaiting elective surgery and whether there is an association with their preoperative nutritional status and postoperative mortality. Methods: A prospective study was conducted on 215 patients with CRC proposed for surgery. Data about nutritional status were collected using the Global Leadership Initiative on Malnutrition (GLIM) criteria, while anxiety and depression symptoms data were collected using Hospital Anxiety and Depression Scale (HADS). Results: HADS detected possible anxiety in 41.9% of patients, probable anxiety in 25.6%, possible depression in 21.9%, and probable depression in 7.9%. GLIM criteria found 116 (53.9%) patients with malnutrition. The HADS score for depression subscale was significantly higher in malnourished patients than in well-nourished (5.61 ± 3.65 vs. 3.95 ± 2.68; p = 0.001). After controlling for potential confounders, malnourished patients were 10.19 times more likely to present probable depression (95% CI 1.13–92.24; p = 0.039). Mortality was 1.9%, 4,2%, and 5.6% during admission and after 6 and 12 months, respectively. Compared to patients without depressive symptomatology, in patients with probable depression, mortality risk was 14.67 times greater (95% CI 1.54–140.21; p = 0.02) during admission and 6.62 times greater (95% CI 1.34–32.61; p = 0.02) after 6 months. Conclusions: The presence of anxiety and depression symptoms in CRC patients awaiting elective surgery is high. There is an association between depression symptoms, preoperative nutritional status, and postoperative mortality.

Intragastric injection of botulinum toxin A (BT-A) has been shown to be effective for weight loss up to six months after administration, according to previous studies. Our objective was to determine, in patients on bariatric surgery waiting lists, the effect of BT-A on weight loss in the pre- and postoperative period and to analyse if there are different responses based on Body Mass Index (BMI). Methods: We performed a follow-up analysis of the IntraTox study, which included 46 patients on bariatric surgery waiting lists in a single-centre, randomised, double-blind, placebo-controlled clinical trial. The treatment group received intragastric BT-A, whereas the control group received physiological saline solution. The one-time procedure was performed at the time of diagnostic endoscopy 7–8 months before surgery. Weight loss was evaluated at admission and after 4 and 12 weeks from the bariatric surgery. Our analysis was stratified by BMI at randomisation. Results: weight loss percentage on the day of surgery, with respect to the initial visit, was −4.5 ± 3.9% for the control group vs. −7.6 ± 4.2%, for the treatment group (p = 0.013). Weight loss percentage tended to remain greater in the treatment group one month after the intervention (−12.7 ± 4.7% vs. −15.2 ± 4.6%, p = 0.07) and become similar three months after (−21.6 ± 4.7% vs. −21.6 ± 4.6%). After stratifying by BMI, only patients with BMI over 50 kg/m2 allocated to the treatment group obtained a greater weight loss at the end of the trial, the day of surgery, and one month after, compared with the placebo group (−4.9 ± 4.9%, −10.8 ± 5.3% and −17.1 ± 3.8% vs. −0.1 ± 2.6%, −4.3 ± 3.2% and −12.8 ± 4.1%, respectively (p < 0.05). Conclusions: intragastric injection of BT-A is effective to achieve significant weight loss, especially in extreme obesity. Its use before bariatric surgery enhances perioperative weight loss. Merz Pharma (Frankfurt am Main, Germany) collaborated with a non-restricted grant. The study was co-funded by the Sociedad Andaluza de Endocrinología, Diabetes y Nutrición (SAEDYN) and the Sociedad Andaluza de Nutrición, Clínica y Dietética (SANCYD). This research was supported by the Plataforma Española de Investigación Clínica y Ensayos Clínicos, SCReN (Spanish Clinical Research Network), funded by ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, through the projects PT13/0002/0020 and PT17/0020, integrated in the Plan Estatal de I+D+I 2013-2016 and co-funded by the European Regional Development Fund (ERDF). Partial funding for open access charge: Universidad de Málaga

Summary Background & aims Several studies have evaluated the effect of intragastric injection of botulinum toxin A to treat obesity, achieving mixed results. Our objective is to determine the effect of intragastric botulinum toxin A on weight loss, satiety, biomarkers, and quality of life of obese patients prior bariatric surgery. Methods Design: single-centre, randomised, double-blind, placebo-controlled clinical trial in 52 obese patients on bariatric surgery waiting lists. Two-arm parallel: the treatment group was administered intragastric botulinum toxin A by endoscopy, whereas the control group was administered physiological saline solution. Weight loss was evaluated at weeks 2, 4, 8, 16, and 24, as well as changes in body composition, satiety (Visual analogue scale (VAS) and GCSI questionnaire), quality of life (GIQLI questionnaire), and biomarkers of satiety and appetite. Results Weight loss at weeks 2, 4, 8, 16, and 24 after the endoscopy, with respect to the basal visit, was 0.6 ± 2 kg, 0.4 ± 2.7 kg, 0.4 ± 3.1 kg, 0.2 ± 4.5 kg, and 0.6 ± 4.3 kg for the control group vs 1.9 ± 2.1 kg, 2 ± 2.6 kg, 2.8 ± 4.1 kg, 3.5 ± 5.3 kg, and 4.5 ± 7 kg for the treatment group, respectively, being differences between groups significant at all times (p = 0.016, 0.031, 0.014, 0.021, and 0.023, respectively). Treatment group patients obtained a significantly higher score for GIQLI questionnaire compared with baseline (104.4 ± 13.9 points vs 97.7 ± 15.6 points; p = 0.024), showing a significant improvement in the section of subjective physical capacity. No significant differences were found regarding perception of satiety, or biomarkers of satiety and appetite. Conclusions Intragastric injection of botulinum toxin A is an effective and safe procedure to achieve a moderate weight loss and improve quality of life. Registered under clinicaltrialsregister.eu Identifier EudraCT number 2015-004391-29 https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004391-29/ES .

Objective: Treatment of hyperglycemia with insulin is associated with increased risk of hypoglycemia in type 2 diabetes mellitus (T2DM) patients receiving total parenteral nutrition (TPN). The aim of this study was to determine the predictors of hypoglycemia in hospitalized T2DM patients receiving TPN. Methods: Post hoc analysis of the INSUPAR study, which is a prospective, open-label, multicenter clinical trial of adult inpatients with T2DM in a noncritical setting with indication for TPN. Results: The study included 161 patients; 31 patients (19.3%) had hypoglycemic events, but none of them was severe. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes with end-organ damage, duration of diabetes, use of insulin prior to admission, glycemic variability (GV), belonging to the glargine insulin group in the INSUPAR trial, mean daily grams of lipids in TPN, mean insulin per 10 grams of carbohydrates, duration of TPN, and increase in urea during TPN. Multiple logistic regression analysis showed that the presence of diabetes with end-organ damage, GV, use of glargine insulin, and TPN duration were risk factors for hypoglycemia. Conclusion: The presence of T2DM with end-organ damage complications, longer TPN duration, belonging to the glargine insulin group, and greater GV are factors associated with the risk of hypoglycemia in diabetic noncritically ill inpatients with parenteral nutrition. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; CV% = coefficient of variation; DM = diabetes mellitus; GI = glargine insulin; GV = glycemic variability; ICU = intensive care unit; RI = regular insulin; T2DM = type 2 diabetes mellitus; TPN = total parenteral nutrition.

Summary Background There is no established insulin regimen in T2DM patients receiving parenteral nutrition. Aims To compare the effectiveness (metabolic control) and safety of two insulin regimens in patients with diabetes receiving TPN. Design Prospective, open-label, multicenter, clinical trial on adult inpatients with type 2 diabetes on a non-critical setting with indication for TPN. Patients were randomized on one of these two regimens: 100% of RI on TPN or 50% of Regular insulin added to TPN bag and 50% subcutaneous GI. Data were analyzed according to intention-to-treat principle. Results 81 patients were on RI and 80 on GI. No differences were observed in neither average total daily dose of insulin, programmed or correction, nor in capillary mean blood glucose during TPN infusion (165.3 ± 35.4 in RI vs 172.5 ± 43.6 mg/dL in GI; p = 0.25). Mean capillary glucose was significantly lower in the GI group within two days after TPN interruption (160.3 ± 45.1 in RI vs 141.7 ± 43.8 mg/dL in GI; p = 0.024). The percentage of capillary glucose above 180 mg/dL was similar in both groups. The rate of capillary glucose ≤70 mg/dL, the number of hypoglycemic episodes per 100 days of TPN, and the percentage of patients with non-severe hypoglycemia were significantly higher on GI group. No severe hypoglycemia was detected. No differences were observed in length of stay, infectious complications, or hospital mortality. Conclusion Effectiveness of both regimens was similar. GI group achieved better metabolic control after TPN interruption but non-severe hypoglycemia rate was higher in the GI group. Clinical trial registry This trial is registered at clinicaltrials.gov as NCT02706119 .

Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL).A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6±1.8% (70.5±15.4mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data.After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72±18.38 vs. 92.07±17.65; p0.028), a 0.5% decrease in HbA1c values (8.4±1.2 vs. 7.9±0.7% [68±9.7 vs. 63±5.5mmol/mol]; p0.032), an improvement in glycaemic variability (standard deviation 66.9±14 vs. 59.4±16mg/dl; p0.05), a decrease in insulin requirements (0.87±0.29 vs. 0.80±0.25U/kg; p0.049), a decrease in number of severe hypoglycaemia episodes (0.44±0.9 vs. 0.05±0.2; p0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8±10.9% vs. 23±18.4%; p0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9±0.7 vs. 7±0.6% [63±5.5 vs. 53±4.5mmol/mol]; p0.001) and EsQOL (91.66±22 vs. 84.53±1.63; p0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7±0.6% [53±4.5mmol/mol] vs. MDI/G 7.6±0.9% [59.6±7.7mmol/mol]; p0.03).Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality., This work was supported by Instituto de Salud Carlos III (ISCIII, co-funded by Fondo Europeo de Desarrollo Regional [FEDER], European Union [EU], Una manera de hacer Europa), Ministerio de Ciencia, Innovacion y Universidades, Gobierno de Espana (PI15/01034), and Sociedad Andaluza de Endocrinologia Diabetes y Nutrition (SAEDYN) 2016 research project. Centro de Investigacion Biomedica en Red (CIBERDEM) is an initiative of the Instituto de Salud Carlos III.

Introduction Few studies assessing the relationship between oxidative stress and glycemic variability in children with type 1 diabetes mellitus (T1DM) are available, and most of them reported no significant results. Objective To assess the relationship between glucose control, glycemic variability, and oxidative stress as measured by urinary excretion of 8-iso-prostanglandin F2-alpha (8-iso-PGF2α) in children with T1DM. Materials and methods A cross-sectional study including 25 children with T1DM. Participants were evaluated during five days in two different situations: 1st phase during a summer camp, and 2nd phase in their everyday life at home. The following data were collected in each study phase:. – Six capillary blood glucose measurements per day. Mean blood glucose (MBG) levels and glucose variability parameters, including standard deviation, coefficient of variation, and mean amplitude of glycemic excursions (MAGE), were calculated. – Capillary HbA1c level. – 24-h urine sample to measure 8-iso-PGF2α. Results There were no statistically significant differences in urinary 8-iso-PGF2α levels (142 ± 37 vs. 172 ± 61 pg/mg creatinine) and glucose control and glycemic variability parameters between both phases. In the 2nd phase, statistically significant correlations were found between urinary 8-iso-PGF2α and HbA1c levels (r = 0.53), MBG (r = 0.72), standard deviation (r = 0.49), and MAGE (r = 0.42). No significant correlations between glucose control, glycemic variability and urinary 8-iso-PGF2α excretion were found in the 1st phase. Conclusions A significant correlation was found between glycemic variability and HbA1c level and urinary 8-iso-PGF2α excretion in a group of children with T1DM during their daily lives. Additional studies are needed to confirm this finding and to explore its long-term impact on health.

Background and objectives: The objective of this study was to establish reference values for hand grip strength, compare the results obtained with Collin and Jamar type dynamometers and determine their association with anthropometric and lean mass measurements. Material and methods: This cross-sectional population-based study was undertaken in Pizarra (Málaga, Spain). The grip strength of the dominant hand was measured using Collin and Jamar dynamometers. Skinfolds (triceps, abdominal, biceps of dominant arm and subscapular) were measured, and body composition was estimated. Eight hundred seventeen adults randomly selected from the census were recruited. Dynamometry reference values are presented for the dominant hand, by gender and age groups. Results: No determinations could be made with the Collin dynamometer in 69 women due to the difficulty in grasping the dynamometer. We found significant positive correlations between the measurements with Jamar and Collin dynamometers (r = 0.782; p < 0.001) and between grip strength and lean mass index (LMI), determined by both dynamometers (r = 0.538, p < 0.001 and r = 0.462, p < 0.001, respectively). Malnourished patients according to LMI had significantly lower grip strength than normally nourished patients (p < 0.001 for Jamar; p < 0.02 for Collin). Conclusions: Dynamometry reference values in the Spanish population are presented. We recommend the use of the Jamar type dynamometer versus the Collin type dynamometer. Hand grip dynamometry is associated with lean mass, which confirms its usefulness in nutritional assessment.

Introducción: La obesidad es una patología de elevada prevalencia en nuestro medio, cuyas comorbilidades asociadas representan un gran reto para la salud pública global.La inyección de toxina botulínica intragástrica en animales y humanos, se ha empleado como tratamiento para la obesidad. Su efecto incluiría el retraso del vaciamiento gástrico y la inducción de saciedad temprana, con la consiguiente disminución de la ingesta y la pérdida de peso.Material y métodos: Se realizó una búsqueda bibliográfica en las bases de datos: Pubmed, Scopus y Embase, para el período comprendido entre 2000 y 2016. Se incluyeron los artículos que trataron las bases del tratamiento con toxina botulínica intragástrica en humanos, así como los diferentes estudios de intervención, aleatorizados o no.Resultados: Se encontraron un total de 105 artículos y utilizando los criterios de inclusión se seleccionaron 10. De ellos, solo cuatro fueron aleatorizados y ocho duraron entre 8 y 24 semanas. En cuatro de los estudios, uno de ellos aleatorizado, se encontró una pérdida de peso significativa, que varió entre los 3,5 y los 11,8 kg.La mayor parte de los estudios halló un enlentecimiento del vaciado gástrico. Ningún estudio comunicó efectos secundarios de relevancia.Conclusiones: La inyección de toxina botulínica intragástrica podría ser eficaz y segura en el tratamiento de la obesidad, pero son necesarios estudios bien diseñados, controlados con placebo, de largo seguimiento y adecuado tamaño muestral.

Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term.The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN).This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality.Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization).The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization.

Few prospective cohort studies have evaluated dietary iodine intake and urinary iodine concentrations in the general adult population. We assess the evolution of urinary iodine excretion and factors that may influence it in an adult population followed for 11 years.A population-based cohort study was undertaken in Pizarra (Spain). In the three study phases (baseline (n = 886), and 6 (n = 788) and 11 years later (n = 501)), participants underwent an interview and a standardized clinical examination that included a food questionnaire, and thyroid hormone and urinary iodine determinations. Subjects with thyroid dysfunction, palpable goiter or urinary iodine excretion400 μg/L were excluded.Urinary iodine increased over the years (100.6 ± 70.0 μg/L at baseline vs. 125.4 ± 95.2 μg/L at 6 years and 141.6 ± 81.4 μg/L at 11 years; p0.0001). Urinary iodine was significantly higher in subjects who reported iodized salt consumption and in subjects with a higher intake of dairy products (p0.05). Consumption of iodized salt (Risk ratio (RR) = 1.23, 95% CI [1.01-2.05]) and dairy products (RR = 2.07, 95% CI [1.01-4.23]), and a baseline urinary iodine concentration ≥100 μg/L (RR = 1.26, 95% CI [1.04-1.53]) were significantly associated with urinary iodine concentrations ≥100 μg/L at 11 years. There is no correlation between thyroid function (TSH, free triiodothyronine or free thyroxine levels) and urinary iodine concentrations in conditions of iodine sufficiency.The increase in urinary iodine concentrations over eleven years is associated with an increase in iodized salt intake and with the dairy products intake, and possibly with a higher iodine content of dairy products. However, individual variability in urinary iodine excretion was not fully explained by dietary iodine intake alone; previous urinary iodine concentrations were also important.

Objective Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose Methods This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage. Results The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose Conclusions The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.

Objective The prevalence of carbohydrate metabolism disorders in patients who receive total parenteral nutrition (TPN) is not well known. These disorders can affect the treatment, metabolic control, and prognosis of affected patients. The aims of this study were to determine the prevalence in noncritically ill patients on TPN of diabetes, prediabetes, and stress hyperglycemia; the factors affecting hyperglycemia during TPN; and the insulin therapy provided and the metabolic control achieved. Methods We undertook a prospective multicenter study involving 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included, and data were collected on demographic, clinical, and laboratory variables (glycated hemoglobin, C-reactive protein [CRP], capillary blood glucose) as well as insulin treatment. Results The study included 605 patients. Before initiation of TPN, the prevalence of known diabetes was 17.4%, unknown diabetes 4.3%, stress hyperglycemia 7.1%, and prediabetes 27.8%. During TPN therapy, 50.9% of patients had at least one capillary blood glucose of > 180 mg/dL. Predisposing factors were age, levels of CRP and glycated hemoglobin, the presence of diabetes, infectious complications, the number of grams of carbohydrates infused, and the administration of glucose-elevating drugs. Most (71.6%) patients were treated with insulin. The mean capillary blood glucose levels during TPN were: known diabetes (178.6 ± 46.5 mg/dL), unknown diabetes (173.9 ± 51.9), prediabetes (136.0 ± 25.4), stress hyperglycemia (146.0 ± 29.3), and normal (123.2 ± 19.9) (P Conclusion The prevalence of carbohydrate metabolism disorders is very high in noncritically ill patients on TPN. These disorders affect insulin treatment and the degree of metabolic control achieved. (Endocr Pract. 2015;21:59-67)

Obesity is a prevalent disease in our environment, which comorbidities suppose a great challenge to public health. Intragastric injection of botulinum toxin has been used as treatment for obesity, both in humans and animals. It acts by inhibiting gastric emptying and inducing early satiety, consequently reducing intake and finally achieving weight loss.A bibliographic search in PubMed, Scopus and EMBASE databases between 2000 and 2016 was carried out. Articles regarding the physiological basis of the treatment with intragastric injection of botulinum toxin in human were included, as well as interventional studies, randomised or not.A total of 105 articles were found and 10 were chosen according to our inclusion criteria. Of those, only 4 were randomised and 8 lasted between 8 and 24 weeks. In four of the studies, one randomised, a statistically significant weight loss was found which varied between 3.5 and 11.8 kg. Most of the studies found slowing of gastric emptying. None of them notified any significant side-effects.Intragastric injection of botulinum toxin could be useful and safe in the treatment of obesity but better designed, placebo-controlled, long term and with an adequate sample size studies are needed.

Objective: To assess glycaemic variability, oxidative stress and their relationship in children and adolescents with type 1 diabetes (T1DM) attending a summer camp. Patients and methods: Cross-sectional study that included 54 children and adolescents with T1DM aged 7–16, attending a 7-day summer camp. Sociodemographic information, clinical data, and blood glucose values measured using an Accu-Chek Nano® glucose metre were recorded. Glucose variability markers (standard deviation [SD], low blood glucose index [LBGI], high blood glucose index [HBGI], mean amplitude of glyacemic excursions [MAGE] and mean of daily differences [MODD]) were calculated. Oxidative stress was assessed by the measurement of 8-iso-prostaglandin F2 alpha (PGF2α) in a 24-h urine sample collected at the end of the camp in 14 children. Results: The Median SD, MAGE and MODD indexes were in the high range (61, 131 and 58 mg/dl, respectively), LBGI in the moderate range (3.3), and HBGI in the low range (4.5). The mean HbA1c was 7.6% and the median urinary excretion rate of 8-iso-PGF2α was 864.39 pg/mg creatinine. The Spearman correlation coefficients between markers of glycaemic variability (SD, HBGI, MAGE, MODD) were significant. Non-significant correlations were found between markers of glycaemic variability and urinary 8-iso-PGF2α. Conclusions: High glycaemic variability was observed in children and adolescents attending a summer camp. However, no correlations were found between markers of glycaemic variability and oxidative stress measured by urinary 8-iso-PGF2α. Further studies are needed to address the relationship between oxidative stress and glycaemic variability in children with T1DM. Resumen: Objetivos: Analizar variabilidad glucémica, el estrés oxidativo y la relación entre ambos en un grupo de en niños y adolescentes con diabetes tipo 1 (DM1) que asistieron a un campamento. Pacientes y método: Estudio transversal que incluyó a 54 niños con DM1 entre 7 y 16 años de edad que asistieron a un campamento de verano de 7 días. Se recogieron datos sociodemográficos, clínicos y valores de glucemia capilar medidos con un glucómetro Accu-Chek Nano®. Se calcularon los marcadores de variabilidad glucémica: desviación estándar (DE), índice de glucemia baja (LBGI), índice de glucemia elevada (HBGI), amplitud media de las excursiones glucémicas (MAGE) y media de las diferencias diarias (MOOD). El estrés oxidativo fue evaluado mediante la medición de 8-iso-prostaglandina F2 alfa (PGF2α) en una muestra de orina de 24 h recogida en 14 niños al final del campamento. Resultados: La mediana de DE, MAGE y MOOD se encontraron en un rango elevado (61, 131 y 59 mg/dl, respectivamente), LBGI en la categoría de riesgo moderado (3,3) y HBGI en la categoría de riesgo bajo (4,5). La media de HbA1c fue del 7,6%. La media de la tasa de excreción urinaria de 8-iso-PGF2α fue 864,39 pg/mg creatinina. No se encontraron correlaciones estadísticamente significativas entre marcadores de variabilidad glucémica y 8-iso PGF2α urinario. Conclusiones: Se ha objetivado una alta variabilidad glucémica en niños y adolescentes con DM1 asistentes a un campamento de verano. Sin embargo, no se han encontrado correlaciones entre marcadores de variabilidad glucémica y de estrés oxidativo medido por 8-iso-PGF2α urinario.

OBJECTIVE Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients. RESEARCH DESIGN AND METHODS This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality. RESULTS The study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels CONCLUSIONS Hyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality.

SummaryObjective Modifications in lifestyle, diet and certain clinical events are major contributors for the high prevalence of obesity. The aim of this study was to assess factors associated with weight gain in a population of Spanish adults. Design The study was undertaken in two population-based cohorts from the north and the south of Spain (baseline and after 6 years). The Asturias Study, in the north, included 1034 persons aged 30–75 years, of whom 701 were reassessed. The Pizarra Study, in the south, included 1226 persons aged 18–65 years, of whom 783 were re-evaluated. Both studies involved a nutritional questionnaire, a physical examination and an oral glucose tolerance test (OGTT). Results During the follow-up, 32·3% of the participants lost weight, 34·5% gained fewer than 4 kg and 33·2% gained more than 4 kg. Weight gain was greater in persons younger than 50 years and in those with an initial body mass index below 30. Weight gain was associated with a greater incidence of type 2 diabetes mellitus (T2DM) and abnormal glucose tolerance, whereas weight loss in persons with these disorders was associated with a normal OGTT 6 years later. Persons who took less exercise and those who reported a higher daily calorie intake experienced greater weight gain. Conclusion The longitudinal changes in weight affect the development of T2DM and abnormal glucose tolerance. The weight is a dynamic phenomenon affected by several social customs.

Background and objetive: The aim of this study was to validate the ability of the Finnish Diabetes Risk Score (FINDRISC) to predict the risk of DM2 in a population of south-eastern Spain (Pizarra Study). Subjects and methods: The Pizarra Study is a population-based prospective study developed in the town of Pizarra (Malaga). The first phase of the study was conducted in 1997-1998, including 1051 individuals aged 18-65 years randomly selected from the municipal census of the town. In 2003-2004 the subjects participating in the first study were reassessed. 824 individuals completed the second phase of the study (78.4%). All participants without known diabetes underwent an oral glucose tolerance test both at baseline and follow-up. We evaluated the ability of the FINDRISC to detect undiagnosed DM2 (first phase: cross-sectional study) and in predicting the incidence of DM2 (second phase: cohort study). Results: The test showed good results both to detect undiagnosed DM2 (ROC-AUC 0.74) and to predict incident DM2 (ROC-AUC 0.75). The best prediction of risk of incident DM2 was found in those subjects with fasting glucose > 100 mg/dl and a FINDRISC 9 (OR: 19.37; 95%IC: 8,86-42,34; P < .0001).

Eur J Clin Invest 2011; 41 (11): 1202–1209 Abstract Background Different studies, mostly cross-sectional, have found an association between low levels of thyroid hormones, even within the normal range, and a greater body mass index. The aim of this study was to determine the association between thyroid function and the risk for obesity. Materials and methods In this population-based prospective study, measurements were made of anthropometric parameters, thyroid hormone function and urinary iodine in a cohort of the Pizarra Study (n = 937), and repeated 6 years later (n = 784). At the second point, measurements were also made of leptin and adiponectin. Results Among the persons who were not obese at the start of the study, the odds ratio (OR) of becoming obese for those in the fourth quartile (Q4) for free triiodothyronine (FT3) (versus those in Q1) was 2·94 (1·46–5·90) (P = 0·005). The OR of becoming obese in persons in Q4 of FT4 (versus those in Q1) was 3·06 (1·23–7·43) (P = 0·01). Those persons in Q4 of weight gain had a higher FT3 at the 6-year follow-up than those whose weight gain was in Q1 (P

Hypoglycemia is the most common adverse event associated with insulin treatment in diabetes. The consequences of hypoglycemia can be quite aversive and potentially life threatening. The physical sequelae provide ample reason for patients to fear hypoglycemia and avoid episodes. For these reasons, our purpose in this study was to develop a new measure that explores specific fear of hypoglycemia (FH) in adult patients with type 1 diabetes and to examine its psychometric properties. The instrument developed to assess FH was initially made up of 20 items, of which 18 were negative and 2 were positive, assessed on a 5-point Likert scale (1-5). This scale was completed by 229 patients with type 1 diabetes. Additionally, a structured interview and a closed question called subjective fear of hypoglycemia were included as diagnostic criteria. A factor analysis employing the principal-components method and promax rotation was carried out, resulting in a new scale composed of 15 items. Three factors (fear, avoidance, and interference) were obtained and explained 58.27% of the variance. The scale showed good internal consistency (Cronbach's α = .891) and test-retest reliability (r = .908, p < .001), as well as adequate concurrent and predictive validity. The cutoff score that provided the highest overall sensitivity and specificity was set at 28 points. The Fear of Hypoglycemia 15-item scale (FH-15) demonstrated good reliability and validity. This study suggests that the new instrument may serve as a valuable measure of specific FH for use in research and clinical practice.

The purpose of this research was to study the effects of treatment with continuous subcutaneous insulin infusion (CSII) on quality of life in patients with type 1 diabetes. A quasi-experimental pretest-posttest design was used. Thirty-seven patients were evaluated before and after receiving treatment. The Diabetes Quality of Life Questionnaire, Beck Depression Inventory-II, State-Trait Anxiety Inventory, and Multidimensional Health Locus of Control Scale were applied. Patients treated with CSII reported a significant improvement in their quality of life (better total quality of life, higher diabetes life satisfaction, and less social and vocational concerns) when compared with patients with Multiple Daily Injections. Although some limitations are described, the results of this study show some evidence of positive effect of pump therapy in patients with poor glycemic control prior to pump start.

Objective The aim of this study was to undertake a prospective study of the changes in certain risk factors for cardiovascular disease occurring during menopause. Methods A longitudinal cohort study of 475 women was followed up for 6 years (Pizarra Study). The final menstrual period was defined after at least 6 months of amenorrhea. The women were classified into three groups: group 1, no menopause at either the first or second study; group 2, no menopause at the first study but menopause at the second study (6 y later); and group 3, menopause at the first study (and also at the second). The following are the main outcome measures used: age; body mass index; waist circumference; waist-to-hip ratio; skinfold thickness; arm circumference; intake of macronutrients (quantitative questionnaire); systolic and diastolic blood pressures; cholesterol, triglycerides; high-density lipoprotein cholesterol; uric acid; homeostasis model assessment of insulin resistance; and the prevalence of obesity, hypertension, type 2 diabetes mellitus, impaired glucose tolerance, and impaired fasting glucose. Results None of the cardiovascular risk factors studied changed during the passage from premenopause to postmenopause, independently of age or physical activity. Conclusions Menopause is a biological condition of the human species, for which has recently received attempts at medicalization that were not always justified. If menopause is not accompanied by any other cardiovascular risk factor independently of age, the stigma of menopause being considered a risk factor should cease. Although the results have the strength of a prospective study, the sample size forced us to consider these findings as preliminary.

Summary Background & aims To analyse the trends in consumption and costs of home enteral nutrition (HEN) products in Andalusia (Spain) and estimate the prevalence of HEN from 2000 to 2007. Methods Using the defined daily dose (DDD) method, we assigned a DDD to each type of diet, grouped as whole diets, supplements, modules and thickeners. The number of cases/10 6 inhabitants/day (CID) was calculated. Results The number of persons receiving HEN rose notably, from 66.4 CID in 2000 to 1315.4 in 2007. The number of persons with home enteral tube feeding has remained stable since 2003, at around 220 CID. HEN with oral nutritional supplements (ONS) increased exponentially, with a prevalence of 910 CID in 2007. The prevalence of HEN in 2007 was similar to that of other European countries. The costs associated with HEN rose from 1.3 million euros in 2000 to over 37 million euros in 2007, due to the progressive increase in the number of persons being prescribed HEN, especially ONS, and the incorporation of more expensive organ-specific formulas. Conclusions DDD is useful to indirectly estimate the prevalence of HEN and evaluate long-term trends in the prescription and costs of various HEN products.

El objetivo de esta investigación fue evaluar la consistencia interna y validez de la versión en español del Transgression-Related Interpersonal Motivations Inventory (TRIM-18) para medir el perdón en el ámbito de las relaciones de pareja en contexto chileno. El TRIM-18 es un cuestionario de auto-reporte que evalúa la motivación hacia la evitación, la venganza y la benevolencia frente a una transgresión relacional. A fin de examinar las propiedades psicométricas de este instrumento, se evaluaron 3 muestras independientes no probabilísticas de la ciudad de Antofagasta, Chile: 2 de estudiantes universitarios (N = 181 y 394) y 1 de la comunidad general (N = 552), con edades entre los 18 y 65 años. Los resultados permiten concluir que el TRIM-18 es un instrumento confiable y válido para su uso en el contexto chileno, presentando buenos índices de consistencia interna y buen ajuste a los datos en una estructura factorial tridimensional. Asimismo, se observaron asociaciones con constructos teóricamente vinculados al perdón, tales como el auto-reporte global del perdón, la satisfacción con la relación y el ajuste socioemocional.

Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose70 mg/dL) in hospitalized patients receiving total parenteral nutrition (TPN).This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage.The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia.The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.

Hypoglycemia is one of the main burdens for type I Diabetes Mellitus (DM I) patients. The consequences of hypoglycemia can be quite unpleasant due to the variety of disagreeable physical and psychological symptoms it triggers. The patient's previous experience with hypoglycemia episodes will condition his psychological reaction to future episodes, promoting behavioral modifications that associate with poor glycemic control and worse prognosis, and even with developing psychological disorders, leading to fear of hypoglycemia (FH). To be able to provide tailored prevention and treatment of patients with FH it is necessary to identify the risk factors in DM I patients. We developed and validated the FH-15 scale, a novel instrument to assess FH, which showed good concurrent and predictive validity in DM I patients. In this work we aim to identify the risk factors for suffering FH by detecting DM I patients with FH using the FH-15 scale and then analyzing the association of clinical and sociodemographic variables. We found that age, needing help to resolve an episode of hypoglycemia, and a perceived lack of social support are risk factors for suffering FH.

The aim of this study was to validate the ability of the Finnish Diabetes Risk Score (FINDRISC) to predict the risk of DM2 in a population of south-eastern Spain (Pizarra Study).The Pizarra Study is a population-based prospective study developed in the town of Pizarra (Málaga). The first phase of the study was conducted in 1997-1998, including 1051 individuals aged 18-65 years randomly selected from the municipal census of the town. In 2003-2004 the subjects participating in the first study were reassessed. 824 individuals completed the second phase of the study (78.4%). All participants without known diabetes underwent an oral glucose tolerance test both at baseline and follow-up. We evaluated the ability of the FINDRISC to detect undiagnosed DM2 (first phase: cross-sectional study) and in predicting the incidence of DM2 (second phase: cohort study).The test showed good results both to detect undiagnosed DM2 (ROC-AUC 0.74) and to predict incident DM2 (ROC-AUC 0.75). The best prediction of risk of incident DM2 was found in those subjects with fasting glucose100mg/dl and a FINDRISC ≥9 (OR: 19.37; 95%IC: 8,86-42,34; P.0001).The results of our study show that FINDRISC can be a useful tool to detect subjects at high risk of diabetes in this population.