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11. Metreleptin-mediated improvements in insulin sensitivity are independent of food intake in humans with lipodystrophy

Author

Brown, Rebecca J., Valencia, Areli, Startzell, Megan, Cochran, Elaine, Walter, Peter J., Garraffo, H. Martin, Cai, Hongyi, Gharib, Ahmed M., Ouwerkerk, Ronald, Courville, Amber B., Bernstein, Shanna, Brychta, Robert J., Chen, Kong Y., Walter, Mary, Auh, Sungyoung, and Gorden, Phillip

Subjects
Metreleptin -- Research -- Health aspects, Glucose metabolism -- Research, Lipodystrophy -- Research -- Diagnosis -- Care and treatment -- Patient outcomes, Health care industry
Abstract

BACKGROUND. Recombinant leptin (metreleptin) ameliorates hyperphagia and metabolic abnormalities in leptin-deficient humans with lipodystrophy. We aimed to determine whether metreleptin improves glucose and lipid metabolism in humans when food intake is held constant. METHODS. Patients with lipodystrophy were hospitalized for 19 days, with food intake held constant by a controlled diet in an inpatient metabolic ward. In a nonrandomized, crossover design, patients previously treated with metreleptin (n = 8) were continued on metreleptin for 5 days and then taken off metreleptin for the next 14 days (withdrawal cohort). This order was reversed in metreleptin-naive patients (n = 14), who were reevaluated after 6 months of metreleptin treatment on an ad libitum diet (initiation cohort). Outcome measurements included insulin sensitivity by hyperinsulinemic-euglycemic clamp, fasting glucose and triglyceride levels, lipolysis measured using isotopic tracers, and liver fat by magnetic resonance spectroscopy. RESULTS. With food intake constant, peripheral insulin sensitivity decreased by 41% after stopping metreleptin for 14 days (withdrawal cohort) and increased by 32% after treatment with metreleptin for 14 days (initiation cohort). In the initiation cohort only, metreleptin decreased fasting glucose by 11% and triglycerides by 41% and increased hepatic insulin sensitivity. Liver fat decreased from 21.8% to 18.7%. In the initiation cohort, changes in lipolysis were not independent of food intake, but after 6 months of metreleptin treatment on an ad libitum diet, lipolysis decreased by 30% (palmitate turnover) to 35% (glycerol turnover). CONCLUSION. Using lipodystrophy as a human model of leptin deficiency and replacement, we show that metreleptin improves insulin sensitivity and decreases hepatic and circulating triglycerides and that these improvements are independent of its effects on food intake. TRIAL REGISTRATION. ClinicalTrials.gov NCT01778556 FUNDING. This research was supported by the intramural research program of the NIDDK., Introduction Leptin is an adipocyte-derived hormone that signals overall body energy sufficiency (1) and acute energy balance (2). Leptin-deficient states, such as starvation or mutations in the leptin gene, lead [...]

Published
2018
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28. The Hispanic paradox in the prevalence of obesity at the county‐level.

Author

Valencia, Areli, Zuma, Bongeka Z., Spencer‐Bonilla, Gabriela, López, Lenny, Scheinker, David, and Rodriguez, Fatima

Subjects
OBESITY, PARADOX, REGRESSION analysis
Abstract

Objective: The percentage of Hispanics in a county has a negative association with prevalence of obesity. Because Hispanic individuals are unevenly distributed in the United States, this study examined whether this protective association persists when stratifying counties into quartiles based on the size of the Hispanic population and after adjusting for county‐level demographic, socioeconomic, healthcare, and environmental factors. Methods: Data were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings. Counties were categorized into quartiles based on their percentage of Hispanics, 0%–5% (n = 1794), 5%–20% (n = 962), 20%–50% (n = 283), and >50% (n = 99). For each quartile, univariate and multivariate regression models were used to evaluate the association between prevalence of obesity and demographic, socioeconomic, healthcare, and environmental factors. Results: Counties with the top quartile of Hispanic individuals had the lowest prevalence of obesity compared to counties at the bottom quartile (28.4 ± 3.6% vs. 32.7 ± 4.0%). There was a negative association between county‐level percentage of Hispanics and prevalence of obesity in unadjusted analyses that persisted after adjusting for all county‐level factors. Conclusions: Counties with a higher percentage of Hispanics have lower levels of obesity, even after controlling for demographic, socioeconomic, healthcare, and environmental factors. More research is needed to elucidate why having more Hispanics in a county may be protective against county‐level obesity. [ABSTRACT FROM AUTHOR]

Published
2021
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29. Human rights trade-offs in a context of systemic unfreedom:the case of the smelter town of La Oroya, Peru

Author

Valencia, Areli

Abstract

This paper examines the interconnecting causes that have placed residents of the community of La Oroya, in Peru’s central Andes, in the dilemma of having to sacrifice their human right to health in order to preserve job opportunities at the town’s smelter. Using the lens of a “capability-oriented model of human rights”, the paper shows how a constellation of environmental, social, institutional and personal factors have resulted in structuring a context of systemic unfreedom in La Oroya. This is a context in which human rights abuses reproduce systemically, affecting the overall wellbeing of individuals and communities, and in turn, diminishing their ability to transform their reality of unfreedom. The paper argues that to understand fully why some residents of the La Oroya community acquiesced in forfeiting their own rights, particular attention has to be paid to the pernicious manner in which living under unfreedom has historically trapped individuals of this community in a vicious cycle of disadvantage. Keywords: human rights, extractive industry,capability approach, structural injustice, environment.AcknowledgementsPart of the research for this paper was undertaken at CDS, Bath; this was made possible thanks to the Michael Smith Foreign Study Supplement granted by the Social Science and Humanities Research Council of Canada (SSHRC). An earlier version of this paper was presented at a seminar hosted at the Centre for Development Studies (CDS), University of Bath, UK, April 2011. I wish to thank Séverine Deneulin and the participants in this seminar for their thoughtful comments and suggestions.

Published
2012

30. Human rights trade-offs in a context of systemic unfreedom: The case of the smelter town of La Oroya, Peru

Author

Valencia, Areli

Subjects
capability approach, ddc:330, structural injustice, human rights, environment, extractive industry
Abstract

This paper examines the interconnecting causes that have placed residents of the community of La Oroya, in Peru's central Andes, in the dilemma of having to sacrifice their human right to health in order to preserve job opportunities at the town's smelter. Using the lens of a 'capability-oriented model of human rights', the paper shows how a constellation of environmental, social, institutional and personal factors have resulted in structuring a context of systemic unfreedom in La Oroya. This is a context in which human rights abuses reproduce systemically, affecting the overall wellbeing of individuals and communities, and in turn, diminishing their ability to transform their reality of unfreedom. The paper argues that to understand fully why some residents of the La Oroya community acquiesced in forfeiting their own rights, particular attention has to be paid to the pernicious manner in which living under unfreedom has historically trapped individuals of this community in a vicious cycle of disadvantage.

Published
2012

31. BackMatter.

Author

Valencia, Areli

Published
2016

33. Abstract 11918: The Hispanic Paradox in County-level Obesity Prevalence

Author

Valencia, Areli, Zuma, Bongeka Z, Knight, Gabriel M, Scheinker, David, Sarraju, Ashish, and Rodriguez, Fatima

Abstract

Introduction:The Hispanic paradox refers to an epidemiological phenomenon where Hispanics experience better health outcomes than expected despite more adverse socioeconomic factors. Prior work has demonstrated that a higher proportion of Hispanics living in a county is associated with lower levels of obesity. We thus sought to determine if this association persisted after adjusting for county-level factors.Methods:County-level data were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings. Counties were categorized into 4 groups based on their percentage of Hispanic persons: <5% (n=1,794), 5<20% (n=962), 20<50% (n=283), and <50% (n=99). For each group of counties, univariate and multivariate regression models were used to evaluate the association between obesity prevalence and demographic, socioeconomic, healthcare, and environmental factors. Kruskal-Wallis test was used for group comparisons.Results:Counties with the highest percentage of Hispanics had the lowest obesity prevalence (28.4%), compared to counties with lower percentage of Hispanics. Counties with the greatest proportion of Hispanics had the lowest household income ($43,910), lowest percentage of population with some college education (46.2%), lowest primary care physician ratio (41.5), highest percentage of uninsured (19.8%), and highest percentage of unemployed (7.2%) (p<0.0001). In unadjusted analyses, Hispanic proportion was negatively associated with county-level obesity rates (Figure 1). In counties with over 5% Hispanics, Hispanic population proportion remained inversely related to county-level obesity after adjusting for all other factors.Conclusion:Counties with higher proportion of Hispanics have lower levels of obesity, even after controlling for demographic and socioeconomic factors. More work is needed to elucidate why the proportion of Hispanics in a county may be protective against obesity.

Published
2019
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34. More Than Just Health Care: An Assessment of the Theoretical Foundations for a Concept of Equality in Health.

Author

Valencia, Areli

Subjects
*EQUALITY, *RIGHT to health, *HUMAN rights, *SOCIAL & economic rights
Abstract

Health is undoubtedly one of the most important conditions for the achievement of equality and freedom. In recent years, important data demonstrates that health inequality is also related to other social disadvantages such as economic inequality, lack of educational and job opportunities as well as geographical location.Conversely, health has not yet been trumped in the discourse of fundamental rights at the national level despite its recognition as a human right internationally. To a significant extent, this situation is the result of the artificial bifurcation of social-economic rights and, political and civil rights that has been exacerbated by the influence of neoliberal values emerging in the last few decades. Consequently, one of the great challenges for the contemporary discourse of rights is to create new strategies that enable social rights claims in the Liberal Welfare State. This paper proposes one alternative to accomplish that. Departing from a capability view of health, this paper explores the theoretical foundations for the recognition of a fundamental right to health as a more comprehensive approach than just health care proposed by some authors. In doing so, I suggest that the grounds for understanding a right to health -constitutionally guaranteed or not- have to be found in the principle of substantive equality that inform any serious discussion of social equity and justice. In that sense, demands for a right to health can be resolved as a question of equality in health within the Canadian context. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Published
2008

35. An Introduction to the Capability Approach: Contributions to Human Development in Latin America

Author

Deneulin, Severine, Clausen Lizarraga, Jhonatan, and Valencia, Areli

Abstract

¿Qué es el desarrollo? ¿Qué criterio utilizar para determinar si los países de América Latina han progresado durante las últimas décadas? A pesar de sus limitaciones, aún hoy, algunos gobiernos latinoamericanos consideran el aumento del ingreso per cápita como el principal criterio para juzgar su éxito. No obstante, si evaluamos el progreso utilizando otro tipo de información ¿cuál es la imagen del desarrollo en América Latina que obtenemos?Este libro introduce de manera accesible el marco normativo alternativo para evaluar el desarrollo propuesto por el Premio Nobel de Economía Amartya Sen, conocido como el “enfoque de las capacidades”. El argumento de Sen es claro: al momento de evaluar el desarrollo es necesario pasar de tomar en cuenta la cantidad de recursos que las personas poseen, a centrarse en los tipos de vida que son realmente capaces de vivir. ¿Son capaces las personas de llevar vidas saludables? ¿Son capaces de desempeñarse en empleos dignos? ¿Son capaces de influir en las decisiones que afectan sus vidas? Las respuestas a estas preguntas hacen referencia a lo que Sen entiende como “capacidades” o libertades sustantivas que las personas tienen para ser y hacer aquello que valoran, y cuya valoración permanece abierta al debate público.Cada capítulo de este libro presenta un aspecto del enfoque de las capacidades y discute sus implicancias para los estudios del desarrollo en América Latina: sus concepciones de bienestar y agencia, la relación entre las libertades individuales y la pertenencia a colectivos sociales, los vínculos entre el ser humano y la naturaleza, sus contribuciones al pensamiento sobre la justicia social, sus implicancias para la medición de la pobreza, su entendimiento de la democracia y del rol de la educación en los procesos de desarrollo, entre otros.El desafío de construir otro modelo de desarrollo para América Latina es urgente e ineludible. Este libro proporciona herramientas para construir ese modelo. Esperamos que genere un diálogo colectivo en la región acerca de cuáles han de ser las mejores decisiones y acciones para promover el desarrollo de cada persona y preservar la vida de los ecosistemas en los que habitan.

Published
2018

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