E González-Reimers

Hospital Universitario de Canarias, San Cristóbal de La Laguna, Canary Islands, Spain

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Publications (151)393.48 Total impact

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    ABSTRACT: A right calcaneus with a deep resorptive lesion surrounded by an osteosclerotic reaction in its lateral aspect was found among intermingled bone remains in a collective burial cave of the island of El Hierro, in the Canary Archipelago. It belonged to an adult prehispanic man, with an estimated antiquity of ≈1000 years BP. The bone shows a penetrating lesion in the lateral aspect slightly superior-anterior to the calcaneal tuberosity, surrounded by a bone rim, and communicating with a large cavity opening cranially where Achilles tendon is inserted. The lesion is suggestive of calcaneal osteomyelitis. The initiating cause was probably a puncture wound, perhaps with a retained foreign body that caused the large abscess. Other infectious and non-infectious etiologic possibilities are discussed.
    03/2015; 8. DOI:10.1016/j.ijpp.2014.08.004
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    ABSTRACT: Sex estimation based on tibial measurements can be achieved using discriminant functions combining several parameters. However, functions differ from one population to another, because sexual dimorphism may be more or less marked among different ancestry or ethnic groups. Calculation of one of these functions with the dimensions of populations other than that from which the function was obtained may misclassify a different proportion of males or females than when calculated with the dimensions of the original population. By dividing the proportions of correctly classified individuals when the function was applied to the population from which it derived and that of El Hierro (Canary Islands), we can calculate an index of male trait expression and an index of female trait expression, and, by addition of both indices, an index of sexual dimorphism. Therefore, it is possible to compare the degree of sexual dimorphism among several populations, at least regarding those measurements included in the function. Based on this fact we have calculated several functions (reported in the scientific literature), obtained from tibiae of modern black, white, and Japanese populations, and from medieval Croatians and prehispanic inhabitants of Gran Canaria (ap. 1000 BP), with the dimensions of the prehispanic population of El Hierro, genetically sexed, also with an antiquity of ap. 1000 BP. Despite the different antiquity, the population of El Hierro was more dimorphic that the modern Japanese one, but less dimorphic than most of the other groups with which it was compared, especially when functions including distal epiphyseal breadth and minimum shaft perimeter (near the distal end of the tibiae) were calculated: in these cases, dimorphism was lower for the population of El Hierro, due to the fact that, although male trait expression index was higher, many females of El Hierro were misclassified as males because of the abnormally thick distal diaphyseal and epiphyseal breadths of El Hierro inhabitants.
    European Journal of Anatomy 01/2015; 19(1):59-64.
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    ABSTRACT: To discern if physical function test are better mortality predictors than muscle mass in elderly hospitalized patients, we analyzed the prognostic value of muscle mass malnutrition and compared it with physical muscle function tests, including the six-minute walking test (6MWT) and hand grip strength. We included the ankle brachial index (ABI) to assess arterial disease, related to muscle atrophy due to hypoperfusion. We also analyzed the relationship of ABI with malnutrition, physical function tests and survival. We studied 310 hospitalized patients older than 60 years. To assess nutritional status, we determined BMI, triceps skinfold and mid-arm muscle area; we performed a subjective nutritional assessment; and evaluated the degree of inflammatory stress. We assessed physical function by hand grip strength and 6MWT. We evaluated arterial disease by ABI. Forty-one patients died during hospitalization; 269 were discharged and followed for a mean 808 days, reaching a mortality of 49%. Muscle malnutrition was frequent and was related to mortality, but the best predictors were physical function tests: inability to perform the 6MWT and low handgrip strength. Function tests were closely related to each other and correlated with nutritional data. Reduced ABI was related to impaired nutritional status, physical function tests and mortality.
    Scientific Reports 12/2014; 4:7530. DOI:10.1038/srep07530 · 5.08 Impact Factor
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    ABSTRACT: To analyze the relationship between low vitamin D levels and mortality among alcoholics.
    Alcohol and alcoholism (Oxford, Oxfordshire). Supplement 11/2014; DOI:10.1093/alcalc/agu076
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    ABSTRACT: Excessive ethanol consumption affects virtually any organ, both by indirect and direct mechanisms. Considerable research in the last two decades has widened the knowledge about the paramount importance of proinflammatory cytokines and oxidative damage in the pathogenesis of many of the systemic manifestations of alcoholism. These cytokines derive primarily from activated Kupffer cells exposed to Gram-negative intestinal bacteria, which reach the liver in supra-physiological amounts due to ethanol-mediated increased gut permeability. Reactive oxygen species (ROS) that enhance the inflammatory response are generated both by activation of Kupffer cells and by the direct metabolic effects of ethanol. The effects of this increased cytokine secretion and ROS generation lie far beyond liver damage. In addition to the classic consequences of endotoxemia associated with liver cirrhosis that were described several decades ago, important research in the last ten years has shown that cytokines may also induce damage in remote organs such as brain, bone, muscle, heart, lung, gonads, peripheral nerve, and pancreas. These effects are even seen in alcoholics without significant liver disease. Therefore, alcoholism can be viewed as an inflammatory condition, a concept which opens the possibility of using new therapeutic weapons to treat some of the complications of this devastating and frequent disease. In this review we examine some of the most outstanding consequences of the altered cytokine regulation that occurs in alcoholics in organs other than the liver.
    World Journal of Gastroenterology 10/2014; 20(40):14660-14671. DOI:10.3748/wjg.v20.i40.14660 · 2.43 Impact Factor
  • Esther Martin-Ponce, Emilio González-Reimers, Francisco Santolaria
    Clinical nutrition (Edinburgh, Scotland) 08/2014; 33(4). DOI:10.1016/j.clnu.2014.02.012 · 3.27 Impact Factor
  • Medicina Clínica 06/2014; 144(3). DOI:10.1016/j.medcli.2014.03.003 · 1.25 Impact Factor
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    ABSTRACT: Selenium is a main component of glutathione peroxidase (GPX), a key antioxidant enzyme. Other elements, such as zinc, copper, manganese and iron, are also involved in the pathogenesis of oxidative damage as well as in other important metabolic pathways. The effects of selenium supplementation on the metabolism of these elements have yield controversial results .The aim of this study is to analyse the effects of selenium supplementation on liver, muscle and urinary excretion of zinc, copper, iron and manganese in a situation of oxidative stress, such as protein deficiency. The experimental design included four groups of adult male Sprague-Dawley rats, which received the Lieber-DeCarli control diet, an isocaloric 2 % protein-containing diet and another similar two groups to which selenomethionine (6 mg/l liquid diet) was added. After sacrifice (5 weeks later), muscle, liver and serum selenium were determined, as well as muscle, liver and urinary zinc, copper, manganese and iron and liver GPX activity and liver malondialdehyde. Selenium addition led to decreased liver copper, increased muscle copper, increased copper excretion and increased liver iron, whereas zinc and manganese parameters were essentially unaltered. Muscle, liver and serum selenium were all significantly correlated with liver GPX activity.
    Biological trace element research 03/2014; 158(2). DOI:10.1007/s12011-014-9928-4 · 1.92 Impact Factor
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    ABSTRACT: Sclerostin inhibits osteoblast functions, differentiations, and survival rates. As an endogenous inhibitor of the Wnt/β-catenin pathway, the sclerostin should be related to decreased bone masses, although several studies indicate opposite results. In addition, it may be related to insulin resistances and carbohydrate metabolisms, a relation shared with other markers of bone metabolisms, such as osteocalcin. Hepatitis C virus (HCV) infected patients may present osteoporosis, and frequently show liver steatosis, which is a consequence of insulin resistance. The behaviour of sclerostin in these patients is yet unknown. The aim of this work is to analyse the relationships between serum sclerostin and osteocalcin levels and bone mineral density (BMD), liver functions, the intensity of liver steatosis and biochemical markers of bone homeostasis and insulin resistance in HCV-infected patients. Forty HCV patients with 20 years of age and gender-matching controls were included in this study and underwent bone densitometry. Serum sclerostin, osteocalcin, collagen telopeptide, adiponectin, leptin, insulin, resistin, tumor necrosis factor (TNF)-α, and interleukin (IL)-6 were determined. Liver fat was histomorphometrically assessed. Sclerostin levels were slightly higher in patients than in controls, and were directly related to BMD at different parts of the skeleton, also to the serum telopeptide, and to the liver steatosis and TNF-α. On the contrary, osteocalcin showed a significant direct relationship with serum adiponectin, and an inverse one with IL-6. Serum sclerostin levels were within the normal range in HCV patients, and correlated directly with BMD and serum telopeptide. In addition, the relationships of sclerostin and osteocalcin with variables associated with insulin resistance suggested the role of bones for intermediary metabolisms.
    02/2014; 21(1):69-75. DOI:10.11005/jbm.2014.21.1.69
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    ABSTRACT: This study was performed in order to analyze the relationships between hair zinc, lead, and cadmium with the kind of diet consumed (by recall of the diet consumed the previous 14 days), living area (urban or rural), tobacco smoking, and body mass index (BMI) among 419 individuals of the Canary Archipelago. Median values and interquartile range were 43 μg/g (18.50-132.50) for zinc, 4.09 μg/g (2.19-8.38) for lead, and 0.128 μg/g (0.05-0.30) for cadmium. We observed that hair zinc was markedly elevated among those consuming fish more frequently and, to a lesser amount, among those who consumed meat frequently, among those living in urban areas, and among those with BMI over 25 kg/m(2), keeping a significant relationship with BMI. Hair lead was also higher among fish consumers, showed a trend to higher values among inhabitants of urban areas, and was lower among obese individuals. Hair cadmium was higher among those who consumed less vegetables and fruits. By multivariate analysis, introducing the variables meat, fish, and vegetable consumption, urban/rural; sex; age; and BMI values, we observed that fish consumption (beta = 0.15) was the only variable independently associated to higher zinc levels; fish consumption (beta = 0.15) and meat consumption (beta = 0.17) were related to high cadmium levels, whereas meat consumption was significantly associated to higher hair lead levels (beta = 0.15). Therefore, we conclude that hair zinc, cadmium, and lead seem to depend more heavily on dietary habits than on tobacco consumption or living in rural or urban areas.
    Biological trace element research 01/2014; 157(3). DOI:10.1007/s12011-014-9896-8 · 1.92 Impact Factor
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    ABSTRACT: Assessment of skeletal robusticity is an important tool for the archaeologist and anthropologist, since it may be related to the intensity and type of activity performed by ancient population groups. Development of computed tomography (CT) allows determination of biomechanical properties of long bones. However, CT technology may not be easily available and is a relatively expensive procedure. Therefore, it is pertinent to estimate whether any of the parameters which can be easily measured in bare bones by simple anthropometry are useful to assess the torsional strength and bending strength of these bones. We included twenty one well preserved tibiae corresponding to prehispanic adult individuals (13 men) of El Hierro. These bones were anthropometrically measured following classical methods, and also subjected to CT analysis, and further calculation of minimum and maximum second moments and polar second moment of area, both at midshaft and at the nutrient foramen levels, using the software (www.hopkinsmedicine.org/FAE/mmacro.htm). The diaphyseal robusticity index showed a close relationship with minimum second moment of area at the nutrient foramen (r=0.824, p<0.001) and polar second moment of area at the nutrient foramen (r=0.824, p<0.001), whereas correlations with the epiphyseal robusticity index were weaker (r=0.628, p=0.005, and r=0.618, p=0.007, respectively). The variable which allows the best estimation of the torsional strength is the perimeter at the nutrient foramen, by the formula Polar second moment of area (in mm3) = -700.30 + 11.77 * perimeter at the nutrient foramen (in mm) for the whole population (standard error of the estimation=56.91; absolute range from-114.26 to 140.29), or Polar second moment of area (in mm3) = -897.93 + 13.74 * perimeter at the nutrient foramen (in mm) when only men were analyzed, with a standard error of the estimation of 32.17 (absolute range= from -44.53 to 50.32 mm3).
    European Journal of Anatomy 01/2014; 18(1):8-15.
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    ABSTRACT: A correct sex assignment of a given bone or bone fragment is of paramount importance for the archaeologist, anthropologist and in forensic medicine. Discriminant functions, combining several anthropometric measurements obtained from individuals with known sex are useful tools for this purpose, but it is essential to know exactly the sex from which the measures are obtained. This is an easy task in modern populations, but it is problematic in ancient ones, since even when the entire skeleton is available, diagnosis of sex is not 100% accurate. Sexing by genetic methods by amplifying the first intron of the amelogenin gene constitutes a much more accurate method for sexing bones and may be the gold standard for further elaboration of discriminant functions which may serve for sexing new bones dug up in future excavations. With this aim we have genetically sexed 52 (out of 59) tibiae belonging to the prehispanic population of El Hierro, in the Canary Islands, identifying 18 women and 34 men, and then, performed discriminant functions combining several anthropometric variables. These functions show a high accuracy in sex diagnosis (94.2%; area under ROC curve ¼ 0.954 with the best of the functions), so that they allow correct sexing of tibiae or tibiae fragments (only proximal third, distal third or midshaft). Thus, genetic sexing obviates the problem of finding an accurate gold standard for the elaboration of discriminant functions for ancient bones. This method could be applied to other populations of different antiquity and different ethnicity.
    Journal of Archaeological Science 01/2014; 40(12). DOI:10.1016/j.jas.2013.06.025 · 2.14 Impact Factor
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    ABSTRACT: Marked eburnation among prehispanic individuals from La Gomera (Canary Islands) Eburnation of the articular surfaces is an advanced feature of osteoarthritis. We here report some striking cases of such a condition in the proximal epiphysis of tibiae of prehispanic inhabitants of La Gomera, in the Canary Archipelago. Resumen Marcada eburnación entre individuos prehispánicos de La Gomera (Islas Canarias) La eburnación de las superficies articular es una característica avanzada de la osteoartritis. Presentamos aquí algunos casos llamativos de tal condición en la epífisis proximal de la tibia de los habitantes prehispánicos de la isla Gomera, en el Archipiélago Canario. Introduction Osteoarthritis is a multi-factorial disease with a final common pathway of cartilage degeneration and bone eburnation. Articular cartilage and subchondral bone form a functional unit which become early altered during the osteoarthritic process [1,5]. Altered biomechanical forces, macrotrauma or repeated microtrauma are able to induce the release of proteolytic enzymes by chondrocytes, which contribute to destroy normal cartilage. In rare instances, defective cartilage may also become destroyed by normal loading forces. Although subchondral bone sclerosis may precede detectable changes in articular cartilage [3], eburnation is a late event of the disease. For instance, it was present in the knee in about 40% of individuals undergoing tibial osteotomy and/or replacement [7]. The presence of eburnation in an ancient bone implies that the destruction of the cartilage was complete [9]. Eburnation has been explained as the result of mechanical attrition and polishing of the exposed bony articular surface. However, the mechanisms underlying eburnation are by far more complex. Articular cartilage and subchondral bone respond in a coupled manner to loading forces that ultimately trigger the osteoarthritic process. The same forces which may destroy the cartilage are also involved in an osteosclerotic bone reaction which affects subchondral bone. Recent research supports a role of the Wnt β catenin /SOST system in increased sclerotic bone response [11]. Sclerostin, a protein derived from SOST gene transcription, inhibits bone formation [4,8], counteracting the action of WNT β catenin, which becomes activated in response to mechanical loading, and which is involved in increased bone synthesis. Indeed, some researchers have found that expression of SOST in osteocytes is decreased in osteoarthritic experimental models [10]. In addition, there is a complex response of the articular cartilage itself and the subchondral trabecular bone: a progressive thickening of the transverse trabeculae, together with a thinning of the vertical trabeculae have been described. Articular cartilage calcifies immediately adjacent to subchondral bone, and is then traversed by blood vessels [6]
  • European Journal of Internal Medicine 10/2013; 24:e80. DOI:10.1016/j.ejim.2013.08.197 · 2.30 Impact Factor
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    ABSTRACT: Alcohol induces cytokine secretion by Kupffer cells, which may exert also deleterious effects on distant organs, mediated in part by cytokine-derived increased production of reactive oxygen species (ROS). It is therefore important to assess antioxidant levels. The objective of this study is to analyse the relation of antioxidant vitamins with brain atrophy and cognitive dysfunction. In 77 alcoholic patients admitted for withdrawal syndrome, subjected to brain computed tomography (CT), and 19 controls, we determined antioxidant vitamin levels and analysed their relationships with data of brain atrophy and dysfunction. Searching for causes of altered vitamin levels, we also assessed liver function, nutritional status, eating habits, alcohol intake, proinflammatory cytokine (TNF-α, IL-6, IL-8) levels and malondialdehyde (MDA) levels. Both retinol (vitamin A) and tocopherol (vitamin E) levels were decreased in alcoholics, the former in relation with liver failure, and the latter in relation with triglyceride levels and fat mass. Both were related to data of brain atrophy and cerebellar shrinkage (to which also IL-6 was significantly related). Among alcoholics, liver function impairment leads to altered serum vitamin A levels, which are related to brain alterations. Vitamin E levels are also decreased, but although in relation with liver function impairment, its decrease seems to be more dependent on nutritional status and irregular eating habits. Both vitamins are lower in patients with cerebellar atrophy and other features related to brain atrophy.
    Alcohol and Alcoholism 09/2013; DOI:10.1093/alcalc/agt150 · 1.96 Impact Factor
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    ABSTRACT: Steatohepatitis is a common finding in chronic hepatitis C virus (HCV) infection. As in other forms of steatohepatitis, oxidative damage may play an outstanding role. However, there are conflicting results relative to the role of iron on hepatic lipogenesis. Proinflammatory cytokines up-regulate ferritin expression, probably reflecting a defensive mechanism against increased oxidative stress, capable to open haem ring and release reactive iron. On the contrary, some adipokines, such as adiponectin, are associated with low ferritin levels. The aim of this study is to analyse the relationships of the amount of liver steatosis with serum iron, transferrin and ferritin as well as with proinflammatory cytokines, such as tumour necrosis factor (TNF)-α and interleukin (IL)-6, and adiponectin levels. We included 82 HCV infected patients and assessed the amount of liver fat by histomorphometry and its relationships with serum iron, ferritin and transferrin, adiponectin and TNF-α and IL-6. Liver steatosis was observed in 67 patients out of 82; in the remaining 15 patients, no steatosis at all was found. Patients with steatosis showed significantly higher serum ferritin levels than patients without steatosis (Z = 2.14; p = 0.032). When patients were classified in quartiles according to the intensity of steatosis, we observed that both TNF-α (KW = 10.6; p = 0.014) and IL-6 (KW = 15.2; p = 0.002) were significantly different among the four groups. Patients with more intense steatosis (highest quartile) showed the highest TNF-α and IL-6 values. Patients with severe hepatitis had higher levels of serum iron than patients with mild to moderate hepatitis. Serum iron also showed a correlation with the proportion of fibrosis (ρ = 0.30; p = 0.007). Serum iron levels are related with biochemical and histological parameters derived from liver inflammation in HCV-associated liver disease. Serum ferritin is higher among those with intense steatosis and also shows a (non-significant) trend to be associated with the more severe forms of hepatitis.
    Biological trace element research 07/2013; DOI:10.1007/s12011-013-9760-2 · 1.92 Impact Factor
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    ABSTRACT: Oxidative damage plays a key role in alcohol-mediated liver alterations. Selenium, a potent antioxidant, is decreased in alcoholics. This study was conducted to analyse if the supplementation with selenium may alter liver changes in a murine model fed ethanol and/or a 2 % protein-containing diet, following the Lieber-DeCarli design. Adult male Sprague Dawley rats were divided into eight groups which received the Lieber-DeCarli control diet; an isocaloric, 36 % ethanol-containing diet; an isocaloric, 2 % protein-containing diet; and an isocaloric diet containing 2 % protein and 36 % ethanol diet; and other similar four groups to which selenomethionine (1 mg/kg body weight) was added. After sacrifice (5 weeks later), liver fat amount and hepatocyte areas of pericentral and periportal cells were measured, and liver and serum selenium, activity of liver glutathione peroxidase (GPX), and liver malondialdehyde were determined. Ethanol-fed rats showed increased hepatocyte areas and fat accumulation especially when ethanol was added to a 2 % protein diet. Selenium caused a decrease in hepatocyte ballooning and liver fat amount, but an increase in GPX activity, and a marked increase in serum and liver selenium. The present study demonstrates that selenium, added to the diet of rats in the form of seleniomethionine, prevents the appearance of early signs of ethanol-mediated liver injury under the conditions of the Lieber-DeCarli experimental design.
    Biological trace element research 07/2013; DOI:10.1007/s12011-013-9734-4 · 1.92 Impact Factor
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    ABSTRACT: In bare bones, transverse lines may have several origins. Defleshing of a prey generates cutmarks, which can also appear in relation with traumatic events, post-mortem changes such as marks of animal teeth, rodent gnawing, or impact of stones, or even bone decoration. We hypothesize that in some instances they may be due to hyperplastic vessels beating on the bone surface, as expression of increased blood flow demand imposed by hypertrophied muscles. We analyzed 140 well-preserved tibiae which belonged to pre-Hispanic individuals from El Hierro, in the Canary Archipelago, currently kept at the Department of Archaeology and Prehistory of the University of La Laguna, and determined robusticity indices. Tibial marks were found in 53 out of 140 cases. Epiphyseal and diaphyseal robusticity indices were significantly higher in the first case among those with marks than among those without marks (T=3.13; p=0.002), and nearly significantly in the latter case (T=1.88; p=0.063). Considering only men, similar differences were observed regarding epiphyseal robusticity index (T=2.90; p=0.005) and diaphyseal robusticity index (T=2.11; p=0.039). There were also differences regarding the depth of the tibial marks: a higher epiphyseal robusticity index was associated with a more marked depth of the lines (T=2.11; p=0.042). An association was also observed between depth of the marks and sex (χ2=4.12; p=0.042), more profound marks being observed among men. In conclusion, we here describe subtle bone marks in tibiae, which seem to correspond to vascular imprinting and are related to bone robustness. Whether or not they really represent an adaptation to an increased blood flow demand by hypertrophied muscles in relation with increased weight-bearing activity remains speculative, but this hypothesis may explain their presence.
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    ABSTRACT: AIMS: Sclerostin is an endogenous inhibitor of the Wnt/β-catenin pathway secreted by osteocytes, which inhibits osteoblast function, differentiation and survival. As a consequence, sclerostin tends to decrease bone mass. Alcoholics frequently present osteoporosis, mainly due to decreased bone synthesis. The behaviour of sclerostin in these patients is unknown. The aim of this work was to analyse the relationship between serum sclerostin levels and bone mineral density (BMD), ethanol consumption, nutritional status, liver function derangement and biomarkers of bone homeostasis in alcoholic patients. METHODS: We included 31 alcoholic patients, of whom 11 were infected with Hepatitis C virus (HCV) and 7 age and sex-matched controls. All underwent densitometry, and serum sclerostin, osteocalcin, collagen telopeptide, parathyroid hormone (PTH), vitamin D, cortisol and testosterone were determined. RESULTS: Sclerostin levels were significantly higher in patients (30.95 ± 18.91 pmol/l) than controls (t = 4.4; P < 0.001), especially in non-HCV patients; they showed an inverse correlation with osteocalcin, prothrombin activity and serum albumin, and a direct correlation with bilirubin and telopeptide, but not with BMD, nutritional status or ethanol intake. CONCLUSIONS: Serum sclerostin was raised in alcoholic patients, and it correlated with decreased markers of bone synthesis and increased markers of bone breakdown. The elevation in sclerostin levels was clearly related with liver function, but not with ethanol intake, nutritional status or concomitant HCV infection.
    Alcohol and Alcoholism 01/2013; DOI:10.1093/alcalc/ags136 · 1.96 Impact Factor