R Casamitjana

Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcino, Catalonia, Spain

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Publications (262)1110.27 Total impact

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    ABSTRACT: Objective The aim of this study was to examine possible associations between ambient temperature and obesity in the Spanish population using an ecological focus.Methods The Di@bet.es study is a national, cross-sectional, population-based survey of cardiometabolic risk factors and their association with lifestyle. Sample: 5,061 subjects in 100 clusters. Variables: Clinical, demographic and lifestyle survey, physical examination, and blood sampling. The mean annual temperature (°C) for each study site was collected from the Spanish National Meteorology Agency (1971-2000).ResultsThe prevalence rates of obesity in the different geographical areas divided according to mean annual temperature quartiles were 26.9% in quartile 1 (10.4-14.5°C), 30.5% in quartile 2 (14.5-15.5°C), 32% in quartile 3 (15.5-17.8°C), and 33.6% in quartile 4 (17.8-21.3°C) (P = 0.003). Logistic regression analyses including multiple socio-demographic (age, gender, educational level, marital status) and lifestyle (physical activity, Mediterranean diet score, smoking) variables showed that, as compared with quartile 1, the odd ratios for obesity were 1.20 (1.01-1.42), 1.35 (1.12-1.61), and 1.38 (1.14-1.67) in quartiles 2, 3, and 4, respectively (P = 0.001 for difference, P < 0.001 for trend).Conclusion Our study reports an association between ambient temperature and obesity in the Spanish population controlled for known confounders.
    Obesity 08/2014; · 3.92 Impact Factor
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    ABSTRACT: Although GLP-1 has been suggested as a major factor for the marked improvement of glucose tolerance commonly seen after sleeve gastrectomy (SG), several observations challenge this hypothesis. To better understand the role of GLP-1 in the remission of T2DM long-term after SG in humans, we conducted two separate cross-sectional studies: (1) the GLP-1 response to a standardized mixed liquid meal (SMLM) was compared in subjects with T2DM antedating SG but with different long-term (>2 years) T2DM outcomes (remission, relapse, or lack of remission), and (2) the effect of GLP-1 receptor blockade with Exendin 9-39 on glucose tolerance was examined in subjects with T2DM antedating surgery, who had undergone SG and presented with long-term T2DM remission. In Study 1, we observed a comparable GLP-1 response to the SMLM regardless of the post-SG outcome of T2DM. In Study 2, the blockade of GLP-1 action resulted in impaired insulin secretion but limited deterioration of glucose tolerance. Thus, our data suggest the enhanced GLP-1 secretion observed long-term after SG is neither sufficient nor critical to maintain normal glucose tolerance in subjects with T2DM antedating the surgery.
    Diabetes 05/2014; · 7.90 Impact Factor
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    ABSTRACT: Dyslipidemia is a significant contributor to the elevated CVD risk observed in type 2 diabetes mellitus. We assessed the prevalence of dyslipidemia and its association with glucose metabolism status in a representative sample of the adult population in Spain and the percentage of subjects at guideline-recommended LDL-C goals. The di@bet.es study is a national, cross-sectional population-based survey of 5728 adults. A total of 4776 subjects were studied. Dyslipidemia was diagnosed in 56.8% of subjects; only 13.2% of subjects were treated with lipid lowering drugs. Lipid abnormalities were found in 56.8% of Spanish adults: 23.3% with high LDL-C, 21.5% high TG, 35.8% high non-HDL-C, and 17.2% low HDL-C. Most normal subjects showed an LDL-C≤3.36mmol/l. Pre-diabetics presented similar proportion when considering a goal of 3.36mmol/l, but only 35% of them reached an LDL-C goal≤2.6mmol/l. Finally, 45.3% of diabetics had an LDL-C≤2.6mmol/l, and only 11.3% achieved an LDL-C≤1.8mmol/l. Our study demonstrates a high prevalence of dyslipidemia in the adult Spanish population, and a low use of lipid-lowering drugs. Moreover, the number of subjects achieving their corresponding LDL-C goal is small, particularly in subjects at high cardiovascular risk, such as diabetics.
    Clinica e Investigacion en Arteriosclerosis 01/2014;
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    ABSTRACT: Background Prevalence rates of “Metabolically healthy Obese” (MHO) subjects vary depending on the criteria used. This study examined the prevalence and characteristics of MHO subjects and metabolically abnormal normal-weight subjects and compared the findings with the NHANES 1999-2004 study. Methods Di@bet.es study is a national, cross-sectional population-based survey of 5728 adults conducted in 2009-2010. Clinical, metabolic, socio-demographic, anthropometric data and information about lifestyle habits as physical activity, smoking habit, alcohol intake and food consumption, were collected. Subjects were classified according to their body mass index (BMI) (normal-weight, <25kg/m2; overweight, 25-29.9 kg/m2; and obese, >30kg/m2). Cardiometabolic abnormalities (CA) included elevated blood pressure; elevated levels of triglycerides, fasting glucose, and high-sensitivity C-reactive protein (hs-CRP); elevated homeostasis model assessment of insulin resistance (HOMA-IR) value and low high-density lipoprotein cholesterol (HDL-c) level. Two phenotypes were defined: metabolically healthy phenotype (0-1 CA) and metabolically abnormal phenotype (≥2 CA). Results The prevalence of metabolically abnormal normal-weight phenotype was slightly lower in the Spanish population (6.5% vs. 8.1%). The prevalence of metabolically healthy overweight and MHO subjects was 20.9% and 7.0% respectively whilst in NHANES study was 17.9% and 9.7%. Cigarette smoking was associated with CA in each phenotype, while moderate physical activity and moderate alcohol intake were associated with being metabolically healthy. Olive oil intake was negatively associated with the prevalence of CA. Conclusions Smoking, physical activity level and alcohol intake contribute to the explanation of the prevalence of CA in the Spanish population, as in the US population. However in Spain, olive oil intake contributes significantly to the explanation of the variance in the prevalence of CA.
    Nutrition, Metabolism and Cardiovascular Diseases. 01/2014;
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    ABSTRACT: To assess the patterns of use of 8 therapeutic drug groups for the treatment of diabetes mellitus and other cardiovascular risk factors, and to identify sociodemographic and health determinants of their use in the overall Spanish population. A representative sample of the Spanish population within the Di@bet.es study, a cross-sectional population-based survey, was included. Study variables: sociodemographic, clinical, and lifestyle data; physical examination, and an oral glucose tolerance test in patients without known diabetes mellitus. Furthermore, patients were systematically queried about current medication use, and 8 pharmacotherapeutic groups were evaluated: lipid-lowering therapy, antihypertensives, oral hypoglycemic agents, insulin, thyroid hormone, uricosurics, psychoactive drugs, and nonsteroidal anti-inflammatory drugs. Sixty-six percent of the Spanish population was taking at least one medication. Therapeutic drug use was associated with age, independently of the higher prevalence of diabetes mellitus, hypertension, or hyperlipidemia in older patients. Sex disparities were found in the use of lipid-lowering agents, allopurinol, levothyroxine, nonsteroidal anti-inflammatory drugs, and psychoactive drugs. Use of psychoactive drugs was related to education level, work status, physical activity, smoking, and alcohol consumption. Almost 30% of patients with diabetes mellitus were taking 6 or more medications daily. Diabetes mellitus was associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs. Age and sex are the most important factors determining therapeutic drug use. Lifestyle patterns and sociocultural factors have an impact only on psychoactive drug use. Diabetes mellitus is associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs. Full English text available from:www.revespcardiol.org/en.
    Revista Espa de Cardiologia 09/2013; · 3.20 Impact Factor
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    ABSTRACT: Residual beta-cell function and gastrointestinal hormones have been suggested as relevant determinants of improved glycemic control ensuing Roux-en-Y gastric bypass (RYGB). The objective of this study was to compare the glycemic control up to 24 months after RYGB in C-peptide negative morbidly obese (MO) type 1 diabetes mellitus (T1 DM) women (n = 7) and C-peptide positive (>.6 ng/mL) MO women with type 2 diabetes mellitus (T2 DM, n = 7) on basal-bolus insulin therapy. The glucagon-like peptide 1 (GLP-1) and glucagon response to a mixed meal challenge were also compared between groups. Percent excess weight loss (%EWL), HbA1c, and daily insulin dose (DID) after RYGB were compared between groups. The GLP-1 and glucagon response (area under the curve 0-120 minutes) after a mixed meal at last follow-up visit were also compared. At 24-months, marked %EWL was observed in women with T1 DM and women with T2 DM (mean±standard error, 82.6%±11.3% and 87.4%±30.5%, respectively; P = .722]. In women with T1 DM, HbA1c (4 months, P<.05) and DID improved transiently (P<.05, up to 8 months) but were comparable to baseline thereafter (HbA1c: baseline, 8.3±1.2 and 24 months, 8.2±.9, P = 1.00; DID: baseline, .61±.17 and 24 months .62±.12 IU/kg/d, P = 1.00]. In contrast, in MO women with T2 DM, HbA1c decreased significantly throughout follow-up, with 2 patients presenting diabetes remission and all but one an HbA1c<7% at 24 months. The GLP-1 response was comparable between groups (P = .612), and was not accompanied by suppression of the glucagon response to meal intake. In the absence of residual beta-cell, RYGB results in no significant benefit on glycemic control, despite a marked response of GLP-1 to meal intake.
    Surgery for Obesity and Related Diseases 08/2013; · 4.12 Impact Factor
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    ABSTRACT: Background:Despite the marked increase in cardiovascular risk factors in Spain in recent years, the prevalence and incidence of cardiovascular diseases have not risen as expected. Our objective is to examine the association between consumption of olive oil and the presence of cardiometabolic risk factors in the context of a large study representative of the Spanish population.Subjects and methods:A population-based, cross-sectional, cluster sampling study was conducted. The target population was the whole Spanish population. A total of 4572 individuals aged 18 years in 100 clusters (health centers) were randomly selected with a probability proportional to population size. The main outcome measures were clinical and demographic structured survey, lifestyle survey, physical examination (weight, height, body mass index, waist, hip and blood pressure) and oral glucose tolerance test (OGTT) (75 g).Results:Around 90% of the Spanish population use olive oil, at least for dressing, and slightly fewer for cooking or frying. The preference for olive oil is related to age, educational level, alcohol intake, body mass index and serum glucose, insulin and lipids. People who consume olive oil (vs sunflower oil) had a lower risk of obesity (odds ratio (OR)=0.62 (95% confidence interval (CI)=0.41-0.93, P=0.02)), impaired glucose regulation (OR=0.49 (95% CI=0.28-0.86, P=0.04)), hypertriglyceridemia (OR=0.53 (95% CI=0.33-0.84, P=0.03)) and low HDL cholesterol levels (OR=0.40 (95% CI=0.26-0.59, P=0.0001)).Conclusions:The results show that consumption of olive oil has a beneficial effect on different cardiovascular risk factors, particularly in the presence of obesity, impaired glucose tolerance or a sedentary lifestyle.European Journal of Clinical Nutrition advance online publication, 17 July 2013; doi:10.1038/ejcn.2013.130.
    European journal of clinical nutrition 07/2013; · 3.07 Impact Factor
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    ABSTRACT: Background and Aims: Mediterranean diet (MedDiet) is causally related to diabetes and is a dietary pattern recommended to individuals with diabetes. We investigated MedDiet adherence in individuals with prediabetes and unknown (PREDM/UKDM) or known diabetes (KDM) compared to those with normal glucose metabolism (NORMAL). Methods: This was a national, population-based, cross-sectional, cluster-sampling study. MedDiet adherence was scored (MedScore, mean ± SD 24 ± 5) using a qualitative food frequency questionnaire. Logistic regression was used to examine the association between MedScore and PREDM/UKDM or KDM versus control subjects. Results: We evaluated 5,076 individuals. Mean age was 50 years, 57% were female, 826 (582/244) were PREDM/UKDM, 478 were KDM and 3,772 were NORMAL. Mean age increased across MedScore tertiles (46, 51 and 56 years, p < 0.0001). Higher age-adjusted adherence to MedDiet (5-unit increment in the MedScore) was associated with lower and nondifferent odds (OR, 95% CI) of prevalent PREDM/UKDM (0.88, 0.81-0.96, p = 0.001) and KDM (0.97, 0.87-1.07, p = 0.279), respectively, compared to individuals in the NORMAL group. Conclusions: In a representative sample of the whole Spanish population, MedDiet adherence is independently associated with PREDM/UKDM. Therapeutic intervention may be, in part, responsible for the lack of differences in adherence observed between the KDM and NORMAL groups. However, reverse causation bias cannot be ruled out in cross-sectional studies.
    Annals of Nutrition and Metabolism 07/2013; 62(4):339-346. · 1.66 Impact Factor
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    ABSTRACT: Always granting that de novo mutations are possible, family history and biological characteristics are nonetheless crucial for the diagnosis of monogenic diabetes. We report here the case of two patients with monogenic diabetes in which the initial family history misled the diagnostic work-up and did not support the diagnosis. Family history details changed substantially after the molecular diagnosis was established.
    Hormones (Athens, Greece) 07/2013; 12(3):466-469. · 2.01 Impact Factor
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    ABSTRACT: : To evaluate the association between glucagon-like peptide 1 (GLP-1) secretion and the long-term (>2 years) outcome of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP). : Cross-sectional study in 18 T2DM morbidly obese subjects who underwent RYGBP but differed in the long-term outcome of T2DM (remission: G1, n = 6; relapse: G2, n = 6; lack of remission: G3: n = 6). Groups were matched for their sex, age, and body mass index. The GLP-1, glucose, C-peptide, and glucagon responses to a standardized test meal (STM) were evaluated. Insulin secretion and insulin sensitivity were estimated from the STM and by frequently sampling intravenous glucose tolerance test (FSIVGTT). Dual-energy X-ray absorptiometry was used to assess body composition. : Patients in G1 presented a lower area under the curve (AUC0-120) of glucose in response to the STM as compared with G2, and G3 (P < 0.01). In contrast, the AUC0-120 of GLP-1 (P = 0.884) and glucagon (P = 0.630) did not differ significantly among the 3 groups. Indices of insulin secretion adjusted by the prevailing insulin sensitivity derived from STM and FSIVGTT, demonstrated larger β-cell function in subjects in G1 as compared with G2 or G3 (Disposition Index-STM, P = 0.005; DI-FSIVGTT, P = 0.006). Body composition and inflammatory markers did not differ significantly among the 3 study groups. : Our data show that in subjects with T2DM an enhanced GLP-1 response to meal intake is not sufficient to maintain normal glucose tolerance in the long term after RYGBP. Our data suggest that β-cell function is a key determinant of the long-term remission of T2DM after this bariatric surgery technique.
    Annals of surgery 05/2013; 257(5):894-9. · 7.90 Impact Factor
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    ABSTRACT: The aim of the study is to assess the prevalence of metabolic syndrome (MetS) in Spain using specific cutoff points for waist circumference (WC) (>94.5 cm for men and >89.5 cm for women) and evaluating the influence of several socio-demographic and economic factors. Data on MetS were obtained from a national study of 4,727 subjects from 18 to 90 years of age, conducted in Spain between 2009 and 2010 (The di@bet.es study). MetS was defined applying the new Harmonized definition (evaluating the use of abdominal obesity (AO) as a obligatory criterion for MetS or not) as well as with other widely used criteria. Results were then compared with data from previous studies. Multiple logistic regression models were used to evaluate the influence of different social factors. The age-standardized MetS prevalence was 38.37 % (CI 35.74-40.99) in men and 29.62 % (CI 27.56-31.69) in women, when AO was required as a diagnostic criterion; 42.13 % (CI 39.37-44.89) and 32.31 % (CI 30.15-34.47) in men and women, respectively, if AO was not considered mandatory. Prevalence of MetS increased with age (p < 0.001 for trend). Women with a lower educational level were more likely to have MetS (OR 4.4; 95 % CI: 2.84-6.7) as compared with those with a higher educational level. Subjects with MetS had a worse physical quality of life. The combination of AO, hypertension and carbohydrate alterations was the most common MetS' pattern. A high prevalence of MetS was detected in the Spanish population especially in men, the elderly and women with a low educational level.
    Acta Diabetologica 03/2013; · 4.63 Impact Factor
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    ABSTRACT: OBJECTIVE Glucagon like peptide-1 (GLP-1) has been suggested as a major factor for the improved glucose tolerance ensuing after Roux-en-Y Gastric Bypass (RYGBP) surgery. We examined the effect of blocking endogenous GLP-1 action on glucose tolerance in subjects with sustained remission of type 2 diabetes (T2DM) present before RYGBP.RESEARCH DESIGN AND METHODS Blood glucose, insulin, C-peptide, glucagon, GLP-1, and glucose-dependent insulinotropic peptide levels were measured after a meal challenge with either exendin-(9-39) (a GLP-1r antagonist) or saline infusion in eight subjects with sustained remission of T2DM after RYGBP and seven healthy controls.RESULTSInfusion of exendin-(9-39) resulted in marginal deterioration of the 2-h plasma glucose after meal intake in RYGBP subjects (saline 78.4 ± 15.1 mg/dL compared with exendin-(9-39) 116.5 ± 22.3 mg/dL; P < 0.001). Furthermore, glucose response to meal intake was similarly enlarged in the two study groups (percent change in the area under the curve of glucose exendin-(9-39)-infusion versus saline-infusion: controls 10.84 ± 8.8% versus RYGBP 9.94 ± 8.4%; P = 0.884). In the RYGBP group, the blockade of the enlarged GLP-1 response to meal intake resulted in reduced insulin (P = 0.001) and C-peptide (P < 0.001), but no change in glucagon (P = 0.258) responses.CONCLUSION The limited deterioration of glucose tolerance on blockade of GLP-1 action in our study suggests the resolution of T2DM after RYGBP may be explained by mechanisms beyond enhancement of GLP-1 action.
    Diabetes care 01/2013; · 7.74 Impact Factor
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    ABSTRACT: Fibroblast growth factor 23 (FGF-23) is known to be produced by the bone and linked to metabolic risk. We aimed to explore circulating FGF-23 in association with fatness and insulin sensitivity, atherosclerosis and bone mineral density (BMD). Circulating intact FGF-23 (iFGF-23) and C-terminal (CtFGF-23) concentrations (ELISA) were measured in 133 middle aged men from the general population in association with insulin sensitivity (Cohort 1); and in association with fat mass and bone mineral density (DEXA) and atherosclerosis (intima media thickness, IMT) in 78 subjects (52 women) with a wide range of adiposity (Cohort 2). Circulating iFGF-23 was also measured before and after weight loss. In all subjects as a whole, serum intact and C-terminal concentrations were linearly and positively associated with BMI. In cohort 1, both serum iFGF-23 and CtFGF-23 concentrations increased with insulin resistance. Serum creatinine contributed to iFGF-23 variance, while serum ferritin and insulin sensitivity (but not BMI, age or serum creatinine) contributed to 17% of CtFGF-23 variance. In cohort 2, CtFGF-23 levels were higher in women vs. men, and increased with BMI, fat mass, fasting and post-load serum glucose, insulin, HOMA-IR and PTH, being negatively associated with circulating vitamin D and ferritin levels. The associations of CtFGF-23 with bone density in the radius, lumbar spine and carotid IMT were no longer significant after controlling for BMI. Weight loss led to decreased iFGF-23 concentrations. In summary, the associations of circulating FGF-23 concentration with parameters of glucose metabolism, bone density and atherosclerosis are dependent on iron and obesity status-associated insulin resistance.
    PLoS ONE 01/2013; 8(3):e58961. · 3.53 Impact Factor
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    ABSTRACT: Introduction and objectives To assess the patterns of use of 8 therapeutic drug groups for the treatment of diabetes mellitus and other cardiovascular risk factors, and to identify sociodemographic and health determinants of their use in the overall Spanish population. Methods A representative sample of the Spanish population within the Di@bet.es study, a cross-sectional population-based survey, was included. Study variables: sociodemographic, clinical, and lifestyle data; physical examination, and an oral glucose tolerance test in patients without known diabetes mellitus. Furthermore, patients were systematically queried about current medication use, and 8 pharmacotherapeutic groups were evaluated: lipid-lowering therapy, antihypertensives, oral hypoglycemic agents, insulin, thyroid hormone, uricosurics, psychoactive drugs, and nonsteroidal anti-inflammatory drugs. Results Sixty-six percent of the Spanish population was taking at least one medication. Therapeutic drug use was associated with age, independently of the higher prevalence of diabetes mellitus, hypertension, or hyperlipidemia in older patients. Sex disparities were found in the use of lipid-lowering agents, allopurinol, levothyroxine, nonsteroidal anti-inflammatory drugs, and psychoactive drugs. Use of psychoactive drugs was related to education level, work status, physical activity, smoking, and alcohol consumption. Almost 30% of patients with diabetes mellitus were taking 6 or more medications daily. Diabetes mellitus was associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs. Conclusions Age and sex are the most important factors determining therapeutic drug use. Lifestyle patterns and sociocultural factors have an impact only on psychoactive drug use. Diabetes mellitus is associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs. Full English text available from:www.revespcardiol.org/en
    Revista Española de Cardiología. 01/2013; 66(11):854–863.
  • European Journal of Clinical Investigation 01/2013; 43(1):1-10. · 3.37 Impact Factor
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    ABSTRACT: Aim: To examine the prevalence of urinary albumin-creatinine ratio (ACR)< 30 mg/g and the associated clinical and environmental factors in a representative sample of the population of Spain. Methods: Di@bet.es study is a national, cross-sectional population-based survey conducted in 2009-10. Clinical, metabolic, socio-demographic, anthropometric data and information about lifestyle habit were collected. Those subjects without known diabetes mellitus (KDM) were given an oral glucose tolerance test (OGTT). Albumin and creatinine were measured in an urinary sample and ACR was calculated. Results: The population prevalence of ACR < 30 mg/g was 7.65% (adjusted for sex and age). The prevalence of ACR<30 mg/g increased with age (p<0.001). Persons with carbohydrate metabolism disorders had a greater prevalence of ACR<30 mg/g but after adjusted for age, sex and hypertension, was significant only those subjects with unknown diabetes mellitus (UKDM) (OR=2.07, 95% CI 1.38-3.09) (p<0.001) and KDM (OR=3.55, 95%CI 2.63-4.80) (p<0.001). Prevalence of ACR<30 mg/g was associated with hypertension (OR=1.48, 95%CI 1.12-1.95) (p=0.001), HOMA-IR (OR=1.47, 95%CI 1.13-1.92) (p=<0.01), metabolic syndrome, (OR=2.17, 95%CI 1.72-2.72) (p<0.001), smoking (OR=1.40, 95%CI 1.06-1.83) (p=<0.05), physical activity (OR=0.68, 95%CI 0.54-0.88) (p=<0.01), and consumption of fish (OR=0.38, 95%CI 0.18-0.78) (p=<0.01). Conclusions: This is the first study that reports the prevalence of ACR < 30 mg/g in the Spanish population. The association between clinical variables and other potentially modifiable environmental variables contribute jointly, and sometimes interactively, to the explanation of prevalence of ACR < 30 mg/g. Many of these risk factors are susceptible to intervention.
    Clinical Science 09/2012; · 4.86 Impact Factor
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    ABSTRACT: OBJECTIVE:: To identify the rates and the predictors of long-term remission and the recurrence of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP) or sleeve gastrectomy (SG). BACKGROUND:: The durability of the improvement of T2DM after bariatric surgery is not well characterized. METHODS:: One hundred fifty-three subjects with T2DM (RYGBP: n = 98; SG: n = 55) were evaluated for remission and recurrence of the disease throughout 35.4 ± 13.5 months' follow-up. The type of surgery, demographic, anthropometric, and biochemical parameters were ascertained as predictors of T2DM outcomes. Glucagon-like peptide 1 (GLP-1) responses after a standard mixed liquid meal were compared between patients presenting with T2DM remission after RYGBP or SG. RESULTS:: 75.2% of subjects presented with remission of T2DM lasting at least 12 months. However, in 12.1% of subjects, T2DM recurred. Regression analysis showed a longer duration of T2DM (P = 0.006), a higher presurgical glycated hemoglobin level (P = 0.019), insulin treatment at baseline (P = 0.001), and a lower excess weight loss at last follow-up visit (P < 0.001) as independent predictors for the lack of T2DM remission. Insulin use before surgery (P = 0.005), an older age (P = 0.05), and weight regain after remission (P = 0.021) predicted recurrence of the disease. Long-term remission of T2DM after SG or RYGBP was associated with a comparably enlarged GLP-1 response to a standard mixed liquid meal challenge. CONCLUSIONS:: Roux-en-Y gastric bypass and SG are associated with comparable remission rates of T2DM. However, insufficient weight loss or weight regain in those with a more advanced disease may hamper the benefits of these surgical techniques on T2DM.
    Annals of surgery 09/2012; · 7.90 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: To date no nation-wide study has yet been undertaken in Spain to estimate the iodine deficiency. The aim was to evaluate iodine intake and its conditioning factors in a representative sample of the whole adult population. METHODS: The Di@bet.es Study is a national, cross-sectional, population-based survey conducted in 2009-2010 in Spain. RESULTS: The median urinary iodine (UI) was 117.2μg/L. Iodized salt (IS) was consumed by 43.9% of the population. The median UI in those who consumed IS and in those who did not consume IS was 131.1 and 110.8μg/L respectively (p<0.0001). The likelihood of having UI levels above 100μg/L was significantly associated with the intake of IS (OR=1.47) and milk at least once a day (OR=1.22). Within each individual autonomous communities, the median UI levels in those who consumed IS correlated significantly with the median levels of those who did not consume IS (r=0.76, p=0.001). CONCLUSIONS: Though strictly speaking, Spain should be considered within the category of a country having an adequate iodine intake, the current value is too close to the cut point and does not guarantee that those groups with a greater need for iodine will have the required intake of iodine.
    Clinical nutrition (Edinburgh, Scotland) 05/2012; · 3.27 Impact Factor
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    ABSTRACT: Recent evidence supports a specific and broad role of androgen produced by theca cells in reproductive physiology. This pilot study evaluated the usefulness of hCG theca stimulation test in predicting ovarian response and pregnancy. Prospective cohort study including 80 infertile women treated with IVF/ICSI. On Day 3 of the menstrual cycle preceding, the first IVF/ICSI cycle a blood sample was drawn to evaluate baseline FSH, estradiol (E(2)), 17-hydroxy-progesterone, androstenedione and testosterone levels. All women then received 250 µg recombinant hCG s.c. and underwent a second blood sampling 24 h after hCG injection to measurement steroid serum levels. Percentage increment of E(2) but not its precursors was significantly higher in normo-responders and pregnancy cycles than in poor responders and non-pregnancy cycles (P = 0.03 and P = 0.02, respectively) diagnostic accuracy being 67 and 75%, respectively. The percentage increase in E(2) thus still fails in as many as 33 and 25% of patients in predicting ovarian response and pregnancy, respectively. In addition, E(2) concentrations are poorly reproducible and a wide range of variation in all serum steroids investigated-including E(2)-after hCG injection was observed. The predictive power of the hCG test is based on E(2) but not androgen response to hCG injection. This test cannot be recommended in routine clinical practice because it is too laborious for screening purposes, shows great variability in the response obtained and its overall accuracy is not better than that reported for other available markers of ovarian reserve. The use of the currently available markers, antral follicle count and anti-Müllerian hormone, is therefore recommended.
    Human Reproduction 02/2012; 27(4):1122-9. · 4.67 Impact Factor
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    ABSTRACT: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) are associated with similar type 2 diabetes mellitus (T2DM) resolution rates for morbidly obese subjects. However, the mechanisms underlying the resolution of T2DM after SG have not been clarified to date. This study aimed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP. This prospective study investigated 12 subjects with T2DM who had undergone SG (n = 6) or RYGBP (n = 6). Five body mass index (BMI)-matched obese non-diabetic subjects and five BMI-matched obese diabetic subjects served as control subjects. Glucose, insulin, glucagon, glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and GLP-2 were determined after a standardized mixed liquid meal before surgery and 6 weeks afterward. After 6 weeks, five of the six subjects in each surgical group presented with T2DM remission, although the area under the curve (AUC)0–120 of glucose was greater than that of the non-diabetic control subjects (P < 0.01). Postsurgically, the indices of insulin and glucagon secretion were comparable between the two surgical groups. The AUC0–120 of GLP-1 (P < 0.05) and GLP-2 (P < 0.05) was significantly and comparably enlarged after SG and RYGB. The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test (ρ = 0.747; P < 0.01). The data show that in a cohort of morbidly obese T2DM subjects, SG and RYGBP are associated with an early improvement in glucose tolerance, similar changes in insulin and glucagon secretion, and a similar GLP-1, GIP, and GLP-2 response to a standardized mixed liquid meal.
    Surgical Endoscopy 02/2012; 26(8):2231-9. · 3.43 Impact Factor

Publication Stats

5k Citations
1,110.27 Total Impact Points

Institutions

  • 2012–2014
    • Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas
      Barcino, Catalonia, Spain
    • Hospital Clínico San Carlos
      Madrid, Madrid, Spain
    • Hospital Regional Universitario Carlos Haya Málaga
      • Departamento de Endocrinología y Nutrición
      Málaga, Andalusia, Spain
  • 2013
    • Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y la Nutrición (CIBERobn)
      Santiago, Galicia, Spain
  • 1988–2013
    • Hospital Clínic de Barcelona
      • • Servicio de Dietética y Endocrinología
      • • Servicio de Enfermedades Autoinmunes y Sistémicas
      • • Servicio de Enfermedades Infecciosas
      • • Servicio de Gastroenterología
      Barcino, Catalonia, Spain
  • 1998–2012
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1985–2012
    • University of Barcelona
      • • Departament de Medicina
      • • Departament d'Obstetrícia i Ginecologia, Pediatria, Radiologia i Anatomia
      Barcelona, Catalonia, Spain
  • 1999–2011
    • Southern Medical Clinic
      San Fernando, City of San Fernando, Trinidad and Tobago
    • Hospital Clínico, Maracaibo
      Maracaibo, Estado Zulia, Venezuela
  • 2010
    • Institut Català d'Oncologia
      Barcino, Catalonia, Spain
  • 2003–2010
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2009
    • Hospital Universitario de La Princesa
      Madrid, Madrid, Spain
  • 1997–2007
    • Hospital Universitari de Girona Dr. Josep Trueta
      Girona, Catalonia, Spain
    • Clinica Girona
      Girona, Catalonia, Spain
  • 2002
    • Universitat de Girona
      Girona, Catalonia, Spain
  • 2000
    • Institut Pasteur de Lille
      Lille, Nord-Pas-de-Calais, France
  • 1987
    • Hospital de la Santa Creu i Sant Pau
      Barcino, Catalonia, Spain
    • Institut Català de la Salut
      Cerdanyola del Vallès, Catalonia, Spain