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Background Recent reports have suggested that air pollution may impact thyroid function, although the evidence is still scarce and inconclusive. In this study we evaluated the association of exposure to air pollutants to thyroid function parameters in a nationwide sample representative of the adult population of Spain. Methods The Di@bet.es study is a national, cross-sectional, population-based survey which was conducted in 2008-2010 using a random cluster sampling of the Spanish population. The present analyses included 3859 individuals, without a previous thyroid disease diagnosis, and with negative thyroid peroxidase antibodies (TPO Abs) and thyroid-stimulating hormone (TSH) levels of 0.1-20 mIU/L. Participants were assigned air pollution concentrations for particulate matter <2.5 mu m (PM2.5) and Nitrogen Dioxide (NO2), corresponding to the health examination year, obtained by means of modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). TSH, free thyroxine (FT4), free triiodothyronine (FT3) and TPO Abs concentrations were analyzed using an electrochemiluminescence immunoassay (Modular Analytics E170 Roche). Results In multivariate linear regression models, there was a highly significant negative correlation between PM2.5 concentrations and both FT4 (p<0.001), and FT3 levels (p<0.001). In multivariate logistic regression, there was a significant association between PM2.5 concentrations and the odds of presenting high TSH [OR 1.24 (1.01-1.52) p=0.043], lower FT4 [OR 1.25 (1.02-1.54) p=0.032] and low FT3 levels [1.48 (1.19-1.84) p=<0.001] per each IQR increase in PM2.5 (4.86 mu g/m(3)). There was no association between NO2 concentrations and thyroid hormone levels. No significant heterogeneity was seen in the results between groups of men, pre-menopausal and post-menopausal women. Conclusions Exposures to PM2.5 in the general population were associated with mild alterations in thyroid function.

Background/Objectives Although vascular endothelial growth factor b (VEGFb) might have an impact on the development of obesity, diabetes and related disorders, the possible relationship between VEGFb serum levels and the incidence of these metabolic complications in humans is still unknown. The aim of our study was to evaluate the association between VEGFb serum levels and the new-onset of metabolic syndrome (MS) and its components in the Spanish adult population after 7.5 years of follow-up. Subjects/Methods A total of 908 subjects from the Di@bet.es cohort study without MS at cross-sectional stage according to International Diabetes Federation (IDF) or Adult Treatment Panel III (ATP-III) criteria were included. Additionally, five sub-populations were grouped according to the absence of each MS component at baseline. Socio-demographic, anthropometric and clinical data were recorded. The Short Form of International Physical Activity Questionnaire (SF-IPAQ) was used to estimate physical activity. A fasting blood extraction and an oral glucose tolerance test were performed. Serum determinations of glucose, lipids, hsCRP and insulin were made. VEGFb levels were determined and categorized according to the 75th percentile of the variable. New cases of MS and its components were defined according to ATPIII and IDF criteria. Results A total of 181 or 146 people developed MS defined by IDF or ATP-III criteria respectively. Serum triglyceride levels, hs-CRP and systolic blood pressure at the baseline study were significantly different according to the VEGFb categories. Adjusted logistic regression analysis showed that the likelihood of developing MS and abdominal obesity was statistically reduced in subjects included in the higher VEGFb category. Conclusion Low serum levels of VEGFb may be considered as early indicators of incident MS and abdominal obesity in the Spanish adult population free of MS, independently of other important predictor variables.

[EN]Exposure to air particulate matter has been linked with hypertension and blood pressure levels. The metabolic risks of air pollution could vary according to the specific characteristics of each area, and has not been sufficiently evaluated in Spain. We analyzed 1103 individuals, participants in a Spanish nationwide population based cohort study (di@bet.es), who were free of hypertension at baseline (2008-2010) and completed a follow-up exam of the cohort (2016-2017). Cohort participants were assigned air pollution concentrations for particulate matter < 10 mu m (PM10) and < 2.5 mu m (PM2.5) during follow-up (2008-2016) obtained through modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). Mean and SD concentrations of PM10 and PM2.5 were 20.17 +/- 3.91 mu g/m(3) and 10.83 +/- 2.08 mu g/m(3) respectively. During follow-up 282 cases of incident hypertension were recorded. In the fully adjusted model, compared with the lowest quartile of PM10, the multivariate weighted ORs (95% CIs) for developing hypertension with increasing PM10 exposures were 0.82 (0.59-1.14), 1.28 (0.93-1.78) and 1.45 (1.05-2.01) in quartile 2, 3 and 4 respectively (p for a trend of 0.003). The corresponding weighted ORs according to PM2.5 exposures were 0.80 (0.57-1.13), 1.11 (0.80-1.53) and 1.48 (1.09-2.00) (p for trend 0.004). For each 5-mu g/m(3) increment in PM10 and PM2.5 concentrations, the odds for incident hypertension increased 1.22 (1.06-1.41) p = 0.007 and 1.39 (1.07-1.81) p = 0.02 respectively. In conclusion, our study contributes to assessing the impact of particulate pollution on the incidence of hypertension in Spain, reinforcing the need for improving air quality as much as possible in order to decrease the risk of cardiometabolic disease in the population.

Background:Longitudinal data assessing the impact of iodine deficiency (ID) on mortality are scarce. We aimed to study the association between the state of iodine nutrition and the risk of total and cause-specific mortality in a representative sample of the Spanish adult population. Methods:We performed a longitudinal observational study to estimate mortality risk according to urinary iodine (UI) concentrations using a sample of 4370 subjects >18 years representative of the Spanish adult population participating in the nationwide study Di@bet.es (2008-2010). We used Cox regression to assess the association between UI at the start of the study (<50, 50-99, 100-199, 200-299, and >= 300 mu g/L) and mortality during follow-up (National death registry-end of follow-up December 2016) in raw models, and adjusted for possible confounding variables: age, sex, educational level, hypertension, diabetes, obesity, chronic kidney disease, smoking, hypercholesterolemia, thyroid dysfunction, diagnosis of cardiovascular disease or cancer, area of residence, physical activity, adherence to Mediterranean diet, dairy and iodinated salt intake. Results:A total of 254 deaths were recorded during an average follow-up period of 7.3 years. The causes of death were cardiovascular 71 (28%); cancer 85 (33.5%); and other causes 98 (38.5%). Compared with the reference category with adequate iodine nutrition (UI 100-300 mu g/L), the hazard ratios (HRs) of all-cause mortality in the category with UI >= 300 mu g/L were 1.04 (95% confidence interval [CI 0.54-1.98]); however, in the categories with 50-99 UI and <50 mu g/L, the HRs were 1.29 [CI 0.97-1.70] and 1.71 [1.18-2.48], respectively (pfor trend 0.004). Multivariate adjustment did not significantly modify the results. Conclusions:Our data indicate an excess mortality in individuals with moderate-severe ID adjusted for other possible confounding factors.

[EN]Exposure to air particulate matter has been linked with hypertension and blood pressure levels. The metabolic risks of air pollution could vary according to the specific characteristics of each area, and has not been sufficiently evaluated in Spain. We analyzed 1103 individuals, participants in a Spanish nationwide population based cohort study (di@bet.es), who were free of hypertension at baseline (2008-2010) and completed a follow-up exam of the cohort (2016-2017). Cohort participants were assigned air pollution concentrations for particulate matter < 10 mu m (PM10) and < 2.5 mu m (PM2.5) during follow-up (2008-2016) obtained through modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). Mean and SD concentrations of PM10 and PM2.5 were 20.17 +/- 3.91 mu g/m(3) and 10.83 +/- 2.08 mu g/m(3) respectively. During follow-up 282 cases of incident hypertension were recorded. In the fully adjusted model, compared with the lowest quartile of PM10, the multivariate weighted ORs (95% CIs) for developing hypertension with increasing PM10 exposures were 0.82 (0.59-1.14), 1.28 (0.93-1.78) and 1.45 (1.05-2.01) in quartile 2, 3 and 4 respectively (p for a trend of 0.003). The corresponding weighted ORs according to PM2.5 exposures were 0.80 (0.57-1.13), 1.11 (0.80-1.53) and 1.48 (1.09-2.00) (p for trend 0.004). For each 5-mu g/m(3) increment in PM10 and PM2.5 concentrations, the odds for incident hypertension increased 1.22 (1.06-1.41) p = 0.007 and 1.39 (1.07-1.81) p = 0.02 respectively. In conclusion, our study contributes to assessing the impact of particulate pollution on the incidence of hypertension in Spain, reinforcing the need for improving air quality as much as possible in order to decrease the risk of cardiometabolic disease in the population.

Background:Longitudinal data assessing the impact of iodine deficiency (ID) on mortality are scarce. We aimed to study the association between the state of iodine nutrition and the risk of total and cause-specific mortality in a representative sample of the Spanish adult population. Methods:We performed a longitudinal observational study to estimate mortality risk according to urinary iodine (UI) concentrations using a sample of 4370 subjects >18 years representative of the Spanish adult population participating in the nationwide study Di@bet.es (2008-2010). We used Cox regression to assess the association between UI at the start of the study (<50, 50-99, 100-199, 200-299, and >= 300 mu g/L) and mortality during follow-up (National death registry-end of follow-up December 2016) in raw models, and adjusted for possible confounding variables: age, sex, educational level, hypertension, diabetes, obesity, chronic kidney disease, smoking, hypercholesterolemia, thyroid dysfunction, diagnosis of cardiovascular disease or cancer, area of residence, physical activity, adherence to Mediterranean diet, dairy and iodinated salt intake. Results:A total of 254 deaths were recorded during an average follow-up period of 7.3 years. The causes of death were cardiovascular 71 (28%); cancer 85 (33.5%); and other causes 98 (38.5%). Compared with the reference category with adequate iodine nutrition (UI 100-300 mu g/L), the hazard ratios (HRs) of all-cause mortality in the category with UI >= 300 mu g/L were 1.04 (95% confidence interval [CI 0.54-1.98]); however, in the categories with 50-99 UI and <50 mu g/L, the HRs were 1.29 [CI 0.97-1.70] and 1.71 [1.18-2.48], respectively (pfor trend 0.004). Multivariate adjustment did not significantly modify the results. Conclusions:Our data indicate an excess mortality in individuals with moderate-severe ID adjusted for other possible confounding factors.

[EN]Exposure to air particulate matter has been linked with hypertension and blood pressure levels. The metabolic risks of air pollution could vary according to the specific characteristics of each area, and has not been sufficiently evaluated in Spain. We analyzed 1103 individuals, participants in a Spanish nationwide population based cohort study (di@bet.es), who were free of hypertension at baseline (2008-2010) and completed a follow-up exam of the cohort (2016-2017). Cohort participants were assigned air pollution concentrations for particulate matter < 10 mu m (PM10) and < 2.5 mu m (PM2.5) during follow-up (2008-2016) obtained through modeling combined with measurements taken at air quality stations (CHIMERE chemistry-transport model). Mean and SD concentrations of PM10 and PM2.5 were 20.17 +/- 3.91 mu g/m(3) and 10.83 +/- 2.08 mu g/m(3) respectively. During follow-up 282 cases of incident hypertension were recorded. In the fully adjusted model, compared with the lowest quartile of PM10, the multivariate weighted ORs (95% CIs) for developing hypertension with increasing PM10 exposures were 0.82 (0.59-1.14), 1.28 (0.93-1.78) and 1.45 (1.05-2.01) in quartile 2, 3 and 4 respectively (p for a trend of 0.003). The corresponding weighted ORs according to PM2.5 exposures were 0.80 (0.57-1.13), 1.11 (0.80-1.53) and 1.48 (1.09-2.00) (p for trend 0.004). For each 5-mu g/m(3) increment in PM10 and PM2.5 concentrations, the odds for incident hypertension increased 1.22 (1.06-1.41) p = 0.007 and 1.39 (1.07-1.81) p = 0.02 respectively. In conclusion, our study contributes to assessing the impact of particulate pollution on the incidence of hypertension in Spain, reinforcing the need for improving air quality as much as possible in order to decrease the risk of cardiometabolic disease in the population.

Background:Longitudinal data assessing the impact of iodine deficiency (ID) on mortality are scarce. We aimed to study the association between the state of iodine nutrition and the risk of total and cause-specific mortality in a representative sample of the Spanish adult population. Methods:We performed a longitudinal observational study to estimate mortality risk according to urinary iodine (UI) concentrations using a sample of 4370 subjects >18 years representative of the Spanish adult population participating in the nationwide study Di@bet.es (2008-2010). We used Cox regression to assess the association between UI at the start of the study (<50, 50-99, 100-199, 200-299, and >= 300 mu g/L) and mortality during follow-up (National death registry-end of follow-up December 2016) in raw models, and adjusted for possible confounding variables: age, sex, educational level, hypertension, diabetes, obesity, chronic kidney disease, smoking, hypercholesterolemia, thyroid dysfunction, diagnosis of cardiovascular disease or cancer, area of residence, physical activity, adherence to Mediterranean diet, dairy and iodinated salt intake. Results:A total of 254 deaths were recorded during an average follow-up period of 7.3 years. The causes of death were cardiovascular 71 (28%); cancer 85 (33.5%); and other causes 98 (38.5%). Compared with the reference category with adequate iodine nutrition (UI 100-300 mu g/L), the hazard ratios (HRs) of all-cause mortality in the category with UI >= 300 mu g/L were 1.04 (95% confidence interval [CI 0.54-1.98]); however, in the categories with 50-99 UI and <50 mu g/L, the HRs were 1.29 [CI 0.97-1.70] and 1.71 [1.18-2.48], respectively (pfor trend 0.004). Multivariate adjustment did not significantly modify the results. Conclusions:Our data indicate an excess mortality in individuals with moderate-severe ID adjusted for other possible confounding factors.

Denominamos Cirugía Bariátrica (CB) al conjunto de técnicas y procedimientos quirúrgicos que se utilizan en los pacientes con formas graves de obesidad, cuya finalidad es conseguir una pérdida de peso, mantenida en el tiempo, capaz de mejorar las enfermedades asociadas y la calidad de vida. El aumento de la prevalencia de la obesidad y la eficacia de la cirugía bariátrica han condicionado que este tratamiento se utilice cada vez con mayor frecuencia. Numerosos estudios han mostrado que, en los pacientes con obesidad grave, la cirugía bariátrica disminuye el riesgo de mortalidad y consigue una remisión o mejoría de la mayor parte de las comorbilidades. Sin embargo, son procedimientos que no están exentos de riesgos. Entre ellos, las deficiencias de vitaminas y minerales son especialmente frecuentes y requieren una evaluación y un tratamiento protocolizados..., Bariatric Surgery (BS) is a set of surgical techniques and procedures used in patients with severe forms of obesity. Its purpose is to achieve weight loss, maintained over time, and improve associated diseases and quality of life.The increase in the prevalence of obesity and the efficacy of bariatric surgery have caused this treatment to be used more and more frequently. Numerous studies have shown that, in patients with severe obesity, BS decreases the risk of mortality and achieves a remission or improvement of most of the comorbidities. However, they are procedures that are not risk free. Among them, vitamin and mineral deficiencies are especially frequent and require a protocolized evaluation and treatment...

Denominamos Cirugía Bariátrica (CB) al conjunto de técnicas y procedimientos quirúrgicos que se utilizan en los pacientes con formas graves de obesidad, cuya finalidad es conseguir una pérdida de peso, mantenida en el tiempo, capaz de mejorar las enfermedades asociadas y la calidad de vida. El aumento de la prevalencia de la obesidad y la eficacia de la cirugía bariátrica han condicionado que este tratamiento se utilice cada vez con mayor frecuencia. Numerosos estudios han mostrado que, en los pacientes con obesidad grave, la cirugía bariátrica disminuye el riesgo de mortalidad y consigue una remisión o mejoría de la mayor parte de las comorbilidades. Sin embargo, son procedimientos que no están exentos de riesgos. Entre ellos, las deficiencias de vitaminas y minerales son especialmente frecuentes y requieren una evaluación y un tratamiento protocolizados..., Bariatric Surgery (BS) is a set of surgical techniques and procedures used in patients with severe forms of obesity. Its purpose is to achieve weight loss, maintained over time, and improve associated diseases and quality of life.The increase in the prevalence of obesity and the efficacy of bariatric surgery have caused this treatment to be used more and more frequently. Numerous studies have shown that, in patients with severe obesity, BS decreases the risk of mortality and achieves a remission or improvement of most of the comorbidities. However, they are procedures that are not risk free. Among them, vitamin and mineral deficiencies are especially frequent and require a protocolized evaluation and treatment...

Denominamos Cirugía Bariátrica (CB) al conjunto de técnicas y procedimientos quirúrgicos que se utilizan en los pacientes con formas graves de obesidad, cuya finalidad es conseguir una pérdida de peso, mantenida en el tiempo, capaz de mejorar las enfermedades asociadas y la calidad de vida. El aumento de la prevalencia de la obesidad y la eficacia de la cirugía bariátrica han condicionado que este tratamiento se utilice cada vez con mayor frecuencia. Numerosos estudios han mostrado que, en los pacientes con obesidad grave, la cirugía bariátrica disminuye el riesgo de mortalidad y consigue una remisión o mejoría de la mayor parte de las comorbilidades. Sin embargo, son procedimientos que no están exentos de riesgos. Entre ellos, las deficiencias de vitaminas y minerales son especialmente frecuentes y requieren una evaluación y un tratamiento protocolizados...

Denominamos Cirugía Bariátrica (CB) al conjunto de técnicas y procedimientos quirúrgicos que se utilizan en los pacientes con formas graves de obesidad, cuya finalidad es conseguir una pérdida de peso, mantenida en el tiempo, capaz de mejorar las enfermedades asociadas y la calidad de vida. El aumento de la prevalencia de la obesidad y la eficacia de la cirugía bariátrica han condicionado que este tratamiento se utilice cada vez con mayor frecuencia. Numerosos estudios han mostrado que, en los pacientes con obesidad grave, la cirugía bariátrica disminuye el riesgo de mortalidad y consigue una remisión o mejoría de la mayor parte de las comorbilidades. Sin embargo, son procedimientos que no están exentos de riesgos. Entre ellos, las deficiencias de vitaminas y minerales son especialmente frecuentes y requieren una evaluación y un tratamiento protocolizados...

El objetivo del proyecto aquí presentado es el de evaluar los criterios diagnósticos antiguos y actuales de la diabetes mellitus gestacional (DMG) y determinar el impacto potencial de su empleo en el periodo postparto; valorar el efecto del tratamiento de la DMG sobre las complicaciones materno fetales derivadas del exceso de peso; investigar posibles estrategias para prevenir la DMG; y examinar el efecto de adoptar una dieta mediterránea (DietMed) en la incidencia de la DMG. Para ello se condujeron, entre 2007-2016, cuatro estudios prospectivos diferentes y una revisión, utilizando datos disponibles en el Departamento de Análisis Clínicos, Departamento de Obstetricia y la Unidad especializada de Diabetes Gestacional del Servicio de Endocrinología y Nutrición del Hospital Clínico San Carlos de Madrid. ESTUDIO 1. El impacto de cambiar al método de un paso para el diagnóstico de DMG sobre las tasas de asistencia al cribado postparto y la presencia de desórdenes glucémicos en mujeres que tuvieron DMG. El Estudio Gestacional San Carlos. Objetivos: Comparar las tasas de desorden glucémico postparto (DGp), basado en la combinación de glucosa basal plasmática (GBP) -HbA1c, en mujeres que fueron diagnosticadas con diabetes mellitus gestacional (DMG) por los criterios de Carpenter-Coustan (CyCc) y los criterios del International Association of Diabetes and Pregnancy Study Groups (IADPSGc)..., The aim of the project hereby presented is to assess the former and present criteria used in gestational diabetes mellitus (GDM) diagnosis, determining the potential impact of their use in the postpartum period; evaluate the effect of GDM treatment on maternal and neonatal outcomes in women with high body mass index (BMI); research possible approaches to preventing GDM; and examine the effect of adopting a Mediterranean diet in GDM incidence. Four different prospective studies and one mini review were conducted between 2007-2016, collecting data available from the Central Laboratory, Department of Obstetrics and the specialized Gestational Diabetes Unit of the Endocrinology and Nutrition Department of the Hospital Clínico San Carlos. STUDY 1. The impact of switching to the one-step method for GDM diagnosis on the rates of postpartum screening attendance and glucose disorder in women with prior GDM. The San Carlos Gestational Study Aims: To compare rates of FPG-HbA1C-based postpartum-glucose disorder (PGD) of women with prior gestational diabetes mellitus (GDM) diagnosed by Carpenter-Coustan criteria (CCc) versus International Association of Diabetes and Pregnancy Study Groups criteria (IADPSGc)...

El objetivo del proyecto aquí presentado es el de evaluar los criterios diagnósticos antiguos y actuales de la diabetes mellitus gestacional (DMG) y determinar el impacto potencial de su empleo en el periodo postparto; valorar el efecto del tratamiento de la DMG sobre las complicaciones materno fetales derivadas del exceso de peso; investigar posibles estrategias para prevenir la DMG; y examinar el efecto de adoptar una dieta mediterránea (DietMed) en la incidencia de la DMG. Para ello se condujeron, entre 2007-2016, cuatro estudios prospectivos diferentes y una revisión, utilizando datos disponibles en el Departamento de Análisis Clínicos, Departamento de Obstetricia y la Unidad especializada de Diabetes Gestacional del Servicio de Endocrinología y Nutrición del Hospital Clínico San Carlos de Madrid. ESTUDIO 1. El impacto de cambiar al método de un paso para el diagnóstico de DMG sobre las tasas de asistencia al cribado postparto y la presencia de desórdenes glucémicos en mujeres que tuvieron DMG. El Estudio Gestacional San Carlos. Objetivos: Comparar las tasas de desorden glucémico postparto (DGp), basado en la combinación de glucosa basal plasmática (GBP) -HbA1c, en mujeres que fueron diagnosticadas con diabetes mellitus gestacional (DMG) por los criterios de Carpenter-Coustan (CyCc) y los criterios del International Association of Diabetes and Pregnancy Study Groups (IADPSGc)..., The aim of the project hereby presented is to assess the former and present criteria used in gestational diabetes mellitus (GDM) diagnosis, determining the potential impact of their use in the postpartum period; evaluate the effect of GDM treatment on maternal and neonatal outcomes in women with high body mass index (BMI); research possible approaches to preventing GDM; and examine the effect of adopting a Mediterranean diet in GDM incidence. Four different prospective studies and one mini review were conducted between 2007-2016, collecting data available from the Central Laboratory, Department of Obstetrics and the specialized Gestational Diabetes Unit of the Endocrinology and Nutrition Department of the Hospital Clínico San Carlos. STUDY 1. The impact of switching to the one-step method for GDM diagnosis on the rates of postpartum screening attendance and glucose disorder in women with prior GDM. The San Carlos Gestational Study Aims: To compare rates of FPG-HbA1C-based postpartum-glucose disorder (PGD) of women with prior gestational diabetes mellitus (GDM) diagnosed by Carpenter-Coustan criteria (CCc) versus International Association of Diabetes and Pregnancy Study Groups criteria (IADPSGc)...

El objetivo del proyecto aquí presentado es el de evaluar los criterios diagnósticos antiguos y actuales de la diabetes mellitus gestacional (DMG) y determinar el impacto potencial de su empleo en el periodo postparto; valorar el efecto del tratamiento de la DMG sobre las complicaciones materno fetales derivadas del exceso de peso; investigar posibles estrategias para prevenir la DMG; y examinar el efecto de adoptar una dieta mediterránea (DietMed) en la incidencia de la DMG. Para ello se condujeron, entre 2007-2016, cuatro estudios prospectivos diferentes y una revisión, utilizando datos disponibles en el Departamento de Análisis Clínicos, Departamento de Obstetricia y la Unidad especializada de Diabetes Gestacional del Servicio de Endocrinología y Nutrición del Hospital Clínico San Carlos de Madrid. ESTUDIO 1. El impacto de cambiar al método de un paso para el diagnóstico de DMG sobre las tasas de asistencia al cribado postparto y la presencia de desórdenes glucémicos en mujeres que tuvieron DMG. El Estudio Gestacional San Carlos. Objetivos: Comparar las tasas de desorden glucémico postparto (DGp), basado en la combinación de glucosa basal plasmática (GBP) -HbA1c, en mujeres que fueron diagnosticadas con diabetes mellitus gestacional (DMG) por los criterios de Carpenter-Coustan (CyCc) y los criterios del International Association of Diabetes and Pregnancy Study Groups (IADPSGc)...

El objetivo del proyecto aquí presentado es el de evaluar los criterios diagnósticos antiguos y actuales de la diabetes mellitus gestacional (DMG) y determinar el impacto potencial de su empleo en el periodo postparto; valorar el efecto del tratamiento de la DMG sobre las complicaciones materno fetales derivadas del exceso de peso; investigar posibles estrategias para prevenir la DMG; y examinar el efecto de adoptar una dieta mediterránea (DietMed) en la incidencia de la DMG. Para ello se condujeron, entre 2007-2016, cuatro estudios prospectivos diferentes y una revisión, utilizando datos disponibles en el Departamento de Análisis Clínicos, Departamento de Obstetricia y la Unidad especializada de Diabetes Gestacional del Servicio de Endocrinología y Nutrición del Hospital Clínico San Carlos de Madrid. ESTUDIO 1. El impacto de cambiar al método de un paso para el diagnóstico de DMG sobre las tasas de asistencia al cribado postparto y la presencia de desórdenes glucémicos en mujeres que tuvieron DMG. El Estudio Gestacional San Carlos. Objetivos: Comparar las tasas de desorden glucémico postparto (DGp), basado en la combinación de glucosa basal plasmática (GBP) -HbA1c, en mujeres que fueron diagnosticadas con diabetes mellitus gestacional (DMG) por los criterios de Carpenter-Coustan (CyCc) y los criterios del International Association of Diabetes and Pregnancy Study Groups (IADPSGc)...

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18years old with overweight of which 600million (13%) are obese. In Spain there is a 22,9% prevalence of obesity (BMI>30 kg/m2)with a 1.8% of morbid obesity (MO) (BMI> 40 kg/m2). Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. Epidemiological studies have shown that obesity is a significant risk factor for type 2 diabetes mellitus. The free fatty acids derived from visceral adipose tissue impair insulin sensitivity and beta cell function (lipotoxicity), leading to metabolic syndrome and diabetes. Given the increasing prevalence of obesity worldwide, the epidemic of diabetes has become an even larger economic and social public health challenge. Long-term glycemic control of diabetes can halt the progression of the disease, prevent complications and reduce cardiovascular risks. However, there are needs that are not addressed by intensified multifactorial interventions due to the need for continual monitoring and increasing doses over time, given the progressive nature of the disease, and most diabetic patients are unable to achieve adequate glucose control with medical therapy in the long term. In contrast, bariatric surgery has been shown to induce the remission of diabetes or to reduce the need for medications with durable long-term results in morbidly obese patients, thereby providing a potentially cost-effective approach to treating type 2 diabetes mellitus. Bariatric surgery (BS) is currently considered the most effective treatment option for morbid obesity, and is associated with25-50%, lower long-term mortality rate, improves comorbidities and avoids further complications related to obesity. This surgical option is indicated in patients with a

The rationale for the present project is to enlarge the knowledge about health related quality of life (HRQoL) in patients with metabolic syndrome (MetS) and diabetes mellitus (DM). DM and MetS suppose a global health burden because of their high prevalence but also because of their association with chronic complications. In addition to the evaluation of morbi - mortality, assessing quality of life is an important outcome, especially in chronic illnesses. DM has been associated with impairments in physical, mental health and social functioning. The data about HRQoL in MetS are scarce. For evaluating HRQoL on DM and MetS three independent studies were performed. The first and the second one were based on the population of the Di@bet.es study that included a wide sample, representative of the Spanish population. It was conducted in Spain between 2009 and 2010, designed to estimate DM prevalence in the country. Considering we had a wide representative sample, firstly we assessed MetS prevalence and then evaluated HRQoL in the group with MetS or DM, comparing them to “healthy” people without them. The third study assesses HRQoL in patients with DM who attend to a monographic Unit for Diabetes attention. It is important to know the most affected areas of HRQoL and the socio demographic factors that can influence on it, in order to create initiatives to implement patients’ care...

La desnutrición en el entorno hospitalario afecta en nuestro medio al 23,7% de los pacientes1, de forma que el soporte nutricional se constituye como una estrategia básica de la atención durante el ingreso. La nutrición parenteral (NP) es el método de tratamiento empleado cuando el paciente no puede ser alimentado completamente por vía oral o por vía enteral a través de sonda (nutrición enteral –NE‐), y aunque es claramente una intervención médica, carece de muchos de los argumentos de evidencia científica que se requieren en el desarrollo de un fármaco comercializado tras ensayos clínicos aleatorizados (figura 1.1)2. En nuestro medio la NP se prescribe en un 1‐3% de los pacientes hospitalizados3. Brevemente, la NP es una técnica de intervención nutricional que consiste en la infusión a través de una vía venosa de prácticamente todos los nutrientes necesarios para cubrir las funciones vitales. Actualmente se presenta en bolsas tricamerales en las que las preparaciones de aminoácidos, las soluciones de glucosa y las emulsiones lipídicas se funden en una sola fórmula con electrolitos, vitaminas y micronutrientes. Puede administrarse por vía central o por vía periférica, en este último caso si la osmolaridad final del preparado es inferior a 800‐ 900 mosmol/kg. Se habla de NP total si los requerimientos del paciente solo se cubren por esa vía –generalmente por fallo intestinal agudo o crónico, o en situaciones donde es necesario mantener el reposo digestivo (por ejemplo en quilotórax o en ascitis quilosa refractarios a tratamiento dietético)‐ o complementaria cuando parte de los nutrientes también se están administrando por vía oral/enteral..., The prevalence of disease‐related malnutrition in hospitalized patients in Spain is close to 24%, so the implementation of nutritional assessment and treatment strategies in the organization is essential to improve the outcomes in this setting. Parenteral nutrition (PN) is a way of nutritional support that provides almost all the nutrients through either a central or a peripheral venous catheter. The formulae are a blend of amino acids, glucose, lipids, electrolytes, vitamins, and oligo elements that are used in patients with partial or total intestinal failure. The development of PN has supposed live‐saving benefits in subjects without oral or enteral access to reach their metabolic demands of energy and nutrients, but several concerns have emerged in relation to the associated complications and the metabolic and immunologic derangements. Controversy exists within scientific community regarding the optimal glucose objective in the management of the associated PN hyperglycaemia. Preliminary evidence in Critical Units stated that a tight glycaemic control below 110 mg/dL was associated with a clear advantage in survival and adverse events when compared with a conventional range of glycemia (180‐200 mg/dL). Subsequent studies in the critical care setting were not able to reproduce the great benefits of such a strict glycaemic control, and on the contrary, some of them had to be prematurely stopped because of an inappropriate high frequency of hypoglycaemic episodes without a clear mortality gain. At the moment, the several published meta‐analysis agree in the risk of associated tight control hypoglycaemia without an improvement in survival. Some reduction in sepsis incidence has been described in critical surgery patients. Also is a theme of debate which is the best metric to report the clinic prognosis associated to glycaemic response in the acute disease. The hyperglycaemia, the hypoglycaemia and the glycaemic variability together have been related to bad prognosis

Hyponatremia is the most common electrolyte disorder in clinical practice. Patients with hyponatremia present high morbimortality rates. The prevalence of hyponatremia among hospitalized patients has been found to vary from 30 to 42%, when defined as a serum sodium level (SNa) below 136 mmol/L, and to be 19.7% when defined as a SNa below 135 mmol/L. In these patients, hyponatremia is most often present at admittance, and is mild (SNa between 130 and 134 mmol/L). However, when hyponatremia is hospital-acquired, it is more often moderate or severe. Several studies have found a high mortality rate in hospitalized hyponatremic patients as compared with those presenting normal SNa. Such is the case in patients with severe hyponatremia (SNa < 120-125 mmol/L) as well as in mild forms. Minor descents in SNa of the order of 4 to 5 mmol/L are already accompanied by an increased mortality rate. In fact, some authors have detected a minimum mortality rate in patients with SNa between 138–142 mmol/L, postulating these levels as representing strict eunatremia. Hyponatremic patients also have longer hospital lengths-of-stay, as well as a higher readmissions rate. Hyponatremia is a consequence of an alteration in water metabolism, most often due to a reduced renal capacity to eliminate free water (antidiuresis), secondary to a non-osmotic increase in the secretion of Arginine Vasopressin (AVP), the Antidiuretic Hormone (ADH) of humans. This increase can be induced by physiologic stimuli (post-surgical stress, pain, nausea...) or by nonphysiologic, inappropriate AVP secretion (the Syndrome of Inappropriate Antidiuretic Hormone Secretion or SIADH). The combination of persistent AVP secretion together with increased oral or parenteral fluid intake results in plasmatic hypoosmolality, and induction or exacerbation of hyponatremia..., La hiponatremia es el trastorno electrolítico más frecuente en la práctica clínica. A nivel hospitalario su importancia no sólo radica en su elevada prevalencia sino en la mayor morbimortalidad que asocia. La hiponatremia se produce por una alteración de los mecanismos que regulan el agua, habitualmente por una disminución de la capacidad renal de eliminar agua libre (antidiuresis), secundaria a un incremento no osmótico de la arginina vasopresina (AVP), la hormona antidiurética del humano (ADH). Este aumento puede estar causado por estímulos fisiológicos (estrés postquirúrgico, dolor, náuseas...) o por una secreción no fisiológica e inapropiada (SIADH). La elevación de ADH combinada con un aumento de agua tanto por vía oral o vÍa parenteral producen un descenso de la natremia, con la aparición o la exacerbación de hiponatremia. El cuadro anterior es frecuente en los pacientes hospitalizados y posiblemente más aún en los pacientes con nutrición artificial por vía parenteral. Estos últimos habitualmente precisan dicho soporte nutricional por una cirugía mayor digestiva (neoplasias, obstrucciones intestinales, isquemia intestinal...) o por otras alteraciones del aparato digestivo que requieren reposo intestinal (vómitos, diarreas...). En estas situaciones generalmente están presentes tanto estímulos fisiológicos de la ADH (dolor, náusea, estrés postquirúgicos...) como no fisiológicos (SIADH neoplásico, SIADH farmacológico...) que disminuyen la eliminación renal de agua libre. Lo anterior combinado con el incremento de aporte de líquidos por la NP produce un descenso de la natremia. En ocasiones se suman pérdidas corporales de sodio que pueden exacerban la hiponatremia. A pesar de esto no se conoce la frecuencia de hiponatremia en este grupo de pacientes ni tampoco su influencia en la morbimortalidad...

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18 years old with overweight of which 600 million (13%) are obese. In Spain the situation is not different with 22,9% prevalence of obesity (BMI>30 kg/m2) with a 1.8%. of morbid obesity (MO) (BMI> 40 kg / m2) Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. In order to curb this situation, comprehensive strategies were implemented worldwide: dietary treatment with lifestyle changes, exercise and behavioral therapy together with adjuvant treatment with drugs when available. These actions achieved a good average of 5 -10% weight loss. However, long-term treatments outcomes have been disappointing, especially in patients with MO, because weight regain occurs in virtually all patients in less than five years term. To date, bariatric surgery (BS) is the only treatment that can improve these expectations in patients with BMI ≥ 35 kg / m2). The BS is associated with 25-50%, lower long term mortality rate, improves comorbidities and avoids further complications related to obesity. Currently the surgical option is indicated in patients with a BMI> 40 kg / m2 or those with BMI 35-40 kg / m2 with comorbidities in whom have failed medical therapy and without contraindications. Most currently used surgical techniques are: Adjustable gastric banding (AGB): a restrictive procedure where a silicone band is placed around the upper stomach and the catheter attached to the band is exteriorized and connected to an infusion port located subcutaneously. Reported %EWL is around 50% depending on the authors.

The rationale for the present project is to enlarge the knowledge about health related quality of life (HRQoL) in patients with metabolic syndrome (MetS) and diabetes mellitus (DM). DM and MetS suppose a global health burden because of their high prevalence but also because of their association with chronic complications. In addition to the evaluation of morbi - mortality, assessing quality of life is an important outcome, especially in chronic illnesses. DM has been associated with impairments in physical, mental health and social functioning. The data about HRQoL in MetS are scarce. For evaluating HRQoL on DM and MetS three independent studies were performed. The first and the second one were based on the population of the Di@bet.es study that included a wide sample, representative of the Spanish population. It was conducted in Spain between 2009 and 2010, designed to estimate DM prevalence in the country. Considering we had a wide representative sample, firstly we assessed MetS prevalence and then evaluated HRQoL in the group with MetS or DM, comparing them to “healthy” people without them. The third study assesses HRQoL in patients with DM who attend to a monographic Unit for Diabetes attention. It is important to know the most affected areas of HRQoL and the socio demographic factors that can influence on it, in order to create initiatives to implement patients’ care...

La desnutrición en el entorno hospitalario afecta en nuestro medio al 23,7% de los pacientes1, de forma que el soporte nutricional se constituye como una estrategia básica de la atención durante el ingreso. La nutrición parenteral (NP) es el método de tratamiento empleado cuando el paciente no puede ser alimentado completamente por vía oral o por vía enteral a través de sonda (nutrición enteral –NE‐), y aunque es claramente una intervención médica, carece de muchos de los argumentos de evidencia científica que se requieren en el desarrollo de un fármaco comercializado tras ensayos clínicos aleatorizados (figura 1.1)2. En nuestro medio la NP se prescribe en un 1‐3% de los pacientes hospitalizados3. Brevemente, la NP es una técnica de intervención nutricional que consiste en la infusión a través de una vía venosa de prácticamente todos los nutrientes necesarios para cubrir las funciones vitales. Actualmente se presenta en bolsas tricamerales en las que las preparaciones de aminoácidos, las soluciones de glucosa y las emulsiones lipídicas se funden en una sola fórmula con electrolitos, vitaminas y micronutrientes. Puede administrarse por vía central o por vía periférica, en este último caso si la osmolaridad final del preparado es inferior a 800‐ 900 mosmol/kg. Se habla de NP total si los requerimientos del paciente solo se cubren por esa vía –generalmente por fallo intestinal agudo o crónico, o en situaciones donde es necesario mantener el reposo digestivo (por ejemplo en quilotórax o en ascitis quilosa refractarios a tratamiento dietético)‐ o complementaria cuando parte de los nutrientes también se están administrando por vía oral/enteral..., The prevalence of disease‐related malnutrition in hospitalized patients in Spain is close to 24%, so the implementation of nutritional assessment and treatment strategies in the organization is essential to improve the outcomes in this setting. Parenteral nutrition (PN) is a way of nutritional support that provides almost all the nutrients through either a central or a peripheral venous catheter. The formulae are a blend of amino acids, glucose, lipids, electrolytes, vitamins, and oligo elements that are used in patients with partial or total intestinal failure. The development of PN has supposed live‐saving benefits in subjects without oral or enteral access to reach their metabolic demands of energy and nutrients, but several concerns have emerged in relation to the associated complications and the metabolic and immunologic derangements. Controversy exists within scientific community regarding the optimal glucose objective in the management of the associated PN hyperglycaemia. Preliminary evidence in Critical Units stated that a tight glycaemic control below 110 mg/dL was associated with a clear advantage in survival and adverse events when compared with a conventional range of glycemia (180‐200 mg/dL). Subsequent studies in the critical care setting were not able to reproduce the great benefits of such a strict glycaemic control, and on the contrary, some of them had to be prematurely stopped because of an inappropriate high frequency of hypoglycaemic episodes without a clear mortality gain. At the moment, the several published meta‐analysis agree in the risk of associated tight control hypoglycaemia without an improvement in survival. Some reduction in sepsis incidence has been described in critical surgery patients. Also is a theme of debate which is the best metric to report the clinic prognosis associated to glycaemic response in the acute disease. The hyperglycaemia, the hypoglycaemia and the glycaemic variability together have been related to bad prognosis

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18years old with overweight of which 600million (13%) are obese. In Spain there is a 22,9% prevalence of obesity (BMI>30 kg/m2)with a 1.8% of morbid obesity (MO) (BMI> 40 kg/m2). Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. Epidemiological studies have shown that obesity is a significant risk factor for type 2 diabetes mellitus. The free fatty acids derived from visceral adipose tissue impair insulin sensitivity and beta cell function (lipotoxicity), leading to metabolic syndrome and diabetes. Given the increasing prevalence of obesity worldwide, the epidemic of diabetes has become an even larger economic and social public health challenge. Long-term glycemic control of diabetes can halt the progression of the disease, prevent complications and reduce cardiovascular risks. However, there are needs that are not addressed by intensified multifactorial interventions due to the need for continual monitoring and increasing doses over time, given the progressive nature of the disease, and most diabetic patients are unable to achieve adequate glucose control with medical therapy in the long term. In contrast, bariatric surgery has been shown to induce the remission of diabetes or to reduce the need for medications with durable long-term results in morbidly obese patients, thereby providing a potentially cost-effective approach to treating type 2 diabetes mellitus. Bariatric surgery (BS) is currently considered the most effective treatment option for morbid obesity, and is associated with25-50%, lower long-term mortality rate, improves comorbidities and avoids further complications related to obesity. This surgical option is indicated in patients with a

Hyponatremia is the most common electrolyte disorder in clinical practice. Patients with hyponatremia present high morbimortality rates. The prevalence of hyponatremia among hospitalized patients has been found to vary from 30 to 42%, when defined as a serum sodium level (SNa) below 136 mmol/L, and to be 19.7% when defined as a SNa below 135 mmol/L. In these patients, hyponatremia is most often present at admittance, and is mild (SNa between 130 and 134 mmol/L). However, when hyponatremia is hospital-acquired, it is more often moderate or severe. Several studies have found a high mortality rate in hospitalized hyponatremic patients as compared with those presenting normal SNa. Such is the case in patients with severe hyponatremia (SNa < 120-125 mmol/L) as well as in mild forms. Minor descents in SNa of the order of 4 to 5 mmol/L are already accompanied by an increased mortality rate. In fact, some authors have detected a minimum mortality rate in patients with SNa between 138–142 mmol/L, postulating these levels as representing strict eunatremia. Hyponatremic patients also have longer hospital lengths-of-stay, as well as a higher readmissions rate. Hyponatremia is a consequence of an alteration in water metabolism, most often due to a reduced renal capacity to eliminate free water (antidiuresis), secondary to a non-osmotic increase in the secretion of Arginine Vasopressin (AVP), the Antidiuretic Hormone (ADH) of humans. This increase can be induced by physiologic stimuli (post-surgical stress, pain, nausea...) or by nonphysiologic, inappropriate AVP secretion (the Syndrome of Inappropriate Antidiuretic Hormone Secretion or SIADH). The combination of persistent AVP secretion together with increased oral or parenteral fluid intake results in plasmatic hypoosmolality, and induction or exacerbation of hyponatremia..., La hiponatremia es el trastorno electrolítico más frecuente en la práctica clínica. A nivel hospitalario su importancia no sólo radica en su elevada prevalencia sino en la mayor morbimortalidad que asocia. La hiponatremia se produce por una alteración de los mecanismos que regulan el agua, habitualmente por una disminución de la capacidad renal de eliminar agua libre (antidiuresis), secundaria a un incremento no osmótico de la arginina vasopresina (AVP), la hormona antidiurética del humano (ADH). Este aumento puede estar causado por estímulos fisiológicos (estrés postquirúrgico, dolor, náuseas...) o por una secreción no fisiológica e inapropiada (SIADH). La elevación de ADH combinada con un aumento de agua tanto por vía oral o vÍa parenteral producen un descenso de la natremia, con la aparición o la exacerbación de hiponatremia. El cuadro anterior es frecuente en los pacientes hospitalizados y posiblemente más aún en los pacientes con nutrición artificial por vía parenteral. Estos últimos habitualmente precisan dicho soporte nutricional por una cirugía mayor digestiva (neoplasias, obstrucciones intestinales, isquemia intestinal...) o por otras alteraciones del aparato digestivo que requieren reposo intestinal (vómitos, diarreas...). En estas situaciones generalmente están presentes tanto estímulos fisiológicos de la ADH (dolor, náusea, estrés postquirúgicos...) como no fisiológicos (SIADH neoplásico, SIADH farmacológico...) que disminuyen la eliminación renal de agua libre. Lo anterior combinado con el incremento de aporte de líquidos por la NP produce un descenso de la natremia. En ocasiones se suman pérdidas corporales de sodio que pueden exacerban la hiponatremia. A pesar de esto no se conoce la frecuencia de hiponatremia en este grupo de pacientes ni tampoco su influencia en la morbimortalidad...

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18 years old with overweight of which 600 million (13%) are obese. In Spain the situation is not different with 22,9% prevalence of obesity (BMI>30 kg/m2) with a 1.8%. of morbid obesity (MO) (BMI> 40 kg / m2) Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. In order to curb this situation, comprehensive strategies were implemented worldwide: dietary treatment with lifestyle changes, exercise and behavioral therapy together with adjuvant treatment with drugs when available. These actions achieved a good average of 5 -10% weight loss. However, long-term treatments outcomes have been disappointing, especially in patients with MO, because weight regain occurs in virtually all patients in less than five years term. To date, bariatric surgery (BS) is the only treatment that can improve these expectations in patients with BMI ≥ 35 kg / m2). The BS is associated with 25-50%, lower long term mortality rate, improves comorbidities and avoids further complications related to obesity. Currently the surgical option is indicated in patients with a BMI> 40 kg / m2 or those with BMI 35-40 kg / m2 with comorbidities in whom have failed medical therapy and without contraindications. Most currently used surgical techniques are: Adjustable gastric banding (AGB): a restrictive procedure where a silicone band is placed around the upper stomach and the catheter attached to the band is exteriorized and connected to an infusion port located subcutaneously. Reported %EWL is around 50% depending on the authors.

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18 years old with overweight of which 600 million (13%) are obese. In Spain the situation is not different with 22,9% prevalence of obesity (BMI>30 kg/m2) with a 1.8%. of morbid obesity (MO) (BMI> 40 kg / m2) Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. In order to curb this situation, comprehensive strategies were implemented worldwide: dietary treatment with lifestyle changes, exercise and behavioral therapy together with adjuvant treatment with drugs when available. These actions achieved a good average of 5 -10% weight loss. However, long-term treatments outcomes have been disappointing, especially in patients with MO, because weight regain occurs in virtually all patients in less than five years term. To date, bariatric surgery (BS) is the only treatment that can improve these expectations in patients with BMI ≥ 35 kg / m2). The BS is associated with 25-50%, lower long term mortality rate, improves comorbidities and avoids further complications related to obesity. Currently the surgical option is indicated in patients with a BMI> 40 kg / m2 or those with BMI 35-40 kg / m2 with comorbidities in whom have failed medical therapy and without contraindications. Most currently used surgical techniques are: Adjustable gastric banding (AGB): a restrictive procedure where a silicone band is placed around the upper stomach and the catheter attached to the band is exteriorized and connected to an infusion port located subcutaneously. Reported %EWL is around 50% depending on the authors.

La desnutrición en el entorno hospitalario afecta en nuestro medio al 23,7% de los pacientes1, de forma que el soporte nutricional se constituye como una estrategia básica de la atención durante el ingreso. La nutrición parenteral (NP) es el método de tratamiento empleado cuando el paciente no puede ser alimentado completamente por vía oral o por vía enteral a través de sonda (nutrición enteral –NE‐), y aunque es claramente una intervención médica, carece de muchos de los argumentos de evidencia científica que se requieren en el desarrollo de un fármaco comercializado tras ensayos clínicos aleatorizados (figura 1.1)2. En nuestro medio la NP se prescribe en un 1‐3% de los pacientes hospitalizados3. Brevemente, la NP es una técnica de intervención nutricional que consiste en la infusión a través de una vía venosa de prácticamente todos los nutrientes necesarios para cubrir las funciones vitales. Actualmente se presenta en bolsas tricamerales en las que las preparaciones de aminoácidos, las soluciones de glucosa y las emulsiones lipídicas se funden en una sola fórmula con electrolitos, vitaminas y micronutrientes. Puede administrarse por vía central o por vía periférica, en este último caso si la osmolaridad final del preparado es inferior a 800‐ 900 mosmol/kg. Se habla de NP total si los requerimientos del paciente solo se cubren por esa vía –generalmente por fallo intestinal agudo o crónico, o en situaciones donde es necesario mantener el reposo digestivo (por ejemplo en quilotórax o en ascitis quilosa refractarios a tratamiento dietético)‐ o complementaria cuando parte de los nutrientes también se están administrando por vía oral/enteral...

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18years old with overweight of which 600million (13%) are obese. In Spain there is a 22,9% prevalence of obesity (BMI>30 kg/m2)with a 1.8% of morbid obesity (MO) (BMI> 40 kg/m2). Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. Epidemiological studies have shown that obesity is a significant risk factor for type 2 diabetes mellitus. The free fatty acids derived from visceral adipose tissue impair insulin sensitivity and beta cell function (lipotoxicity), leading to metabolic syndrome and diabetes. Given the increasing prevalence of obesity worldwide, the epidemic of diabetes has become an even larger economic and social public health challenge. Long-term glycemic control of diabetes can halt the progression of the disease, prevent complications and reduce cardiovascular risks. However, there are needs that are not addressed by intensified multifactorial interventions due to the need for continual monitoring and increasing doses over time, given the progressive nature of the disease, and most diabetic patients are unable to achieve adequate glucose control with medical therapy in the long term. In contrast, bariatric surgery has been shown to induce the remission of diabetes or to reduce the need for medications with durable long-term results in morbidly obese patients, thereby providing a potentially cost-effective approach to treating type 2 diabetes mellitus. Bariatric surgery (BS) is currently considered the most effective treatment option for morbid obesity, and is associated with25-50%, lower long-term mortality rate, improves comorbidities and avoids further complications related to obesity. This surgical option is indicated in patients with a

The rationale for the present project is to enlarge the knowledge about health related quality of life (HRQoL) in patients with metabolic syndrome (MetS) and diabetes mellitus (DM). DM and MetS suppose a global health burden because of their high prevalence but also because of their association with chronic complications. In addition to the evaluation of morbi - mortality, assessing quality of life is an important outcome, especially in chronic illnesses. DM has been associated with impairments in physical, mental health and social functioning. The data about HRQoL in MetS are scarce. For evaluating HRQoL on DM and MetS three independent studies were performed. The first and the second one were based on the population of the Di@bet.es study that included a wide sample, representative of the Spanish population. It was conducted in Spain between 2009 and 2010, designed to estimate DM prevalence in the country. Considering we had a wide representative sample, firstly we assessed MetS prevalence and then evaluated HRQoL in the group with MetS or DM, comparing them to “healthy” people without them. The third study assesses HRQoL in patients with DM who attend to a monographic Unit for Diabetes attention. It is important to know the most affected areas of HRQoL and the socio demographic factors that can influence on it, in order to create initiatives to implement patients’ care...

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18 years old with overweight of which 600 million (13%) are obese. In Spain the situation is not different with 22,9% prevalence of obesity (BMI>30 kg/m2) with a 1.8%. of morbid obesity (MO) (BMI> 40 kg / m2) Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. In order to curb this situation, comprehensive strategies were implemented worldwide: dietary treatment with lifestyle changes, exercise and behavioral therapy together with adjuvant treatment with drugs when available. These actions achieved a good average of 5 -10% weight loss. However, long-term treatments outcomes have been disappointing, especially in patients with MO, because weight regain occurs in virtually all patients in less than five years term. To date, bariatric surgery (BS) is the only treatment that can improve these expectations in patients with BMI ≥ 35 kg / m2). The BS is associated with 25-50%, lower long term mortality rate, improves comorbidities and avoids further complications related to obesity. Currently the surgical option is indicated in patients with a BMI> 40 kg / m2 or those with BMI 35-40 kg / m2 with comorbidities in whom have failed medical therapy and without contraindications. Most currently used surgical techniques are: Adjustable gastric banding (AGB): a restrictive procedure where a silicone band is placed around the upper stomach and the catheter attached to the band is exteriorized and connected to an infusion port located subcutaneously. Reported %EWL is around 50% depending on the authors.

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18years old with overweight of which 600million (13%) are obese. In Spain there is a 22,9% prevalence of obesity (BMI>30 kg/m2)with a 1.8% of morbid obesity (MO) (BMI> 40 kg/m2). Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. Epidemiological studies have shown that obesity is a significant risk factor for type 2 diabetes mellitus. The free fatty acids derived from visceral adipose tissue impair insulin sensitivity and beta cell function (lipotoxicity), leading to metabolic syndrome and diabetes. Given the increasing prevalence of obesity worldwide, the epidemic of diabetes has become an even larger economic and social public health challenge. Long-term glycemic control of diabetes can halt the progression of the disease, prevent complications and reduce cardiovascular risks. However, there are needs that are not addressed by intensified multifactorial interventions due to the need for continual monitoring and increasing doses over time, given the progressive nature of the disease, and most diabetic patients are unable to achieve adequate glucose control with medical therapy in the long term. In contrast, bariatric surgery has been shown to induce the remission of diabetes or to reduce the need for medications with durable long-term results in morbidly obese patients, thereby providing a potentially cost-effective approach to treating type 2 diabetes mellitus. Bariatric surgery (BS) is currently considered the most effective treatment option for morbid obesity, and is associated with25-50%, lower long-term mortality rate, improves comorbidities and avoids further complications related to obesity. This surgical option is indicated in patients with a

Overweight and obesity have become a major health problem in developed countries. In 2014, according to WHO, the obesity rate has tripled since1980́s, with 900 million people over 18 years old with overweight of which 600 million (13%) are obese. In Spain the situation is not different with 22,9% prevalence of obesity (BMI>30 kg/m2) with a 1.8%. of morbid obesity (MO) (BMI> 40 kg / m2) Moreover, obesity is responsible of 3,4 million deaths and 3,9% life-years lost. It is also a risk factor for developing diseases such as cancer, cardiovascular disease and diabetes mellitus. In order to curb this situation, comprehensive strategies were implemented worldwide: dietary treatment with lifestyle changes, exercise and behavioral therapy together with adjuvant treatment with drugs when available. These actions achieved a good average of 5 -10% weight loss. However, long-term treatments outcomes have been disappointing, especially in patients with MO, because weight regain occurs in virtually all patients in less than five years term. To date, bariatric surgery (BS) is the only treatment that can improve these expectations in patients with BMI ≥ 35 kg / m2). The BS is associated with 25-50%, lower long term mortality rate, improves comorbidities and avoids further complications related to obesity. Currently the surgical option is indicated in patients with a BMI> 40 kg / m2 or those with BMI 35-40 kg / m2 with comorbidities in whom have failed medical therapy and without contraindications. Most currently used surgical techniques are: Adjustable gastric banding (AGB): a restrictive procedure where a silicone band is placed around the upper stomach and the catheter attached to the band is exteriorized and connected to an infusion port located subcutaneously. Reported %EWL is around 50% depending on the authors.

The rationale for the present project is to enlarge the knowledge about health related quality of life (HRQoL) in patients with metabolic syndrome (MetS) and diabetes mellitus (DM). DM and MetS suppose a global health burden because of their high prevalence but also because of their association with chronic complications. In addition to the evaluation of morbi - mortality, assessing quality of life is an important outcome, especially in chronic illnesses. DM has been associated with impairments in physical, mental health and social functioning. The data about HRQoL in MetS are scarce. For evaluating HRQoL on DM and MetS three independent studies were performed. The first and the second one were based on the population of the Di@bet.es study that included a wide sample, representative of the Spanish population. It was conducted in Spain between 2009 and 2010, designed to estimate DM prevalence in the country. Considering we had a wide representative sample, firstly we assessed MetS prevalence and then evaluated HRQoL in the group with MetS or DM, comparing them to “healthy” people without them. The third study assesses HRQoL in patients with DM who attend to a monographic Unit for Diabetes attention. It is important to know the most affected areas of HRQoL and the socio demographic factors that can influence on it, in order to create initiatives to implement patients’ care...

La desnutrición en el entorno hospitalario afecta en nuestro medio al 23,7% de los pacientes1, de forma que el soporte nutricional se constituye como una estrategia básica de la atención durante el ingreso. La nutrición parenteral (NP) es el método de tratamiento empleado cuando el paciente no puede ser alimentado completamente por vía oral o por vía enteral a través de sonda (nutrición enteral –NE‐), y aunque es claramente una intervención médica, carece de muchos de los argumentos de evidencia científica que se requieren en el desarrollo de un fármaco comercializado tras ensayos clínicos aleatorizados (figura 1.1)2. En nuestro medio la NP se prescribe en un 1‐3% de los pacientes hospitalizados3. Brevemente, la NP es una técnica de intervención nutricional que consiste en la infusión a través de una vía venosa de prácticamente todos los nutrientes necesarios para cubrir las funciones vitales. Actualmente se presenta en bolsas tricamerales en las que las preparaciones de aminoácidos, las soluciones de glucosa y las emulsiones lipídicas se funden en una sola fórmula con electrolitos, vitaminas y micronutrientes. Puede administrarse por vía central o por vía periférica, en este último caso si la osmolaridad final del preparado es inferior a 800‐ 900 mosmol/kg. Se habla de NP total si los requerimientos del paciente solo se cubren por esa vía –generalmente por fallo intestinal agudo o crónico, o en situaciones donde es necesario mantener el reposo digestivo (por ejemplo en quilotórax o en ascitis quilosa refractarios a tratamiento dietético)‐ o complementaria cuando parte de los nutrientes también se están administrando por vía oral/enteral...

Hyponatremia is the most common electrolyte disorder in clinical practice. Patients with hyponatremia present high morbimortality rates. The prevalence of hyponatremia among hospitalized patients has been found to vary from 30 to 42%, when defined as a serum sodium level (SNa) below 136 mmol/L, and to be 19.7% when defined as a SNa below 135 mmol/L. In these patients, hyponatremia is most often present at admittance, and is mild (SNa between 130 and 134 mmol/L). However, when hyponatremia is hospital-acquired, it is more often moderate or severe. Several studies have found a high mortality rate in hospitalized hyponatremic patients as compared with those presenting normal SNa. Such is the case in patients with severe hyponatremia (SNa < 120-125 mmol/L) as well as in mild forms. Minor descents in SNa of the order of 4 to 5 mmol/L are already accompanied by an increased mortality rate. In fact, some authors have detected a minimum mortality rate in patients with SNa between 138–142 mmol/L, postulating these levels as representing strict eunatremia. Hyponatremic patients also have longer hospital lengths-of-stay, as well as a higher readmissions rate. Hyponatremia is a consequence of an alteration in water metabolism, most often due to a reduced renal capacity to eliminate free water (antidiuresis), secondary to a non-osmotic increase in the secretion of Arginine Vasopressin (AVP), the Antidiuretic Hormone (ADH) of humans. This increase can be induced by physiologic stimuli (post-surgical stress, pain, nausea...) or by nonphysiologic, inappropriate AVP secretion (the Syndrome of Inappropriate Antidiuretic Hormone Secretion or SIADH). The combination of persistent AVP secretion together with increased oral or parenteral fluid intake results in plasmatic hypoosmolality, and induction or exacerbation of hyponatremia...

Hyponatremia is the most common electrolyte disorder in clinical practice. Patients with hyponatremia present high morbimortality rates. The prevalence of hyponatremia among hospitalized patients has been found to vary from 30 to 42%, when defined as a serum sodium level (SNa) below 136 mmol/L, and to be 19.7% when defined as a SNa below 135 mmol/L. In these patients, hyponatremia is most often present at admittance, and is mild (SNa between 130 and 134 mmol/L). However, when hyponatremia is hospital-acquired, it is more often moderate or severe. Several studies have found a high mortality rate in hospitalized hyponatremic patients as compared with those presenting normal SNa. Such is the case in patients with severe hyponatremia (SNa < 120-125 mmol/L) as well as in mild forms. Minor descents in SNa of the order of 4 to 5 mmol/L are already accompanied by an increased mortality rate. In fact, some authors have detected a minimum mortality rate in patients with SNa between 138–142 mmol/L, postulating these levels as representing strict eunatremia. Hyponatremic patients also have longer hospital lengths-of-stay, as well as a higher readmissions rate. Hyponatremia is a consequence of an alteration in water metabolism, most often due to a reduced renal capacity to eliminate free water (antidiuresis), secondary to a non-osmotic increase in the secretion of Arginine Vasopressin (AVP), the Antidiuretic Hormone (ADH) of humans. This increase can be induced by physiologic stimuli (post-surgical stress, pain, nausea...) or by nonphysiologic, inappropriate AVP secretion (the Syndrome of Inappropriate Antidiuretic Hormone Secretion or SIADH). The combination of persistent AVP secretion together with increased oral or parenteral fluid intake results in plasmatic hypoosmolality, and induction or exacerbation of hyponatremia...

Estudio 1. Efecto del estilo de vida sobre el riesgo de diabetes gestacional en mujeres inmigrantes hispanas residentes en España. Hipótesis de trabajo. Existen datos limitados sobre los hábitos de alimentación y los factores de riesgo de DG de la población inmigrante de etnia hispana residente en España. El conocimiento de los aspectos diferenciales en cuanto a factores de riesgo, si los hubiera, respecto a la población española permitiría diseñar de forma más adaptada las estrategias preventivas dirigidas a la población inmigrante. Objetivo. Comparar los factores de riesgo relacionados con el estilo de vida para el desarrollo de la DG en mujeres españolas y en mujeres de etnia hispana residentes en España y sus resultados en cuanto a evolución de la gestación, del parto y del recién nacido. Estudio 2. Asociación de concentraciones bajas de 25-hidroxi-vitamina D materna con los parámetros de la homeostasis de la glucosa y con los resultados obstétricos y del recién nacido. Hipótesis de trabajo. El déficit de 25-hidroxi-vitamina D (25-OH-vitD) materna como factor de riesgo emergente para el desarrollo de DG ha resultado controvertido en estudios previos. Por otra parte, los niveles de 25-OH-vitD también podrían estar implicados en una adecuada evolución de la gestación, del parto y del recién nacido. El estudio de estas asociaciones permitirá evaluar las recomendaciones actuales sobre suplementación con vitamina D durante la gestación. Objetivo. Evaluar la asociación de los niveles de 25-OH-vitD materna durante la gestación con los parámetros de la homeostasis de la glucosa y con el riesgo de DG y con los resultados obstétricos y del recién nacido. Estudio 3. Aplicación de la Telemedicina como nueva aproximación para facilitar el seguimiento de la diabetes gestacional. Comparación frente al seguimiento tradicional con visitas presenciales. Hipótesis de trabajo. Nuevos modelos asistenciales dirigidos a la mujer con DG son necesarios para compatibilizar un seguimiento

Estudio 1. Efecto del estilo de vida sobre el riesgo de diabetes gestacional en mujeres inmigrantes hispanas residentes en España. Hipótesis de trabajo. Existen datos limitados sobre los hábitos de alimentación y los factores de riesgo de DG de la población inmigrante de etnia hispana residente en España. El conocimiento de los aspectos diferenciales en cuanto a factores de riesgo, si los hubiera, respecto a la población española permitiría diseñar de forma más adaptada las estrategias preventivas dirigidas a la población inmigrante. Objetivo. Comparar los factores de riesgo relacionados con el estilo de vida para el desarrollo de la DG en mujeres españolas y en mujeres de etnia hispana residentes en España y sus resultados en cuanto a evolución de la gestación, del parto y del recién nacido. Estudio 2. Asociación de concentraciones bajas de 25-hidroxi-vitamina D materna con los parámetros de la homeostasis de la glucosa y con los resultados obstétricos y del recién nacido. Hipótesis de trabajo. El déficit de 25-hidroxi-vitamina D (25-OH-vitD) materna como factor de riesgo emergente para el desarrollo de DG ha resultado controvertido en estudios previos. Por otra parte, los niveles de 25-OH-vitD también podrían estar implicados en una adecuada evolución de la gestación, del parto y del recién nacido. El estudio de estas asociaciones permitirá evaluar las recomendaciones actuales sobre suplementación con vitamina D durante la gestación. Objetivo. Evaluar la asociación de los niveles de 25-OH-vitD materna durante la gestación con los parámetros de la homeostasis de la glucosa y con el riesgo de DG y con los resultados obstétricos y del recién nacido. Estudio 3. Aplicación de la Telemedicina como nueva aproximación para facilitar el seguimiento de la diabetes gestacional. Comparación frente al seguimiento tradicional con visitas presenciales. Hipótesis de trabajo. Nuevos modelos asistenciales dirigidos a la mujer con DG son necesarios para compatibilizar un seguimiento

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 ? 3.36 mmol/l. Pre-diabetics presented similar proportion when considering a goal of 3.36 mmol/l, but only 35% of them reached an LDL-C goal ? 2.6 mmol/l. Finally, 45.3% of diabetics had an LDL-C ? 2.6 mmol/l, and only 11.3% achieved an LDL-C ? 1.8 mmol/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.Copyright © 2013 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

Estudio 1. Efecto del estilo de vida sobre el riesgo de diabetes gestacional en mujeres inmigrantes hispanas residentes en España. Hipótesis de trabajo. Existen datos limitados sobre los hábitos de alimentación y los factores de riesgo de DG de la población inmigrante de etnia hispana residente en España. El conocimiento de los aspectos diferenciales en cuanto a factores de riesgo, si los hubiera, respecto a la población española permitiría diseñar de forma más adaptada las estrategias preventivas dirigidas a la población inmigrante. Objetivo. Comparar los factores de riesgo relacionados con el estilo de vida para el desarrollo de la DG en mujeres españolas y en mujeres de etnia hispana residentes en España y sus resultados en cuanto a evolución de la gestación, del parto y del recién nacido. Estudio 2. Asociación de concentraciones bajas de 25-hidroxi-vitamina D materna con los parámetros de la homeostasis de la glucosa y con los resultados obstétricos y del recién nacido. Hipótesis de trabajo. El déficit de 25-hidroxi-vitamina D (25-OH-vitD) materna como factor de riesgo emergente para el desarrollo de DG ha resultado controvertido en estudios previos. Por otra parte, los niveles de 25-OH-vitD también podrían estar implicados en una adecuada evolución de la gestación, del parto y del recién nacido. El estudio de estas asociaciones permitirá evaluar las recomendaciones actuales sobre suplementación con vitamina D durante la gestación. Objetivo. Evaluar la asociación de los niveles de 25-OH-vitD materna durante la gestación con los parámetros de la homeostasis de la glucosa y con el riesgo de DG y con los resultados obstétricos y del recién nacido. Estudio 3. Aplicación de la Telemedicina como nueva aproximación para facilitar el seguimiento de la diabetes gestacional. Comparación frente al seguimiento tradicional con visitas presenciales. Hipótesis de trabajo. Nuevos modelos asistenciales dirigidos a la mujer con DG son necesarios para compatibilizar un seguimiento

Estudio 1. Efecto del estilo de vida sobre el riesgo de diabetes gestacional en mujeres inmigrantes hispanas residentes en España. Hipótesis de trabajo. Existen datos limitados sobre los hábitos de alimentación y los factores de riesgo de DG de la población inmigrante de etnia hispana residente en España. El conocimiento de los aspectos diferenciales en cuanto a factores de riesgo, si los hubiera, respecto a la población española permitiría diseñar de forma más adaptada las estrategias preventivas dirigidas a la población inmigrante. Objetivo. Comparar los factores de riesgo relacionados con el estilo de vida para el desarrollo de la DG en mujeres españolas y en mujeres de etnia hispana residentes en España y sus resultados en cuanto a evolución de la gestación, del parto y del recién nacido. Estudio 2. Asociación de concentraciones bajas de 25-hidroxi-vitamina D materna con los parámetros de la homeostasis de la glucosa y con los resultados obstétricos y del recién nacido. Hipótesis de trabajo. El déficit de 25-hidroxi-vitamina D (25-OH-vitD) materna como factor de riesgo emergente para el desarrollo de DG ha resultado controvertido en estudios previos. Por otra parte, los niveles de 25-OH-vitD también podrían estar implicados en una adecuada evolución de la gestación, del parto y del recién nacido. El estudio de estas asociaciones permitirá evaluar las recomendaciones actuales sobre suplementación con vitamina D durante la gestación. Objetivo. Evaluar la asociación de los niveles de 25-OH-vitD materna durante la gestación con los parámetros de la homeostasis de la glucosa y con el riesgo de DG y con los resultados obstétricos y del recién nacido. Estudio 3. Aplicación de la Telemedicina como nueva aproximación para facilitar el seguimiento de la diabetes gestacional. Comparación frente al seguimiento tradicional con visitas presenciales. Hipótesis de trabajo. Nuevos modelos asistenciales dirigidos a la mujer con DG son necesarios para compatibilizar un seguimiento

Existe suficiente evidencia sobre la asociación de alteraciones en el metabolismo de la glucosa, las lipoproteínas, la acción de la insulina, la hipertensión y la obesidad de distribución central. Esta asociación se denomina Síndrome Metabólico. A pesar de que ha sido cuestionada su existencia por la ADA y la EASD, es una herramienta útil que permite identificar a las personas que tienen un alto riesgo de desarrollar enfermedad cardiovascular. El síndrome metabólico y sus componentes individuales se asocian a una elevada incidencia de enfermedad cardiovascular. La obesidad y el sedentarismo son factores de riesgo subyacentes en la ruta patogénica de este síndrome, por tanto la modificación de los hábitos de vida es una intervención de primera línea en la prevención y tratamiento de la resistencia insulínica, la hiperglucemia, la dislipemia aterogénica y la hipertensión arterial. La reducción ponderal y el ejercicio son las claves del plan global, pero entre los tratamientos no farmacológicos la dieta permanece como una de las estrategias de reducción del riesgo cardiovascular más importantes. Estudios epidemiológicos han observado que una ingesta elevada de azúcares simples, de alimentos con alto índice glucémico y de dietas con alta carga glucémica se asocian a resistencia insulínica, diabetes mellitus tipo 2, hipertrigliceridemia y cifras bajas de colesterol- HDL. Un bajo consumo de grasa saturada a favor de ácidos grasos poliinsaturados y monoinsaturados se ha implicado en una reducción de la incidencia de diabetes mellitus tipo 2 y dislipemia, aunque continúa el debate. La fibra dietética de cereales no refinados ha sido beneficiosa en la reducción del riesgo de diabetes. Entre los patrones dietéticos, la dieta mediterránea se ha visto relacionada con una menor incidencia de diabetes y con una reducción del riesgo de muerte. Estudios de intervención para la prevención de diabetes tipo 2 han propuesto dietas hipograsas (reduciendo grasa saturada y trans-), con al