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Compared to body mass index, waist circumference (WC), and adiposity measurements, adipose tissue (AT) morpho-functionality evaluations are better predictors of cardiometabolic abnormalities (CA). The present study establishes a dysfunctional adiposity index (DAI) as an early marker of CA based on adipocytes morpho-functional abnormalities. DAI was established in 340 subjects without cardiovascular risk factors selected from a cross-sectional study (n=1600). Then, DAI was calculated in 36 healthy subjects who underwent subcutaneous AT biopsy. The correlation of DAI with adipocyte morphology (size/number) and functionality (adiponectin/leptin ratio) was analyzed. The DAI cutoff point was identified and its independent association with CA was determined in 1418 subjects from the cross-sectional study. The constant parameters to calculate the DAI were [WC/[22.79+[2.68*BMI]]]*[triglycerides (TG, mmol/L)/1.37]*[1.19/high density lipoproteincholesterol (HDL-C, mmol/L)] for males, and [WC/[24.02+[2.37*BMI]]]*[TG(mmol/L)/1.32]*[1.43/ HDL-C(mmol/L)] for females. DAI correlated with adipocytes mean area, adipocyte number and adiponectin/leptin ratio. DAI ≥1.065 was independently associated with diabetes, non-alcoholic fatty liver disease, subclinical atherosclerosis, and hypertension. The present study highlights that DAI is associated with early CA independently of adiposity and other risk factors. Since DAI is obtained using accessible parameters, it can be easily incorporated into clinical practice for early identification of AT abnormalities in apparently healthy subjects.

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Introducción: Evaluar la presencia de desnutrición y obesidad en adultos mayores con distintos tipos de apoyo social en Sinaloa, México. Material y métodos: Estudio comparativo, observacional, prospectivo y transversal en 91 adultos mayores. Se determinó el peso corporal, la estatura y medidas antropométricas. Se aplicó el Mini Nutritional Assessment (MNA). Se estimaron los promedios y las desviaciones estándar, así como la distribución de las diferencias entre las mediciones antropométricas y los resultados del MNA de las distintas poblaciones. Se analizaron los datos con las pruebas de KruskalWallis y Ji-cuadrado 2 . Se utilizó el coeficiente de Pearson para evaluar la correlación entre indicadores antropométricos con MNA. Se consideró significancia estadística un valor de p<0.05. Resultados: La muestra estudiada incluyó 91 adultos mayores: 35 usuarios de una casa de día, 28 miembros de un centro cultural, y 28 residentes de dos asilos. Se observó una prevalencia de desnutrición del 32,1%, 14,3% y 3,5% en institucionalizados, casa de día y adultos independientes, respectivamente. Un 93,2 % de la población estudiada padecía acúmulo de grasa a nivel visceral según el índice de cintura talla (ICT). El índice de masa corporal (IMC) y la circunferencia de la pantorrilla (CP) se correlacionaron significativamente con MNA (p<0.05). Conclusiones: Se observó una mayor prevalencia de desnutrición en la población residente de asilos y en los usuarios de casas de día, principalmente en mujeres y población mayor de 80 años de edad. El exceso de tejido adiposo prevalece en la tercera edad. Es necesaria la implementación de estrategias nutricionales específicas para este grupo de edad. Results: 91 elderlies were evaluated: 35 users of a day House, 28 members of a cultural centre, and 28 residents of two nursing homes. There was a prevalence of malnutrition of 32.1% in the institutionalized, 14.3% on the day house, and 3.5% in independent adult. Obesity were diagnosed in 93.2% of people by Waist/Height Ratio. Good correlations were found between body mass index (BMI) and calf circumference (CC) with MNA (p<0.05). Conclusions: High prevalences of undernutrition were found in nursing homes and user of day homes, with major risks in womans and people major of 80 years. The implementation of nutritional interventions depending on the type of social assistance received is required. PALABRAS CLAVE

La enfermedad renal crónica y el estado urémico se asocian con alteraciones en la permeabilidad intestinal y cambios en la microbiota intestinal, provocando una mayor producción y translocación de toxinas urémicas como sulfato de indoxilo (IS) y sulfato de p-cresilo (pCS), detonando una respuesta inflamatoria. El estado inflamatorio y el incremento en concentraciones séricas de IS y pCS se han asociado con una mayor mortalidad, mayor número de eventos cardiovasculares y mayores alteraciones en el metabolismo mineral y óseo. Se han estudiado diversas estrategias nutricionales y farmacológicas para modular la microbiota intestinal y mejorar las alteraciones en la permeabilidad intestinal, entre ellas la suplementación con probióticos, prebióticos y simbióticos, modificaciones en la composición de la dieta y uso de agentes adsorbentes. El objetivo del presente trabajo es realizar una revisión de las causas de las alteraciones intestinales y de la microbiota intestinal en el paciente con enfermedad renal crónica, analizando las consecuencias de dichos cambios y las intervenciones estudiadas hasta la actualidad. PALABRAS CLAVE R E S U M E NAlteraciones en el eje intestino-riñón durante la enfermedad renal crónica: causas, consecuencias y propuestas de tratamiento

BackgroundCompared to body mass index (BMI), waist circumference (WC), and adiposity measurements, adipose tissue morpho-functionality evaluations are more consistent predictors of cardiometabolic abnormalities. However, these evaluations require determination of adipokines and other non-routine biochemical parameters, which is not feasible in clinical practice. The present study establishes dysfunctional adiposity index (DAI) as a simple, accessible, and reliable marker of early adipocytes morpho-functional abnormalities and cardiometabolic diseases.MethodsTo establish the DAI constant parameters, 340 subjects (134 males and 206 females) without cardiovascular risk factors were selected from a cross-sectional study. Then, DAI was calculated in 36 healthy subjects who underwent subcutaneous adipose tissue biopsy, for whom adipocytes number and size, body composition, circulating adipokines, glucose, insulin, and lipids were also determined. The correlation of DAI with adipocyte morphology (size/number of adipocytes) and functionality (adiponectin/leptin ratio) was analyzed. The receiver operating characteristic curve was used to define the optimal DAI cut-off point to identify metabolic abnormalities. Finally, the independent association of DAI with cardiometabolic abnormalities was determined in 1418 subjects from the cross-sectional study through multivariate analyses.ResultsThe constant parameters to calculate the DAI were [WC/[22.79+[2.68*BMI]]]*[triglycerides (TG, mmol/L)/1.37]*[1.19/high density lipoprotein-cholesterol (HDL-C, mmol/L)] for males, and [WC/[24.02+[2.37*BMI]]]*[TG(mmol/L)/1.32]*[1.43/HDL-C(mmol/L)] for females. In subjects underwent biopsy, DAI correlated with adipocytes mean area (r=0.358; p=0.032), adipocyte number (r=-0.381; p=0.024), adiponectin/leptin ratio (r=-0.483; p=0.003), and systemic inflammation markers. Compared to BMI, WC, and visceral fat, DAI was the only determination associated with insulin resistance (area under the curve: 0.743; p = 0.017). In the cross-sectional study, DAI ≥1.065 was independently associated with diabetes (OR: 1.96; 95%CI: 1.36-2.84), non-alcoholic fatty liver disease (OR: 2.57; 95%CI: 1.98-3.33), subclinical atherosclerosis (OR: 1.74; 95%CI: 1.02-2.94), and hypertension (OR: 1.44; 95%CI: 1.10-1.88).ConclusionsThe present study establishes the constant parameters to calculate the DAI and highlights that a DAI ≥ 1.065 is associated with early cardiometabolic abnormalities independently of adiposity and other risk factors. Since DAI is calculated using accessible parameters routinely used in the clinic, this indicator can be easily incorporated in clinical practice for the early identification of adipose tissue abnormalities in apparently healthy subjects.

Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition–Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition–Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.

La enfermedad renal crónica tiene implicaciones directas en el estado nutricional, provocando anorexia y catabolismo muscular, situaciones más frecuentes en los pacientes con terapia renal sustitutiva, donde las alteraciones nutricionales y los mecanismos inflamatorios asociados a la terapia suelen ocasionar el desarrollo de desgaste proteico energético. La terapia médico nutricional ha mostrado ser una estrategia terapéutica adecuada para prevenir y tratar las alteraciones metabólicas, disminuyendo el riesgo de complicaciones quirúrgicas y nutricionales en los pacientes que son sometidos a trasplante renal. El presente caso reporta la intervención nutricional implementada en un paciente en diálisis peritoneal continua ambulatoria, que posteriormente se le prescribió diálisis peritoneal automatizada, para finalmente someterse a un trasplante renal de donador vivo. PALABRAS CLAVE