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INTRODUCTION: The inflammatory state that accompanies adiposity and the metabolic syndrome (MetS) is called "low-grade" inflammation. White blood cell count (WBC) has been proposed as an emerging biomarker for predicting future cardiovascular events, MetS and mortality. Bariatric surgery (BS) improves comorbidities associated with obesity and the MetS and the surgically induced weight loss is known to improve inflammatory status. OBJECTIVES: To analyze the improvement of low-grade inflammation associated to obesity in patients with metabolically healthy severe obesity (MHSO) and patients with metabolically unhealthy obesity (MUSO) (severe obesity with MetS) after primary bariatric surgery as well as the protective effect of BS against the development of MetS in patients with MHSO by reducing the WBC. MATERIALS AND METHODS: Retrospective analysis of prospectively collected data of patients undergoing laparoscopic primary BS (gastric by-pass or sleeve gastrectomy) from January 2004-December 2015. Outcomes included changing of low-grade inflammation in terms of leukocytes, neutrophils, lymphocytes, and platelets. RESULTS: Twenty-one patients with MHSO and 167 patients with MUSO underwent laparoscopic primary BS. The preoperative values of leukocyte and platelet were statistically higher in the group of patients with MHSO. In both groups, there was significant postoperative decrease of inflammatory markers. The greatest drop in WBC occurred in the second postoperative year. No patient of the group of patients with MHSO developed MetS within five postoperative years. CONCLUSIONS: Surgically induced weight loss plays an important role for improvement in chronic inflammation associated to obesity because of reduction of visceral fat mass. MHSO associates a low-grade chronic inflammatory status comparable to MUSO. The improvement or decrease of low-grade inflammation in patients with metabolically healthy severe obesity after bariatric surgery could have a protective effect against the development of MetS and medical conditions associated with severe obesity.

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The increase in the prevalence of type 2 diabetes and the worldwide expansion of overweight and obesity are intrinsically linked. The percentage of diabetes attributable to weight gain amounts to more than 80% in many countries. This relationship is addressed in a Spanish Consensus Document from SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN and SEMFYC published in 2015 and which gathers best available evidences. Based on the statements of this consensus document, we propose five recommendations for clinical practice to establish a diagnosis of precision and the most appropriate treatment for joint diabetes and obesity. These recommendations have been agreed by the SENDIMAD, SOMAMFYC, SEMG Madrid and RedGDPS Working Groups: 1. For every patient with diabetes and obesity, in addition to the calculation of the body mass index, the percentage of body fat and the approximation to the assessment of body composition should be evaluated throughout the whole process (both at the beginning and follow up). 2. The approximation to the degree and distribution of body fat requires the measurement and recording of the waist circumference of these patients. 3. The integrated assessment of the patient with type 2 diabetes-obesity requires the evaluation of the degree of physical activity and/or characterization of the sedentary condition. 4. The prescription of lifestyle changes should be incorporated into therapeutic education (individualized, flexible, autonomous and sustainable diet and physical activity plan. 5. The pharmacological approach in the treatment of type 2 diabetes-obesity implies the choice of anti-diabetic drugs that facilitate the loss of fat.

El aumento en la prevalencia de diabetes tipo 2 y la expansión a nivel mundial de los estados de sobrepeso y obesidad están intrínsecamente vinculados, de forma que el porcentaje de diabetes atribuible al aumento de peso llega a ser superior al 80% en muchos países. En 2015 se publica un Documento de Consenso español de SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC que aborda esta doble condición de acuerdo con las mejores evidencias. Desde las afirmaciones de dicho consenso proponemos cinco recomendaciones para la práctica clínica consensuadas por los Grupos de trabajo de SENDIMAD, SOMAMFYC, SEMG Madrid y RedGDPS, con el fin de establecer un diagnóstico de precisión y el tratamiento más adecuado:1. En todo paciente con diabetes y obesidad debe abordarse, tanto al inicio como en el seguimiento, además del cálculo del índice de masa corporal (IMC), el porcentaje de grasa corporal y la valoración de la composición corporal.2. La aproximación al grado y distribución de la grasa corporal requiere incluir la medición y registro del perímetro de cintura de estos pacientes.3. La valoración integral del paciente con diabetes tipo 2-obesidad exige la evaluación del grado de actividad física y/o caracterizar la condición de sedentarismo.4. La prescripción de cambios del estilo de vida debe ser incorporada a la educación terapéutica (plan dietético y de actividad física individualizado, flexible, autónomo y sostenible).5. El abordaje farmacológico en el tratamiento de la diabetes-obesidad implica la elección de fármacos antidiabéticos que faciliten la pérdida de grasa.

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El aumento en la prevalencia de diabetes tipo 2 y la expansión a nivel mundial de los estados de sobrepeso y obesidad están intrínsecamente vinculados, de forma que el porcentaje de diabetes atribuible al aumento de peso llega a ser superior al 80% en muchos países. En 2015 se publica un Documento de Consenso español de SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC que aborda esta doble condición de acuerdo con las mejores evidencias. Desde las afirmaciones de dicho consenso proponemos cinco recomendaciones para la práctica clínica consensuadas por los Grupos de trabajo de SENDIMAD, SOMAMFYC, SEMG Madrid y RedGDPS, con el fi n de establecer un diagnóstico de precisión y el tratamiento más adecuado: 1. En todo paciente con diabetes y obesidad debe abordarse, tanto al inicio como en el seguimiento, además del cálculo del índice de masa corporal (IMC), el porcentaje de grasa corporal y la valoración de la composición corporal. 2. La aproximación al grado y distribución de la grasa corporal requiere incluir la medición y registro del perímetro de cintura de estos pacientes. 3. La valoración integral del paciente con diabetes tipo 2-obesidad exige la evaluación del grado de actividad física y/o caracterizar la condición de sedentarismo. 4. La prescripción de cambios del estilo de vida debe ser incorporada a la educación terapéutica (plan dietético y de actividad física individualizado, flexible, autónomo y sostenible). 5. El abordaje farmacológico en el tratamiento de la diabetes-obesidad implica la elección de fármacos antidiabéticos que faciliten la pérdida de grasa

The increase in the prevalence of type 2 diabetes and the worldwide expansion of overweight and obesity are intrinsically linked. The percentage of diabetes attributable to weight gain amounts to more than 80% in many countries. This relationship is addressed in a Spanish Consensus Document from SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN and SEMFYC published in 2015 and which gathers best available evidences. Based on the statements of this consensus document, we propose five recommendations for clinical practice to establish a diagnosis of precision and the most appropriate treatment for joint diabetes and obesity. These recommendations have been agreed by the SENDIMAD, SOMAMFYC, SEMG Madrid and RedGDPS Working Groups: 1. For every patient with diabetes and obesity, in addition to the calculation of the body mass index, the percentage of body fat and the approximation to the assessment of body composition should be evaluated throughout the whole process (both at the beginning and follow up). 2. The approximation to the degree and distribution of body fat requires the measurement and recording of the waist circumference of these patients. 3. The integrated assessment of the patient with type 2 diabetes-obesity requires the evaluation of the degree of physical activity and/or characterization of the sedentary condition. 4. The prescription of lifestyle changes should be incorporated into therapeutic education (individualized, fl exible, autonomous and sustainable diet and physical activity plan. 5. The pharmacological approach in the treatment of type 2 diabetes-obesity implies the choice of anti-diabetic drugs that facilitate the loss of fat

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BACKGROUND: There are a variable number of obese subjects with self-reported diagnosis of asthma but without current or previous evidence of airflow limitation, bronchial reversibility, or airway hyperresponsiveness (misdiagnosed asthma). However, the mechanisms of asthma-like symptoms in obesity remain unclear. OBJECTIVES: We sought to evaluate the perception of dyspnea during bronchial challenge and exercise testing in obese patients with asthma and misdiagnosed asthma compared with obese control subjects to identify the mechanisms of asthma-like symptoms in obesity. METHODS: In a cross-sectional study we included obese subjects with asthma (n = 25), misdiagnosed asthma (n = 23), and no asthma or respiratory symptoms (n = 27). Spirometry, lung volumes, exhaled nitric oxide levels, and systemic biomarker levels were measured. Dyspnea scores during adenosine bronchial challenge and incremental exercise testing were obtained. RESULTS: During bronchial challenge, patients with asthma or misdiagnosed asthma reached a higher Borg-FEV1 slope than control subjects. Moreover, maximum dyspnea and the Borg-oxygen uptake (V'O2) slope were significantly greater during exercise in subjects with asthma or misdiagnosed asthma than in control subjects. The maximum dyspnea achieved during bronchial challenge correlated with IL-1ß levels, whereas peak respiratory frequency, ventilatory equivalent for CO2, and IL-6 and IL-1ß levels were independent predictors of the Borg-V'O2 slope during exercise (r(2) = 0.853, P < .001). CONCLUSIONS: A false diagnosis of asthma (misdiagnosed asthma) in obese subjects is attributable to an increased perception of dyspnea, which, during exercise, is mainly associated with systemic inflammation and excessive ventilation for metabolic demands.

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BACKGROUND: Specific data is needed to safely expand bariatric surgery and to preserve good surgical outcomes in response to the non-stop increase in obesity prevalence worldwide. OBJECTIVE: The aims of this study are to provide an overview of the baseline characteristics, type of surgery, and 30-day postoperative morbidity and mortality in patients undergoing bariatric surgery in Spanish public hospitals, and evaluate changes throughout the 2000-2014 period. MATERIAL AND METHODS: This is a descriptive study using data from the RICIBA, a computerized multicenter and multidisciplinary registry created by the Obesity Group of the Endocrinology and Nutrition Spanish Society. Three periods according to the date of surgery were created: January 2000 to December 2004 (G1), January 2005 to December 2009 (G2), and January 2010 to December 2014 (G3). RESULTS: Data from 3843 patients were available (44.8 ± 10.5 years, a 3:1 female-to-male ratio, 46.9 ± 8.2 kg/m(2)). Throughout the 15-year period assessed, candidate patients for bariatric surgery were progressively older and less obese, with an increase in associated comorbidities and in the prevalence of men. The global trend also showed a progressive decrease in Roux-en-Y gastric bypass, the most performed bariatric procedure (75.1 % in G1, 69.3 % in G2, and 42.6 % in G3; p < 0.001), associated with a parallel increase in sleeve gastrectomy (0.8 % in G1, 18.1 % in G2, and 39.6 % in G3; p < 0.001). An overall mortality rate of 0.3 % was reported. CONCLUSIONS: Data from Spain is similar to data observed worldwide. Information recorded in the National Registries like RICIBA is necessary in order to safely expand bariatric surgery in response to increasing demand.

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UNLABELLED: With a prevalence of Morbid Obesity of 1,2% of the Spanish population, the current criteria for Bariatric Surgery do not classify patients taking into consideration co-morbidities or functional status. We need new staging systems useful in predicting mortality and able to support prioritizing treatments. AIM: Applying Edmonton staging system to patients awaiting Bariatric Surgery. METHOD: Data collected from 81 patients from 2011- 2013 after pre-surgery protocol. Weight, height, waist, BMI, biochemical parameters and blood pressure are registered. Also taken down are hepatic, renal, osteoarticular diseases, sleep-apnea syndrome and/or gastro-oesophageal reflux, if present. Edmonton staging of ten variables is applied to each patient. RESULTS: 81 patients: 67% women, average age 47y, 18% below 30y. Average BMI of 47, 90% of patients have a BMI >40. 34% of patients show sleep-apnea syndrome and 25% gastro-oesophageal reflux. 9% of the patients have a BMI >45, diabetes mellitus and sleep-apnea syndrome. Applying the Edmonton Staging, nine patients (11%) are in the highest risk range (stage 3), 70% are in the high-risk range (stage 2) and 15 patients (18%) are included in the low-risk range. No patient was found to be in stage 0 without obesity risk factors. CONCLUSIONS: The Edmonton staging system provides us with information on presence or extent of co-morbidities that guide decision making in individuals. The mortality- predictive ability of Edmonton proposal could help to assist in determining the urgency of Bariatric Surgery and establish better criteria to prioritize these group of patients.

Con una prevalencia de obesidad mórbida del 1,2% en población española, los criterios de indicación para Cirugía Bariátrica (CB) no consideran comorbilidades ni estado funcional. Es necesaria una aproximación diagnóstica capaz de predecir mortalidad y sustentar criterios de priorización terapéutica. Objetivo: Aplicar la propuesta Edmonton como sistema de estadiaje clínico para la clasificación de pacientes en lista de espera de CB. Método: Se recogen datos de 81 pacientes (2011 ­ 2013), tras protocolo prequirúrgico. Se registra peso, talla, IMC, cintura, determinaciones bioquímicas, TA, presencia de enfermedad hepática, renal, osteoarticular, síndrome apnea-hipopnea del sueño (SAHS) y reflujo gastroesofágico. Se aplica a cada persona la propuesta de estadiaje de Edmonton, con 10 variables. Resultados: 67% mujeres. Edad media: 47 años, 18% con edad inferior a 30 años. IMC medio: 47 (37-67), 90% IMC > de 40. El 34% de los pacientes presentan SHAS y el 25% enfermedad por reflujo. Un 9% asocia IMC > 45, disglucosis- diabetes mellitus y SAHS. Aplicando el modelo de Edmonton, nueve pacientes (11%) se sitúan en el rango de mayor riesgo (estadío 3), 70% en rango de riesgo elevado (estadío 2), y 15 pacientes (18%), están incluidos en la condición de bajo riesgo. Ningún paciente se situaba en estadio 0, sin factores de riesgo asociados a obesidad. Conclusiones: El estadiaje de Edmonton nos aporta información sobre la presencia y extensión de co-mobilidades, que apoye la toma de decisiones terapéuticas. La capacidad predictiva de mortalidad de la propuesta de Edmonton podría ser útil para establecer criterios de priorización quirúrgica.

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