La diabetes mellitus tipo 1 (DM1) es una enfermedad crónica con importante repercusión sociosanitaria ante la que se requiere de información epidemiológica para una correcta gestión sanitaria. El objetivo del estudio es conocer la incidencia de DM1 en Asturias entre 2011 y 2020.Estudio descriptivo en el que se han incluido los diagnósticos de DM1 en Asturias entre los años 2011 y 2020, captados como fuente primaria mediante revisión del registro de análisis de autoinmunidad pancreática. Se han estimado las tasas de incidencia (TI), expresadas por 100.000 habitantes-año de riesgo por grupos de edad, sexo y área sanitaria.Fueron diagnosticado 815 pacientes; el 53,13% eran hombres. La edad media fue de 34,32 ± 22,07 años; 9,85 ± 4,46 en menores de 19 años (10,48 ± 4,45 en varones y 9,00 ± 4,36 en mujeres). El 55,34% de los diagnósticos se produjo a edad superior a los 30 años. La TI fue de 7,82 (7,29-8,37); de 19,65 (17,17-22,39) en menores de 15 años y de 12,84 (11,73-14,03) en menores de 40. El pico máximo de TI se produjo entre los 10 y los 14 años, tanto en hombres (31,16; 23,89-39,95) como en mujeres (21,72; 15,59-29,47). No se apreció aumento significativo de la incidencia en los años estudiados.Asturias presenta una incidencia alta de DM1. En nuestro estudio no se aprecia adelanto en la edad al diagnóstico ni aumento de la TI. Con respecto a estudios previos, la TI aumenta debido, con alta probabilidad, a una mejora en la captura de datos, no a un aumento real de la incidencia. Un alto porcentaje de los diagnósticos se producen en la edad adulta.Type 1 diabetes mellitus (DM1) is a chronic disease with important socio-health repercussions that requires epidemiological information for proper health management. The aim of this study was to determine the incidence of DM1 in Asturias between 2011-2020.Descriptive study which included diagnoses of DM1 in Asturias between 2011-2020 captured as a primary source by reviewing the register of pancreatic autoimmunity analysis. Incidence rates were estimated, expressed per 100,000 population-years of risk by age group, sex, and health area.A total of 815 patients were diagnosed, 53.13% men. The mean age was 34.32±22.07 years; 9.85±4.46 in children under 19 years of age (10.48±4.45 in males and 9.00±4.36 in females). Of the diagnoses, 55.34% occurred at an age over 30 years. The incidence was 7.82 (7.29-8.37); 19.65 (17.17-22.39) in under 15s and 12.84 (11.73-14.03) in under 40s. The maximum incidence peak was between 10-14 years, both in males 31.16 (23.89-39.95) and in females 21.72 (15.59-29.47). There was no significant increase in incidence over the years studied.Asturias has a high incidence of DM1. In our study no earlier age at diagnosis was observed or an increase in incidence. Compared to previous studies, the increase in incidence is most likely due to an improvement in data capture, not to a real increase in incidence. A high percentage of diagnoses occur in adulthood.

Background: Sleeve Gastrectomy (SG) is one of the most performed surgical techniques. However in case of weight loss failure (WLF) there are controversies about which technique should be performed.

Despite the beneficial effect of bariatric surgery (BS) on overall health, this therapeutic approach may compromise protein status (PS). BS decreases food and protein intake (PI) and changes the gastrointestinal tract, which may result in maldigestion and malabsorption. Both factors can compromise PS. Changes in PS may have a negative impact on several systems of body functions, such as skeletal muscle mass, protein turnover, resting energy expenditure, bone density, branched-chain amino acid circulating levels, the immune system, and satiety. In this chapter we will review the mechanisms by which BS alters PS, and the resulting health consequences. In a more translational approach, the methods to perform a quantitative and qualitative PS assessment will be briefly reviewed.

An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; “Morbid Obesity, an Interdisciplinary Approach”. During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity. Key-words: Morbid obesity, bariatric surgery, gastric bypass surgery, biliopancretic diversion, ghrelin, medical therapy.

CONTEXT:The mechanisms underlying weight loss after Roux-en-Y gastric bypass (RYGBP) are not well understood.OBJECTIVE:The objective of the study was to assess the changes in active glucagon-like peptide 1 (GLP-1) and total peptide YY (PYY) after RYGBP and examine their relationship with changes in hunger and satiety.DESIGN:This was a prospective study on the changes in active GLP-1, PYY, hunger, and satiety in response to a standardized test meal in nine normal-glucose-tolerant obese subjects [body mass index (BMI) 47.4 +/- 6.1 kg/m(2)] before and 6 wk after RYGBP.RESULTS:Before surgery, meal ingestion failed to stimulate GLP-1 and PYY secretion. Six weeks after surgery, despite subjects still being markedly obese (BMI 43.6 +/- 7.8 kg/m(2)), the area under the curve(0-120') of GLP-1 and of PYY in response to the standardized test meal were significantly elevated (P < 0.05 and P < 0.01, respectively). These hormonal responses were significantly larger (P < 0.01) than those observed in a group matched for the BMI attained 6 wk after surgery. The 2.9 +/- 1.2- and 1.6 +/- 1.9-fold increase, respectively, in the area under the curve(0-120') of GLP-1 and PYY were accompanied by a significant decrease in fasting (P < 0.05) and postprandial hunger (P = 0.05) and a significant increase in satiety (P < 0.05) after meal intake. Nevertheless, a significant correlation between changes in the hormonal and eating behavior parameters was not found.CONCLUSION:Our data show that RYGBP is associated with an improvement in the active GLP-1 and total PYY response to a liquid-meal intake. Moreover, we provide circumstantial evidence for a potential role of these gastrointestinal hormones on the decreased appetite after RYGBP.

OBJECTIVE:To prospectively evaluate the short-term effects of Roux-en-Y gastric bypass (RYGBP) on ghrelin secretion and its relevance on food intake and body weight changes. RESEARCH METHODS AND PROCEDURES:Ghrelin response to a standardized test meal was evaluated in eight obese patients (BMI, 43.5 to 59.1 kg/m2) before and 6 weeks after RYGBP. Ghrelin response was compared with that of an age-matched group of six normal weight individuals (BMI, 19.6 to 24.9 kg/m2). RESULTS:Fasting serum ghrelin levels were lower in obese subjects compared with controls (p < 0.05). Meal ingestion significantly suppressed ghrelin concentration in controls (p < 0.05) and obese subjects (p < 0.05), albeit to a lesser degree in the latter group (p < 0.05). Despite a 10.3 +/- 1.5% weight loss, fasting serum ghrelin levels were paradoxically further decreased in obese subjects 6 weeks after RYGBP (p < 0.05). Moreover, at this time-point, food intake did not elicit a significant ghrelin suppression. The changes in ghrelin secretion after RYGBP correlated with changes in insulin sensitivity (p < 0.05) and caloric intake (p < 0.05). DISCUSSION:This study showed that the adaptive response of ghrelin to body weight loss was already impaired 6 weeks after RYGBP. Our study provides circumstantial evidence for the potential role of ghrelin in the negative energy balance in RYGBP-operated patients.