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Fidilio E, Navarro-González E, Romero-Lluch AR, Iglesias P, Diez Gómez JJ, Anda Apiñániz E, Santos Mazo E, Zafón C. Thyroid disorders associated with immune control point inhibitors. ENDOCRINOL DIAB NUTR 2021; 68:408-415. [PMID: 34742474 DOI: 10.1016/j.endien.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/25/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICPI) have improved progression-free survival in several solid tumors. Side effects are related to overstimulation of the immune system. Thyroid dysfunction (TD) is the most common endocrine immune-related adverse event of ICPI. OBJECTIVE To describe the clinical presentation and the course of TD in cancer patients treated with ICPI referred to an endocrinology outpatient clinic. MATERIAL AND METHODS This was a descriptive, retrospective and multicenter study of patients with TD associated with ICPI in six Spanish hospitals. RESULTS 120 patients (50.8% women), mean age 60 ± 12 years were included. The initial TD was hypothyroidism in 49% of patients and hyperthyroidism in 51%, with an average of 76 (41-140) and 43 (26-82) days respectively between the onset of ICPI and the analytical alteration. Significantly, the earlier the first analytical determination was, the greater the prevalence of hyperthyroidism. A turnover was observed in 80% of subjects during follow-up, mostly from hyperthyroidism to hypothyroidism. Twenty-one percent received double ICPI therapy. The most frequent form of presentation in monotherapy was hypothyroidism (57%), and in double therapy it was hyperthyroidism (77%) (p = 0.002). Patients under double therapy showed thyroid alterations earlier than those in the monotherapy group (p = 0.001). After a follow-up of 205 (112-360) days, half of the patients continued under levothyroxine treatment. CONCLUSIONS Hypothyroidism and hyperthyroidism present in a similar proportion in cancer patients undergoing ICPI therapy. Our results suggest that transitory hyperthyroidism may not be detected in a relevant number of cases. In addition, TD in double therapy presents earlier. This should be taken into account in the follow-up protocols of these patients.
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Affiliation(s)
- Enzamaria Fidilio
- Servicio de Endocrinología y Nutrición, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Elena Navarro-González
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana R Romero-Lluch
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Juan José Diez Gómez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Emma Anda Apiñániz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Estefanía Santos Mazo
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Burgos, Burgos, Spain
| | - Carles Zafón
- Servicio de Endocrinología y Nutrición, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Ciudin A, Sánchez M, Hernandez I, Cordero E, Fidilio E, Comas M, Gonzalez C, Lopez N, Vilallonga R, Giralt M, Ferrer R, Hernández C, Simó R. Canagliflozin: A New Therapeutic Option in Patients That Present Postprandial Hyperinsulinemic Hypoglycemia after Roux-en-Y Gastric Bypass: A Pilot Study. Obes Facts 2021; 14:291-297. [PMID: 33965935 PMCID: PMC8255644 DOI: 10.1159/000515598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) is the most common surgical procedure for morbid obesity. However, it can present serious late complications, like postprandial hyperinsulinemic hypoglycemia (PHH). Recent data suggested an increase in intestinal SGLT-1 after RYGB. However, there is no data on the inhibition of SGLT-1 to prevent PHH in patients with prior RYBG. On this basis, we aimed to evaluate (a) the effect of canagliflozin 300 mg on the response to 100 g glucose overload (oral glucose tolerance test [OGTT]); (b) the pancreatic response after intra-arterial calcium stimulation in the context of PHH after RYGB. MATERIALS AND METHODS This is a prospective pilot study including patients (n = 21) with PHH after RYGB, matched by age and gender with healthy controls (n = 5). Basal OGTT and after 2 weeks of daily 300 mg of canagliflozin was performed in all cases. In addition, venous sampling after intra-arterial calcium stimulation of the pancreas was performed in 10 cases. RESULTS OGTT after canagliflozin showed a significant reduction of plasma glucose levels (minute 30: 161.5 ± 36.22 vs. 215.9 ± 58.11 mg/dL; minute 60: 187.46 ± 65.88 vs. 225.9 ± 85.60 mg/dL, p < 0.01) and insulinemia (minute 30: 95.6 ± 27.31 vs. 216.35 ± 94.86 mg/dL, p = 0.03; minute 60: 120.85 ± 94.86 vs. 342.64 ± 113.32 mIU/L, p < 0.001). At minute 180, a significant reduction (85.7%) of the rate of hypoglycemia was observed after treatment with canagliflozin (p < 0.00001). All cases presented normal pancreatic response after intra-arterial calcium administration. CONCLUSION Canagliflozin (300 mg) significantly decreased glucose absorption and prevented PHH after 100 g OGTT in patients with RYGB. Our results suggest that canagliflozin could be a new therapeutic option for patients that present PHH after RYGB.
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Affiliation(s)
- Andreea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- *Andreea Ciudin,
| | - Marta Sánchez
- Endocrinology and Nutrition Department, Hospital Universitario Gran Canaria Doctor Negrín, Las Palmas, Spain
| | - Irene Hernandez
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Efrain Cordero
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Enzamaria Fidilio
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
| | - Marta Comas
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Carla Gonzalez
- Angioradiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Natividad Lopez
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Ramon Vilallonga
- Bariatric and Metabolic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Marina Giralt
- Clinical Biochemistry Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Roser Ferrer
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- Clinical Biochemistry Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Cristina Hernández
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Rafael Simó
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
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Ciudin A, Ortiz-Zuñiga AM, Fidilio E, Romero D, Sánchez M, Comas M, Gonzalez O, Vilallonga R, Simó-Servat O, Hernández C, Simó R. Retinal Microperimetry: A Useful Tool for Detecting Insulin Resistance-Related Cognitive Impairment in Morbid Obesity. J Clin Med 2019; 8:jcm8122181. [PMID: 31835729 PMCID: PMC6947364 DOI: 10.3390/jcm8122181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 01/04/2023] Open
Abstract
Background: There is clear association between type 2 diabetes (T2D) and cognitive decline. Retinal microperimetry is a useful tool for detecting cognitive impairment in T2D. Morbid obesity (MO) has been associated with cognitive impairment. Insulin resistance (IR) seems a major determinant, but the data are unclear. The aim of this study was to evaluate the cognitive impairment in MO as well as the utility of retinal microperimetry in identifying these alterations. Methods: In total, 50 consecutive patients with MO were matched by age and gender with 30 healthy controls. All patients underwent cognitive evaluation (Montreal Cognitive Assessment Test-MoCA) and retinal microperimetry, using MAIA microperimeter 3rd generation. Retinal sensitivity and gaze fixation parameters were used for the evaluation of the analysis. Results: MO patients showed a significantly lower neurocognitive performance than the controls: MoCA score 24.94 ± 2.74 vs. 28.95 ± 1.05, p < 0.001. Cognitive function inversely correlated with the HOMA-IR (r = −0.402, p = 0.007). The AUROC for cognitive impairment using microperimetry was 0.807, CI 95% (0.592–0.947), p = 0.017. Conclusions: (1) Systemic insulin resistance is a major underlying mechanism accounting for the higher prevalence of cognitive impairment detected in young MO subjects. (2) Retinal microperimetry is a useful tool for identifying MO patients with cognitive impairment.
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Affiliation(s)
- Andreea Ciudin
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Plaça Cívica, Barcelona 08193, Spain; (A.M.O.-Z.); (E.F.); (D.R.); (O.S.-S.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid 28020, Spain
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
- Correspondence: (A.C.); (R.S.); Tel.: +34-934-894-172 (A.C.); +34-934-894-172 (R.S.)
| | - Angel Michael Ortiz-Zuñiga
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Plaça Cívica, Barcelona 08193, Spain; (A.M.O.-Z.); (E.F.); (D.R.); (O.S.-S.); (C.H.)
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
| | - Enzamaria Fidilio
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Plaça Cívica, Barcelona 08193, Spain; (A.M.O.-Z.); (E.F.); (D.R.); (O.S.-S.); (C.H.)
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
| | - Diana Romero
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Plaça Cívica, Barcelona 08193, Spain; (A.M.O.-Z.); (E.F.); (D.R.); (O.S.-S.); (C.H.)
| | - Marta Sánchez
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
| | - Marta Comas
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
| | - Oscar Gonzalez
- Department of Surgery. Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (O.G.); (R.V.)
| | - Ramon Vilallonga
- Department of Surgery. Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (O.G.); (R.V.)
| | - Olga Simó-Servat
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Plaça Cívica, Barcelona 08193, Spain; (A.M.O.-Z.); (E.F.); (D.R.); (O.S.-S.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid 28020, Spain
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
| | - Cristina Hernández
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Plaça Cívica, Barcelona 08193, Spain; (A.M.O.-Z.); (E.F.); (D.R.); (O.S.-S.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid 28020, Spain
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
| | - Rafael Simó
- Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Plaça Cívica, Barcelona 08193, Spain; (A.M.O.-Z.); (E.F.); (D.R.); (O.S.-S.); (C.H.)
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid 28020, Spain
- Department of Endocrinology, Vall d’Hebron University Hospital. Passeig Vall d’Hebron 119-139, Barcelona 08035, Spain; (M.S.); (M.C.)
- Correspondence: (A.C.); (R.S.); Tel.: +34-934-894-172 (A.C.); +34-934-894-172 (R.S.)
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Ciudin A, Fidilio E, Ortiz A, Pich S, Salas E, Mesa J, Hernández C, Simó-Servat O, Lecube A, Simó R. Genetic Testing to Predict Weight Loss and Diabetes Remission and Long-Term Sustainability after Bariatric Surgery: A Pilot Study. J Clin Med 2019; 8:jcm8070964. [PMID: 31277226 PMCID: PMC6679039 DOI: 10.3390/jcm8070964] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: The aim of this pilot study was to assess genetic predisposition risk scores (GPS) in type 2 diabetic and non-diabetic patients in order to predict the better response to bariatric surgery (BS) in terms of either weight loss or diabetes remission. Research Design and Methods: A case-control study in which 96 females (47 with type 2 diabetes) underwent Roux-en-Y gastric by-pass were included. The DNA was extracted from saliva samples and SNPs were examined and grouped into 3 GPS. ROC curves were used to calculate sensitivity and specificity. Results: A highly sensitive and specific predictive model of response to BS was obtained by combining the GPS in non-diabetic subjects. This combination was different in diabetic subjects and highly predictive of diabetes remission. Additionally, the model was able to predict the weight regain and type 2 diabetes relapse after 5 years’ follow-up. Conclusions: Genetic testing is a simple, reliable and useful tool for implementing personalized medicine in type 2 diabetic patients requiring BS.
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Affiliation(s)
- Andreea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 08950 Barcelona, Spain.
| | - Enzamaria Fidilio
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - Angel Ortiz
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - Sara Pich
- Scientific Department, Gendiag.exe, Joan XXIII, 10, Esplugues de LLobregat, 08950 Barcelona, Spain
| | - Eduardo Salas
- Scientific Department, Gendiag.exe, Joan XXIII, 10, Esplugues de LLobregat, 08950 Barcelona, Spain
| | - Jordi Mesa
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 08950 Barcelona, Spain
| | - Cristina Hernández
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 08950 Barcelona, Spain
| | - Olga Simó-Servat
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 08950 Barcelona, Spain
| | - Albert Lecube
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 08950 Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Universitat de Lleida, 25198 Lleida, Spain
| | - Rafael Simó
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08035 Barcelona, Spain.
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 08950 Barcelona, Spain.
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Rojas E, Bermúdez V, Motlaghzadeh Y, Mathew J, Fidilio E, Faria J, Rojas J, de Bravo MC, Contreras J, Mantilla LP, Angarita L, Sepúlveda PA, Kuzmar I. Stevia rebaudiana Bertoni and Its Effects in Human Disease: Emphasizing Its Role in Inflammation, Atherosclerosis and Metabolic Syndrome. Curr Nutr Rep 2018; 7:10.1007/s13668-018-0228-z. [PMID: 29995279 DOI: 10.1007/s13668-018-0228-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Stevia rebaudiana Bertoni is a perennial shrub with zero calorie content that has been increasing in popularity for its potential use as an adjuvant in the treatment of obesity. The level of evidence supporting general benefits to human health is insufficient. We conducted a review of the literature summarizing the current knowledge and role in human disease. RECENT FINDINGS Despite stevia's minimal systemic absorption, studies have been promising regarding its potential benefits against inflammation, carcinogenesis, atherosclerosis glucose control, and hypertension. On the other hand, the growing popularity of artificial sweeteners does not correlate with improved trends in obesity. An increased intake of artificial non-caloric sweeteners may not be associated with decreased intake of traditional sugar-sweetened beverages and foods. The effects of Stevia on weight change have been linked to bacteria in the intestinal microbiome, mainly by affecting Clostridium and Bacteroides sp. POPULATIONS A growing body of evidence indicates that Stevia rebaudiana Bertoni is protective against malignant conversion by inhibition of DNA replication in human cancer cell growth in vitro. Consumption of Stevia has demonstrated to be generally safe in most reports. Further clinical studies are warranted to determine if regular consumption brings sustained benefits for human health.
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Affiliation(s)
- Edward Rojas
- Department of Medicine, Rutgers University, 150 Bergen St, Newark, NJ, 07101, USA.
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela.
| | - Valmore Bermúdez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
- Investigation Group High Studies of Frontier, Simón Bolívar University, Barranquilla, Colombia
| | - Yasaman Motlaghzadeh
- Department of Medicine, Rutgers University, 150 Bergen St, Newark, NJ, 07101, USA
| | - Justin Mathew
- Department of Medicine, Rutgers University, 150 Bergen St, Newark, NJ, 07101, USA
| | - Enzamaria Fidilio
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Judith Faria
- Department of Medicine, St. Michael's Medical Center, Newark, New Jersey, USA
| | - Joselyn Rojas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Julio Contreras
- Investigation Group High Studies of Frontier, Simón Bolívar University, Barranquilla, Colombia
| | - Linda Pamela Mantilla
- Investigation Group High Studies of Frontier, Simón Bolívar University, Barranquilla, Colombia
| | - Lissé Angarita
- Nutrition School of Andres Bello University, Concepcion, Chile
| | - Paola Amar Sepúlveda
- Investigation Group for Innovations and Entrepreneurship, Simon Bolivar University, Barranquilla, Colombia
| | - Isaac Kuzmar
- Faculty of Health Sciences, Research, Innovation and Development Department, Simón Bolívar University, Barranquilla, Colombia
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Giribes M, Cárdenas G, Fidilio E, Guerrero M, Velasquez M, Ortiz A, Romero D, Mesa J, Ciudin A, Segurola H, Burgos R. OR39: Changes in Resting Energy Expenditure in Patients with Extreme Obesity After Bariatric Surgery. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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