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Linares-Pineda TM, Peña-Montero N, Gutiérrez-Repiso C, Lima-Rubio F, Sánchez-Pozo A, Tinahones FJ, Molina-Vega M, Picón-César MJ, Morcillo S. Epigenome wide association study in peripheral blood of pregnant women identifies potential metabolic pathways related to gestational diabetes. Epigenetics 2023; 18:2211369. [PMID: 37192269 DOI: 10.1080/15592294.2023.2211369] [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] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023] Open
Abstract
Gestational diabetes mellitus (GDM) increases the risk of developing metabolic disorders in both pregnant women and their offspring. Factors such as nutrition or the intrauterine environment may play an important role, through epigenetic mechanisms, in the development of GDM. The aim of this work is to identify epigenetic marks involved in the mechanisms or pathways related to gestational diabetes. A total of 32 pregnant women were selected, 16 of them with GDM and 16 non-GDM. DNA methylation pattern was obtained from Illumina Methylation Epic BeadChip, from peripheral blood samples at the diagnostic visit (26-28 weeks). Differential methylated positions (DMPs) were extracted using ChAMP and limma package in R 2.9.10, with a threshold of FDR <0.05, deltabeta >|5|% and B >0. A total of 1.141 DMPs were found, and 714 were annotated in genes. A functional analysis was performed, and we found 23 genes significantly related to carbohydrate metabolism. Finally, a total of 27 DMPs were correlated with biochemical variables such as glucose levels at different points of oral glucose tolerance test, fasting glucose, cholesterol, HOMAIR and HbA1c, at different visits during pregnancy and postpartum. Our results show that there is a differentiated methylation pattern between GDM and non-GDM. Furthermore, the genes annotated to the DMPs could be implicated in the development of GDM as well as in alterations in related metabolic variables.
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Affiliation(s)
- Teresa María Linares-Pineda
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Departamento de Bioquímica y Biología Molecular 2, Universidad de Granada, Granada, Spain
| | - Nerea Peña-Montero
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - Carolina Gutiérrez-Repiso
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Fuensanta Lima-Rubio
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - Antonio Sánchez-Pozo
- Departamento de Bioquímica y Biología Molecular 2, Universidad de Granada, Granada, Spain
| | - Francisco J Tinahones
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - María Molina-Vega
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - María José Picón-César
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - Sonsoles Morcillo
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Obesidad, diabetes y sus comorbilidades: prevención y tratamiento, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Fernández-Valero A, Peña-Montero N, Lima-Rubio F, Gutiérrez-Repiso C, Linares-Pineda TM, Picón-César MJ, Sancho-Marín R, Tinahones FJ, Morcillo S, Molina-Vega M. Changes in Oxidative Stress and Intestinal Permeability during Pregnancy in Women with Gestational Diabetes Mellitus Treated with Metformin or Insulin and Healthy Controls: A Randomized Controlled Trial. Antioxidants (Basel) 2023; 12:1981. [PMID: 38001834 PMCID: PMC10669428 DOI: 10.3390/antiox12111981] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
Both oxidative stress and intestinal permeability are increased in hyperglycemic situations and have been shown to be reduced by metformin in type 2 diabetes mellitus (T2DM) patients. The aim of this study was to elucidate the effect of metformin on oxidative stress and intestinal permeability in women with gestational diabetes mellitus (GDM) treated with metformin compared to those treated with insulin and healthy controls. A total of 120 women were included from August 2016 to February 2022: 41 received metformin (MET group), 38 received insulin (INS group), and 41 were healthy controls. Baseline and antenatal visits were carried out at 25.4 ± 4.8 and 36.1 ± 0.8 weeks of pregnancy, respectively. Advanced oxidation protein products (AOPPs), total antioxidant capacity (TAC), and zonulin levels were measured at every visit. Zonulin levels from baseline to prepartum visit increased significantly in both healthy controls (0.6 ± 0.9 to 1.2 ± 1.7 ng/mL, p = 0.004) and the INS group (0.4 ± 0.3 to 0.6 ± 0.5 ng/mL, p = 0.034) but did not significantly change in the MET group (0.4 ± 0.4 to 0.5 ± 0.4 ng/mL, p = 0.202). However, TAC and AOPP levels significantly increased in women with GDM, both in the INS and MET groups but not in the healthy controls. In conclusion, in our population, metformin has been shown to avoid an increase in intestinal permeability but failed to avoid an increase in oxidative stress related to hyperglycemia.
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Affiliation(s)
- Andrea Fernández-Valero
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain (M.M.-V.)
- Department of Medicine and Dermatology, Málaga University, 29010 Málaga, Spain
| | - Nerea Peña-Montero
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
| | - Fuensanta Lima-Rubio
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
| | - Carolina Gutiérrez-Repiso
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Teresa María Linares-Pineda
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
| | - María José Picón-César
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain (M.M.-V.)
| | - Raquel Sancho-Marín
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain (M.M.-V.)
- Department of Medicine and Dermatology, Málaga University, 29010 Málaga, Spain
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Sonsoles Morcillo
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain (M.M.-V.)
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - María Molina-Vega
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain (M.M.-V.)
- Laboratory of the Biomedical Research Institute of Málaga, Virgen de la Victoria University Hospital, Universidad de Málaga, 29010 Málaga, Spain
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Linares-Pineda TM, Gutiérrez-Repiso C, Peña-Montero N, Molina-Vega M, Rubio FL, Arana MS, Tinahones FJ, Picón-César MJ, Morcillo S. Higher β cell death in pregnant women, measured by DNA methylation patterns of cell-free DNA, compared to new-onset type 1 and type 2 diabetes subjects: a cross-sectional study. Diabetol Metab Syndr 2023; 15:115. [PMID: 37264478 DOI: 10.1186/s13098-023-01096-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023] Open
Abstract
Diabetes is a metabolic disorder of glucose homeostasis in which β cell destruction occurs silently and is detected mainly when symptoms appear. In the last few years, it has emerged a great interest in developing markers capable of detecting pancreatic β cell death focused on improving early diagnosis and getting a better treatment response, mainly in type 1 diabetes. But other types of diabetes would also benefit from early detection of β cell death. Differentially methylated circulating DNA is being studied as minimally invasive biomarker of cell death. We aimed to explore whether the unmethylated/methylated ratio of the insulin and amylin genes might be a good biomarker of β cell death in different types of diabetes. A lower index ∆Ct indicates a higher rate of β-cell death. Plasma samples from subjects without diabetes, pregnant women, pregnant with gestational diabetes (GDM), type 1 diabetes and type 2 diabetes were analyzed. A qPCR reaction with specific primers for both methylated and unmethylated fragments of insulin and amylin genes were carried out. Pregnant women, GDM and non- GDM, showed a higher β-cell death for both markers (∆INS = 3.8 ± 2.1 and ∆Amylin = 8.5 ± 3.6), whereas T1D presented lower rate (∆INS = 6.2 ± 2.1 and ∆Amylin = 10.7 ± 2.9) comparable to healthy subjects. The insulin methylation index was associated with the newborn birth weight (r = 0.46; p = 0.033) and with insulin resistance (r = -0.533; p = 0.027) in the GDM group. The higher rate of β-cell death was observed in pregnant women independently of their metabolic status. These indexes could be a good indicator of β cell death in processes caused by defects on insulin secretion, insulin action, or both.
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Affiliation(s)
- Teresa María Linares-Pineda
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Carolina Gutiérrez-Repiso
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Nerea Peña-Montero
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - María Molina-Vega
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Fuensanta Lima Rubio
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - María Suárez Arana
- Department of Obstetrics and Gynecology, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Francisco J Tinahones
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - María José Picón-César
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - Sonsoles Morcillo
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
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Molina-Vega M, Gutiérrez-Repiso C, Lima-Rubio F, Suárez-Arana M, Linares-Pineda TM, Cobos Díaz A, Tinahones FJ, Morcillo S, Picón-César MJ. Impact of the Gestational Diabetes Diagnostic Criteria during the Pandemic: An Observational Study. J Clin Med 2021; 10:4904. [PMID: 34768425 PMCID: PMC8585066 DOI: 10.3390/jcm10214904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To analyze the effect of applying alternative diagnostic criteria for gestational diabetes mellitus (GDM) during the COVID-19 pandemic on GDM prevalence and obstetrical and perinatal outcomes, in comparison to usual diagnostic approaches. METHODS Data from women referred to GDM diagnosis from 1 September to 30 November 2019 were retrospectively collected (2019-group). The same data from the same period in 2020 were prospectively collected (2020-group). In both cases, a two-step diagnostic approach was used, the first step being a screening test (1 h 50 goral glucose tolerance test, OGTT). In 2019 it was followed by a 100 gr OGTT for diagnosis. In 2020, this was replaced by a blood test for the measurement of plasma glucose and HbA1c, according to alternative GDM diagnostic criteria during the COVID-19 pandemic. RESULTS From 237 women in the 2019 group, 40 (16.9%) were diagnosed with GDM, while from 255 women in the 2020 group, 37 (14.5%) had GDM (p = 0.470). More women in the 2020 group, in comparison to the 2019 group, were nulligravid (41.9% vs. 47.2%, p = 0.013), had a personal history of GDM (11.4% vs. 4.6%, p = 0.013) and had macrosomia in previous pregnancies (10.2% vs. 2.1%, p = 0.001). Obstetrical and perinatal outcomes were similar when comparing women with GDM to non-GDM women in the 2019 and 2020 groups and between GDM women and non-GDM women. CONCLUSION In a Spanish population, GDM prevalence during the COVID-19 pandemic using the alternative diagnostic criteria was similar to that found in 2019 using the usual diagnostic criteria. Despite women referred for GDM diagnosis during the pandemic having more GDM risk factors, obstetrical and perinatal outcomes were comparable to those observed before the pandemic.
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Affiliation(s)
- María Molina-Vega
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
| | - Carolina Gutiérrez-Repiso
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Fuensanta Lima-Rubio
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
| | - María Suárez-Arana
- Departmento de Obstetricia y Ginecología, Hospital Regional Universitario de Málaga, IBIMA, 29009 Málaga, Spain;
| | - Teresa María Linares-Pineda
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Andrés Cobos Díaz
- Laboratorio de Análisis Clínico, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Francisco J. Tinahones
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Sonsoles Morcillo
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
- Laboratorio de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (C.G.-R.); (F.L.-R.); (T.M.L.-P.)
- Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición, Instituto Salud Carlos III, 28029 Madrid, Spain
| | - María J. Picón-César
- Departmento de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain; (M.M.-V.); (M.J.P.-C.)
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Gutiérrez-Repiso C, Linares-Pineda TM, Gonzalez-Jimenez A, Aguilar-Lineros F, Valdés S, Soriguer F, Rojo-Martínez G, Tinahones FJ, Morcillo S. Epigenetic Biomarkers of Transition from Metabolically Healthy Obesity to Metabolically Unhealthy Obesity Phenotype: A Prospective Study. Int J Mol Sci 2021; 22:ijms221910417. [PMID: 34638758 PMCID: PMC8508854 DOI: 10.3390/ijms221910417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Identifying those parameters that could potentially predict the deterioration of metabolically healthy phenotype is a matter of debate. In this field, epigenetics, in particular DNA methylation deserves special attention. Results: The aim of the present study was to analyze the long-term evolution of methylation patterns in a subset of metabolically healthy subjects in order to search for epigenetic markers that could predict the progression to an unhealthy state. Twenty-six CpG sites were significantly differentially methylated, both at baseline and 11-year follow-up. These sites were related to 19 genes or pseudogenes; a more in-depth analysis of the methylation sites of these genes showed that CYP2E1 had 50% of the collected CpG sites differently methylated between stable metabolically healthy obesity (MHO) and unstable MHO, followed by HLA-DRB1 (33%), ZBTB45 (16%), HOOK3 (14%), PLCZ1 (14%), SLC1A1 (12%), MUC2 (12%), ZFPM2 (12.5%) and HLA-DQB2 (8%). Pathway analysis of the selected 26 CpG sites showed enrichment in pathways linked to th1 and th2 activation, antigen presentation, allograft rejection signals and metabolic processes. Higher methylation levels in the cg20707527 (ZFPM2) could have a protective effect against the progression to unstable MHO (OR: 0.21, 95%CI (0.067–0.667), p < 0.0001), whilst higher methylation levels in cg11445109 (CYP2E1) would increase the progression to MUO; OR: 2.72, 95%CI (1.094–6.796), p < 0.0014; respectively). Conclusions: DNA methylation status is associated with the stability/worsening of MHO phenotype. Two potential biomarkers of the transition to an unhealthy state were identified and deserve further investigation (cg20707527 and cg11445109). Moreover, the described differences in methylation could alter immune system-related pathways, highlighting these pathways as therapeutic targets to prevent metabolic deterioration in MHO patients.
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Affiliation(s)
- Carolina Gutiérrez-Repiso
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; (C.G.-R.); (T.M.L.-P.); (F.A.-L.)
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Teresa María Linares-Pineda
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; (C.G.-R.); (T.M.L.-P.); (F.A.-L.)
| | - Andres Gonzalez-Jimenez
- ECAI Bioinformática Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Francisca Aguilar-Lineros
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; (C.G.-R.); (T.M.L.-P.); (F.A.-L.)
| | - Sergio Valdés
- Departamento de Endocrinología and Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29009 Málaga, Spain; (S.V.); (F.S.); (G.R.-M.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Federico Soriguer
- Departamento de Endocrinología and Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29009 Málaga, Spain; (S.V.); (F.S.); (G.R.-M.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Gemma Rojo-Martínez
- Departamento de Endocrinología and Nutrición, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29009 Málaga, Spain; (S.V.); (F.S.); (G.R.-M.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; (C.G.-R.); (T.M.L.-P.); (F.A.-L.)
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Málaga, Spain
- Correspondence: (F.J.T.); (S.M.)
| | - Sonsoles Morcillo
- Unidad de Gestión Clínica de Endocrinología y Nutrición del Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain; (C.G.-R.); (T.M.L.-P.); (F.A.-L.)
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (F.J.T.); (S.M.)
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