Lifestyle mediators of associations among siestas, obesity, and metabolic health

OBJECTIVE

The aim of this study was to determine the association between siestas/no siestas and obesity, considering siesta duration (long: >30 minutes, short: ≤30 minutes), and test whether siesta traits and/or lifestyle factors mediate the association of siestas with obesity and metabolic syndrome (MetS).

METHODS

This was a cross-sectional study of 3275 adults from a Mediterranean population (the Obesity, Nutrigenetics, TIming, and MEditerranean [ONTIME] study) who had the opportunity of taking siestas because it is culturally embedded.

RESULTS

Thirty-five percent of participants usually took siestas (16% long siestas). Compared with the no-siesta group, long siestas were associated with higher values of BMI, waist circumference, fasting glucose, systolic blood pressure, and diastolic blood pressure, as well as with a higher prevalence of MetS (41%; p = 0.015). In contrast, the probability of having elevated SBP was lower in the short-siesta group (21%; p = 0.044) than in the no-siesta group. Smoking a higher number of cigarettes per day mediated the association of long siestas with higher BMI (by 12%, percentage of association mediated by smoking; p < 0.05). Similarly, delays in nighttime sleep and eating schedules and higher energy intake at lunch (the meal preceding siestas) mediated the association between higher BMI and long siestas by 8%, 4%, and 5% (all p < 0.05). Napping in bed (vs. sofa/armchair) showed a trend to mediate the association between long siestas and higher SBP (by 6%; p = 0.055).

CONCLUSIONS

Siesta duration is relevant in obesity/MetS. Timing of nighttime sleep and eating, energy intake at lunch, cigarette smoking, and siesta location mediated this association.

Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial

INTRODUCTION

To compare the conventional treatment of gestational diabetes mellitus (GDM) with flexible treatment according to the measurement of fetal abdominal circumference (AC) in daily clinical practice.

RESEARCH DESIGN AND METHODS

Two hundred and sixty pregnant women diagnosed with GDM before week 34 were randomly placed in two groups: a control group, treated according to maternal capillary glycemia, and an experimental group, treated according to ultrasound parameters of fetal growth. The glycemic targets in the control group were blood glucose levels when fasting and 1 hour postprandial (<95/140 mg/dL). In the experimental group, glycemic targets depended on the percentile (p) of fetal AC: if AC p <75th, then blood glucose targets when fasting and at 1 hour postprandial were <120/180 mg/dL; and if AC p ≥75th, then the glycemic targets were <80/120 mg/dL. The follow-up of both groups was scheduled according to the GDM protocol of our diabetes and gestation unit.

RESULTS

The study was completed by 246 pregnant women, 125 in the control group and 121 in the experimental group. In the experimental group, insulin treatment and neonatal hypoglycemia were significantly lower (p=0.018 and p 0.035, respectively). No differences were observed in large and small infants according to gestational age. However, macrosomic infants were less frequent in the experimental group, although this difference did not reach statistical significance. In terms of gestation complications, the type of delivery and its complications and the rest of the neonatal complications analyzed, no significant differences were observed.

CONCLUSIONS

The treatment of flexible GDM according to the measurement of fetal AC is safe for the mother and the fetus and almost halves the number of pregnant women who require insulin treatment, without increasing the number of ultrasound checks or medical visits.

Therapist characteristics that predict the outcome of multipatient psychotherapy: systematic review of empirical studies

We defined multipatient psychotherapy as the set of psychotherapeutic techniques applied with more than one patient in the room. Assumptions of what makes a psychotherapist effective guide training programmes but may not be supported by evidence. We need to identify the empirical data on what makes a multipatient psychotherapist effective. We undertook the systematic review of empirical studies which correlate therapist characteristics with measurable patient outcome in multipatient psychotherapy. We found that the scientific literature on the topic is broad and heterogeneous in scope, studying demographic, professional and psychosocial characteristics of the therapists, but is poor in quality. The most solid results are that ethnic matching improves the outcome of family therapy with drug abusing adolescents in some ethnic minorities and that therapist knowledge patterns affect patient satisfaction. We concluded that the therapist characteristics that affect clinical outcome seem to be internal to the therapist and depend on the patient treated.

Obesity and inflammation: change in adiponectin, C-reactive protein, tumour necrosis factor-alpha and interleukin-6 after bariatric surgery

BACKGROUND

Obesity is associated with a low-grade inflammatory state. A causal association between inflammation and atherosclerosis has been suggested. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients after weight loss following bariatric surgery.

METHODS

In this study, we measured levels of adiponectin, high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) and their relation to insulin resistance and lipid parameters in 60 morbidly obese women at baseline and 3, 6 and 12 months after gastric bypass.

RESULTS

Twelve months after surgery, there was a significant increase in plasma levels of adiponectin (p < 0.001) and high-density lipoprotein cholesterol (p < 0.01) and a significant decrease in levels of IL-6 (p < 0.001), hs-CRP (p < 0.001), cholesterol (p < 0.001), triglycerides (p < 0.001), low-density lipoprotein cholesterol (p < 0.001), glucose (p < 0.001), insulin (p < 0.001) and homeostasis model assessment (HOMA; p < 0.001). At 12 months, correlations were seen between IL-6 levels and the following: body mass index (BMI) (r = 0.53, p < 0.001), insulin (r = 0.51, p < 0.001) and HOMA (r = 0.55, p < 0.001). Also, hs-CRP levels correlated with BMI (r = 0.40, p = 0. 004), triglycerides (r = 0.34, p = 0.017), insulin (r = 0.50, p = 0.001) and HOMA (r = 0.46, p = 0.002).

CONCLUSIONS

In patients with morbid obesity, significant weight loss is followed by a significant improvement in the inflammatory state, insulin sensitivity and lipid profile. A relationship exists between improved inflammatory profile and insulin sensitivity.