Monday 30 September 2013

Journey through Ireland


I made a travel with my wife and a couple of friends to Ireland at the beginning of August, and it lasted one and a half weeks.  We flew with a low cost company from Madrid to Dublin, and once there we rented a car with the purpose of driving around the southern half of the island. At first it was nerve wrecking: having to drive on the left side of the road, the absence of verge, the huge green mass of vegetation invading the road every now and then, and the fear of scratching the immaculate car; but after a few hundreds of kilometers we eventually got used to it.
As high points I would mention the beauty of the scenery, with countless tones of green, the ever present historical buildings like medieval castles, churches and cathedrals, extremely well conserved, the permanent absence of litter,the warmth of the people, and the magnificent beer.
After struggling a bit with my memory, the only drawback that I have been able to recall is the extremely limited range of dishes available, which were repeated again and again almost in the same order in every restaurant.
All in all, it has been an unforgettable journey that I wouldn't mind repeating.


Wednesday 25 September 2013

The persistence of memory. Dalí, 1931

THE PERSISTENCE OF MEMORY
(Dalí, 1931)


The first element in the painting that catches your eye is the presence of these old-fashioned pocket watches that are melting. After that, you become aware of the almost deserted scenery except for the apparently dead tree on the left and the unrecognizable creature in the centre of the painting. Then, it dawns on you the unnatural illumination that transports you to those places in the brain that you only visit in your dreams.
Subjecting the painting to a deeper analysis, we can see the cliffs at the top right hand corner. They are the key of the composition: it is them what is hard, what is perdurable. Contrasting with the hard cliffs are the soft watches and creature that represent degradation, mortality. In fact, the creature is said to be Dalí´s face, soft, quite distorted, with an immense nose, oversized eyelashes, and an enormous tongue protruding from a hidden mouth.
Returning to the watches, as you can see, at the bottom left hand corner lies the only rigid watch, covered with ants, which express rottenness. The other watches symbolize the relativeness of time, as each of them is showing a different time.
Summing up, the painting shows the perishability of human beings in contrast with the perdurability of inanimate objects like those composing the landscape.
The reason why I like this painting, apart from the originality and precision of the style, is that it reminds you of your place in History: how little, unimportant and transitory we are compared with the old Earth.

Saturday 21 September 2013

Metabolic syndrome article

Metabolic syndrome and nutrition in a Granada´s tropical coast population
http://www.nutricionhospitalaria.com/pdf/6033.pdf

INTRODUCTION:

The Metabolic Syndrome (MS) was called X Syndrome by Reaven1, and although several authors had been warning about the cardiovascular risk of suffering dyslipidemia, obesity, arterial hypertension (HTN) and glucose intolerance, it was Reaven's group the one that confirmed the association of these metabolic alterations with insulin resistance, even in apparently healthy and thin individuals2,3.
There are several sets of defining criteria for MS: in 1988 the World Health Organization4 considers that metabolic syndrome can be diagnosed when the glycemia level in fasting conditions is 110 mg/dl and/or when the glycemia level after two hours of drinking a glucose solution is 140mg/dl, or when there is a diagnosed insulin resistance, along with, at least, two of the following:
  • Dyslipidemia (Triglycerides >150 mg/dl and/or cholesterol HDL >35 or 39 mg/dl in men and women respectively).
  • HTN (≥140-90mmHg).
  • Obesity (waist/hip index >0,9-0,8 in men and women respectively and/or body mass index (BMI) > 30 Kg/m2).
  • Microalbuminuria (short-time urine collection of 20 mg/min).
Currently, the Adult Treatment Panel III (ATP III 2001)5 diagnostic criteria are considered the most useful and the most commonly used to diagnose Metabolic Syndrome:
It requieres the existance of at least three of the following:
  • Central obesity (waist circumference > 102 cm (male) and > 88 cm (female).
  • Triglycerides ≥ 150 mg/dl
  • HDL cholesterol < 40 mg/dl (male) and < 50 mg/dl (female).
  • Blood pressure ≥ 130-85 mmHg.
  • Fasting plasma glucose ≥ 110 mg/dl
Therefore, the metabolic syndrome prevalence may vary depending on which set of criteria is applied for its diagnose, and other factors such as age, gender, ethnicity, and lifestyle. However, it has been estimated a prevalence of 24% (slightly higher in men) in the United States6. In Spain, a national register of metabolic syndrome (MESYAS, Metabolic Syndrome in Active Subjects) was promoted by the Preventive Cardiology Section of the Spanish Cardiology Society with the purpose of analyzing the prevalence of MS in a wide spanish sample. In May 2005, the MESYAS register, with over 19.000 entries, indicated an overall prevalence of 12% (16% in males and 8% in females).
This register shows differences in the MS prevalence depending on the geographical area, indicating a lower prevalence in the northern areas of Spain. Half of the individuals with MS possess three factors: raised blood pressure, hypertriglyceridemia, and raised BMI in men; and raised BMI, reduced HDL cholesterol, and raised blood pressure in women7.
The MS and its components are related to a high risk of developing cardiovascular disease; obesity and sedentariness are underlying risk factors, therefore, the first line treatment is change of lifestyle,   modifying physical activity and diet8-11 in order to normalize the individual disorders that comprise the MS. 
Recent research shows the important rol of visceral obesity in the development of MS21. Obesity and overweight tend to trigger an increase of the insulin resistance22. It also has been noticed a relationship between obesity and arteriosclerosis, caused by the increase of free fatty acids, the unbalance of cytosines, and the insulin resistance. Through the insulin resistance, glucose intolerance and diabetes type II are developed. But also, in association with the increase of the free fatty acids, the insulin resistance plays a role in the development of dyslipidemia, that results in a reduced amount of HDL cholesterol and raised triglycerides23.
The aim of this article is to show the relationships between variables such as gender, age, HDL cholesterol, triglycerides, glycemia, BMI, percentage of body fat, central obesity, blood pressure, and diet with the MS diagnose in a population of the tropical coast of Granada.

MATERIALS AND METHODS

Subjects

This study was conducted in a sample of 119 individuals belonging to the so called tropical coast of Granada. All the subjects had previously and voluntarily signed an informed consent (according to the WMA Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects) expressing their willingness to take part in this study and giving permission to collect, use and disclose their personal analytic data anonymously. All the individuals were given a control number to guaratee their anonymousness. Regarding the composition of the sample in terms of gender and age, 52% of the subjects were women and 48% were men, and their ages ranged between 15 and 90, (fig. 1).

Information collected

The individuals were subjected to several tests and measurements:
  • Anthropometric measurements such as weight (Kg), height (m), BMI (Kg/m2), and waist circumference (cm).
  • The skinfold test was used to calculate the percentage of body fat. Points of measurement: biceps, triceps, subescapular, and iliac crest.
  • Blood pressure measurement (mmHg).
  • Clinical analysis of glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides.
  • A survey of the the subjects’ diet 24 hours prior to the blood extraction.
Once the analytic parameters were taken, the individuals were divided into a control group and a group with MS according to the diagnose criteria of the ATP III 20015.

Materials and methods

The equipment used for the anthropometric measurements was: electronic scales model OMRN HN283 to measure weight, stadiometer BAME to measure height, fiberglass tape GULICK to measure waist circumference, and caliper HOLTAIN to do the skinfold test.
The BMI was calculated following the World Health Organization (WHO) criterion: BMI = Weight (Kg) / Height (m)2. The percentage of body fat was calculated using the Siri Equation20. Blood pressure was measured with a sphygmomanometer model OMRON wrist R6/HEM 6001-E.
The blood samples for the measurement of glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were taken in fasting conditions between 8:30 and 9:30 in the morning. Venojet® tubes were used for the biochemical analysis, where 6 ml of blood with EDTA were introduced for the collect of blood serum or plasma. All the determinations were performed at 37ºC by the biochemical analyser Techinicon RA-1000. The reagents used were make QCA (Química Clínica Aplicada S.A.), and they were: liquid glucose GOD-POD method for the measurement of glucose, liquid cholesterol colorimetric CHOD-PAP method for total cholesterol, direct HDL cholesterol calorimetric method for HDL cholesterol, and liquid triglycerides GPO method for triglycerides.

Statistical analysis

The statistical analysis was performed with Microsoft Excel 2000 and Statistical Analysis System, SAS® version 9.1 for Windows. The statistical techniques used were the Wilcoxon Test, descriptive analysis, and Anova.

RESULTS and DISCUSSION:

This research shows that 20,2% of the sample was diagnosed with MS. Significant statistical differences were found between the individuals with MS and the control group. When analyzing table I, it is possible to appreciate the figures for each parameter that was measured as well as its  level of statistical significance.
According to the data, the prevalence of MS in the sample is 20,2%, 58,3% of which were women. Comparing our figure for prevalence (20,2%) with that of other researchers in the United States6 (22%) it is noticeable how similar they are. If also compared the sample of this research with the Spanish population as a whole7 (MESYAS) in terms of prevalence, it can be noticed that our figure is higher, but it has to be taken into consideration that the prevalence of MS in the Spanish population is not homogeneous, on the contrary the prevalence in the south of Spain is higher than in the north, in agreement with our results. In the developed countries there is an estimated prevalence of 24% in adults, whereas the figure exceeds 40% in the elderly23.
Obesity is a condition characterised by the excess of body fat. According to the quantity of body fat, a person could be defined as obese when his or her percentage of body fat exceeds the figures considered as normal: 12 to 20% in men and 20 to 30% in women24.
The BMI, in spite of not being an excellent indicator of adiposity in muscular or elderly people, is the parameter most used in the majority of epidemiologic studies and the most recommended one by medical societies and international health organizations for medical use, due to its reproducibility, easy use, and capability to show the adiposity of the majority of the population.
When we talk about obessity in our research, it is refered to BMI and body fat percentage. In our study there are differences between the individuals with MS and the control ones (Table II). The individuals with MS of our sample have an average BMI of 32,5 Kg/m2 (falling into the “Obese grade I” category according to the WHO) and an average body fat percentage of 34,8% (falling into the “Obese” category according to scientists and doctors)19.
Diet is the main exogenetic factor that influences the concentration and composition of blood lipids. The total calorie content in the diet has an effect on the blood lipids. Diets with excess calories (hypercaloric) stimulate the production of triglycerides by the liver and increase the level of LDL cholesterol.
When studying the diet8-11 of the indivuals in our sample (data obtained through dietetic survey) no significant differences can de appreciated in terms of percentage of lipids, carbohydrates and proteins, and Kcal/day between the subjects with MS and the control ones (Table III).

CONCLUSION

The prevalence of MS in the tropical coast of Granada is similar to that of other national (MESYAS) and international studies. This prevalence is high, but it is important to know that corrective  and preventive measures can be taken involving diet and physical activity.
The BMI and the body fat percentage are relevant factors to consider when talking about MS since significant differences have been found between individuals with and without MS.
Regarding diet, our results (obtained through dietetic survey) don´t agree with those of other studies related to MS, reaching the conclusion that this method may not be the most suitable to obtain this kind of information.
More controled conditions should be applied to obtain the data related to the individuals food intake. We would suggest conducting the research among guests of some kind of canteen, where the menu is perfectly known.
MS is related to variables, apart from diet, such as physical activity and genotype that were not taken into account in this research and therefore may have altered the results in one direction or the other.