Aguas-Ayesa, M. (Maite)
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- Cardiometabolic risk stratification using a novel obesity phenotyping system based on body adiposity and waist circumference(Elsevier B.V., 2024) Marugan-Pinos, R. (Rocío); Perdomo-Zelaya, C.M. (Carolina M.); Ramirez, B. (Beatriz); Catalan, V. (Victoria); Aguas-Ayesa, M. (Maite); Becerril, S. (Sara); Frühbeck, G. (Gema); Olazarán, L. (Laura); Salmón-Gómez, L. (Laura); Silva, C. (Camilo); Gomez-Ambrosi, J. (Javier); Rodriguez, A. (Amaia); Escalada, J. (Javier); Yárnoz-Esquiroz, P. (Patricia)Background: The estimation of obesity-associated cardiometabolic risk does not usually take into account body composition or the distribution of adiposity. The aim of the present study was to assess the clinical usefulness of a novel obesity phenotyping system based on the combination of actual body fat percentage (BF%) and waist circumference (WC) according to the cardiometabolic risk estimation. Methods: A classification matrix combining BF% and WC as measures of both amount and distribution of adiposity establishing nine body phenotypes (3 BF% x 3 WC) was developed. Individuals were grouped in five different cardiometabolic risk phenotypes. We conducted a validation study in a large cohort of White subjects from both genders representing a wide range of ages and adiposity (n = 12,754; 65 % females, aged 18–88 years). Results: The five risk groups using the matrix combination of BF% and WC exhibited a robust linear distribution regarding cardiometabolic risk, estimated by the Metabolic Syndrome Severity Score, showing a continuous increase between groups with significant differences (P < 0.001) among them, as well as in other cardiometabolic risk factors. An additional 24 % of patients at very high risk was detected with the new classification system proposed (P < 0.001) as compared to an equivalent matrix using BMI and WC instead of BF% and WC. Conclusions: A more detailed phenotyping should be a priority in the diagnosis and management of patients with obesity. Our classification system allows to gradually estimate the cardiometabolic risk according to BF% and WC, thus representing a novel and useful tool for both research and clinical practice.
- ‘Obesities’: Position statement on a complex disease entity with multifaceted drivers(Wiley, 2022) Montecucco, F. (Fabrizio); Perdomo-Zelaya, C.M. (Carolina M.); Fernández-Formoso, J.A. (José Antonio); Portincasa, P. (Piero); Aguas-Ayesa, M. (Maite); Frühbeck, G. (Gema); Olazarán, L. (Laura); García-Goñi, M. (Maite); Silva, C. (Camilo); Escalada, J. (Javier); Yárnoz-Esquiroz, P. (Patricia)Academic medicine fosters research that moves from discovery to translation, at the same time as promoting education of the next generation of professionals. In the field of obesity, the supposed integration of knowledge, discovery and translation research to clinical care is being particularly hampered. The classification of obesity based on the body mass index does not account for several subtypes of obesity. The lack of a universally shared definition of “obesities” makes it impossible to establish the real burden of the different obesity phenotypes. The individual's genotype, adipotype, enterotype and microbiota interplays with macronutrient intake, appetite, metabolism and thermogenesis. Further investigations based on the concept of differently diagnosed “obesities” are required.
- Revisiting the beyond BMI paradigm in excess weight diagnosis and management: A call to action(John Wiley & Sons, 2024) Aguas-Ayesa, M. (Maite); García-Almeida, J.M. (José Manuel); Frühbeck, G. (Gema); Olazarán, L. (Laura); Perdomo, C. (Carolina); Gomez-Ambrosi, J. (Javier); Vegas-Aguilar, I.M. (Isabel María); Yárnoz-Esquiroz, P. (Patricia)Adolphe Quételet, a 19th-century Belgian sociologist and statistician, pioneered the incorporation of statistics into social sciences. He initiated the development of anthropometry since he was interested in identifying the proportions of the 'ideal man'. He devised a ratio between weight and height, originally termed the Quételet Index, and today widely known and used as the body mass index or BMI. In 1835, he demonstrated that a normal curve accommodates the distribution of human traits articulating his reasoning on human variance around the average. Quételet's long-lasting legacy of the establishment of a simple measure to classify people's weight relative to an ideal for their height endures today with minor variations having dramatically influenced public health agendas. While being very useful, the limitations of the BMI are well known. Thus, revisiting the beyond BMI paradigm is a necessity in the era of precision medicine with morphofunctional assessment representing the way forward via incorporation of body composition and functionality appraisal. While healthcare systems were originally designed to address acute illnesses, today's demands require a radical rethinking together with an original reappraisal of our diagnosis and treatment approaches from a multidimensional perspective. Embracing new methodologies is the way forward to advance the field, gain a closer look at the underlying pathophysiology of excess weight, keep the spotlight on improving diagnostic performance and demonstrate its clinical validity. In order to provide every patient with the most accurate diagnosis together with the most appropriate management, a high degree of standardization and personalization is needed.
- Precision nutrition in the context of bariatric surgery(Springer, 2023) Aguas-Ayesa, M. (Maite); Frühbeck, G. (Gema); Olazarán, L. (Laura); Gomez-Ambrosi, J. (Javier); Yárnoz-Esquiroz, P. (Patricia)Bariatric surgery (BS) is the most effective long-term treatment for severe obesity. This review summarizes the main nutritional deficiencies before and after BS, as well as current dietary and supplementation recommendations to avoid them. Likewise, we have reviewed all those aspects that in recent years have been shown to be related to postoperative weight loss (WL) and its subsequent maintenance, such as hormonal changes, dietary patterns, changes in food preference, adherence to recommendations and follow-up, genetic factors and microbiota, among others. Despite all the knowledge, nutritional deficiencies and weight regain after BS are frequent. It is essential to continue studying in this field in order to establish more precise recommendations according to the individual characteristics of patients. It is also a major objective to understand more deeply the role of the factors involved in WL and its maintenance. This will allow the development of precision treatments and nutrition for patients with obesity, optimizing their benefit after BS.
- Comment on: “Pregnancy outcomes after bariatric surgery: importance of maternal ferritin on birth weight”(Springer, 2024) Aguas-Ayesa, M. (Maite); Frühbeck, G. (Gema); Gomez-Ambrosi, J. (Javier)Of all the available therapies, in adequately selected patients, bariatric surgery (BS) is the most efective treatment for severe obesity and its complications. Despite the numerous benefits of BS, even in reproductive performance, women who have undergone BS have higher rates of small-for-gestational age (SGA) fetuses and preterm births than non-intervened women with the same body mass index (BMI). The mechanisms involved are not known, but nutritional defciencies, common after BS, have been identifed as one of the factors that could contribute to these pregnancy complications.