Lopez-Legarrea, P. (Patricia)

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    The reduction of the metabolyc syndrome in Navarra-Spain (RESMENA-S) study; a multidisciplinary strategy based on chrononutrition and nutritional education, together with dietetic and psychological control
    (Sociedad Española de Nutrición Parenteral y Enteral, 2011) Zulet, M.A. (María Ángeles); Navas-Carretero, S. (Santiago); Abete, I. (Itziar); Forga, L. (Luis); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la; Bondia-Pons, I. (I.)
    Introduction: The high prevalence of metabolic syndrome (MS) in Spain requires additional efforts for prevention and treatment. Objective: The study RESMENA-S aims to improve clinical criteria and biomarkers associated with MS though an integral therapy approach. Methods: The study is a randomized prospective parallel design in which is expected to participate a total of 100 individuals. The RESMENA-S group (n = 50) is a personalized weight loss (30% energy restriction) diet, with a macronutrient distribution (carbohydrate / fat / protein) of 40/30/30, high meal frequency (7 / day), low glycemic index/load and high antioxidant capacity as well as a high adherence to the Mediterranean diet. The control group (n = 50) is assigned to a diet with the same energy restriction and based on the American Heart Association pattern. Both experimental groups are under dietary and psychological control during 8 weeks. Likewise, for an additional period of 16 weeks of self-control, is expected that volunteers will follow the same pattern but with no dietary advice. Results: Anthropometrical data and body composition determinations as well as blood and urine samples are being collected at the beginning and end of each phase. This project is registered at www.clinicaltrials.gov with the number NCT01087086 and count with the Research Ethics Committee of the University of Navarra approval (065/2009). Conclusions: Intervention trials to promote the adoption of dietary patterns and healthy lifestyle are of great importance to identify the outcomes and nutritional mechanisms that might explain the link between obesity, metabolic syndrome and associated complications.
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    Evaluation of a new dietary strategy for the treatment of obesity and associated inflammation: endocrine and epigenetic mechanisms
    (Servicio de Publicaciones de la Universidad de Navarra, 2014) Lopez-Legarrea, P. (Patricia); Martinez, J.A. (José Alfredo); Zulet, M.A. (María Ángeles)
    Obesity and metabolic syndrome (MetS) have become major public health problems worldwide. Dietary strategies represent the primary choice treatment. The aim of this study was to investigate the effect of a new energy-restricted dietary strategy (RESMENA) involving different dietary aspects such us a modified macronutrient profile including a moderately increased amount of proteins, an augmented meal frequency, an enhancement of low GI/GL and high antioxidant content food and with a high adherence to the Mediterranean Diet, on anthropometric, biochemical and inflammatory markers in obese subjects presenting MetS features after a nutritional intervention of 8 weeks duration. Additionally, the effectiveness of the RESMENA diet was compared with a pattern based on the American Heart Association (AHA) guidelines and potential underlying mechanisms such us hormonal influences and epigenetic modifications were studied. It was observed that the two dietary plans were equally effective on improving anthropometric and biochemical markers. Dietary total antioxidant capacity was evidenced as the major influential element given that several anthropometric and biochemical indicators were influenced by it. Moreover, the AHA-based pattern showed to be more beneficial in order to improve the inflammation status (CRP, PAI-1, TNF-α, IL-6) associated to obesity, at least in the short-term and it was observed an association between protein intake and the inflammation condition. Interestingly, animal origin protein as a whole, and meat derived protein showed to negatively influence the inflammatory status. However associations were found neither for vegetal origin protein, nor for fish. Subsequently, the new recently discovered myokine irisin was studied. It was observed that irisin plasma concentrations decreased after following the energy-restricted dietary patterns, without differences between them, in association with body weight reduction. Then, it was evidenced that irisin levels were associated with the changes in glucose homeostasis parameters, being greater the reductions on glucose, insulin and HOMA index among the participants with higher irisin baseline levels. Finally, DNA methylation of SERPINE1 gene, which codes for PAI-1, was assessed and it was observed that the higher methylation levels at baseline, the greater reductions were observed in some obesity indicators. In summary, these data evidenced the effectiveness of a new dietary pattern and the influence of specific dietary components on anthropometric, biochemical and inflammatory markers of obese subjects with MetS after an intervention of 8-weeks duration. Furthermore, the influence of the recently discovered irisin and the epigenetics modifications have been ¿manifested as influential in mediating the obtained outcomes.
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    Nutrición en el enfermo con fibrosis quística
    (Sociedad Española de Nutrición Parenteral y Enteral, 2010) Martinez, J.A. (José Alfredo); Lopez-Legarrea, P. (Patricia)
    La fibrosis quística es una enfermedad que se asocia a una mutación de un gen localizado en el brazo largo del cromosoma 7. Esta enfermedad multisistémica afecta especialmente a los pulmones y al páncreas exocrino, lo cual supone el trastorno más influyente en la nutrición de estos pacientes. Generalmente, la suplementación con enzimas pancreáticas es necesaria como elemento terapéutico. La prevalencia de diabetes en esta enfermedad aumenta con la edad, mientras que la afectación hepática clínica es menos frecuente y otras complicaciones intestinales como el ileomeconial, el reflujo gastroesofágico o la obstrucción del intestino distal pueden condicionar también la malnutrición. La prevalencia de la desnutrición en los pacientes con fibrosis quística es elevada, aunque variable, y se asocia directamente con el estado pulmonar y la supervivencia. La terapia nutricional ha adquirido gran importancia ya que se asocia con un mejor crecimiento y mejora o estabilización de la función pulmonar, por lo que debe ser una parte integral del tratamiento de estos pacientes.
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    Plasma irisin depletion under energy restriction is associated with improvements in lipid profile in metabolic syndrome patients
    (Wiley, 2014) Martinez, J.A. (José Alfredo); Casanueva, F.F. (Felipe F.); Zulet, M.A. (María Ángeles); Pardo, M. (M.); Crujeiras, A.B. (Ana B.); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la
    Objective A recently discovered myokine, irisin, may have an important role in energy metabolism. This study aimed to evaluate the relationship between this hormone and the lipid profile of Metabolic Syndrome (MetS) patients following a hypocaloric diet. Design Ninety-three Caucasian adults (52 men/41 women) diagnosed with MetS followed an 8-week-long energy restricted programme (-30% of the energy requirements). Anthropometric measurements, biochemical markers and plasma irisin levels were analysed before and after the nutritional intervention. Results Global plasma irisin levels were significantly reduced at the end of the study (-72•0 ± 100•9 ng/mL, p < 0•001) accompanying the weight loss (-6•9%). The depletion of irisin significantly correlated with changes in some atherogenic-related variables: total cholesterol (B = 0•106, p = 0•018), total cholesterol/high density lipoprotein-cholesterol ratio (B = 0•002, p = 0•036), low density lipoprotein-cholesterol (B = 0•085, p = 0•037) and apolipoprotein B (B = 0•052, p = 0•002), independently of changes in body weight. Conclusions An association between the reduction of plasma irisin levels and the depletion of important lipid metabolism biomarkers was observed in patients with MetS undergoing an energy restricted programme.
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    Beneficial effects of the RESMENA Dietary pattern on oxidative stress in patients suffering from metabolic syndrome with hyperglycemia are associated to dietary TAC and fruit consumption
    (MDPI, 2013) Martinez, J.A. (José Alfredo); Celada, P. (Paloma); Zulet, M.A. (María Ángeles); Sanchez-Muniz, F.J. (Francisco J.); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la
    Hyperglycemia and oxidative stress are conditions directly related to the metabolic syndrome (MetS), whose prevalence is increasing worldwide. This study aimed to evaluate the effectiveness of a new weight-loss dietary pattern on improving the oxidative stress status on patients suffering MetS with hyperglycemia. Seventy-nine volunteers were randomly assigned to two low-calorie diets (-30% Energy): the control diet based on the American Health Association criteria and the RESMENA diet based on a different macronutrient distribution (30% proteins, 30% lipids, 40% carbohydrates), which was characterized by an increase of the meal frequency (seven-times/day), low glycemic load, high antioxidant capacity (TAC) and high n-3 fatty acids content. Dietary records, anthropometrical measurements, biochemical parameters and oxidative stress biomarkers were analyzed before and after the six-month-long study. The RESMENA (Metabolic Syndrome Reduction in Navarra) diet specifically reduced the android fat mass and demonstrated more effectiveness on improving general oxidative stress through a greater decrease of oxidized LDL (oxLDL) values and protection against arylesterase depletion. Interestingly, oxLDL values were associated with dietary TAC and fruit consumption and with changes on body mass index (BMI), waist circumference, fat mass and triacilglyceride (TG) levels. In conclusion, the antioxidant properties of the RESMENA diet provide further benefits to those attributable to weight loss on patients suffering Mets with hyperglycemia.
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    Higher baseline irisin concentrations are associated with greater reductions in glycemia and insulinemia after weight loss in obese subjects
    (Nature Publishing Group, 2014) Martinez, J.A. (José Alfredo); Casanueva, F.F. (Felipe F.); Zulet, M.A. (María Ángeles); Pardo, M. (M.); Crujeiras, A.B. (Ana B.); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la
    Irisin is assumed to be a relevant link between muscle and weight maintenance as well as to mediate exercise benefits on health. The aim of this study was to assess the possible associations between irisin levels and glucose homeostasis in obese subjects with metabolic syndrome (MetS) following an energy-restricted treatment. Ninety-six adults with excessive body weight and MetS features underwent a hypocaloric dietary pattern for 8 weeks, within the RESMENA randomized controlled trial (www.clinicaltrials.gov; NCT01087086). After the intervention, dietary restriction significantly reduced body weight and evidenced a dietary-induced decrease in circulating levels of irisin in parallel with improvements on glucose homeostasis markers. Interestingly, participants with higher irisin values at baseline (above the median) showed a greater reduction on glucose (P=0.022) and insulin (P=0.021) concentrations as well as on the homeostasis model assessment index (P=0.008) and triglycerides (P=0.006) after the dietary intervention, compared with those presenting low-irisin baseline values (below the median). Interestingly, a positive correlation between irisin and carbohydrate intake was found at the end of the experimental period. In conclusion, irisin appears to be involved in glucose metabolism regulation after a dietary-induced weight loss.
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    Association between circulating irisin levels and the promotion of insulin resistance during the weight maintenance period after a dietary weight-lowering program in obese patients
    (WB Saunders, 2014) Martinez, J.A. (José Alfredo); Casanueva, F.F. (Felipe F.); Zulet, M.A. (María Ángeles); Pardo, M. (M.); Carreira, M.C. (Marcos C.); Crujeiras, A.B. (Ana B.); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la
    Objective. Weight regain is associated with the promotion of insulin resistance. The newly discovered myokine irisin, which was proposed to be involved in the management of insulin sensitivity, could play a role in this process. This study aimed to investigate the association between irisin and reduced insulin sensitivity induced by weight regain. Materials/Methods. Insulin sensitivity was evaluated according to the homeostasis model assessment of insulin resistance (HOMA-IR) in 136 obese patients who followed an eight-week hypocaloric diet (30% reduced energy expenditure) to lose weight and were re-evaluated four or six months after treatment. Irisin plasma levels, as well as the levels of leptin, adiponectin, ghrelin and TNF-α, were quantified in a sub-cohort (n=73) from the initially studied patients at baseline (T0), at the diet endpoint (T1) and after the follow-up period (T2). Results. After a successful dietary intervention to lose weight, 50% of the patients who regained the lost weight during the follow-up period were categorized as insulin resistant (HOMA-IR≥2.5) compared with only 25% of patients who maintained the weight loss (p=0.018). Importantly, in addition to the well-studied hormones leptin and adiponectin, irisin plasma levels were statistically associated with several risk factors for insulin resistance. Indeed, the increased risk of insulin resistance during the follow-up period was related to high irisin levels at baseline (odds ratio=4.2; p=0.039). Conclusions. Circulating irisin predicts the insulin resistance onset in association with weight regain. Therefore, irisin could be secreted as an adaptive response to counteract the deleterious effect of excess adiposity on glucose homeostasis.
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    A new dietary strategy for long-term treatment of the metabolic syndrome is compared with the American Heart Association (AHA) guidelines: the MEtabolic Syndrome REduction in NAvarra (RESMENA) project
    (Cambridge University Press, 2014) Martinez, J.A. (José Alfredo); Zulet, M.A. (María Ángeles); Navas-Carretero, S. (Santiago); Abete, I. (Itziar); Forga, L. (Luis); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la; Bondia-Pons, I. (I.)
    The long-term effects of dietary strategies designed to combat the metabolic syndrome (MetS) remain unknown. The present study evaluated the effectiveness of a new dietary strategy based on macronutrient distribution, antioxidant capacity and meal frequency (MEtabolic Syndrome REduction in NAvarra (RESMENA) diet) for the treatment of the MetS when compared with the American Heart Association guidelines, used as Control. Subjects with the MetS (fifty-two men and forty-one women, age 49 (se 1) years, BMI 36·11 (se 0·5) kg/m) were randomly assigned to one of two dietary groups. After a 2-month nutritional-learning intervention period, during which a nutritional assessment was made for the participants every 15 d, a 4-month self-control period began. No significant differences were found between the groups concerning anthropometry, but only the RESMENA group exhibited a significant decrease in body weight ( - 1·7%; P= 0·018), BMI ( - 1·7%; P= 0·019), waist circumference ( - 1·8%; P= 0·021), waist:hip ratio ( - 1·4%; P= 0·035) and android fat mass ( - 6·9%; P= 0·008). The RESMENA group exhibited a significant decrease in alanine aminotransferase and aspartate aminotransferase (AST) concentrations ( - 26·8%; P= 0·008 and - 14·0%; P= 0·018, respectively), while the Control group exhibited a significant increase in glucose (7·9%; P= 0·011), AST (11·3%; P= 0·045) and uric acid (9·0%; P< 0·001) concentrations. LDL-cholesterol (LDL-C) concentrations were increased (Control group: 34·4%; P< 0·001 and RESMENA group: 33·8%; P< 0·001), but interestingly so were the LDL-C:apoB ratio (Control group: 28·7%; P< 0·001, RESMENA group: 17·1%; P= 0·009) and HDL-cholesterol concentrations (Control group: 21·1%; P< 0·001, RESMENA group: 8·7; P= 0·001). Fibre was the dietary component that most contributed to the improvement of anthropometry, while body-weight loss explained changes in some biochemical markers. In conclusion, the RESMENA diet is a good long-term dietary treatment for the MetS.
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    A decline in inflammation is associated with less depressive symptoms after a dietary intervention in metabolic syndrome patients: a longitudinal study
    (BioMed Central, 2014) Lacunza, C.I. (Clara I.); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Perez-Cornago, A. (Aurora); Zulet, M.A. (María Ángeles); Lahortiga, F. (Francisca); Navas-Carretero, S. (Santiago); Abete, I. (Itziar); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la
    BACKGROUND: Metabolic syndrome (MetS) and depression have become two prevalent diseases worldwide, whose interaction needs further investigation. Dietary treatment for weight loss in patients with MetS may improve depressive manifestations, however, the precise interactive pathways remain uncertain. Therefore, the aim of this study was to examine the effects of a hypocaloric diet designed to reduce MetS features on self-perceived depression and the possible underlying factors. METHODS: Sixty subjects (Age:50 +/- 1 y; BMI:36.1 +/- 0.6 kg/m2) with MetS were selected from the RESMENA study (control and intervention) after they completed the 6-months hypocaloric treatment and rated for depressive symptoms using the Beck Depression Inventory (BDI). Anthropometric and biochemical measurements including leptin, C-reactive protein (CRP) and insulin levels were evaluated. RESULTS: Depressive symptoms decreased during the weight loss intervention, with no differences between both dietary groups (control group -4.2 +/- 0.8 vs RESMENA group -3.2 +/- 0.6, P = 0.490). The number of criteria of the MetS was higher among subjects with more somatic-related depressive symptoms at baseline (B = 1.032, P-trend = 0.017). After six months of dietary treatment, body weight decreased in all subjects (-8.7%; confidence interval (95%CI) = 7.0-9.7) and also self-perceived depression (-37.9%; 95%CI = 2.7-4.9), as well as circulating leptin (-20.1%; 95%CI = 1.8-6.8), CRP (-42.8%; 95%CI = 0.6-3.0) and insulin (-37.7%; 95%CI = 4.1-7.2) concentrations. The decrease in BDI was significantly associated with declines in body fat mass (B = 0.34, 95%CI = 0.11-0.56) and also with the decrease in leptin (B = 0.16, 95%CI = 0.04-0.28) and CRP (B = 0.24, 95%CI = 0.01-0.46) concentrations. CONCLUSIONS: The decrease in depressive manifestations after a weight loss intervention was related with adiposity, CRP and leptin in subjects with MetS.
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    Short-term role of the dietary total antioxidant capacity in two hypocaloric regimes on obese with metabolic syndrome symptoms: the RESMENA randomized controlled trial
    (BioMed Central, 2013) Martinez, J.A. (José Alfredo); Zulet, M.A. (María Ángeles); Navas-Carretero, S. (Santiago); Abete, I. (Itziar); Forga, L. (Luis); Lopez-Legarrea, P. (Patricia); Iglesia, R. (Rocío) de la; Bondia-Pons, I. (I.)
    Background: Dietary strategies seem to be the most prescribed therapy in order to counteract obesity regarding not only calorie restriction, but also bioactive ingredients and the composition of the consumed foods. Dietary total antioxidant capacity (TAC) is gaining importance in order to assess the quality of the diet. Methods: Ninety-six obese adults presenting metabolic syndrome (MetS) symptoms completed an 8-week intervention trial to evaluate the effects of a novel dietary program with changes in the nutrient distribution and meal frequency and to compare it with a dietary pattern based on the American Heart Association (AHA) guidelines. Anthropometric and biochemical parameters were assessed at baseline and at the endpoint of the study, in addition to 48-hours food dietary records. Results: Both diets equally (p > 0.05) improved MetS manifestations. Dietary TAC was the component which showed the major influence on body weight (p = 0.034), body mass index (p = 0.026), waist circumference (p = 0.083) and fat mass (p = 0.015) reductions. Transaminases (ALT and AST) levels (p = 0.062 and p = 0.004, respectively) were associated with lower TAC values. Conclusion: RESMENA diet was as effective as AHA pattern for reducing MetS features. Dietary TAC was the most contributing factor involved in body weight and obesity related markers reduction.