Browsing by Author "Alberti, Gigliola"
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- ItemActualización en el manejo de pacientes con insuficiencia intestinal(2014) Alberti, Gigliola; Le Roy, Catalina; Cofré Dougnac, Colomba del Carmen; Patillo, Juan C.; Domínguez, P.; Guerra Castro, Juan Francisco
- ItemAsociación entre bilirrubina sérica y puntajes contínuos basados en componentes del síndrome metabólico en mujeres normoglicémicas chilenas(2021) Manzor Latorre, Soledad; Santos Martín, José Luis; Alberti, Gigliola; Pontificia Universidad Católica de Chile. Escuela de MedicinaEl síndrome metabólico (MetS) es un conjunto de trastornos que incluyen a la obesidad visceral o abdominal, la hipertensión arterial, la hipertrigliceridemia, el colesterol HDL bajo y la hiperglicemia. Ante la presencia de tres o más de los cinco criterios definidos se confirma el diagnóstico. Durante años han existido discrepancias sobre la terminología y criterios de diagnóstico, pero existe consenso en que sus componentes aceleran el desarrollo de enfermedades cardiovasculares (ECV) y diabetes. Diferentes estudios apoyan una posible función protectora de la bilirrubina frente al desarrollo Síndrome Metabólico (MetS). Las variables que componen la definición de MetS entregan un riesgo reconocidamente progresivo, por lo que algunos autores han sugerido el uso de un puntaje continuo para describir MetS y asociarlo con diferentes variables relacionadas con la salud. De este modo, es posible establecer un gradiente de puntajes continuos de MetS que comprenden desde perfiles saludables hasta puntajes de mayor severidad. Se ha propuesto que la bilirrubina actúa como un potente antioxidante endógeno que proteger frente a la inflamación crónica y el estrés oxidativo, que serían determinantes en el inicio y evolución del MetS. Objetivos: Evaluar la asociación entre bilirrubina circulante y puntajes continuos basados en componentes del síndrome metabólico en mujeres normoglicémicas chilenas. Métodos: En un grupo de 74 mujeres chilenas (GEDYMET; 18-48 años), nulíparas, sin antecedentes familiares de diabetes, no embarazadas, se midieron niveles séricos de bilirrubina total y directa, calculando posteriormente los niveles de bilirrubina indirecta como la diferencia entre las dos primeras. Se calcularon puntajes continuos de MetS por diferentes metodologías tales como normalización/estandarización, análisis de residuales y componentes principales. La asociación entre bilirrubina sérica y los diferentes puntajes de Mets se analizó vía correlaciones simples y regresión lineal múltiple. Resultados: Todos los puntajes de MetS basados en datos derivados de GEDYMET se asociaron significativamente y de forma inversa con la bilirrubina sérica total e indirecta. El análisis de regresión lineal múltiple confirmó la significación estadística tras el ajuste por edad e índice de masa corporal. Conclusión: Existe una asociación inversa entre los niveles de bilirrubina circulante y puntajes continuos basados en componentes del síndrome metabólico en mujeres jóvenes normoglicémicas.
- ItemAsociación entre la variante genética p.I148M de PNPLA3 e hígado graso no-alcohólico en adolescentes de la cohorte chilena Estudio de crecimiento y obesidad (ECO)(2023) Lagos de la Fuente, Alejandra; Santos Martín, José Luis; Alberti, Gigliola; Pontificia Universidad Católica de Chile. Escuela de MedicinaIntroducción: El hígado graso no alcohólico (HGNA) en un desorden hepático crónico caracterizado por la acumulación hepática de grasa en más del 5% de los hepatocitos. HGNA puede progresar a fibrosis o cirrosis hepática. Su prevalencia global en adultos es de 25%, siendo mayor en el Medio Oriente y en Sudamérica. En Chile su prevalencia en adolescentes es de un 9.7%. Sus causas son multifactoriales, incluyendo factores ambientales/nutricionales relacionados con la obesidad, y susceptibilidad genética. Estudios de asociación de genoma completo han mostrado que existe una asociación entre el polimorfismo p.I148M (C>G; sustitución de isoleucina por metionina) del gen PNPLA3 y la concentración de grasa hepática. Esta variante podría disminuir la actividad lipolítica hepática, aumentando la acumulación de triglicéridos en el hígado. Objetivo: Evaluar la asociación entre el polimorfismo p.148M del gen PNPLA3 con la presencia de hígado graso en adolescentes de la cohorte chilena “Estudio de Crecimiento y Obesidad” (ECO). Métodos: Análisis de corte transversal de 784 participantes de la cohorte ECO, quienes fueron genotipados para la variante p.I148M de PNPLA3, realizándose ecografías abdominales para evaluar la presencia de hígado graso en la etapa adolescente (edad: 13-17 años). En un grupo reducido de controles sin hígado graso (n=19) y adolescentes con hígado graso (n=63), se evaluó la asociación entre el polimorfismo p.I148M y grasa hepática medida por resonancia magnética nuclear. Resultados: Al evaluar la asociación entre polimorfismo p.148M de PNPLA3 en distintos modelos, se encontró una tendencia a aumentar el riesgo de tener HGNA, observándose una interacción significativa entre p.I148M y el Z- score de IMC. Según esta interacción, el efecto de susceptibilidad de la variante p.148M sobre HGNA es progresivamente mayor en participantes con mayores z-score de IMC. Específicamente, la concurrencia de obesidad (>2 de z-score IMC) y ser portador de la variante p.148M está ligada a una odds ratio de 14.8 (IC95%: 5.4-40.6) comparado con adolescentes normopeso no-portadores. Conclusión: Se encontró una interacción estadísticamente significativa entre la variante p.I148M en PNPLA3 y el Z- score de IMC en el desarrollo de hígado graso, de tal manera que el riesgo de hígado graso es notoriamente mayor en adolescentes con obesidad portadores de esta variante genética comparado con la ausencia de la mutación.
- ItemChildhood obesity: a risk factor for non-alcoholic fatty liver disease in adolescence(2019) Cuzmar Benítez, Valeria; Gana Ansaldo, Juan Cristóbal; Alberti, Gigliola; Pontificia Universidad Católica de Chile. Facultad de MedicinaNon-alcoholic fatty liver disease (NAFLD), defined as fat accumulation >5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Objective: To identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence. Methods: Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study' (GOCS) consisting of 513 children born in 2002-2003, with yearly anthropometric data collected over a 10 year period. The presence of intra-hepatic fat in the livers of subjects 14-16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD. Results: 9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03-16.11). Among participants with NAFLD, those with altered liver elasticity (≥7 Kpa) had greater weight, BMI z-score, waist and hip circumference and altered liver enzymes (p<0.05). Conclusion: The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.
- ItemDietary and Nutritional Interventions in Nonalcoholic Fatty Liver Disease in Pediatrics(2023) Farías, Camila; Cisternas, Camila; Gana Ansaldo, Juan Cristóbal; Alberti, Gigliola; Echeverría González, Francisca Cecilia; Videla, Luis A.; Mercado, Lorena; Muñoz, Yasna; Valenzuela, RodrigoNonalcoholic fatty liver disease (NAFLD) is pediatrics’ most common chronic liver disease. The incidence is high in children and adolescents with obesity, which is associated with an increased risk of disease progression. Currently, there is no effective drug therapy in pediatrics; therefore, lifestyle interventions remain the first line of treatment. This review aims to present an updated compilation of the scientific evidence for treating this pathology, including lifestyle modifications, such as exercise and dietary changes, highlighting specific nutritional strategies. The bibliographic review was carried out in different databases, including studies within the pediatric population where dietary and/or nutritional interventions were used to treat NAFLD. Main interventions include diets low in carbohydrates, free sugars, fructose, and lipids, in addition to healthy eating patterns and possible nutritional interventions with n-3 polyunsaturated fatty acids (EPA and DHA), amino acids (cysteine, L-carnitine), cysteamine, vitamins, and probiotics (one strain or multi-strain). Lifestyle changes remain the main recommendation for children with NAFLD. Nevertheless, more studies are required to elucidate the effectiveness of specific nutrients and bioactive compounds in this population.
- ItemEarly Obesity: Risk Factor for Fatty Liver Disease(LIPPINCOTT WILLIAMS & WILKINS, 2020) Cuzmar, Valeriau; Alberti, Gigliola; Uauy, Ricardo; Pereira, Ana; Garcia, Cristian; De Barbieri, Florencia; Corvalan, Camila; Santos, Jose L.; Mericq, Veronica; Villarroel, Luis; Gana, Juan CristobalNonalcoholic fatty liver disease (NAFLD), defined as fat accumulation greater than 5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Fatty liver has become the most frequent indication for liver transplantation in adults. Objective: The aim of the study was to identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence. Methods: Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study' (GOCS) consisting of 513 children born in 2002 to 2003, with yearly anthropometric data collected over a 10-year period. The presence of intrahepatic fat in the livers of subjects 14 to 16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD. Results: 9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03-16.11). Among participants with NAFLD, those with altered liver elasticity (>= 7 kPa) had greater weight, BMIz-score, waist and hip circumference, and altered liver enzymes (P < 0.05). Conclusion: The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.
- ItemFish oil-based lipid emulsions versus standard lipid emulsions for prevention of parenteral nutrition-associated liver disease in children(2016) Gana Ansaldo, Juan Cristóbal; Castet, A.; Villarroel del Pino, Luis A.; Cifuentes, Lorena; Torres Robles, R.; Alberti, Gigliola
- ItemFish oil-based lipid emulsions versus standard lipid emulsions for treatment of parenteral nutrition-associated liver disease in children(2016) Alberti, Gigliola; Castet, Alex; Villarroel del Pino, Luis A.; Cifuentes, Lorena; Rivera Cornejo, Marcela; Gana Ansaldo, Juan Cristóbal
- ItemFructose, Omega 3 Fatty Acids, and Vitamin E: Involvement in Pediatric Non-Alcoholic Fatty Liver Disease(2020) Alberti, Gigliola; Gana, Juan Cristóbal; Santos, José L.Non-alcoholic fatty liver disease (NAFLD) is currently the most common form of liver disease in both adults and children, becoming the leading cause for liver transplant in many countries. Its prevalence has increased considerably in recent years, mainly due to the explosive increase in pediatric obesity rates. NAFLD is strongly associated with central obesity, diabetes, dyslipidemia and insulin resistance, and it has been considered as the hepatic manifestation of the metabolic syndrome. Its complex pathophysiology involves a series of metabolic, inflammatory and oxidative stress processes, among others. Given the sharp increase in the prevalence of NAFLD and the lack of an appropriate pharmacological approach, it is crucial to consider the prevention/management of the disease based on lifestyle modifications such as the adoption of a healthy nutrition pattern. Herein, we review the literature and discuss the role of three key nutrients involved in pediatric NAFLD: fructose and its participation in metabolism, Omega-3 fatty acids and its anti-inflammatory effects and vitamin E and its action on oxidative stress.
- ItemGenetic determinants of serum bilirubin using inferred native American gene variants in Chilean adolescents(2024) Miranda Marín, José Patricio; Pereira, Ana; Corvalán, Camila; Miquel P., Juan Francisco; Alberti, Gigliola; Gana Ansaldo, Juan Cristóbal; Santos Martín, José LuisGene variants in the UGT1A1 gene are strongly associated with circulating bilirubin levels in several populations, as well as other variants of modest effect across the genome. However, the effects of such variants are unknown regarding the Native American ancestry of the admixed Latino population. Our objective was to assess the Native American genetic determinants of serum bilirubin in Chilean admixed adolescents using the local ancestry deconvolution approach. We measured total serum bilirubin levels in 707 adolescents of the Chilean Growth and Obesity Cohort Study (GOCS) and performed high-density genotyping using the Illumina-MEGA array (>1.7 million genotypes). We constructed a local ancestry reference panel with participants from the 1000 Genomes Project, the Human Genome Diversity Project, and our GOCS cohort. Then, we inferred and isolated haplotype tracts of Native American, European, or African origin to perform genome-wide association studies. In the whole cohort, the rs887829 variant and others near UGT1A1 were the unique signals achieving genome-wide statistical significance (b = 0.30; p = 3.34 × 10−57). After applying deconvolution methods, we found that significance is also maintained in Native American (b = 0.35; p = 3.29 × 10−17) and European (b = 0.28; p = 1.14 × 10−23) ancestry components. The rs887829 variant explained a higher percentage of the variance of bilirubin in the Native American (37.6%) compared to European ancestry (28.4%). In Native American ancestry, carriers of the TT genotype of this variant averaged 4-fold higher bilirubinemia compared to the CC genotype (p = 2.82 × 10−12). We showed for the first time that UGT1A1 variants are the primary determinant of bilirubin levels in Native American ancestry, confirming its pan-ethnic relevance. Our study illustrates the general value of the local ancestry deconvolution approach to assessing isolated ancestry effects in admixed populations.
- ItemGlycemic Response after Starch Consumption in Relation to Salivary Amylase Activity and Copy-number Variation of AMY1 Gene(2015) Alberti, Gigliola; Parada, Javier; Rodrigo Cataldo, L.; Vega, Javier; Aguilera, Concepción M.; Alvarez-Mercado, Ana I.; Hodgson Bunster, María Isabel; López, Alberto; Angellotti, Isidora; Gil, Angel; Santos Martín, José Luis
- ItemGrowth patterns in infants born to women with pregestational overweight/obesity supplemented with docosahexaenoic acid during pregnancy(2024) De Toro Navarrete, Valeria Francisca; Alberti, Gigliola; Domínguez, Angélica; Carrasco Negüe, Karina Andrea; Ferrer, Pedro; Valenzuela, Rodrigo; Garmendia. María Luisa; Casanello Toledo, Paola CeciliaBackground: Previous studies of maternal docosahexaenoic acid (DHA) supplementation during pregnancy have controversial and contrasting results on the short and long-term effects on early child growth. The impact of this nutritional intervention on the postnatal growth patterns in the offspring of women with pregestational overweight/obesity (PGO) also remains controversial. Objective: To analyze the postnatal growth patterns during the first 4 months of life in the offspring of women with PGO randomly supplemented with 800 mg/day (PGO-800) compared with normative doses of 200 mg/day (PGO-200) of DHA during pregnancy (<15 weeks of gestation until delivery). Methods: This study evaluated the growth patterns during the first 4 months of life of 169 infants of the women that participated in the MIGHT study (NCT02574767). We included the infants of women from the PGO-200 (n = 81) and PGO-800 group (n = 88). The growth patterns (weight, length, and head circumference) and change in z-score (WHO charts) were evaluated. Results: Throughout the first 4 months of life, the infants of the PGO-800 group had lower weight-for-length z-score (coef. −0.65, 95% confidence interval [CI] −1.07, −0.22, p = 0.003) and lower body mass index-for-age z-score (coef. −0.56, 95% CI −0.99, −0.12, p = 0.012) compared with the PGO-200 group adjusted by maternal body mass index, gestational weight gain, gestational age, insulin in cord blood and infant feeding (exclusive breastfed, not breastfed, and partially breastfed). Conclusions: Maternal supplementation with DHA during pregnancy could beneficially limit the offspring's postnatal weight gain during the first 4 months of life.
- ItemLong-term effects of adenotonsillectomy in children with obstructive sleep apnoea : protocol for a systematic review(2016) Damiani Rebolledo, L. Felipe; Rada G., Gabriel; Gana Ansaldo, Juan Cristóbal; Brockmann Veloso, Pablo Edmundo; Alberti, Gigliola
- ItemMalnutrición por exceso : alta frecuencia de sobrepeso y obesidad en escolares chilenos con síndrome de Down(2015) Jimenez, Lily; Cerda, Jaime; Alberti, Gigliola; Lizama C., Macarena
- ItemRelación entre la trayectoria de la composición corporal desde la infancia a la adolescencia y el riesgo de desarrollar hígado graso no alcohólico(2020) Faune Palacios, Mariana Carmen; Alberti, Gigliola; Gana Ansaldo, Juan Cristóbal; Pontificia Universidad Católica de Chile. Facultad de MedicinaIntroducción: El hígado graso no alcohólico (HGNA) es una enfermedad definida por la acumulación de grasa en más del 5% de los hepatocitos. La obesidad central es un factor de riesgo para desarrollar HGNA. Conocer los factores de riesgo relacionados a la composición corporal durante la infancia asociados a la aparición de HGNA en la adolescencia permitirá realizar a futuro intervenciones preventivas precoces. Objetivo: Describir la trayectoria de la composición corporal a lo largo de la infancia y relacionarla con el riesgo de desarrollar HGNA en la adolescencia. Sujetos y Métodos: Estudio de Cohorte que incluyó 784 adolescentes con evaluaciones periódicas de estado nutricional y composición corporal desde los 3 años y a los que durante la adolescencia se les realizó un ultrasonido abdominal para evaluar la presencia de HGNA. Las evaluaciones incluyeron peso, talla, circunferencia de cintura, pliegues cutáneos, bioimpedanciometría y absorciometría de energía dual de rayos X (DXA). Se compararon las evaluaciones de los adolescentes con HGNA versus controles. Resultados: Se diagnosticó HGNA en 9.8% de los adolescentes y en un 38% de los adolescentes con obesidad. Mayores niveles de circunferencia de cintura se asociaron con HGNA desde los 3 años (p<0.05), los pliegues cutáneos desde los 4 años (p<0.05) y las mediciones por DXA desde los 10 años en porcentaje de grasa y grasa en tronco en mujeres (p<0.05). A los 5 años, el grupo HGNA presentó un índice de masa grasa (IMG) mayor que el grupo control (p<0.05). De igual manera, el índice de masa libre de grasa (IMLG) fue mayor en mujeres, pero no en hombres (p=0.206). Los terciles dos y tres de IMG presentan OR de 2.19 [1.48-3.25] IC 95% y de 6.94 [4.79-10.04] IC 95%, respectivamente. Conclusiones: Un mayor IMG durante la infancia aumenta el riesgo de desarrollar HGNA en la adolescencia. Mayores niveles de circunferencia de cintura, grasa corporal, tronco y subcutánea durante la infancia se asocian con la presencia de HGNA en la adolescencia.
- ItemRelation between body composition trajectories from childhood to adolescence and nonalcoholic fatty liver disease risk(2024) Alberti, Gigliola; Faune Palacios, Mariana Carmen; Santos Martín, José Luis; De Barbieri Magnone, Florencia Beatriz; García B., Cristián; Pereira, Ana; Becerra, Fernando; Gana Ansaldo, Juan CristóbalNAFLD has become the leading cause of chronic liver disease in children, as a direct consequence of the high prevalence of childhood obesity. This study aimed to characterize body composition trajectories from childhood to adolescence and their association with the risk of developing nonalcoholic fatty liver disease (NAFLD) during adolescence. The participants were part of the ‘Chilean Growth and Obesity Cohort Study’, comprising 784 children who were followed prospectively from age 3 years. Annual assessments of nutritional status and body composition were conducted, with ultrasound screening for NAFLD during adolescence revealing a 9.8% prevalence. Higher waist circumference measures were associated with NAFLD from age 3 years (p = 0.03), all skin folds from age 4 years (p < 0.01), and DXA body fat measurements from age 12 years (p = 0.01). The fat-free mass index was higher in females (p = 0.006) but not in males (p = 0.211). The second and third tertiles of the fat mass index (FMI) had odds ratios for NAFLD during adolescence of 2.19 (1.48–3.25, 95% CI) and 6.94 (4.79–10.04, 95% CI), respectively. Elevated waist circumference, skin folds, and total body fat were identified as risk factors for future NAFLD development. A higher FMI during childhood was associated with an increased risk of NAFLD during adolescence.
- ItemSevere acute pancreatitis secondary to hypertriglyceridemia as the onset of Type 1 Diabetes Mellitus in the pediatric age(2024) Munoz, Camila; De Toro, Valeria; Gana, Juan Cristobal; Harris, Paul R.; Loureiro, Carolina; Alberti, GigliolaHypertriglyceridemia (HTG)-induced acute pancreatitis (AP) secondary to insulin deficiency following the onset of type 1 diabetes mellitus (T1DM) is a rare but serious complication in children. Objective: To describe the diagnosis and treatment of severe HTG and to emphasize the need for timely diagnosis of T1DM. Clinical Case: A 15-year-old female adolescent with a history of overweight presented with a two-weeks history of fever, anorexia, and diffuse abdominal pain. Laboratory tests revealed triglycerides of 17,580 mg/dL, lipase of 723 U/L, and blood glucose of 200 mg/dL. An abdominal CT scan showed an enlarged and edematous pancreas. She was hospitalized with a diagnosis of AP and severe HTG, which progressed to acute necro-hemorrhagic pancreatitis. Treatment included continuous intravenous insulin infusion until triglyceride levels decreased. Upon discontinuation of insulin, fasting hyperglycemia (206 mg/dL) and metabolic acidosis recurred, therefore DM was suspected. Upon targeted questioning, a history of polydipsia, polyuria, and weight loss during the last 3 months stood out. Glycated hemoglobin was markedly elevated (14.7%). Insulin therapy was optimized, achieving stabilization of laboratory parameters after 15 days of treatment and complete anatomical resolution of pancreatic involvement at one year of follow-up. Conclusions: The presence of severe HTG in pediatrics compels us to consider its secondary causes, such as the onset of T1DM. It is crucial to improve the ability to diagnose T1DM early, as it may present with infrequent and high-risk presentations for the patient.
- ItemTeduglutide for the treatment of patients with short bowel syndrome(John Wiley and Sons Ltd, 2021) Riutort Kreft, María Cecilia; Alberti, Gigliola; Gana Ansaldo, Juan Cristóbal; Villarroel del Pino, Luis A.; Cifuentes Aguila, Lorena Isabel; Rivera Cornejo, MarcelaObjectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To evaluate the safety and efficacy of teduglutide for the treatment of patients with short bowel syndrome when compared with placebo or no intervention.