Health : “Malnutrition is a key factor for a worse evolution”

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Javier Escalada San Martín is director of the Department of Endocrinology and Nutrition and has a preferential dedication to the study and treatment of Diabetes Mellitus and the study and endocrinological treatment of gastroenteropancreatic tumors. Currently, he is president of the Spanish Society of Endocrinology and Nutrition. He also has a degree in Medicine and Surgery from the University of the Basque Country (1986) and a Doctor of Medicine from the University of Alcalá de Henares (1994). Specialist in Endocrinology, Metabolism and Nutrition at the Ramón y Cajal Hospital in Madrid (1988-1991).

Covid-19 has caused a global crisis, which is affecting millions of people in many areas. In this sense, there are those who say that food is the greatest risk of coronavirus, is that right?

In this regard, we must be careful. So far, there is no data that relates “diet” to coronavirus. The relationship that has been found, with much scientific evidence, by the way, is between obesity and poor evolution of the COVID infection. Patients with obesity and COVID infection have a higher risk of worse evolution.

What are the diseases or pathologies that have a worse prognosis for Covid-19 infection?

In the studies published to date, the clinical factors related to the specialty of Endocrinology and Nutrition and the type of patient that we usually see in our consultations, which have shown a relationship with a worse prognosis of COVID-19 infection are age (the older the worse), obesity, hypertension, poorly controlled diabetes (hyperglycemia even in patients without known diabetes), vitamin D deficiency and, of course, the presence of previous comorbidities (respiratory, cardiovascular, neoplastic, etc.). On the other hand, during admission, malnutrition is a key factor for a worse evolution.

People with diabetes or obesity suffer from metabolic syndrome, what exactly is this syndrome?

The metabolic syndrome (MS) is defined as the set of metabolic and cardiovascular alterations that appear related to the state of insulin resistance (IR). RI can be genetically conditioned and appears, fundamentally, in those people with exogenous conditions that increase it (abdominal obesity, physical inactivity, etc.); For this reason, MS appears years after IR and its prevalence is proportional to the age of the population and the prevalence of aggravating factors in this population.

Among the metabolic alterations related to MS, the following stand out: 1) dyslipidemia (mainly hypertriglyceridemia, decrease in HDL-cholesterol and presence of small and dense LDL), with plasma increase in free fatty acids (FFA); 2) hyperglycemia or diabetes; 3) arterial hypertension (HT). These alterations together with abdominal obesity are the parameters that have been established for the diagnosis of MS.

Can the risk of suffering from these diseases be controlled? Is it as difficult as people think?

Yes. Sure you can. The key is in an adequate population education that instills the importance of following a healthy lifestyle. We are talking about healthy eating and avoiding a sedentary lifestyle. Most of these metabolic alterations would be avoided with the early introduction, from childhood, of this type of measures. As for the difficulty, it depends on how you look at it. It is more difficult to change habits when someone leads a certain lifestyle for 30, 40 or 50 years than to acquire healthy habits from the first years of life. In the latter case, the difficult thing is to raise public awareness.

Returning to the crisis caused by Covid-19, what role do endocrinology services have in the fight against this virus?

Endocrinology and Nutrition services are key in the fight against COVID-19. If not, let’s review the factors related to a worse evolution of the infection: obesity, diabetes in poor control or new-onset hyperglycemia, malnutrition during admission … All these diseases are our daily bread, so Endocrinology services and Nutrition should be within the COVID teams. Specifically, during hospitalization, we can be very useful in the management of hyperglycemia, generally difficult to control in these patients, and of malnutrition.

What is being done from the Spanish Society of Endocrinology and Nutrition? Are you working together with other societies and associations?

The Spanish Society of Endocrinology and Nutrition (SEEN), from the beginning, has worked with its different working groups to establish recommendations for doctors and patients regarding the management of metabolic and endocrinological pathologies in patients with COVID-19, and they have been prepared materials available on our website. And of course, we have been in contact with patient associations (FEDE, for example) and other scientific societies (FACME, I COVID-19 national congress, etc.). I would like to highlight the development of telemedicine that our society has made to serve our patients in this difficult situation. Taking into account the circumstances we are experiencing, we continue with all these open and active collaborations.

What are the main challenges that society currently faces?

SEEN, as an active society, has multiple challenges ahead. In addition to continuing to work on COVID-19 infection (recommendations, research projects, improvement of telemedicine …), we have many other aspects related to everything that is non-COVID that, unfortunately, seems to have gone into the background. Among them, projects related to relations with Latin American scientific societies, teaching projects (relationship with the university), research projects and data management (big data, artificial intelligence), etc.

One of the most important lines for you is research, do you consider that it is crucial for the development of the specialty?

Without research, there is no progress. With this I think my idea about the importance of research in the development, in this case, of Endocrinology and Nutrition is clear. And I am referring to basic research, “laboratory research” so that people understand it, but with a clearly translational intention, and clinical research, fundamental to know the pathologies we cover as well as possible, in order to be able to design strategies. improvement.

How will you promote this research at SEEN?

SEEN has been making moves to improve research for some time now. Specifically, our incorporation to RedCap (electronic data capture software and a workflow methodology to design clinical trial research databases and translational research) has just been managed and we want to join the Big Data analysis and use of artificial intelligence. On the other hand, we are redesigning the financial support strategy for those quality projects that require it.

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