Carlos O. Mendivil

Epilepsy frequently requires treatment with antiseizure medications (ASM). With the progressive rise in life expectancy in this population, patients are more exposed to potential undesirable effects, some of them on bone tissue. Here, we review current knowledge concerning the impact of ASM on bone biology. Cytochrome P450 inductors decrease serum concentrations of active vitamin D, increasing parathyroid hormone (PTH) secretion and hence bone resorption. Valproic acid also reduces active vitamin D, but in addition activates osteoclasts and impairs osteoblastic function through different pathways. Although the mechanism remains unclear, topiramate is associated with reductions in bone mineral density and increased PTH. Levetiracetam has a very favorable bone profile. Lacosamide and lamotrigine have a preferable bone effect compared to other sodium channel blockers. These ASM with a lower impact on bone biology should be prioritized whenever possible. Every person with epilepsy receiving high-risk ASM should undergo fracture risk assessment.

Diabetic retinopathy (DR) is a preventable, frequent, and serious complication of diabetes, with a large impact on morbidity and disability. More than 125 million people worldwide suffer from DR. The pathogenesis of DR involves different pathways, many of them exacerbated by chronic hyperglycemia, but not necessarily a direct consequence of it. Fibrates are a well-known family of medications traditionally employed for the treatment of hypertriglyceridemia and low HDL cholesterol, which act through binding to the nuclear receptor peroxisome proliferator-activated receptors (PPAR)-alpha in several tissues. PPAR-alpha is expressed in the human retina. Animal and cellular models have demonstrated that PPAR activation by fibrates improves cellular phenomena involved in the genesis of DR, including chronic inflammation, oxidative damage, vascular hyperpermeability and microglial activation. Secondary analyses of fenofibrate trials originally designed to assess cardiovascular outcomes, systematically found an apparent benefit from fenofibrate treatment on diverse measures of DR appearance and severity. Finally, the LENS (Lowering Events in Non-Proliferative Retinopathy) study proved in a dedicated randomized trial that early fenofibrate use lowers the risk of DR progression in a statistically significant and clinically meaningful manner. These results have positioned fenofibrate as the first agent proven to specifically delay DR, without mediation by glycemic control. Future studies will test whether this effect extends to other microvascular diabetes complications.

Background: Non-communicable diseases (NCDs) pose a significant global health challenge, with varying perceptions and attitudes influencing public health responses and policy development. This study aims to elucidate the cross-cultural perceptions and attitudes towards NCDs across five diverse countries, providing insights into global public health strategies. Methods: We analysed data from the ‘Measuring Public Perceptions of Noncommunicable Diseases’ survey, developed by Gallup and conducted in Colombia, India, Jordan, Tanzania and the USA. The survey encompassed questions on the perceived harmfulness of NCDs, empowerment for risk reduction and the influence of various entities on health. Statistical analysis included bivariate and multiple logistic regression models to assess the impact of socio-demographic factors on these perceptions. Findings: The study revealed significant cross-country variations in the perception of NCDs’ harmfulness and the public’s empowerment to reduce their risk. High-income and education levels were consistently associated with a greater perception of NCD harmfulness and empowerment across the surveyed nations. Notably, the USA exhibited a paradoxical trend of high empowerment and knowledge levels about NCDs, but low support for health policies like increased taxes on sugary beverages and alcohol. The proportion of participants from India and Jordan who manifested they could take actions to modify their risk of NCDs was remarkably low. Tanzanian and Jordanian respondents, especially female, showed lower empowerment levels, highlighting cultural and socioeconomic disparities in health literacy and policy support. Interpretation: These findings underscore the complexity of addressing NCDs globally and point to the need for culturally and socioeconomically tailored public health interventions. Understanding local perceptions and attitudes is crucial for designing effective health literacy programmes and policies to mitigate NCD risks.

La diabetes tipo 2 es una enfermedad con un impacto devastador sobre las sociedades, debido a su alta prevalencia, las múltiples complicaciones orgánicas y su alta carga de morbimortalidad asociada. En Colombia, encuestas poblacionales recientes estiman una prevalencia urbana de diabetes tipo 2 en adultos entre el 10 % y el 11 %, lo que representa un número potencial de personas con diabetes de entre 3.5 y 3.9 millones de personas. Las complicaciones crónicas de la diabetes, además de ser severas, letales e incapacitantes, acarrean una enorme carga de costos para el sistema de salud. Más importante aún, dichas complicaciones son casi enteramente prevenibles mediante un buen control metabólico integral. En este sentido, análisis de datos del sistema de salud colombiano han evidenciado que un adecuado y sostenido control de una triple meta -que incluye tensión arterial sistólica <130 mmHg, HbA1c <7.0% y colesterol de LDL <100 mg/dL- se asocia con una reducción sustancial de la probabilidad de muerte de hasta 81 % en un periodo de cuatro años. A pesar de ello, tan solo uno de cada cuatro pacientes con diabetes en Colombia alcanza y sostiene esta meta básica.

Context: Medical nutritional therapy is a cornerstone intervention for managing type 2 diabetes. However, despite existing clinical guidelines, robust evidence to support recommendations on many topics remains limited. Objective: The objective of this work is to develop an expert consensus that provides clinically relevant guidance by integrating professional expertise with a systematic interpretation of the available evidence. This approach aims to ensure that decisions are informed, balanced, and grounded in the best possible understanding of current research and practical experience. Methods: This consensus process followed a structured three-step approach. First, a focus group was conducted to identify key topics requiring attention. Next, PICO model questions were formulated, and evidence was systematically reviewed to address them. Finally, the Nominal Group Technique was applied to achieve consensus among the panel members. A combination of quantitative and qualitative analysis was used to formulate the final consensus statements. Results: Six main topics related to medical nutritional therapy in type 2 diabetes were rigorously analyzed and discussed. A systematic review of 256 peer-reviewed articles supported the expertise of the multidisciplinary panel. The panel generated 127 ideas across the 6 topics, achieving consensus on 78 of them. These consensus statements provide clear definitions and practical recommendations for implementing medical nutritional therapy in clinical practice. Conclusions: This consensus represents the first step forward in addressing a common yet often overlooked aspect of type 2 diabetes treatment in Colombia: medical nutritional therapy. By integrating multidisciplinary expertise and evidence-based analysis, it delivers actionable and clinically meaningful recommendations to improve patient care.

Introduction: Familial chylomicronemia syndrome (FCS) is an autosomal recessive disorder that affects approximately 1 to 10 individuals per million and is caused by variants in the genes encoding for the lipoprotein lipase (LPL) enzyme. In addition to its heterogeneous clinical presentation, FCS is characterized by a higher risk of life-threatening, recurrent acute pancreatitis and type 3 diabetes. Since available evidence on FCS in Latin America is limited, there is a clear need for a consensus document that provides relevant [...] Abstract Introduction: Familial chylomicronemia syndrome (FCS) is an autosomal recessive disorder that affects approximately 1 to 10 individuals per million and is caused by variants in the genes encoding for the lipoprotein lipase (LPL) enzyme. In addition to its heterogeneous clinical presentation, FCS is characterized by a higher risk of life-threatening, recurrent acute pancreatitis and type 3 diabetes. Since available evidence on FCS in Latin America is limited, there is a clear need for a consensus document that provides relevant

Introduction: We explored the changes in the prevalence and distribution of excess body adiposity in urban Colombia after the COVID-19 pandemic and associated lockdown. Methods: We executed a population-based, stratified, multi-stage study of individuals aged 2–80 years from five Colombian cities, between November and December 2022. We explored the prevalences of excess adiposity measures and their association with socioeconomic variables and contrasted the results with the previous wave of the study, conducted in 2018. Results: We studied 2115 individuals (83.5% adults, 51.7% female). Between 2018 and 2022, the adult prevalence of excess body weight (EBW, body mass index >25 kg/m²) increased by 4.5% in males and decreased by 0.6% in females. Women had almost twice the prevalence of obesity as men. The prevalence of obesity for underage females soared from 7.6% in 2018 to 18.4% in 2022. Abdominal obesity increased by 10.3% in men, up to 39.8%. Adult female obesity was negatively associated with socioeconomic status (SES) (OR 2.01 (95% CI 1.33 to 3.04) for lowest SES relative to highest). Abdominal obesity among women in the lowest SES reached 55.2% in 2022. There was a strong negative relationship between education and EBW among women, the OR of obesity for women with only primary education relative to college graduates was 2.48 (95% CI 1.52 to 4.06). Conclusions: The obesity epidemic worsened in urban Colombia after the COVID-19 pandemic and associated lockdown, especially among adult males and underage females. The burden of excess adiposity is concentrated in women from disadvantaged groups.