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Author: search.filters.author.Evelyn Frias-ToralHas files: No

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    Multilevel barriers to clinical and nutritional research in Latin America: a socioeconomic comparative analysis
    (Frontiers Media SA, 2025-12-31)
    Evelyn Frias-Toral
    ;
    Jaime Angamarca-Iguago
    ;
    Isabel Calvo Higuera
    ;
    Jorge Carriel-Mancilla
    ;
    Guillermo Contreras
    Clinical and nutritional research in Latin America faces significant challenges that limit scientific development and evidence-based healthcare. Understanding these barriers is essential for developing effective strategies to enhance research capacity in the region. This study aimed to identify multilevel barriers to clinical and nutritional research in Latin America and compare them between countries of different socioeconomic levels. Methods A cross-sectional study was conducted with 327 healthcare professionals involved in clinical and nutritional research across Latin America. Data collection occurred via an online survey in which participants rated the importance of 16 potential barriers on a 3-point Likert scale. Analysis included descriptive statistics, chi-square tests to compare barriers between upper-middle and lower-middle-income countries, logistic regression to identify predictors of research participation, and k-means cluster analysis to identify researcher profiles. Results Funding (84.4%), research materials (71.6%), and time constraints (70.9%) emerged as the most significant barriers across all countries. Three barriers showed statistically significant differences between income levels: participant commitment (73.6% vs. 42.6%, < 0.001), frequent appointments (56.6% vs. 37.8%, = 0.02), and language barriers (39.6% vs. 22.9%, = 0.02), all of which were higher in lower-middle-income countries. Logistic regression identified the importance of research materials (OR = 0.36, = 0.002) and telemedicine (OR = 1.74,  = 0.044) as significant predictors of research participation. Cluster analysis revealed three distinct researcher profiles based on barrier perception patterns. Conclusion Multilevel barriers to research in Latin America are dominated by universal resource constraints (funding, materials, time), with lower-middle-income countries facing additional challenges in participant engagement and study logistics. The relative homogeneity of most barriers across income groups suggests that regional and institutional factors may be more influential than national income levels. These findings provide a foundation for developing targeted strategies to strengthen research capacity and infrastructure across Latin America.
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    Signals for Muscular Protein Turnover and Insulin Resistance in Critically Ill Patients: A Narrative Review
    (MDPI AG, 2023-02-21)
    Sebastián P. Chapela
    ;
    SIMANCAS RACINES, DANIEL ALEJANDRO  
    ;
    Martha Montalvan
    ;
    Evelyn Frias-Toral
    ;
    Alison Simancas-Racines
    <jats:p>Sarcopenia in critically ill patients is a highly prevalent comorbidity. It is associated with a higher mortality rate, length of mechanical ventilation, and probability of being sent to a nursing home after the Intensive Care Unit (ICU). Despite the number of calories and proteins delivered, there is a complex network of signals of hormones and cytokines that affect muscle metabolism and its protein synthesis and breakdown in critically ill and chronic patients. To date, it is known that a higher number of proteins decreases mortality, but the exact amount needs to be clarified. This complex network of signals affects protein synthesis and breakdown. Some hormones regulate metabolism, such as insulin, insulin growth factor glucocorticoids, and growth hormone, whose secretion is affected by feeding states and inflammation. In addition, cytokines are involved, such as TNF-alpha and HIF-1. These hormones and cytokines have common pathways that activate muscle breakdown effectors, such as the ubiquitin–proteasome system, calpain, and caspase-3. These effectors are responsible for protein breakdown in muscles. Many trials have been conducted with hormones with different results but not with nutritional outcomes. This review examines the effect of hormones and cytokines on muscles. Knowing all the signals and pathways that affect protein synthesis and breakdown can be considered for future therapeutics.</jats:p>
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    The Molecular Mechanisms of the Relationship between Insulin Resistance and Parkinson’s Disease Pathogenesis
    (MDPI AG, 2023-08-15)
    RUIZ POZO, VIVIANA ALEJANDRA  
    ;
    TAMAYO TRUJILLO, VICTOR RAFAEL  
    ;
    CADENA ULLAURI, SANTIAGO ANDRE  
    ;
    Evelyn Frias-Toral
    ;
    Sebastián Chapela
    <jats:p>Parkinson’s disease (PD) is a degenerative condition resulting from the loss of dopaminergic neurons. This neuronal loss leads to motor and non-motor neurological symptoms. Most PD cases are idiopathic, and no cure is available. Recently, it has been proposed that insulin resistance (IR) could be a central factor in PD development. IR has been associated with PD neuropathological features like α-synuclein aggregation, dopaminergic neuronal loss, neuroinflammation, mitochondrial dysfunction, and autophagy. These features are related to impaired neurological metabolism, neuronal death, and the aggravation of PD symptoms. Moreover, pharmacological options that involve insulin signaling improvement and dopaminergic and non-dopaminergic strategies have been under development. These drugs could prevent the metabolic pathways involved in neuronal damage. All these approaches could improve PD outcomes. Also, new biomarker identification may allow for an earlier PD diagnosis in high-risk individuals. This review describes the main pathways implicated in PD development involving IR. Also, it presents several therapeutic options that are directed at insulin signaling improvement and could be used in PD treatment. The understanding of IR molecular mechanisms involved in neurodegenerative development could enhance PD therapeutic options and diagnosis.</jats:p>
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    The Impact of a Very-Low-Calorie Ketogenic Diet in the Gut Microbiota Composition in Obesity
    (MDPI AG, 2023-06-13)
    ZAMBRANO ESPINOSA, ANA KARINA  
    ;
    CADENA ULLAURI, SANTIAGO ANDRE  
    ;
    Evelyn Frias-Toral
    ;
    Sebastián Chapela
    ;
    Martha Montalván
    <jats:p>The very-low-calorie KD (VLCKD) is characterized by a caloric intake of under 800 kcal/day divided into less than 50 g/day of carbohydrate (13%) and 1 to 1.5 g of protein/kg of body weight (44%) and 43% of fat. This low carbohydrate intake changes the energy source from glucose to ketone bodies. Moreover, clinical trials have consistently shown a beneficial effect of VLCKD in several diseases, such as heart failure, schizophrenia, multiple sclerosis, Parkinson’s, and obesity, among others. The gut microbiota has been associated with the metabolic conditions of a person and is regulated by diet interactions; furthermore, it has been shown that the microbiota has a role in body weight homeostasis by regulating metabolism, appetite, and energy. Currently, there is increasing evidence of an association between gut microbiota dysbiosis and the pathophysiology of obesity. In addition, the molecular pathways, the role of metabolites, and how microbiota modulation could be beneficial remain unclear, and more research is needed. The objective of the present article is to contribute with an overview of the impact that VLCKD has on the intestinal microbiota composition of individuals with obesity through a literature review describing the latest research regarding the topic and highlighting which bacteria phyla are associated with obesity and VLCKD.</jats:p>
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    Adherence to the Mediterranean diet as a possible additional tool to be used for screening the metabolically unhealthy obesity (MUO) phenotype
    (Springer Science and Business Media LLC, 2023-09-28)
    Luigi Barrea
    ;
    Ludovica Verde
    ;
    SIMANCAS RACINES, DANIEL ALEJANDRO  
    ;
    ZAMBRANO ESPINOSA, ANA KARINA  
    ;
    Evelyn Frias-Toral
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>The terms metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) categorize subjects with obesity based on the presence or absence of cardio-metabolic risk factors. Detecting MUO phenotype is crucial due to the high risk of cardio-metabolic complications, requiring tailored and intensive follow-up. However, diagnosing MUO is time-consuming and costly. Thus, we aimed to investigate the role of Mediterranean diet (MD) in determining MHO/MUO phenotypes and whether adherence to MD could serve as an additional screening tool for MUO phenotype.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>The study population of this cross-sectional observational study consisted of 275 subjects with obesity. We assessed their lifestyle habits (physical activity and smoking habits), anthropometric measurements (weight, height, waist circumference, body mass index), blood pressure, metabolic parameters, inflammatory marker (high sensitivity C reactive protein levels), adherence to MD (by <jats:italic>PREvención con DIetaMEDiterránea</jats:italic> (PREDIMED) questionnaire), and MHO/MUO phenotypes.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The study included 275 individuals with obesity (256F/19M; 34.0 ± 10.5 years; BMI 38.3 ± 5.95 kg/m<jats:sup>2</jats:sup>). Among them, 114 (41.5%) exhibited MHO phenotype, while 161 (58.5%) had MUO phenotype. MHO phenotype exhibited favorable anthropometric and cardio-metabolic profiles, characterized by lower waist circumference (p &lt; 0.001), BMI (p &lt; 0.001), insulin resistance (p &lt; 0.001), blood pressure (p &lt; 0.001), inflammation (p &lt; 0.001), and lipid levels (p &lt; 0.001) compared to MUO phenotype. Notably, we found that MHO phenotype had higher adherence to MD (p &lt; 0.001) and consumed more extra virgin olive oil (EVOO) (p &lt; 0.001), vegetables (p &lt; 0.001), fruits (p &lt; 0.001), legumes (p = 0.001), fish (p &lt; 0.001), wine (p = 0.008), and nuts (p = 0.001), while reporting lower intake of red/processed meats (p &lt; 0.001), butter, cream, margarine (p = 0.008), soda drinks (p = 0.006), and commercial sweets (p = 0.002) compared to MUO phenotype. Adherence to MD (p &lt; 0.001) and EVOO (p = 0.015) intake were identified as influential factors in determining the presence of MUO/MHO phenotypes. Furthermore, a PREDIMED score &lt; 5 proved to be the most sensitive and specific cut-point value for predicting the presence of MUO phenotype (p &lt; 0.001).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>High adherence to MD was associated with MHO phenotype. Moreover, we suggest that a specific cut-off of the PREDIMED score could be an indicator to discriminate patients with MUO/MHO phenotypes and therefore help in identifying patients at higher cardiovascular risk who will require specific dietary intervention.</jats:p> </jats:sec>