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    Available evidence on integrating COVID-19 into sentinel surveillance systems: A scoping review
    (Medwave Estudios Limitada, 2025-10-20)
    Jorge Gualotuña-Suntaxi
    ;
    Diana Pérez-Muñoz
    ;
    Raynier Zambrano-Villacres
    ;
    ;
    Daniel Simancas-Racines
    Introduction The COVID-19 pandemic exposed the weaknesses of epidemiological surveillance systems and highlighted the need to integrate new respiratory viruses into sentinel surveillance systems. However, current evidence on their effectiveness remains limited. Aim This project conducts a scoping review to describe the available evidence on the integration of COVID-19 into sentinel surveillance systems. Methods The included studies addressed sentinel surveillance in the context of the pandemic following the World Health Organization declaration. A systematic search was performed in databases including MEDLINE, LILACS, EPISTEMONIKOS, and DIMENSIONS, selecting observational studies and systematic reviews. Data collection and analysis were organized into categories such as clinical characteristics, timely detection, geographic representativeness, co-infection, and adaptability with genomic surveillance. Seventeen studies reporting on COVID-19 integration impact and one preliminary WHO report were identified. Results Results identified the most prevalent symptoms in the general population: fever (73%), cough (51.8%), loss of taste or smell (45.1%), hypoxemia (33%), and sputum production (23.9%). A high correlation was obtained between SARI cases or hospitalizations due to respiratory infection and the incidence of COVID-19 (ρ = 0.78 and ρ = 0.82 respectively). Conclusions Integrating COVID-19 into the sentinel surveillance system could improve detection, response, and follow-up capacity. Additionally, implementing standardized case definitions promotes more efficient use of laboratory resources, thereby enhancing the sustainability of the surveillance system.
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    Obesity and breast cancer: exploring the nexus of chronic inflammation, metabolic dysregulation, and nutritional strategies
    (Informa UK Limited, 2025-06-23)
    Claudia Reytor-González
    ;
    Daniel Simancas-Racines
    ;
    Náthaly Mercedes Román-Galeano
    ;
    Martín Campuzano-Donoso
    ;
    Angelo Michele Carella
    The global prevalence of obesity has risen to epidemic proportions, posing significant health challenges across populations and contributing to increased morbidity and mortality from non-communicable diseases. Among its many consequences, obesity is now firmly established as a modifiable risk factor for breast cancer, particularly in postmenopausal women. The association between obesity and breast cancer is driven by complex and interrelated biological mechanisms, including chronic low-grade inflammation, hormonal imbalances, adipokine dysregulation, insulin resistance, and metabolic dysfunction. These factors collectively create a pro-tumorigenic environment that supports cancer initiation, progression, and recurrence. This review explores the multifaceted nexus between obesity and breast cancer, emphasizing the critical role of inflammatory, hormonal, and metabolic pathways in mediating disease risk and outcomes. Additionally, it highlights the emerging contribution of gut microbiome dysbiosis in modulating host immunity and systemic inflammation in the context of obesity. Nutritional strategies—ranging from dietary pattern modification to caloric restriction and time-restricted feeding (TRF)—are examined for their potential to reduce risk, enhance treatment efficacy, and improve survivorship in breast cancer patients.
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    Timing matters: lipid intake and its influence on menopausal-related symptoms
    (Springer Science and Business Media LLC, 2025-08-18)
    Ludovica Verde
    ;
    Luigi Barrea
    ;
    Evelyn Frias-Toral
    ;
    Raynier Zambrano-Villacres
    ;
    Background Menopause contributes to central obesity and increases cardiovascular risk in women. Diet influences both menopausal symptoms and cardiovascular health, but the impact of chrononutrition, namely food timing, is not well understood. This cross-sectional study investigated whether the timing of food intake affected menopausal symptoms in 100 postmenopausal women with overweight or obesity. Methods Anthropometric and clinical parameters, and lifestyle habits were assessed. Menopausal symptoms were evaluated using the Menopause Rating Scale (MRS). Nutritional assessment utilized 7-day food records. Food intake was divided into morning intake (meals from breakfast to lunch) and evening intake (meals from afternoon snacks to dinner). Results The mean MRS score was 22.7 ± 7.8, showing a high prevalence of symptoms in the study population. Postmenopausal women under the median of morning energy intake showed a significantly a higher score for heart discomfort (p = 0.045), while those under the median of morning intake of lipids showed significantly higher scores for heart discomfort and lower scores for bladder problems (p = 0.013 and p = 0.040, respectively). Postmenopausal women above the median evening intake of lipids showed a significantly higher score for heart discomfort (p = 0.007). The heart discomfort score correlated negatively and positively with the morning (r = -0.210, p = 0.034) and evening (r = 0.210, p = 0.034) intakes of lipids, respectively, even after correction for confounding factors (r = -0.219 and r = 0.219, p = 0.028 for both). Conclusion Consuming most of the energy and lipids later in the day was linked to higher prevalence of menopausal symptoms in postmenopausal women with overweight or obesity. This eating pattern may potentially have adverse effects on the cardiovascular health of these women. Therefore, adopting chrononutrition behaviors, particularly favoring an earlier intake of energy and lipids, could prove beneficial as an additional measure in the nutritional therapy for postmenopausal women dealing with overweight or obesity.
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    Beyond dietary therapy: addressing weight stigma awareness in medical students
    (Springer Science and Business Media LLC, 2025-08-22)
    Giuseppe Annunziata
    ;
    Giordano Bruno Zonzini
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    Evelyn Frias-Toral
    ;
    Raynier Zambrano-Villacres
    ;
    Alexander Bertuccioli
    Background The growing prevalence of obesity worldwide has drawn increased attention to the issue of weight stigma. Discriminatory attitudes related to body weight are evident across various settings, including those that should ideally offer support to individuals with obesity, such as schools and sports facilities. This research aimed to examine weight-related stigma among university students enrolled in healthcare-related academic programs. Methods To measure weight stigma, researchers administered the Italian version of the Attitude Toward Obese Persons (I-ATOP) questionnaire to 201 students from the University of Urbino (Italy) and the University of Malaga (Spain). The analysis explored variations in stigma levels based on gender, BMI classification, nationality, Italian regional location, level of academic education, medical history, and lifestyle factors. Results The participant pool was predominantly female (58.2%) and Spanish (66.7%), with an average age of 22.86 ± 3.08 years and a mean BMI of 22.80 ± 3.25 kg/m, placing most respondents in the normal weight range. Nearly half (47.8%) demonstrated a low degree of stigmatising attitudes. Within the sample, significantly lower stigma levels were reported among female and Spanish students (> = 0.001 and > = 0.011, respectively), as well as among those without a history of eating disorders (> = 0.017) and those who engaged in physical activity (> = 0.029). Additionally, stigma showed a notable decline in relation to higher educational attainment ConclusionThis pilot study reveals the presence of weight stigma even within healthcare education settings, where future health professionals are being trained. These findings underscore the urgent need for comprehensive educational strategies aimed at fostering inclusive and nonjudgmental attitudes toward individuals with obesity. Importantly, the assessment and management of weight stigma should extend beyond nutritional therapy alone, recognizing its psychological, social, and structural dimensions. Integrating this broader perspective into healthcare curricula is thus essential to improve the quality of care for individuals living with one of the most prevalent and complex chronic conditions.
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    Preventing and Managing Pre- and Postoperative Micronutrient Deficiencies: A Vital Component of Long-Term Success in Bariatric Surgery
    (MDPI AG, 2025-02-20) ;
    Evelyn Frias-Toral
    ;
    ; ;
    Raynier Zambrano-Villacres
    Bariatric surgery (BS) is an effective treatment for severe obesity and its related comorbidities, such as type 2 diabetes and hypertension. However, the anatomical and physiological changes associated with these procedures significantly increase the risk of preoperative and postoperative micronutrient deficiencies, which can lead to severe complications such as anemia, osteoporosis, and neurological disorders. This narrative review examines the prevalence and clinical implications of micronutrient deficiencies in BS patients, as well as evidence-based strategies for their prevention and management. The most common deficiencies include iron, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, E, and K). Procedures with a hypoabsorptive component, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), pose higher risks of deficiencies compared to restrictive procedures like sleeve gastrectomy (SG). Effective strategies involve the preoperative correction of deficiencies, continuous monitoring, and tailored supplementation. However, long-term adherence to supplementation tends to decrease over time, influenced by behavioral and socioeconomic factors. Hence, preventing and managing micronutrient deficiencies are crucial for the long-term success of BS. While current guidelines provide valuable recommendations, many are based on low-certainty evidence, underscoring the need for more robust studies. A multidisciplinary approach, combined with innovative strategies, such as telemedicine, can enhance adherence and achieve sustainable clinical outcomes.
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    Preoperative Nutrition in Bariatric Surgery: A Narrative Review on Enhancing Surgical Success and Patient Outcomes
    (MDPI AG, 2025-02-02) ;
    Evelyn Frias Toral
    ;
    Martín Campuzano-Donoso
    ;
    ;
    Raynier Zambrano-Villacres
    Bariatric surgery has become the preferred treatment for individuals with morbid obesity. Nutrition is key in optimizing surgical outcomes by reducing risks and enhancing recovery. Preoperative strategies, such as reducing body fat, decreasing liver size, and improving metabolic profiles, have been shown to facilitate safer surgical procedures with fewer complications. This narrative review aims to provide an analysis of the fundamental role of preoperative nutritional management in improving bariatric surgery outcomes, emphasizing the importance of addressing specific nutritional challenges to enhance surgical safety, recovery, and overall health. Preoperative nutritional interventions focus on correcting comorbidities and nutritional deficiencies, particularly hypovitaminosis and micronutrient imbalances, through a multidisciplinary approach involving nutritionists and other healthcare professionals. These interventions not only prepare patients for the physiological demands of surgery but also initiate a period of adaptation to new dietary habits, aiming to improve long-term compliance and mitigate risks such as postoperative weight regain and dumping syndrome. Adopting dietary changes, such as very low-calorie or ketogenic diets 6–12 weeks before surgery, enhances adherence to postoperative restrictions and overall surgical success. Future research should focus on developing comprehensive guidelines for preoperative nutritional care to improve patient outcomes globally.
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    Microbiota dynamics preceding bariatric surgery as obesity treatment: a comprehensive review
    (Frontiers Media SA, 2024-04-03) ;
    Elius Paz-Cruz
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    Viviana A. Ruiz-Pozo
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    Santiago Cadena-Ullauri
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    Rafael Tamayo-Trujillo
    The review present data on the intricate relationship between bariatric surgery, gut microbiota, and metabolic health in obesity treatment. Bariatric surgery, is recognized as an effective intervention for managing morbid obesity, including various techniques with distinct mechanisms of action, efficacy, and safety profiles including Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG), Laparoscopic Adjustable Gastric Banding (LAGB), and Biliopancreatic Diversion (BPD). RYGB and SG are the most prevalent procedures globally, inducing gut microbiota changes that influence microbial diversity and abundance. Post-surgery, alterations in bacterial communities occur, such as the increased of <jats:italic>Escherichia coli inversely correlated with fat mass and leptin levels. During digestion, microbiota produce physiologically active compounds like bile acids (Bas) and short-chain fatty acids (SCFAs). SCFAs, derived by microbial fermentation, influence appetite, energy metabolism, and obesity-related pathways. Bas, altered by surgery, modulate glucose metabolism and insulin sensitivity. Furthermore, SG and RYGB enhance incretin secretion, particularly glucagon-like peptide 1 (GLP-1). Therefore, understanding microbiota changes after bariatric surgery could be crucial for predicting metabolic outcomes and developing targeted interventions for obesity management.
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    Molecular mechanisms of semaglutide and liraglutide as a therapeutic option for obesity
    Obesity, a chronic global health problem, is associated with an increase in various comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, hypertension, and certain types of cancer. The increasing global prevalence of obesity requires research into new therapeutic strategies. Glucagon-like peptide-1 receptor agonists, specifically semaglutide and liraglutide, designed for type 2 diabetes mellitus treatment, have been explored as drugs for the treatment of obesity. This minireview describes the molecular mechanisms of semaglutide and liraglutide in different metabolic pathways, and its mechanism of action in processes such as appetite regulation, insulin secretion, glucose homeostasis, energy expenditure, and lipid metabolism. Finally, several clinical trial outcomes are described to show the safety and efficacy of these drugs in obesity management.
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    Obesity and periodontitis: a comprehensive review of their interconnected pathophysiology and clinical implications
    (Frontiers Media SA, 2024-08-07) ; ;
    Natali González
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    Alison Simancas-Racines
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    Raynier Zambrano-Villacres
    Obesity and periodontitis are significant health problems with a complex bidirectional relationship. Excess body fat is linked to systemic diseases and can lead to persistent inflammation, potentially harming periodontal health. Periodontitis, a chronic inflammatory condition affecting the supporting structures of teeth, poses substantial health risks. Both conditions share pathological processes such as inflammation and oxidative stress, which aggravate health status and make treatment more challenging. Understanding this interaction is crucial for developing effective management strategies for both diseases. This study explores the multifaceted aspects of obesity and periodontitis and their reciprocal relationship.