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The Molecular Mechanisms Underlying Dercum’s Disease: Exploring the Intersection of Obesity, Pain, and Inflammation
(MDPI AG, 2025-11-18)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Emilia Jiménez Flores
;
Melannie Toral-Noristz
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Campuzano Donoso Martín
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ROMAN GALEANO, NATHALY MERCEDES
Obesity is increasingly recognized not only as a metabolic disorder, but also as a state of chronic low-grade inflammation that predisposes to systemic complications. Within this context, Dercum’s disease (DD), or adiposis dolorosa, emerges as a rare yet debilitating disorder characterized by painful subcutaneous lipomas, most commonly affecting middle-aged women. Despite its clinical impact, DD remains underdiagnosed and is often misclassified as lipedema, fibromyalgia, or lipomatosis, complicating prevalence estimates and hindering the development of targeted interventions. Current evidence suggests that DD represents a distinctive model of inflammatory obesity, where adipose tissue actively contributes to pain generation rather than serving as a passive fat reservoir. Histological and molecular findings point to adipose tissue dysfunction, immune cell infiltration, and elevated secretion of pro-inflammatory adipokines, signals which appear to fuel systemic low-grade inflammation, perineural immune interactions, and nociceptor sensitization. Peripheral mechanisms further shape the clinical phenotype. While familial clustering suggests possible genetic contributions, no definitive markers have been identified, and the role of obesity-induced epigenetic modifications remains unexplored. Therapeutic strategies remain largely symptomatic, including analgesics, antidepressants, physical rehabilitation, and surgical excision of lipomas, whereas molecularly targeted and diet-based interventions are still experimental. This article discusses the pathophysiology of DD, current treatments, and future perspectives, emphasizing that advancing patient registries, omics-based analyses, and interdisciplinary clinical trials will be crucial to elucidate disease mechanisms and guide novel therapies. Improved understanding of DD may not only enhance patient care, but also provide broader insights into the interplay between obesity, inflammation, and chronic pain.
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Endocrinologist's crucial role in metabolic dysfunction-associated steatotic liver disease: a comprehensive review
(Edizioni Minerva Medica, 2025-06)
Claudia REYTOR-GONZÁLEZ
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Giuseppe ANNUNZIATA
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Martín CAMPUZANO-DONOSO
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Tania MORALES-LÓPEZ
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Carmen BASANTES-TITUAÑA
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a widespread disorder strongly associated with metabolic conditions such as obesity, insulin resistance, and type 2 diabetes (T2D). The progression of MASLD, which can lead to severe complications like hepatic fibrosis and cirrhosis, is closely tied to cardiometabolic risks, including cardiovascular disease, and to liver-related cancers associated with metabolic dysfunction. Endocrinologists are uniquely positioned to detect MASLD early, particularly in individuals with metabolic risk factors such as T2D, polycystic ovary syndrome (PCOS), and thyroid dysfunction. While they may not routinely perform advanced diagnostic procedures, they play a critical role in identifying at-risk patients and collaborating with specialists for further evaluation, including the use of transient elastography to assess liver stiffness and fibrosis. By doing so, they help reduce the need for invasive procedures. Beyond screening and diagnosis, endocrinologists collaborate with hepatologists, cardiologists, and nutritionists to ensure a comprehensive, multidisciplinary treatment approach. Managing MASLD requires addressing both liver-specific conditions and broader metabolic dysfunctions through lifestyle interventions and pharmacological therapies. Recent studies highlight the potential benefits of medications, such as farnesoid X receptor (FXR) agonists and peroxisome proliferator-activated receptor (PPAR) agonists, when combined with lifestyle interventions such as modifying diet and engaging in more physical activity. This review highlights the pivotal role of endocrinologists in managing MASLD, focusing on their contributions to screening, diagnosis, and integrated care. It examines the complex interplay between hormonal regulation and both pharmacological and non-non-pharmacological treatment strategies, providing insights for enhancing clinical practice and improving patient outcomes through a comprehensive, multidisciplinary approach.
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Oesophageal adenocarcinoma, obesity, and cancer: the role of nutrition in prevention and management
(Informa UK Limited, 2025-05-29)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
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SIMANCAS RACINES, DANIEL ALEJANDRO
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Emilia Jiménez Flores
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Martín Campuzano Donoso
;
Angelo Michele Carella
Oesophageal adenocarcinoma (EAC) is increasingly associated with obesity, metabolic dysfunction, and genetic predispositions. This review explores how nutritional factors interact with these risk elements, emphasizing the potential of dietary strategies in EAC prevention and management. Diets such as the Mediterranean and plant-based patterns may reduce inflammation, oxidative stress, and metabolic imbalance, thereby modulating cancer risk. Nutrient-rich foods–particularly omega-3 fatty acids, cruciferous vegetables, and dietary fibre–offer additional protective effects. Personalized nutrition, tailored to individual genetic and metabolic profiles, is emerging as a promising tool in cancer prevention. Moreover, weight management strategies like caloric restriction and intermittent fasting may contribute to risk reduction. Integrating these approaches into clinical and public health practices could play a critical role in mitigating the underlying drivers of EAC. Further research is needed to strengthen dietary guidelines and advance precision nutrition for high-risk populations.
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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)
REYTOR GONZÁLEZ, CLAUDIA MARÍA
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Evelyn Frias-Toral
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NUÑEZ VASQUEZ, CRISTINA ELIZABETH
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PARISE VASCO, JUAN MARCOS
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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)
SIMANCAS RACINES, DANIEL ALEJANDRO
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Evelyn Frias Toral
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Martín Campuzano-Donoso
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RAMOS SARMIENTO, DANIEL ALEXANDER
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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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