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Original article
Dietary-fat effect of the rs10830963 polymorphism in MTNR1B on insulin resistance in response to 3 months weight-loss diets
Efecto del polimorfismo rs10830963 MTNR1B y la composición de grasa de la dieta en la resistencia a la insulina tras la pérdida de peso durante 3 meses
Daniel Antonio de Luisa,b,
Corresponding author
dadluis@yahoo.es

Corresponding author.
, Olatz Izaolaa,b, David Primoa,b, Rocio Allera,b
a Centro de Investigacion de Endocrinología y Nutrición Clínica, Facultad de Medicina, Valladolid, Spain
b Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">There is evidence that the human metabolism is related to the circadian system&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">1</span></a> In some studies&#44; alterations to the circadian rhythm have even been associated with overweight&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">2</span></a> Some studies have also shown that energy metabolism is basically controlled through a central pacemaker in the circadian system&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">3</span></a> and that circadian alterations may induce obesity and metabolic complications associated with it&#44; such as type 2 diabetes mellitus&#44; glucose intolerance&#44; hyperlipidemia&#44; hypertension or cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Melatonin is a hormone produced by the pineal gland that fundamentally controls the circadian rhythms&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">5</span></a> The effect of melatonin is mediated through two membrane receptors&#58; melatonin receptor 1 &#40;MT1&#44; encoded by MTNR1A&#41; and melatonin receptor 2 &#40;MT2&#44; encoded by MTNR1B&#41;&#46; MTNR1B is the most ubiquitous receptor of the two&#44; and is found in the pancreatic islets&#44; diencephalon and eyes &#40;retina&#41;&#46; Some polymorphisms &#40;single nucleotide polymorphism &#91;SNP&#93;&#41; located in genes involved in circadian systems such as melatonin have been related to overweight and obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">6</span></a> For example&#44; an SNP in the melatonin receptor type 1B &#40;MTNR1B&#41; gene has been associated with alterations in melatonin signal and rhythm&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">7</span></a> Interestingly&#44; this genetic variant has also been linked to type 2 diabetes mellitus&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">8&#44;9</span></a> dyslipidemia<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">10&#44;11</span></a> and overweight&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">12</span></a> In addition&#44; polymorphism rs10830963 of the MTNR1B receptor gene has been shown to interact with dietary fat and the serum lipid profile&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite these described relationships&#44; research into the effect of this polymorphism upon the response to weight loss strategies is scarce&#46; Goni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">14</span></a> have shown that variant rs10830963 could be related to weight loss induced by calorie restriction&#46; The same authors<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">15</span></a> detected an association of this genetic variant with lipid response after two years of diet and weight loss&#46; A significant interaction has also been identified between the genotypes of the variant rs10830963<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">16</span></a> and dietary intervention in relation to the occurrence of gestational diabetes mellitus in young women homozygous for the C allele&#46; In turn&#44; patients with obesity subjected to a Mediterranean low-calorie diet have shown a different response regarding insulin levels and insulin resistance&#59; these differences were related to the minor allele of this SNP&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The present study evaluates the effect of this SNP on changes in different cardiovascular risk factors and weight loss after a low-calorie diet with a high monounsaturated fat content or a low-calorie diet with a high polyunsaturated fat content in obese patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study recruited obese Caucasian individuals using a consecutive&#44; non-probabilistic sampling method among subjects referred by primary care physicians to specialized clinics&#46; A total of 361 patients were recruited in the Clinical Nutrition Unit&#46; The study was conducted in accordance with the guidelines of the Declaration of Helsinki&#59; the local Ethics Committee approved all the procedures&#44; and informed consent was obtained from all the patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main exclusion criteria were&#58; dieting during the 6 months prior to the study&#44; the presence of unstable cardiovascular or cerebrovascular disease&#44; insufficient motivation&#44; and the use of any of the following drugs&#58; metformin&#44; dipeptidyl peptidase type IV &#40;DPP-4&#41; inhibitors&#44; thiazolidinedione&#44; GLP-1 analogs&#44; sGLT2 inhibitors&#44; insulin&#44; glucocorticoids&#44; angiotensin receptor blockers&#44; angiotensin converting enzyme inhibitors &#40;ACEIs&#41;&#44; psychoactive drugs&#44; statins&#44; and other lipid medicinal products&#46; The inclusion criteria included a body mass index &#40;BMI&#41; &#62;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> and a patient age between 18 and 70 years&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Venous blood samples &#40;15<span class="elsevierStyleHsp" style=""></span>ml&#41; were collected in EDTA-treated tubes&#44; after a 10-h fasting period&#46; Basal glucose&#44; C-reactive protein &#40;CRP&#41;&#44; insulin&#44; insulin resistance &#40;HOMA-IR&#41;&#44; total cholesterol&#44; LDL-cholesterol&#44; HDL-cholesterol&#44; triglycerides and serum adipokines &#40;leptin&#44; adiponectin and resistin&#41; were measured at the start of the study and were repeated after three months of both diets&#46; The anthropometric parameters &#40;weight&#44; height&#44; waist circumference &#91;WC&#93; and body fat mass determined by bioimpedance&#41;&#44; as well as blood pressure&#44; were likewise measured on both occasions&#46; The genotype of the MTNR1B gene polymorphism &#40;rs10830693&#41; was evaluated&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dietary intervention</span><p id="par0040" class="elsevierStylePara elsevierViewall">Both low-calorie diets were designed to provide 400&#8211;500<span class="elsevierStyleHsp" style=""></span>kcal&#47;day less than the individually estimated total energy expenditure&#46; The obese subjects were randomly assigned to one of the two diets for a period of three months&#46; The percentage of energy derived from carbohydrates&#44; fats and proteins in the diets was&#58; diet P &#40;a low-calorie diet with a high polyunsaturated fat content&#58; 45&#46;7&#37; carbohydrates&#44; 34&#46;4&#37; lipids and 19&#46;9&#37; proteins&#41; and diet M &#40;a low-calorie diet with a high monounsaturated fat content&#58; 46&#46;6&#37; carbohydrates&#44; 34&#46;1&#37; lipids and 19&#46;2&#37; proteins&#41;&#46; The distribution of fats in diet P was as follows&#58; 21&#46;8&#37; saturated fat&#44; 55&#46;5&#37; monounsaturated fat and 22&#46;7&#37; polyunsaturated fat &#40;7<span class="elsevierStyleHsp" style=""></span>g of &#969;-6 fatty acids a day&#44; 2<span class="elsevierStyleHsp" style=""></span>g&#47;day of &#969;-3 fatty acids&#44; and an &#969;6&#47;&#969;3 ratio of 3&#46;5&#41;&#46; The fat distribution in diet M was&#58; 21&#46;7&#37; saturated fat&#44; 67&#46;5&#37; monounsaturated fat and 10&#46;8&#37; polyunsaturated fat&#46; The exercise program consisted of aerobic exercise at least three times a week &#40;each session 60<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; The records of daily dietary intake on three days&#44; including a weekend day&#44; were evaluated using software &#40;Dietosource&#174;&#44; Geneva&#44; Switzerland&#41;&#46; The Spanish national food composition tables were used as reference&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">18</span></a> An investigator checked compliance with both diets every 7 days by means of a phone call&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Anthropometrics</span><p id="par0045" class="elsevierStylePara elsevierViewall">Body weight and waist circumference were measured in the morning before breakfast&#44; at the start and after three months of follow-up&#46; The body mass index was calculated using the formula &#40;body weight in kg&#47;&#91;height<span class="elsevierStyleSup">2</span> in m&#93;&#41;&#46; The waist circumference was measured at the narrowest diameter between the xiphoid process and the iliac crest&#46; Electrical bioimpedance was used to measure body composition with a precision of 50<span class="elsevierStyleHsp" style=""></span>g&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">19</span></a> Blood pressure was measured twice with a 10-min rest in between using a mercury sphygmograph&#44; and the average of the two values was calculated &#40;Omron&#44; Los Angeles&#44; CA&#44; USA&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Biochemical determinations</span><p id="par0050" class="elsevierStylePara elsevierViewall">Insulin was measured by radioimmunoassay &#40;RIA Diagnostic Corporation&#44; Los Angeles&#44; CA&#44; USA&#41; with a sensitivity of 0&#46;5<span class="elsevierStyleHsp" style=""></span>mIU&#47;l &#40;normal range 0&#46;5&#8211;30<span class="elsevierStyleHsp" style=""></span>mIU&#47;l&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">20</span></a> plasma glucose levels were measured using an automated glucose oxidase method &#40;Glucose analyser 2&#44; Beckman Instruments&#44; Fullerton&#44; CA&#44; USA&#41;&#44; and insulin resistance &#40;HOMA-IR&#41; was calculated using these values&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">21</span></a> The serum concentrations of total cholesterol and triglycerides were measured using an enzymatic colorimetric assay &#40;Technicon Instruments&#44; Ltd&#46;&#44; New York&#44; NY&#44; USA&#41;&#46; HDL-cholesterol was measured enzymatically in the supernatant after the precipitation of other lipoproteins with dextran sulphate-magnesium&#46; LDL-cholesterol was calculated using the Friedewald formula &#40;LDL-cholesterol<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>total cholesterol<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>HDL-cholesterol<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>triglycerides&#47;5&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">22</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Leptin in turn was measured by enzyme-linked immunosorbent assay &#40;ELISA&#41; &#40;Diagnostic Systems Laboratories&#44; Inc&#46;&#44; TX&#44; USA&#41;&#44; with a percentage coefficient of variation &#40;CV&#37;&#41; of 3&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">23</span></a> Resistin was measured by ELISA &#40;Biovendor Laboratory&#44; Inc&#46;&#44; Brno&#44; Czech Republic&#41;&#44; with a CV&#37; of 3&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">24</span></a> Adiponectin was measured by ELISA &#40;R&#38;D systems&#44; Inc&#46;&#44; Minneapolis&#44; USA&#41; &#40;DRP300&#41;&#44; with a CV&#37; of 3&#46;8&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">25</span></a> C-reactive protein was determined by immunoturbidimetry &#40;Roche Diagnostics GmbH&#44; Mannheim&#44; Germany&#41;&#44; with a CV&#37; of 2&#46;8&#37;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Genotyping of the polymorphism of the MTNR1B gene</span><p id="par0060" class="elsevierStylePara elsevierViewall">Genomic DNA was extracted from the buffy coat fraction of the centrifuged blood with a commercial kit &#40;Biorad&#44; LA&#44; CA&#44; USA&#41;&#46; The primers were designed with Sequenom Assay Design v4 &#40;SEQUENOM&#44; Inc&#46;&#44; San Diego&#44; CA&#44; USA&#41;&#46; Genotyping of polymorphism rs10830963 was carried out via real-time polymerase chain reaction &#40;RT-PCR&#41; analysis&#46; This polymerase chain reaction was performed with 20&#8211;25<span class="elsevierStyleHsp" style=""></span>ng of genomic DNA and 0&#46;1&#8211;0&#46;15<span class="elsevierStyleHsp" style=""></span>&#956;l of each of the oligonucleotides for rs10830963 &#40;forward primer&#58; 5&#8242;-ACGTTGGGGATGCCCCCCCCCAGTGATGCTAAGAAGAAT-3&#8242; and vice versa 5&#8242;-ACGTGGGATGGGGCATAGGCAGAATATTCCC-3&#8242; in an end volume of 2<span class="elsevierStyleHsp" style=""></span>&#956;l &#40;Thermocycler from Life Technologies&#44; LA&#44; CA&#44; USA&#41;&#46; The Hardy&#8211;Weinberg equilibrium was calculated using a statistical test &#40;chi-squared test&#41;&#46; The variant of the MTNR1B gene was in Hardy-Weinberg equilibrium &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;31&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Categorical variables were compared using the chi-squared test&#46; Numerical variables exhibiting a normal distribution were analyzed using a two-tailed Student <span class="elsevierStyleItalic">t</span>-test&#46; Nonparametric variables were analyzed using the Wilcoxon test&#46; The statistical analysis to assess the interaction between the gene and diet was based on analysis of covariance &#40;ANCOVA&#41;&#46; The statistical analysis was carried out for CG and GG combined as a group and the CC genotype as a second group&#44; with a dominant model&#46; The sample size was calculated to detect differences of more than 2&#46;5<span class="elsevierStyleHsp" style=""></span>kg in body weight loss with a statistical power of 90&#37; and a 5&#37; significance level &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>150 in each diet group&#41;&#46; Statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The SPSS version 15&#46;0 statistical package &#40;IL&#44; USA&#41; was used throughout&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">A total of 361 subjects were enrolled in the study&#46; The mean patient age was 49&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1 years &#40;range&#58; 27&#8211;67&#41;&#44; with a mean body mass index of 36&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;1<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;range&#58; 31&#46;0&#8211;39&#46;3&#41;&#46; A total of 194 patients &#40;54&#46;0&#37;&#41; had the CC genotype&#44; 142 had the CG genotype &#40;39&#46;3&#37;&#41;&#44; and 25 patients had the GG phenotype &#40;6&#46;7&#37;&#41;&#46; Patient age was similar in all three genotypes &#40;CC 49&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1 years vs&#46; CG 48&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;2 years vs&#46; GG 48&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;0 years&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ns&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the group of 177 patients treated with diet M &#40;91 subjects with the CC genotype and 86 carriers of allele G&#41;&#44; the baseline assessment of nutritional intake showed a caloric intake of 2009&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>322&#46;1<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#44; a carbohydrate intake of 199&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;day &#40;43&#46;2&#37; of the total calories&#41;&#44; a fat intake of 64&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;day &#40;33&#46;9&#37; of calories&#41;&#44; and a protein intake of 78&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;1<span class="elsevierStyleHsp" style=""></span>g&#47;day &#40;23&#46;9&#37; of the total calories&#41;&#46; During the dietary intervention&#44; these patients complied with the theoretical recommendations of diet M&#58; 1459&#46;2 calories a day &#40;45&#46;0&#37; carbohydrates&#44; 34&#46;0&#37; lipids and 21&#46;0&#37; proteins&#41;&#46; The dietary fat distribution was as follows&#58; 20&#46;4&#37; saturated fat&#44; 67&#46;8&#37; monounsaturated fat and 11&#46;8&#37; polyunsaturated fat&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the group of 184 subjects treated with diet P &#40;104 carriers of genotype CC and 80 allele G carriers&#41;&#44; the baseline assessment of nutritional intake showed a caloric intake of 1997&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>623&#46;1<span class="elsevierStyleHsp" style=""></span>kcal&#47;day&#44; a carbohydrate intake of 208&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>60&#46;9<span class="elsevierStyleHsp" style=""></span>g&#47;day &#40;43&#46;4&#37; of the total calories&#41;&#44; a fat intake of 82&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;day &#40;36&#46;3&#37; of calories&#41;&#44; and a protein intake of 88&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;1<span class="elsevierStyleHsp" style=""></span>g&#47;day &#40;20&#46;3&#37; of the total calories&#41;&#46; During the intervention&#44; these subjects complied with the theoretical recommendations of diet P&#58; 1453&#46;9 calories a day &#40;45&#46;3&#37; carbohydrates&#44; 34&#46;1&#37; lipids and 20&#46;8&#37; proteins&#41;&#46; The dietary fat distribution was as follows&#58; 20&#46;6&#37; saturated fat&#44; 53&#46;9&#37; monounsaturated fat&#44; and 23&#46;5&#37; polyunsaturated fat &#40;6&#46;8<span class="elsevierStyleHsp" style=""></span>g daily of &#969;-6 fatty acids&#44; 1&#46;9<span class="elsevierStyleHsp" style=""></span>g daily of &#969;-3 fatty acids&#44; and an &#969;6&#47;&#969;3 ratio of 3&#46;6&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the anthropometric parameters and blood pressure characteristics of the participants at the start and after three months of intervention&#46; In both genotypes&#44; body weight&#44; the body mass index&#44; body fat mass&#44; waist circumference and systolic blood pressure &#40;SBP&#41; decreased significantly&#46; After weight loss with a low-calorie diet rich in monounsaturated fat &#40;M diet&#59; WC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#41;&#44; the following parameters were seen to have decreased&#59; the BMI &#40;delta&#58; &#8722;0&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> vs&#46; &#8722;0&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; weight &#40;delta&#58; &#8722;4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>kg vs&#46; &#8722;2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>kg&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; body fat mass &#40;delta&#58; &#8722;3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>kg vs&#46; &#8722;2&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>kg&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and waist circumference &#40;delta&#58; &#8722;3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>cm vs&#46; &#8722;2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>cm&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The improvement of these variables was greater in those not carrying the G allele&#46; Following weight loss with a diet enriched with polyunsaturated fats &#40;P diet&#59; CC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#41;&#44; the following parameters also decreased&#58; the BMI &#40;delta&#58; &#8722;0&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> vs&#46; &#8722;0&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; weight &#40;delta&#58; &#8722;3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>kg vs&#46; &#8722;2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; body fat mass &#40;delta&#58; &#8722;3&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>kg vs&#46; &#8722;1&#46;4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and waist circumference &#40;delta&#58; &#8722;3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>cm vs&#46; &#8722;2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>cm&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Likewise&#44; the decrease in anthropometric parameters was greater among the patients that did not carry the G allele&#46; The systolic blood pressure values improved after both low-calorie diets&#44; regardless of the genotype &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the biochemical variables&#46; After weight loss with diet M &#40;diet M&#59; WC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#41;&#44; total cholesterol &#40;delta&#58; &#8722;10&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; &#8722;6&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; LDL-cholesterol &#40;delta&#58; &#8722;7&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; &#8722;2&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; insulin &#40;delta&#58; &#8722;3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>IU&#47;l vs&#46; &#8722;2&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>IU&#47;l&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and HOMA-IR &#40;delta&#58; &#8722;3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>units vs&#46; &#8722;2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>units&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; improved in those that did not carry the G allele&#46; After weight loss with diet P&#44; in the group of subjects without the G allele&#44; insulin levels &#40;delta &#91;CC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#93;&#58; &#8722;2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>IU&#47;l vs&#46; &#8722;0&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>IU&#47;l&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and HOMA-IR &#40;delta &#91;CC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#93;&#58; &#8722;0&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>units vs&#46; &#8722;0&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleHsp" style=""></span>units&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; also decreased&#46; In both genotypes treated with diet P&#44; cholesterol levels remained unchanged&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> reports the serum adipokine levels&#46; After weight loss with both diets &#40;M vs&#46; P&#41;&#44; those patients without the G allele showed a significant decrease in leptin levels &#40;delta&#58; &#8722;15&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&#58; ng&#47;ml vs&#46; &#8722;18&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;2<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The same improvement in leptin levels was seen in the carriers of the G allele &#40;delta&#58; &#8722;19&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1<span class="elsevierStyleHsp" style=""></span>ng&#47;ml vs&#46; &#8722;15&#46;1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>9&#46;8<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The effect upon leptin levels was independent of dietary intervention&#46; The levels of the remaining adipokines remained unchanged&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">In this short-term dietary intervention trial we detected a significant interaction between variant rs10830963 of the MTNR1B gene and dietary fat intake in relation to changes in LDL-cholesterol and total cholesterol&#46; This genetic variant of the MTNR1B gene is also related to body weight loss and the response to insulin resistance&#46; Our results show the G allele to be associated with less weight loss and insulin resistance secondary to both low-calorie diets&#44; whereas a greater decrease in total and LDL-cholesterol was observed after a low-calorie monounsaturated fat enriched diet in patients without the G allele&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Many genes in certain tissues exhibit a clear diurnal cycle&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">26</span></a> In this context&#44; the MTNR1B receptor is also involved in circadian cycles through cross-communication with the circulating hormone melatonin released by the pineal gland&#44; and which penetrates different cells&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">27</span></a> SNP rs10830963 of the MTNR1B gene has been associated with obesity and fasting glucose levels in different cross-sectional studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">28&#44;12</span></a> However&#44; few studies have evaluated the relationship between dietary intervention and this genetic variant located in MTNR1B&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">14&#44;29</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The circadian system plays an important role in the coordination of the lipid metabolic pathways through activation or repression of the genes involved in metabolism&#44; either indirectly or directly through the control of other transcription factors&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">30</span></a> In this regard&#44; melatonin is one of the chronobiotic agents used to synchronize circadian rhythms&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">31</span></a> In the field of lipid metabolism&#44; both human and animal studies have shown that the administration of melatonin can decrease lipid levels&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">32</span></a> In one study&#44; the daily administration of melatonin reduced LDL-cholesterol in subjects with metabolic syndrome<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">31</span></a> and also in patients with type 2 diabetes poorly controlled with metformin&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">33</span></a> In our current study&#44; we observed a relationship between variant rs10830963 of the MTNR1B gene and body weight loss related to energy restriction in obese individuals with both low-calorie diets&#44; as was demonstrated in two previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">12&#44;17</span></a> Carriers of the G allele showed less body weight loss and improvement in insulin and HOMA-IR than non-carriers of the G allele&#44; regardless of the type of diet involved&#46; However&#44; other studies<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">34&#8211;36</span></a> have found no association between this genetic variant of the MTNR1B gene and body weight changes following prolonged dietary interventions&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The mechanisms by which variant rs10830963 affects lipid metabolism or insulin resistance remain unknown&#46; The effect of fat in the fatty diet upon the rhythmic expression of clock gene mRNA<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">37</span></a> or the circadian rhythmic balance<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">38</span></a> has also been demonstrated in animals&#46; It is possible that the effect of the genetic variant MTNR1B upon the dynamics of melatonin expression may influence lipoprotein metabolism&#46; Goni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">17</span></a> showed dietary fat consumption to modify the effect of variant rs10830963 of the MTNR1B gene upon changes in total cholesterol and LDL-cholesterol&#44; in a way similar to our own study&#46; A meta-analysis also reported significant interactions between the MTNR1B genotype and fat consumption in relation to cholesterol levels&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">13</span></a> There is evidence that a high-fat diet could alter the mRNA expression levels of the clock genes and lipogenic genes controlled by the circadian clock&#46; For example&#44; when mice were fed a high-fat diet&#44; the rhythmic expression of these genes in the liver tissue was both over- and under-expressed&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">39</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Grotenfelt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">29</span></a> reported the relationship of this genetic variant to glucose metabolism&#46; This study showed that among women at risk of gestational diabetes mellitus&#44; those who did not carry the G allele appeared to benefit from the lifestyle intervention&#46; The G risk allele has also been linked to decreased insulin secretion in response to glucose<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">40</span></a> and to decreased insulin sensitivity&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">41</span></a> A study<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">42</span></a> observed that the G allele of rs10830963 leading to an increase in glucose levels was also associated with a decrease in pancreatic cell function &#40;HOMA-B&#41;&#46; Lastly&#44; Sparso et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">43</span></a> in subjects with the G allele&#44; demonstrated a reduction in the suppression of liver glucose production during hyperinsulinemic&#8211;euglycemic clamping&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Our study has limitations&#46; Firstly&#44; we analyzed only one SNP of the MTNR1B gene&#59; other SNPs therefore could be related to our observations&#46; Secondly&#44; short-term intervention may restrict the possibility of detecting long-term differences&#46; Thirdly&#44; we did not measure circulating melatonin levels in the study population&#44; and this could lead to a misinterpretation of our findings&#46; Lastly&#44; our sample was not necessarily representative of the general population and should be replicated in order to be extended to other ethnic groups&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In sum&#44; our study demonstrates the association between MTNR1B rs10830963 polymorphism and body weight loss induced by two different low-calorie diets&#44; and provides additional evidence of the metabolic response&#44; such as insulin resistance and fasting insulin levels&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financial support</span><p id="par0135" class="elsevierStylePara elsevierViewall">This study received no financial support&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">All patients signed an informed consent form&#44; and the protocol was approved by the local Ethics Committee&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Authorship</span><p id="par0145" class="elsevierStylePara elsevierViewall">D&#46;A&#46; de Luis wrote the article&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">O&#46; Izaola performed the nutritional assessment&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">D&#46; Primo carried out the biochemical evaluation&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">R&#46; Aller performed the statistical analysis&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and aims</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The risk allele &#40;G&#41; of rs10830963 in the melatonin receptor 1B &#40;MTNR1B&#41; gene presents an association with obesity&#46; We study the effect of this SNP on cardiovascular risk factors and weight loss secondary to 2 hypocaloric diets&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">361 obese subjects were randomly allocated during 3 months &#40;diet M &#8211; high monounsaturated fat hypocaloric diet vs&#46; diet P &#8211; high polyunsaturated fat hypocaloric diet&#41;&#46; Anthropometric parameters&#44; fasting blood glucose&#44; C-reactive protein &#40;CRP&#41;&#44; insulin concentration&#44; insulin resistance &#40;HOMA-IR&#41;&#44; lipid profile and adipocytokines levels were measured&#46; Genotype of <span class="elsevierStyleItalic">MTNR1B</span> gene polymorphism &#40;rs10830963&#41; was evaluated&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All anthropometric parameters&#44; systolic blood pressure and leptin levels decreased in all subjects after both diets&#46; This improvement of anthropometric parameters was higher in non G allele carriers than G allele carriers&#46; After dietary intervention with diet M &#40;CC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#41;&#59; total cholesterol &#40;delta&#58; &#8722;10&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; &#8722;6&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; LDL-cholesterol &#40;delta&#58; &#8722;7&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; &#8722;2&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; insulin &#40;delta&#58; &#8722;3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>UI&#47;l vs&#46; &#8722;2&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>UI&#47;l&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and HOMA-IR &#40;delta&#58; &#8722;3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>units vs&#46; &#8722;2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9<span class="elsevierStyleHsp" style=""></span>units&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; improved in no G allele carriers&#46; After diet P&#44; in the group of subjects without G allele CC&#44; insulin levels &#40;delta&#58; &#8722;2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0<span class="elsevierStyleHsp" style=""></span>UI&#47;l vs&#46; &#8722;0&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>UI&#47;l&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; and HOMA-IR &#40;delta &#40;CC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#41;&#58; &#8722;0&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2<span class="elsevierStyleHsp" style=""></span>units vs&#46; &#8722;0&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3<span class="elsevierStyleHsp" style=""></span>units&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; decreased&#44; too&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our study detected a relationship of rs10830963 <span class="elsevierStyleItalic">MTNR1B</span> SNP with body weight loss and insulin resistance modification induced by 2 different hypocaloric&#46; Only monounsaturated enriched hypocaloric diet and in no-G allele carriers showed a significant effect on lipoproteins&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El alelo de riesgo &#40;G&#41; de la variante rs10830963 en el gen del receptor de melatonina 1 B &#40;MTNR1B&#41; se relaciona con la obesidad&#46; En este trabajo evaluamos el efecto de este SNP sobre los factores de riesgo cardiovascular y la p&#233;rdida de peso secundaria a 2 dietas hipocal&#243;ricas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Trescientos sesenta y un sujetos obesos fueron asignados aleatoriamente durante 3 meses &#40;dieta M&#58; dieta hipocal&#243;rica alta en grasas monoinsaturadas vs&#46; dieta P&#58; dieta hipocal&#243;rica alta en grasas poliinsaturadas&#41;&#46; Se midieron los par&#225;metros antropom&#233;tricos&#44; glucemia en ayunas&#44; prote&#237;na C reactiva&#44; concentraci&#243;n de insulina&#44; resistencia a la insulina &#40;HOMA-IR&#41;&#44; perfil de l&#237;pidos y los niveles de adipocitoquinas&#46; Se evalu&#243; el genotipo del polimorfismo del gen MTNR1B &#40;rs10830963&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Todos los par&#225;metros antropom&#233;tricos&#44; la presi&#243;n arterial sist&#243;lica y los niveles de leptina disminuyeron en todos los sujetos despu&#233;s de ambas dietas&#46; Esta mejora de los par&#225;metros antropom&#233;tricos fue mayor en los no portadores del alelo G que en los portadores del alelo G&#46; Tras la intervenci&#243;n con dieta M &#40;CC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#41;&#44; el colesterol total &#40;delta&#58; &#8722;10&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; &#8722;6&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#58; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; colesterol LDL &#40;delta&#58; &#8722;7&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; &#8722;2&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#58; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; insulina &#40;delta&#58; &#8722;3&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>UI&#47;l vs&#46; &#8722;2&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0<span class="elsevierStyleHsp" style=""></span>UI&#47;l&#58; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y HOMA IR &#40;delta&#58; &#8722;3&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0 unidades vs&#46; &#8722;2&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;9 unidades&#58; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; mejoraron en los no portadores del alelo G&#46; Tras la dieta P&#44; en el grupo de sujetos sin alelo G&#44; los niveles de insulina &#40;delta&#58; &#8722;2&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0<span class="elsevierStyleHsp" style=""></span>UI&#47;l vs&#46; &#8722;0&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2<span class="elsevierStyleHsp" style=""></span>UI&#47;l&#58; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y HOMA-IR &#40;delta &#91;CC vs&#46; CG<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>GG&#93;&#58; &#8722;0&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2 unidades vs&#46; &#8722;0&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;3 unidades&#58; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; tambi&#233;n disminuyeron&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio detect&#243; una relaci&#243;n de la variante rs10830963 de MTNR1B con la p&#233;rdida de peso corporal y la modificaci&#243;n de la resistencia a la insulina inducida por 2<span class="elsevierStyleHsp" style=""></span>dietas hipocal&#243;ricas diferentes&#46; Solo la dieta hipocal&#243;rica enriquecida en grasa monoinsaturada y los no portadores del alelo G mostraron un efecto significativo sobre las lipoprote&#237;nas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Please cite this article as&#58; de Luis DA&#44; Izaola O&#44; Primo D&#44; Aller R&#46; Efecto del polimorfismo rs10830963 MTNR1B y la composici&#243;n de grasa de la dieta en la resistencia a la insulina tras la p&#233;rdida de peso durante 3 meses&#46; Endocrinol Diabetes Nutr&#46; 2020&#59;67&#58;43&#8211;52&#46;</p>"
      ]
    ]
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      0 => array:8 [
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at1"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; BMI&#58; body mass index&#59; DBP&#58; diastolic blood pressure&#59; SBP&#58; systolic blood pressure&#59; WC&#58; waist circumference&#46;</p>"
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                  \t\t\t\t" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3 months&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3 months&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">96&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">92&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">97&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">92&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Body fat mass &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WC &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">110&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">124&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">103&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">98&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDL-cholesterol &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HDL-cholesterol &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;78<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triglycerides &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">124&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CRP &#40;ng&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insulin &#40;mIU&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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ISSN: 25300180
Original language: English
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2021 July 21 9 30
2021 June 24 6 30
2021 May 29 17 46
2021 April 78 13 91
2021 March 19 9 28
2021 February 28 10 38
2021 January 9 9 18
2020 December 10 10 20
2020 November 13 9 22
2020 October 13 9 22
2020 September 12 10 22
2020 August 16 15 31
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos