Practical Dermatology
Psoriasis and Obesity: A Review and Practical Recommendations
Psoriasis y obesidad: revisión y recomendaciones prácticas
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Farías, V. Serrano, C. de la Cruz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.M." "apellidos" => "Farías" "email" => array:1 [ 0 => "mmfarias@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "V." "apellidos" => "Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "de la Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Nutrición, Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Psoriasis y obesidad: revisión y recomendaciones prácticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">It has recently been found that patients with psoriasis have a higher prevalence of certain metabolic disorders considered to be cardiovascular risk factors,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> particularly obesity, diabetes or impaired glucose tolerance, dyslipidemias, and systemic hypertension, which together are known as the metabolic syndrome.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Psoriasis is now also considered to be a marker of increased risk of myocardial infarction in young patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Obesity is a chronic disease characterized by excess weight due to increased energy deposits in the form of fat. Specifically, this excess weight due to an increase in body fat mass is described in relation to the height of the patient, and the diagnosis of overweight is established using the body mass index (BMI), defined as the weight in kilograms divided by the square of the height in meters. The World Health Organization<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> currently recommends classification of the adult population into the following categories according to BMI cutoff points: normal, 18.5 to 24.9 kg/m<span class="elsevierStyleSup">2</span>; overweight, 25 to 29.9<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>; and obese, greater than 30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Obesity is a growing epidemic worldwide.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Both overweight and obesity have increased in Spain in recent years.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The close association between obesity and higher mortality, as well as the increased risk of developing type 2 diabetes, systemic hypertension, dyslipidemia, cardiovascular disease, and cancer, among other diseases, makes obesity a major public health problem.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The association between obesity and certain skin diseases has been extensively studied and demonstrated<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a>; in the case of psoriasis, it was first detected in epidemiological studies conducted in Europe.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> In 1986, a Scandinavian study revealed a higher prevalence of obesity in women with psoriasis than in other women.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Later, Herron<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> provided further evidence of this association when he detected a higher probability of developing obesity in his cohort of 500 patients with psoriasis than in the rest of the population of the state of Utah, United States (34% vs 18%; <span class="elsevierStyleItalic">P</span><.001). Based on their findings, those authors suggested obesity was a consequence of psoriasis rather than a risk factor for the skin disease. In addition, a study by Neimann<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> demonstrated that the risk of obesity was higher in patients with severe psoriasis (odds ratio [OR],<span class="elsevierStyleHsp" style=""></span>1.8) than in those with moderate psoriasis (OR,<span class="elsevierStyleHsp" style=""></span>1.3).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The idea of a connection between nutrition and the clinical course of psoriasis arose when symptomatic improvement was observed during periods of fasting or lower calorie intake.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The Bardazzi research group,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> with a sample of 33 patients with moderate to severe psoriasis, reported a greater response to biological therapy in those patients who reduced their BMI, even with reductions of as little as 5<span class="elsevierStyleHsp" style=""></span>kg body weight over 8 months of follow-up. In a study performed in Croatia involving 82 patients with a 10-year history of psoriasis vulgaris treated using standard topical treatment, 40 patients received the usual hospital diet and 42 received a low-calorie diet.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> After 4 weeks, the low-calorie-diet group showed a statistically significant improvement in their skin lesions compared to the control group. In another study involving 61 obese patients with moderate or severe psoriasis on treatment with low-dose ciclosporin, the response to the drug was considerably better in the group receiving a low-calorie diet (reduction of 500<span class="elsevierStyleHsp" style=""></span>kcal/day) than in the control group with no change in calorie intake.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Those studies coincide in proposing a low-calorie diet as coadjuvant therapy in the management of psoriasis. It would therefore be interesting to reach a better understanding of this association and to develop useful tools for the nutritional management of these patients in the dermatology clinic.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Obesity and Inflammation</span><p id="par0035" class="elsevierStylePara elsevierViewall">Obesity is currently considered to be a low-grade chronic inflammatory disease characterized by an elevation of the plasma levels of proinflammatory cytokines, such as tumor necrosis factor (TNF) α and interleukin (IL) 6, and of acute-phase proteins such as C-reactive protein (CRP).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The association of psoriasis with obesity may be explained by the specific inflammatory activity of the adipocytes. Adipose tissue, typically thought of as an energy store, is able to communicate with the rest of the body through the secretion of adipokines, which are molecules with proinflammatory, thrombotic, and vasoactive properties.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Particularly important adipokines are TNF-α, plasminogen activator inhibitor 1, IL-6, and leptin. There is also a fall in the levels of adiponectin, a cytokine with anti-inflammatory activity.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> These signals attract macrophages to the adipose tissue. After entering the adipose tissue, mature macrophages maintain the cytokine secretion, leading to a local primary inflammatory response. The cytokines subsequently trigger the production of inflammatory proteins in the liver, thus causing the low-grade systemic inflammatory state observed in obesity.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Cytokines also increase lipolysis, leading to a constant release of free fatty acids from the adipose tissue into the peripheral circulation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Free fatty acids are considered to be an important link between adipose tissue activity and chronic inflammation as they can increase oxidative stress and thus augment the inflammatory environment and vascular activity.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It should be noted that predominantly central obesity, compared with a peripheral distribution of fat, is associated with a large amount of visceral fat. Adipocytes in the visceral fat are metabolically more active and they release larger quantities of cytokines and fatty acids. This would lead us to expect an even more active inflammatory environment in patients with abdominal obesity.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Foods have also been implicated in inflammation. Aijada et al<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> showed that eating fast food (900<span class="elsevierStyleHsp" style=""></span>kcal, rich in fats and simple sugars) could lead to an increase in inflammatory factors such as CRP. This effect would be mediated by the activation of the nuclear factor kappa B (NF-κB) present in the white blood cells; the transcriptional activity of NF-κB is related to the release of free oxygen radicals and cytokines with inflammatory activity. This same effect was observed after administering an intravenous infusion of triglycerides to healthy individuals.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It has been suggested that the inflammatory state associated with obesity is the link between various pathological conditions that make up the metabolic syndrome.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The effect of the cytokines on insulin sensitivity in the liver<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and muscle<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> has been studied extensively, whereas the association between psoriasis and obesity has only been demonstrated clinically in recent decades,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a> and there has been no detailed study of the molecular mechanisms involved. However, psoriasis and obesity are both inflammatory disorders, and the pathophysiological changes, including inflammatory pathways and elevated cytokine levels, are similar in the 2 conditions.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> From this point of view, it would appear reasonable to suggest that a reduction in energy intake, with the consequent weight loss, could contribute positively to reducing the proinflammatory state and improving the clinical course of obese patients with psoriasis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Recommendations</span><p id="par0055" class="elsevierStylePara elsevierViewall">The high prevalence of comorbid diseases in patients with psoriasis means that they would benefit from a holistic approach with multisystem management.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> It is particularly important to stratify patients according to their cardiovascular risk. For this purpose, the National Psoriasis Foundation<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> recommends adherence to the current guidelines for screening and goals for cardiovascular risk factors established by the American Heart Association (AHA)(<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Those guidelines have been modified with lower cutoff points for cholesterol levels in patients with high cardiovascular risk. Specialist consultation is recommended in these cases in order to avoid any delay in the initiation of aggressive management of the metabolic parameters.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">All patients, and particularly those with a BMI over 25, should be instructed in nonpharmacological measures aimed at lifestyle changes. The objective is to achieve healthy eating habits that can be maintained over time and that will result in controlled weight loss. A low-calorie diet based on the Step 1 diet (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) should be recommended.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> This diet involves reducing total calorie intake by 500 to 1000<span class="elsevierStyleHsp" style=""></span>kcal per day, depending on the patient's energy expenditure. An individual's energy expenditure at rest can be calculated using measurement techniques, such as indirect calorimetry, or mathematical formulae, the most widely used of which is the Harris-Benedict formula (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), which takes into account parameters such as sex, age, and height.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> To achieve good adherence to the dietary therapy, we recommend application of the practical recommendations proposed by the AHA (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Patients with severe obesity (BMI >40) should be referred to a specialist to consider surgical treatment. The effectiveness of this type of procedure in the remission of comorbid conditions and in the long-term maintenance of body weight makes it the treatment of choice in patients with severe obesity.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> There have recently been case reports describing patients with psoriasis whose lesions have shown a marked improvement within months of undergoing gastric bypass surgery.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37,38</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Physical activity should be indicated on an individual basis according to age, tolerance, preference, etc.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Ideally, patients should start with 30<span class="elsevierStyleHsp" style=""></span>minutes of physical activity 3 times a week,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> but a metabolic effect with major benefit is obtained with at least 150<span class="elsevierStyleHsp" style=""></span>minutes of moderately intense physical activity per week.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Furthermore, patients must stop smoking, as this is known to exacerbate psoriasis.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Specialist management is essential when comorbid psychiatric and psychological conditions are detected.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Finally, current evidence indicates that it is essential to take all comorbid metabolic conditions into account before deciding which pharmacological therapy to prescribe for psoriasis.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Conditions such as obesity and nonalcoholoic fatty liver or steatohepatitis are relative contraindications for the use of methotrexate, due to the risk of hepatic toxicity.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42,43</span></a> Some immunomodulating biologic agents, such as alefacept, etanercept, and ustekinumab, are less effective in obese patients, whereas others, such as infliximab, whose dose must be adjusted according to the BMI, maintain their effectiveness.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> In addition, obesity, hypertension, and dyslipidemia interfere with the use of ciclosporin as they increase the risk of nephrotoxicity.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41,44</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Conventional psoriasis treatments are based on the severity of the disease. The need for safe and effective treatments has led to a search for modifiable factors that could improve the response to conventional therapy.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The pathophysiology of psoriasis and of obesity have common inflammatory pathways and cytokine activation.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> Clinical studies have strengthened the idea that weight loss could have an additional therapeutic effect in the conventional treatment of obese patients with psoriasis, particularly in those with moderate to severe disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Furthermore, psoriasis should be considered to be a specific cardiovascular risk factor. A higher incidence of ischemic events has been reported in these patients independently of their other cardiovascular risk factors.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,47</span></a> A possible benefit in the reduction of cardiovascular risk has also been attributed to immunomodulatory treatment with TNF-α inhibitors.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> We hope that the international guidelines for cardiovascular risk prevention will take these findings into consideration in the future.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Education regarding modifiable factors (healthy eating, maintenance of an appropriate weight, physical activity, and quitting smoking) is therefore essential in the treatment of this disease and is one of the primary interventions that can affect the prognosis of patients with psoriasis.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres95353" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82513" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95354" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82514" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Obesity and Inflammation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Recommendations" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-01-26" "fechaAceptado" => "2011-03-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82513" "palabras" => array:3 [ 0 => "Psoriasis" 1 => "Obesity" 2 => "Inflammation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82514" "palabras" => array:3 [ 0 => "Psoriasis" 1 => "Obesidad" 2 => "Inflamación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epidemiological studies have shown that patients with psoriasis have a higher risk of developing certain metabolic disorders, particularly obesity. Psoriasis and obesity are linked through a common pathophysiological mechanism of chronic low-grade inflammation. Not only is obesity associated with a higher incidence of psoriasis and greater severity, but it also affects response to treatment. The dermatologic management of these patients must therefore take their overall metabolic situation into consideration. We present a review of the recent literature on this subject and practical recommendations on the management of this group of patients, including relevant additional tests and advice on diet and a healthy lifestyle.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A través de estudios epidemiológicos se ha identificado un mayor riesgo de desarrollar algunas alteraciones metabólicas en los pacientes con psoriasis, dentro de las cuales destaca la obesidad. La obesidad y la psoriasis estarían vinculadas mediante un mecanismo fisiopatológico común, que se explica por una inflamación crónica de bajo grado. No sólo la obesidad se asocia con una mayor incidencia y severidad de la psoriasis, sino que también afecta su respuesta al tratamiento. Como consecuencia, la aproximación dermatológica hacia estos pacientes debiera contemplar su condición metabólica global. Se presenta una revisión actual de la literatura con respecto a este nuevo tema, así como recomendaciones prácticas para ser consideradas en este grupo de pacientes, tales como exámenes complementarios, consejo nutricional y de hábitos de estilo de vida saludables.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Farías MM, et al. Psoriasis y obesidad: revisión y recomendaciones prácticas. Actas Dermosifiliogr. 2011;102:505-9.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Objective \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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 \t\t\t\t">Blood pressure \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 \t\t\t\t">Measure at least every 2 years \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 \t\t\t\t"><120/80<span class="elsevierStyleHsp" style=""></span>mm Hg \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Body mass index \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 \t\t\t\t">Calculate at least every 2 years \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 \t\t\t\t">< 25 kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Abdominal circumference \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 \t\t\t\t">Measure at least every 2 years \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 \t\t\t\t"><88<span class="elsevierStyleHsp" style=""></span>cm in women, <102<span class="elsevierStyleHsp" style=""></span>cm in men \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Fasting lipid profile \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 \t\t\t\t">Request analyses at least every 5 years, or every 2 years in smokers and in patients with a personal or family history of dyslipidemia \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 \t\t\t\t">Total cholesterol, <200 mg/dL; HDL-C, >50 mg/dL; optimal LDL-C, <100 mg/dL; near optimal, 100-129 mg/dL; borderline high, 130-159 mg/dL; high, 160-189 mg/dL; very high, >190 mg/dL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Fasting blood glucose \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 \t\t\t\t">Request analysis at least every 5 years, or every 2 years in patients with risk factors \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 \t\t\t\t"><100 mg/dL \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab181801.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">American Heart Association Proposed Recommendations for the Detection of Cardiovascular Risk Factors.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Nutrient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Recommended Intake \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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 \t\t\t\t">Calories \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 \t\t\t\t">Reduction of approximately 500 to 1000<span class="elsevierStyleHsp" style=""></span>kcal per day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Total fat \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 \t\t\t\t">30% or less of the total calorie intake \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Saturated fat \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 \t\t\t\t">8% to 10% of the total calorie intake \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Monounsaturated fat \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 \t\t\t\t">Up to 15% of the total calorie intake \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Polyunsaturated fat \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 \t\t\t\t">Up to 10% of the total calorie intake \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Total cholesterol \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 \t\t\t\t">Less than 300<span class="elsevierStyleHsp" style=""></span>mg per day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Protein \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 \t\t\t\t">Approximately 15% of the total calorie intake \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Carbohydrate \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 \t\t\t\t">At least 55% of the total calorie intake \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Sodium \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 \t\t\t\t">Not more than 100 mmoL/day (approximately 2.4<span class="elsevierStyleHsp" style=""></span>g of sodium) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Calcium \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 \t\t\t\t">1000 to 1500<span class="elsevierStyleHsp" style=""></span>mg per day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Fiber \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 \t\t\t\t">20 to 30<span class="elsevierStyleHsp" style=""></span>g per day \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab181802.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The Low-Calorie Step I Diet.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><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 \t\t\t\t">Men \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 \t\t\t\t">Energy expenditure (kcal)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>66<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>(13.7 x weight [kg])<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>(5 x height [cm])<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>(6.8 x age [y]) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Women \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 \t\t\t\t">Energy expenditure (kcal)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>665<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>(9.6 x weight [kg])<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>(1.8 x height [cm])<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>(4.7 x age [y]) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab181804.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Basal Metabolic Rate According to the Harris-Benedict Formula.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><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 \t\t\t\t">Eat a diet rich in fruit and vegetables \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Choose whole-grain, high-fiber foods \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Eat fish, particularly oily fish, at least twice a week \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Choose lean meat and vegetarian alternatives, use fat-free dairy products, and minimize the intake of partially hydrogenated fat \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Avoid drinks and juices with added sugar \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">Choose and prepare foods with little salt \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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 \t\t\t\t">If you consume alcohol, do so in moderation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab181803.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">American Heart Association Nutrition Committee Practical Recommendations to Keep to a Healthy Diet.</p>" ] ] ] 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 11 | 19 |
| 2024 Octubre | 75 | 48 | 123 |
| 2024 Septiembre | 66 | 18 | 84 |
| 2024 Agosto | 106 | 55 | 161 |
| 2024 Julio | 78 | 30 | 108 |
| 2024 Junio | 101 | 44 | 145 |
| 2024 Mayo | 91 | 32 | 123 |
| 2024 Abril | 80 | 35 | 115 |
| 2024 Marzo | 88 | 21 | 109 |
| 2024 Febrero | 62 | 29 | 91 |
| 2024 Enero | 60 | 41 | 101 |
| 2023 Diciembre | 57 | 18 | 75 |
| 2023 Noviembre | 81 | 40 | 121 |
| 2023 Octubre | 59 | 31 | 90 |
| 2023 Septiembre | 57 | 30 | 87 |
| 2023 Agosto | 45 | 14 | 59 |
| 2023 Julio | 65 | 31 | 96 |
| 2023 Junio | 47 | 20 | 67 |
| 2023 Mayo | 65 | 32 | 97 |
| 2023 Abril | 43 | 19 | 62 |
| 2023 Marzo | 64 | 21 | 85 |
| 2023 Febrero | 64 | 24 | 88 |
| 2023 Enero | 37 | 32 | 69 |
| 2022 Diciembre | 64 | 45 | 109 |
| 2022 Noviembre | 54 | 28 | 82 |
| 2022 Octubre | 40 | 20 | 60 |
| 2022 Septiembre | 26 | 41 | 67 |
| 2022 Agosto | 15 | 30 | 45 |
| 2022 Julio | 19 | 36 | 55 |
| 2022 Junio | 23 | 27 | 50 |
| 2022 Mayo | 55 | 44 | 99 |
| 2022 Abril | 61 | 36 | 97 |
| 2022 Marzo | 64 | 52 | 116 |
| 2022 Febrero | 58 | 37 | 95 |
| 2022 Enero | 62 | 40 | 102 |
| 2021 Diciembre | 41 | 47 | 88 |
| 2021 Noviembre | 40 | 49 | 89 |
| 2021 Octubre | 39 | 49 | 88 |
| 2021 Septiembre | 28 | 35 | 63 |
| 2021 Agosto | 29 | 36 | 65 |
| 2021 Julio | 25 | 26 | 51 |
| 2021 Junio | 44 | 31 | 75 |
| 2021 Mayo | 40 | 43 | 83 |
| 2021 Abril | 53 | 33 | 86 |
| 2021 Marzo | 51 | 30 | 81 |
| 2021 Febrero | 35 | 34 | 69 |
| 2021 Enero | 52 | 29 | 81 |
| 2020 Diciembre | 42 | 17 | 59 |
| 2020 Noviembre | 29 | 16 | 45 |
| 2020 Octubre | 38 | 11 | 49 |
| 2020 Septiembre | 42 | 19 | 61 |
| 2020 Agosto | 32 | 30 | 62 |
| 2020 Julio | 25 | 13 | 38 |
| 2020 Junio | 44 | 33 | 77 |
| 2020 Mayo | 29 | 31 | 60 |
| 2020 Abril | 39 | 14 | 53 |
| 2020 Marzo | 37 | 20 | 57 |
| 2020 Febrero | 5 | 6 | 11 |
| 2020 Enero | 0 | 18 | 18 |
| 2019 Diciembre | 2 | 29 | 31 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 4 | 3 | 7 |
| 2019 Agosto | 0 | 4 | 4 |
| 2019 Julio | 0 | 5 | 5 |
| 2019 Junio | 2 | 27 | 29 |
| 2019 Mayo | 1 | 27 | 28 |
| 2019 Abril | 0 | 19 | 19 |
| 2019 Marzo | 2 | 10 | 12 |
| 2019 Febrero | 2 | 22 | 24 |
| 2019 Enero | 4 | 2 | 6 |
| 2018 Diciembre | 3 | 1 | 4 |
| 2018 Noviembre | 3 | 3 | 6 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 1 | 3 |
| 2018 Agosto | 0 | 8 | 8 |
| 2018 Julio | 0 | 4 | 4 |
| 2018 Junio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 6 | 6 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 0 | 4 | 4 |
| 2018 Febrero | 33 | 15 | 48 |
| 2018 Enero | 55 | 8 | 63 |
| 2017 Diciembre | 45 | 11 | 56 |
| 2017 Noviembre | 33 | 10 | 43 |
| 2017 Octubre | 29 | 8 | 37 |
| 2017 Septiembre | 35 | 9 | 44 |
| 2017 Agosto | 51 | 19 | 70 |
| 2017 Julio | 48 | 16 | 64 |
| 2017 Junio | 62 | 27 | 89 |
| 2017 Mayo | 59 | 25 | 84 |
| 2017 Abril | 61 | 13 | 74 |
| 2017 Marzo | 41 | 14 | 55 |
| 2017 Febrero | 37 | 25 | 62 |
| 2017 Enero | 25 | 13 | 38 |
| 2016 Diciembre | 47 | 9 | 56 |
| 2016 Noviembre | 58 | 10 | 68 |
| 2016 Octubre | 42 | 25 | 67 |
| 2016 Septiembre | 54 | 21 | 75 |
| 2016 Agosto | 58 | 6 | 64 |
| 2016 Julio | 47 | 11 | 58 |
| 2016 Junio | 9 | 7 | 16 |
| 2016 Mayo | 7 | 7 | 14 |
| 2016 Abril | 6 | 7 | 13 |
| 2016 Marzo | 10 | 3 | 13 |
| 2016 Febrero | 8 | 15 | 23 |
| 2016 Enero | 10 | 12 | 22 |
| 2015 Diciembre | 5 | 1 | 6 |
| 2015 Noviembre | 4 | 2 | 6 |
| 2015 Octubre | 14 | 1 | 15 |
| 2015 Septiembre | 5 | 1 | 6 |
| 2015 Agosto | 11 | 7 | 18 |
| 2015 Julio | 56 | 7 | 63 |
| 2015 Junio | 46 | 6 | 52 |
| 2015 Mayo | 109 | 14 | 123 |
| 2015 Abril | 76 | 7 | 83 |
| 2015 Marzo | 65 | 13 | 78 |
| 2015 Febrero | 61 | 17 | 78 |
| 2015 Enero | 26 | 11 | 37 |
| 2014 Diciembre | 43 | 15 | 58 |
| 2014 Noviembre | 32 | 14 | 46 |
| 2014 Octubre | 55 | 15 | 70 |
| 2014 Septiembre | 41 | 13 | 54 |
| 2014 Agosto | 44 | 15 | 59 |
| 2014 Julio | 51 | 23 | 74 |
| 2014 Junio | 52 | 11 | 63 |
| 2014 Mayo | 63 | 21 | 84 |
| 2014 Abril | 59 | 11 | 70 |
| 2014 Marzo | 61 | 30 | 91 |
| 2014 Febrero | 56 | 35 | 91 |
| 2014 Enero | 61 | 19 | 80 |
| 2013 Diciembre | 66 | 17 | 83 |
| 2013 Noviembre | 42 | 24 | 66 |
| 2013 Octubre | 59 | 28 | 87 |
| 2013 Septiembre | 22 | 22 | 44 |
| 2013 Agosto | 10 | 15 | 25 |
| 2013 Julio | 7 | 29 | 36 |
| 2013 Junio | 7 | 35 | 42 |
| 2013 Mayo | 10 | 25 | 35 |
| 2013 Abril | 11 | 24 | 35 |
| 2013 Marzo | 13 | 12 | 25 |
| 2013 Febrero | 18 | 8 | 26 |
| 2013 Enero | 20 | 8 | 28 |
| 2012 Diciembre | 14 | 4 | 18 |
| 2012 Noviembre | 0 | 7 | 7 |
| 2012 Octubre | 4 | 6 | 10 |
| 2012 Septiembre | 2 | 0 | 2 |
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