Association between osteoporosis treatment and severe periodontitis in postmenopausal women.

OBJECTIVE: To estimate the association between osteoporosis treatment and severe periodontitis in postmenopausal women. METHODS: This cross-sectional study comprised of 492 postmenopausal women, 113 women in osteoporosis treatment, and 379 not treated. Osteoporosis treatment consisted of systemic estrogen alone, or estrogen plus progestin, and calcium and vitamin D supplements, for at least 6 months. Severe periodontitis was defined as at least two interproximal tooth sites with clinical attachment loss of at least 6 mm, and at least one interproximal site with probing depth of at least 5 mm; and dental caries experience was measured using the decayed, missing, and filled teeth (DMFT) index. Analysis included descriptive statistics and Poisson multivariate analysis with robust variance. RESULTS: Women receiving osteoporosis treatment had less periodontal probing depth, less clinical attachment loss, and less gingival bleeding than women not receiving treatment for osteoporosis (P ≤ 0.05). In the osteoporosis treatment group, the estimated mean DMFT index score was approximately 20, the most frequent component being the number of missing teeth, and in the nontreated group, the DMFT index was approximately 19. The prevalence of severe periodontitis was 44% lower in the osteoporosis treatment group than in the nontreatment group. The prevalence ratioadjusted was 0.56, 95% confidence interval was 0.31 to 0.99 (P = 0.05), after adjustments for smoking, age, family income, and visit to the dentist. CONCLUSIONS: The results suggest that women treated with estrogen for postmenopausal osteoporosis have a lower prevalence of severe periodontitis than women not receiving treatment.

Prognostic value of endothelial dysfunction in type 1 diabetes mellitus.

Patients with diabetes mellitus are at high risk of developing atherosclerosis, associated with higher rates of micro and macro vascular involvement such as coronary artery disease and renal disease. The role of hyperglycemia to induce synthesis of reactive oxygen species by the oxidation of glucose, leading to an increased production of advanced glycosylation end products, as well as inflammation and oxidative stress has been proposed as a possible mechanism in the pathogenesis of endothelial dysfunction (ED). The interaction between C-peptide - the connecting segment of pro-insulin-and nitric oxide in vasodilation is also discussed. Therefore, endothelial dysfunction has been identified as an early marker of vascular disorder in type 1 and type 2 diabetes mellitus. In some other diseases, ED has been considered an independent predictor of vascular disease, regardless of the method used. Studies have demonstrated the importance of endothelial dysfunction as an useful tool for identifying the risk of vascular complications in patients with type 1 diabetes mellitus, particularly as regards to renal impairment. The aim of this review is to clarify the prognostic value of endothelial dysfunction as a marker of vascular disease in these subjects.

Adherence to nutritional therapy in obese adolescents; a review.

Considering the controversies existent on the subject, the aim of this review is to discuss adherence to diet in obese adolescents. The selection of articles was made in the SCOPUS, COCHRANE, APA Psyc Net, SciELO, LILACS, CAPES Journals, PUBMED/MEDLINE and GOOGLE ACADEMIC databases. Studies published between 2002 and 2012 were selected. There was lack of evidence of conceptual discussion about adherence to diet in obesity in the child-youth context, in addition to scarcity of data on adherence to diet itself in obese adolescents and the methods of evaluating this. Lastly, multiple interdependent factors were found which both facilitated and made the process of adherence to diet difficult for obese youngsters. The majority of these (factors) belong to the socioeconomic and cultural dimension, in addition to pointing out cognitive and psychological factors and those associated with health services and professionals.

Considerando las actuales controversias sobre el tema, el objetivo de esta revisión es discutir la adhesión a la dieta en adolescentes obesos. Los artículos publicados entre 2002 y 2012 fueron seleccionados en las siguientes basis de datos SCOPUS, COCHRANE, APA Psyc Net, SciELO, LILACS, Revistas CAPES, PubMed/MEDLINE y GOOGLE ACADÉMICO. Observa-se ausencia de discusión conceptual sobre el tema, así como escasez de datos sobre adherencia a la dieta en adolescentes obesos y de métodos de evaluación para aferir esta adherencia. Por último, fueron identificados varios factores ínter-dependientes que facilitan y obstaculizan la adhesión a la dieta en jóvenes obesos. La mayoría de estas dimensiones se refieren a los factores socio-económicos y culturales, además de los cognitivos, psicológicos y aquellos relacionados con los servicios de salud y los profesionales.

The influence of weight excess on the postprandial lipemia in adolescents.

BACKGROUND: Postprandial lipemia (PL) in adults has been extensively studied, but little explored in youth. The aim of this study was to evaluate the influence of weight excess on postprandial lipemia in adolescents. METHODS: Eighty-three adolescents were classified into Groups 1 (n= 49, overweight) and 2 (n=34, eutrophic). Total cholesterol (TC), triglycerides (TG), HDL and LDL cholesterol were measured before, 2 and 4 hours after a standardized 25 g lipid and 25 g of carbohydrate test meal; glycemia and insulin measured only at baseline. Anthropometric evaluation was performed. RESULTS: Basal TG were higher in Group 1 (p= 0.022). The total increase (Δ-TG), corresponding to the difference between the maximum and the basal TG level was similar in both groups (29.8 ± 21.5 mg/dl vs. 28.2 ± 24.5 mg/dl, p= 0.762). TC, HDL and LDL did not change significantly throughout the test. By analyzing all the adolescents together, the waist circumference was positively correlated with TG at fasting (r = 0.223; p= 0.044) and at 4 hours (r = 0.261; p= 0.019). Only overweight adolescents with hypertriglyceridemia, who also had higher HOMA-IR, presented significant elevation of TG levels 2 and 4 hours after the overload. CONCLUSION: The behavior of lipoproteins in the post-prandial state is similar in eutrophic and overweight adolescents. Thus, apparently the weight excess does not induce post prandial lipemic alterations.

Autoimmune endocrine disorders and coeliac disease in children and adolescents with juvenile idiopathic arthritis and rheumatic fever.

OBJECTIVES: There have been few studies on the association between childhood autoimmune and rheumatic diseases. Therefore, this study aims to assess the frequency of autoimmune thyroiditis (AT), coeliac disease (CD) and type 1 diabetes mellitus (T1DM) in children and adolescents with juvenile idiopathic arthritis (JIA) and rheumatic fever (RF). METHODS: This cross-sectional study includes 53 patients with JIA, 66 patients with RF and 40 healthy subjects controls. All subjects were evaluated for thyrotropin (TSH), triiodothyronine (T3), free thyroxine (FT4), antithyroglobulin (Tg) and antiperoxidase antibodies, fasting glucose, C-peptide, anti-glutamic acid decarboxylase (GAD), anti-islet cell (IA) and antitransglutaminase IgA (tTG) antibodies. Patients with thyroid dysfunction, positive anti-thyroid antibodies or tTG underwent thyroid ultrasonography and jejunal biopsy, respectively. RESULTS: In group 1 (n=53), 21 patients presented thyroid disorders (40%; 42% oligoarticular), either subclinical hypothyroidism (13%) or positive anti-thyroid antibodies (26%, 50% oligoarticular), significantly higher than in control group (p<0.009, OR=10.5, CI 1.29-85.2). In group 2 (n=66), thyroid disorders were identified in 11 patients, four (6%) with subclinical hypothyroidism and seven (11%) with positive anti-thyroid antibodies (p=0.06, compared with the control group). There were no cases of clinical overt hypothyroidism, positive anti-GAD or anti-IA, nor changes in serum C-peptide and glycemia. CD was confirmed in one patient from each group. CONCLUSIONS: Patients with JIA (especially the oligoarticular form) and RF should be investigated for thyroid dysfunction. Longitudinal studies could establish screening protocols for CD in patients with JIA and RF. The cost-effectiveness of T1DM screening is not justified in this population.

C-reactive protein and metabolic syndrome in youth: a strong relationship?

OBJECTIVE: Metabolic syndrome (MS) is on the rise in youth. As high-sensitivity C-reactive protein (hs-CRP) is associated with cardiovascular/metabolic disorders, we evaluated the association between MS and its components and hs-CRP in a sample of Brazilian overweight and obese youth. METHODS AND PROCEDURES: A total of 407 students (229 girls, 273 with excessive weight, 11.3+/-3.2 years) were evaluated. Measurement included BMI, waist circumference (WC), blood pressure, lipids, insulin, and hs-CRP. Excessive weight was defined using BMI z -score; MS by the modified National Cholesterol Education Program-Adult Treatment Panel III. RESULTS: Subjects were classified into two groups: with MS (n=72) and without (n=335). hs-CRP means and medians were higher in MS group (1.41 mg/l vs. 1.06 mg/l, P<0.001; 2.21 mg/l vs. 1.23 mg/l, P<0.001). Associations between hs-CRP quartiles and insulin resistance (IR) (P<0.001), MS (P<0.001), WC (P<0.000), BMI z-score (P<0.001), hypertension (P<0.001), hypertriglyceridemia (P<0.001), and low HDL-c (P=0.023) were significant; adjustment of hs-CRP for BMI z-score eliminated the previous association, except for the number of MS components (nMSc) (P<0.001). Adjusting for homeostasis model assessment method of IR (HOMA-IR) did not eliminate the relation between hs-CRP and MS components. Furthermore, increases in BMI z-score and nMSc were associated with an increased hs-CRP. Excessive weight (odds ratio (OR), 7.9; confidence interval (CI), 4.7-13.4; P=0.000), hypertension (OR, 2.3; CI, 1.3-4.2; P=0.003), and hypertriglyceridemia (OR, 2.3; CI, 1.5-3.7; P<0.001) were independently associated with hs-CRP. DISCUSSION: In youth, hs-CRP is strongly related with MS and its components, and is also determined by the body composition. This association indicates a precocious proinflammatory state.

Prevalência de doenças da tireóide em uma comunidade do nordeste brasileiro / Prevalence of thyroid disease in a northeast brazilian community

Foram estudadas a prevalência de tireopatias e as características clínico-laboratoriais de 210 habitantes do município de Cabaceiras, Paraíba, classificados em: 1) grupo de estudo (n=122), pacientes da área rural, com queixas e/ou quadro clínico de doença tireoideana; 2) grupo exploratório (n=88), voluntários da área urbana, sem queixas. A investigação constou de exame clínico, dosagens hormonais (TSH, T3, T4 livre), pesquisa de anticorpo anti-microssomal (AAM) e ultrasonografia da tireóide. Na população estudada, 79 por cento (n=166) era do gênero feminino e com média de idade de 31,3ñ20,1 anos (3-85). No grupo 1, as prevalências de hipotireoidismo (12,3 por cento e hipertireoidismo (7,3 por cento) foram similares às encontradas no grupo 2 (15,9 por cento e 4,5 por cento, respectivamente). A positividade isolada do AAM foi detectada em 20 por cento (43/210); desses, 26 eram da área urbana. 42 por cento dos pacientes da área rural apresentaram alterações tireoideanas à USG, com predomínio de bócio difuso atóxico (30,7 por cento). Em conclusão, a prevalência de portadores de tireopatias no município é alta, mesmo entre voluntários sem queixas. Diversos fatores de origem genética e/ou ambiental podem estar envolvidos, justifican-do a realização de estudos futuros, inclusive aqueles associados à iodúria.