RESUMO
INTRODUCTION: Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight ≤ 10 was 14.8 %. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.
INTRODUCCIÓN: Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón no está clara. El objetivo es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional. Evaluamos: IMC antes del embarazo, aumento de peso materno total, aumento de peso durante tercer trimestre, semana gestacional de inicio y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (≤ 10) y grande para la edad gestacional (> 90). Resultados: el porcentaje de recién nacidos con peso ≤ 10 fue 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0,06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento la madre dejó de ganar 0,13 ± [(- 0,15)-(- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg versus 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su influir en el peso neonatal.
Assuntos
Peso ao Nascer , Diabetes Gestacional/dietoterapia , Diabetes Gestacional/tratamento farmacológico , Ganho de Peso na Gestação , Insulina/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Terceiro Trimestre da Gravidez , Estudos RetrospectivosAssuntos
Hiperparatireoidismo/diagnóstico por imagem , Osteíte Deformante/complicações , Adenoma/sangue , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Fosfatase Alcalina/sangue , Densidade Óssea , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/etiologia , Difosfonatos/uso terapêutico , Feminino , Humanos , Hipercalcemia/etiologia , Hiperparatireoidismo/sangue , Hiperparatireoidismo/complicações , Imidazóis/uso terapêutico , Osteíte Deformante/sangue , Osteoporose/sangue , Osteoporose/diagnóstico por imagem , Osteoporose/tratamento farmacológico , Osteoporose/etiologia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia , Cintilografia , Ácido ZoledrônicoRESUMO
OBJECTIVE: To study the prevalence of hyperuricemia in children with overweight or obesity and analyze the relation with metabolic syndrome and the diseases that define it. MATERIALS AND METHODS: This is a cross-sectional prevalence study in 148 children recruited from pediatric endocrinology consultation, with overweight or obesity (12±3 years, 48% boys, BMI 31.8±6.1). We measured BMI, waist-height, waist circumference, blood pressure with standard instrumentation and glucose (fasting and after overload with 75 g), insulin resistance, cholesterol HDL, triglycerides and uric acid. RESULTS: The prevalence of hyperuricemia was 53%. Patients with hyperuricemia had greater BMI (33.9 vs 30.6, p=0.003), plus waist circumference (101.4 vs 91.1cm, p<0.001), higher blood pressure: systolic (123.4 vs 111.9 mm Hg, p<0.001), diastolic (78.2 vs 68.7 mm Hg, p<0.001). They presented greater blood glucose after overload oral glucose (107.5 vs 100.7 mg/dl, p=0.03), insulin was higher (29.2 vs 20.7 mg/dl, p=0.001) as well as HOMA IR (6.5 vs 4.4, p<0.001) and HDL levels were lower (49.5 vs 54.4 mg/dl, p=0.02). Uric acid's level which most is the likely diagnosis of metabolic syndrome corresponds to 5.4 mg/dl in our sample (sensitivity: 64% and specificity 62%). CONCLUSION: The prevalence of hyperuricemia in children with overweight and obesity is high. In the group of patients with obesity and hyperuricemia, we found out that the parameters measured to diagnose with metabolic syndrome were less favorable. Uric acid's level from where there is a higher possibility to see metabolic syndrome is 5.4 mg/dl.
Assuntos
Hiperuricemia/epidemiologia , Síndrome Metabólica/epidemiologia , Sobrepeso/epidemiologia , Adolescente , Antropometria , Pressão Sanguínea , Criança , Comorbidade , Estudos Transversais , Jejum/sangue , Feminino , Humanos , Hiperuricemia/sangue , Resistência à Insulina , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Obesidade/sangue , Obesidade/epidemiologia , Sobrepeso/sangue , Período Pós-Prandial , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Prevalência , Curva ROC , Espanha/epidemiologiaRESUMO
OBJECTIVE: To perform a casuistry review of patients diagnosed with pituitary adenomas (PA) who underwent surgery performed by the same neurosurgeon after 1995. MATERIAL AND METHODS: A descriptive and retrospective study was performed in 98 patients with PA undergoing surgery from 1995-2008. Tumor size and data on functionality, pathology and postprocedural complications were analyzed. The study was divided into two periods: 1995-2002 (first period) and 2003-2008 (second period). RESULTS: A total of 110 surgical interventions (59 in the first period and 51 in the second) were performed for 49 non-hormone-producing PA and 61 hormone-producing PA. There were 85 macroadenomas and 25 microadenomas. Cure was achieved in 31 patients (36%) with macroadenomas and in 21 patients (84%) with microadenomas (P=0.05).The number of complications was significantly higher in the first period [32 patients (54 %)] than in the second period [16 patients (31.3%)] (P<0.05). Cure was achieved in 28 patients (47.4%) in the first period compared with 31 (52.1%) in the second (P=0.1). The mortality rate was 0.9%. CONCLUSIONS: As described in previous studies, the cure rate was significantly higher for microadenomas than for macroadenomas. There was a significant reduction in the incidence of surgical complications and a trend toward an increase in the percentage of overall healing in the second period of the study. These results are probably related to the neurosurgeon's greater experience and surgical skill.
Assuntos
Adenoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , EspanhaRESUMO
INTRODUCTION: There is currently a disproportionate increase in childhood and adolescent obesity worldwide, together with other disorders involving substantial cardiometabolic risk in adulthood, such as alterations in carbohydrate metabolism. OBJECTIVE: To establish the prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) after an oral glucose tolerance test, and the prevalence of type 2 diabetes mellitus (DM-2) in a pediatric population with severe obesity. Additionally, we aimed to assess clinical metabolic differences between prediabetic obese patients and obese subjects without prediabetes. MATERIAL AND METHODS: A cross-sectional study was carried out in children and adolescents with severe obesity (>97th percentile). The variables studied were age, sex, height, weight, body mass index, waist circumference, fasting plasma glucose and oral glucose tolerance test, insulinemia, insulin resistance assessed by the homeostasis model assessment (HOMA) index, glycated hemoglobin (HbA(1c)), triglycerides, high-density lipoprotein cholesterol (HDL), and systolic and diastolic blood pressure. RESULTS: A total of 133 patients were included: 67 boys (50.4%) and 66 girls (49.6%), with a mean age of 12.17±3.27 years. Fourteen patients (10.52%) had prediabetes (10 IFG, 3 IGT, 1 IFG+IGT): 7 girls and 8 boys, with a mean age of 13.2±3.3 years. One patient had DM2 (0.75%). Patients with prediabetes had significantly higher concentrations of fasting glucose (98±10.76 vs 88.53±6.3mg/d; p=0.001), insulinemia (35.38±14.22 vs 22.95±14.30µU/ml; p=0.009) and HOMA index (8.10±3.24 vs 4.89±3.27; p=0.004) than patients without impaired carbohydrate metabolism. These patients also had higher values of HbA(1c), triglycerides, blood pressure and HDL concentrations, although differences were not statistically significant. CONCLUSIONS: The prevalence of prediabetes (IFG/IGT) in children with severe obesity was high (10.52%). These patients should therefore be investigated to establish early diagnosis and appropriate treatment. Obese patients with prediabetes have significantly higher levels of insulin and insulin resistance than individuals without impaired carbohydrate metabolism.