Official position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry: part I (technical aspects)-general concepts, indications, acquisition, and analysis.

OBJECTIVE: To review the technical aspects of body composition assessment by dual-energy X-ray absorptiometry (DXA) and other methods based on the most recent scientific evidence. MATERIALS AND METHODS: This Official Position is a result of efforts by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and health care professionals with expertise in body composition assessment who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications. In this first part of the Official Position, the authors discuss the different methods and parameters used for body composition assessment, general principles of DXA, and aspects of the acquisition and analysis of DXA scans. CONCLUSION: Considering aspects of accuracy, precision, cost, duration, and ability to evaluate all three compartments, DXA is considered the gold-standard method for body composition assessment, particularly for the evaluation of fat mass. In order to ensure reliable, adequate, and reproducible DXA reports, great attention is required regarding quality control procedures, preparation, removal of external artifacts, imaging acquisition, and data analysis and interpretation.

Associations between markers of glucose metabolism and bone measures among diabetic and non-diabetic adults.

PURPOSE: To investigate the relationships between bone measures, vitamin D status and markers of glucose metabolism among diabetic and non-diabetic adults. METHODS: Cross sectional study with 298 adults (mean age 57.5 years, SD = 14.8; 44.3% male, 16.9% diabetic) participants of the Health Survey-São Paulo (ISA-Capital) 2014-2015. Blood samples were collected to assess serum glucose, insulin and 25 hydroxyvitamin D [25(OH)D] concentrations. Dual-energy x-ray absorptiometry (DXA) was performed to determine total body fat; total lean mass; full body bone mineral density (BMD); lumbar spine BMD and bone mineral content (BMC); and femur BMD and BMC. Fat mass index (FMI), lean mass index (LMI), quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment of insulin resistance (HOMA-IR) and of ß-pancreatic cell function (HOMA-ß) were calculated. Linear regression analysis were performed. RESULTS: Multiple bone measures were associated with markers of glucose metabolism in analyses adjusted by age and sex. However, after additional adjustments by LMI, FMI and serum 25(OH)D, only associations of lumbar spine BMC with HOMA-IR (ß = 0.167; p = 0.035) and QUICKI (ß = -1.879; p = 0.027) persisted, in the subgroup of diabetic participants. Analysis restricted to diabetic subjects revealed stronger correlations between bone parameters and markers of glucose metabolism. CONCLUSIONS: Our study observed positive associations between BMD and markers of insulin resistance among a sample of adults. Correlations were stronger among diabetic subjects, and some associations between bone and glucose metabolism were independent of adiposity. Findings reinforce the need of further research for better understanding the bidirectional and multifactorial crosstalk between glucose homeostasis and bone metabolism.

Crosstalk Between Bone and Fat Tissue: Associations Between Vitamin D, Osteocalcin, Adipokines, and Markers of Glucose Metabolism Among Adolescents.

OBJECTIVES: This study aimed to investigate the relationship between 25-hydroxyvitamin D (25(OH)D), osteocalcin, markers of glucose metabolism, and obesity-related parameters among adolescents. METHODS: This was a cross-sectional study with 198 adolescents age 14-18 years. Weight, height, and waist and hip circumferences were measured, as well as the following biochemical parameters: serum 25(OH)D, parathyroid hormone (PTH), total (tOC) and undercarboxylated (ucOC) osteocalcin, adiponectin, leptin, glucose, and insulin. The homeostasis model of assessment estimate of insulin resistance (HOMA-IR) and ß-cell function (HOMA-ß) and quantitative insulin sensitivity check index (QUICKI) were calculated. Student's t test, analysis of variance (ANOVA), Pearson's correlation, and linear regression models were performed. RESULTS: Overweight was observed in 42.6% of the sample. This group presented significantly higher PTH, leptin, insulin, HOMA-IR, and HOMA-ß and lower 25(OH)D, adiponectin, tOC, ucOC, and QUICKI than normal-weight subjects. 25(OH)D was positively correlated with ucOC and adiponectin and negatively associated with body mass index (BMI), weight, and waist circumference (p < 0.05 for all). The association between 25(OH)D and ucOC was also observed in the multiple regression analysis, adjusted for age, BMI, and season of the year (partial r2 = 0.071, p < 0.0001). 25(OH)D and ucOC were not associated with markers of glucose metabolism. However, leptin was strongly correlated with insulin, HOMA-IR, HOMA-ß, and QUICKI (p < 0.0001 for all). CONCLUSION: The present study demonstrated that undercarboxylated osteocalcin is related to 25(OH)D and adiponectin concentrations. Both ucOC and 25(OH)D were lower in overweight and obese adolescents, reinforcing the importance of fighting obesity. Although a relationship of ucOC and 25(OH)D with markers of glucose metabolism was not observed, leptin has shown to be the hormone most related to energy homeostasis.

Digital vertebral morphometry performed by DXA: a valuable opportunity for identifying fractures during bone mass assessment.

OBJECTIVES: To evaluate the usefulness of vertebral morphometry in identifying unreferred vertebral fractures and correlate potential risk factors. SUBJECTS AND METHODS: Female patients above 45 years, postmenopausal for at least 2 years, diagnosed with osteoporosis and undergoing treatment for at least three months were considered eligible. All of them underwent bone densitometry and vertebral morphometry performed by concomitant DXA. The presence of fractures was defined between T7 and L4; only moderate and severe fractures were considered for analysis. All volunteers were submitted to laboratory tests, anthropometry and responded a questionnaire on their lifestyle habits and medical history. RESULTS: Thirty two (17%) out of the 188 female patients presented with at least one vertebral fracture, among whom only 4 (12.5%) were previously aware of the fracture. The fractures were mainly located on the thoracic spine. Nine patients had severe fractures (28.1%), whereas 23 had moderate fractures (71.9%). On average, patients with fractures were 5 years older and weighed 5 kilograms less than those without fractures. The creatinine clearance was on average 9 mL/min less in patients with vertebral fracture. The assessment of vertebral fractures by morphometry is a fast, accurate and complementary method associated with low radiation exposure for identifying moderate and severe vertebral fractures. Predisposition to vertebral fractures does not depend solely on BMD.

Digital vertebral morphometry performed by DXA: a valuable opportunity for identifying fractures during bone mass assessment

Objectives To evaluate the usefulness of vertebral morphometry in identifying unreferred vertebral fractures and correlate potential risk factors. Subjects and methods Female patients above 45 years, postmenopausal for at least 2 years, diagnosed with osteoporosis and undergoing treatment for at least three months were considered eligible. All of them underwent bone densitometry and vertebral morphometry performed by concomitant DXA. The presence of fractures was defined between T7 and L4; only moderate and severe fractures were considered for analysis. All volunteers were submitted to laboratory tests, anthropometry and responded a questionnaire on their lifestyle habits and medical history. Results Thirty two (17%) out of the 188 female patients presented with at least one vertebral fracture, among whom only 4 (12.5%) were previously aware of the fracture. The fractures were mainly located on the thoracic spine. Nine patients had severe fractures (28.1%), whereas 23 had moderate fractures (71.9%). On average, patients with fractures were 5 years older and weighed 5 kilograms less than those without fractures. The creatinine clearance was on average 9 mL/min less in patients with vertebral fracture. The assessment of vertebral fractures by morphometry is a fast, accurate and complementary method associated with low radiation exposure for identifying moderate and severe vertebral fractures. Predisposition to vertebral fractures does not depend solely on BMD. .

Ingestão de cálcio e vitamina D pela população infanto-juvenil / Calcium and vitamin D intake by the population of children and teenagers

Os autores abordam a importância do cálcio e da vitamina D na alimentação de crianças e adolescentes, ressaltando as consequências de sua deficiência na dieta. Descrevem as fontes mais ricas nesses elementos e as doses recomendadas em cada faixa etária, destacando a situação insatisfatória encontrada no Brasil. Finalmente, tratam da suplementação tanto do cálcio como da vitamina D no dia-a-dia da população infanto-juvenil...

Nutritional aspects of the prevention and treatment of osteoporosis.

Osteoporosis is a global health problem characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. Nutrition plays a critical role in reducing the risk of osteoporosis through its effect on all of these fragility factors, especially on the development and maintenance of bone mass. An adequate calcium, vitamin D and protein intake resulted in reduced bone remodeling, better calcium retention, reduced age-related bone loss, and reduced fracture risk. Recent evidence indicates that a healthy dietary pattern including dairy products (mainly fat free), fruit and vegetables and adequate amounts of meat, fish and poultry is positively related to bone health. Furthermore, mineral and vitamin supplementation should be closely monitored by health professionals since it could have adverse effects and be insufficient to ensure optimal protection of bone health.

Nutritional aspects of the prevention and treatment of osteoporosis / Aspectos nutricionais na prevenção e no tratamento da osteoporose

Osteoporosis is a global health problem characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. Nutrition plays a critical role in reducing the risk of osteoporosis through its effect on all of these fragility factors, especially on the development and maintenance of bone mass. An adequate calcium, vitamin D and protein intake resulted in reduced bone remodeling, better calcium retention, reduced age-related bone loss, and reduced fracture risk. Recent evidence indicates that a healthy dietary pattern including dairy products (mainly fat free), fruit and vegetables and adequate amounts of meat, fish and poultry is positively related to bone health. Furthermore, mineral and vitamin supplementation should be closely monitored by health professionals since it could have adverse effects and be insufficient to ensure optimal protection of bone health.

A osteoporose é um problema de saúde global, caracterizada por baixa massa óssea e deterioração da microarquitetura do tecido ósseo, com consequente aumento da fragilidade óssea e suscetibilidade a fraturas. A nutrição desempenha um papel fundamental na redução do risco de osteoporose por seu efeito sobre todos os fatores relacionados à fragilidade óssea, principalmente no desenvolvimento e na manutenção da massa óssea. Uma adequada ingestão de cálcio, vitamina D e proteína leva à redução da remodelação óssea, à maior retenção de cálcio, à redução da perda óssea relacionada à idade e à redução do risco de fraturas. Evidências recentes indicam que uma alimentação saudável, incluindo a ingestão de produtos lácteos (principalmente os desnatados), frutas e verduras, e uma quantidade adequada de carnes, peixes e aves, está relacionada positivamente com a saúde óssea. Além disso, a suplementação de vitaminas e minerais deve ser monitorada de perto, por profissionais de saúde, uma vez que pode ter efeitos adversos e ser insuficiente para assegurar uma eficaz proteção à saúde óssea.

[There are no association between vitamin D metabolites and blood pressure in adolescents]. / Metabólitos séricos da vitamina D não se correlacionam com pressão arterial em adolescentes.

OBJECTIVES: The purpose of this study was to evaluate the relationships between serum levels of vitamin D and blood pressure (BP) in adolescents. METHODS: The anthropometric measurements, body composition, dietary intake, blood pressure and biochemical measurements was undertaken. RESULTS: Two hundred and five adolescents, 106 boys and 99 girls, mean aged 18.2 years old, participate of the study. Elevated BP was observed in 12.19% of the adolescents. Mean 25OHD concentration was 29.2(0.8) ng/mL. Vitamin D insufficiency was observed in 62% of adolescents. There were no correlation between systolic and diastolic BP with 25OHD and 1,25(OH)2D concentration. An inverse correlation between adiponectin and diastolic BP was observed and positive significant correlation was observed between waist circumference with systolic and diastolic BP in both boys and in girls. In conclusion, no relationships between vitamin D levels and blood pressure were observed. CONCLUSION: However, the intra-abdominal adiposity offers potential risk to BP elevation in adolescents.

Metabólitos séricos da vitamina D não se correlacionam com pressão arterial em adolescentes / There are no association between vitamin D metabolites and blood pressure in adolescents

OBJETIVO: O objetivo deste estudo foi avaliar a associação entre o estado nutricional da vitamina D, a adiposidade e a pressão arterial (PA) em adolescentes. MÉTODOS: Foi realizada avaliação antropométrica, da composição corporal, da ingestão alimentar, de medidas bioquímicas e aferição da PA de 205 adolescentes, com média de idade de 18,2 anos. RESULTADOS: Destes, 12,19% apresentaram PA elevada. O nível sérico médio da 25OHD foi 29,2(0,8) ng/mL, e 62% dos adolescentes apresentaram insuficiência de vitamina D. Não foi encontrada correlação significativa entre a PAS e a PAD com a 25OHD e a 1,25(OH)2D. Houve correlação negativa entre a PAD com os níveis séricos de adiponectina, e tanto a PAS quanto a PAD apresentaram correlação positiva com a circunferência da cintura em ambos os sexos. CONCLUSÃO: Não houve relação entre os níveis séricos de vitamina D e a PA. Porém, a gordura visceral apresenta risco potencial para elevação da PA em adolescentes.

OBJETIVES: The purpose of this study was to evaluate the relationships between serum levels of vitamin D and blood pressure (BP) in adolescents. METHODS: The anthropometric measurements, body composition, dietary intake, blood pressure and biochemical measurements was undertaken. RESULTS: Two hundred and five adolescents, 106 boys and 99 girls, mean aged 18.2 years old, participate of the study. Elevated BP was observed in 12.19% of the adolescents. Mean 25OHD concentration was 29.2(0.8) ng/mL. Vitamin D insufficiency was observed in 62% of adolescents. There were no correlation between systolic and diastolic BP with 25OHD and 1,25(OH)2D concentration. An inverse correlation between adiponectin and diastolic BP was observed and positive significant correlation was observed between waist circumference with systolic and diastolic BP in both boys and in girls. In conclusion, no relationships between vitamin D levels and blood pressure were observed. CONCLUSION: However, the intra-abdominal adiposity offers potential risk to BP elevation in adolescents.

Prevalence of vitamin D insufficiency in Brazilian adolescents.

BACKGROUND/AIMS: Cutaneous sun exposure and dietary vitamin D intake are important determinants of vitamin D status. The objective of the present study was to evaluate the vitamin D status of a group of healthy adolescent students living in Brazil. METHODS: One hundred and thirty-six adolescents, 64 boys and 72 girls, aged 16-20 years old, living in a rural town in the state of São Paulo, Brazil, participated in this study. RESULTS: The mean dietary vitamin D intake was 140 (120-156) IU/day [3.5 (3.0-3.9) microg/day]. Only 14.9% of the students met the daily adequate intake recommendation of vitamin D. Only 27.9% practice physical activity outdoors and 17.6% of the adolescents apply sunscreen daily. The mean 25(OH)D concentration was 73.0 (22.0) nmol/l [29.2 (8.8) ng/ml]. Vitamin D insufficiency was observed in 60% of adolescents. CONCLUSIONS: The present study suggests that even in a sunny climate like Brazil the prevalence of vitamin D insufficiency in adolescents is high. Most likely this is due to low intakes of vitamin D in this group. Due to the limited extent of natural dietary sources of vitamin D, a policy of vitamin D food fortification should be considered in the future, and in the meantime greater use of vitamin D supplements in this population group should be encouraged to provide the increased amounts of this essential nutrient for optimal health.

Vitamina D em adolescentes: ingestão, nível sérico e associação com adiposidade e pressão arterial / Vitamin D in adolescents: dietary intake, serum levels and association with adiposity and blood pressure

Introdução - Atualmente, vários estudos epidemiológicos têm se direcionado à população de adolescentes, devido aos seus hábitos alimentares que, quando inadequados, podem favorecer o aparecimento de diversas doenças crônicas não transmissíveis na vida adulta. A vitamina D é um nutriente de fundamental importância durante os diversos ciclos de vida, porém sua determinação é inadequada através dos questionários/recordatórios alimentares. Níveis séricos reduzidos de vitamina D estão relacionados à patogênese de diversas doenças crônicas não transmissíveis. Objetivo - Objetivou-se investigar a ingestão e os níveis séricos de vitamina D em adolescentes saudáveis, assim como quais fatores influenciam a adequação da vitamina D e a associação entre o estado nutricional da vitamina D com a adiposidade e a pressão arterial. Métodos - Trata-se de estudo transversal, onde foram avaliados 205 adolescentes, sendo 106 meninos e 99 meninas, com média de idade de 18,25 (0,07). Avaliou-se a ingestão alimentar (diário alimentar de 3 dias), o estado nutricional (peso, altura, IMC, gordura corporal e massa magra pela bioimpedância elétrica), o nível de atividade física (questionário de atividade física, desenvolvido e validado para adolescentes), pressão arterial (de acordo com as recomendações das V Diretrizes Brasileiras de Hipertensão Arterial) e marcadores bioquímicos (níveis séricos de calcidiol e calcitriol, cálcio sérico total, paratormônio sérico e adiponectina). Resultados - O nível sérico médio de calcidiol foi 29,2(0,8) ng/ml, e 62,1% dos adolescentes apresentaram insuficiência de vitamina D. A média de ingestão de cálcio e vitamina D foi de 682,2 (14,2) mg/dia e 3,1 (0,1) g/dia, respectivamente. Apenas 3,8% dos adolescentes ingeriram o recomendado para cálcio e nenhum adolescente apresentou ingestão próxima ao recomendado para vitamina D. Houve correlação positiva entre o consumo de produtos lácteos com a ingestão de cálcio e vitamina D (r=0,597 e r=0,561, respectivamente; p=0,000). Adolescentes que apresentavam o hábito de realizar o café da manhã apresentaram ingestão significativamente maior de cálcio, vitamina D e produtos lácteos do que aqueles adolescentes que não realizavam esta refeição. Quanto aos níveis de pressão arterial, 12,19% dos adolescentes apresentaram-na elevada. Não foi encontrada correlação significante entre a pressão arterial sistólica e diastólica com o calcidiol e o calcitriol. Tanto a pressão arterial sistólica quanto a diastólica apresentaram correlação positiva com a circunferência da cintura em ambos os sexos. A gordura corporal não apresentou correlação com os níveis séricos de calcidiol. Conclusões - A prevalência de insuficiência de vitamina D foi elevada nesta amostra de adolescentes. Não houve relação entre os níveis séricos de vitamina D e pressão arterial. A maioria dos adolescentes não ingere o recomendado para cálcio e vitamina D. E o hábito de realizar o café da manhã regularmente assim como a ingestão de produtos lácteos são importantes estratégias para aumentar a ingestão destes nutrientes.

Introduction - Several epidemiologic studies have been developed in adolescent population, due to alimentary habits that when inadequate can contribute to development of non-communicable chronic diseases in the adult life. The vitamin D status is of fundamental importance during life cycles. Reduced serum levels of vitamin D have been related to many non-communicable chronic diseases pathogenesis. Purpose - The purpose of this study was to evaluate the vitamin D intake and the serum 25(OH)D concentration in healthy adolescents, as well to investigate factors that could influence the vitamin D status, and the relationships between the nutritional status of vitamin D, adiposity and blood pressure. Methods - This is a cross-sectional study, including two hundred and five adolescents, 106 boys and 99 girls, mean age 18.25 (0.07) years old. Dietary intake (three-day dietary records), nutritional status (weight, height, BMI, fat mass and lean mass by bioelectrical impedance), physical activity (validated physical activity evaluation questionnaire for adolescents), blood pressure (in accordance with V Diretrizes Brasileiras de Hipertensão Arterial recommendations), and biochemical markers (blood levels of calcidiol, calcitriol, serum total calcium, intact parathormone and adiponectin) was evaluated. Results - The mean serum of calcidiol was 29.2 (0.8) ng/ml, and the vitamin D insufficiency was observed in 62.1% of the adolescents. Mean dietary calcium and vitamin D intake was 682.2 (14.2) mg/day and 3.1 (0.1) g/day, respectively. Only 3.8% of adolescents met the daily adequate intake recommendation for calcium, and none of adolescents met the adequate intake recommendation for vitamin D. There was a positive correlation between dairy products and both calcium and vitamin D intake (r=0.597 e r=0.561, respectively; p=0.000). Adolescents who ate breakfast had a significant higher mean calcium, vitamin D and dairy products intake than adolescents who did not eat. Elevated blood pressure was observed in 12.19% of the adolescents. There were no correlations between systolic and diastolic blood pressure with calcidiol and calcitriol. A positive significant correlation was observed between waist circumference with systolic and diastolic blood pressure in both boys and in girls. There was no correlation between fat mass and blood levels of calcidiol. Conclusions - The prevalence of vitamin D insufficiency was elevated in this group of adolescents. No relationships between serum vitamin D levels and blood pressure were observed. The majority of adolescents were not consuming recommended levels of calcium and vitamin D. The regular breakfast habit and consumption of dairy products are important strategies in improving calcium and vitamin D intake in the diet.

Nutritional assessment of patients with secondary hyperparathyroidism / Avaliação nutricional de pacientes com hiperparatireoidismo secundário / Evaluación nutricional de pacientes con hiperparatiroidismo secundario

Secondary hyperparathyroidism (SHPT) is a common complication in patients undergoing hemodialysis. Nutritional counseling is an integral part of treatment, with potential positive impact on retention of calcium and phosphorus. The aim of this study was to monitor the nutritional status during a year of nutritional intervention. Forty-one hemodialysis patients, in the Outpatient Renal Osteodystrophy, Hospital das Clinicas in São Paulo, with a mean age of 43.4 (15.7) years were evaluated. During the evaluation period, some patients underwent parathyroidectomy (PTX) and surgical or chemical analysis was based on three groups according to treatment: diet group (n = 21), PTX chemical group (n = 9) and PTX surgical group (n = 11). Could be evaluated intakes of energy, protein, calcium and phosphorus in the nutrition survey in three days. Weight, height, BMI and% body fat were measured, and biochemical markers of bone metabolism. Dietary measures, and anthropometric and biochemical changes were implemented in early clinical intervention and after one year. There were no significant changes in intakes of energy, protein and calcium during the study, even after nutritional counseling. The dietary phosphorus remained within the recommendations. There were no changes in anthropometric parameters. There was a significant decrease in total serum calcium, ionized calcium, phosphorus, CaxP product and iPTH levels in patients undergoing surgical PTX. Although this practice has shown significant improvement in biochemical parameters of SHPT, dietary control can be effective for non-aggravation of the nutritional status of the parameters of SHPT with low cost.

O hiperparatiroidismo secundário (HPTS) é uma complicação comum em pacientes que realizam hemodiálise. A orientação nutricional é parte integrante do tratamento, com potencial impacto favorável na retenção de cálcio e fósforo. O objetivo deste estudo foi monitorar o estado nutricional durante um ano de intervenção nutricional. Quarenta e um pacientes hemodializados, atendidos no Ambulatório de Osteodistrofia Renal do Hospital das Clínicas, em São Paulo, com média de idade de 43,4 (15,7) anos foram avaliados. Durante o período de avaliação, alguns pacientes foram submetidos à paratiroidectomia (PTX) química ou cirúrgica e a análise foi feita baseada em três grupos, de acordo com o tratamento: grupo dieta (n=21), grupo PTX química (n=9) e grupo PTX cirúrgica (n=11). Puderam ser avaliadas as ingestões de energia, proteína, cálcio e fósforo por inquérito alimentar de três dias. Peso, altura, IMC e % gordura corporal foram mensurados, bem como marcadores bioquímicos do metabolismo ósseo. As medidas dietéticas, antropométricas e bioquímicas foram executadas no início da intervenção clínica e após um ano. Não houve alterações significativas nas ingestões de energia, proteína e cálcio durante o estudo, mesmo após a orientação nutricional. O fósforo dietético permaneceu dentro das recomendações. Não foram observadas alterações nos parâmetros antropométricos. Houve diminuição significativa no cálcio sérico total, cálcio iônico, fósforo, produto CaxP e níveis de PTHi nos pacientes submetidos à PTX cirúrgica. Embora esta prática tenha apresentado significante melhora nos parâmetros bioquímicos do HPTS, o controle dietético pode ser efetivo para o não-agravo do estado nutricional dos parâmetros do HPTS com baixo custo.

El hiperparatiroidismo secundario (HPTS) es una complicación frecuente en pacientes sometidos a hemodiálisis. consejería nutricional es una parte integral del tratamiento, con un impacto potencial positivo en la retención de calcio y fósforo. El objetivo de este estudio fue monitorear el estado nutricional durante un año de la intervención nutricional. Cuarenta y un pacientes en hemodiálisis, en la osteodistrofia renal para pacientes ambulatorios del Hospital das Clínicas de São Paulo, con una edad media de 43,4 (15,7) años fueron evaluados. Durante el período de evaluación, algunos pacientes fueron sometidos a paratiroidectomía (PTX) y el análisis quirúrgica o química se basa en tres grupos según el tratamiento: grupo de la dieta (n = 21), grupo PTX químicos (n = 9) y PTX quirúrgica grupo (n = 11). ¿Podría ser evaluado la ingesta de energía, proteínas, calcio y fósforo en la encuesta de nutrición en tres días. Peso, talla, índice de masa corporal y el% de grasa corporal fueron medidos, y los marcadores bioquímicos del metabolismo óseo. Medidas dietéticas y cambios antropométricos y bioquímicos se llevaron a cabo en la intervención clínica temprana y después de un año. No hubo cambios significativos en la ingesta de energía, proteínas y calcio durante el estudio, incluso después del asesoramiento nutricional. El fósforo en la dieta se mantuvo dentro de las recomendaciones. No hubo cambios en los parámetros antropométricos. Hubo una disminución significativa en el calcio sérico total, calcio iónico, fósforo, producto CaxP y los niveles de PTH en pacientes sometidos a cirugía PTX. Aunque esta práctica ha demostrado una mejora significativa en los parámetros bioquímicos de SHPT, control de la dieta puede ser eficaz para que no se agrave la situación nutricional de los parámetros de SHPT con bajo costo.

Effects of parathyroidectomy on bone remodeling markers and vitamin D status in patients with chronic kidney disease-mineral and bone disorder.

BACKGROUND/AIMS: Chronic renal failure (CRF) is often associated with bone disorders including chronic kidney disease-mineral and bone disorder (CKD-MBD). Parathyroid hormone (PTH) has a relationship to bone remodeling, and so this study was undertaken to evaluate changes in bone remodeling markers after parathyroidectomy (PTX). METHODS: Twelve adult patients, mean age 43.4 +/- 12.7 years, of both genders, were evaluated, prior to and six months after PTX. Analysis of biochemical markers of bone metabolism, such as total and ionized calcium, phosphorus, 25(OH)D(3), total alkaline phosphatase (TAP), bone-specific alkaline phosphatase (BAP), intact PTH, osteoprotegerin (OPG), and tartrate-resistant acid phosphatase isoform 5b (TRAP), were measured. RESULTS: No changes were observed after PTX in the serum total and ionized calcium, TAP, BAP, and 25(OH)D(3). After surgery there was a significant decrease in serum phosphorus, iPTH, and TRAP (P < 0.001). No significant change was observed in OPG; however there was a positive correlation between OPG and 25(OH)D(3) before and after surgery (r = 0.774, P = 0.014; and r = 0.706, P = 0.01, respectively). The percentage of patients with vitamin D deficiency decreased from 16.7% to 8.3%, while those with sufficient levels increased from 41.7% to 58.3%. CONCLUSION: The small number of patients in the study notwithstanding, the present study is unique because it provides information on bone metabolism and vitamin D status six months after PTX. The removal of parathyroid glands significantly decreased bone resorption and indicated a tendency of 25(OH)D(3) concentration to increase. However, the precise role of OPG and BAP in the improvement in bone remodeling in patients with CKD-MBD requires further study.

Evolução do estado nutricional de pacientes com insuficiência renal crônica e hiperparatireoidismo secundário submetido a paratireoidectomia / Nutritional evaluation in chronic renal failure patients with secondary hyperathyroidism after parathyroidectomy

Objetivo: Sendo o hiperparatireodismo um agravante para desnutrição em pacientes com Insuficiência Renal Crônica (IRC), o objetivo deste trabalho foi avaliar o estado nutricional de pacientes com ICR em programa de hemodiálise com Hiperparatireoidismo Secundário (HPT2) submetidos a Paratireoidectomia (PTX). Resultados: Não houve alteração significante nos valores médios de energia, ingestão de carboidratos, lipídeos, proteínas, e fósforo após a cirurgia, somente a ingestão média de cálcio aumentou significativamente após a PTX (de 382,2 mais ou menos 209,6 mg para 656,6 mais ou menos 313,8 mg; p<0,05). O peso e IMC também não apresentaram alteração durante o estudo. Quanto aos dados obtidos pela BIA, a gordura corporal (GC), massa magra (MM), água corporal total (ACT), e a água extracelular (AEC) não apresentaram alteração significativa após os 6 meses da cirurgia; entretanto, o ângulo de fase (ф) e a reactância (Xc) aumentaram significativamente após a PTX (5,0 mais ou menos 1,4 graus para 5,6 mais ou menos 1,3 graus; 44,1 mais ou menos 15,6 Ohm para 57,1 mais ou menos 14,4 Ohm, respectivamente; p<0,05). Foi encontrada correlação negativa entre o iPTH e a GC (r= -0,69, p=0,014) apenas antes da PTX. Como esperado, houve melhora significante no fósforo sérico (Ps), fosfatase alcalina total (Fat), fração óssea da fosfatase alcalina (Fafo) e iPTH após a PTX (6,7 mais ou menos 1,8 para 4,5 mais ou menos 1,5 mg/dl; 542,3 mais ou menos 835,4 para 111,9 mais ou menos 68,2 U/I; 135,6 mais ou menos 230,1 para 24,5 mais ou menos 16,0 U/I; 1221,6 mais ou menos 685,1 para 153,1 mais ou menos 189,2 pg/ml, respectivamente; p<0,005), e também na albumina e proteína total. Não houve alteração quanto ao cálcio sérico total, vitamina D e proteína C reativa. Conclusão: No presente estudo foram observados benefícios da PTX para o estado nutricional de pacientes com altos níveis de iPTH. Houve melhora na composição corporal de acordo com os dados da BIA, melhora nos parâmetros bioquímicos relacionados ao estado nutricional e ao metabolismo ósseo, e, além disso, verificou-se ausência do efeito negativo do PTH na gordura corporal.