Association of Dietary Inflammatory Potential in Metabolically Healthy and Metabolically Unhealthy Obese Individuals

Abstract Introduction: Currently, two types of phenotypes have been recognized in individuals who are obese. Among the factors related to lifestyle, diet has a relevant influence, although there is no consensus regarding the role of diet in metabolic phenotypes; furthermore, diet is a strong moderator of chronic systemic inflammation. Objective: Investigate dietary inflammatory potential between metabolic phenotypes and to compare the differences between anti-inflammatory and pro-inflammatory diets in individuals with the same phenotype. Methods: This is a cross-sectional observational study that utilized the database of 533 individuals divided into 4 groups, according to metabolic phenotype and dietary inflammatory characteristic. Sociodemographic, clinical, anthropometric and biochemical characteristics were evaluated and the inflammatory index of the diet was calculated. Results: The mean Dietary Inflammatory index (DII) of the total sample was 0.974±1.02, with a maximum of 4.34 and a minimum of −1.74. In the metabolically unhealthy groups, we found a statistical difference in relation to systolic blood pressure when comparing the anti-inflammatory [median 120 (110.0-130.0)] and pro-inflammatory diets [median 130 (120.0-140.0); p = 0.022], and mean isoprostane concentrations were lower in the metabolically healthy group with anti-inflammatory diet. In regression analysis, the only variable that demonstrated a higher risk of alterations in all groups when compared to the metabolically healthy and anti-inflammatory group were isoprostane concentrations. Conclusion: We are able to conclude that an anti-inflammatory diet is associated with lower oxidative stress in metabolically healthy obese, and a pro-inflammatory diet is associated with higher systolic blood pressure values.

Food Consumption and Health Outcomes in Women During the COVID-19 Pandemic

Abstract Background The COVID-19 pandemic has changed food consumption. Objective Evaluate the association between metabolic phenotypes, changes in food consumption during the pandemic, and health outcomes in obese women. Methods Cross-sectional observational study including 491 women without previous diagnosis of chronic diseases, evaluated according to metabolic phenotype. During the pandemic, a subsample was re-evaluated by online questionnaires via Google Forms. Analyzed anthropometric, biochemical, and dietary data as well as health outcomes (coronary artery disease, type 2 diabetes, hypertension, dyslipidemia or death). Information on mortality was collected from the Internal Affairs Office of the State of Rio de Janeiro and the Health Department of the State of Rio de Janeiro. Statistical analysis was performed using the statistical program SPSS 21, with Mann-Whitney test, Pearson's chi-squared, Spearman correlation, and binary logistic regression, at a significance level of 5%. Results The anthropometric, glucose, and lipid profiles showed significant differences between the metabolically healthy and metabolically unhealthy groups (p = 0.00). Before the pandemic, women in the metabolically unhealthy group had higher dietary intakes of lipids (p = 0.01), saturated fat (p = 0.01) and sodium (p = 0.04), during the pandemic, they consumed more energy (p = 0.04), lipids (p = 0.02), saturated fat (p = 0.02), proteins (p = 0.03) and sodium from ultra-processed foods (p = 0.03). Consequently, health outcomes were more prevalent in the metabolically unhealthy group (p = 0.00). Conclusion Observed that metabolically healthy women had qualitatively better food intake and fewer health outcomes throughout the study.

Effect of Hypoenergetic Diet Combined With Pumpkin Seed Flour Consumption on Obese Women

Abstract Background Dietary treatment containing fiber-rich foods may contribute to lowering weight in obese women. Objective To investigate the effect of a hypoenergetic diet combined with pumpkin seed flour (PSF) consumption on diet quality, anthropometric indices, and glucose and lipid metabolism in obese women. Methods We conducted a randomized, double-blind, placebo-controlled, 90-day clinical trial with obese women, distributed into the following two groups: hypoenergetic diet + placebo (PG) and hypoenergetic diet + pumpkin seed flour (PSFG). A total of 100 participants were included in the PSFG (n = 47) and PG (n = 53). We evaluated neck circumference (NC); waist to height ratio; conicity index; fat mass (FM); lipid profile; blood concentrations of glucose and insulin; homeostatic model assessment for insulin resistance (HOMA-IR); quantitative insulin sensitivity check index (QUICKI); and blood pressure at baseline, 30, 60, and 90 days. Dietary analysis was determined by differences between diet quality indices before and after prescribing the experimental diet. Chi-squared, Student's t-tests and analysis for repeated measures were used, and values were considered significant at p < 0.05. Results The dietary pattern improved after 90 days in both groups. The PSFG presented lower NC (p < 0.001), FM (p = 0.010), triglycerides (TG) (p = 0.025), insulin (p = 0.003), and HOMA-IR (p = 0.018). The PG presented a lower diastolic blood pressure (p = 0.004) and low-density lipoprotein cholesterol (LDL-c) (p = 0.056). Conclusion A hypoenergetic diet combined with PSF consumption contributes to lowering NC, FM, HOMA-IR, TG, and insulin concentrations.

Vegetarian Diets and Cardiovascular Risk in Women

Abstract Introduction: Vegetarian diets have favorable effects on cardiovascular risk, provided that they do not contain ultra-processed foods (UPF). Objective: To compare the metabolic profile, cardiovascular risk, body composition, and food consumption in vegan (VEG), lacto-ovo vegetarian (LOV), and omnivorous (OMNI) women. To verify the association between UPF consumption and cardiovascular risk. Methods: Cross-sectional study with 119 VEG (n = 43), LOV (n = 38), and OMNI (n = 38) women. Anthropometric and biochemical parameters and the Framingham risk score were assessed. Food consumption was assessed by means of a 3-day food register, and intake of macronutrients, micronutrients, and UPF was estimated. The correlation between UPF consumption and cardiovascular risk was assessed using Spearman's coefficient, with a significance level of 5%. Results: The groups showed low cardiovascular risk, without significant difference between them. The VEG and LOV groups had lower body mass index, neck circumference, body shape index, and systolic blood pressure (p < 0.05) than the OMNI group; greater consumption of carbohydrates, sugars, dietary fibers, micronutrients, beta-carotene, and carotenoids; and lower consumption of total fat, saturated fatty acids, and cholesterol (p < 0.05). Consumption of UPF was lower in the LOV group (5.7 [0.0- 19.8]) than in the OMNI group (14.9 [5.1 - 22.3]; p < 0.05). UPF consumption was associated with SBP (ρ = 0.439; p = 0.007) and blood sugar (ρ = 0.422; p = 0.010) in the VEG group, and in the LOV group it was inversely associated with LDL-c (ρ = −0.456; p = 0.010). Conclusion: Vegetarian women showed better body composition and dietary quality than OMNI women. It is important to take consumption of UPF in vegetarians into consideration, in order to improve cardiovascular risk in women.

Effects of a hypoenergetic diet associated with açaí (Euterpe oleracea Mart.) pulp consumption on antioxidant status, oxidative stress and inflammatory biomarkers in overweight, dyslipidemic individuals.

OBJECTIVE: To evaluate the effects of a hypoenergetic diet (HD)associated with açaí pulp consumption on oxidative stress, antioxidant status and inflammatory biomarkers in overweight, dyslipidemic individuals. RESEARCH METHODS & PROCEDURES: A randomized, double-blind, placebo-controlled clinical trial was conducted for 90 days. The study began with a 30-day run-in period, during which the intervention was exclusively a HD. Following this period, volunteers were randomized into 2 groups, and 200 g of either açaí pulp or placebo were added to the HD for 60 days. Anthropometric measurements, arterial pressure, oxidative stress and antioxidant status biomarkers, inflammatory and biochemical biomarkers were evaluated. RESULTS: Sixty-nine volunteers completed the clinical trial, 30 of which were in the HD + açaí group and 39 in HD + placebo group. Plasma 8-isoprostane concentrations significantly reduced 60 days after the intervention in the açaí group (p = 0.000), and there was a significant difference between the groups (açaí versus placebo; p = 0.037). Regarding inflammatory status parameters, a significant reduction in IL-6 was observed in the HD + açaí group (p = 0.042), and IFN-γ decreased significantly in both groups, HD + açaí (p = 0.001) and HD + placebo (p = 0.008); there were, however, no differences between the groups. Lipid profile parameters and blood glucose levels did not show change, regardless of nutritional intervention. CONCLUSION: The addition of açaí to a HD, for 60 days, reduced oxidative stress and improved inflammation in overweight, dyslipidemic individuals.

Is it Possible to Easily Identify Metabolically Healthy Obese Women? / É Possível Identificar Facilmente Mulheres Obesas Metabolicamente Saudáveis?

Abstract Background: Obesity is recognized as a major risk factor for the development of several metabolic complications. However, some obese individuals have a favorable metabolic profile. Objective: The aim of this study was to identify an easy parameter for recognizing metabolically healthy obese (MHO) women. Methods: A total of 292 non-diabetic women with a body mass index (BMI) ≥ 30 kg/m2 were selected, and 239 composed the final cohort. We classified the participants according to their metabolic state determined by homeostasis model assessment (HOMA) into MHO or metabolically unhealthy obese (MUO). Both groups were compared regarding biochemical, anthropometric, and body composition characteristics. Results: The average age of the cohort was 43.9 ± 10.9 years and the average BMI was 37.2 ± 5.3 kg/m2. In total, 75.7% of the participants were classified as MHO by HOMA. A cutoff of 108.2 cm for waist circumference (WC) identified MHO participants with a sensitivity of 72.4% (95% confidence interval [CI]: 59.8-82.3%), specificity of 66.9% (95% CI: 59.71-73.3%), and negative likelihood ratio of 0.41 (95% CI: 0.36-0.47). Additionally, a visceral adiposity index cutoff value of 99.2 identified MHO women with a sensitivity of 89.7% (95% CI: 79.2-95.2%), specificity of 48.6% (95% CI: 41.4-55.9%), and negative likelihood ratio of 0.21 (95% CI: 0.15-0.30). Conclusion: Women classified as MHO exhibited smaller WC measurements and lower body fat percentages, as well as lower blood glucose and insulin levels. WC emerged as an easy parameter for identifying MHO women.

Resumo Fundamento: A obesidade é reconhecida como um fator de risco importante no desenvolvimento de várias complicações metabólicas. Porém, alguns indivíduos obesos apresentam um perfil metabólico favorável. Objetivo: O objetivo do presente estudo foi identificar um parâmetro fácil para reconhecer mulheres obesas metabolicamente saudáveis (OMS) Métodos: Foram selecionadas 292 mulheres não diabéticas com índice de massa corporal (IMC) ≥ 30 kg/m2 e a coorte final foi composta de 239. De acordo com o estado metabólico determinado pelo modelo de avaliação da homeostase (HOMA), as participantes foram classificadas como obesas metabolicamente saudáveis (OMS) ou obesas metabolicamente não saudáveis (OMNS). Compararam-se ambos os grupos quanto às características bioquímicas, antropométricas e de composição corporal. Resultados: A idade média da coorte foi de 43,9 ± 10,9 anos e o IMC médio foi 37,2 ± 5,3 kg/m2. No total, 75,7% das participantes foram classificadas como OMS pelo HOMA. O ponto de corte para a circunferência da cintura (CC) de 108,2 identificou mulheres OMS com sensibilidade de 72,4% (intervalo de confiança [IC] de 95%: 59,8-82,3%), especificidade de 66,9% (IC 95%: 59,71-73,3%) e razão de verossimilhança negativa (RVN) de 0,41 (IC 95%: 0,36-0,47). Adicionalmente, o ponto de corte de 99,2 para o índice de adiposidade visceral (IAV) identificou mulheres OMS com sensibilidade de 89,7% (IC 95%: 79.2-95.2%), especificidade de 48,6% (IC 95%: 41,4-55,9%) e RVN de 0,21 (IC 95%: 0.15-0.30). Conclusões: Mulheres classificadas como OMS apresentaram menor CC, menor percentual de gordura corporal e menores níveis séricos de glicose e de insulina. A CC foi identificada como um parâmetro fácil para identificar mulheres OMS.

Anthropometric Profile, Serum Leptin, Antioxidant Vitamins, LEPR Q223R Polymorphism and Cardiovascular Risk Factors in Adolescents.

Cardiovascular disease (CVD) risk factors, such as bad eating habits, are typical in adolescence and lead to the consumption of meals that are not always sufficient in vitamins A, E, ß-carotene, excess calories and elevated serum leptin levels. The purpose of this research is to study the relationship between vitamin A deficiency (VAD), ß-carotene deficiency (ßcD), vitamin E deficiency (VED) and to explore the association of leptin receptor Q223R polymorphisms with obesity and other risk factors for CVD. Method: This observational study included 237 adolescents recruited from Adolescents Reference Center, Brazil. It was collected: socioeconomic and clinical data, laboratory and molecular samples. Results: The average age was 14.93 ± 2.18 years, 66.2 % were girls, 38.0 % had high levels of total cholesterol (TC) between 10-14 years Triceps (TSF) and subscapular skinfolds (SSF) measurements were inversely correlated with VAD. There was also an association between VAD, ßcD and high triglyceride (TG) levels. Adolescents with the RR genotype presented a trend toward higher levels of body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), TC, TG, low density lipoprotein (LDLC), leptin and low levels of high-density lipoprotein (HDL-c). Conclusion: The girls had higher levels of leptin than boys. Abdominal fat, ßcD and VED were observed in adolescents with VAD. Individuals with RR genotype have drawn attention to cardiovascular risk factors such as high rate of LDLC and reduced rate of HDLc. Thus, it is possible that individuals with this genotype may be more susceptible to the presence of cardiovascular risk factors.

Avaliação de Compostos Bioativos, Composição Físico-Química e Atividade Antioxidante In Vitro da Farinha de Berinjela / Assessment of Bioactive Compounds, Physicochemical Composition, and In Vitro Antioxidant Activity of Eggplant Flour

Fundamento: A berinjela (Solanum melongena) é um fruto de consumo mundial. Seu processamento em forma de farinha é uma maneira de evitar perdas e aproveitar suas características nutricionais. Objetivos: Este estudo avaliou a composição físico-química (umidade, proteínas, lipídeos, fibra bruta, carboidratos, minerais, niacina, saponinas, acidez titulável, fibra alimentar e fenóis totais) da farinha de berinjela preparada a partir do fruto inteiro desidratado em estufa. Métodos: Avaliou-se a atividade antioxidante in vitro usando os seguintes ensaios: radical 2,2-difenil-1-picrilhidrazila (DPPH); poder antioxidante de redução do ferro (FRAP); e análise de polifenóis com Cromatografia Líquida de Alta Eficiência (CLAE - ácido clorogênico, ácido cafeico, ácido ferúlico e rutina). Resultados: Verificou-se a presença de: 23,09% de carboidratos; 13,34% de proteínas; 1,85% de lipídeos; 39,19% de fibras totais; 1.540 mg/100 g de compostos fenólicos solúveis totais; 840 mg/100 g de saponinas; minerais (potássio, magnésio, cobre, ferro, zinco, manganês); e niacina. Observou-se atividade antioxidante in vitro para DPPH (455,6 mg de ácido ascórbico/100 g) e FRAP (486,8 mg de ácido ascórbico/100 g). A CLAE determinou a presença de ácido ascórbico, tirosina e ácidos fenólicos (ácido clorogênico, ácido cafeico e ácido ferúlico). Conclusão: A farinha de berinjela tem alto teor de fibra além de bom teor de compostos fenólicos e saponinas com importante capacidade antioxidante observada através de ensaios in vitro. A farinha de berinjela é uma boa opção para ser adicionada à dieta da população, devido aos seus potenciais benefícios à saúde

Background: The eggplant (Solanum melongena) is a fruit of world consumption. Its processing in the form of flour is a way to avoid losses and to take advantage of its nutritional characteristics. Objective: This study assessed the physicochemical composition (moisture, proteins, lipids, crude fiber, carbohydrates, minerals, niacin, saponins, titratable acidity, dietary fiber, and total phenols) of eggplant flour prepared from the whole fruit dehydrated in an oven. Methods: In vitro antioxidant activity was assessed using the following methods: 2.2-diphenyl-1-picrylhydrazyl radical (DPPH); Ferric Reducing/ Antioxidant Power (FRAP); and analysis of polyphenols using HPLC (chlorogenic acid, caffeic acid, ferulic acid, and rutin). Results: It was possible to observe: 23.09% carbohydrates; 13.34% proteins; 1.85% lipids; 39.19% total fibers; 1,540 mg/100 g total soluble phenolic compounds; 840 mg/100 g saponins; minerals (potassium, magnesium, copper, iron, zinc, manganese); and niacin. In vitro antioxidant activity was observed through DPPH (455.6 mg ascorbic acid/100 g) and FRAP (486.8 mg ascorbic acid/100 g). The HPLC method determined the presence of ascorbic acid, tyrosine, and phenolic acids (chlorogenic acid, caffeic acid, and ferulic acid). Conclusion: The eggplant flour had great fiber content in addition to good content of phenolic compounds and saponins with important antioxidant capacity observed through in vitro assays. As a result, eggplant flour is a good addition to the diet of the population, since it can bring potential health benefits

Consumo de Vitaminas Antioxidantes em Dislipidêmicos com Excesso de Peso / Antioxidant Vitamin Intake in Dyslipidemic Overweight Individuals

Fundamentos: Dislipidemia e obesidade estão associadas com insuficiente consumo de frutas, verduras e legumes, e com desequilíbrio do estado antioxidante. Objetivos: Avaliar o consumo dietético das vitaminas A, E e C e dos macronutrientes, correlacionando-os com biomarcadores em dislipidêmicos com excesso de peso. Métodos: Foram selecionados indivíduos dislipidêmicos de ambos os sexos, com idade ≥ 20 anos e índice de massa corporal (IMC) ≥ 25 kg/m2. Foram excluídos aqueles em uso de medicamentos anorexígenos e/ou realizando dieta hipoenergética. Analisaram-se as variáveis antropométricas [massa corporal, estatura, circunferência da cintura (CC), IMC] e bioquímicas [colesterol total, HDL-C, LDL-C, triglicerídeos (TGs) e F2-isoprostano plasmático]. Avaliou-se o consumo alimentar pelo questionário de frequência alimentar. Testou-se a normalidade das variáveis pelo teste não paramétrico de Kolmogorov-Smirnov e realizou-se a correlação de Spearman, empregando-se o pacote estatístico SPSS18 com nível de significância de 5%.Resultados: Dos 284 participantes, 264 (93,1%) eram mulheres. As médias do IMC e da CC foram 36,0 ± 5,8 kg/m2 e 106,2 ± 12,7cm, respectivamente. O consumo de vitaminas A e C, carboidratos, proteínas, açúcar, ácidos graxos (AG) saturados e AG trans foi superior às recomendações, enquanto os consumos de vitamina E e AG poli- e monoinsaturados não alcançaram 50% das recomendações. Evidenciou-se correlação negativa entre as seguintes variáveis: vitamina E com LDL-C e colesterol total; açúcar e HDL-C; AG poli-insaturados e colesterol total e LDL-C. Observaram-se correlações positivas entre colesterol dietético, CC e IMC, e entre massa gorda e TGs. Conclusão: Observou-se inadequação no consumo dietético de vitamina E, açúcar, AG poli-insaturados e trans, o mesmo não acontecendo com as vitaminas A e C. Não houve correlação de biomarcadores e variáveis dietéticas com F2-isoprostano plasmático

Background: Insufficient consumption of fruits, vegetables and pulses is associated with dyslipidemia and obesity and with antioxidant status imbalance. Objective: To assess the dietary intake of vitamins A, E and C and of macronutrients, correlating them with biomarkers in dyslipidemic overweight individuals. Methods: Dyslipidemic individuals of both sexes, aged ≥ 20 years, with body mass index (BMI) ≥ 25 kg/m2 were selected. Individuals on anorectic drugs and/or hypocaloric diets were excluded. Anthropometric [body mass, height, waist circumference (WC), BMI] and biochemical variables [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and plasma F2-isoprostane) were assessed. Food intake was assessed using the Food Frequency Questionnaire. Statistical analyses were performed with SPSS 18. Results: Of the 284 participants, 264 (93.1%) were women. Mean BMI and WC values were 36.0 ± 5.8kg/m2 and 106.2 ± 12.7cm, respectively. The intakes of vitamins A and C, carbohydrates, proteins, sugar, saturated and trans fatty acids were above the recommended values; the intakes of vitamin E, polyunsaturated fatty acids, and monounsaturated fatty acids were below 50% of the recommended values. There was a negative correlation between the following variables: vitamin E, LDL-C and TC; sugar and HDL-C; and polyunsaturated fatty acids, TC and LDL-C. Positive correlations were observed between dietary cholesterol, WC and BMI; and between fat mass and triglycerides. Conclusion: Inappropriate intakes of vitamin E, sugar, polyunsaturated and trans fatty acids were observed, but not of vitamins A and C. No correlation of biomarkers and dietary variables was observed with plasma F2-isoprostane

Efeitos de Diferentes Tipos de Linhaça nas Sensações de Apetite eSaciedade no Sobrepeso e na Obesidade / Effects of Different Types of Flaxseed Flour in Appetite and Satiety Sensations Among Overweighed and Obese Women

A linhaça, rica em fibras, é estratégia nutricional para o tratamento da obesidade. Objetivo: Comparar os efeitos de três tipos de farinha de linhaça nas sensações de apetite e saciedade em mulheres com sobrepeso e obesidade. Métodos: Foram consumidos aleatoriamente cinco tipos de refeição-teste: 400g de iogurte de baixo teor de gordura com 30g de farinha de linhaça: marrom integral (FLMI), marrom desengordurada (FLMD), dourada (FLD) ou 14 g de fibra solúvel (goma guar) ou iogurte (controle). A avaliação da sensação de apetite e saciedade foi realizada em 0 (em jejum), 15, 45, 75 e 105 minutos após a refeição-teste, utilizando escala visual analógica adaptada. Avariação da taxa entre os tempos T0-T15 e T15-T105 foi calculada e os voluntários classificados em quatro quadrantes, de acordo com média e taxas de variação. Resultados: Os grupos suplementados com linhaça apresentaram comportamento semelhante na sensação de apetite e saciedade; com FLMD houve menor sensação de apetite e maior saciedade, e maior frequência no quadrante “Perde lento e ganha lento” do grupo com sobrepeso (47,0%) e do grupo obesidade grau 1 (47,6%). No quadrante “Perde rápido e ganha rápido” o grupo com sobrepeso (41,2%) foi o mais frequente e no quadrante “Perde lento e ganha rápido” o grupo obesidade grau 1 (31,8%) foi o mais frequente. Conclusão: A ingestão de FLMD favoreceu a redução do apetite e aumento da saciedade provavelmente por viscosidade mais elevada e maior quantidade de proteínas desta linhaça...

Flaxseed is rich in fibers and is a nutritional strategy for the treatment of obesity . Objective: To compare the effects of three types of flaxseed flours in the appetite and satiety sensations in overweighed and obese women. Methods: Five types of test meals were randomly consumed: 400g of low-fat yogurt with 30g of the following types of flaxseed flour: whole brown flaxseed flour (WBFF), brown defatted flaxseed flour (BDFF), golden flaxseed flour (GFF) or 14g of soluble fiber (guar gum) or yogurt (control). Evaluation of the appetite and satiety sensation was held 0 (fasting), 15, 45, 75 and 105 minutes after the test meal using an adapted visual analogue scale. Variation on the rate between times T0-T15 and T15-T105 was calculated and the volunteers were ranked into four quadrants according to the average and variation rates. Results: The groups supplemented with flaxseed showed similar behavior in the sensation of appetite and satiety; with BDFF, there was a weaker sensation of appetite and greater satiety, and greater frequency of the overweight group (47.0%) and grade 1 obesity group (47.6%) in the “Loses slowly and gains slowly” quadrant. The overweight group appeared more frequently (41.2%) in the “Loses quickly and gains quickly” quadrant. The grade 1 obesity group appeared more frequently (31.8%) in the “Loses slowly and gains quickly” quadrant. Conclusion: Intake of BDFF led to reduced appetite and increased satiety probably due to the higher viscosity and greater amount of protein found in flaxseed...

Additive effect of linseed oil supplementation on the lipid profiles of older adults.

BACKGROUND: Linseed oil has been investigated as a rich source of n-3 series polyunsaturated fatty acids, which mainly produce a non-atherogenic lipid profile. The objective of this study was to investigate the effect of linseed oil supplementation associated with nutritional guidelines on the lipid profiles of older adults, according to the intake of saturated fatty acids (SFA). METHODS: We conducted a double-blind, placebo-controlled clinical trial with 110 older adults randomized in two groups: placebo and linseed oil. The linseed oil group received supplementation with 3 g of linseed oil. Both groups received nutritional guidance and were supplemented for 90 days with monthly blood collection for biochemical analysis. The dietary intake of saturated fat was subdivided into low (<7% SFA/day of the total energy value) and high consumption groups (>7% SFA/day of the total energy value). RESULTS: Low SFA (<7% SFA/day of total energy value) consumption was associated with lower total cholesterol concentrations. However, we observed that the linseed oil group, including older adults who consumed >7% SFA/day, had a greater reduction in total cholesterol than the placebo group (P=0.020). The same was observed for low-density lipoprotein (LDL) cholesterol (P<0.050), suggesting an additive effect of linseed oil and diet. High-density lipoprotein (HDL) cholesterol concentrations were increased significantly in only the linseed group, suggesting that the nutritional intervention alone did not improve HDL cholesterol. CONCLUSION: The results suggest that the nutritional intervention was effective, but linseed oil showed notable effects by increasing the HDL cholesterol concentration. In addition, consumption of <7% SFA/day of the total energy value increased the effect of linseed oil, demonstrating the importance of reducing the consumption of saturated fat.

A COCONUT EXTRA VIRGIN OIL-RICH DIET INCREASES HDL CHOLESTEROL AND DECREASES WAIST CIRCUMFERENCE AND BODY MASS IN CORONARY ARTERY DISEASE PATIENTS.

INTRODUCTION: saturated fat restriction has been recommended for coronary arterial disease, but the role of coconut oil (Cocos nucifera L.) extra virgin, lauric acid source in the management of lipid profile remains unclear. OBJECTIVE: to evaluate the effect of nutritional treatment associated with the consumption of extra virgin coconut oil in anthropometric parameters and lipid profile. METHODS: we conducted a longitudinal study of 116 adults of both sexes presenting CAD. Patients were followed in two stages: the first stage (basal-3 months), intensive nutritional treatment. In the second stage (3-6 months), the subjects were divided into two groups: diet group associated with extra virgin coconut oil consumption (GDOC) and diet group (DG). Held monthly anthropometric measurements: body mass, waist circumference (WC), neck circumference (PP), body mass index (BMI). Gauged to collected blood pressure and blood samples were fasted for 12 hours, for total cholesterol analysis and fractions apoproteins (Apo A-1 and B), glucose, glycated hemoglobin (HbA1C), insulin (I). Comparing the averages at the beginning and end of the study employing the paired Student t-independent. And set the diastolic blood pressure by BMI using ANOVA. Analyses were performed using the SPSS statistical package, being significant p < 0.05. RESULTS: the mean age of the population was 62.4 ± 7.7 years, 63.2% male, 70% elderly, 77.6% infarcted, 52.6% with angina, hypertension and dyslipidemia 100%. In the first stage the nutritional treatment reduced body weight, WC, BMI and PP and insulin concentrations, HbA1C, HOMA-IR and QUICK, without changing the other parameters. In the second stage of the study, it was observed that the GDOC maintained the reduction of body mass, BMI, WC, with a significant difference between groups for DC (-2.1 ± 2,7 cm; p < 0.01). In addition, there was an increase in HDL-C concentrations, Apo A, with significant difference in GD, only for HDL-C (3.1 ± 7.4 mg/dL; p = 0.02). CONCLUSION: it was observed that the nutritional treatment associated with extra virgin coconut oil consumption reduced the CC and increased HDL-C levels in patients with CAD.

Introducción: el aceite de coco (Cocos nucifera L.) virgen extra contiene una alta proporción de ácidos grasos de cadena media que parecen contribuir a la reducción del peso y podría ayudar en la prevención secundaria de la enfermedad arterial coronaria (EAC). Objetivo: evaluar el efecto del tratamiento nutricional asociado con el consumo de aceite de coco virgen extra en los parámetros antropométricos y el perfil lipídico. Métodos: se realizó un estudio longitudinal de 116 adultos de ambos sexos que presentan CAD. Los pacientes fueron seguidos en dos etapas: en la primera etapa (basal-3 meses), se llevo a cabo un tratamiento nutricional intensivo. En la segunda etapa (3-6 días), los sujetos fueron divididos en dos grupos: grupo asociado con el consumo de aceite extra virgen de coco (GDOC) y el grupo de dieta (GD). Se realizaron mediciones mensuales antropométricas: peso, circunferencia de la cintura (CC), circunferencia del cuello (PP) e índice de masa corporal (IMC). Se tomó la presión arterial y muestras de sangre recogidas en ayunas durante 12 horas para el análisis de colesterol total y lipoproteínas, apoproteínas (Apo A-1 y B), glucosa, hemoglobina glucosilada (HbA1c) e insulina (I). Se compararon los promedios al principio y al final del estudio mediante el test t de Student-independiente. Se ajustó la presión arterial diastólica por el IMC mediante ANOVA. Los análisis se realizaron con el paquete estadístico SPSS, siendo significativa p < 0.05. Resultados: la edad media de la población fue de 62,4 ± 7,7 años, el 63,2% hombres, 70% mayores, el 77,6% con infarto de miocardio, el 52,6% con angina de pecho y el 100% con hipertensión arterial y dislipidemia. En la primera etapa del tratamiento nutricional se redujeron las concentraciones de insulina, peso, WC, IMC y PP, HbA1C, HOMA-IR y rápido, sin cambiar otros parámetros. En la segunda etapa del estudio se observó que la GDOC mantiene la reducción del peso, BMI, WC, con una diferencia significativa entre los grupos para DC (-2,1 ± 2,7 cm; p < 0,01). Además, se produjo un aumento en las concentraciones de HDL-C, Apo A, con una diferencia significativa en GD, solo para HDL-C (3,1 ± 7,4 mg/dl; p = 0,02). Conclusión: se observó que el tratamiento nutricional asociado con el consumo de aceite de coco virgen extra redujo la CC e incrementó los niveles de HDL-C en pacientes con CAD.

Improvement of antioxidant status after Brazil nut intake in hypertensive and dyslipidemic subjects.

OBJECTIVES: To investigate the effect of partially defatted Granulated Brazil nut (GBN) on biomarkers of oxidative stress and antioxidant status of hypertensive and dyslipidemic patients on nutrition and drug approaches. METHODS: Ninety one hypertensive and dyslipidemic subjects of both genders (51.6 % men), mean age 62.1 ± 9.3 years, performed a randomized crossover trial, double-blind, placebo controlled. Subjects received a diet and partially defatted GBN 13 g per day (≈227.5 µg/day of selenium) or placebo for twelve weeks with four-week washout interval. Anthropometric, laboratory and clinic characteristics were investigated at baseline. Plasma selenium (Se), plasma glutathione peroxidase (GPx3) activity, total antioxidant capacity (TAC), 8-epi PGF2α and oxidized LDL were evaluated at the beginning and in the end of each intervention. RESULTS: GBN intake significantly increased plasma Se from 87.0 ± 16.8 to 180.6 ± 67.1 µg/L, increased GPx3 activity in 24,8% (from 112.66 ± 40.09 to 128.32 ± 38.31 nmol/min/mL, p < 0,05), and reduced 3.25% of oxidized-LDL levels (from 66.31 ± 23.59 to 60.68 ± 20.88 U/L, p < 0.05). An inverse association between GPx3 and oxidized LDL levels was observed after supplementation with GBN by simple model (ß -0.232, p = 0.032) and after adjustment for gender, age, diabetes and BMI (ß -0.298, p = 0.008). There wasn't association between GPx3 and 8-epi PGF2α (ß -0.209, p = 0.052) by simple model. CONCLUSION: The partially defatted GBN intake has a potential benefit to increase plasma selenium, increase enzymatic antioxidant activity of GPx3 and to reduction oxidation in LDL in hypertensive and dyslipidemic patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01990391; November 20, 2013.

Avaliação da Qualidade da Dieta Hipoenergética em Mulheres com Excesso de Peso / Assessment of the Quality of Hypoenergetic Diet in Overweight Women

Fundamentos: O número de mortes atribuíveis à dieta não saudável aumentou nas últimas décadas e osinstrumentos para sua avaliação apresentam inúmeras limitações.Objetivo: Avaliar o efeito da dieta hipoenergética nos dados antropométricos e bioquímicos e verificar sua qualidade pelo índice de qualidade da dieta revisado para população brasileira (IQD-R) e consumo de alimentosultraprocessados (AU), em mulheres com excesso de peso. Métodos: Estudadas 44 mulheres, com excesso de peso, submetidas à dieta hipoenergética por 180 dias. Foram coletados, mensalmente: pressão arterial (PA), dados antropométricos, bioquímicos e dietéticos. Para avaliação da qualidade da dieta empregou-se o IQD-R e o consumo de AU e ingredientes de adição. Utilizaram-se os testes de Wilcoxon e Mann-Whitney com significância estatística de p<0,05. Resultados: A média de idade encontrada foi 47,0±11,0 anos e do índice de massa corporal (IMC) foi 36,0±7,3kg/m2.Observou-se redução da massa corporal, IMC, perímetro do pescoço e da cintura, razão cintura/estatura, índice de adiposidade visceral, PA sistólica, concentrações de glicose, de triglicerídeos e lipopoproteínas de muito baixa densidade (VLDL-c). Houve melhora da qualidade da dieta em ambos os grupos com redução significativa do consumo de proteínas, lipídeos totais, ácidos graxos e sódio na dieta classificada como adequada; e redução da energia, glicose, VLDL-c e da PA na inadequada. Houve redução significativa do consumo de AU comorefrigerantes, macarrão instantâneo, sucos industrializados e açúcar de adição.Conclusão: A dieta hipoenergética reduziu parâmetros antropométricos e bioquímicos e essas modificações nãoforam explicadas pelo IQD-R, mas pela avaliação dos AU e ingredientes de adição.

Background: The number of deaths attributable to unhealthy diet has increased in recent decades, and the instruments for their assessment have several limitations. Objective: Evaluate the effect of the hypoenergetic diet in anthropometric and biochemical data, and check its quality based on the diet quality index revised for the Brazilian population (DQI-R), and on the consumption of ultra-processed food products (UPP) in women with overweight. Methods: This study covered 44 women with overweight undergoing a hypoenergetic diet for 180 days. Monthly appraisals: bloodpressure (BP), anthropometric, biochemical and dietary data. The DQI-R and the consumption of UPP and additives were used ascriteria to assess the diet quality. The Wilcoxon and Mann-Whitney tests were employed, with statistical significance of p<0.05. Results: The mean age found was 47.0±11.0 years, and the body mass index (BMI) was 36.0±7.3 kg/m2. It was observed a decrease in body mass, BMI, neck and waist circumferences, waist-to-height ratio, visceral adiposity index, systolic blood pressure, and in the concentrations of glucose, triglycerides and very low-density lipoproteins (VLDL-C). The quality of diet improved in both groupswith significant reduction in the consumption of protein, total lipids, fatty acids and sodium in the adequate diet; and there was a reduction in energy, glucose, VLDL-C and BP in the inadequate diet. There was a significant decrease in the consumption of UPP,such as soft drinks, instant noodles, processed juices, and added sugar foods.Conclusion: The hypoenergetic diet reduced anthropometric and biochemical parameters and these changes were not explained by DQI-R, but by the evaluation of UPP and additives.

Associação entre a homocisteína e os polimorfismos do gene da MTHFR em mulheres brasileiras obesas / Association between homocysteine and polymorphisms in MTHFR in Brazilian obese women

Fundamentos: Pesquisas nacionais brasileiras indicam aumento da obesidade e doenças cardiovasculares em mulheres. Objetivo: Determinar a frequência dos polimorfismos 677C>T e 1298A>C do gene da metilenotetra-hidrofolato redutase (MTHFR) em mulheres brasileiras obesas e avaliar sua associação com as concentrações séricas de homocisteína (Hcy),folato e cobalamina, no período após a fortificação das farinhas de trigo e milho com ácido fólico no Brasil. Métodos: Estudo transversal realizado no período de 2008 a 2009, com 133 mulheres obesas. Kits comerciais foramutilizados para realizar análises laboratoriais, incluindo mensuração de lipídeos e glicose por métodos enzimáticos; Hcy total e o folato plasmático, utilizando um imunoensaio competitivo; e cobalamina baseado em quimiluminescência. A genotipagem foi realizada por PCR, seguido por fragmento de restrição enzimática. Resultados: A média de idade dos participantes foi 39,0±4,4 anos e o índice de massa corporal, 32,5±2,1 kg/m². Distribuições dos genótipos encontradas: CC (47%), CT (44%) e TT (9%) para a posição 677 da MTHFR e AA (60%), AC (35%), e CC (5%) para a posição 1298. As concentrações de Hcy correlacionaram-se negativamente com a concentração de folato plasmático no grupo exibindo os genótipos 677CT, 1298AC ou 1298CC (r=0,554, p<0,01). Conclusão: Mulheres brasileiras obesas com genótipos 677TT estudadas apresentaram maiores concentrações de Hcy do que aquelas que apresentaram os genótipos 677CT e 677CC. Além disso, genótipos 1298CC mostraram associação com concentrações de Hcy maiores do que os genótipos 1298AC e 1298AA.

Background: Brazilian national surveys have indicated a rise in obesity and cardiovascular disease in women.Objective: To determine the frequency of 677C>T and 1298A>C polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene in obese Brazilian women and to assess the potential association of these polymorphisms with serum concentrations of homocysteine (Hcy), folate and cobalamin after fortification of wheat and corn flour with folic acid in Brazil. Methods: A cross-sectional study was conducted from 2008 to 2009 with 133 obese women. Commercial kits were employed to perform laboratory analyses including measurement of lipids and glucose using enzymatic methods, total Hcy and serum folate using a competitive immunoassay and cobalamin based on chemiluminescence. Genotyping was performed by PCR, followed by restriction fragment lengthpolymorphism analysis. Results: The average age of participants was 39.0±4.4 years and mean body mass index was 32.5±2.1kg/m². The distributions of the genotypeswere CC (47%), CT (44%), and TT (9%) for the position MTHFR 677 and AA (60%), AC (35%), and CC (5%) for the position 1298. Hcy levels correlated negatively with serum folate in the group displaying the 677CT, 1298AC, or 1298CC genotypes (r=-0.554, p<0.01). Conclusion: Our findings suggest that obese Brazilian women with genotypes 677TT have higher Hcy concentrations than those carrying the genotypes 677CT and 677CC. Additionally, genotypes 1298CC are associated with higher Hcy concentrations than genotypes 1298AC and 1298AA.

Hypocaloric diet associated with the consumption of jam enriched with microencapsulated fish oil decreases insulin resistance.

BACKGROUND: The metabolic syndrome is related to the increase in cardiovascular diseases. Polyunsaturated fatty acids from fish oil help in reducing cardiovascular risk factors and are natural bindings of PPAR2. OBJECTIVE: To evaluate the impact of hypocaloric diet associated with microencapsulated fish oil supplementation in women with metabolic syndrome. METHODS: We conducted a randomized, single-blind and placebo-controlled clinical trial with adult women who presented metabolic syndrome (n = 30) for 90 days. The volunteers were divided into two groups: placebo group (n = 15) and microencapsulated fish oil group (n = 15) (3 g/day of microencapsulated fish oil containing 0.41 g/day of eicosapentaenoic acid and decosahexaneoic acid). Anthropometric, body composition, clinical and laboratory parameters were assessed before and after the intervention. Paired t-test was used for comparisons within groups and Student's t-test for comparison between groups. We considered p < 0.05 as significant values. RESULTS: The comparison between groups revealed a significant reduction of blood glucose, insulinemia and the homeostasis model assessment in the microencapsulated fish oil group after 90 days, as opposed to the placebo group. We also observed reduction of the systolic arterial pressure in the microencapsulated fish oil group. CONCLUSION: A hypocaloric diet associated with the consumption of microencapsulated fish oil was effective in reducing blood glucose, insulinemia and insulin resistance in women with MS.

Antecedentes: El síndrome metabólico se relaciona con un incremento de las enfermedades cardiovasculares. Los ácidos grasos poliinsaturados del aceite de pescado ayudan a reducir los factores de riesgo cardiovascular y son ligandos naturales del PPAR2. Objetivo: Evaluar el impacto de la dieta hipocalórica asociada con suplementación de aceite de pescado microencapsulado en mujeres con síndrome metabólico. Métodos: Realizamos un ensayo clínico de distribución aleatoria, simple ciego y controlado con placebo en mujeres adultas con síndrome metabólico (n = 30) durante 90 días. Se dividió a las voluntarias en dos grupos: el grupo placebo (n = 15) y el grupo con aceite de pescado microencapsulado (n = 15) (3 g/día de aceite de pescado microencapsulado que contienen 0,41 g/día de ácido eicosapentaenoico y de ácido decosahexaneoico). Se evaluaron parámetros antropométricos, clínicos y de laboratorio y la composición corporal antes y después de la intervención. Se emplearon la prueba t pareada para las comparaciones dentro de los grupos y la prueba t de Student para la comparación entre grupos. Consideramos valores significativos de p < 0,05. Resultados: La comparación entre grupos reveló una reducción significativa de la glucosa sanguínea, la insulinemia y la evaluación del modelo homeostático en el grupo de aceite de pescado microencapsulado tras 90 días, en comparación con el grupo placebo. También observamos una reducción de la presión arterial sistólica en el grupo con aceite de pescado microencapsulado. Conclusión: La dieta hipocalórica asociada con el consumo de aceite de pescado microencapsulado fue eficaz en la reducción de la glucosa sanguínea, la insulinemia y la resistencia a la insulina en mujeres con SM.

Associação da deficiência de ácido fólico com alterações patológicas e estratégias para sua prevenção: uma visão crítica / Association between folic acid deficiency and disease and prevention strategies: a critical view

A deficiência de ácido fólico está associada às doenças crônicas não-transmissíveis, complicações na gestação e doenças neurodegenerativas. Objetivou-se discutir o papel do ácido fólico na prevenção de doenças, os aspectos epidemiológicos de sua deficiência, fortificação dos alimentos e suplementação medicamentosa. Realizou-se levantamento bibliográfico, consultando as bases de dados para a obtenção dos artigos completos: MedLine, SciELO, PubMed, Highwire Press e Science Direct. Foram selecionados estudos realizados com seres humanos publicados entre 2004 e 2010. O ácido fólico é importante para as reações de metilação do ácido desoxirribonucléico, prevenção da hiper-homocisteinemia e atua como antioxidante. A deficiência dessa vitamina é descrita em adolescentes, mulheres em idade fértil, gestantes e em idosos. Seu alcance pela dieta é difícil, sendo necessária a inclusão de alimentos fortificados ou suplementos. É importante avaliar o estado nutricional de ácido fólico dos indivíduos antes e após a adoção dessas estratégias, de modo a gerar subsídios para ela-boração de medidas governamentais mais adequadas e eficazes. Destacamos ainda a necessidade da reeducação nutricional para a população brasileira a fim de aumentar o consumo de alimentos fontes de ácido fólico.

Folic acid deficiency is associated with non-communicable chronic diseases, pregnancy-associated complications and neurodegenerative diseases. The objective of this paper was to discuss the role of folic acid in disease prevention, the epidemiological aspects of its deficiency and food fortification and supplementation. Articles were searched in the following databases: MedLine, SciELO, PubMed, Highwire Press and Science Direct. Only original studies with humans published between 2004 and 2010 were included. Folic acid is important for DNA methylation and prevention of hyperhomocysteinemia. It also presents antioxidant activity. Folic acid deficiency has been described in adolescents, women of childbearing age, pregnant women and the elderly. It is difficult to meet the folic acid requirement with diet alone, so fortified foods and supplements are necessary. It is important to assess folic acid levels before and after the implementation of such strategies to enable the development of better and more effective public strategies. It is also important to provide nutrition education for the Brazilian population for them to increase their consumption of dietary sources of folic acid.

[Metabolic syndrome in coronary artery and occlusive vascular diseases: a systematic review].

Nowadays, the metabolic syndrome (MS) is highly prevalent and is associated with risk factors for non-transmissible chronic diseases, such as type 2 diabetes mellitus, and coronary atherosclerotic disease. The objective of this systematic review is to describe the results of studies that investigated the association of MS with coronary artery disease and occlusive vascular diseases. We conducted a systematic review of data from original studies published between 1999 and 2008, written in English or Portuguese, using the databases Medline, Pubmed, Science Direct and HighWire Press. We included articles in which the diagnosis of MS was made by the criteria of the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III, 2001). We excluded studies with animals, supplementation studies, and those with oral or intravenous administration of any substance, as well as those of low methodological quality and those which had a heterogeneous initial sample. Despite the heterogeneity among studies, we observed that individuals with MS had a higher probability (risk = 2.13) of developing occlusive vascular diseases, coronary disease, diabetes and stroke. Lifestyle changes such as healthy eating habits, regular physical activity and cessation of smoking should be encouraged by health professionals to minimize the complications and morbidity associated with MS.

Síndrome metabólica na doença arterial coronariana e vascular oclusiva: uma revisão sistemática / Metabolic syndrome in coronary artery and occlusive vascular diseases: a systematic review

Atualmente, a síndrome metabólica (SM) se mostra altamente prevalente, sendo associada a fatores de risco para doenças crônicas não transmissíveis, tais como diabetes mellitus tipo 2, doenças ateroscleróticas e coronarianas. O objetivo desta revisão sistemática foi descrever os resultados de estudos que investigaram a associação da SM com a doença arterial coronariana e doenças vasculares oclusivas. Foi realizada a revisão sistemática com dados de estudos originais publicados entre 1999 e 2008, escritos em inglês ou português, utilizando-se as bases de dados Medline, Pubmed, Highwire Press e Science Direct. Foram incluídos artigos que fizeram o diagnóstico da SM através do critério do National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III, 2001). Foram excluídos estudos realizados com animais, de suplementação e que realizaram administração oral ou endovenosa de qualquer substância, assim como aqueles de baixa qualidade metodológica e com amostra inicialmente heterogênea. Apesar da heterogeneidade entre os estudos, observou-se que indivíduos com SM apresentam maior probabilidade (risco = 2,13) de desenvolverem as doenças vasculares oclusivas, doença coronariana, diabetes mellitus e acidente vascular encefálico. Mudanças no estilo de vida, como práticas alimentares saudáveis, atividade física regular e a cessação do tabagismo devem ser incentivadas pelos profissionais da saúde a fim de minimizar as complicações e a morbimortalidade associada à SM.

Nowadays, the metabolic syndrome (MS) is highly prevalent and is associated with risk factors for non-transmissible chronic diseases, such as type 2 diabetes mellitus, and coronary atherosclerotic disease. The objective of this systematic review is to describe the results of studies that investigated the association of MS with coronary artery disease and occlusive vascular diseases. We conducted a systematic review of data from original studies published between 1999 and 2008, written in English or Portuguese, using the databases Medline, Pubmed, Science Direct and HighWire Press. We included articles in which the diagnosis of MS was made by the criteria of the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III, 2001). We excluded studies with animals, supplementation studies, and those with oral or intravenous administration of any substance, as well as those of low methodological quality and those which had a heterogeneous initial sample. Despite the heterogeneity among studies, we observed that individuals with MS had a higher probability (risk = 2.13) of developing occlusive vascular diseases, coronary disease, diabetes and stroke. Lifestyle changes such as healthy eating habits, regular physical activity and cessation of smoking should be encouraged by health professionals to minimize the complications and morbidity associated with MS.

Association of homocysteinemia with high concentrations of serum insulin and uric acid in Brazilian subjects with metabolic syndrome genotyped for C677T polymorphism in the methylenetetrahydrofolate reductase gene.

Information on plasma homocysteine concentrations and their associated factors in Brazilian subjects with metabolic syndrome (MS) is nonexistent. Therefore, a cross-sectional study was conducted to investigate the association of homocysteinemia with MS components; folate and cobalamin biochemical and dietary indices of nutritional status; and genetic, anthropometric, and lifestyle factors in Brazilian subjects with MS. Waist circumference; body fat; body mass index; insulin resistance; lipid profiles; glycemia; uricemia; insulinemia; erythrocyte folate and plasma homocysteine; folate and cobalamin concentrations; C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene; coffee and alcohol intake; and smoking were determined in 63 subjects (24 males and 39 females) with MS. No difference in homocysteine plasma was observed between sexes. Hyperhomocysteinemia (Hhcy) frequency was 49.2% (n = 31) in the group studied. The distribution of MTHFR genotypes was as follows: CC, 64% (n = 42); CT, 32% (n = 19); and TT, 4% (n = 2). No association was found between Hhcy and C677T polymorphism in the MTHFR gene. Plasma homocysteine concentrations showed no association with age; blood pressure; dietary intakes of folate, cobalamin, and pyridoxine; body mass index; waist circumference; body fat; glycemia; lipid profile; insulin resistance; and concentrations of folate erythrocyte and plasma folate and cobalamin. Also, there was no correlation between Hhcy, sex, and lifestyle factors. In this study, the variables uricemia (C = 0.67, chi(2) = 2.23, P = .27) and insulinemia (C = 0.86, chi(2) = 2.98, P = .07) were positively associated with homocysteinemia. In conclusion, our results suggest that high concentrations of serum insulin and uric acid are associated with an increased risk of developing Hhcy in subjects with MS.