RESUMEN
BACKGROUND: Familial chylomicronemia syndrome (FCS) is a rare monogenic form of severe hypertriglyceridemia, caused by mutations in genes involved in triglyceride metabolism. Herein, we report the case of a Korean family with familial chylomicronemia syndrome caused by compound heterozygous deletions of glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1). CASE PRESENTATION: A 4-year-old boy was referred for the evaluation of severe hypertriglyceridemia (3734 mg/dL) that was incidentally detected 4 months prior. His elder brother also demonstrated an elevated triglyceride level of 2133 mg/dL at the age of 9. Lipoprotein electrophoresis revealed the presence of chylomicrons, an increase in the proportion of pre-beta lipoproteins, and low serum lipoprotein lipase levels. The patient's parents and first elder brother had stable lipid profiles. For suspected FCS, genetic testing was performed using the next-generation sequencing-based analysis of 31 lipid metabolism-associated genes, which revealed no pathogenic variants. However, copy number variant screening using sequencing depth information suggested large heterozygous deletion encompassing all the coding exons of GPIHBP1. A real-time quantitative polymerase chain reaction was performed to validate the deletion site. The results showed that the siblings had two heterozygous copy number variants consisting of the whole gene and an exon 4 deletion, each inherited from their parents. During the follow-up period of 17 months, the patient did not develop pancreatitis, following dietary intervention. CONCLUSION: These siblings' case of familial chylomicronemia syndrome caused by rare GPIHBP1 deletions highlight the implementation of copy number variants-beyond next-generation sequencing-as an important consideration in diagnosis. Accurate genetic diagnosis is necessary to establish the etiology of severe hypertriglyceridemia, which increases the risk of pancreatitis.
Asunto(s)
Hiperlipoproteinemia Tipo I , Hipertrigliceridemia , Pancreatitis , Receptores de Lipoproteína , Preescolar , Humanos , Masculino , Hiperlipoproteinemia Tipo I/diagnóstico , Hiperlipoproteinemia Tipo I/genética , Hipertrigliceridemia/etiología , Lipoproteína Lipasa/genética , Lipoproteína Lipasa/metabolismo , Receptores de Lipoproteína/genética , Receptores de Lipoproteína/química , Receptores de Lipoproteína/metabolismo , Hermanos , Triglicéridos , NiñoRESUMEN
BACKGROUND: Although low high-density lipoprotein cholesterol (HDL-C) levels are a common metabolic abnormality associated with insulin resistance, their role in cardiovascular risk stratification remains controversial. Recently, we developed a simple, high-throughput, cell-free assay system to evaluate the "cholesterol uptake capacity (CUC)" as a novel concept for HDL functionality. In this study, we assessed the CUC in patients with hypertriglyceridemia and diabetes mellitus. METHODS: The CUC was measured using cryopreserved serum samples from 285 patients who underwent coronary angiography or percutaneous coronary intervention between December 2014 and May 2019 at Kobe University Hospital. RESULTS: The CUC was significantly lower in diabetic patients (n = 125) than in nondiabetic patients (93.0 vs 100.7â arbitrary units (A.U.), P = 0.002). Patients with serum triglyceride (TG) levels >150â mg/dL (n = 94) also had a significantly lower CUC (91.8 vs 100.0â A.U., P = 0.004). Furthermore, the CUC showed a significant inverse correlation with TG, hemoglobin A1c (Hb A1c), homeostasis model assessment of insulin resistance (HOMA-IR), and body mass index (BMI). Finally, the HDL-C/Apolipoprotein A1 (ApoA1) ratio, calculated as a surrogate index of HDL particle size, was significantly positively correlated with the CUC (r2 = 0.49, P < 0.001), but inversely correlated with TG levels (r2 = -0.30, P < 0.001). CONCLUSIONS: The CUC decreased in patients with hypertriglyceridemia and diabetes mellitus, and HDL particle size was a factor defining the CUC and inversely correlated with TG levels, suggesting that impaired CUC in insulin-resistant states was partially due to the shift in HDL towards smaller particles. These findings provide a better understanding of the mechanisms underlying impaired HDL functionality.
Asunto(s)
HDL-Colesterol , Hipertrigliceridemia , Resistencia a la Insulina , Triglicéridos , Humanos , Hipertrigliceridemia/sangre , Hipertrigliceridemia/diagnóstico , Hipertrigliceridemia/complicaciones , Hipertrigliceridemia/etiología , Masculino , Femenino , Persona de Mediana Edad , Anciano , HDL-Colesterol/sangre , Triglicéridos/sangre , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Apolipoproteína A-I/sangre , Colesterol/sangre , Hemoglobina Glucada/metabolismo , Hemoglobina Glucada/análisisRESUMEN
Abstract: Objective: Evaluate association of dietary patterns with metabolic syndrome (MetS) and metabolic markers. Materials and methods: 654 adolescents from Guadalajara, Jalisco, participated in a cross-sectional study. Diet was evaluated using a food frequency questionnaire; 24 food groups were integrated, and dietary patterns were derived using cluster analysis. MetS was defined according to International Diabetes Federation (IDF), Cook and colleagues, Ford and colleagues, and de Ferranti and colleagues criteria. Results: Dietary patterns identified were: "DP1", "DP2", and "DP3". Among males, "DP3" was associated with MetS (Cook and collaborators) (OR, 12.14; 95%CI, 1.66-89.05), hypertriglyceridemia (OR, 3.89; 95%CI, 1.01-15.07), and insulin resistance (OR, 6.66; 95%CI, 1.12-39.70). "DP2" was associated with abdominal obesity (OR, 5.11; 95%CI, 1.57-16.66). Conclusions: "DP3" entertained a greater risk of MetS, hypertriglyceridemia, and insulin resistance, while "DP2" possessed a greater risk of abdominal obesity among adolescent males.
Resumen: Objetivo: Evaluar la asociación de patrones dietarios (PD) con síndrome metabólico (SM) y marcadores metabólicos. Material y métodos: Estudio transversal con 654 adolescentes. Dieta evaluada con el cuestionario "frecuencia de consumos de alimentos"; se identificaron 24 grupos de alimentos, para obtener PD mediante análisis de conglomerados. SM se definió según los criterios: Federación de Diabetes Internacional (IDF), Cook y colaboradores, Ford y colaboradores y Ferranti y colaboradores. Resultados: Se identificaron tres PD: "PD1", "PD2" y "PD3". En hombres, "PD3" se asoció con SM (Cook y colaboradores) (RM, 12.14; IC95%, 1.66-89.05), hipertrigliceridemia (RM, 3.89; IC95%, 1.01-15.07) y resistencia a insulina (RM, 6.66; IC95%, 1.12-39.70). El patrón "PD2" se asoció con obesidad abdominal (RM, 5.11; IC95%, 1.57-16.66). Conclusiones: El patrón "PD3" aumenta el riesgo de SM, hipertrigliceridemia y resistencia a insulina y el "PD2" el riesgo de obesidad abdominal en adolescentes hombres.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Síndrome Metabólico/etiología , Conducta Alimentaria , Ingestión de Energía , Resistencia a la Insulina , Hipertrigliceridemia/etiología , Modelos Logísticos , Oportunidad Relativa , Factores Sexuales , Estudios Transversales , Obesidad Abdominal/etiología , Comida Rápida/efectos adversos , Obesidad Infantil/epidemiología , Tamaño de la Porción , Alimentos/clasificaciónRESUMEN
The metabolic syndrome describes a group of signs that increase the likelihood for developing type 2 diabetes mellitus, cardiovascular diseases and some types of cancer. The action of insulin depends on its binding to membrane receptors on its target cells. We wonder if blood insulin could travel bound to proteins and if, in the presence of hyperinsulinemia, a soluble insulin receptor might be generated. We used young adult Wistar rats (which have no predisposition to obesity or diabetes), whose drinking water was added 20 % of sugar and that were fed a standard diet ad libitum for two and six months. They were compared with control rats under the same conditions, but that had running water for consumption. At two months, the rats developed central obesity, moderate hypertension, high triglyceride levels, hyperinsulinemia, glucose intolerance and insulin resistance, i.e., metabolic syndrome. Electrophoresis of the rats plasma proteins was performed, followed by Western Blot (WB) for insulin and for the outer portion of the insulin receptor. The bands corresponding to insulin and to the receptor external part were at the same molecular weight level, 25-fold higher than that of free insulin. We demonstrated that insulin, both in control animals and in those with hyperinsulinemia, travels bound to the receptor outer portion (ectodomain), which we called soluble insulin receptor, and that is released al higher amounts in response to plasma insulin increase; in rats with metabolic syndrome and hyperinsulinemia, plasma levels are much higher than in controls. Soluble insulin receptor increase in blood might be an early sign of metabolic syndrome.
Asunto(s)
Humanos , Animales , Ratas , Resistencia a la Insulina/fisiología , Receptor de Insulina/metabolismo , Síndrome Metabólico/etiología , Hiperinsulinismo/metabolismo , Insulina/metabolismo , Hipertrigliceridemia/etiología , Ratas Wistar , Intolerancia a la Glucosa/etiología , Síndrome Metabólico/metabolismo , Diabetes Mellitus Tipo 2/etiología , Modelos Animales de Enfermedad , Obesidad Abdominal/etiología , Hipertensión/etiología , Insulina/sangreRESUMEN
Abstract Hypertriglyceridemia is common in antiretroviral therapy-treated patients and Omega 3 fatty acids are being used as a intervention in reducing serum triglycerides (TG) in these patients. The objective of this study is to evaluate the effectiveness of the use of Omega 3 in the treatment of hypertriglyceridemia in HIV/AIDS patients on antiretroviral therapy. This study is a systematic review with meta-analysis of randomized clinical trials. Electronic databases - PubMed, Cochrane and Lilacs were researched. Fifty one articles were encountered. Nine were added to the meta-analysis. The reduction of triglycerides level was -77.55 mg (IC of -121.85 to -33.25) in Omega 3 groups. The analysis considering trials with more than 1000 mg of EPA/DHA included seven studies and the heterogeneity dropped to 0%.The reduction of combined averages was -101.56mg (IC of -145.76 to -57.37). The analysis considering trials with patients that had more than 200 mg/dL of initial triglycerides included also seven trials and the heterogeneity dropped to 0%. The reduction of combined averages was -114.15 mg (IC of -162.34 to -65.97). EPA/DHA supplementation reduces serum triglycerides levels in patients with HIV/AIDS-associated hypertriglyceridemia in stable use of antiretroviral therapy.
Resumo A hipertrigliceridemia é comum em pacientes tratados com terapia antirretroviral e os ácidos graxos ômega 3 estão sendo usados como uma intervenção na redução triglicérides séricos (TG) nesses pacientes. O objetivo deste estudo é avaliar a eficácia do uso do ômega 3 no tratamento da hipertrigliceridemia em pacientes com HIV/Aids em terapia antirretroviral. Este estudo é uma revisão sistemática com metanálise de ensaios clínicos randomizados. As bases de dados eletrônicas - PubMed, Cochrane e Lilacs foram pesquisadas. Cinquenta e um artigos foram encontrados. Nove incluídos na metanálise. A redução do nível de triglicerídios foi -77.55 mg (IC de -121,85 a - 33,25) no grupo com Omega 3. A análise considerando ensaios com mais de 1000 mg de EPA/DHA incluiu sete estudos e a heterogeneidade caiu para 0%. A redução das médias combinada foi -101.56 mg (IC de -145,76 a -57,37). A análise considerando ensaios com doentes que tinham mais do que 200 mg/dL, de triglicéridos iniciais incluiu também sete ensaios e a heterogeneidade caiu para 0%. A redução das médias combinada foi -114.15 mg (IC de -162,34 a -65,97). A suplementação de EPA/DHA reduz níveis de triglicérides séricos em pacientes com hipertrigliceridemia associada ao HIV/AIDS em uso de terapia antirretroviral estável.
Asunto(s)
Humanos , Hipertrigliceridemia/tratamiento farmacológico , Ácidos Grasos Omega-3/uso terapéutico , Fármacos Anti-VIH/efectos adversos , Triglicéridos/sangre , Hipertrigliceridemia/etiología , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéuticoRESUMEN
Adherence to antiretroviral therapy is key contributor to decreasesing morbidity and mortality from HIV/ AIDS infection. However, it is affected by treatment-related factors including the multiple adverse reactions and interactions arising from chronic polypharmacy. In order to determine drug-related problems, 66 outpatients from Hospital Carlos Van Buren on antiretroviral therapy were monitored. 100 % had medication-related problems and 46.1% of those problems were related to the safety of the therapy. Hypertriglyceridemia associated to the combined use of both nucleoside reverse transcriptase inhibitor and a non-nucleoside reverse transcriptase inhibitor was the most frequent adverse reaction. Results show that pharmacological monitoring of patients on antiretroviral treatment is necessary for the early identification of drug-related problems and for the proposal of alternatives that promote therapeutic safety and efficacy.
La adherencia al tratamiento anti-retroviral es un pilar fundamental en la reducción de la morbi-mortalidad de la infección por VIH/SIDA. Sin embargo, se ve dificultada por ser un tratamiento que involucra numerosos medicamentos administrados de forma crónica, con posibilidad de presentar reacciones adversas y/o interacciones. Se realizó un seguimiento farmacoterapéutico a 66 pacientes ambulatorios con tratamiento anti-retroviral del Hospital Carlos Van Buren. El 100% de los pacientes presentó problemas relacionados con medicamentos, afectando en 46,1% a la seguridad de la terapia. La reacción adversa más frecuente fue hipertrigliceridemia, principalmente asociada al uso de dos inhibidores nucleosídico de la transcriptasa reversa con un inhibidor no nucleosídico de la transcriptasa reversa. Los resultados permiten concluir que la monitorización farmacológica de pacientes con tratamiento anti-retroviral identifica en forma precoz los problemas relacionados con medicamentos, favoreciendo la seguridad y eficacia de la terapia propuesta.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Fármacos Anti-VIH/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Estudios de Seguimiento , Hipertrigliceridemia/inducido químicamente , Hipertrigliceridemia/etiología , Cumplimiento de la Medicación , Pacientes Ambulatorios , Factores Socioeconómicos , Resultado del TratamientoRESUMEN
Introduction: Highly effective antiretroviral triple therapy (TAR3) has led to a significant increase in survival of patients (pts) infected with human immunodeficiency virus. In 1999 it was started in the Chilean public health system, including Arriarán Foundation (FA) access to TAR, reaching full coverage since 2003. By October 31, 2009 124 pts had reached 10 years of uninterrupted TAR3 in FA. Objective: To describe and analyze the profile of pts, their therapeutic regimen (s) and clinical outcomes during 10 years of TAR3. Methods: Retrospective descriptive study. We reviewed the records of pts who had reached 10 years of uninterrupted TAR3 in FA. Demographic data, baseline and virological staging at start of TAR3, comorbidities and complications were recorded. Drug regimens used were analyzed, as well as toxicity, virological and immunological outcomes, frequency and reasons for change in therapy. Complications were classified as opportunistic and not opportunistic during this evolution and the latest known clinical and laboratory data were registered. A database program based on Excel was used. Results: 121/124 pts were available for analysis, 76.8% male, male-female ratio was 3.3:1. Baseline median age: 36 years (20-69); CD4 cells 176/ mm³ (8-1,224) with 65.3% < 200; median viral load (STL): 60,078 copies/ml (1,100- 7,900,000); 36.3% were in clinical AIDS stage. Patients received an average of 3.5 therapies regimens during the decade (range, 1 [14 pts, 11.5%] to 7 [3 pts, 2.4%]), with average duration of 42 months each and a median of 36 months. As initial TAR3 regimen 2 backbone nucleoside analogues (ITRN) was the most frequent, with a protease inhibitor (PI) in 51.2% and non-nucleoside RTIs (NNRTIs) in 38.8%. Adverse reactions were the main reason for change of therapy (24.7%), followed by virological failure (24.2%) and treatment simplification (16.6%). At the latest assessment, all with > 10 years of TAR3 median CD4 was 602 cells/mm³, 11 pts (9%) had CD4 < 200/mm³; 85.2% had undetectable VL (< 80 copies/mL); the remaining 14.8% had a median of 1,800 copies/mL. Only 2 pts (1.7%) were in AIDS clinical stage. Current regimens were 2 NRTI plus 1 NNRTI in 61 pts (50.4%), 2 or more NRTI plus 1 PI in 46 (38%). Seventy two pts (60.3%) had chronic comorbidities at latest follow up. Dyslipidemia, hypertension, diabetes mellitus and renal failure were the most frequent conditions; 17 pts (14%) had clinical lipodystrophy secondary to TAR. Conclusion: Achieving a decade of TAR is already a reality and in the short term will be routine. This is rarely achieved with the initial therapeutic regimen. The major obstacles to prolonged maintenance of a single therapeutic regimen have been adverse effects and virological failure, although current drugs with better efficacy and safety profile may allow longer use for each regimen. Despite the difficulty of treating these pts, they can achieve long-term survival with good virologic control, immune recovery and absence of opportunistic complications associated with HIV infection. Nonetheless, the high frequency of non opportunistic chronic comorbidities and antiretroviral therapy side effects after prolonged or life-long use is becoming a major issue.
La introducción de la triterapia anti-retroviral de alta efectividad (TAR3) ha llevado a un significativo aumento en la sobrevida de los pacientes infectados por virus de inmunodeficiencia humana. En 1999 se inició en el sistema público de salud chileno, incluida la Fundación Arriarán (FA) el acceso progresivo a TAR3, que alcanzó cobertura completa desde 2003. En FA al 31 de octubre de 2009 se compatibilizaban 124 pacientes (pts) que habían alcanzado 10 años de TAR3 ininterrumpida. Objetivo: Describir y analizar el perfil de los pts, sus terapias y la evolución clínica durante el período de 10 años de TAR3. Material y Método: estudio descriptivo y retrospectivo. Se revisaron las fichas de los pts que alcanzaron 10 años de TAR3 en FA. Se registraron datos demográficos, clínicos y clasificación por etapas, co-morbilidades y complicaciones al inicio de tratamiento. Se analizaron los esquemas terapéuticos recibidos, toxicidades y desenlaces virológicos e inmunológicos, así como la frecuencia y razones de cambio de terapias, las complicaciones oportunistas y no oportunistas durante esta evolución y el último estado clínico y de laboratorio conocido. Se empleó una base de datos en base al programa Excel. Resultados: se lograron analizar 121/124 pts, 76,8% hombres, relación hombre:mujer 3,3:1. Mediana basal: edad, 36 años (20-69); recuento de linfocitos CD4 de 176 céls/mm³ (8-1.224), con 65,3% < de 200 céls/mm³; carga viral (CV): 60.078 copias/ml (1.100 -7.900.000); 44/121 (36,3%) en etapa SIDA clínica inicial. Los pacientes recibieron un promedio de 3,5 esquemas de terapias durante el decenio (rango, 1 [14 pts, 11,5 %] a 7 [3 pts, 2,4 %]), con duración promedio de 42 meses en cada uno y una mediana de 36. TAR3 inicial con dos análogos nucleosídicos (ITRN) fue lo más frecuente, con un inhibidor de la proteasa (IP) en 51,2% o con ITR no nucleosídico (ITRnN) en 38,8%. Las reacciones adversas fueron el principal motivo de cambio de esquemas (24,7%), seguido de fracaso virológico (24,2%) y simplificación terapéutica (16,6%). En su última evaluación y con > 10 años de TAR3 la mediana de linfocitos CD4 era de 602 céls/mm³; había 11 pts (9 %) con CD4 < 200/ mm³; 85,2% estaba con CV indetectable (< 80 copias/ mL), 14 (14,8%) con detectabilidad viral, y éstos con una mediana de 1.800 copias/mL. Sólo 2 pts (1,7%) estaban en etapa clínica de SIDA. El esquema de TAR3 actual más frecuente era de dos ITRN más un ITRnN, en 61 pts (50,4%) y luego dos ITRN más un IP en 46 (38%). En 72 pts (60,3%) se pesquisaron co-morbilidades crónicas: dislipidemias, hipertensión arterial, diabetes mellitus y/o insuficiencia renal; 17 pts (14%) presentaban lipodistrofia clínica secundaria a TAR3 Conclusión: Alcanzar una década de TAR3 ya está siendo una realidad y a corto plazo será rutinario. Esto rara vez se logra con la primera terapia, aunque esquemas contemporáneos más efectivos y seguros pueden hacerlo posible a futuro. Los principales obstáculos para lograr mantención prolongada de un solo esquema terapéutico son los efectos adversos y el fracaso virológico. A pesar de las dificultades terapéuticas estos pts pueden alcanzar sobrevida a largo plazo con buen control virológico, recuperación inmune y control de las complicaciones oportunistas asociadas a la infección por VIH. Destaca la alta frecuente de co-morbilidades crónicas no oportunistas y secuelas de la terapia anti-retroviral.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Fármacos Anti-VIH/administración & dosificación , Terapia Antirretroviral Altamente Activa/efectos adversos , Sobrevivientes de VIH a Largo Plazo/estadística & datos numéricos , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Fármacos Anti-VIH/efectos adversos , Terapia Antirretroviral Altamente Activa/métodos , Enfermedad Crónica , Comorbilidad , Chile/epidemiología , Esquema de Medicación , Dislipidemias/etiología , Hipertrigliceridemia/etiología , Lipodistrofia/etiología , Evaluación del Resultado de la Atención al Paciente , Razón de MasculinidadRESUMEN
The metabolic effects of carbohydrate supplementation in mice have not been extensively studied. In rats, glucose- and fructose-rich diets induce hypertriacylglycerolemia. In the present study, we compared the metabolic responses to two monosaccharide supplementations in two murine models. Adult male Wistar rats (N = 80) and C57BL/6 mice (N = 60), after 3 weeks on a standardized diet, were submitted to dietary supplementation by gavage with glucose (G) or fructose (F) solutions (500 g/L), 8 g/kg body weight for 21 days. Glycemia was significantly higher in rats after fructose treatment (F: 7.9 vs 9.3 mM) and in mice (G: 6.5 vs 10 and F: 6.6 vs 8.9 mM) after both carbohydrate treatments. Triacylglycerolemia increased significantly 1.5 times in rats after G or F supplementation. Total cholesterol did not change with G treatment in rats, but did decrease after F supplementation (1.5 vs 1.4 mM, P < 0.05). Both supplementations in rats induced insulin resistance, as suggested by the higher Homeostasis Model Assessment Index. In contrast, mice showed significant decreases in triacylglycerol (G: 1.8 vs 1.4 and F: 1.9 vs 1.4 mM, P < 0.01) and total cholesterol levels (G and F: 2.7 vs 2.5 mM, P < 0.05) after both monosaccharide supplementations. Wistar rats and C57BL/6 mice, although belonging to the same family (Muridae), presented opposite responses to glucose and fructose supplementation regarding serum triacylglycerol, free fatty acids, and insulin levels after monosaccharide treatment. Thus, while Wistar rats developed features of plurimetabolic syndrome, C57BL/6 mice presented changes in serum biochemical profile considered to be healthier for the cardiovascular system.
Asunto(s)
Animales , Masculino , Ratones , Ratas , Carbohidratos de la Dieta/efectos adversos , Fructosa/administración & dosificación , Glucosa/administración & dosificación , Hipertrigliceridemia/etiología , Resistencia a la Insulina , Colesterol/sangre , Modelos Animales de Enfermedad , Suplementos Dietéticos/efectos adversos , Fructosa/efectos adversos , Glucosa/efectos adversos , Hipertrigliceridemia/metabolismo , Ratas Wistar , Triglicéridos/sangreRESUMEN
La aterosclerosis constituye la primera causa de muerte y también de morbilidad en ingresos hospitalarios en el ámbito mundial donde las infecciones no ocupan este lugar tan preponderante. En Cuba, sus más frecuentes y dañinas consecuencias orgánicas constituyen también la primera causa de muerte. Se realizó una investigación descriptiva en 108 adultos mayores de un total de 427 pacientes de ambos sexos durante el año 2003 para identificar factores de riesgo aterogénicos. Se utilizó el modelo de recolección del dato primario para obtener información sobre la edad, peso al nacer, antecedentes patológicos personales y familiares, consumo de cigarrillos, tensión arterial sistólica y diastólica, concentración del colesterol del suero y de su fracción de alta densidad y el grado de actividad física. Se encontró que el 26,9 por ciento de la muestra eran fumadores activos, el 33,3 por ciento tenían sobrepeso, el 15,7 eran obesos, el 81,4, hipertensos y de ellos el 50 por ciento eran pacientes nuevos. Un alto porcentaje no practicaba ejercicios físicos. Se apreció que 78 pacientes tenían hipercolesterolemia y en 46, la concentración de la lipoproteína de alta densidad estaba disminuida. En la población de adultos mayores estudiada se identificaron, en porcentajes apreciables, factores de riesgo aterogénicos que pueden ser modificados en aras de tener una mejor salud y calidad de vida(AU)
The aterosclerosis constitutes the first cause of death and also of morbilidad in hospital revenues in the world environment where the infections don't occupy this place so preponderant. In Cuba, their most frequent and harmful organic consequences also constitute the first cause of death. He/she was carried out a descriptive investigation in 108 adults bigger than a total of 427 patients of both sexes during the year 2003 to identify factors of risk aterogénicos. The pattern of gathering of the primary fact was used to obtain information on the age, weight when being born, personal and family pathological antecedents, consumption of cigarettes, systolic arterial tension and diastólica, concentration of the cholesterol of the serum and of its fraction of high density and the degree of physical activity. It was found that 26,9 percent of the sample was smoking active, 33,3 percent had overweight, the 15,7 were obese, the 81,4, hipertensos and of them 50 percent was patient new. A high percentage didn't practice physical exercises. It was appreciated that 78 patients had hipercolesterolemia and in 46, the concentration of the lipoproteína of high density was diminished. In the studied bigger population of adults they were identified, in appreciable percentages, factors of risk aterogénicos that can be modified for the sake of having a better health and quality of life(AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Arteriosclerosis/mortalidad , Calidad de Vida , Hipertrigliceridemia/etiología , Factores de Riesgo , Estilo de Vida , Lipoproteínas HDL/efectos adversos , Epidemiología Descriptiva , Recolección de Datos/métodosRESUMEN
Rats fed a high-fructose diet represent an animal model for insulin resistance and hypertension. We recently showed that a high-fructose diet containing vegetable oil but a normal sodium/potassium ratio induced mild insulin resistance with decreased insulin receptor substrate-1 tyrosine phosphorylation in the liver and muscle of normal rats. In the present study, we examined the mean blood pressure, serum lipid levels and insulin sensitivity by estimating in vivo insulin activity using the 15-min intravenous insulin tolerance test (ITT, 0.5 ml of 6 æg insulin, iv) followed by calculation of the rate constant for plasma glucose disappearance (Kitt) in male Wistar-Hannover rats (110-130 g) randomly divided into four diet groups: control, 1:3 sodium/potassium ratio (R Na:K) diet (C 1:3 R Na:K); control, 1:1 sodium/potassium ratio diet (CNa 1:1 R Na:K); high-fructose, 1:3 sodium/potassium ratio diet (F 1:3 R Na:K), and high-fructose, 1:1 sodium/potassium ratio diet (FNa 1:1 R Na:K) for 28 days. The change in R Na:K for the control and high-fructose diets had no effect on insulin sensitivity measured by ITT. In contrast, the 1:1 R Na:K increased blood pressure in rats receiving the control and high-fructose diets from 117 + or - 3 and 118 + or - 3 mmHg to 141 + or - 4 and 132 + or - 4 mmHg (P<0.05), respectively. Triacylglycerol levels were higher in both groups treated with a high-fructose diet when compared to controls (C 1:3 R Na:K: 1.2 + or - 0.1 mmol/l vs F 1:3 R Na:K: 2.3 + or - 0.4 mmol/l and CNa 1:1 R Na:K: 1.2 + or - 0.2 mmol/l vs FNa 1:1 R Na:K: 2.6 + or - 0.4 mmol/l, P<0.05). These data suggest that fructose alone does not induce hyperinsulinemia or hypertension in rats fed a normal R Na:K diet, whereas an elevation of sodium in the diet may contribute to the elevated blood pressure in this animal model
Asunto(s)
Animales , Masculino , Ratas , Presión Sanguínea , Dieta , Fructosa/fisiología , Resistencia a la Insulina , Glucemia/análisis , Hiperinsulinismo/etiología , Hipertensión/etiología , Hipertrigliceridemia/etiología , Lípidos/sangre , Potasio/administración & dosificación , Ratas Wistar , Sodio/administración & dosificaciónRESUMEN
OBJETIVO: Determinar prevalência de hipertensão arterial, diabete melito, hipercolesterolemia e hipertrigliceridemia em uma população brasileira de acordo com grau de obesidade. MÉTODO: Estudo retrospectivo em 1213 adultos (média de idade: 45,2 ± 12,8 anos; 80,6 % sexo feminino) em grupos de acordo com índice de massa corpórea (normal:18,5-24,4 Kg/m2; sobrepeso 25-29,9 Kg/m2; obesidade classe1: 30-34,9 Kg/m2; classe 2: 35-39,9 Kg/m2 ; classe 3:³ 40 Kgm2). Analisamos presença de hipertensão arterial, diabete melito, hipercolesterolemia e hipertrigliceridemia em cada grupo. Determinamos severidade do risco cardiovascular, considerando risco alto pacientes com 2 ou mais dos seguintes fatores: hipertensão arterial, HDL < 35mg/dl, colesterol total >240mg/dl, triglicérides >200mg/dl quando HDL < 35mg/dl e glicemia >126mg/dl; risco moderado aqueles com 2 ou mais dos seguintes fatores: hipertensão arterial, HDL < 45, triglicérides >200mg/dl e colesterol total >200mg/dl. RESULTADOS: Houve aumento significativo da prevalência de hipertensão arterial, diabete melito, hipertrigliceridemia, HDL-colesterol baixo, porém não houve maior prevalência de hipercolesterolemia. O odds ratio, ajustado para idade e sexo, para obesidade em relação aos indivíduos de peso normal foi 5,9, 8,6 e 14,8 para hipertensão; 3,8, 5,8 e 9,2 para diabete melito e 1,2, 1,3 e 2,6 para hipertrigliceridemia. Após estabelecer severidade do risco cardiovascular, verificamos que o índice de massa corpórea se correlacionou de forma significativa com alto risco cardiovascular (p< 0.0001). CONCLUSÃO: Em nossa população, observamos aumento do risco cardiovascular com aumento do índice de massa corpórea.