Glycogen synthase kinase-3 (GSK-3) a magic enzyme: it's role in diabetes mellitus and glucose homeostasis, interactions with fluroquionlones. A mini-review / Glicogênio sintase quinase-3 (GSK-3), uma enzima mágica: seu papel no diabetes mellitus e na homeostase da glicose: interações com fluoroquinolonas. Uma mini-revisão

Abstract Diabetes mellitus (DM) is a non-communicable disease throughout the world in which there is persistently high blood glucose level from the normal range. The diabetes and insulin resistance are mainly responsible for the morbidities and mortalities of humans in the world. This disease is mainly regulated by various enzymes and hormones among which Glycogen synthase kinase-3 (GSK-3) is a principle enzyme and insulin is the key hormone regulating it. The GSK-3, that is the key enzyme is normally showing its actions by various mechanisms that include its phosphorylation, formation of protein complexes, and other cellular distribution and thus it control and directly affects cellular morphology, its growth, mobility and apoptosis of the cell. Disturbances in the action of GSK-3 enzyme may leads to various disease conditions that include insulin resistance leading to diabetes, neurological disease like Alzheimer's disease and cancer. Fluoroquinolones are the most common class of drugs that shows dysglycemic effects via interacting with GSK-3 enzyme. Therefore, it is the need of the day to properly understand functions and mechanisms of GSK-3, especially its role in glucose homeostasis via effects on glycogen synthase.

Resumo O diabetes mellitus (DM) é uma doença não transmissível em todo o mundo, na qual existe nível glicêmico persistentemente alto em relação à normalidade. O diabetes e a resistência à insulina são os principais responsáveis ​​pelas morbidades e mortalidades de humanos no mundo. Essa doença é regulada principalmente por várias enzimas e hormônios, entre os quais a glicogênio sintase quinase-3 (GSK-3) é uma enzima principal e a insulina é o principal hormônio que a regula. A GSK-3, que é a enzima-chave, normalmente mostra suas ações por vários mecanismos que incluem sua fosforilação, formação de complexos de proteínas e outras distribuições celulares e, portanto, controla e afeta diretamente a morfologia celular, seu crescimento, mobilidade e apoptose do célula. Perturbações na ação da enzima GSK-3 podem levar a várias condições de doença que incluem resistência à insulina que leva ao diabetes, doenças neurológicas como a doença de Alzheimer e câncer. As fluoroquinolonas são a classe mais comum de drogas que apresentam efeitos disglicêmicos por meio da interação com a enzima GSK-3. Portanto, é necessário hoje em dia compreender adequadamente as funções e mecanismos da GSK-3, principalmente seu papel na homeostase da glicose via efeitos na glicogênio sintase.

Riscos de infecção por SARS-CoV-2 e COVID-19 em mulheres com síndrome dos ovários policísticos / Risks of SARS-CoV-2 and COVID-19 infection in women with polycystic ovary syndrome

Esta revisão narrativa teve como objetivo avaliar possíveis riscos da associação entre a infecção por SARS-CoV-2 (causa da COVID-19) e as características metabólicas e endócrinas frequentemente encontradas em mulheres com a síndrome dos ovários policísticos (SOP). A COVID-19 é mais grave em indivíduos com obesidade, diabetes mellitus, dislipidemia e hipertensão arterial. Como essas condições são comorbidades comumente associadas à SOP, foi hipotetizado que mulheres com SOP teriam maior risco de adquirir COVID-19 e desenvolver formas clínicas mais graves da doença. Considerando vários estudos epidemiológicos, a presente revisão mostra que mulheres com SOP têm risco 28% a 50% maior de serem infectadas pelo vírus SARS-CoV-2 em todas as idades e que, nessas mulheres, a COVID-19 está associada a maiores taxas de hospitalização, morbidade e mortalidade, especialmente naquelas com alterações no metabolismo de carboidratos e lipídios, hiperandrogenemia e aumento do tecido adiposo visceral. Os mecanismos que explicam o maior risco de infecção por COVID-19 em mulheres com SOP são considerados.(AU)

Resistencia a Insulina: Revisión de literatura / Insulin Resistance: Literature Review

La resistencia a la insulina es una condición patológica de expresión variable asociada a riesgo cardiovascular, diabetes mellitus tipo 2, hígado graso de etiología no alcohólica, lipodistrofias, síndrome de ovario poliquístico y algunos cánceres. El propósito de esta revisión bibliográfica es brindar información actualizada al lector sobre algunos de los avances actuales de la resistencia a la insulina. Se realizó una búsqueda de literatura en PUBMED de enero 2014-octubre 2021, obteniéndose 1,354 referencias, seleccionando 39 publicaciones. Aunque continúe la discusión sobre la definición clínica y laboratorial, se ha determinado que el manejo terapéutico y preventivo para casos de resistencia a la insulina se debe basar en cambios de estilo de vida con apoyo farmacológico individualizado. El impacto actual y potencial en el futuro inmediato de la epidemiología de la resistencia a la insulina está en los estudios clínico-terapéuticos en curso y en las políticas públicas dirigidas a fomentar el estilo de vida saludable...(AU)

Factores que influyen en el sobrepeso en los escolares de 5-10 años / Factors that influence overweight in school children aged 5-10

El sobrepeso es una condición de salud limitante para el desempeño humano, esto se debe a las complicaciones de salud que derivan o están asociadas a esta condición tales como: Insulinorresistencia, Diabetes mellitus tipo 2, enfermedades cardiovasculares, complicaciones ortopédicas y de índole traumatológicas, así como afecciones de tipo psicosociales. El sobrepeso fue considerado por la Organización Mundial de la Salud (OMS) como una epidemia mundial, emergente, de efectos inmediatos en la población infantil y es a su vez estimado en el área de salud pública por tener las implicaciones anteriormente descritas. Objetivo: Describir los factores que influyen en el sobrepeso de los escolares de 5 a 10 años. Materiales y métodos: Estudio tipo cualitativo, con una metodología descriptiva, donde se recopila información bibliográfica de publicaciones vía web y artículos científicos, relevante con el tema en estudio. Las etapas de elaboración del estudio contemplan, lectura y revisión de la información reciente, análisis del contenido, organización y resumen y redacción para plasmar una perspectiva de la situación con transcriptores relacionados con las palabras claves: sobrepeso, escolares entre 5-10 años. Conclusiones: Un número importante de la población infantil está siendo afectada por el sobrepeso y la obesidad, lo que se traduce en adultos con sobrepeso y obesidad si no son corregidos los hábitos alimenticios y la conducta ante los estilos de vida. Tener en consideración y abordar los aspectos relacionados con este tema es de vital importancia debido a que constituye un grave problema de salud a nivel mundial y sus implicaciones de salud en el transcurso de la vida, donde el persona se afecta por la condición de salud generada, que en la mayoría de los casos crea individuos con discapacidades o disfuncionales(AU)

Overweight is a limiting health condition for human performance, this is due to health complications that derive or are associated with this condition such as: insulin resistance, type 2 diabetes mellitus, cardiovascular diseases, orthopedic and trauma complications. as well as psychosocial conditions. Overweight was considered by the World Health Organization (WHO) as a global, emerging epidemic with immediate effects on the child population and is in turn estimated in the area of public health for having the implications described above. Objective: To describe the factors that influence overweight in schoolchildren aged 5 to 10 years. Materials and methods: Qualitative type study, with a descriptive methodology, where bibliographic information of publications via the web and scientific articles, relevant to the subject under study, is collected. The stages of elaboration of the study contemplate, reading and review of recent information, content analysis, organization and summary and writing to capture a perspective of the situation with transcriptionists related to the keywords: overweight, schoolchildren between 5-10 years. Conclusions: A significant number of the child population is being affected by overweight and obesity, which translates into overweight and obese adults if eating habits and behavior towards lifestyles are not corrected. Taking into consideration and addressing the aspects related to this issue is of vital importance because it constitutes a serious health problem worldwide and its health implications throughout life, where the person is affected by the health condition generated, which in most cases creates disabled or dysfunctional individuals(AU)

Anthropometric markers of abdominal adiposity and its relation to dyslipidemia and insulin resistance among overweight/obese schoolchildren and adolescents / Marcadores antropométricos de adiposidade abdominal e sua relação com dislipidemia e resistência à insulina em escolares e adolescentes com sobrepeso/obesidade

Objective: to assess the relationship between anthropometric indicators and laboratorial markers of cardiovascular risk in overweight/obese children and adolescents, in order to verify whether any anthropometric indicator has a better potential for use in screening cardiovascular risk in the population. Method: retrospective cross-sectional study enrolling 237 individuals aged 7 to 18 years. Body mass index (BMI), waist circumference (WC), waist circumference/height index (WC/H), glucose, HOMA-IR, total cholesterol (TC), LDL, HDL, triglycerides and TC/HDL and LDL/HDL indexes were obtained. Associations between anthropometric and laboratory markers were tested in contingency tables using the chi-square test. Correlations were tested by Spearman's correlation. Results: higher WC (Freedman cutoffs) was associated with lower levels of HDL and higher score in the TC/HDL and LDL/HDL indexes, but, using +2 z-scores as the cutoff, there were associations with low HDL and higher HOMA-IR. WC/H indicator (0.5 cutoff) was not associated with any of the outcomes, but, using +2 z-scores, an association was found with HOMA-IR. Z-scores of WC, WC/H and BMI showed positive correlation with HOMA-IR, TC/HDL and HOMA-IR, respectively. Negative correlations were found between WC and WC/H z-scores with HDL. WC and WC/H z-score were related to changes in HDL and HOMA-IR. Conclusions: there seems to be an advantage in using WC alone as a possible predictor of dyslipidemia and insulin resistance in children and adolescents. It is not possible to state that WC, WC/H or BMI measurements differ in their abilities to identify Brazilian children and adolescents with risk factors for cardiovascular diseases (AU)

Objetivo: avaliar a relação entre indicadores antropométricos e marcadores laboratoriais de risco cardiovascular em crianças e adolescentes com sobrepeso / obesidade, a fim de verificar se algum indicador antropométrico tem melhor potencial para uso no rastreamento de risco cardiovascular na população. Método: estudo transversal retrospectivo com 237 indivíduos com idades entre 7 e 18 anos. Índice de massa corporal (IMC), circunferência da cintura (CC), índice de circunferência da cintura / altura (CC / H), glicose, HOMA-IR, colesterol total (CT), LDL, HDL, triglicerídeos e índices CT/HDL e LDL/HDL foram obtidos. As associações entre marcadores antropométricos e laboratoriais foram testadas em tabelas de contingência por meio do teste do qui-quadrado. As correlações foram testadas pela correlação de Spearman. Resultados: CC mais elevado (pontos de corte de Freedman) foi associado a níveis mais baixos de HDL e maior pontuação nos índices TC/HDL e LDL/HDL, mas, usando +2 escores z como ponto de corte, houve associações com HDL baixo e HOMA-IR mais alto. O indicador CC/H (0,5 ponto de corte) não foi associado a nenhum dos desfechos, mas, usando +2 escores z, foi encontrada associação com o HOMA-IR. Os escores Z de CC, CC/E e IMC mostraram correlação positiva com HOMA-IR, TC/HDL e HOMA-IR, respectivamente. Correlações negativas foram encontradas entre CC e escores z de CC/H com HDL. CC e escore z de CC/H foram relacionados a mudanças em HDL e HOMA-IR. Conclusões: parece haver vantagem em usar a CC isoladamente como possível preditor de dislipidemia e resistência à insulina em crianças e adolescentes. Não é possível afirmar que as medidas de CC, CC/E ou IMC diferem na capacidade de identificar crianças e adolescentes brasileiros com fatores de risco para doenças cardiovasculares (AU)

Espectros clínicos y fisiopatológicos del síndrome de Bernardinelli Seip / Clinical and pathophysiological spectra of Bernardinelli Seip syndrome

Introducción: La lipodistrofia congénita de Berardinelli-Seip es un síndrome genético autosómico recesivo, caracterizado por la ausencia generalizada del tejido adiposo, el déficit de leptina y las alteraciones metabólicas incluidas la resistencia a la insulina, la esteatohepatitis y la hipertrigliceridemia. Objetivo: Definir los diferentes espectros clínicos y fisiopatológicos del síndrome y su relación con el fenotipo definiendo las estrategias terapéuticas actuales. Métodos: Se realizó una búsqueda bibliográfica no sistemática en las bases de datos Science Direct, EMBASE, LILACS, Redalyc, SciELO y PubMed. Los criterios de inclusión fueron publicaciones en inglés, portugués o español, en las que el título y las palabras clave, abordaban el tema planteado con una vigencia de 10 años. Se obtuvieron 50 artículos relacionados con el síndrome, de los cuales 30 fueron seleccionados para su revisión. Conclusiones: El diagnóstico de la enfermedad es principalmente clínico. Se establece en presencia de tres criterios mayores o la combinación de dos mayores con dos menores y/o por la identificación de variantes patogénicas por medio del estudio genético y molecular. La dieta y el ejercicio conjuntamente con la administración de la metreleptina son pilares fundamentales en el manejo de estos pacientes. El reconocimiento temprano del síndrome es esencial para prevenir las complicaciones, y brindar asesoría genética y reproductiva a los pacientes y familiares(AU)

Introduction: Berardinelli-Seip congenital lipodystrophy is an autosomal recessive genetic syndrome, characterized by the general absence of adipose tissue, leptin deficiency and metabolic alterations including insulin resistance, steatohepatitis and hypertriglyceridemia. Objective: To present the different clinical and pathophysiological spectra of the syndrome, its relationship with the phenotype, defining the current therapeutic strategies. Methods: A non-systematic bibliographic search was carried out in Science Direct, EMBASE, LILACS, Redalyc, SciELO and PubMed databases. The inclusion criteria were publications in English, Portuguese and Spanish, in which the title and keywords included information pertinent to the stated objective with a periodicity of 10 years, 50 articles were retrieved, and 30 of them were selected. Conclusions: The diagnosis of the disease is mainly clinical. It is established in the presence of three major criteria or the combination of two major and two minor criteria and/or by the identification of pathogenic variants through genetic and molecular studies. Diet and exercise together with the administration of metreleptin are fundamental pillars in the management of these patients. Early recognition of the syndrome is essential to prevent complications, allowing genetic and reproductive counseling to be provided to patients and their families(AU)

Associação entre Hipovitaminose D e Resistência Insulínica em crianças e adolescentes com excesso de peso / Association between hypovitaminosis d and insulin resistance in children and adolescents with overweight

Introdução: A redução dos níveis séricos de vitamina D também foi associada ao aumento da prevalência de Síndrome Metabólica ou a seus componentes individualmente. Na faixa etária pediátrica, essa relação ainda é controversa. Objetivo: Avaliar a associação entre vitamina D sérica e parâmetros bioquímicos de resistência insulínica (RI) em crianças e adolescentes com excesso de peso. Métodos: Estudo observacional em 122 crianças e adolescentes com excesso de peso acompanhados em serviço de atenção secundária entre agosto de 2014 e dezembro de 2018. As variáveis clínicas foram sexo, idade, IMC (escore-Z), grau de excesso de peso (OMS) e estação do ano. Os parâmetros bioquímicos analisados foram vitamina D, glicemia e insulina de jejum, Modelo de Avaliação da Homeostase para RI (HOMA-IR), relação glicemia/insulina de jejum e Proteína C Reativa (PCR). Utilizaram-se para análise de dados os testes de Kolmogorov- Smirnov, qui-quadrado e de Kruskal-Wallis. O nível de significância estatística adotado foi p < 0,05. Resultados: Houve associação entre hipovitaminose D sérica e parâmetros bioquímicos de RI. O grupo com hipovitaminose D apresentou maior ocorrência de insulina e HOMA-IR elevados e relação G/I baixa. Constatou-se uma alta ocorrência de insuficiência de vitamina D (69,7%). Os adolescentes apresentaram maiores valores de insulina sérica e índice HOMA-IR, compatível com o seu momento biológico. Conclusão: Observou-se associação entre hipovitaminose D sérica e parâmetros bioquímicos de RI de forma que o grupo com hipovitaminose D apresentou maior ocorrência de insulina, HOMA-IR e relação G/I alterados. Verificou-se, ainda, uma alta ocorrência de hipovitaminose D (69,7%).

Introduction: Reduced serum vitamin D levels have also been associated with an increased prevalence of metabolic syndrome or its individual components. This relationship is still controversial in the pediatric age group. Objective: To evaluate the association between serum vitamin D and biochemical parameters of insulin resistance (IR) in children and adolescents with overweight. Methods: This is an observational study performed with 122 children and adolescents with overweight who were followed up in a secondary healthcare center between August 2014 and December 2018. The clinical variables analyzed in this study were sex, age, body mass index (BMI, Z-score), degree of overweight (according to the World Health Organization), and season of the year. The analyzed biochemical parameters were vitamin D, fasting blood sugar and insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting glucose/insulin ratio, and C-reactive protein (CRP). Data analysis used Kolmogorov-Smirnov, chi-squared, and Kruskal-Wallis tests. The statistical significance level defined for this study was p < 0.05. Results: An association was observed between serum hypovitaminosis D and biochemical parameters of IR. The group with hypovitaminosis D presented a higher occurrence of increased insulin and HOMA-IR and a low glucose/insulin ratio. We observed a high occurrence of vitamin D insufficiency (69.7%). Adolescents presented higher values of serum insulin and HOMA-IR, which is compatible with their stage of biological development. Conclusions: We observed an association between serum hypovitaminosis D and biochemical parameters of IR in a way that the group with hypovitaminosis D presented a higher occurrence of altered insulin levels, HOMAIR, and glucose/insulin ratios. We also observed a substantial occurrence of hypovitaminosis D (69.7%).

What anthropometric indicators are associated with insulin resistance? Cross-sectional study on children and adolescents with diagnosed human immunodeficiency virus

ABSTRACT BACKGROUND: Studies that test associations between anthropometric indicators and insulin resistance (IR) need to provide better evidence in the context of the pediatric population (children and adolescents) with human immunodeficiency virus (HIV), as anthropometric indicators present a better explanation of the distribution of body fat. OBJECTIVE: To test the associations between anthropometric indicators and insulin resistance (IR) among children and adolescents diagnosed with HIV. DESIGN AND SETTING: Cross-sectional study on 65 children and adolescents (8-15 years) infected with HIV through vertical transmission conducted at the Joana de Gusmão Children's Hospital, Florianópolis, Brazil. METHODS: The anthropometric indicators measured were the abdominal (ASF), triceps (TSF), subscapular (SSF) and calf (CSF) skinfolds. The relaxed arm (RAC), waist (WC) and neck (NC) circumferences were also measured. Body mass index (BMI) was calculated from the relationship between body mass and height. IR was calculated through the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Simple and multiple linear regression analyses were used. RESULTS: After adjustment for covariates (sex, bone age, CD4+ T lymphocytes, CD8+ T lymphocytes, viral load, and physical activity), associations between IR and models with SSF and CSF remained. Each of these explained 20% of IR variability. For females, in the adjusted analyses, direct associations between IR and models with ASF (R² = 0.26) and TSF (R² = 0.31) were observed. CONCLUSIONS: SSF and CSF in males and ASF and TSF in females were associated with IR in HIV-infected children and adolescents.

Elevated levels of interleukin-18 are associated with several indices of general and visceral adiposity and insulin resistance in women with polycystic ovary syndrome

ABSTRACT Objective: Our aim was to analyze levels of proinflammatory biomarker interleukin-18 (IL-18) in healthy controls and patients with polycystic ovary syndrome (PCOS) focusing on its association with obesity, clinical, hormonal, and metabolic characteristics. Subjects and methods: Fifty-eight patients with PCOS were enrolled in the study fulfilling the Rotterdam criteria and were matched for age, body mass index (BMI), and ethnicity with 30 healthy controls. Detailed anthropometric measurements, clinical investigations, hormonal and biochemical tests were obtained between the 3rd and 5th day of a menstrual cycle. A subanalysis of the PCOS group was performed separating patients into several groups according to a waist-to-height ratio (WHtR), insulin resistance (IR), and free androgen index (FAI). Serum IL-18 levels were measured using the ELISA method. Results: Levels of IL-18 were similar between PCOS patients and controls. IL-18 was higher in overweight/obese women compared to normal-weight women when analyzing all participants together and separately PCOS or controls group (p < 0.001, p < 0.001, p = 0.01, respectively). Additionally, IL-18 levels were higher in high-WHtR and IR subgroups compared to low-WHtR (p < 0.001) and non-IR PCOS women (p < 0.001). PCOS women with high FAI had greater serum IL-18 levels than normal-FAI patients (p = 0.002). Levels of IL-18 correlated positively with most of the anthropometric and metabolic parameters. In multiple linear regression, age, waist circumference, and fasting insulin were independently related factors with IL-18. Conclusion: Elevated levels of IL-18 were related to several indices of general and visceral adiposity and insulin resistance in PCOS.

Anthropometric markers of abdominal adiposity and its relation to dyslipidemia and insulin resistance among overweight/obese schoolchildren and adolescents / Marcadores antropométricos de adiposidade abdominal e sua relação com dislipidemia e resistência à insulina em escolares e adolescentes com sobrepeso/obesidade

ABSTRACT: Objective: to assess the relationship between anthropometric indicators and laboratorial markers of cardiovascular risk in overweight/obese children and adolescents, in order to verify whether any anthropometric indicator has a better potential for use in screening cardiovascular risk in the population. Method: retrospective cross-sectional study enrolling 237 individuals aged 7 to 18 years. Body mass index (BMI), waist circumference (WC), waist circumference/height index (WC/H), glucose, HOMA-IR, total cholesterol (TC), LDL, HDL, triglycerides and TC/HDL and LDL/HDL indexes were obtained. Associations between anthropometric and laboratory markers were tested in contingency tables using the chi-square test. Correlations were tested by Spearman's correlation. Results: higher WC (Freedman cutoffs) was associated with lower levels of HDL and higher score in the TC/HDL and LDL/HDL indexes, but, using +2 z-scores as the cutoff, there were associations with low HDL and higher HOMA-IR. WC/H indicator (0.5 cutoff) was not associated with any of the outcomes, but, using +2 z-scores, an association was found with HOMA-IR. Z-scores of WC, WC/H and BMI showed positive correlation with HOMA-IR, TC/HDL and HOMA-IR, respectively. Negative correlations were found between WC and WC/H z-scores with HDL. WC and WC/H z-score were related to changes in HDL and HOMA-IR. Conclusions: there seems to be an advantage in using WC alone as a possible predictor of dyslipidemia and insulin resistance in children and adolescents. It is not possible to state that WC, WC/H or BMI measurements differ in their abilities to identify Brazilian children and adolescents with risk factors for cardiovascular diseases. (AU)

RESUMO:Objetivo: avaliar a relação entre indicadores antropométricos e marcadores laboratoriais de risco cardiovascular em crianças e adolescentes com sobrepeso / obesidade, a fim de verificar se algum indicador antropométrico tem melhor potencial para uso no rastreamento de risco cardiovascular na população. Método: estudo transversal retrospectivo com 237 indivíduos com idades entre 7 e 18 anos. Índice de massa corporal (IMC), circunferência da cintura (CC), índice de circunferência da cintura / altura (CC / H), glicose, HOMA-IR, colesterol total (CT), LDL, HDL, triglicerídeos e índices CT/HDL e LDL/HDL foram obtidos. As associações entre marcadores antropométricos e laboratoriais foram testadas em tabelas de contingência por meio do teste do qui-quadrado. As correlações foram testadas pela correlação de Spearman. Resultados: CC mais elevado (pontos de corte de Freedman) foi associado a níveis mais baixos de HDL e maior pontuação nos índices TC/HDL e LDL/HDL, mas, usando +2 escores z como ponto de corte, houve associações com HDL baixo e HOMA-IR mais alto. O indicador CC/H (0,5 ponto de corte) não foi associado a nenhum dos desfechos, mas, usando +2 escores z, foi encontrada associação com o HOMA-IR. Os escores Z de CC, CC/E e IMC mostraram correlação positiva com HOMA-IR, TC/HDL e HOMA-IR, respectivamente. Correlações negativas foram encontradas entre CC e escores z de CC/H com HDL. CC e escore z de CC/H foram relacionados a mudanças em HDL e HOMA-IR. Conclusões: parece haver vantagem em usar a CC isoladamente como possível preditor de dislipidemia e resistência à insulina em crianças e adolescentes. Não é possível afirmar que as medidas de CC, CC/E ou IMC diferem na capacidade de identificar crianças e adolescentes brasileiros com fatores de risco para doenças cardiovasculares. (AU)

Bioavailability of ellagitannins from cambuci (Campomanesia Phaea Berg) in healthy and obese subjects / Avaliação da biodisponibilidade dos elagitaninos de cambuci (Campomanesia phaea Berg) em indivíduos saudáveis e com sobrepeso/obesidade

Cambuci (Campomanesia phaea Berg) is a native fruit of the Atlantic Coastal Forest, belonging to the Myrtaceae family, rich in ellagitannins (ET), proanthocyanidins and other bioactive phenolic compounds (BPCs) related to beneficial effects to human health, such as systemic inflammation and attenuation of insulin resistance. Evidence indicates that the beneficial effects of some BPCs, such as ellagitannins, are associated to their chronic intake and the action of the metabolites produced. Urolithins are the main metabolites produced after consumption from a rich source of ellagitannins. According to the metabolite produced, subjects can be classified into metabotypes (A, B e 0). However, nothing is known about the uptake and metabolism of BPC from cambuci. Thus, the objectives of this study were the physical-chemical characterization of cambuci pulp, identification of BPC profile and the determination of their bioavailability in healthy and overweight/obese subjects. Therefore, subjects (n = 28, being 15 healthy and 13 overweight/obese) consumed cambuci juice, and their respective urines 24 hours after drinking were collected to identify the metabolites of ellagitannins. Cambuci presented high acidity, with pH values of ~ 2.3 and titratable acidity of ~ 1.9 g citric acid equivalents/100 g fresh weight (FW), and solids content of ~7.5 ° Brix, not being characterized as a very sweet fruit. The total phenolic content was ~ 780 mg gallic acid/100 mL juice. The total amount of flavan-3-ols found in the fruit was 45.45 g/kg dry weight (DW) and the main monomers identified were gallocatechin (22.25 g/kg DW) and epigallocatechin gallate (16.48 g/kg DW). The degree of polymerization of flavan3-ol was 32.78, indicating a high intensity of astringency and low bioavailability. Through LC-MS, 26 BPCs were identified, most of them being derived from ellagitannins, and among those identified, telemagrandin II and, pedunculagin. The total ellagic acid content found was ~6.2 mg/g DW, demonstrating that cambuci is a fruit rich in ellagic acid and its derivatives. The 28 volunteers who consumed cambuci juice for the bioavailability assessment were classified, for the first time, into metabotypes according to the type of urolithin produced. Metabotype A was the most prevalent (64.3%), followed by metabotype B (17.9%) and 0 (17.9%). When analyzed according to nutritional status, metabotype A was prevalent in both groups. In conclusion, the BCP profile of cambuci stands out for the presence of ET, such as telemagrandin II and pedunculagin. Due to the high degree of polymerization, no proanthocyanidin metabolites were observed. Metabotype A was the most prevalent in this study population, and nutritional status may not be a determining factor in the type of urolithin produced

O cambuci (Campomanesia phaea Berg), é um fruto nativo da mata Atlântica, pertencente à família das mirtáceas, rico em elagitaninos (ET), proantocianidinas e outros compostos bioativos fenólicos (CBF) que estão associados a vários efeitos biológicos benéficos à saúde humana, tais como atenuação inflamação sistêmica e da resistência à insulina. Evidências apontam que os efeitos benéficos de alguns CBF, como os elagitaninos, estão associados com sua ingestão crônica e à ação dos metabólitos produzidos. As urolitinas são os principais metabólitos produzidos após o consumo de uma fonte rica em elagitaninos. De acordo com o metabólito produzido, os indivíduos podem ser classificados em metabotipos (A, B e 0). No entanto, nada se sabe sobre a absorção e a metabolização dos CBF do cambuci. Desta forma, os objetivos deste trabalho foram a caracterização físico-química da polpa de cambuci, a identificação dos CBF e a avaliação da biodisponibilidade dos polifenóis presentes no suco deste fruto, em seres humanos saudáveis e com sobrepeso/obesidade. Para tanto, os voluntários (n = 28, sendo 15 saudáveis e 13 obesos) consumiram suco de cambuci, e suas respectivas urinas 24 horas, após a ingestão da bebida, foram coletadas para identificação dos metabólitos de elagitaninos. O cambuci apresentou uma alta acidez, com valores de pH de ~2,3 e acidez total titulável de ~1,9 g equivalentes de ácido cítrico/100 g em base úmida (b.u.), e teor de sólidos solúveis de ~7,5 ºBrix, não sendo, portanto, muito ácido. O teor de fenólicos totais encontrado foi ~ 780 mg equivalentes de ácido gálico/100 mL de suco. A quantidade total de flavan-3-ois encontrada na polpa de cambuci foi de 45,45 g/kg em base seca (b.s.) e os principais monômeros identificados foram a galocatequina (22,25 g/kg b.s.) e a epigalocatequina galato (16,48 g/kg b.s.). O grau de polimerização do flavan-3-ol foi de 32,78 indicando uma alta intensidade de adstringência e baixa biodisponibilidade. Através de LCMS foi feita a identificação de 26 CBF, sendo sua grande maioria derivados de elagitaninos, e dentre os identificados podemos destacar telemagrandina II e pedunculagina. O teor de elagitaninos encontrado foi de ~6,2 mg/g (b.s.), demonstrando que o cambuci é um fruto rico em ácido elágico e seus derivados. Os 28 voluntários que consumiram o suco de cambuci para ensaio de biodisponibilidade foram classificados, pela primeira vez, em metabotipos de acordo com o tipo de urolitina produzida. O metabotipo A foi o mais prevalente (64,3%), seguido pelo metabotipo B (17,9%) e 0 (17,9%). Quando analisados de acordo com o estado nutricional, o metabotipo A foi prevalente em ambos os grupos. Conclui-se, portanto, que o perfil de CBF do cambuci se destaca pela presença de ET, tais como telimagrandina II e pedunculagina. Devido ao alto grau de polimerização não foram observados metabólitos de proantocianidinas. O metabotipo A foi o mais prevalente na população deste estudo, e o estado nutricional pode não ser um fator determinante no tipo de urolitina produzida

6-Gingerol ameliorates adipose tissue insulin resistance in aging rats / 中国中药杂志

This study investigated the effects and mechanisms of 6-gingerol on adipose tissue insulin resistance in naturally aging rats with glycolipid metabolism disorders. Twenty-seven aging male SD rats were randomly divided into a model group(aged, n=9) and two groups treated with 6-gingerol at 0.05 mg·kg~(-1)(G-L, n=9) and 0.2 mg·kg~(-1)(G-H, n=9). Six young rats were randomly assigned to a normal control group(NC). Rats were treated for seven weeks by gavage. Non-esterified fatty acid(NEFA) and insulin content was determined by enzyme-linked immunosorbent assay(ELISA), and adipose tissue insulin resistance index(Adipo-IR) was calculated. HE staining was used to observe the size of adipocytes in epididymal white adipose tissue(eWAT). The gene and protein expression levels of adiponectin receptor 1(AdipoR1), AMP-activated protein kinase α(AMPKα), phosphorylated AMPK(p-AMPKα~(Thr172)), peroxisome proliferator-activated receptor-γ coactivator-1α(PGC-1α), phosphatidylinositol 3-kinase(PI3 K), protein kinase B(Akt), phosphorylated Akt(p-Akt~(Ser473)), tumor necrosis factor-α(TNF-α), c-Jun N-terminal kinase 1/2(JNK1/2), phosphorylated JNK1/2(p-JNK~(Thr183/Tyr185)), interleukin-1β(IL-1β), and interleukin-6(IL-6) in adiponectin(APN), insulin, and inflammatory factor signaling pathways were detected by Western blot and real-time RCR, respectively. The results showed that 6-gingerol at a high dose could significantly decrease the fasting plasma content of NEFA and insulin and reduce Adipo-IR. Additionally, 6-gingerol at a high dose significantly increased the protein and mRNA expression of APN, AdipoR1, PGC-1α, and PI3 K in eWAT, elevated the relative expression of p-AMPK~(Thr172) and p-Akt~(Ser 473), reduced the protein and mRNA expression of TNF-α, IL-1, and IL-6 in eWAT, and decreased the relative expression of p-JNK1 and p-JNK2. This study reveals that 6-gingerol can improve insulin sensitivity of adipose tissues in aging rats with glycolipid metabolism disorders, and this effect is presumedly achieved by enhancing the PI3 K/Akt signaling pathway, inhibiting adipose tissue inflammation, increasing APN synthesis, enhancing AdipoR1 expression, and activating its downstream AMPK/PGC-1α signaling pathway.

Adiposidad abdominal y resistencia a la insulina al finalizar el primer trimestre de la gestación / Abdominal Adiposity and Insulin Resistance at the End of the First Trimester of Gestation

Introducción: La adiposidad central como factor desencadenante de resistencia a la insulina precoz constituye una amenaza potencial de riesgo metabólico y cardiovascular en el embarazo. Objetivo: Determinar la capacidad discriminante de las grasas abdominales sobre la resistencia a la insulina, diagnosticada por el índice triglicéridos/glucosa-IMC al finalizar el primer trimestre del embarazo. Métodos: Se realizó un estudio observacional analítico de 526 gestantes con embarazo simple y edad gestacional entre 12 y 13 semanas, entre los años 2016 y 2020. Se estudió el test de triglicéridos/glucosa-IMC y las grasas abdominales por ultrasonido. Se utilizaron las curvas ROC (Receiver operating characteristic Curve) para discriminar la resistencia a la insulina al finalizar el primer trimestre de la gestación, cuando aumentan las grasas abdominales. Resultados: La grasa subcutánea fue la que presentó mayor área bajo la curva en la discriminación de la resistencia a la insulina, con un nivel de sensibilidad y especificidad aceptable. Conclusiones: La grasa subcutánea, aunque con bajo valor discriminativo, puede considerarse como augurio de resistencia a la insulina y de diabetes gestacional. Se requiere profundizar en el estudio de las grasas abdominales dado el conocimiento de su impacto en los desórdenes metabólicos en el curso avanzado de la gestación(AU)

Introduction: Central adiposity as a triggering factor for early insulin resistance is a potential threat of metabolic and cardiovascular risk in pregnancy. Objective: To determine the discriminating capacity of abdominal fat over insulin resistance, diagnosed by the triglyceride/glucose-BMI index at the end of the first trimester of pregnancy. Methods: An analytical and observational study was carried out with 526 pregnant women of singleton pregnancy and gestational age between twelve and thirteen weeks, between 2016 and 2020. The triglyceride/glucose-BMI test was studied, together with abdominal fats by ultrasound. ROC (receiver operating characteristic) curves were used to discriminate insulin resistance at the end of the first trimester of gestation, when abdominal fats increase. Results: Subcutaneous fat presented the highest area under the curve in the discrimination of insulin resistance, with an acceptable level of sensitivity and specificity. Conclusions: Subcutaneous fat, although with low discriminative value, can be considered as a harbinger of insulin resistance and gestational diabetes. Further study of abdominal fat is required, given the knowledge of its impact on metabolic disorders in late gestation(AU)

Desirability Function in analytical method development for determination of glitazones and metabolites employing HF-LPME

Abstract Thiazolidinedione, often shortened to TZD or glitazone, helps lower insulin resistance, which is the underlying problem for many people with type 2 diabetes. The two most known glitazones are pioglitazone (PGZ), with the brand name medicine Actos®, and rosiglitazone (RSG), which is Avandia®. This study presented a multivariate optimization in the microextraction procedure employing Fractional Factorial Design (FFD) combined with Desirability Function (DF) to determine TZD and metabolites in biological samples. Microextraction requires several parameters to be optimized; however, most of them still use univariate optimization. Finding optimum conditions by simple response is relatively simple, but the problems, in case of microextractions, are often more complex when it has more responses. For example, changing one factor that promotes one response may suppress the effect of the others. Thus, this multivariate optimization was applied for two bioanalytical methods for determination of TZD and metabolites, one by HPLC and other by CE, both using Hollow Fiber Liquid-Phase Microextraction (HF-LPME). The results establish the optimal values and elucidate how the factors that affect HF-LPME procedure perform in extraction efficiency for TZDs. Additionally, this study demonstrates that DF can be an important tool to optimize microextraction procedures.

Efeitos da ingestão do suco de laranja Pera e suco de laranja Moro na microbiota intestinal e marcadores inflamatórios em indivíduos com obesidade / Effect of Pera and Moro orange juice consumption on the gut microbiota and inflammatory parameters in volunteers with obesity

A obesidade é uma doença complexa que está associada inflamação crônica de baixo grau que contribui para o desenvolvimento de diversos distúrbios metabólicos como a resistência à insulina e estudos recentes sugerem a influência da microbiota intestinal no desenvolvimento e manutenção da doença. Diversos estudos apontam para o benefício da ingestão de frutas e vegetais na prevenção e tratamento de doenças crônicas. O suco de laranja contém diversos compostos bioativos com ações anti-inflamatórias, antioxidantes com efeitos na composição da microbiota intestinal. Deste modo, o objetivo principal deste estudo foi avaliar os efeitos da ingestão do suco de laranja Pera e Moro sobre a composição da microbiota intestinal e de parâmetros inflamatórios em voluntários com obesidade e resistência à insulina. Foi realizado um ensaio clínico crossover com suplementação de suco de laranja (400ml/dia) por 15 dias com um período de washout de 40 dias. As análises de sangue, fezes, urina, composição corporal, consumo alimentar foram realizadas antes e após cada intervenção. A comparação entre os tratamentos foi realizada utilizando equações de estimativas generalizadas e adotou-se um nível de significância de 5%. Em relação à microbiota intestinal, em ambos os tratamentos, os dois filos mais abundantes foram Firmicutes e Actinobateria. Dos gêneros analisados, observou-se maior abundância de Bifidobacterium após a suplementação com o suco de laranja Moro. O suco de laranja Pera promoveu uma diminuição da zonulina e o suco de laranja Moro contribuiu para redução de citocinas inflamatórias, diminuição da pressão arterial e aumento nos níveis de acetato nas fezes. Após a separação dos voluntários por grau de obesidade, observamos que o suco de laranja Moro contribuiu para o aumento na abundância de Akkermansia, Alistipes, Bacteroides e Catenibacterium em indivíduos com obesidade grau 3. Além disso, em ambos os sucos encontramos redução da razão Firmicutes/Bacteroidetes e aumento da excreção de metabólitos de flavonoides após os tratamentos. Diante destes resultados, conclui-se que o suco de laranja Pera apresentou ações positivas sobre a permeabilidade intestinal e o suco de laranja Moro promoveu efeitos mais expressivos na modulação da inflamação associada à obesidade e da microbiota intestinal

Obesity is a complex disease that is associated with low-grade chronic inflammation, and it contributes to the development of several metabolic disorders such as insulin resistance, and recent studies suggest the influence of the intestinal microbiota in the development and maintenance of the disease. Several studies have suggested the benefit of fruits and vegetables consumption in the prevention and treatment of chronic diseases. The orange juice contains some bioactive compounds with anti-inflammatory and antioxidant actions with effects in the composition of the gut microbiota. Thus, the main objective of this study was to evaluate the effects of Pera and Moro orange juice consumption on the composition of the gut microbiota and inflammatory parameters in volunteers with obesity and insulin resistance. A crossover clinical trial was carried out with orange juice supplementation (400ml/day) for 15 days with a washout period of 40 days. Blood, feces, urine, body composition, food consumption were analyzed before and after each intervention. Comparison between treatments was performed using generalized estimating equations and a significance level of 5% was adopted. In relation to gut microbiota, in both treatments, the two most abundant phyla were Firmicutes and Actinobateria. In the analysis of bacterial genera, a greater abundance of Bifidobacterium was observed after supplementation with Moro orange juice. The Pera orange juice reduced zonulin and Moro orange juice contributed to a reduction on inflammatory cytokines, a decrease in blood pressure and an increase in acetate levels in the stool. After separating the volunteers by degree of obesity, we observed that Moro orange juice contributed to the increase in the abundance of Akkermansia, Alistipes, Bacteroides and Catenibacterium in individuals with grade 3 obesity. Furthermore, in both juices we found a reduction in the Firmicutes/Bacteroidetes ratio and increased excretion of flavonoid metabolites after treatments. Therefore, we concluded that Pera orange juice had positive actions on intestinal permeability and Moro orange juice promoted more expressive effects on the modulation of inflammation associated with obesity and on the intestinal microbiota

Association of low birth weight and prematurity with blood pressure and biomarkers of renal and endocrine-pancreatic functions in adults without nephropathy or diabetes / Associação de baixo peso ao nascer com pressão arterial e biomarcadores de função renal e endócrino-pancreática em adultos sem diabetes e nefropatia

Introduction: Low birth weight (LBW), a proxy for hostile intrauterine environment, has been associated with these diseases in adulthood. In Brazil, there is scarce literature on the association of LBW with blood pressure (BP) or kidney and pancreatic functions in adults. The big ELSA-Brasil database allowed to explore whether: 1) pre-diabetic individuals could have kidney function impairment, detectable by renal biomarkers; 2) LBW is associated with less favorable BP levels and kidney and pancreatic function in adulthood compared to normal birth weight. Objectives: To analyze the association of LBW with BP and biomarkers of kidney and endocrine-pancreatic function in adults without DM or nephropathy. The specific objectives were: Paper 1: to review the literature on the prevalence of diabetic kidney disease (DKD) in pre-diabetic individuals. Paper 2: to assess serum Cystatin C (sCys C) as an early marker of kidney dysfunction in individuals without DM. Paper 3: to compare BP levels and kidney function biomarkers (estimated glomerular filtration rate - eGFR, albumin-creatinine ratio - ACR and sCys C) according to the presence of LBW and to analyze their associations with BP and kidney function biomarkers in individuals without DM or nephropathy. Paper 4: to compare markers of ß-cell function and insulin sensitivity (HOMA-ß, HOMA-IR, HOMA-AD, QUICKI, TyG and TG/HDL) according to the presence of LBW and to analyze LBW associations with markers of ß-cell function and insulin sensitivity. Methods: Cross-sectional analysis of ELSA-Brasil data includes 2 fronts: assessment of the LBW associations with BP and kidney function and with endocrine-pancreatic function. Individuals aged > 60 years, BMI < 18.5 kg/m², DM, kidney, thyroid and liver dysfunction were excluded. Sociodemographic data, lifestyle, birth weight and previous diseases were collected by questionnaires, and clinical and laboratory data in the HU/USP. Dependent variables were BP, biomarkers of kidney and pancreatic functions, and independent variable was LBW. Categorical variables were compared using the chi-squared test and continuous variables by Student t test or the Wilcoxon test. Multiple linear regression models were employed to analyze associations between LBW and the outcome variables. Directed acyclic graph (DAG) was used to make the minimum necessary adjustment to the models. The propensity score method was applied to homogenize differences in sample size. Results: Paper 1: Prevalence of DKD ranged from 4.5 to 26.0% in pre-diabetic individuals. Considering eGFR in isolation, the prevalence rates varied from 4.5 to 21.3%, based only on ACR from 7.0 to 26.0% and based on combined criteria the prevalence was between 12.3 and 17.7%. Paper 2: Pre-diabetic individuals had higher sCys C levels than normoglycemic ones [0.67 (0.41-0.95) vs 0.48 (0.31-0.81) mg/L, p<0.001] and lower eGFR (96.3±17.4 vs 100.6±17.1 mL/min/1.73m², p<0.001). Normoglycemic hyperfiltrating individuals had lower sCys C than normofiltrating ones (p=0.035). Comparing eGFR levels between groups, this gradually decreased as the sCys C and ACR parameters worsened (p-trend=0.06). Paper 3: The LBW group had higher systolic (p=0.015) and diastolic BP (p=0.014) and ACR values (p=0.031), and lower eGFR (p=0.015) than normal birth weight. The preterm group had higher mean BP levels, but no difference in kidney function was detected. In a regression model, BP levels were associated with LBW, but this association disappeared after adding prematurity, which remained associated with BP (p=0.017). Having applied propensity score matching, LBW was associated with ACR (p=0.003), but not with eGFR or BP levels. Paper 4: Individuals with LBW or normal birth weight reported similar BMI at the age 20 years and current BMI was slightly lower in the LBW group. Cardiometabolic and endocrine-pancreatic function parameters were within normal ranges. In regression analysis, log-transformed HOMA-ß, but not the other indexes, was associated with LBW (p=0.014) independent of sex, skin color, prematurity, and family history of DM. After applying propensity score matching LBW was associated with HOMA-AD and TG/HDL indexes. Discussion: Our findings suggest that individuals with near-normal glucose metabolism disturbance could have some impaired kidney function. Looking at early-life risk factors is relevant since their associations with BP and renal and pancreatic function biomarkers could already be identified even in healthy individuals, without DM and nephropathy. Prospective studies are needed to assess the predictive value aiming at proposing prevention measures.

Introdução: O baixo peso ao nascer (BPN), proxy de ambiente intrauterino hostil, tem sido associado a estas doenças no adulto. Em nosso meio, é escassa a literatura sobre associações de BPN com pressão arterial (PA) e função renal e endócrino-pancreática em adultos. O extenso banco de dados ELSA-Brasil permitiu explorar se: 1) indivíduos pré-diabéticos já poderiam apresentar acometimento renal, detectado de forma precoce por biomarcadores; 2) o BPN associar-se-ia no adulto à PA e marcadores de função renal e endócrino-pancreática mais desfavoráveis que nascidos de peso adequado. Objetivos: Analisar a associação do BPN com PA e marcadores de função renal e endócrino-pancreática em adultos sem DM e sem nefropatia. Os objetivos específicos foram: no Artigo 1, rever a literatura sobre a prevalência de doença renal diabética em indivíduos pré-diabéticos; Artigo 2, analisar a cistatina C sérica (sCys C) como marcador precoce de disfunção renal em indivíduos sem DM do ELSA-São Paulo; Artigo 3, comparar os valores de PA e de marcadores de função renal (taxa de filtração glomerular estimada - TFGe, razão albumina-creatinina - ACR e sCys C) segundo a presença de BPN e analisar sua associação com PA e marcadores de função renal, em indivíduios sem DM e nefropatia; Artigo 4, comparar os valores de marcadores de função de células ß e sensibilidade à insulina (HOMA-ß, HOMA-IR, HOMA-AD, QUICKI, TyG e TG/HDL), segundo a presença de BPN e analisar sua associação com marcadores de função de células ß e sensibilidade à insulina. Métodos: Análises transversais de dados do ELSA-Brasil contemplaram 2 frentes, associação do BPN com PA e função renal e com função pancreática. Foram excluídos indivíduos com >60 anos, IMC <18,5 kg/m², DM, disfunção renal, tireoidiana e hepática. Dados sociodemográficos e de saúde foram coletados por questionários e os clínico-laboratoriais no HU/USP. As variáveis dependentes foram PA, marcadores de função renal e pancreática e a independente o BPN. Variáveis categóricas foram comparadas pelo qui-quadrado e contínuas por teste t de Student ou Wilcoxon. Usou-se regressão linear múltipla para testar associações do peso ao nascer com desfechos e DAG para obter os mínimos ajustes necessários nos modelos. Aplicou-se o escore de propensão para homogeneizar diferenças nos tamanhos amostrais. Resultados: Artigo 1: Verificou-se prevalência de 4,5 a 26,0% de nefropatia diabética no pré-DM. Com base na TFGe, esta taxa variou de 4,5 a 21,3%, na albuminúria de 7,0 a 26,0% e quando combinadas de 12,3 a 17,7%. Artigo 2: Indivíduos com pré-DM tiveram maiores valores de sCys C que os normoglicêmicos [0,67 (0,41-0,95) vs 0,48 (0,31-0,81) mg/L, p<0,001] e menores de TFGe (96,3±17,4 vs 100,6±17,1 mL/min/1,73m², p<0,001). Normoglicêmicos hiperfiltrantes apresentaram valores menores de sCys C que os normofiltrantes (p=0,035). Comparando a TFGe entre os grupos, observou-se queda gradual à medida que pioravam a sCys C e ACR (p-trend=0,06). Artigo 3: O grupo com BPN apresentou níveis mais altos de PA sistólica (p=0,015), diastólica (p=0,014) e de ACR (p=0,031), e menores de TFGe (p=0,015) que o grupo nascido com peso normal. Os prematuros apresentaram níveis médios de PA mais altos que os nascidos com peso normal, mas não houve diferença em marcadores de função renal. À análise de regressão, níveis de PA sistólica e diastólica associaram-se com BPN, mas tal associação não se manteve após incluir prematuridade no modelo, a qual permaneceu associada com PA (p=0,017). Após aplicar escore de propensão, o BPN associou-se com ACR (p = 0.003) mas não com TFGe. Artigo 4: Indivíduos com BPN ou peso normal relataram valores similares de IMC aos 20 anos e o atual foi ligeiramente menor no grupo BPN. Seus dados cardiometabólicos e função endócrino-pancreática foram normais. Em análise de regressão, o HOMA-ß mas não outros índices associou-se ao BPN (p=0,014) independente do sexo, cor, prematuridade e história familiar de DM. Após aplicar o escore de propensão, BPN manteve associação com HOMA-AD e TG/HDL. Conclusão: Nossos achados sugerem que indivíduos com alterações iniciais do metabolismo da glicose já podem apresentar biomarcadores de função renal comprometidos. Atentar-se a eventos precoces da vida como o BPN e prematuridade é relevante, uma vez que associações com PA e biomarcadores de função renal e endócrino-pancreática já podem ser identificadas mesmo em indivíduos saudáveis sem DM e nefropatia. Estudos prospectivos são necessários para avaliar o valor preditivo vislumbrando propor medidas de prevenção.

Análisis comparativo de respuesta glicémica y de péptido C, tras la ingesta de estevia y D-tagatosa, según habitualidad de consumo de edulcorantes no nutritivos y preferencias alimentarias reportadas por mujeres con resistencia a la insulina / Comparative analysis of glicemic response and c peptide, after comsumption of stevia and d tagatosa, according to regular compsumtion of not nutritive sweeteners andnourish preferences reported by woman with insuline resistance

INTRODUCCIÓN: El consumo de edulcorantes no nutritivos (ENN) ha ido en aumento. A pesar de ello, se desconoce el efecto entre el consumo habitual de ENN y las preferencias alimentarias con parámetros bioquímicos en pacientes con resistencia a la insulina. OBJETIVO: Comparar la respuesta glicémica y de péptido C, según habitualidad de consumo de edulcorantes y preferencias alimentarias reportados por mujeres con resistencia a la insulina tras la ingesta de estevia y D-tagatosa. MÉTODOS: Treinta y tres mujeres con RI se sometieron a una encuesta de opción múltiple sobre preferencias alimentarias y ETCC modificada de edulcorantes. Aleatoriamente recibieron una precarga de control o experimental (estevia y D-tagatosa) donde se midió glicemia y péptido C en los tiempos -10, 30, 60, 90, 120, 180. RESULTADOS: Se encontró un ABC de péptido C más alto después de la ingesta de D-tagatosa (p = 0,02) en pacientes que prefieren alimentos ricos en proteínas en comparación con aquellos que prefieren alimentos ricos en grasas o en carbohidratos simples. Se observó un mayor ABC de péptido C (p = 0,04) para la prueba control en quienes prefieren el sabor salado y consumen menor cantidad de ENN, sin diferencias significativas entre quienes prefirieron sabor dulce. CONCLUSIONES: Al comparar las respuestas glicémicas e insulinémicas entre habitualidad de consumo de edulcorantes y preferencias alimentarias reportados por las pacientes tras la ingesta de agua, estevia y D-Tagatosa, no se obtuvieron diferencias significativas. Salvo en quienes preferían alimentos ricos en proteínas tras la ingesta de D- tagatosa y quienes preferían sabor salado con menor consumo habitual de ENN tras ingesta control.

INTRODUCTION: The consumption of non-nutritive sweeteners (NNS) has been increasing. Despite this, the effect between the habitual consumption of ENN and food preferences with biochemical parameters in patients with insulin resistance is unknown. OBJECTIVE: To compare the glycemic and C-peptide response, according to the habitual consumption of sweeteners and food preferences reported by women with insulin resistance after ingesting stevia and D-tagatose. METHODS: Thirty-three women with IR underwent a multiple choice survey on food preferences and modified ETCC for sweeteners. They randomly received a control or experimental preload (stevia and D-tagatose) where glycemia and peptide C were measured at times -10, 30, 60, 90, 120, 180. RESULTS: A higher C-peptide AUC was found after ingestion of D-tagatose (p = 0.02) in patients who prefer foods rich in protein compared to those who prefer foods rich in fat or simple carbohydrates. A higher AUC of peptide C (p = 0.04) is performed for the control test in those who prefer a salty taste and consume a lower amount of ENN, without significant differences between those who prefer a sweet taste. CONCLUSION: When comparing the glycerol and insulin responses between the habitual consumption of sweeteners and the food preferences reported by the patients after the ingestion of water, stevia and D-Tagatose, no significant differences were obtained. Except in those who prefer foods rich in protein after ingesting D-tagatose and those who prefer salty taste with less habitual consumption of NNS after control intake.

Fisiopatología y alteraciones clínicas de la diabetes mellitus tipo 2: revisión de literatura / Physiopathology and clinical alterations of diabetes mellitus 2: literature review

Resumen La diabetes mellitus tipo 2 constituye una condición clínica debilitante, degenerativa y multifacética de alta prevalencia a nivel mundial. Dada la complejidad de su fisiopatología y las variadas opciones terapéuticas que existen esta enfermedad presenta un desafío para el médico general, se hace imperativo describir comprensiblemente esta patología para mejorar la resolutividad de ésta en atención primaria. Tras una búsqueda bibliográfica exhaustiva de 103 estudios publicados hasta el año 2010, se identificaron los aspectos más importantes tanto de la fisiología, fisiopatología, complicaciones y terapéuticas de esta patología. La resistencia a la insulina (RI) es una condición metabólica central en la etiopatogenia de esta patología donde se logra reconocer de manera clásica tanto la pérdida de la acción periférica de la insulina por parte de los diferentes tejidos, así como defectos en la secreción de insulina conllevando estados de hiperglucemia constantes asociados tanto a complicaciones agudas como crónicas caracterizadas por provocar disfunción y fallo en diferentes órganos. Es de conocimiento general que parte importante de los resultados en el manejo de esta patología se logran con cambios en el estilo de vida que van desde modificaciones en la dieta a cambios en el patrón de actividad física con pérdida de peso corporal. No obstante, existe a su vez una amplia gama de terapias farmacológicas orientadas a controlar estados hiperglucémicos ante la falla de la terapia no farmacológica. Dentro de este mismo contexto varias son las dianas y objetivos terapéuticos en el tratamiento del diabético tipo 2, sin embargo, todas confluyen en el control metabólico de los estados de hiperglucemia y la prevención de sus complicaciones.

Abstract Type 2 diabetes mellitus is a debilitating, degenerative and multifaceted clinical condition with a high prevalence worldwide. Given the complexity of its pathophysiology and the various therapeutic options that exist, this disease presents a challenge for the general practitioner, it is imperative to understand this pathology to improve its resolution in primary care. After an exhaustive bibliographic search of 103 studies published up to 2010, the most important aspects of both the physiology, pathophysiology, complications, and therapeutics of this pathology were identified. Insulin resistance (IR) is a central metabolic condition in the etiopathogenesis of this pathology. Classically it is possible to recognize both the loss of the peripheral action of insulin by the different tissues as well as defects in the secretion of insulin that leads to constant hyperglycemic states associated with both acute and chronic complications characterized by causing dysfunction and failure in different organs. It is generally known that an important part of the results in the management of this pathology are achieved with changes in lifestyle that range from modifications in diet to changes in the pattern of physical activity with loss of body weight. However, there also is a wide range of pharmacological therapies aimed at controlling hyperglycemic states in the event of the failure of non-pharmacological therapy. Within this same context, there are several therapeutic targets and objectives in the treatment of type 2 diabetics, however, they all converge in the metabolic control of hyperglycemic states and the prevention of their complications