Effects of exercise type and intensity on visfatin and the metabolic syndrome in obesity / Efectos del tipo de ejercicio y de la intensidad en la visfatina y el síndrome metabólico en la obesidad / Efeitos do tipo de exercício e da intensidade na visfatina e a síndrome metabólica na obesidade

ABSTRACT Objective: Visfatin may regulate a variety of physiological functions and it has great potential to significantly enhance our knowledge of the treatment of metabolic syndrome. Metabolic syndrome (MS) refers to metabolic abnormalities, such as abdominal obesity, dyslipidemia, high low-density cholesterol, high blood pressure and diabetes, and physical activity is an important factor for the management of MS. Therefore, the purpose of this study is to investigate the effects of visfatin on MS and MS risk factors through differences in aerobic exercise intensity and exercise type based on the premise of the same amount of exercise (energy expenditure of 400 kcal per day). Method: Thirty two obese, middle-aged women were randomly assigned to exercise intensity groups VO2max 50% (MAE, n=8) and VO2max 80% (VAE, n=8) and to type of exercise groups VO2max 50% + TRX (MARE, n=8) and VO2max 80% + TRX (VARE, n=8). The exercise program was performed 5 times a week. The data was analyzed using two-way repeated measures ANOVA and post-hoc tests within groups with LSD. Results: Body weight (p<.01 and p<.001) and % body fat (p<.05 and p<.01) significantly decreased in all groups and visfatin only increased significantly after exercise in the VARE group (p<.05). TG, glucose, and waist circumstance (p<.05, p<.01, and p<.001) significantly decreased in all groups and HDL-C (p<.05) only increased significantly after exercise only in the MARE group. Conclusion: These results suggest that, in spite of differences in exercise intensity and exercise type, exercise is effective in improving obesity and MS risk factors, but further research is needed on the exact mechanisms of visfatin. Level of evidence I; Therapeutic Studies Investigating the Results of Treatment .

RESUMEN Objetivo: La visfatina puede regular diversas funciones fisiológicas y tiene gran potencial para mejorar significativamente nuestro conocimiento sobre el tratamiento del síndrome metabólico. El síndrome metabólico (SM) se refiere a anormalidades metabólicas, como obesidad abdominal, dislipidemia, colesterol de baja densidad elevado, hipertensión y diabetes, siendo la actividad física un factor importante para el manejo del SM. Siendo así, el objetivo de este estudio es investigar los efectos de la visfatina sobre los factores de riesgo de SM por medio de diferencias de la intensidad de ejercicios aeróbicos y del tipo de ejercicio, con base en la premisa de misma cantidad de ejercicio (gasto energético de 400 kcal por día). Método: Treinta y dos mujeres obesas de media edad fueron aleatoriamente designadas para grupos de intensidad de ejercicio con VO2máx de 50% (EAM, n = 8) y VO2máx de 80% (EAV, n = 8) y grupos con VO2máx de 50% + ERC (EARM, n = 8) y VO2máx de 80% + ERC (EARV, n = 8). El programa de ejercicios fue realizado cinco veces por semana. Los datos fueron analizados con ANOVA de dos vías con medidas repetidas y tests post-hoc en los grupos con DMS. Resultados: El peso corporal (p < 0,01 y p < 0,001) y porcentual de grasa corporal (p < 0,05 y p < 0,01) disminuyeron significativamente en todos los grupos y la visfatina sólo aumentó significativamente después del ejercicio en el grupo EARV (p < 0,05). Los triglicéridos, la glucosa y la circunferencia de la cintura (p < 0,05, p < 0,01 e p < 0,001) disminuyeron significativamente en todos los grupos y el HDL-C (p < 0,05) sólo aumentó significativamente después del ejercicio sólo en el grupo EARM. Conclusión: Esos resultados sugieren que, a pesar de las diferencias de intensidad y tipo de los ejercicios, los mismos son eficaces para mejorar la obesidad y los factores de riesgo del SM, por ende, son necesarias más investigaciones sobre los mecanismos exactos de la visfatina. Nivel de Evidencia I; Estudios terapéuticos - Investigación de los resultados del tratamiento .

RESUMO Objetivo: A visfatina pode regular diversas funções fisiológicas e tem grande potencial para aprimorar significativamente nosso conhecimento sobre o tratamento da síndrome metabólica. A síndrome metabólica (SM) refere-se a anormalidades metabólicas, como obesidade abdominal, dislipidemia, colesterol de baixa densidade elevado, hipertensão e diabetes, sendo a atividade física um fator importante para o manejo da SM. Assim sendo, o objetivo deste estudo é investigar os efeitos da visfatina sobre os fatores de risco de SM por meio de diferenças da intensidade de exercícios aeróbicos e do tipo de exercício, com base na premissa de mesma quantidade de exercício (gasto energético de 400 kcal por dia). Método: Trinta e duas mulheres obesas de meia-idade foram randomicamente designadas para grupos de intensidade de exercício com VO2máxde 50% (EAM, n = 8) e VO2máxde 80% (EAV, n = 8) e grupos com VO2máxde 50% + ERC (EARM, n = 8) e VO2máxde 80% + ERC (EARV, n = 8). O programa de exercícios foi realizado 5 vezes por semana. Os dados foram analisados com ANOVA de duas vias com medidas repetidas e testes post-hoc nos grupos com DMS. Resultados: O peso corporal (p < 0,01 e p < 0,001) e percentual de gordura corporal (p < 0,05 e p < 0,01) diminuíram significativamente em todos os grupos e a visfatina só aumentou significativamente depois do exercício no grupo EARV (p < 0,05). Triglicérides, glicose e circunferência da cintura (p < 0,05, p < 0,01 e p < 0,001) diminuíram significativamente em todos os grupos e o HDL-C (p < 0,05) só aumentou significativamente depois o exercício apenas no grupo EARM. Conclusão: Esses resultados sugerem que, apesar das diferenças de intensidade e tipo dos exercícios, eles são eficazes para melhorar a obesidade e os fatores de risco da SM, porém, são necessárias mais pesquisas sobre os mecanismos exatos da visfatina. Nível de Evidência I; Estudos terapêuticos - Investigação dos resultados do tratamento .

Circulating IL-6, clusterin and irisin in obese subjects with different grades of obesity: association with insulin resistance and sexual dimorphism

ABSTRACT Objective: There are discrepancies about the relationship of IL-6, clusterin and irisin with obesity and obesity associated insulin resistance and also about their sexual dimorphism. This study aimed at evaluating the circulating levels of IL-6, clusterin and irisin in obese subjects of both sexes who had different grades of obesity and examining their sexual dimorphism and their association with insulin resistance. Subjects and methods: This study included 176 non-diabetic subjects of both sexes who were classified according to their sex into two groups; the male and the female groups. The male group (88 men) was classified according to BMI into; group 1 (22 lean men), group 2 (22 class I obese men), group 3 (22 class II obese men) and group 4 (22 class III obese men). The female group (88 women) was classified according to BMI exactly as the male group. Metabolic parameters, IL-6, clusterin, and irisin levels were measured. Data were analyzed by ANOVA test, post hoc Tukey's test and independent t-test. Pearson correlation was used to assess the association between variables. Results: In obese subjects of both sexes, circulating IL-6, clusterin and irisin levels were significantly elevated and positively correlated with HOMA-IR. Obese males showed significantly higher HOMA-IR, IL-6, clusterin and irisin levels than obese females. Conclusion: Obesity in both sexes, especially in males was associated with high levels of IL-6, clusterin and irisin and worsened the metabolic pattern. Circulating IL-6, clusterin and irisin may represent possible therapeutic targets for insulin resistance in obese subjects.

Serum Magnesium and High-sensitive C-reactive Proteins in Hypertensive, Obese Female School Learners

ABSTRACT Objective: To examine the relationship of serum magnesium and high-sensitive C-reactive proteins (hsCRPs) with overweight/obesity, and its association with hypertension in lean versus overweight/obese (O/O), female, adolescent school learners living in Mthatha, Eastern Cape, South Africa. Methods: A case-control study was conducted involving age-matched, non-pregnant and nonlactating lean and O/O females aged 13-17 years. Relevant data on demography, anthropometry (height, weight, and waist and hip circumferences), blood pressure and venous blood samples were collected. Results: A significant inverse correlation was observed between serum magnesium and waist circumference (WC) (r = −0.3153; 95% CI = −3.843, −0.8681; p = 0.0022). Serum hsCRP levels were significantly higher in O/O participants. Participants with a WC > 80 cm had significantly higher mean systolic blood pressure and mean diastolic blood pressure (MDBP). A hip circumference (HC) > 94 cm was associated with higher mean systolic blood pressure (MSBP) and MDBP (120 ± 2 vs 113 ± 2, p = 0.009 and 73 ± 2 vs 68 ± 1, p = 0.003). Both WC and HC were found to be positively correlated with both MSBP (r = 0.2691; 95% CI = 0.042, 0.457; p = 0.018 and r = 0.2758; 95% CI = 0.03184, 0.3001; p = 0.0159) and MDBP (r = 0.2686; 95% CI = 0.0286, 0.320; p = 0.19 and r = 0.2836; 95% CI = 0.05382, 0.4455; p = 0.013), respectively. Conclusion: In our study, low-grade inflammation and early-onset hypertension in O/O adolescent females were consistent with evidence that support the beneficial effect of maintaining lean body habitus. There is an urgent need to prevent overweight/obesity among adolescents.

A single session of low-volume high-intensity interval and moderate-intensity continuous exercise elicits a transient reduction in ghrelin levels, but not in post-exercise energy intake in obese men

ABSTRACT Objective: This study investigated the acute effects of high-intensity interval (HIIE) and moderate-intensity continuous (MICE) exercise on ghrelin levels in obese men. Subjects and methods: A total of 10 obese men (age 27.6 ± 1.8 years, body mass index 35.4 ± 4.5 kg/m², body fat 39.9 ± 2.1%) performed two exercise sessions in a randomized order: HIIE (10 × 1 min intervals at 90% of the maximal heart rate [HRmax] interspersed by 1 min of active recovery) and MICE (20 min at 70% of the HRmax). Ghrelin levels were assessed pre-, post- and 1h post-exercise, and energy intake was assessed 1h post-exercise through an ad libitum meal. Results: HIIE and MICE showed a trend to decrease ghrelin levels immediately post-exercise (-14.1 ± 21.6% and −9.6 ± 23.8%, respectively, p = 0.07) and decreased 1h post-exercise (-12.7 ± 31.8% and −13.8 ± 21.7%, respectively, p < 0.05). No changes were observed for post-exercise energy intake (p > 0.05). There was a positive correlation between the change in ghrelin levels and post-exercise energy intake only for HIIE (r = 0.63, p = 0.05). Conclusion: In summary, a single session of HIIE and MICE elicits a reduction on ghrelin levels without changing post-exercise energy intake in obese men.

Plasmatic adipocyte biomarkers and foot pain associated with flatfoot in schoolchildren with obesity

SUMMARY OBJECTIVE The aim of this study was to determine the potential association of foot pain and plasmatic adipocytes as physiological biomarkers of childhood obesity with the incidence of flatfoot in a cohort of Egyptian school children aged 6 -12 years. METHODS A total of 550 Egyptian schoolchildren (220 boys and 330 girls) aged 6-12 years were randomly invited to participate in this descriptive survey analysis. For all children, we assessed the diagnosis and severity of flatfoot as well as plasma adipocytes, as well as adiponectin, leptin, resistin, IL-6, and TNF-α, using the Dennis method and immunoassay techniques respectively. Foot pain was assessed by using a standard VAS of 100 mm and Faces Pain Scale, respectively. RESULTS Flat foot was predicted in 30.4% of school-age children, most of them showed a higher frequency of overweight (33.3%) and obesity (62.5%). Boys showed higher ranges of flat foot than girls. Foot pain significantly correlated with flat foot and obesity among the studied populations. In overweight-obese children, plasmatic adipocyte variables, as well as adiponectin, leptin, resistin, IL-6, TNF-α.; showed significant correlations with foot stance, especially in boys. Also, the studied adipocyte variables along with BMI, age, gender explained about~65% of the variance of flatfoot with pain among our school-age students. CONCLUSION Foot pain showed an association with flat foot and childhood obesity in 30.4% of school-age students (6-12 years). Foot pain was shown to correlate positively with the incidence of flat foot and changes in adiposity markers, as well as adiponectin, leptin, resistin, Il-6, TNF-α

RESUMO OBJETIVO O objetivo deste estudo foi determinar a potencial associação de dor no pé e adipócitos plasmáticos como biomarcadores fisiológicos da obesidade infantil com incidência de pé plano em uma coorte de escolares egípcios de 6 a 12 anos. MÉTODOS Um total de 550 escolares egípcios (220 meninos e 330 meninas) com idades entre 6 e 12 anos foram convidados aleatoriamente para participar desta análise descritiva. Para todas as crianças, diagnóstico e gravidade do flatfoot, bem como adipócitos plasmáticos; adiponectina, leptina, resistina, IL-6 e TNF-α; foram avaliados pelo método de Dennis e técnicas de imunoensaio, respectivamente. A dor no pé foi avaliada usando uma EVA padrão de 100 mm e a Faces Pain Scale, respectivamente. RESULTADOS O pé plano foi predito em 30,4% das crianças em idade escolar; a maioria apresentou maior frequência de sobrepeso (33,3%) e obesidade (62,5%). Os meninos apresentaram maiores faixas de pé plano do que as meninas. A dor no pé correlacionou-se significativamente com pé plano e obesidade entre as populações estudadas. Em crianças obesas com sobrepeso, variáveis adipocitárias plasmáticas; adiponectina, leptina, resistina, IL-6 e TNF-α; apresentaram correlação significativa com a postura do pé, em meninos e meninas. Além disso, as variáveis estudadas dos adipócitos, juntamente com o IMC, idade e sexo, explicaram cerca de 65% da variância do pé plano com a dor entre os nossos alunos em idade escolar. CONCLUSÃO A dor no pé mostrou associação com pé plano e obesidade infantil em 30,4% dos estudantes em idade escolar (6-12 anos). A dor no pé se correlacionou positivamente com a incidência de pé plano e a mudança nos marcadores de adiposidade; adiponectina, leptina, resistina, IL-6, TNF-α.

Relationship between Dyslipidemia, Cultural Factors, and Cardiorespiratory Fitness in Schoolchildren / Relação entre Dislipidemia, Fatores Culturais e Aptidão Cardiorrespiratória em Escolares

Abstract Background: The presence of dyslipidemia and behavioral aspects are determinants of cardiovascular risk, especially in childhood and adolescence. Objective: To verify possible relationships between dyslipidemia, cultural factors, and cardiorespiratory fitness (CRF) in schoolchildren. Methods: This cross-sectional study evaluated a sample of 1,254 children and adolescents between the ages of 7 and 17 from the South of Brazil, 686 of whom were female. Dyslipidemia was defined as increased levels of at least one of the following lipid profile parameters: triglycerides (TG), total cholesterol (TC) and fractions of high (HDL-c) and low-density lipoprotein (LDL-c). Cultural aspects were evaluated by a self-reported questionnaire. Data were analyzed by logistic regression, considering the odds ratios (OR) and confidence intervals (CI) at 95%. Results: The results revealed a high prevalence of dyslipidemia (41.9%), which was associated with female sex (OR: 1.56; IC: 1.24-1.96) and overweight/obese status (OR: 1.55; IC: 1.20-2.00). When lipid profile parameters were evaluated separately, high levels of LDL-c were observed to be associated with sedentary school transport (OR: 1.59; IC: 1.20-2.09). Schoolchildren who were overweight/obese had higher chances of elevated levels of TC (OR: 1.40; IC: 1.07-1.84) and TG (OR: 3.21; IC: 1.96-5.26). HDL-c was shown to be related to high television time (OR: 1.59; IC: 1.00-2.54). Conclusion: Alterations in lipid parameters are associated with cultural factors, especially those related to sedentary lifestyle and low levels of CRF.

Resumo Fundamento: A presença de dislipidemia e os aspectos comportamentais são fatores determinantes do risco cardiovascular, sobretudo na infância e adolescência. Objetivos: Verificar possíveis relações entre dislipidemia, fatores culturais e aptidão cardiorrespiratória (APCR) em escolares. Métodos: São sujeitos deste estudo transversal 1.254 crianças e adolescentes do Sul do Brasil, sendo 686 do sexo feminino, com idade entre 7 e 17 anos. Foi considerada dislipidemia a presença de níveis aumentados em pelo menos um dos parâmetros do perfil lipídico: triglicerídeos (TG), colesterol total (CT) e frações de alta (HDL-c) e baixa densidade (LDL-c). Os aspectos culturais foram avaliados por meio de questionário autorreferido pelo escolar. Os dados foram analisados pela regressão logística, considerando os valores de razão de chances (odds ratio; OR) e intervalos de confiança (IC) para 95%. Resultados: Foi encontrada elevada prevalência de dislipidemia (41,9%), a qual esteve associada com o sexo feminino (OR: 1,56; IC: 1,24-1,96) e com a presença de sobrepeso/obesidade (OR: 1,55; IC: 1,20-2,00). Quando os componentes do perfil lipídico foram avaliados de forma separada, observou-se que altos níveis de LDL-c se associaram ao deslocamento sedentário para a escola (OR: 1,59; IC: 1,20-2,09). Escolares com sobrepeso/obesidade apresentam maiores chances de elevação nos níveis de CT (OR: 1,40; IC: 1,07-1,84) e TG (OR: 3,21; IC: 1,96-5,26). O HDL-c apresentou associação com o elevado tempo em frente à televisão (OR: 1,59; IC: 1,00-2,54). Conclusão: A presença de alteração nos parâmetros lipídicos associa-se com fatores culturais, especialmente voltados ao sedentarismo e baixos níveis de APCR.

Increased ApoB/ApoA1 ratio is associated with excess weight, body adiposity, and altered lipid profile in children / A razão ApoB/ApoA1 aumentada está associada ao excesso de peso, de adiposidade corporal e ao perfil lipídico alterado em crianças

Abstract Objective: To investigate ApoB/ApoA1 ratio and its association with cardiovascular risk factors in children. Methods: Cross-sectional study with 258 children aged 8 and 9 years old, enrolled in all urban schools in the city of Viçosa-MG. Anthropometric and body composition assessment, as well as biochemical profile of the children was performed. Socioeconomic variables and sedentary lifestyle were evaluated through a semi-structured questionnaire. Results: Many children had excess weight (35.2%), abdominal adiposity (10.5%), and body fat (15.6%), as well as increased ApoB/ApoA1 ratio (14.7%), total cholesterol (51.8%), and triglycerides (19.8%). Children with excess weight and total and central fat had a higher prevalence of having a higher ApoB/ApoA1 ratio, as well as those with atherogenic lipid profile (increased LDL-c and triglycerides and low HDL-c). A direct association was found between the number of cardiovascular risk factors and the ApoB/ApoA1 ratio (p = 0.001), regardless of age and income. Conclusion: The increased ApoB/ApoA1 ratio was associated with excess weight, body adiposity (total and central), and altered lipid profile in children. Children with a higher number of cardiovascular risk factors had higher ApoB/ApoA1 ratio, in both genders.

Resumo Objetivo: Investigar a razão ApoB/ApoA1 e sua relação com fatores de risco cardiovascular em crianças. Métodos: Estudo transversal com 258 crianças de 8 e 9 anos, matriculadas em todas as escolas urbanas de Viçosa-MG. Foi feita avaliação antropométrica, da composição corporal e bioquímica das crianças. As variáveis socioeconômicas e o sedentarismo foram avaliados por questionário semiestruturado. Resultados: Muitas crianças apresentaram excesso de peso (35,2%), de adiposidade abdominal (10,5%) e de gordura corporal (15,6%), bem como a razão ApoB/ApoA1 (14,7%), colesterol-total (51,8%) e triglicerídeos (19,8%) aumentados. Crianças com excesso de peso e de gordura total e central apresentaram maiores prevalências de maior razão ApoB/ApoA1, bem como as com perfil lipídico aterogênico (LDL-c e triglicerídeos aumentados e baixo HDL-c). Foi encontrada associação direta entre o número de fatores de risco cardiovascular e a razão ApoB/ApoA1 (p = 0,001), independente da idade e renda. Conclusão: A razão ApoB/ApoA1 aumentada esteve associada ao excesso de peso, de adiposidade corporal (total e central) e ao perfil lipídico alterado nas crianças. As crianças com maior número de fatores de risco cardiovascular apresentaram maior razão ApoB/ApoA1, em ambos os sexos.

Psoriasis in obesity: comparison of serum levels of leptin and adiponectin in obese subjects - cases and controls

Abstract BACKGROUND: Psoriasis and obesity are somewhat related to a low-grade systemic inflammatory response. OBJECTIVES: To determine leptin and adiponectin levels in psoriasis patients compared to control patients matched for weight. METHODS: A case-control study was performed, evaluating 113 psoriasis patients and 41 controls with other dermatologic diseases. RESULTS: The prevalence of obesity was 33% in cases and 21.9% in controls. All evaluated comorbidities were more prevalent among cases. When stratified by weight, the comorbidities were more frequent in overweight patients. We found no correlation between being overweight (p=0.25), leptin (p=0.18) or adiponectin (p=0.762) levels and psoriasis severity. When overweight cases and controls were compared, we found differences in the adiponectin values (p= 0.04). The overweight cases had lower adiponectin levels than the overweight controls. We found no differences in the leptin dosage between cases and controls. The overweight cases had higher leptin values than the normal weight cases (p<0.001). STUDY LIMITATIONS: Several patients used systemic anti-inflammatory medication. CONCLUSIONS: The prevalence of obesity among psoriasis cases (33%) was higher than in the general population (17.4%). We did not find any correlation between severity of psoriasis and inflammatory cytokines and the condition of being overweight. The overweight cases had lower values of adiponectin than the overweight controls. It seems, therefore, that there is a relationship between adiponectin and psoriasis, but this relationship depends on the presence of obesity.

A Proposed Inflammatory Score of Circulating Cytokines/Adipokines Associated with Resistant Hypertension, but Dependent on Obesity Parameters / Proposta de um Escore Inflamatório de Citocinas e Adipocinas Plasmáticas Associado à Hipertensão Resistente, mas Dependente dos Parâmetros de Obesidade

Abstract Background: There is evidence that subclinical systemic inflammation is present in resistant hypertension (RHTN). Objective: The aim of the study was to develop an integrated measure of circulating cytokines/adipokines involved in the pathophysiology of RHTN. Methods: RHTN (n = 112) and mild to moderate hypertensive (HTN) subjects (n=112) were studied in a cross-sectional design. Plasma cytokines/adipokines (TNF-alpha, interleukins [IL]-6, -8, -10, leptin and adiponectin) values were divided into tertiles, to which a score ranging from 1 (lowest tertile) to 3 (highest tertile) was assigned. The inflammatory score (IS) of each subject was the sum of each pro-inflammatory cytokine scores from which anti-inflammatory cytokines (adiponectin and IL-10) scores were subtracted. The level of significance accepted was alpha = 0.05. Results: IS was higher in RHTN subjects compared with HTN subjects [4 (2-6) vs. 3 (2-5); p = 0.02, respectively]. IS positively correlated with body fat parameters, such as body mass index (r = 0.40; p < 0.001), waist circumference (r = 0.30; p < 0.001) and fat mass assessed by bioelectrical impedance analysis (r = 0.31; p < 0.001) in all hypertensive subjects. Logistic regression analyses revealed that IS was an independent predictor of RHTN (OR = 1.20; p = 0.02), independent of age, gender and race, although it did not remain significant after adjustment for body fat parameters. Conclusion: A state of subclinical inflammation defined by an IS including TNF-alpha, IL-6, IL-8, IL-10, leptin and adiponectin is associated with obese RHTN. In addition, this score correlates with obesity parameters, independently of hypertensive status. The IS may be used for the evaluation of conditions involving low-grade inflammation, such as obesity-related RHTN. Indeed, it also highlights the strong relationship between obesity and inflammatory process.

Resumo Fundamento: Evidências indicam que a inflamação sistêmica subclínica está presente na hipertensão arterial resistente (HAR). Objetivo: Desenvolver uma medida que integra citocinas envolvidas na fisiopatologia da HAR. Métodos: Indivíduos com HAR (n = 112) e indivíduos com hipertensão leve a moderada (HT) (n = 112) foram estudados em delineamento transversal. Valores de citocinas/adipocinas plasmáticas [TNF-alfa, interleucinas (IL)-6, -8, -10, leptina e adiponectina] foram divididos em tercis, e lhes atribuído um escore variando de 1 (tercil mais baixo) a 3 (tercil mais alto). O escore inflamatório (EI) de cada participante foi calculado como a soma do escore de cada citocina pró-inflamatória da qual subtraiu-se o escore de cada citocina anti-inflamatória (adiponectina e IL-10). O nível de significância aceito foi alfa = 0,05. Resultados: O EI foi mais alto nos indivíduos com HAR em comparação a indivíduos com HT [4 (2-6) vs. 3 (2-5); p = 0,02, respectivamente]. O EI correlacionou-se positivamente com parâmetros de gordura corporal, tais como índice de massa corporal (r = 0,40; p < 0,001), circunferência da cintura (r = 0,30; p < 0,001) e massa gorda avaliada por bioimpedância (r = 0,31; p < 0,001) em todos os indivíduos hipertensos. Análises de regressão logística mostraram que o EI foi um preditor independente de HAR (OR = 1,20; p = 0,02), independentemente de idade, sexo e raça; porém, o modelo perdeu significância estatística após ajuste para os parâmetros de gordura corporal. Conclusão: Um estado de inflamação subclínica definida pelo EI incluindo TNF-alfa, IL-6, IL-8, IL-10, leptina e adiponectina está associado com indivíduos obesos com HAR. Além disso, o escore correlaciona-se com parâmetros de obesidade, independentemente do grau de hipertensão. O EI pode ser usado na avaliação de condições que envolvem inflamação subclínica, tal como HAR relacionada à obesidade. O estudo também destaca a forte relação entre obesidade e inflamação.

Obesidad, hipertensión, síndrome metabólico y diabetes mellitus tipo 2 en dadores de sangre, individuos presuntamente sanos, del banco de sangre, tejidos y biológicos, de la ciudad de Posadas / Obesity, hypertension, metabolic syndrome and type 2 diabetes mellitus in blood donors, presumably healthy individuals, from the blood, tissue and biological bank of the city of Posadas

Resumen La enfermedad cardiovascular ocupa uno de los primeros puestos como causa de muerte en el mundo. Durante el primer año del proyecto, nos propusimos hallar la prevalencia y su distribución por sexo de hipertensión, obesidad general y abdominal en donantes de sangre. Establecer la frecuencia y su distribución por sexo de Síndrome Metabólico y hallar la incidencia de diabetes mellitus tipo 2; en el segundo año nos centramos en re-evaluar y valorar el impacto de la intervención en cada individuo. En una población de dadores de sangre presuntamente sanos del Banco de Sangre, Tejidos y Biológicos de la Provincia de Misiones. Se obtuvieron datos antropométricos y presión arterial. Se realizó una extracción sanguínea con ayuno de 12 horas para las determinaciones bioquímicas, consulta médica y tratamiento para quienes lo necesitaron. Se realizó una encuesta abierta cualitativa. Se obtuvieron datos de 141 donantes voluntarios de sangre, 47 mujeres y 94 varones. El 38,1% tenía presión arterial elevada. El 29,5% presento obesidad. El 59 % obesidad abdominal. 41,7 % de los donantes presentaba SM. Se halló una incidencia de diabetes mellitus tipo 2 de 8,6 % (n=12). El 39,6 % (n=55) de los individuos presentó Glucemia Alterada en Ayunas. Todos los individuos que presentaron algún factor de riesgo, concurrieron a la consulta médica. Al año se los recito para su control. De los 30 individuos que estaban en tratamiento solo 9 continuaron haciendolo, impidiendo esto una correcta evaluación clínica global y medición del impacto de las intervenciones que se realizaron. De toda la poblacion de estudio, solo en 4 individuos se ha notado un cambio significativo transcurrido un año. Casi la totalidad de la población de donantes presentó al menos un factor de riesgo para enfermedad cardiovascular, todos ellos modificables, destacando de ello la corta edad de la población. Ninguno de los individuos del estudio tenía conocimiento de su estado.

ABSTRACT Cardiovascular disease occupies one of the first places as a cause of death in the world. During the first year of the project, we set out to find the prevalence and its distribution by sex of hypertension, general and abdominal obesity in blood donors. Establish the frequency and distribution by sex of Metabolic Syndrome (MS) and find the incidence of type 2 diabetes mellitus; while in the second year we focused on re-evaluating and assessing the impact of the intervention on each individual. In a population of presumably healthy blood donors of the Blood, Tissue and Biological Bank of the Province of Misiones. Volunteer donors between 20 and 50 years were evaluated, 2014-2015 period. Anthropometric data and blood pressure were obtained. A blood extraction with fasting of 12 hours was performed for biochemical determinations, medical consultation and treatment for those who needed it. Period 2015-2016, a qualitative open survey and biochemical-clinical evaluation of individuals was conducted. Data were obtained from 141 voluntary blood donors, 47 women and 94 men. 38.1% of the total population had high blood pressure, 29.5% obesity, 59% of the study population had abdominal obesity and 41.7% of donors had MS. An incidence of type 2 diabetes mellitus of 8.6% (n = 12) and 39.6% (n = 55) of the individuals had altered fasting blood glucose. All the individuals who presented some risk factor attended the medical consultation. At the end of one year they are re-scheduled for re-evaluation. Although, the majority agreed on the importance of carrying out health checks, of the 30 individuals who were in treatment only 9 continued to do so, preventing this a correct global clinical evaluation and measuring the impact of the interventions that were performed. Of all the study population, only 4 individuals have noticed a significant change after one year, improving all their risk factors. The parameter that showed the greatest change, in a year, was the fasting blood glucose. Everyone was aware of the significance of cardiovascular risk factors and what their consequences were. Almost all of the donor population had at least one risk factor for cardiovascular disease, all of them modifiable, highlighting the short age of the population. None of the individuals in the study was aware of their condition. Only 9 individuals completed the treatment scheme indicated according to their pathology.

Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile / Percentual de gordura corporal é melhor que indicadores da condição do peso para identificar crianças e adolescentes com perfil lipídico desfavorável

Abstract Objective: To assess whether the indicators of weight status body mass index and waist-to-height ratio are similar to body fat percentage to identify obese children and adolescents with unfavorable lipid profile. Methods: This was a cross-sectional study involving 840 children and adolescents (6-18 years). The same individuals were classified as non-obese (<P95) or obese (≥P95) according to body fat percentage and indicators of weight status, body mass index, and waist-to-height ratio. Body fat percentage was obtained by multi-frequency bioelectrical impedance. Linear association between obesity and increased lipid fractions was tested by ANCOVA. Normal distribution curves of non-HDL cholesterol were designed for obese and non-obese. To provide the proportion of obese individuals with elevated non-HDL-c across all indicators, Z-score was calculated. Results: Obese boys presented higher non-HDL cholesterol when compared with those non-obese, classified by body mass index (107 ± 28 vs. 94 ± 25 mg/dL, p = 0.001), waist-to-height ratio (115 ± 29 vs. 94 ± 25 mg/dL, p < 0.001) and body fat percentage (119 ± 33 vs. 94 ± 24 mg/dL, p < 0.001). Differently, obese girls presented with higher non-HDL cholesterol when compared with those non-obese only according to the body fat percentage classification (118 ± 24 vs. 96 ± 26 mg/dL, p = 0.001). A large shift to the right in the distribution curve of non-HDL cholesterol among obese girls compared with non-obese was observed only when body fat percentage was used to discriminate between obese and non-obese. Conclusion: Body fat percentage was better than the indicators of weight status to identify children and adolescents with unfavorable lipid profile, mainly among girls.

Resumo Objetivo: Investigar se os indicadores da condição do peso, índice de massa corporal e razão cintura/estatura são semelhantes ao percentual de gordura corporal para identificação de crianças e adolescentes obesos com perfil lipídico desfavorável. Métodos: Estudo transversal que envolveu 840 crianças e adolescentes (6‐18 anos). Os mesmos indivíduos foram classificados em não obesos (p < 95) ou obesos (p ≥ 95) de acordo com o percentual de gordura corporal e os indicadores da condição do peso, índice de massa corporal e razão cintura/estatura. O percentual de gordura corporal foi obtido por bioimpedância multifrequencial tetrapolar. A associação linear entre obesidade e aumento das frações lipídicas foi tesada por ANCOVA. As curvas de distribuição normal de colesterol não HDL foram construídas para obesos e não obesos. Para fornecer a proporção de indivíduos obesos com colesterol não HDL elevado para todos os indicadores, o escore z foi calculado. Resultados: Os meninos obesos apresentaram maior colesterol não HDL em comparação com não obesos de acordo com a classificação fornecida pelo índice de massa corporal (107 ± 28 em comparação com 94 ± 25 mg/dL, p = 0,001), razão cintura/estatura (115 ± 29 em comparação com 94 ± 25 mg/dL, p < 0,001) e percentual de gordura corporal (119 ± 33 em comparação com 94 ± 24 g/dL, p < 0,001). Diferentemente, as meninas obesas apresentaram maior colesterol não HDL em comparação com as não obesas, somente de acordo com a classificação fornecida pelo percentual de gordura corporal (118 ± 24 em comparação com 96 ± 26 mg/dL, p = 0,001). Um grande deslocamento para a direita na curva de distribuição de colesterol não HDL entre meninas obesas em comparação com não obesas foi observado somente quando o percentual de gordura corporal foi utilizado para discriminar obesas e não obesas. Conclusão: O percentual de gordura corporal é melhor do que os indicadores da condição do peso na identificação de crianças e adolescentes com perfil lipídico desfavorável, principalmente entre meninas.

High prevalence of obesity in rheumatoid arthritis patients: association with disease activity, hypertension, dyslipidemia and diabetes, a multi-center study

Abstract Introduction: Rheumatoid arthritis (RA) is a well-documented independent risk factor for cardiovascular disease. Obesity may provide an additional link between inflammation and accelerated atherosclerosis in RA. Objective: To evaluate the association between obesity and disease parameters and cardiovascular risk factors in RA patients. Method: Cross-sectional study of a cohort of RA patients from three Brazilian teaching hospitals. Information on demographics, clinical parameters and the presence of cardiovascular risk factors was collected. Blood pressure, weight, height and waist circumference (WC) were measured during the first consultation. Laboratory data were retrieved from medical records. Obesity was defined according to the NCEP/ATPIII and IDF guidelines. The prevalence of obesity was determined cross-sectionally. Disease activity was evaluated using the DAS28 system (remission < 2.6; low 2.6—3.1; moderate 3.2-5.0; high >5.1). Results: The sample consisted of 791 RA patients aged 54.7 ± 12.0 years, of whom 86.9% were women and 59.9% were Caucasian. The mean disease duration was 12.8 ± 8.9 years. Three quarters were rheumatoid factor-positive, the mean body mass index (BMI) was 27.1 ±4.9, and the mean WC was 93.5 ± 12.5 cm. The observed risk factors included dyslipidemia (34.3%), type-2 diabetes (15%), hypertension (49.2%) and family history of premature cardiovascular disease (16.5%). BMI-defined obesity was highly prevalent (26.9%) and associated with age, hypertension and dyslipidemia. Increased WC was associated with diabetes, hypertension, dyslipidemia and disease activity. Conclusion: Obesity was highly prevalent in RA patients and associated with disease activity.

Methylation profile of the ADRB3 gene and its association with lipid profile and nutritional status in adults

BACKGROUND: Defects in DNA methylation have been shown to be associated with metabolic diseases such as obesity, dyslipidemia, and hypercholesterolemia. To analyze the methylation profile of the ADRB3 gene and correlate it with lipid profile, lipid intake, and oxidative stress based on malondialdehyde (MDA) and total antioxidant capacity (TAC), homocysteine and folic acid levels, nutritional status, lifestyle, and socioeconomic variables in an adult population. A cross-sectional epidemiological study representative of the East and West regions of the municipality of João Pessoa, Paraíba state, Brazil, enrolled 265 adults of both genders. Demographic, lifestyle, and socioeconomic questionnaires and a 24-h recall questionnaire were applied by trained interviewers' home. Nutritional and biochemical evaluation (DNA methylation, lipid profile, MDA, TAC, homocysteine and folic acid levels) was performed. RESULTS: DNA hypermethylation of the ADRB3 gene, analyzed in leukocytes, was present in 50% of subjects and was associated with a higher risk of being overweight (OR 3.28; p = 0.008) or obese (OR 3.06; p = 0.017), a higher waist-hip ratio in males (OR 1.17; p = 0.000), greater intake of trans fats (OR 1.94; p = 0.032), higher LDL (OR 2.64; p = 0.003) and triglycerides (OR 1.81; p = 0.031), and higher folic acid levels (OR 1.85; p = 0.022). CONCLUSIONS: These results suggest that epigenetic changes in the ADRB3 gene locus may explain the development of obesity and non-communicable diseases associated with trans-fat intake, altered lipid profile, and elevated folic acid. Because of its persistence, DNA methylation may have an impact in adults, in association with the development of non-communicable diseases. This study is the first population-based study of the ADRB3 gene, and the data further support evaluation of ADRB3 DNA methylation as an effective biomarker.

Comparação entre dietas com restrição de carboidratos e de gorduras no combate à obesidade: uma revisão sistemática / Comparison of diets with carbohydrate and fat restriction to fight obesity: a systematic review

OBJETIVO: Comparar dietas com restrição de carboidratos e com restrição de gorduras, para analisar a eficácia de ambas em relação a perda de peso, LDL-c, HDL-c, triglicerídeos, glicemia em jejum e pressão arterial. MÉTODOS: Foram analisados, em três diferentes bancos de dados, estudos de intervenção randomizados publicados entre 2002 e 2016. Após avaliação de qualidade, oito artigos foram selecionados para o presente estudo. RESULTADOS: Dietas com restrição de carboidratos demonstraram maior eficácia em relação à perda ponderal, à elevação dos níveis de HDL-c e à diminuição dos níveis de triglicerídeos, glicemia de jejum e pressóricos. A única variável em que houve maior benefício aparente com a restrição de gorduras foi a diminuição dos níveis de LDL-c. CONCLUSÃO: Uma dieta com restrição de carboidratos pode ser uma alternativa mais eficaz do que com restrição de gorduras no combate à obesidade e à síndrome metabólica. No entanto, a realização de estudos mais aprofundados é essencial para avaliar alterações em outros marcadores metabólicos importantes. (AU)

OBJECTIVES: To compare low-carbohydrate and low-fat diets to analyze their efficacy in relation to weight loss, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting glycaemia and blood pressure. METHODS: For this, three randomized intervention studies published between 2002 and 2016 were analyzed in three different databases. After being evaluated for quality, eight articles were selected for the present study. RESULTS: Low-carbohydrate diets demonstrated greater efficacy concerning weight loss, elevated HDL-C levels and a decrease in triglyceride levels, fasting glycaemia and blood pressure levels. The only variable in which there was a greater apparent benefit with low-fat diet was the decrease in LDL-C levels. CONCLUSION: A low-carbohydrate diet may be a more effective alternative than a low-fat diet in the fight against obesity and metabolic syndrome. However, more in-depth studies are essential to evaluate changes in other important metabolic markers. (AU)

Lipid disorders among Black Africans non-users of lipid-lowering medication

ABSTRACT Objective: Angola is a sub-Saharan African country where the population has scarce access to lipidlowering medication. We sought to determine the frequency of lipid disorders among Angolan nonusers of lipid-lowering medication. Material and methods: A cross-sectional descriptive study was carried out in a sample of 604 workers from the public sector. Blood pressure and anthropometric data were measured along with biochemical parameters including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). LDL-C to HDL-C ratio (LDL-C/HDL-C) was obtained from LDL-C and HDL-C levels. Results: High frequencies of elevated blood pressure (44.8%), metabolic syndrome (20.2%), increased TC (39.2%) and increased LDL-C (19.3%) were found. Low HDL-C was more frequent in women (62.4% vs. 36.1%, p < 0.001). Isolated hypercholesterolemia was more frequent in men (9.6% vs. 2.5%, p < 0.001). Among men TC, TG, LDL-C and LDL-C/HDL-C ratio were higher and HDL-C was lower in obese than in low-weight and normal-weight participants. Among women TC, TG, LDL-C and LDL-C/HDL-C ratio were higher in obese than in normal-weight participants. Significant linear trend of increasing TC and LDL-C levels as age increased was detected for both genders (p for trend < 0.05). Conclusion: The results of our study showed a high frequency of lipid disorders in Angolan non-users of lipid-lowering medication.

Influencia del consumo de quinua sobre parámetros bioquímicos e histomorfometría intestinal en ratas obesas / Influence of the consumption of quinoa on the biochemical parameters and intestinal histomorphometry in obese rats

RESUMEN Objetivo . Determinar la influencia del consumo de tres variedades de quinua sobre parámetros bioquímicos e histomorfometría intestinal en ratas obesas. Materiales y Métodos . Se utilizaron 42 ratas obesas Holtzman dispuestas en siete tratamientos de seis animales cada uno, que fueron alimentados durante 23 días con una de las siete dietas: una obesogénica de control y las otras conteniendo además 20% de quinua Altiplano, Pasankalla y Negra Collana procesadas por cocción o tostado. Al finalizar el periodo de alimentación se tomaron muestras de sangre para la determinación de niveles de glucosa, triglicéridos y C-HDL; posteriormente los animales fueron sacrificados y el hígado, intestino delgado (ID) y riñones fueron pesados; muestras de ID fueron extraídas para histomorfometría intestinal. Los datos se sometieron a ANOVA utilizando el GLM bajo diseño completamente aleatorizado con arreglo factorial 3x2 más control y comparación de medias mediante prueba de Fisher. Resultados . Los niveles de glucosa, triglicéridos y C-HDL no presentaron diferencias en comparación al grupo control; además, el peso de los riñones no fue afectado por las dietas experimentales. Sin embargo, el ID presentó mayor peso en el grupo control en comparación a los que contenían quinua procesada. La histomorfometría del ID no fue afectada significativamente por las dietas experimentales. Conclusiones. La alimentación de ratas obesas con dietas que contienen variedades de quinua procesada no modifica los parámetros bioquímicos y no afecta la histomorfometría intestinal; sin embargo, disminuye el peso del intestino delgado en ratas obesas.

ABSTRACT Objective . To determine the influence of the consumption of three varieties of quinoa on the biochemical parameters and intestinal histomorphometry in obese rats. Materials and Methods . A total of 42 obese Holtzman rats arranged in seven treatments of six animals each were used and fed during 23 days with one of the seven diets: an obesogenic control and the others six containing 20% of Altiplano, Pasankalla, or Negra Collana quinoas processed by cooking or roasting. At the end of the feeding period, blood samples were taken for the determination of glucose, triglycerides, and C-HDL levels; later, the animals were sacrificed, and the liver, small intestine, and kidneys were weighed. Small intestine samples were extracted for intestinal histomorphometry. Data were analyzed through ANOVA using GLM under a completely randomized design with 3x2 plus control factorial arrangement and comparison of means by Fisher test. Results . Glucose, triglyceride, and C-HDL levels did not differ compared to the control group; in addition, the weight of the kidneys was not affected by the experimental diets. However, the small intestine presented greater weight in the control group compared to those containing processed quinoa. Histomorphometry of the small intestine was not significantly affected by experimental diets. Conclusions. Feeding obese rats with diets containing processed quinoa varieties does not modify the biochemical parameters and does not affect intestinal histomorphometry; however, it decreases the weight of the small intestine in obese rats.

Correlation of body mass index Z-scores with glucose and lipid profiles among overweight and obese children and adolescents / Correlação dos escores-z de IMC com os perfis glicêmico e lipídico entre crianças e adolescentes com sobrepeso e obesidade

Abstract Objective To evaluate the prevalence of abnormalities in plasma lipid and glucose profiles among overweight and obese children and adolescents, and to assess the presence of a correlation between body mass index Z-scores and indicators of comorbidities related to both profiles. Methods This was a multicenter cross-sectional study conducted at two outpatient clinics. The study included all 417 comers for the first visit from 2008 to 2012, aged between 7 and 18 years, with BMI above the Z-score +1. Anthropometry and blood sampling were obtained. The prevalence of dyslipidemias, hyperglycemia, and insulin resistance were evaluated, together with the correlations of these variables with the increase of Z-BMI. Results Dyslipidemia was observed in 43.4% of the boys and 66.1% of the girls, with no difference between genders. High glucose levels were detected in 6.2% of the individuals. Insulin resistance was present in 32.3% and 41.7% of the cases, with no statistical significance between boys and girls. Correlations between the Z-BMI were noted for triglycerides in the entire group and among girls; for HDL-c, only among girls; for glucose, a correlation was observed for the entire group, but not when stratified by gender. The indicators of insulin resistance were all correlated with Z-BMI, even when corrected for age. Conclusions Overweight and obesity give origin to a high prevalence of dyslipidemia and insulin resistance. BMI Z-scores showed a weak positive correlation with glucose and triglyceride, and negative with HDL-c. In turn, the strongest positive correlation was found with insulin resistance indicators.

Resumo Objetivo Avaliar a prevalência de anormalidades nos perfis lipídico e glicêmico entre crianças e adolescentes com sobrepeso e obesidade e também verificar se existe correlação entre os escores-z de índice de massa corporal (z-IMC) e indicadores de comorbidades ligados a esses perfis. Métodos Estudo de corte transversal multicêntrico, incluiu 417 pacientes entre 7 e 18 anos e IMC acima do escore-z > + 1 que fizeram a consulta de caso novo entre 2008 e 2012. Antropometria e coleta de sangue foram realizadas. As prevalências de dislipidemia, hiperglicemia e resistência insulínica foram avaliadas, juntamente com as correlações entre essas variáveis e o z-IMC. Resultados Dislipidemia foi encontrada em 43,4% dos meninos e 66,1% das meninas, sem diferença entre os sexos. Hiperglicemia foi encontrada em 6,2% dos indivíduos. Resistência insulínica esteve presente entre 32,3 e 41,7% dos casos, sem diferença estatística entre os sexos. Foi observada correlação com z-IMC para triglicerídeos quando considerado o grupo todo e entre as meninas; e para HDL-c apenas entre as meninas. A glicemia apresentou correlação quando considerado o grupo todo, mas não quando separados por sexo. Os indicadores de resistência insulínica estiveram todos correlacionados com IMC, mesmo quando se executou correção para a idade. Conclusões Sobrepeso e obesidade levam a prevalências elevadas de dislipidemia e resistência insulínica. Os escores-z de IMC mostraram discreta correlação positiva com glicose e triglicerídeos e negativa com HDL-c. Por outro lado, correlação positiva mais forte foi observada com os indicadores de resistência insulínica.

Glucose alteration and insulin resistance in asymptomatic obese children and adolescents / Alteração de glicose e resistência à insulina em crianças e adolescentes obesos assintomáticos

Abstract Objective Obesity is associated with the abnormal glucose metabolism preceding type 2 diabetes mellitus. Thus, further investigation on the prediction of this lethal outcome must be sought. The objective was the profile glycemic assessment of asymptomatic obese children and adolescents from Salvador, Brazil. Method A fasting venous blood sample was obtained from 90 consecutive obese individuals aged 8-18 years, of both sexes, for laboratory determinations of glycated hemoglobin, basal insulin, and the Homeostasis Model Assessment Insulin Resistance index. The clinical evaluation included weight, height, waist circumference, assessment of pubertal development, and acanthosis nigricans research. The body mass index/age indicator was used for the severity of overweight assessment. Results Glycemic alterations were evidenced clinically and biochemically, although these individuals had no complaints or symptoms related to blood sugar levels. Quantitative and qualitative variables were respectively expressed measures of central tendency/dispersion and simple/relative frequency, using the SPSS, version 20.0. A p-value <0.05 was considered significant. Conclusion Notably, this study found a high prevalence of glucose and insulin disorders in asymptomatic obese children and adolescents.

Resumo Objetivo A obesidade está associada ao metabolismo da glicose anormal que antecede o diabetes mellitus tipo 2. Assim, uma investigação adicional sobre a predição desse resultado letal deve ser antecipada. O objetivo era a avaliação do perfil glicêmico de crianças e adolescentes obesos assintomáticos de Salvador, Brasil. Método Uma amostra de sangue venoso em jejum foi obtida de 90 indivíduos obesos consecutivos entre 8-18 anos, de ambos os sexos, para determinações laboratoriais de hemoglobina glicosilada, insulina basal e Índice do Modelo de Avaliação da Homeostase de Resistência à Insulina (HOMA-IR). A avaliação clínica incluiu peso, estatura, circunferência da cintura, avaliação do desenvolvimento puberal e pesquisa sobre a acantose nigricans. Utilizamos o indicador de índice de massa corporal/idade referente à gravidade da avaliação de sobrepeso. Resultados Alterações glicêmicas foram comprovadas clínica e bioquimicamente, apesar de esses indivíduos não apresentarem queixas ou sintomas relacionados a níveis de açúcar no sangue. Variáveis quantitativas e qualitativas foram, respectivamente, medidas expressas de tendência central/dispersão e amostra/frequência relativa, com o software Pacote Estatístico para as Ciências Sociais, versão 20.0. O valor de p < 0,05 foi considerado significativo. Conclusão Observamos, contudo, alta prevalência de distúrbios de glicose e insulina em crianças e adolescentes obesos assintomáticos.

Platelets volume indexes and cardiovascular risk factors

SUMMARY Obesity, diabetes and hypertension are risk factors for cardiovascular diseases (CVD) because they promote a state of hypercoagulability. It is known that platelets play an important role in the development of atherosclerosis. Recent studies have evaluated platelet volume indexes (PVIs) in individuals with risk factors for CVD to better understand the platelet mechanisms involved in their development. The IVPs indirectly estimate platelet function and are easily obtained from automated hematology analyzers, which provide platelet counts, mean platelet volume (MPV), platelet distribution width (PDW) and the platelet-large cell ratio (P-LCR). The present study aims to review literature studies that investigated the association between PVIs and obesity, diabetes, and arterial hypertension, in order to evaluate its use as a potential subclinical marker of CVD. Studies have shown promising results for MPV, an index that allows for early detection of platelet activation and may be useful in identifying patients before the onset of CVD development so that preventive strategies can be implemented. The PDW, although evaluated by a smaller number of studies, also showed promising results. However, there is still a long way to go in order for the MPV and PDW to be used in clinical practice, since there is still a need for more epidemiological evidence, establishing reference values, and standardizing the way results are presented.

RESUMO A obesidade, o diabetes e a hipertensão arterial são fatores de risco para as doenças cardiovasculares (DCV) por promoverem um estado de hipercoagulabilidade. É sabido que as plaquetas desempenham um importante papel no desenvolvimento da aterosclerose. Diante disso, estudos recentes têm avaliado os índices de volumes plaquetários (IVPs) em indivíduos com fatores de risco para DCV, para melhor se entenderem os mecanismos plaquetários envolvidos no seu desenvolvimento. Os IVPs estimam indiretamente a função plaquetária e são facilmente obtidos a partir de analisadores hematológicos automáticos, que fornecem contagens de plaquetas, volume médio de plaquetas (VPM), largura de distribuição de plaquetas (PDW) e a proporção de plaquetas grandes (P-LCR). O presente trabalho tem por objetivo revisar na literatura estudos que investigaram a associação entre os IVPs e obesidade, diabetes e hipertensão arterial, a fim de avaliar o seu uso como potencial marcador subclínico das DCV. Estudos demonstraram resultados promissores quanto ao VPM, um índice que permite uma detecção precoce da ativação de plaquetas e que pode ser útil na identificação de pacientes antes do início do desenvolvimento de DCV, de tal forma que estratégias preventivas possam ser implantadas. O PDW, embora tenha sido avaliado por um número menor de estudos, também demonstrou resultados promissores. Entretanto, ainda existe um longo caminho a se percorrer para que o VPM e o PDW sejam utilizados na prática clínica, pois ainda são necessárias mais evidências epidemiológicas, o estabelecimento de valores de referência e a padronização da forma de expressar os resultados.

Relationship between adiponectin and leptin on osteocalcin in obese adolescents during weight loss therapy

ABSTRACT Objectives: Obesity is a multifactorial disease characterized by the presence of the pro-inflammatory state associated with the development of many comorbidities, including bone turnover marker alterations. This study aimed to investigate the role of the inflammatory state on bone turnover markers in obese adolescents undergoing interdisciplinary weight loss treatment for one year. Subjects and methods: Thirty four post-pubescent obese adolescents with primary obesity, a body mass index (BMI) greater than > 95th percentile of the CDC reference growth charts, participated in the present investigation. Measurements of body composition, bone turnover markers, inflammatory biomarkers and visceral and subcutaneous fat were taken. Adolescents were submitted to one year of interdisciplinary treatment (clinical approach, physical exercise, physiotherapy intervention, nutritional and psychological counseling). Results: Reduction in body mass, body fat mass, visceral and subcutaneous fat, as well as, an increase in the body lean mass and bone mineral content was observed. An improvement in inflammatory markers was seen with an increase in adiponectin, adiponectin/leptin ratio and inteleukin-15. Moreover, a positive correlation between the adiponectin/leptin ratio and osteocalcin was demonstrated. Further, both lean and body fat mass were predictors of osteocalcin. Negative associations between leptin with osteocalcin, adiponectin with Beta CTX-collagen, and visceral fat with adiponectin were observed. Conclusions: It is possible to conclude that the inflammatory state can negatively influence the bone turnover markers in obese adolescents. In addition, the interdisciplinary weight loss treatment improved the inflammatory state and body composition in obese adolescents. Therefore, the present findings should be considered in clinical practice.