Dislipemia y circunferencia de cuello en pacientes de un hospital privado peruano / Dyslipidemia and neck circumference in patients from a Peruvian private hospital

Introducción: Las dislipidemias son alteraciones que están asociadas al riesgo de enfermedades cardiovasculares, infarto agudo de miocardio, evento cerebrovascular (ECV) o la artropatía periférica.Objetivo: Analizar la relación entre la circunferencia de cuello y el perfil lipídico de pacientes adultos atendidos en la clínica privada Rebagliatti.Materiales y métodos: Investigación de enfoque cuantitativo de diseño no experimental, transversal de nivel correlacional – causal. La muestra del estudio estuvo conformada por 120 pacientes ambulatorios de 18 a 59 años que asistieron a clínica privada Rebagliatti, durante el periodo octubre a noviembre del 2023. La medición de la circunferencia de cuello se realizó con una cinta métrica de la marca Lufkin y los valores del perfil lipídico se obtuvieron de la revisión de la historia clínica del paciente. Para evaluar la relación de las variables se utilizó la prueba no paramétrica coeficiente de correlación de Spearman.Resultados: el promedio de la circunferencia de cuello fue 36,21 ± 2,34 cm, del colesterol total fue 237,55 ± 67,47 mg/dL, del colesterol LDL fue 126,55 ± 34,97 mg/dL, del colesterol HDL fue 37,10 ± 4,35 mg/dL y de los triglicéridos fue 219,72 ± 88,65 mg/dL. Al analizar la relación entre la circunferencia de cuello y el nivel de perfil lipídico se encontró (p<0,05).Conclusiones: La circunferencia de cuello tiene relación directa con el nivel de colesterol total, triglicéridos y colesterol LDL; no obstante, se encontró una relación inversa con el nivel de colesterol HDL en pacientes.(AU)

Introduction: Dyslipidemias are alterations that are asso-ciated with the risk of cardiovascular diseases, acute myocar-dial infarction, and cerebral vascular disease (CVD).Objective: To analyze the relationship between dyslipide-mia and neck circumference in patients treated in a privatehospital in Peru.Materials and methods: Quantitative research with anon-experimental, cross-sectional design at a correlational –causal level, carried out on 120 patients aged 18-59 who at-tended the Los Andes private clinic in November 2023; loca-ted in the city of Huancayo – Peru. The measurement of neckcircumference was performed with a Lufkin brand measuringtape and the lipid profile through low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TotalChol) and triglycerides (TG), was obtained from the patient’smedical history. A descriptive analysis was performed (mean,standard deviation, minimum, maximum); To evaluate the re-lationship of the variables, the non-parametric Spearman co-rrelation coefficient test was used.Results: the average neck circumference was 36.21 ± 2.34 cm, total cholesterol was 237.55 ± 67.47 mg/dL,LDL cholesterol was 126.55 ± 34.97 mg/dL, HDL choleste-rol was 37.10 ± 4.35 mg/dL and triglycerides was 219.72 ± 88.65 mg/dL. When analyzing the relationship betweenneck circumference with total cholesterol, triglycerides andLDL, a direct and significant relationship was obtained(p<0.05). However, when evaluating the relationship withHDL cholesterol, an inverse and significant relationship wasobtained (p<0.05).Conclusions: Patients with a larger neck circumferencehave a higher risk of dyslipidemia. Likewise, a direct and sig-nificant relationship was found with the level of total choles-terol, triglycerides and LDL cholesterol; however, inverse rela-tionship with the level of HDL cholesterol. Therefore, neckcircumference measurement represents a useful and practicalmethod in predicting dyslipidemia.(AU)

Potential molecular mechanism of the Xiexin capsule in the intervention of dyslipidemia based on bioinformatics and molecular docking.

Introduction: Objective: bioinformatic methods and molecular docking technology were used to predict the active components, targets, and related biological pathways of the Xiexin capsule in the intervention for dyslipidemia, exploring its mechanism. Methods: the active components and targets of the Xiexin capsule were screened by the TCMSP (Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform )database. Genecards (The Human Gene Database), OMIM (Online Mendelian Inheritance in Man), PharmGkb (Pharmacogenomics Knowledge Base database), TTD (Therapeutic Target Database), and Drugbank platforms were used to search the disease targets of dyslipidemia. The Cytoscape 3.8.0 software was used to construct the 'component-target' network diagram, and the STRING (functional protein association networks) platform was used to analyze protein-protein interaction (PPI). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomics (KEGG) enrichment analyses were performed by R language data packets to predict the mechanism of action. The AutoDockVina and PyMol software were used to dock the key active components in the Xiexin capsule and the core proteins in PPI. Results: a total of 66 effective components were screened, involving 114 targets; 87 key active compounds were screened from the 'drug-component-target' diagram. The PPI network mainly involved core proteins such as PTGS2 (prostaglandin-endoperoxide synthase 2), PTGS1 (prostaglandin-endoperoxide synthase 1), and HSP90AA1 (heat shock protein 90 alpha family class A member 1). GO and KEGG enrichment analysis results of common targets mainly involved hormone-mediated signaling pathway, steroid hormone response, lipid transport and metabolism, regulation of cholesterol storage, cyclooxygenase pathway, and other biological pathways, as well asMM PPAR (peroxisome proliferators-activated receptor) signaling pathway, IL-17 (interleukin 17) signaling pathway, PI3K-Akt (protein kinase b) signaling pathway, FcεRI signaling pathway, and other related pathways. Molecular docking verification showed that quercetin had the best binding with the core target protein HSP90AA1, and HSP90AA1 was the target protein with the best binding activity for the key chemical components in Xiexin capsules. Conclusion: the main chemical components in the Xiexin capsules may participate in the regulation of PPAR and other signaling pathways by regulating key genes such as ESR1 (estrogen receptor 1), MAPK14 (mitogen-activated protein kinase 14), and HSP90AA1, to exert the pharmacological effect of the intervention on dyslipidemia.

Introducción: Objetivo: se utilizaron métodos bioinformáticos y técnicas de acoplamiento molecular para predecir componentes efectivos, objetivos y vías biológicas relacionadas de la cápsula Xiexin en la intervención de dislipidemia y explorar su mecanismo. Métodos: los componentes activos y los objetivos de la cápsula Xiexin fueron seleccionados por la base de datos TCMSP. Se utilizaron plataformas Genecards, OMIM, PharmGkb, Therapeutic Target Database y Drugbank para buscar dianas de la enfermedad en la dislipidemia. El diagrama reticular "componente-diana" fue construido por el software Cytoscape 3.7.0, y la interacción proteína-proteína (PPI) fue analizada por la plataforma STRING. Los análisis de enriquecimiento de Gene Ontology (GO) y Kyoto Encyclopedia of Genes and Genomics se realizaron mediante paquetes de datos en lenguaje R para predecir mecanismo de acción. El software AutoDockVina y PyMol se utilizó para unir componentes activos clave de la cápsula Xiexin y las proteínas clave de la PPI. Resultados: se seleccionaron 65 componentes activos y 114 dianas. Veintitrés compuestos activos clave fueron seleccionados a partir de la tabla "componentes farmacéuticos-dianas". Las redes PPI incluyen principalmente proteínas básicas como PTGS2, PTGS1 y HSP90AA1. Los resultados del análisis de enriquecimiento de GO y KEGG en los objetivos comunes se refieren principalmente a la vía de señalización mediada por esteroides, la respuesta hormonal esteroidea, el transporte y metabolismo lipídicos, la regulación del almacenamiento de colesterol, la vía de la ciclooxigenasa y otras vías biológicas, así como la vía de señalización de PPAR, IL-17, PI3K-Akt, FcεRI y otras vías relacionadas. La prueba de acoplamiento molecular mostró que la quercetina se une mejor a la proteína diana central HSP90AA1, que es la proteína diana con la mejor actividad de unión de los componentes químicos clave de la cápsula Xiexin. Conclusión: los principales componentes químicos de la cápsula Xiexin pueden participar en la regulación de la PPAR y otras vías de señalización mediante la regulación de genes clave como ESR1, MAPK14 (mitogen-activated protein kinase 14), HSP90AA1, por lo que pueden desempeñar un papel farmacológico en la intervención de dislipidemia.

Phytosterol supplementation in the treatment of dyslipidemia in children and adolescents: a systematic review / Suplementação de fitoesteróis no tratamento da dislipidemia em crianças e adolescentes: uma revisão sistemática

ABSTRACT Objective: To carry out a systematic review on the effects of phytosterol supplementation on the treatment of dyslipidemia in children and adolescents. Data sources: Review in the SciELO, Lilacs, Bireme, PubMed and Web of Science databases, with no time limit. Descriptors: phytosterols or plant sterols and dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, in English and Portuguese. The articles included were published in Portuguese, English or Spanish and evaluated the effect of phytosterol supplementation in pediatric patients with dyslipidemia. Documents that involved adults or animals, review papers, case studies and abstracts were excluded. Two authors performed independent extraction of articles. Of 113 abstracts, 19 were read in full and 12 were used in this manuscript. Data synthesis: Phytosterol supplementation to reduce cholesterol levels has been shown to be effective in reducing LDL-cholesterol levels by approximately 10%, with reductions above 10% in LDL-cholesterol levels observed after 8 to 12 weeks of intervention. Studies have not shown significant changes in HDL-cholesterol and triglyceride levels. Based on the absence of adverse effects, its use seems to be safe and of good tolerance in children and adolescents. Conclusions: Phytosterol supplementation seems to be of great therapeutic aid for the treatment of hypercholesterolemia in children and adolescents. Further studies assessing the long-term effect of phytosterol supplementation are necessary.

RESUMO Objetivo: Realizar uma revisão sistemática sobre os efeitos da suplementação de fitoesteróis no tratamento da dislipidemia em crianças e adolescentes. Fontes de dados: Revisão nos bancos SciELO, Lilacs, Bireme, Pubmed e Web of Science, sem limite de tempo. Descritores: phytosterols or plant sterols, dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, nas línguas inglesa e portuguesa. Os artigos incluídos foram publicados nos idiomas português, inglês ou espanhol e avaliaram o efeito da suplementação de fitoesteróis em pacientes pediátricos com dislipidemia. Estudos que envolviam adultos ou animais, trabalhos de revisão, estudos de caso e resumos foram excluídos. A extração independente de artigos foi realizada por dois autores. Do total de 113 resumos, 19 foram lidos na íntegra, e 12 utilizados neste manuscrito. Síntese de dados: A suplementação de fitoesteróis para a redução dos níveis de colesterol mostrou-se eficiente, de forma a promover a redução de aproximadamente 10% dos níveis de LDL-colesterol, sendo observadas reduções acima de 10% em 8 a 12 semanas de intervenção. Os estudos não mostraram alterações significantes nos níveis de HDL-colesterol e triglicérides. Com base na ausência de efeitos adversos, seu uso parece ser seguro e de boa tolerância em crianças e adolescentes. Conclusões: A suplementação com fitoesteróis parece ser de grande auxílio terapêutico para o tratamento da hipercolesterolemia em crianças e adolescentes. São necessários mais estudos que avaliem o efeito em longo prazo da suplementação de fitoesteróis.

Avaliação da capacidade redutora de lipidograma do extrato aquoso de Abelmoschus esculentus: estudo in vivo / Lipidogram reducing capacity assessment of Abelmoschus esculentus water extract: in vivo study

Objetivo: Avaliar a relação do extrato aquoso de A. esculentus como agente redutor das taxas de lipídeos no sangue periférico de Rattus novergicus. Métodos: Foram usados Rattus novergicus (n=21), divididos em três grupos de sete, com alimentação ad libitum, sendo um grupo controle negativo, um controle positivo e um teste, onde os três foram submetidos a uma dieta hipercalórica, sendo que no segundo houve administração de Sinvastatina® e no terceiro, extrato aquoso de A. esculentus. Foi realizada a dosagem sérica de colesterol total, triglicerídeos e HDL, além das medidas de peso e tamanho. Resultados:O grupo T apresentou resultado significativo para o colesterol HDL, quando comparado ao controle negativo, mostrando-se com valor de 40,33 ± 1,25 mg/dl e 35,5 ± 0,92 mg/dl, respectivamente, p < 0,05. Porém, em relação aos demais parâmetros, o extrato aquoso não apresentou significância estatística, quando comparado aos controles positivo e negativo. Conclusão: O extrato aquoso de A. esculentus mostrou-se eficaz na elevação do HDL plasmático.

Objective: To evaluate the relationship of the aqueous extract of A. esculentusas a lipid lowering agent in Rattus novergicus peripheral blood. Methods:Rattus novergicus (n = 21) were used, divided into three groups of seven, with ad libitum feeding, being a negative control group, a positive control and a test, where the three were submitted to a hypercaloric diet, and in the second Sinvastatin® was administered, and in the third, aqueous extract of A. esculentus. Serum total cholesterol, triglycerides and HDL were measured, as well as weight and size measurements. Results: Group T showed a significant result for HDL cholesterol when compared to the negative control, with values of 40.33 ± 1.25 mg / dl and 35.5 ± 0.92 mg / dl (p < 0,05), respectively. However, in relation to the other parameters, the aqueous extract wasn't statistically significant when compared to the positive and negative controls. Conclusion: The aqueous extract of A. esculentus was effective in elevating plasma HDL.

Análise crítica dos estudos que mudaram a prática clínica recente: dislipidemias / Critical analysis of studies that changed recent clinical practice: dyslipidemias

Os eventos isquêmicos continuam a ocorrer em pacientes com fatores de risco mal controlados, como os que têm concentrações elevadas de LDL-colesterol ou de triglicérides, nos que têm diabetes e doença aterosclerótica multivascular, a despeito do tratamento com estatinas. Além dos eventos iniciais, esses pacientes têm risco substancial de eventos recorrentes, possivelmente fatais. A avaliação dos eventos recorrentes traz a perspectiva da carga total de eventos ateroscleróticos a que esses pacientes estão expostos e não apenas dos primeiros eventos. Dois estudos com novas terapêuticas hipolipemiantes abordaram a redução de eventos cardiovasculares e também de eventos totais, de um primeiro evento e de eventos subsequentes. O evolocumabe, um inibidor da pró-proteína convertase subtilisina/quexina tipo 9 e o icosapenta etil, formulação altamente purificada de ácido graxo ômega 3 demonstraram reduções dos eventos cardiovasculares primários e secundários chave, bem como dos eventos totais, dos primeiros eventos e dos eventos subsequentes em pacientes de alto risco e risco muito alto que usam estatinas, mas com um risco elevado de novos eventos cardiovasculares. Pelos benefícios demonstrados, essas estratégias terapêuticas poderão ser incorporadas à prática clínica, desde que avaliadas num contexto de risco e benefício, e com um custo-efetividade aceitável

Ischemic events continue to occur in patients with poorly controlled risk factors, such as those with high concentrations of LDL-cholesterol or triglycerides and those with diabetes and multivascular artherosclerotic disease, in spite of treatment with statins. These patients are at risk not only for the first, but also for recurrent ischemic events, which can be fatal. The evaluation of recurrent events brings a perspective of the total burden of artherosclerotic events to which the patient is exposed and not only of the first one. Two studies using new lipid-lowering therapies addressed the reduction of cardiovascular events and also of total events, of a first event, and of subsequent events. Evolocumab, a proprotein convertase subutilisin kexin type 9 inhibitor, and icosapent ethyl, a highly purified formulation of omega-3 fatty acid, demonstrated reductions in key primary and secondary cardiovascular events, as well as in total events, first events and subsequent events in high and very high risk patients taking statins, but with a high risk of new cardiovascular events. Based on the benefits observed, these therapeutic strategies can be incorporated into clinical practice, provided they are evaluated within a risk benefit context, with an acceptable cost-effectiveness ratio

Evolución de la Enfermedad Cerebrovascular Isquémica Aguda en pacientes con Síndrome Metabólico / Evolution of Acute Ischemic Cerebrovascular Disease in patients with Metabolic Syndrome

Introducción: La isquemia cerebral es la de mayor incidencia y prevalencia entre las enfermedades cerebrovasculares y con frecuencia se asocia a la presencia del síndrome metabólico, pues muchos de sus factores de riesgo conforman este síndrome. Objetivo: Determinar la relación entre la evolución del paciente con Enfermedad Cerebrovascular Isquémica aguda y la presencia de Síndrome Metabólico. Material y Métodos: Se realizó un estudio analítico prospectivo con una muestra de 100 pacientes. Se conformaron 2 grupos, uno con pacientes con Síndrome Metabólico(SM), según criterios del NCEP/ATPIII (III Panel de Tratamiento del Adulto del Programa Nacional de Educación en Colesterol) (grupo A), y otro sin Síndrome Metabólico (grupo B) .En ambos grupos se aplicó la escala de NIHSS para evaluar la severidad y evolución de la enfermedad cerebrovascular. Resultados: En el grupo con SM prevalecieron los del sexo masculino (60 por ciento), el color de piel blanca (52 por ciento) y la media de edad fue de 61,2 años. Los principales antecedentes patológicos personales fueron Hipertensión Arterial, Cardiopatías y Tabaquismo. La severidad de la enfermedad cerebrovascular al ingreso fue peor en el grupo A (media 13,2), los que tuvieron mayor número de complicaciones neurológicas: hipertensión endocraneana y convulsiones (12 por ciento), y no neurológicas: bronconeumonía (40 por ciento) y úlceras de decúbito (28 por ciento), con un riesgo superior: OR: 6,2. Al egreso, 36 por ciento de los pacientes con SM empeoraron, según escala de NIHSS. Conclusiones: El Síndrome metabólico constituye un factor que incrementa en la Enfermedad cerebrovascular isquémica el riesgo de complicaciones, y empeora su evolución y pronóstico(AU)

Introduction: Cerebrovascular ischemia represents the highest incidence and prevalence among cerebrovascular diseases. It is frequently associated with Metabolic Syndrome because many risk factors for cerebrovascular ischemia correspond to this entity. Objective: To determine the relationship between the evolution of the patient with Acute Ischemic Cerebrovascular Disease (AICVD) and the presence of Metabolic Syndrome (MS). Material and Methods: An analytical prospective study was conducted with a sample of 100 patients, which were divided into two groups: group A, that was composed of patients with Metabolic Syndrome (MS) according to NCEP/ATPIII criteria (The Adult Treatment Panel III of the National Cholesterol Education), and group B that was composed of patients without Metabolic Syndrome. The National Institutes of Health Stroke Scale (NIHSS) was applied in both groups to evaluate the severity and evolution of cerebrovascular disease. Results: The Male sex (60 percent), and white people (52 percent) prevailed in the group with MS, and the mean age was 61,2 years. The main personal pathological antecedents were Arterial hypertension, cardiopathies, and smoking habit. The severity of cerebrovascular disease on admission was worse in group A (mean: 13,2). These patients presented a greater number of neurological complications such as: intracranial hypertension and convulsions (12 percent); they also presented non-neurological complications such as: bronchopneumonia (40 percent), and ulcers resulting from time spent on supine position (28 percent) with a higher risk (OR: 6,2). After discharge from hospital, 36 percent of patients with MS got worse, according to Scale NIHSS. Conclusions: The metabolic syndrome is a risk factor that increases the risk of complications in Ischemic Cerebrovascular Disease and worsens its evolution and prognosis(AU)

Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: A systematic review.

OBJECTIVES: Evaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over. DESIGN: Systematic review. DATA SOURCE: PubMed/Medline database, with language restrictions. Papers published between 2010 and 2016 were included. STUDY SELECTION: A total of 30 randomised controlled trials were included that focused on physical activity and dietary interventions in patients with type 2 diabetes mellitus and include participants aged 60 years and over. RESULTS: The selected articles have shown that the implementation of physical activity programs (aerobic, resistance, flexibility and combined exercises), and programs based on a higher intake of vegetables, grains, legumes, fruits, unsaturated fatty acids, as well as consumption of foods with low glycaemic index, calorie restriction, intake of probiotics, vitamin D supplementation and educational sessions about diabetes improves blood glucose levels, as well as the lipid profile, in patients with type 2 diabetes. CONCLUSIONS: Physical activity and dietary programs are fundamental in the treatment and metabolic control of type 2 diabetes mellitus.

Combined bioactive approach over atherosclerosis risk biomarkers / Abordagem combinada de compostos bioativos sobre biomarcadores de risco para aterosclerose

Atherosclerosis, one major cause of morbidity and mortality worldwide, is a complex and multifactorial disease that involves three mainly conditions: chronic inflammation, dyslipidemia and oxidative stress. Although statins are the first-line therapy for LDL cholesterol (LDL-C) lowering, the efficacy of cardiovascular events prevention is limited to 30-40%. This residual risk brought attention to the need of new therapies and clinical targets beyond LDL-C, such as inflammation and oxidative stress. Importantly, suboptimal treatment and/or statin discontinuation due to adverse effects have also been a very challenging clinical problem. Complementary diet therapy can be an effective and safe approach to support pharmacological treatment, especially when drugs alone are insufficient to attenuate risk factors and/or the recommended dose is not well tolerated. The aim of this study was to evaluate the effects of three bioactive components, namely omega-3 fatty acids, plant sterols and polyphenols, on markers of dyslipidemia, inflammation and oxidative stress in patients treated with statins. A randomized, crossover clinical study was carried out, with the participation of 53 subjects. At each intervention period, study participants received a packaged for the functional or control treatment. Functional treatment consisted of fish oil (1.7 g of EPA+DHA/day), chocolate containing plant sterols (2.2 g/day) and green tea (two tea sachets/day). Control treatment consisted of soy oil softgels, regular chocolate and anise tea. After 6 weeks of intervention, functional treatment reduced plasma LDL-C (-13.7% ± 3.7, p=0.002) and C-reactive protein (-35.5% ± 5.9, p=0.027). Plasma triacylglycerol (-15.68% ± 5.94, p=0.02) and MDA (-40.98% ± 6.74, p=0.04) were reduced in subgroups of patients (n=23) with baseline values above the median (93 mg/dL and 2.23 umol/L, respectively). Analysis of lathosterol and campesterol in plasma suggested that intensity of LDL-C reduction was influenced by cholesterol absorption rate rather than its endogenous synthesis. After multivariate analysis, patients identified as "good responders" to supplementation (n=10) were recruited for a pilot protocol of statin dose reduction with complementary diet therapy. Responders received the functional treatment for 12 weeks: standard statin therapy was kept during the first 6 weeks and reduced by 50% from weeks 6 to 12. No difference was observed for plasma lipids and inflammation biomarkers, cholesterol efflux capacity or HDL particle number after statin dose reduction when compared to standard therapy. Although limited by the small sample size, our study demonstrates the potential for a new therapeutic approach combining lower statin dose and specific dietary compounds. This may be particularly helpful for the many patients with, and at risk for, CVD who cannot tolerate high-dose statin therapy

A aterosclerose, uma importante causa mundial de morbidade e mortalidade, é uma doença complexa e multifatorial que envolve três principais condições: inflamação crônica, dislipidemia e estresse oxidativo. Embora as estatinas sejam fármacos de primeira linha para redução de LDL colesterol (LDL-C), sua eficácia na prevenção de eventos cardiovasculares é limitadada a 30-40%. Este risco cardiovascular residual evidencia a necessidade de novas terapias e marcadores clínicos que vão além do LDL-C, como inflamação e estresse oxidativo. Não obstante, tratamento subótimo e/ou interrupção do uso de estatinas devido à ocorrencia de efeitos adversos também é um grave obstáculo na clínica médica. Neste contexto, a terapia dietética complementar representa uma abordagem efetiva e segura para o suporte do tratamento farmacológico, especialmente quando as drogas são insuficientes para atenuar fatores de risco e/ou quando a dose recomendada não é bem tolerada. O objetivo do presente estudo foi avaliar o efeito de três compostos bioativos - ácidos graxos ômega 3, fitosteróis e polifenóis - sobre marcadores de inflamação, lipemia e estresse oxidativo em indivíduos tradados com estatinas. Foi realizado um estudo clínico randomizado, de delineamento crossover, com a participação de 53 voluntários. A cada período de intervenção, os participantes receberam um tratamento funcional ou controle. O tratamento funcional foi composto por cápsulas de óleo de peixe (1.7 g/dia de EPA+DHA), chocolate contendo fitosteróis (2.2 g/dia) e chá verde (dois sachês/dia). O tratamento controle foi composto por cápsulas de óleo de soja, chocolate sem adição de fitosteróis e chá de anis. Após 6 semanas de intervenção, o tratamento funcional reduziu a concentração plasmática de LDL-C (-13.7% ± 3.7, p=0.002) e proteína C-reativa (-35.5% ± 5.9, p=0.027). Triglicerídeos (- 15.68% ± 5.94, p=0.02) e malondialdeído (-40.98% ± 6.74, p=0.04) foram reduzidas apenas em subgrupos de indivíduos que apresentavam valores basais acima da mediana (93 mg/dL e 2.23 umol/L, respectivamente). A análise de latosterol e campesterol no plasma sugeriu que a intensidade da redução de LDL-C não foi influenciada pela síntese endógena de colesterol, mas sim pela taxa de absorção. Após análise multivariada dos resultados, pacientes identificados como "good responders" à suplementação (n=10) foram recrutados para um estudo piloto de redução da dosagem da estatina, aliado à terapia dietética complementar. Estes pacientes receberam o tratamento funcional por 12 semanas: durante as 6 primeiras semanas mantevese a dosagem de estatina, que em seguida foi reduzida em 50% das semanas 6 a 12. Não foram observadas diferenças para os marcadores plasmáticos de lipídeos, inflamação, capacidade de efluxo de colesterol ou número de partículas de HDL após a redução da dose de estatina, quando comparada à terapia convencional. Embora limitado pelo reduzido número de pacientes, o estudo demonstra o potencial para uma nova abordagem terapêutica, combinando reduzida dose de estatina com específicos compostos bioativos. Esta pode ser uma importante alternativa para muitos pacientes em risco cardiovascular e que são intolerantes à terapia com altas doses de estatina.

Dislipidemia aterogénica en latino américa: prevalencia, causas y tratamiento / Atherogenic dyslipidemia in Latin America: prevalence, causes and treatment

En las guías clínicas actuales, la dislipidemia aterogénica (DA) es una entidad no muy atendida. Debido a las frecuentes alteraciones en los lípidos asociados a la DA en Latino América (LA). Métodos: organizamos un grupo de expertos denominado Academia Latino Americana para el estudio de los Lípidos (ALALIP) para así generar un documento con análisis de su prevalencia y recomendaciones terapéuticas prácticas. Se utilizó la metodología Delphi modificada, con una revisión integral de la literatura y énfasis en las publicaciones con implicaciones para LA. Subsecuentemente, desarrollamos preguntas claves para ser discutidas. Resultados: En Latinoamérica (LA) no existe un estudio global sobre los factores de riesgo que representan a la totalidad de la población. El análisis sistemático de las encuestas nacionales de salud y de los estudios sistemáticos de cohorte muestran consistentemente una alta prevalencia de las anormalidades lipídicas que definen la DA. La concentración baja del colesterol unido a las lipoproteínas de alta densidad (C-HDL) varía entre 34,1% a 53,3% y la de triglicéridos (TG) elevados del 25,5% al 31,2%, con mayor prevalencia entre los hombres. La DA bien puede ser tratada con los cambios del estilo de vida (CTEV) como ncremento en laactividad física, dieta baja en carbohidratos y alta en ácidos grasos poliinsaturados, tales como los ácidos grasos omega-3 como intervención primaria. De ser necesario, esta estrategia sera suplementada con terapia farmacológica como la monoterapia con estatinas o la combinación de fibratos/ácidos grasos omega-3. Conclusiones: Las anormalidades lipídicas que definen la DA tienen una elevada prevalencia en LA; su interacción con un estilo de vida no saludable, herencia y cambios epigenéticos están ligados a sus posibles causas. La DA es una causa importante de riesgo cardiovascular residual (RCVR) que debe ser diagnosticada y tratada. Es importante y necesario diseñar un estudio global de factores de riesgo en LA para conocer la real prevalencia de la DA(AU)

In the current clinical guidelines, atherogenic Med Interna (Caracas) 2017; 33 (3): 121 - 139 Dislipidemia Aterogénica en Latino América: Prevalencia, causas y tratamiento Carlos I. Ponte-N, Jesús E. Isea-Pérez, Alberto J. Lorenzatti, Patricio López-Jaramillo, Fernando Stuardo Wyss-Q, Xavier Pintó, Fernando Lanas, Josefina Medina, Livia T. Machado-H, Mónica Acevedo, Paola Varleta Alfonso Bryce, Carlos Carrera, Carlos Ernesto Peñaherrera, José Ramón Gómez-M, Alfredo Lozada, Alonso Merchan-V, Daniel Piskorz, Enrique Morales, María Paniagua, Félix Medina-Palomino, Raúl Alejandro Villar-M, Leonardo Cobos, Enrique Gómez-Álvares, Rodrigo Alonso, Juan Colan, Julio Chirinos, Jofre Lara, Vladimir Ullauri, Ildefonso Arocha Documento de la posición de expertos de la Academia Latino Americana para el estudio de los Lípidos (ALALIP) y avalado por la Sociedad Interamericana de Cardiología (SIAC), Sociedad Sur Americana de Cardiología (SSC), el Colegio Panamericano de Endotelio (CPAE) y la Sociedad Internacional de Aterosclerosis (IAS). Publicado en conjunto con las Revistas de la Sociedad Venezolana de Medicina Interna y de la Sociedad Venezolana de ndocrinología y Metabolismo. dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named Latin American Academy for the study of Lipids (ALALIP), to generate a document to analize it´s prevalence and to offer practical recommendations. Methodology: Using the Delphi methodology, we conducted a comprehensive literature review, with emphasis on those publications with implications for LA. Subsequently we developed key questions to be discussed. Results: In LA There is no a global study on risk factors that represent the entire population. The systematic analysis of national health surveys and regional cohort studies showed a consistent high prevalence of the lipid abnormalities that define AD. Low high density lipoprotein cholesterol (HDL-C) ranges from 34.1% to 53.3% and elevated triglycerides (TG) from 25.5% to 31.2% more prevalent in men. There are multiple causes: high consumption of foods with a high caloric density, cholesterol and trans fats, sedentary lifestyle and epigenetic changes. AD must be well treated with therapeutic changes in lifestyle with increase in physical activities, regular exercise and a diet with a low proportion of carbohydrates and rich in poliunsatured fatty acid, such as omega-3 fatty acids as primary intervention. If needed, this strategy must be supplemented with pharmacological therapies such as monotherapy with statins or a combination of fibrates plus omega-3. fatty acid. conclusions: Lipid abnormalities that define AD have a high prevalence in LA; the interaction between non-healthy lifestyle, inheritance and epigenetic changes, possibly are the cause. AD is an important cause of cardiovascular residual risk (CVRR), that must be diagnosed and treated It is important and necesary to design a global study of risk factors in LA to know the true prevalence of AD(AU)

[Map of resources and healthcare needs for patients with dyslipidaemia in Spain: The MADI study]. / Mapa de recursos y necesidades asistenciales del paciente dislipidémico en España: estudio MADI.

INTRODUCTION: Dyslipidaemia is a major modifiable determining factor of vascular risk and, despite this, a significant number of patients do not achieve lipid goals. The aim of this study is to describe the resources and current needs in clinical practice in Spain, through an analysis of management, organisation and the patient care circuit of dyslipidaemia patient. METHODS: A descriptive, cross-sectional, multicentre study, using a questionnaire, was conducted on physicians, 266 in primary care (PC) and 258 in specialised care (SC), who attended patients with dyslipidaemia in hospitals and centres within the National Health System. Probabilistic analyses were performed, stratifying by care-level, existence of a lipid unit (LU), and geographic area. RESULTS: Observed differences were mostly due to geographic location, rather than the existence of LU in the referral hospitals. Most system deficiencies were found in the southern provinces of the country. Nearly all primary care physicians declared that they diagnose, manage and control dyslipidaemia patients, but a general agreement was lacking for diagnostic and referral criteria. The scarce use of a shared protocol between PC and SC showed evidence of poor coordination between health care providers. Furthermore, there was a remarkably low proportion of patients receiving health care education for their disease. CONCLUSIONS: This study emphasises the need to identify weaknesses in the dyslipidaemia patient care circuit, and to perform the appropriate remedial actions, in particular, to promote coordination between levels of care and to foster patient education about their disease.

Efeito dos compostos fenólicos do camu-camu e do cupuaçu no desenvolvimento da obesidade e diabetes mellitus tipo 2 / Effects of camu camu and cupuassu phenolic compounds on obesity and type 2 diabetes mellitus development

A incidência da obesidade e do diabetes do tipo 2 tomou proporções epidêmicas nos últimos anos, atingindo bilhões de indivíduos em todo o mundo. A descoberta de formas inovadoras capazes de reduzir as alterações metabólicas associadas a estas doenças é fundamental para minimizar o seu impacto na qualidade de vida da população e na economia dos países. Muitos estudos têm demonstrado que os compostos bioativos de alimentos possuem efeitos benéficos à saúde. O camu-camu e o cupuaçu são frutas nativas da região amazônica com potencial agroeconômico ainda inexplorado, que contêm um grande número de compostos fitoquímicos que podem atuar sobre o metabolismo corporal. Desta forma, o objetivo deste estudo foi verificar os efeitos dos compostos fenólicos de extratos do camu-camu e do cupuaçu no desenvolvimento da obesidade e do diabetes tipo 2 em ensaios in vivo e in vitro, e identificar os possíveis metabólitos envolvidos nestes efeitos. Os extratos ricos em compostos fenólicos da polpa comercial destes frutos foram extraídos em fase sólida, caracterizados por cromatografia líquida de alta eficiência (CLAE/DAD) e avaliados quanto à inibição da atividade de enzimas digestivas in vitro. Os extratos obtidos foram então testados em duas diferentes concentrações (2,25 e 4,5 mg de equivalentes de catequina/Kg de peso corporal para o cupuaçu; 7 e 14 mg de equivalentes de ácido gálico/Kg de peso corporal para o camu camu) em um modelo animal de obesidade e resistência insulínica induzida por dieta com alto teor de lipídios e sacarose em camundongos C57BL/6J. Foram investigados os efeitos destes compostos sobre as homeostases glicídica e lipídica através de análises séricas, testes de tolerância à insulina e à glicose e conteúdo de lipídios hepáticos e fecais. O extrato do camu camu apresentou flavonóis, ácido elágico e elagitaninos em sua composição. A suplementação com o extrato de compostos fenólicos do camu camu reduziu o ganho de peso corporal e diminuiu a intolerância à glicose e à insulina, independente da dose administrada. No entanto, a administração destes extratos não apresentou efeitos sobre o metabolismo lipídico. Estes resultados foram associados a um possível efeito de saciedade, com consequente redução da ingestão da dieta e da glicolipotoxicidade, e com um efeito anti-inflamatório devido à diminuição dos níveis de proteína C reativa. Já o extrato de cupuaçu apresentou flavanóis, flavonas e proantocianidinas em sua composição. A suplementação com o extrato de cupuaçu na maior dose testada melhorou a homeostase da glicose e principalmente dos lipídios, protegendo o tecido hepático dos danos causados pela dieta com alto teor de lipídios e sacarose. Estes efeitos foram associados à inibição de enzimas digestivas, com consequente menor absorção de lipídios provenientes da dieta, reduzindo assim a resistência à insulina no fígado, a hiperglicemia e a dislipidemia. Ainda, foi avaliada a distribuição de metabólitos no trato gastrointestinal de camundongos após a administração aguda do extrato de cupuaçu. Foi possível identificar a complexa mistura de polifenóis presentes no extrato de cupuaçu ao longo do trato gastrointestinal, que posteriormente foi metabolizada pela microbiota. Entre os metabólitos encontrados estão as agliconas hipolaetina e isoscutelareína, e os metabolitos microbianos da epicatequina como o 3,4-diHPP-2-ol e a 5-(3,4-dihidroxiphenil)-γ-valerolactona. De acordo com estes resultados, as diferenças na composição de compostos fenólicos encontradas entre os extratos das duas frutas foram responsáveis pelos diferentes resultados nos protocolos in vivo e a identificação dos metabólitos microbianos possibilita o conhecimento dos compostos possivelmente implicados nos efeitos benéficos. Novos estudos podem contribuir para um melhor entendimento dos mecanismos, bem como quais metabólitos estão associados aos efeitos benéficos que os compostos presentes nestas duas frutas apresentaram neste estudo

The incidence of obesity and type 2 diabetes reached epidemic proportions in recent years, arriving to billions of people around the world. The discovery of innovative ways that can reduce the metabolic abnormalities associated with these diseases is essential to minimize its impact on the population's quality of life and the economy of the countries. Many studies have demonstrated that food bioactive compounds have beneficial health effects. Camu-camu and cupuassu are native fruits of the Amazon region with unexplored agroeconomic potential, which contain a large number of phytochemical compounds that can act on body metabolism. Thus, the objective of this study was verify the effects of phenolic compounds of camu-camu and cupuassu extracts on the development of obesity and type 2 diabetes in vivo and in vitro, and identfy the possible metabolites involved in these effects. The phenolic compound-rich extracts were obtained from commercial frozen fruit pulps by solid phase extraction, characterized by high-performance liquid chromatography (HPLC/DAD) and evaluated for inhibition of digestive enzymes activities in vitro. Then, the extracts were tested at two different doses (2.25 and 4.5 mg catechin equivalents/kg body weight for cupuassu; 7 and 14 mg of gallic acid equivalents/kg body weight for camu camu) in an animal model (C57BL/6J mice) of obesity and insulin resistance induced by high fat high sucrose diet. The effects of extract supplementation on glucose and lipid homeostasis were assessed by serum analysis, insulin and glucose tolerance tests in mice, and contents of fat in liver and fecal samples. Camu camu extract presented flavonols, ellagic acid and ellagitannins in its composition. Supplementation with camu camu phenolic extract reduced weight gain and decreased glucose and insulin intolerance independent of the dose administered. However, no effects on lipid metabolism were found. These findings were associated with a possible effect of satiety with a consequent reduction in energy intake and glicolipotoxicity, and anti-inflammatory properties. Cupuassu extract presented flavanols, flavones and proanthocyanidins in its composition. Supplementation with cupuacu extract at the highest dose improved glucose homeostasis and plasmatic lipid levels, protecting the liver tissue from damage caused by diet rich in lipids and sucrose. These effects were associated with inhibition of digestive enzymes, with consequent lower absorption of lipids from the diet, thereby reducing the insulin resistance in the liver, the hyperglycemia and dyslipidemia. Furthermore, the distribution of metabolites in the gastrointestinal tract of mice was evaluated after acute administration of cupussu extract by HPLC-ESI-QTOF. We identified the complex mixture of polyphenols present in cupuassu extract along the gastrointestinal tract, which was subsequently metabolized by the intestinal microbiota. Among detected metabolites are hypolaetin and isoscutellarein aglycones and microbial metabolites of epicatechin as 3,4-diHPP-2-ol and 5-(3,4-dihydroxyphenyl)-γvalerolactone. According to these results, the differences in the composition of phenolic compounds found between the two fruit extracts were responsible for the different effects in vivo and identification of microbial metabolites enables the knowledge of the compounds potentially implicated in the beneficial effects. New studies can contribute to a better understanding of the metabolism and mechanisms of action

Cultivation, Genetic, Ethnopharmacology, Phytochemistry and Pharmacology of Moringa oleifera Leaves: An Overview.

Moringa oleifera is an interesting plant for its use in bioactive compounds. In this manuscript, we review studies concerning the cultivation and production of moringa along with genetic diversity among different accessions and populations. Different methods of propagation, establishment and cultivation are discussed. Moringa oleifera shows diversity in many characters and extensive morphological variability, which may provide a resource for its improvement. Great genetic variability is present in the natural and cultivated accessions, but no collection of cultivated and wild accessions currently exists. A germplasm bank encompassing the genetic variability present in Moringa is needed to perform breeding programmes and develop elite varieties adapted to local conditions. Alimentary and medicinal uses of moringa are reviewed, alongside the production of biodiesel. Finally, being that the leaves are the most used part of the plant, their contents in terms of bioactive compounds and their pharmacological properties are discussed. Many studies conducted on cell lines and animals seem concordant in their support for these properties. However, there are still too few studies on humans to recommend Moringa leaves as medication in the prevention or treatment of diseases. Therefore, further studies on humans are recommended.

Plantas consideradas útiles como hipoglicemiantes, antihipertensivas o hipolipemiantes por pacientes con enfermedades vasculares periféricas / Plants considered useful for hypoglycemic, antihypertensive or hypolipidemic treatments by patients with peripheral vascular diseases

Introducción: el conocimiento tradicional de los pacientes sobre la utilidad de las plantas medicinales puede servir de base para su educación en el uso racional de las preparaciones herbarias. Objetivo: caracterizar las plantas que los pacientes con enfermedades vasculares consideran útiles para el tratamiento de la diabetes, la hipertensión y como hipolipemiante. Métodos: se realizó una encuesta a los pacientes del Instituto Nacional de Angiología y Cirugía Vascular entre febrero y abril de 2007. Las características del empleo de las plantas con fines medicinales y los nombres de las especies consideradas útiles para tratar la diabetes, la hipertensión arterial y la dislipidemia fueron tabulados. Resultados: doscientos cuarenta y cinco adultos voluntarios de ambos sexos (142 femeninos/103 masculinos, edad 44 a 72 años) fueron incluidos en el estudio. Más del 80 por ciento de ellos utilizaban las plantas medicinales al menos ocasionalmente y confiaban en su eficacia para tratar diferentes enfermedades. Quince especies, fundamentalmente Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq., Morinda citrifolia L., Ocinum sanctum L. y Salvia officinalis L., pertenecientes a 11 familias botánicas, fueron mencionadas por los participantes en la encuesta. La mayoría de los planteamientos de los pacientes sobre las propiedades de estas plantas tienen algún fundamento científico, sin embargo, las evidencias farmacológicas disponibles son fundamentalmente de tipo pre-clínico y los resultados de los ensayos clínicos efectuados no son concluyentes. La carencia de preparaciones derivadas de plantas estandarizadas, con principios activos identificados y efectividad clínica demostrada, son limitaciones para recomendar su utilización terapéutica. Conclusiones: esta es la...

Introduction: knowing patients ‘believes about the medicinal utility of plants may provide a basis for educating them for a rational use of herb preparations. Objective: to characterize the plants that are considered useful for antidiabetic, antihypertensive or hypolipidemic treatment among patients with peripheral vascular diseases. Methods: a survey was performed among patients of the National Institute of Angiology and Vascular Surgery from February through April 2007. The characteristics of the use of plants as medicinal remedies and the names of species considered useful for the treatment of diabetes, arterial hypertension and dyslipidemia were recorded. Results: two hundred and forty five both sex adult volunteers (142 female/103 male), aged 44 to 72 years) were included in the study. More than 80 % of them used medicinal plants at least occasionally and confided on their efficacy to treat different illnesses Fifteen species, mainly Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq.., Morinda citrifolia L., Ocinum sanctum L and Salvia officinalis L, from 11 botanical families, were mentioned by participants. Most patients claims about plants´ properties have been scientifically supported in some extent, nevertheless, the majority of the pharmacological evidence relays on pre-clinical studies and results of clinical trials are not conclusive. The lack of standardized plant preparations with identified active principles and demonstrated clinical effectiveness are limitations for recommending their therapeutic use. Conclusion: this study has provided the first characterization of the use of plant products by patients with peripheral vascular diseases for medicinal purposes and confirmed that physicians should be aware about the possibility of herb-drug interactions that should be diagnosed. This information would aid the scientifically supported integration of Phytotherapy to the clinical practice(AU)

Plants considered useful for hypoglycemic, antihypertensive or hypolipidemic treatments by patients with peripheral vascular diseases / Plantas consideradas útiles como hipoglicemiantes, antihipertensivas o hipolipemiantes por pacientes con enfermedades vasculares periféricas

INTRODUCTION: knowing patients 'believes about the medicinal utility of plants may provide a basis for educating them for a rational use of herb preparations. OBJECTIVE: to characterize the plants that are considered useful for antidiabetic, antihypertensive or hypolipidemic treatment among patients with peripheral vascular diseases. METHODS: a survey was performed among patients of the National Institute of Angiology and Vascular Surgery from February through April 2007. The characteristics of the use of plants as medicinal remedies and the names of species considered useful for the treatment of diabetes, arterial hypertension and dyslipidemia were recorded. RESULTS: two hundred and forty five both sex adult volunteers (142 female/103 male), aged 44 to 72 years) were included in the study. More than 80 % of them used medicinal plants at least occasionally and confided on their efficacy to treat different illnesses Fifteen species, mainly Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq.., Morinda citrifolia L., Ocinum sanctum L and Salvia officinalis L, from 11 botanical families, were mentioned by participants. Most patients' claims about plants´ properties have been scientifically supported in some extent, nevertheless, the majority of the pharmacological evidence relays on pre-clinical studies and results of clinical trials are not conclusive. The lack of standardized plant preparations with identified active principles and demonstrated clinical effectiveness are limitations for recommending their therapeutic use. CONCLUSION: this study has provided the first characterization of the use of plant products by patients with peripheral vascular diseases for medicinal purposes and confirmed that physicians should be aware about the possibility of herb-drug interactions that should be diagnosed. This information would aid the scientifically supported integration of Phytotherapy to the clinical practice.

INTRODUCCIÓN: el conocimiento tradicional de los pacientes sobre la utilidad de las plantas medicinales puede servir de base para su educación en el uso racional de las preparaciones herbarias. OBJETIVO: caracterizar las plantas que los pacientes con enfermedades vasculares consideran útiles para el tratamiento de la diabetes, la hipertensión y como hipolipemiante. MÉTODOS: se realizó una encuesta a los pacientes del Instituto Nacional de Angiología y Cirugía Vascular entre febrero y abril de 2007. Las características del empleo de las plantas con fines medicinales y los nombres de las especies consideradas útiles para tratar la diabetes, la hipertensión arterial y la dislipidemia fueron tabulados. RESULTADOS: doscientos cuarenta y cinco adultos voluntarios de ambos sexos (142 femeninos/103 masculinos, edad 44 a 72 años) fueron incluidos en el estudio. Más del 80 % de ellos utilizaban las plantas medicinales al menos ocasionalmente y confiaban en su eficacia para tratar diferentes enfermedades. Quince especies, fundamentalmente Allium sativum L., Citrus aurantifolia Ch., Justicia pectoralis Jacq., Morinda citrifolia L., Ocinum sanctum L. y Salvia officinalis L., pertenecientes a 11 familias botánicas, fueron mencionadas por los participantes en la encuesta. La mayoría de los planteamientos de los pacientes sobre las propiedades de estas plantas tienen algún fundamento científico, sin embargo, las evidencias farmacológicas disponibles son fundamentalmente de tipo pre-clínico y los resultados de los ensayos clínicos efectuados no son concluyentes. La carencia de preparaciones derivadas de plantas estandarizadas, con principios activos identificados y efectividad clínica demostrada, son limitaciones para recomendar su utilización terapéutica. CONCLUSIONES: esta es la primera caracterización del uso de productos de plantas con fines medicinales por pacientes con enfermedades vasculares periféricas, y confirma que los facultativos deben conocer sobre la posibilidad de interacciones planta-medicamento que deben ser diagnosticadas. Esta información ayudaría a la integración de la Fitoterapia a la práctica clínica sustentada científicamente.

Diet, nutraceuticals and the tear film.

Nutrition disorders and their correlates such as obesity are increasingly prevalent worldwide. A number of studies to date have suggested numerous potential associations between diet and tear film health; this paper will provide a summary of the available literature. The tear film is characterized through its protein and lipid content and through clinical measurements of characteristics such as osmolarity, volume and stability. Malnutrition, protein and vitamin-A deficiencies are extremely deleterious to tear film health and supplementation with oral vitamin A in this setting is of clear benefit. The relative impact of diet on tear film within what would be considered normal ranges of consumption is less clear. A number of population studies have suggested that hyperlipidemia and a diet low in omega-3 fatty acids are risks factor for dry eye disease. Numerous studies have investigated the effectiveness of oral supplementation with antioxidants, omega-3 (e.g. fish oil and linseed oil) and omega-6 (e.g. evening primrose oil) fatty acids in the last 10 years. Taken together, these suggest a small benefit of oral supplementation on tear film volume, stability and decreased ocular symptoms in patients previously diagnosed with diseases involving the ocular surface (e.g. Sjögren's syndrome, meibomian gland dysfunction, dry eye disease) and contact lens wearers suffering from dry eye. More research is required to determine the exact composition, dosage and indications for their use and to fully characterize how these nutraceuticals modulate the tear film.

[Metabolic syndrome reversion by polyunsaturated fatty acids ingestion]. / Reversión del síndrome metabólico por el consumo de ácidos grasos poliinsaturados.

BACKGROUND AND OBJECTIVE: Metabolic syndrome (MS) frequency is growing and diet has an important influence on its evolution. Our objective was to study the effect of 3 sources of polyunsaturated fatty acids on MS parameters in humans. PATIENTS AND METHOD: The MS was diagnosed according to the International Diabetes Federation. Three groups of individuals (n=15/group) were quasi-randomly assigned to one of the following treatments during 6 weeks: a) 1.8 g/d n-3 (1.08g eicosapentoaenoic acid+0.72 g docosahexaenoic acid); b) 2.0 g/d conjugated linoleic acid (CLA, 50:50, cis9:trans11, trans10:cis12), and c) 40 g/d walnut. The clinical and biochemical parameters were evaluated at the beginning and the end of the essay. RESULTS: In the group with n-3 the triglycerides level decreased from 183.9 ± 35.2mg/dl to 149.6 ± 29.0mg/dl (P=.007). In the group with walnut the HDL level rose from 41.7 ± 5.2mg/dl to 47.8 ± 5.4 mg/dl (P=.004) and the Castelli index (total cholesterol/HDL) decreased from 4.86 ± 0.97 to 3.82 ± 0.81 (P=.004). There were not significant changes in the CLA group. At the end of the essay, 46.7% of walnut group patients, 46.7% of n-3 group and 20% of CLA group, had no MS. CONCLUSIONS: The groups that consumed polyunsaturated fatty acids n-3 and those in walnut in moderate daily doses during 6 weeks had an improvement of the dyslipidemia component of MS, hypertriglyceridemia and low HDL level.

Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de comorbidades em pacientes com artrite reumatoide / 2012 Brazilian Society of Rheumatology Consensus on the management of comorbidities in patients with rheumatoid arthritis

OBJETIVO: Elaborar recomendações da Comissão de Artrite Reumatoide da Sociedade Brasileira de Reumatologia (SBR) para o manuseio das comorbidades em artrite reumatoide (AR). MÉTODOS: Revisão da literatura e opinião de especialistas da Comissão de AR da SBR. RESULTADOS E CONCLUSÕES: Recomendações: 1) Diagnosticar e tratar precoce e adequadamente as comorbidades; 2) O tratamento específico da AR deve ser adaptado às comorbidades; 3) Inibidores da enzima conversora da angiotensina (IECA) ou bloqueadores dos receptores de angiotensina II (BRA) são preferidos no tratamento da hipertensão arterial sistêmica; 4) Em pacientes com AR e diabetes mellitus, deve-se evitar o uso contínuo de dose cumulativa alta de corticoides; 5) Sugere-se o uso de estatinas para manter níveis de LDL menor que 100 mg/dL e índice aterosclerótico menor que 3,5 em pacientes com AR e comorbidades; 6) A síndrome metabólica deve ser tratada; 7) Recomenda-se a realização de exames para a investigação de aterosclerose subclínica; 8) Maior vigilância para um diagnóstico precoce de neoplasia oculta; 9) Medidas de prevenção para trombose venosa são sugeridas; 10) Recomenda-se a realização de densitometria óssea em pacientes com AR acima de 50 anos, e naqueles com idade menor com corticoide maior que 7,5 mg por mais de três meses; 11) Pacientes com AR e osteoporose devem evitar quedas, e devem ser aconselhados a aumentarem a ingestão de cálcio, aumentarem a exposição solar e fazerem atividade física; 12) Suplementação de cálcio e vitamina D é sugerida.Autilização de bisfosfonatos é sugerida para pacientes com escore T menor que -2,5 na densidade mineral óssea; 13) Recomenda-se equipe multidisciplinar, com participação ativa do médico reumatologista no tratamento das comorbidades.

OBJECTIVE: To elaborate recommendations of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology (SBR) to manage comorbidities in rheumatoid arthritis (RA). METHODS: To review the literature and the opinions of the SBR RA Committee experts. RESULTS AND CONCLUSIONS: Recommendations: 1) Early diagnosis and proper treatment of comorbidities are recommended; 2) The specific treatment of RA should be adapted to the presence of comorbidities; 3) Angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers are preferred to treat systemic arterial hypertension; 4) In patients diagnosed with rheumatoid arthritis and diabetes mellitus, the continuous use of a high cumulative dose of corticoids should be avoided; 5) Statins should be used to maintain LDL cholesterol levels under 100 mg/dL and the atherosclerotic index lower than 3.5 in patients with RA who have other comorbidities; 6) Metabolic syndrome should be treated; 7) Performing non-invasive tests to investigate subclinical atherosclerosis is recommended; 8) Greater surveillance for the early diagnosis of occult malignancy is recommended; 9) Preventive measures of venous thrombosis are suggested; 10) Bone densitometry is recommended in RA patients over the age of 50 years and in younger patients on corticoid therapy at a dose greater than 7.5 mg for over three months; 11) Patients with RA and osteoporosis should be instructed to avoid falls, to increase their dietary calcium intake and sun exposure, and to exercise; 12) Calcium and vitamin D supplementation is suggested. Bisphosphonates are suggested for patients with T score < -2.5 on bone densitometry; 13) A multidisciplinary team, with the active participation of a rheumatologist, is recommended to treat comorbidities.

Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy / Avaliação nutricional e do perfil lipídico em crianças e adolescentes infectadas pelo HIV tratadas com terapia antirretroviral de alta potência

INTRODUCTION: HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART) regimens that include a protease inhibitor (PI) can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. METHODS: Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. RESULTS: Fifty-one individuals were studied, of these, 16 were healthy. After 12 months follow-up, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study [PI groups: 114 (43 - 336), and 136 (63 - 271) versus control group: 54.5 (20 - 162); p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 - 273) versus 67.5 (33 - 117); p = 0.004]. HDL-cholesterol was lower in HIV-positive individuals [HIV-positive groups: 36 (27 - 58) and 36 (23 - 43); control 49.5 (34 - 69); p = 0.004]. CONCLUSIONS: HIV-infected children and adolescents treated with highly active antiretroviral therapy showed compromised nutritional parameters compared to a paired healthy control group. Individuals using protease inhibitor presented worse triglyceride serum levels compared to their healthy counterparts.

INTRODUÇÃO: Crianças e adolescentes infectadas pelo HIV e tratadas com terapia antirretroviral de alta potência (TAAP), que inclui inibidor de protease (IP) podem apresentar significante melhora clínica no estado nutricional e na qualidade de vida. O objetivo é relatar as alterações nutricionais e metabólicas em pacientes pediátricos expostos a TAAP e controles saudáveis durante 1 ano. MÉTODOS: O perfil clínico, antropométrico e lipídico, bem como dados da ingestão alimentar foram coletados prospectivamente durante aproximadamente 12 meses. RESULTADOS: Cinquenta e um indivíduos foram estudados. Dezesseis eram saudáveis. Após 12 meses de acompanhamento, indivíduos HIV-positivo permaneceram abaixo dos parâmetros do grupo controle saudável. Nenhuma mudança foi observada em relação à ingestão alimentar. Níveis séricos de triglicerídeos foram maiores em pacientes usando inibidor de protease no começo do estudo [IP grupo: 114 (43 - 336), e 136 (63 - 271) versus grupo controle: 54.5 (20 - 162); p = 0.003], porém após doze meses de acompanhamento, apenas o grupo que recebeu inibidor de protease por não mais do que dois meses apresentou maiores valores [140 (73 - 273) versus 67.5 (33 - 117); p = 0.004]. HDL-colesterol foi menor nos indivíduos HIV-positivos [grupo HIV-positivo: 36 (27 - 58) e 36 (23 - 43); controle 49.5 (34 - 69); p=0.004]. CONCLUSÕES: Crianças e adolescentes infectadas pelo HIV e tratadas com terapia antirretroviral de alta potência tiveram seus parâmetros nutricionais comprometidos quando comparados com o pareado grupo controle. Indivíduos usando inibidor de protease apresentaram piores níveis séricos de triglicerídeos quando comparados com os saudáveis.

Efeitos da suplementação dietética com óleo de coco no perfil lipídico e cardiovascular de indivíduos dislipidêmicos / Effects of dietary supplementation with coconut oil on lipid and cardiovascular profile of dyslipidemic subjects

Objetivo. Avaliar o efeito da suplementação dietética com óleo de coco extravirgem no perfil lipídico e cardiovascular de indivíduos hipercolesterolêmicos. Método. Trata-se de uma pesquisa de intervenção realizada no ambulatório de cardiologia de Valparaíso de Goiás. A amostra foi composta de 32 pacientes, hipercolesterolêmicos, 50% do sexo feminino, idade média de 48 anos. Todos os pacientes foram suplementados com 30 mL/dia de óleo de coco extravirgem durante três meses. Analisou-se o peso corporal, o índice de massa corporal, o perímetro abdominal, a relação abdômen-quadris, o consumo alimentar (recordatório de 24 horas), assim como lipidograma completo, glicemia de jejum, apolipoproteínas (apo) A-I e B, proteína C reativa ultrassensível (PCR-us), lipoproteína (a) [Lp(a)] e fibrinogênio antes e depois da suplementação. Usou-se, para análise dos dados, o teste estatístico t de Student, e considerou-se significância de 5%. Resultados. Após a suplementação com óleo de coco, observou-se redução significativa do peso, índice de massa corporal, relação abdômen-quadris, perímetro abdominal, triglicérides, lipoproteína de muito baixa densidade (VLDL-c) e PCR-us, bem como aumento significativo nas concentrações de apo A-I. Observou-se, também, tendência à redução do colesterol total, lipoproteína de baixa densidade (LDL-c) e Lp(a), assim como um ligeiro aumento de lipoproteína de alta densidade (HDL-c) e fibrinogênio, porém esses resultados não foram significativos. Conclusão. Os resultados sugerem que a suplementação dietética com óleo de coco extravirgem é capaz de exercer benefícios no perfil lipídico e cardiovascular de indivíduos dislipidêmicos.

Objective. To evaluate the effect of dietary supplementation with extra virgin coconut oil on lipid profile and cardiovascular dyslipidemic subjects.Method. This is an intervention research conducted in a cardiology clinic of Valparaiso de Goiás. The sample consisted of 32 patients with hypercholesterolemia, 50% female, mean age 48 years. All patients were supplemented with 30 mL/day coconut oil for three months. The authors analyzed body weight, body mass index, abdominal perimeter and abdomen-hip ratio, dietary intake (24 hour recall), as well as full lipid profile, fasting glucose, apolipoprotinein AI and B, high-sensitivity C-reactive protein, lipoprotein (a) [Lp (a)] and fibrinogen before and after supplementation. The t-Student test with 5% significance was used.Results. After supplementation with coconut oil, there was significant reduction in weight, body mass index, abdomen hip ratio, abdominal perimeter, triglycerides, very low density lipoprotein (VLDL-c), and high-sensitivity C-reactive protein, as well as significant increase in the levels of apo A-I . There was also a trend towards a reduction in total cholesterol, low-density lipoprotein (LDL-C) and Lp (a), as well as a slight increase in high density lipoprotein (HDL-C) and fibrinogen, but these results were not significant. Conclusion. The results suggest that dietary supplementation with extra virgin coconut oil is able to exert ?benefits on lipid profile and cardiovascular hypercholesterolemic subjects. However, randomized controlled trials are needed.

Efecto de la Inulina extraído de la raíz de Cichorium intybus L. sobre el perfil lipídico en ratas dislipidémicas / Effect of Inulin extracted from the root of Cichorium intybus L. on the lipid profile in dyslipidemic rats

La inulina está presente en la raíz de la achicoria (Cichorium intybus L.), que es poco usada en nuestro país, sin embargo presenta propiedades farmacológicas importantes. El objetivo fue determinar el efecto hipolipemiante de la inulina de la raíz de Cichorium intybus L. en ratas dislipidémicas. Se utilizaron 6 grupos de 8 ratas Holtzmann cada uno, el grupo 1 sin inducción a dislipidemia, grupo 2 con dislipidemia inducida por la administración oral de una suspensión alcohólica de colesterol 120mg/Kg, el grupo 3 con administración oral de atorvastatina 2mg/Kg, los grupos 4,5 y 6 con dosis de 215, 430 y 860 mg/kg de inulina respectivamente, la atorvastatina y la inulina se administraron desde el día 31 y hasta el final del estudio. Al grupo 2, se evaluó el perfil lipídico al inicio y final del experimento. En los resultados se observó que el método usado para la inducción de la dislipidemia es adecuado ya que hubo un aumento del colesterol total (+18%), LDL colesterol (+23%), una disminución del HDL colesterol (-36.1%) y que al administrar inulina disminuyó el Colesterol total (-17%), LDL colesterol (-21%), lípidos totales (-14%), y el HDL colesterol aumento (+34.2%), en ratas dislipidémicas que recibieron inulina 860 mg/Kg (p<0,05). No se observaron diferencias significativas sobre los niveles de triglicéridos, colesterol VLDL. Se puede concluir que la inulina de la raíz de Cichorium intybus L. disminuye los niveles de colesterol total, lípidos totales y colesterol LDL, mantiene los niveles de triglicéridos y eleva el colesterol HDL, con efectos similares a los de la atorvastatina.