ENERGY EXPENDITURE IN 21-HYDROXYLASE CONGENITAL ADRENAL HYPERPLASIA PATIENTS AND COMPARISON WITH PREDICTIVE EQUATIONS.

Objective: To characterize resting energy expenditure (REE) in patients with classic 21-hydroxylase congenital adrenal hyperplasia (21-OH CAH) using indirect calorimetry and compare it to the most commonly used REE predictive equations. Methods: This case-control study comprised 29 post-pubertal 21-OH CAH patients regularly followed at the University of Campinas. Elevated serum 17-hydroxyprogesterone and CYP21 gene molecular analysis confirmed the diagnosis. A healthy control group paired by age, gender, and body mass index was examined. Dual-energy X-ray absorptiometry (DEXA) measured body compositions. A bioimpedance analyzer determined fat-free mass, and indirect calorimetry using a metabolic cart measured REE. Results: Unlike our initial hypothesis, REE was similar between the groups (18.7 ± 3.1 kcal/kg/day in CAH vs. 20.3 ± 3.5 kcal/kg/day in controls; P = .728). No predictive equations reached the stipulated accuracy criteria, thus lacking validity in REE assessment in adults with the characteristics of the group studied. DEXA analysis revealed higher body fat and diminished nonbone lean mass in 21-OH CAH. Anthropometric and bioelectrical impedance parameters were not significantly different. Conclusion: Classic 21-OH CAH is generally followed in reference centers, which may facilitate indirect calorimetry use for REE measurement. Alternatively, considering our REE findings in adult 21-OH CAH patients, nutrition management based on 25 kcal/body weight/day (measured REE × activity factor 1.2 to 1.3) may be reasonable for current body weight maintenance in these patients. Abbreviations: 17-OHP = 17-hydroxyprogesterone; 21-OH CAH = classic 21-hydroxylase deficiency congenital adrenal hyperplasia; BMI = body mass index; REE = resting energy expenditure; VO2 = volume of oxygen; VCO2 = volume of carbon dioxide.

Neck circumference as a simple tool for identifying the metabolic syndrome and insulin resistance: results from the Brazilian Metabolic Syndrome Study.

OBJECTIVE: To investigate the relationship of the neck circumference (NC) with the metabolic syndrome (MetS) and insulin resistance (IR) in a large Brazilian population-based sample, within a wide range of adiposity and glucose tolerance, and to establish cut-off values of the NC for MetS and IR. CONTEXT: The NC correlates with cardiovascular risk factors, IR and components of MetS. Upper-body subcutaneous (sc) fat, as estimated by the NC, is associated with cardiovascular risk factors as much as abdominal fat, which is usually estimated by the waist circumference (WC). There are few epidemiological population-based studies on the clinical significance of the NC to MetS and IR. DESIGN: This is a cross-sectional study. PATIENTS: About 1053 Brazilian adults (18-60 years). MEASUREMENTS: Patients with BMI 18.5-40.0 kg/m(2), with normal glucose tolerance or type 2 diabetes (T2DM), were submitted to anthropometric measurements including waist circumference (WC), NC and BMI. Abdominal visceral fat (VF) was assessed by ultrasound. Insulin sensitivity (IS) was assessed by euglycaemic-hyperinsulinaemic clamp (10% of total sample) and HOMA-IR. Spearman correlations were used to evaluate the association between NC and IR and MetS risk factors. Receiver operating characteristic (ROC) curves were used for gender-specific cut-off values for the prediction of IR and MetS. Binary logistic regression analysis was used to assess the chance of developing IR or MetS according to the enlargement of NC and WC. RESULTS: The sample consisted of 28.6% men, with a mean age of 39.4 (12 years). T2DM diagnosis was present in 306 individuals, of whom 34% were men. NC correlated with WC and BMI in both men and women (P < 0.001). In both genders, NC showed a positive correlation with triglycerides, fasting glucose, fasting insulin and HOMA-IR, and NC had a negative association with high-density lipoprotein (HDL). NC and IS showed a moderate negative correlation. A significant correlation was demonstrated between VF and NC. In the ROC curves, NC presented the largest AUC for IR in women (P < 0.001), while NC presented a large AUC for MetS in both genders. CONCLUSIONS: Neck circumference measurements are an alternative and innovative approach for determining body fat distribution. The NC is positively associated with MetS risk factors, IR and VF, with established cut-off values for the prediction of MetS and IR.

The threshold value for identifying insulin resistance (HOMA-IR) in an admixed adolescent population: A hyperglycemic clamp validated study.

Objective: To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient - B = -0.087, 95% confidence interval [CI] = -0.135 to -0.040) and postpubertal (B = -0.101, 95% CI, -0.145 to -0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean =-0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion: The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.

Parental body mass index and maternal gestational weight gain associations with offspring body composition in young women from the Nutritionists' Health Study.

Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of preconception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (ß = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (ß = 0.11, p = 0.003) and fat mass index (FMI) (ß = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (ß = 0.42, p = 0.046), FMI (ß = 0.22, p = 0.005) and android-to-gynoid fat ratio (ß = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

Short-chain fatty acids are associated with adiposity, energy and glucose homeostasis among different metabolic phenotypes in the Nutritionists' Health Study.

BACKGROUND AND AIMS: The gut microbiome is associated with obesity, mainly mediated by bacteria-produced short-chain fatty acids (SCFAs). It is unknown how SCFA concentrations are associated with the phenotypes metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obese/overweight (MHO), and metabolically unhealthy obese/overweight (MUO). We compared plasma and fecal SCFA concentrations among adult women categorized according to the metabolic phenotypes mentioned above and examined associations between SCFA and adiposity and components of energy and glucose homeostasis. METHODS: This was a cross-sectional study involving 111 participants. Body composition was assessed by DEXA. Energy and glycemic homeostasis were assessed by the standard mixed-meal tolerance test coupled with indirect calorimetry. SCFAs were quantified by gas chromatography and mass spectrometry. RESULTS: Only plasma propionate was increased in the MHNW phenotype compared to the MHO and MUO phenotypes [p < 0.05]. Fecal propionate and butyrate concentrations and plasma propionate concentrations were inversely associated with total and visceral adiposity [p < 0.05]. Fecal and plasma SCFA concentrations were associated with reduced glucose, insulin and HbA1c levels, increased fasting and postprandial GLP-1 levels; and more preserved beta-cell function [p < 0.05]. Fecal and plasma SCFA concentrations were positively correlated with resting energy expenditure and lipid oxidation rate and inversely correlated with the oxidation rate of carbohydrates [p < 0.05]. CONCLUSION: These findings reinforce the concept that fecal and plasma SCFA concentrations are linked to specific components of energy and glucose homeostasis; and body adiposity. However, it was not possible to discriminate the different metabolic phenotypes of adiposity based on the determination of fecal SCFA concentrations.

Obesity and excess protein and carbohydrate consumption are risk factors for thyroid cancer.

Conflicting data concerning the association between obesity and differentiated thyroid cancer (DTC) may be attributed to the lack of records showing dietary intake and inadequate evaluation of nutrient composition. We evaluated 115 DTC patients carefully paired with 103 healthy control individuals by using a structured questionnaire, including a 24-h recordatory during 3 days, to investigate calorie intake and macronutrient (proteins, carbohydrates, and lipids) composition of the diet. We observed that excess weight (body mass index > 25 kg/m(2)) increased individual susceptibility to DTC [odds ratio (OR) = 3.787; 95% confidence interval (CI) = 1.115-6.814; P < 0.0001). This augmented risk was evident in women (OR = 1.925; 95% CI = 1.110-3.338; P = 0.0259) but not in men (P = 0.3498). Excess calorie intake was more frequent in patients with DTC than in controls (OR = 5.890; 95% CI = 3.124-11.103; P < 0.0001), and both excess protein (OR = 4.601; 95% CI = 1.634-12.954; P = 0.0039) and carbohydrate (OR = 4.905; 95% CI = 2.593-9.278; P < 0.0001) consumption were associated with an increased risk of DTC, contrarily to lipid/fiber intake and physical activity (P = 0.894 and 0.5932, respectively). In conclusion, our data indicate that overweight and risk of DTC are associated with higher protein and carbohydrate consumption than the rates recommended by the World Health Organization. The nutritional orientation should be part of preventive strategy targets designed to combat the increasing incidence of both obesity and DTC.

Insulin Resistance in Congenital Adrenal Hyperplasia is Compensated for by Reduced Insulin Clearance.

CONTEXT: Congenital adrenal hyperplasia (CAH) patients have potential normal longevity. However, a greater risk for cardiovascular disease has been reported. Insulin resistance and hyperinsulinemia have been described in CAH patients, whereas the prevalence of overt type 2 diabetes is not higher in CAH than in normal population. OBJECTIVE: To examine the contributions of insulin secretion and of hepatic insulin clearance to compensatory hyperinsulinemia in young insulin-resistant adults with classic CAH due to 21-hydroxylase deficiency (21-OHD). DESIGN: Cross-sectional. SETTING: University outpatient clinics. METHODS: Fifty-one participants: 21 controls, and 30 CAH (15 virilizing and 15 salt-wasting phenotypes), female/male (33/18), age (mean [SD]): 24.0 (3.6) years, body mass index: 24.6 (4.9)kg/m2 with normal glucose tolerance, were submitted to a hyperglycemic clamp study. MAIN OUTCOME MEASURES: Insulin sensitivity, beta cell function, and hepatic insulin clearance using appropriate modeling. RESULTS: We found an increased insulin resistance in 21-OHD. The systemic hyperinsulinemia (posthepatic insulin delivery) was elevated in CAH patients. No increases were observed in insulin secretory rate (beta cell function) in the first phase or during the hyperglycemic clamp. The increase in insulin concentrations was totally due to a ~33% reduction in insulin clearance. CONCLUSION: 21-OHD nonobese subjects have reduced insulin sensitivity and beta cell response unable to compensate for the insulin resistance, probably due to overexposure to glucocorticoids. Compensatory hyperinsulinemia is most related with reduced hepatic insulin clearance. The exclusive adaptation of the liver acts as a gating mechanism to regulate the access of insulin to insulin-sensitive tissues to maintain glucose homeostasis.

FODMAP project: Development, validation and reproducibility of a short food frequency questionnaire to estimate consumption of fermentable carbohydrates.

BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a functional disorder that is characterized by gastrointestinal symptoms and that has a major impact on quality of life, resulting in direct and indirect health care costs. The majority of patients with IBS suffer from food intolerances, most commonly related to the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). This study aimed to develop and verify the validity and reproducibility of a short food frequency questionnaire (FFQ) to assess typical FODMAP consumption in adults with IBS. METHODS: The primary FFQ list consisted of source foods of FODMAPs that contributed at least 10% to the frequency of consumption among 855 adults from a population-based study in the municipality of Campinas in 2014/2015. In addition, source foods of FODMAPs (according to the Monash University Low FODMAP Diet application) and foods commonly consumed by the Brazilian population (according to the FFQ for adults validated in the city of São Paulo) were included. One hundred and five (n = 105) healthy subjects were recruited to respond to the FFQ twice and to respond the 24-h dietary recall (24HR) three times during a 3-month period. The relative validity of the proposed instrument was compared with the average of the three 24HRs, and the reproducibility of the instrument was assessed by comparing both FFQ applications. The following statistical analyses were used for validation and reproducibility: Wilcoxon's test, Spearman's correlation analysis, weighted kappa, Bland Altman's plot and index, and interclass correlation coefficient. RESULTS: The final list of items for the short FFQ included 54 different foods. The foods were organized by FODMAP groups: free fructose, lactose, total oligosaccharides and total polyols, with variations of categories of responses for consumption frequency between 0 and 10 times and the unit of time in days, weeks or months. In the validity analyses, the correlation coefficients ranged from 0.209 (polyols) to 0.652 (lactose) (p < 0.05). There was no correlation between the methods in the fructose and oligosaccharide groups. The lactose group presented good agreement, and the remaining groups had a lack of agreement, with a mean of 15.7%. The Bland-Altman index values were 4.7% (fructose), 3.8% (lactose), 5.7% (oligosaccharides) and 6.6% (polyols). Regarding reproducibility, the interclass and Spearman's correlation coefficients varied from ICC = 0.781 and r = 0.725 (oligosaccharides) to ICC = 0.913 and r = 0.807 (lactose) (p < 0.05), showing strongly reproducible results for lactose and polyols and good results for fructose and oligosaccharides. Accurate agreement between FFQ applications had a mean of 67.3%, and 3.0% showed disagreement between FFQ1 and FFQ2. The weighted kappa coefficient ranged from 0.576 (polyols) to 0.645 (lactose). CONCLUSION: The semi-quantitative short FFQ was developed to evaluate the consumption of FODMAPs in adults in São Paulo. The instrument presents good reproducibility for all groups of FODMAPs, good validity for lactose and weaker validity for fructose, polyols and oligosaccharides. As the short FFQ was carefully designed for the study population, its estimates are relatively reliable at the population group level. A future reanalysis of this questionnaire would be useful when the chemical composition data of FODMAPs are available.

Maternal and paternal obesity are associated with offspring obestatin levels in the Nutritionists' Health Study.

OBJECTIVES: The aim of this study was to examine whether paternal and maternal body mass indexes (BMIs) were independently associated with obestatin and visfatin levels in adult offspring. METHODS: This cross-sectional analysis included 124 women who participated in the Nutritionists' Health Study (NutriHS) at baseline. Early life events, anthropometry, dual-energy x-ray absorptiometry-determined body composition and blood sample were obtained. Associations of parental BMI with outcomes (obestatin and visfatin) were tested by multiple linear regression, using minimal sufficient adjustments recommended by Directed Acyclic Graph. Participants' mean BMI was 25 ± 5 kg/m2 and 74% were metabolically healthy. Median obestatin and visfatin levels were 56.4 pg/mL (42-72) and 17.7 ng/mL (14-21.8), respectively. Eleven percent of mothers and 39% of fathers were overweight/obese. RESULTS: Daughters born from overweight/obese mothers had higher BMI than those born from normal weight women (P = 0.003). In adjusted regression model, offspring obestatin levels were associated with maternal BMI (ß = -0.03; P = 0.045) and paternal BMI (ß = -0.02; P = 0.048) independently of maternal and paternal education, maternal age, and maternal use of tobacco, alcohol, and/or drugs. No association was detected with visfatin levels. CONCLUSION: Inverse associations of maternal and paternal BMIs with offspring obestatin concentrations in women could suggest a utility of this biomarker of energy regulation determined in early adulthood. Whether obestatin could be an indicator of protection against obesity-related disorders in the life course requires investigation in studies designed to test such hypothesis.

Accuracy of predictive equations versus indirect calorimetry for the evaluation of energy expenditure in cancer patients with solid tumors - An integrative systematic review study.

BACKGROUND & AIMS: Cancer is one the principal causes of death, and is considered a health issue worldwide. Cancer patients are at high risk of malnutrition due to the disease and the treatment itself. Nutritional therapy is part of a multi-modal treatment and it is important to be aware of the patient's energy expenditure to aid in decision-making for dietotherapeutic prescription. Indirect Calorimetry (IC) is the gold standard method for measuring energy expenditure (EE); but due to its often high cost in clinical practise, equations that measure energy expenditure are usually used. OBJECTIVES: To perform an integrative systematic review, searching in the literature for how predictive equations of EE behave in relation to IC in cancer patients with solid tumors, considering the overall accuracy for cancer patients, the different tumor types, and the type of anti-cancer therapy applied. METHODS: A review was carried out of systematic integrative type literature. The articles were searched for in three databases (Pubmed, Embase, and Web of Science) using descriptors accompanied by Boolean operators. Inclusion and exclusion criteria were determined, and the articles found went through selection, analysis and extraction of their results. RESULTS: A total of 688 articles were identified that underwent a thorough selection, resulting in 15 studies that included in this review. In five studies, the results showed that predictive equations underestimated the EE of cancer patients; in three studies the EE was overestimated by predictive equations, and in seven studies predictive equations underestimated or overestimated the EE. The low accuracy of predictive EE equations was present regardless of tumor type and type of anti-cancer therapy received by patients. CONCLUSION: The predictive energy expenditure equations available to date are generally not in accordance with IC results for cancer patients with solid tumors, since these individuals present clinical situations or are exposed to factors that alter EE and are not considered in these equations.

NUTRITIONAL STATUS, QUALITY OF LIFE AND LIFE HABITS OF WOMEN WITH IRRITABLE BOWEL SYNDROME: A CASE-CONTROL STUDY.

BACKGROUND: Irritable bowel syndrome is a functional and chronic gastrointestinal disorder that may cause abdominal pain and altered bowel habits, affecting the nutritional status and quality of life of its carriers. Its prevalence is high, affecting about 10% to 15% of the general population in developed countries, being more prevalent in women than in men in the proportion 2:1. OBJECTIVE: The aim of our study was to compare the profile of body adiposity, life habits, and the quality of life of women with irritable bowel syndrome with a healthy control group. METHODS: Case-control study on 70 women, 34 with irritable bowel syndrome and 36 healthy. We applied the "Irritable Bowel Syndrome Quality of Life Questionnaire"to assess quality of life. Body adiposity was assessed from body mass index, waist circumference, and waist-to-hip ratio. We investigated the self-reporting of gastrointestinal symptoms with food deemed as problematic for carriers of irritable bowel syndrome and the presence of typical comorbidities. Assessment of life habits included: practice of physical activities, alcoholism, smoking, daytime sleepiness, and exclusion of foods from the feeding routine. For statistical analysis we used the IBM SPSS program, with a significance level at 5%. RESULTS: There was higher volume of central and general adiposity in the case group compared with the control group (P<0.05). Cases presented a higher chance of developing IBS-related comorbidities (P<0.05). About of 80% of patients with irritable bowel syndrome have excluded some food from the diet (P<0.01) and the total amount of troublesome foods varied from 7 to 21 (P<0.01). The case group featured worse quality of life compared with the control (P<0.05). CONCLUSION: Compared to the control group, women with irritable bowel syndrome showed greater body adiposity, higher frequency of comorbidities, greater restriction on the consumption of problematic foods and worse quality of life.

[Plasmatic lipid profile indicators related to insulin resistance]. / Indicadores do perfil lipídico plasmático relacionados à resistência à insulina.

PURPOSE: To investigate the effectiveness of biochemical indicators from the plasmatic lipid profile to identify the insulin resistance (IR), assessed by the HOMA-IR index (Homeostasis Model Assessment -Insulin Resistance). METHODS: 138 healthy men (20-59 years) were evaluated. The lipid profile biochemical indicators analyzed were the following: triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C, and TC/HDL-C and TG/HDL-C ratios. The percentile 75 was considered as the cut-off point for IR. Statistical analysis consisted of Spearman correlation coefficient, ROC curves and calculation of the areas under the curve (AUC). RESULT: The TG/HDL-C ratio showed the strongest correlation and the greatest AUC (r = 0.334 and AUC = 0.724 +/- 0.046, p < 0.001) respectively, followed by the HDL-C (r = -0.313 and AUC = 0.716 +/- 0.052, p < 0.01), the TG (r = 0.261 and AUC = 0.048 +/- 0.674, p < 0.01) and CT/HDL-C ratio (r = 0.259 and AUC = 0.655 +/- 0.05, p < 0.01). Results for TC and LDL-C showed no statistical significant (p > 0.05). CONCLUSION: The TG/HDL-C ratio showed the greatest ability to identify IR, proved to be an alternative and easy access instrument to assess IR in clinical practice, therefore providing diseases prevention for the adult male population.

PREVALENCE OF HEPATIC STEATOSIS AMONG CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS AND ITS ASSOCIATION WITH NUTRITIONAL STATUS.

OBJECTIVE: To determine the prevalence of hepatic steatosis (HS) in children and adolescents with cystic fibrosis (CF) and associate it with nutritional status. METHODS: Cross-sectional study with children and adolescents with CF diagnosis. Weight and height were used to calculate the body mass index (BMI) and subsequent classification of the nutritional status. The midarm circumference (MAC), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were used to evaluate body composition. Abdominal ultrasonography was performed for diagnosis of HS. The statistical tests used were Student's t test, Mann-Whitney test and chi-square test with significance level of 5%. RESULTS: 50 patients with CF were evaluated, 18 (36%) were diagnosed with HS (Group A) and 32 (64%) without HS (Group B). The mean age of Group A was 13,2±4,9 years old and Group B 11,7±4,9; for BMI, the value for Group A was 18,0±4,1 and Group B was 15,7±3,8; the TSF of Group A was 8,4±3,5 mm and Group B was 7,0±2,5 mm. For these variables, there was no significant difference between the groups. The mean of MAC and MAMC differed significantly between the groups, being higher in the HS group, with p values of 0,047 and 0,043. CONCLUSIONS: The frequency of HS in patients with CF is high and it is not related to malnutrition, according to the parameters of BMI, TSF and MAMC. The values of MAC and MAMC indicated a greater reserve of muscle mass in patients with HS.

Prevalence of hepatitis B and hepatitis C among diabetes mellitus type 2 individuals.

Diabetes mellitus type 2 (DM2) patients have higher risk to be infected with parenterally transmitted viruses, like hepatitis B or C virus. This study aims to determine HBV and HCV infection prevalence in DM2 patients from Northeast and Southeast Brazil. A total of 537 DM2 patients were included, 194 (36.12%) males and 343 (63.87%) females, with mean age of 57.13±11.49 years. HBV and HCV markers were determined using serological and molecular analysis, and risk factors were evaluated in a subgroup from Southeast (n = 84). Two HBV acute (HBsAg+/anti-HBc -) and one HBV chronic case (HBsAg+/anti-HBc+) were found. Six individuals (1.1%) were isolated anti-HBc, 37 (6.9%) had HBV infection resolved (anti-HBc+/anti-HBs+), 40 (7.4%) were considered HBV vaccinated (anti-HBc-/anti-HBs+). Thirteen patients (2.42%) had anti-HCV and 7 of them were HCV RNA+. In the subgroup, anti-HBc positivity was associated to age and anti-HCV positivity was associated to age, time of diabetes diagnosis, total bilirubin, indirect bilirubin, alkaline phosphatase at bivariate analysis, but none of them was statistically significant at multivariate analysis. As conclusion, low prevalence of HBV and high prevalence HCV was found in DM2 patients.

Inflammatory process of patients receiving parenteral nutrition is not exclusively responsible for low selenium and glutathione peroxidase levels.

OBJECTIVE: The aim of this study was to verify if the selenium status of patients residing in locations with selenium-poor soil who receive parenteral nutrition (PN) without selenium supplementation is associated with the inflammatory process. METHODS: This was a prospective cohort study with hospitalized patients who started PN. The analyzed biochemical tests were plasma selenium, glutathione peroxidase (GPx), C-reactive protein, prealbumin, albumin, creatinine, lymphocytes, total cholesterol, high-density lipoprotein, and triglycerides. RESULTS: Seventy-seven patients with a mean age of 56.2 ± 15.7 y were studied. Most of them used PN as a result of clinical issues (70.1%) such as, gastric, renal, or hematologic neoplasia; gastrointestinal dysfunction; pancreatitis; sepsis; trauma without surgical needs; chylothorax; and fistula not related to surgical procedure. There were low levels of plasma selenium (98.7%) and GPx (60%) and elevated C-reactive protein (98.5%) in most cases. At the beginning of PN there was no correlation between selenium and laboratory tests (P > 0.05). At the second evaluation (seventh day of PN), there was a positive correlation of selenium levels with lymphocyte levels (r = 0.36; P = 0.04). After 2 wk of PN, there was a statistically significant correlation between selenium and GPx (r = 0.70; P = 0.02). CONCLUSIONS: Very low values of selenium and GPx from the beginning of PN were identified. The correlation of selenium levels with GPx in only 14 d of PN, regardless of inflammation, may reflect a critical selenium status, mainly because the correlation was verified after the acute phase. Therefore it is important to emphasize that supplementation should be started from the beginning of PN, especially in regions with selenium-deficient soil.

Irritable bowel syndrome: associations between FODMAPS intake, problematic foods, adiposity, and gastrointestinal symptoms.

This study investigated the association between fermentable oligo-di-mono-saccharides and polyols (FODMAPs) intake, problematic foods, body adiposity, and gastrointestinal symptoms in 44 women with irritable bowel syndrome (IBS). Around 84% reported to have excluded some food from their diet. Adiposity was not associated with the frequency of gastrointestinal symptoms and IBS severity. Controlling for BMI, there were significant correlations between number of problematic foods versus waist circumference (r = 0.306; p = 0.049) and protein intake (r = -0.378; p = 0.014). The IBS severity correlated to the carbohydrate intake (r = -0.320; p = 0.039). Patients with diarrhea demonstrated statistical tendency to restrict the intake of fat (p = 0.058), free fructose (p = 0.07), and oligosaccharides (p = 0.051). Patients with mucus in the stool had higher lactose intake (p = 0.025). The number of food considered problematic was higher for patients who reported stomach burning (p = 0.0001). Associations among adiposity, gastrointestinal symptoms, problematic food, and FODMAPs were identified and reaffirm the role of individualized nutritional treatment in the management of IBS.

Homeostatic model assessment of adiponectin (HOMA-Adiponectin) as a surrogate measure of insulin resistance in adolescents: Comparison with the hyperglycaemic clamp and homeostatic model assessment of insulin resistance.

BACKGROUND: Studies on adults have reported inverse association between the homeostatic model assessment (HOMA) of adiponectin (HOMA-Adiponectin) and the insulin resistance assessed by the glucose clamp technique. To our knowledge, in the pediatric population this association has not been previously investigated. OBJECTIVES: To evaluate the association between the HOMA-Adiponectin and the insulin resistance assessed by the glucose clamp technique in adolescents, and to compare the accuracy of HOMA-Adiponectin and HOMA-insulin resistance (HOMA-IR) for identifying insulin resistance. METHODS: This was a cross-sectional study of 56 adolescents (aged 10-18 years). Insulin resistance was assessed using the HOMA-IR, HOMA-Adiponectin and the hyperglycaemic clamp technique. The clamp-derived insulin sensitivity index, HOMA-Adiponectin, and HOMA-IR were log-transformed to get closer to a normal distribution before analysis. RESULTS: In the multivariable linear regression analysis controlling for sex and Tanner stage, HOMA-Adiponectin was inversely associated with the clamp-derived insulin sensitivity index (unstandardized coefficient [B] = -0.441; P < 0.001). After additional adjustment for waist circumference-to-height ratio, this association remained significant (B = -0.349; P = < 0.001). Similar results were observed when HOMA-IR replaced HOMA-Adiponectin in the model (B = -1.049 and B = -0.968 after additional adjustment for waist circumference-to-height ratio); all P < 0.001. The area under the receiver operating characteristic curve for predicting insulin resistance was 0.712 (P = 0.02) for HOMA-Adiponectin and 0.859 (P < 0.0001) HOMA-IR. CONCLUSIONS: The HOMA-Adiponectin was independently associated with insulin resistance and exhibited a good discriminatory power for predicting it. However, it did not show superiority over HOMA-IR in the diagnostic accuracy.

Glucose Metabolism Parameters and Post-Prandial GLP-1 and GLP-2 Release Largely Vary in Several Distinct Situations: a Controlled Comparison Among Individuals with Crohn's Disease and Individuals with Obesity Before and After Bariatric Surgery.

BACKGROUND: This study aims to compare the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 among individuals with Crohn's disease (CD), obese individuals before and after bariatric surgery, and healthy controls. METHODS: This an exploratory cross-sectional study that involved five groups of patients (two groups of individuals with CD-active and inactive), bariatric patients (pre- and post-surgery, who were their own controls), and a distinct separated control group of healthy volunteers. C-reactive protein (CRP) levels and the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 curves were assessed and compared. RESULTS: The pre-RYGB group presented significantly higher levels of CRP than the post-RYGB (p = 0.001) and the control group (p = 0.001). The inactive CD group presented a higher post-prandial GLP-1 area under the curve (AUC) than the pre-RYGB group (p = 0.009). The post-RYGB group presented significantly higher AUCs of GLP-2 than the pre-RYGB group (p < 0.0001), both inactive and active CD groups (p < 0.0001 in both situations), and the control group (p = 0.002). The pre-RYGB group presented a significantly higher AUC of glucose than the post-RYGB (p = 0.02) and both active and inactive CD groups (p = 0.019 and p = 0.046, respectively). The pre-RYGB group presented a significantly higher AUC of insulin than the control (p = 0.005) and both CD groups (p < 0.0001). CONCLUSIONS: Obesity is associated with an inflammatory state comparable to the one observed in CD; inflammation may also be enrolled in the blockade of GLP-2. CD individuals present a more incretin-driven pattern of glucose metabolism, as a way to prevent hypoglycemia and compensate the carbohydrate malabsorption and GLP-2 blockade.

The threshold value for identifying insulin resistance (HOMA-IR) in an admixed adolescent population: A hyperglycemic clamp validated study

ABSTRACT Objectives: To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient - B = −0.087, 95% confidence interval [CI] = −0.135 to −0.040) and postpubertal (B = −0.101, 95% CI, −0.145 to −0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean = −0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion: The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.

Parental body mass index and maternal gestational weight gain associations with offspring body composition in young women from the Nutritionists' Health Study

ABSTRACT Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Materials and methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of pre-conception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (β = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (β = 0.11, p = 0.003) and fat mass index (FMI) (β = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (β = 0.42, p = 0.046), FMI (β = 0.22, p = 0.005) and android-to-gynoid fat ratio (β = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.