Motivations for weight loss in adolescents with overweight and obesity: a systematic review.

BACKGROUND: Adolescents with overweight and obesity report various motivations for weight loss other than the desire for better health. However, there is little evidence regarding the main motivations for weight loss in adolescents. The present systematic review aimed to identify the motivations for weight loss in adolescents with overweight and obesity. METHODS: A systematic search for original articles published up to December 2016 was carried out in the PubMed, Scopus, LILACS, and ADOLEC databases. The terms used in the search were: motivation, motive, reason, "weight loss," "lose weight," and adolescent. RESULTS: Six studies (all cross-sectional) met the selection criteria and were included in the review. The instruments used to assess the participants' motivations for weight loss were interviews and questionnaires with open questions. Seventeen motivations for weight loss were identified, the main ones being better health, esthetic/cosmetic reasons, improvements in self-esteem, and avoidance of provocation/bullying. CONCLUSIONS: The results of the present review show the need for validated instruments to assess the motivations for weight loss in adolescents with overweight and obesity. Moreover, the high frequency of motivations for weight loss related to appearance and social acceptance evidences the need for multidisciplinary weight loss interventions that consider not only the biological factors, but also the psychological and social aspects.

Low bone mineral density in patients with type 1 diabetes: association with reduced expression of IGF1, IGF1R and TGF B 1 in peripheral blood mononuclear cells.

BACKGROUND: The negative effects of type 1 diabetes (T1D) on growth factors of bone metabolism lead to a reduction in bone mineral density. This study aimed to evaluate the association between bone mineral density and insulin-like growth factor 1 (IGF1), insulin-like growth factor 1 receptor (IGF1R) and transforming growth factor beta 1 (TGFB1) expressions in children and adolescents with T1D. Moreover, the influences of age at diagnosis, time since diagnosis, glycaemic control and albuminuria on bone mineral density were investigated. METHODS: Eighty-six T1D children/adolescents (T1D group) and ninety normoglycaemic controls (normoglycaemic group) were included. T1D patients were analysed as a whole and also in subsets of patients with good glycaemic control (glycated hemoglobin concentration ≤7.5%) and with poor glycaemic control (glycated hemoglobin concentration >7.5%). Bone mineral density was assessed by dual energy x-ray absorptiometry. Glycaemic control, renal function and bone markers were also assessed. IGF1, IGF1R and TGFB1 expressions were determined in peripheral blood mononuclear cells by real-time polymerase chain reaction. RESULTS: Patients with T1D showed low bone mineral density and poor glycaemic control. Serum total calcium and urinary albumin-to-creatinine ratio were higher in patients with poor glycaemic control compared to those with good glycemic control (p = 0.003 and p = 0.035, respectively). There was a reduction of IGF1, IGF1R and TGFB1 expressions in the T1D patients and in the subset with poor glycaemic control compared to normoglycaemic controls (p < 0.05). CONCLUSIONS: The decreased IGF1, IGF1R and TGFB1 expressions in the T1D patients, who presented with T1D at an early age, had been diagnosed with T1D for a longer time, had poor glycaemic control and albuminuria may contribute to low bone mineral density. Copyright © 2016 John Wiley & Sons, Ltd.

Association of polymorphisms in IL6 gene promoter region with type 1 diabetes and increased albumin-to-creatinine ratio.

BACKGROUND: Pro-inflammatory cytokines, such as interleukin-6 (IL-6), have been considered as key factors in type 1 diabetes mellitus (T1DM) and diabetic nephropathy, thus, our aim was to investigate the association of IL6-174G>C (rs1800795) and -634C>G (rs1800796) polymorphisms with T1DM susceptibility and diabetic nephropathy. METHODS: These polymorphisms were analyzed in 144 children and adolescents with T1DM and 173 normoglycemic control subjects. Glycemic control, laboratory parameters of kidney function and serum lipids were evaluated. By studying only T1DM patients, we evaluated the polymorphisms associated with relevant biochemical parameters in various genetic models. RESULTS: Type 1 diabetes mellitus patients showed poor glycemic control and albumin-to-creatinine ratio, total cholesterol and LDL-cholesterol levels increased when compared with normoglycemic subjects (p < 0.001, p = 0.004 and p < 0.001, respectively). IL6-174C allele was associated with an increased risk of developing T1DM (OR = 1.53, CI = 1.01-2.31, p = 0.044). In the T1DM group, IL6-174CC carriers showed higher concentrations of glycated hemoglobin (p = 0.029), albumin-to-creatinine ratio (p = 0.021), total cholesterol (p = 0.010), and LDL-cholesterol (p = 0.002), when compared with GG+GC carriers. No association was found for the IL6-634C>G polymorphism. CONCLUSIONS: These results suggest that IL6-174G>C may contribute to T1DM and increased albumin-to-creatinine ratio as well as to poor glycemic control and hyperlipidemia.

Increased TLR2 expression in patients with type 1 diabetes: evidenced risk of microalbuminuria.

OBJECTIVE: To study the activation of an inflammatory cascade through leukocyte mRNA expression of TLR2, TLR4, MyD88, and pro-inflammatory cytokines in individuals with childhood onset type 1 diabetes. DESIGN AND METHODS: Seventy-six type 1 diabetic patients and 100 normoglycemic subjects (NG) 6 to 20 years old were recruited. Type 1 diabetic patients (DM1) were considered to have good (DM1G) or poor (DM1P) glycemic control according to the values of glycated hemoglobin. TLR2, TLR4, MyD88, interleukin -1ß (IL-1ß), IL-6, and tumor necrosis factor alpha (TNF-α) mRNA expressions were measured in peripheral blood leukocytes (PBL) by real-time polymerase chain reaction (PCR). Urea, creatinine, albumin, and total protein serum levels were determined. Urinary albumin-to-creatinine ratio (ACR) was calculated. RESULTS: DM1 and DM1P patients showed higher glycated hemoglobin (10 and 11%, respectively) and serum glucose concentrations (208 and 226 mg/dL, respectively) compared to NG (Glycated hemoglobin: 7% and glucose: 76 mg/dL) (p < 0.05). PBL mRNA expressions of TLR2, MyD88, IL-1ß, IL-6, and TNF-α were higher in DM1 and TLR2, IL-1ß, and IL-6 expressions were higher in DMP1 compared to NG (p < 0.05). In DM1, serum albumin and total protein were lower, while serum urea and ACR were higher in comparison to NG (p < 0.05). However, these differences compared to NG were more pronounced in DM1P, which included nine individuals with microalbuminuria. CONCLUSIONS: Increased mRNA expression of TLR2, MyD88, and pro-inflammatory cytokines in leukocytes of patients with childhood onset type 1 diabetes indicates the development of a TLR2-mediated pro-inflammatory process, which may also be associated with an early inflammatory process in the kidney and the occurrence of microalbuminuria.

Prediction equations for fat and fat-free body mass in adolescents, based on body circumferences.

BACKGROUND: Fat mass (FM) and fat-free body mass (FFB) are important parameters for assessing nutritional status, since they are associated with higher prevalence of excess body fat and malnutrition worldwide. AIM: To develop prediction equations for fat and fat-free body mass in adolescents using body circumferences. SUBJECTS AND METHODS: This cross-sectional study included 218 adolescents (10-16 years) with normal weight as defined by body mass index. FM(Pred) and FFB(Pred) were estimated using stepwise multiple linear regression, considering age and body circumferences. Response variables, FM(BIA) and FFB(BIA) were estimated using bioelectric impedance analysis (BIA). The accuracy of the prediction equations was evaluated using the coefficient of determination (R(2)) and Akaike's Information Criterion (AIC). RESULTS: The best prediction equations for males were FM(Pred) = -7.114 - 0.592(age) - 0.958(wrist)+0.191(hip)+0.295(abdomen); R(2) = 0.552; AIC = 416.04 and FFB(Pred) = - 52.180+1.913(age)+1.954(wrist)+1.635(forearm); R(2) = 0.869; AIC = 578.24. For females, the best equations were FM(Pred) = -17.580 - 0.678(wrist)+0.221(abdomen)+0.241(hip)+0.202(proximal thigh) - 0.228(calf); R(2) = 0.838; AIC = 415.36 and FFB(Pred) = -31.066+0.90(age)+1.090(wrist) - 0.139(abdomen)+0.326(hip)+0.632(calf); R(2) = 0.878; AIC = 512.48. CONCLUSION: The equations developed to estimate fat body mass in females and fat-free body mass in both genders had high adjusted coefficients of determination and are therefore preferable to those derived using BIA.

Association of CYP2R1 and VDR Polymorphisms with Metabolic Syndrome Components in Non-Diabetic Brazilian Adolescents.

Associations between vitamin D deficiency and metabolic syndrome (MS) have been reported; however, the underlying biological mechanisms remain controversial. The aim of this study was to investigate the associations of CYP2R1 and VDR variants with MS and MS components in non-diabetic Brazilian adolescents. This cross-sectional study included 174 adolescents who were classified as overweight/obese. Three CYP2R1 variants and four VDR variants were identified by allelic discrimination. The CYP2R1 polymorphisms, rs12794714 (GG genotype) (odds ratio [OR] = 3.54, 95% confidence interval [CI] = 1.24-10.14, p = 0.023) and rs10741657 (recessive model-GG genotype) (OR = 3.90, 95%CI = 1.18-12.92, p = 0.026) were significantly associated with an increased risk of MS and hyperglycemia, respectively. The AG + GG genotype (dominant model) of the rs2060793 CYP2R1 polymorphism was associated with hyperglycemia protection (OR = 0.28, 95%CI = 0.08-0.92, p = 0.037). Furthermore, the CC genotype (recessive model) of the rs7975232 VDR polymorphism was significantly associated with a risk of hypertension (OR = 5.91, 95%CI = 1.91-18.32, p = 0.002). In conclusion, the CYP2R1 rs12794714 polymorphism could be considered a possible new molecular marker for predicting the risk of MS; CYP2R1 rs10741657 polymorphism and VDR rs7975232 polymorphism are associated with an increased risk of diabetes and hypertension in adolescents with overweight/obesity.

Newest Diabetes-Related Technologies for Pediatric Type 1 Diabetes and Its Impact on Routine Care: a Narrative Synthesis of the Literature.

Purpose of Review: This review aims to address the actual state of the most advanced diabetes devices, as follows: continuous subcutaneous insulin infusions (CSII), continuous glucose monitoring systems (CGM), hybrid-closed loop (HCL) systems, and "Do-it-yourself" Artificial Pancreas Systems (DIYAPS) in children, adolescents, and young adults. This review has also the objective to assess the use of telemedicine for diabetes care across three different areas: education, social media, and daily care. Recent Findings: Recent advances in diabetes technology after integration of CSII with CGM have increased the popularity of this treatment modality in pediatric age and shifted the standard diabetes management in many countries. We found an impressive transition from the use of CSII and/or CGM only to integrative devices with automated delivery systems. Although much has changed over the past 5 years, including a pandemic period that precipitated a broader use of telemedicine in diabetes care, some advances in technology may still be an additional burden of care for providers, patients, and caregivers. The extent of a higher rate of "auto-mode" use in diabetes devices while using the HCL/DIYAPS is essential to reduce the burden of diabetes treatment. Summary: More studies including higher-risk populations are needed, and efforts should be taken to ensure proper access to cost-effective advanced technology on diabetes care. Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-021-00248-7.

Chloroquine as a promising adjuvant therapy for type 1 Diabetes Mellitus.

Chloroquine (CQ) and hydroxychloroquine, are promising anti-inflammatory drugs for the treatment of Diabetes mellitus (DM) to prevent associated complications. Therefore, this study evaluated the anti-inflammatory effects of CQ-free and CQ-incorporated polylactic acid nanoparticles (NPs) in the peripheral blood mononuclear cells (PBMCs) of patients with type 1 Diabetes mellitus (T1DM). In total, 25 normoglycemic individuals and 25 patients with T1DM aged 10-16 years were selected and glycemic controls evaluated. After cell viability assessed by MTT assay, T1DM PBMCs were subjected to a CQ concentration of 10 µM in three different conditions: not treated (NT), treated with CQ, and treated with CQ NPs. The cells were incubated for 48 h, and the mRNA expressions of cytokines IL1B, IFNG, TNFA, IL12, and IL10 were determined by relative quantification through real-time PCR at 24 h intervals. IL1B expression decreased in CQ and CQ NP-treated cells after 48 h (p < 0.001) and 24 h (p < 0.05) of treatment, respectively. IFNG and IL12 expressions significantly decreased (p < 0.001) in cells treated with CQ and CQ NPs at 24 and 48 h compared to NT. TNFA and IL10 expressions significantly decreased after 48 h (p < 0.001) and 24 h (p < 0.002), respectively, by both CQ and CQ NPs treatment. Despite being a preliminary in vitro study, CQ has anti-inflammatory activity in the primary cells of T1DM patients and could represent an alternative and adjuvant anti-inflammatory therapy to prevent diabetes complications.

Development and content validity of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity.

OBJECTIVE: To develop and validate the content of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity. METHODS: The development and validation of the instrument were conducted in five stages, for which two systematic reviews were conducted. The first one, for the identification of questionnaires assessing the motivation for weight loss, included six studies and contributed to the selection of the domains for the instrument. The second one, conducted to identify the motivations for weight loss in adolescents with overweight and/or obesity, included six studies and contributed to the selection of 17 motivations included in the initial version of the instrument. The motivations most commonly identified were: having better health, improving my appearance, improving my self-esteem and avoiding bullying. The content validity was confirmed by a committee of 12 experts from the areas of nutrition, endocrinology, psychology, and physical education. Based on these evaluations, the content validity index was calculated. Only the items with a content validity index >0.80 for practical relevance were held in the instrument. RESULTS: Five of the 17 motivations included in the initial version of the instrument were excluded because they had content validity index <0.80 for practical relevance. Of the 12 items held in the instrument, five were revised by experts in order to standardize wording and make the language more appropriate for adolescents. Experts categorized the items into the health, personal satisfaction, appearance and social domains. CONCLUSIONS: This is the first instrument assessing the motivation for weight loss in adolescents with overweight and obesity in Brazil. The content validity evaluation by the panel of experts provided more practical relevance, as well as contributed to a better presentation of the items. Further psychometric testing is needed to determine reliability and construct validity of the instrument.

Effects of aerobic interval training on glucose tolerance in children and adolescents with cystic fibrosis: a randomized trial protocol.

BACKGROUND: Individuals with cystic fibrosis (CF) may develop CF-related diabetes (CFDR). This comorbidity is related to a poorer quality of life, microvascular complications, a decline in lung function, and an increase in exacerbations, as well as delayed growth and puberty. Evidence exists that physical exercise contributes to glycemic control in individuals with non-CF-related diabetes. This exercise is usually continuous with moderate intensity and long duration, which can cause muscle dyspnea and fatigue in CF individuals. Aerobic interval training (AIT) emerges as a safe and effective alternative for treating these individuals. The objective of this study is to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. METHODS: This study will be a two-arm, prospectively registered, randomized controlled trial with blind assessors and twenty 6- to 18-year-old individuals with cystic fibrosis (CF) from two different Brazilian states. People with CF will be randomly allocated to either the experimental or control group using block randomization, stratified by puberty stage,. Participants from both groups will receive an educational intervention and will be asked to continue their usual daily treatment for the full duration of the study. Those in the experimental group will perform AIT on a cycle ergometer at home three times a week, for 8 consecutive weeks. The sample characterization will include an assessment of puberty stage, socioeconomic status, dyspnea, and anthropometry. The primary outcome will be the change in glucose tolerance, while the secondary outcomes will include lung function, exercise tolerance, respiratory muscle strength, quality of life, and CF exacerbations. All outcomes will be assessed at baseline, week 9, and week 17. DISCUSSION: This is the first study to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. This study will serve as a basis for guiding clinical practice and decision-making in treating glucose intolerance and CF-related diabetes (CFRD) in children and adolescents with CF. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration System: NCT03653949. Registered on August 31, 2018.

Instruments for evaluation of motivations for weight loss in individuals with overweight and obesity: A systematic review and narrative synthesis.

This systematic review aims to identify instruments used to assess motivations for weight loss in individuals with overweight and obesity from different age groups, such as children, adolescents, adults, and older adults. The virtual search was carried out using the PubMed, Scopus, LILACS, and ADOLEC databases, and by manual search. The following descriptors were used: questionnaire, scale, instrument, evaluation, motivation, motive, reason, "lose weight," "losing weight," "weight loss," and slimming. Methodological quality was assessed according to the criteria of the COSMIN checklist. The search yielded 3,524 results, seven of which were included in the review. Six questionnaires assessing motivations for weight loss, which could be applied to various age groups, were identified. All the questionnaires presented items related to appearance and health as the main motivation for weight loss. In addition to these motivations, the questionnaires also included items related to improved sports performance, self-confidence, participation in important social events, family and social pressure, and fitting into different clothes. The most evaluated measurement properties in the studies were internal consistency, reliability, content validity, and construct validity. Regarding internal consistency, one was rated as excellent, one as fair, and three as poor. For reliability, two were rated as being of fair quality, and one as of poor quality. Two studies analyzed the content validity and the questionnaires were rated as being of poor methodological quality. Regarding structural validity, one was rated as excellent, another as fair, and another as poor quality. Only the Weight Loss Motivation Questionnaire presented excellent methodological quality for most of the analyzed criteria. There is a need to develop questionnaires that are of better methodological quality to assess motivations for weight loss. Instruments targeting the adolescent population should also be developed.

The low-density lipoprotein receptor-related protein 5 (LRP5) 4037C>T polymorphism: candidate for susceptibility to type 1 diabetes mellitus.

OBJECTIVE: The present study has investigated the association between low-density lipoprotein receptor-related protein 5 (LRP5) 4037C>T polymorphism and type 1 diabetes mellitus (T1DM) susceptibility in a Brazilian population. SUBJECTS AND METHODS: A total number of 134 T1DM patients and 180 normoglycemic individuals (NG) aged 6-20 years were studied. Glycated hemoglobin and glucose levels were determined. Genotyping of LRP5 4037C>T (rs3736228) was performed. RESULTS: T1DM patients showed poor glycemic control. Genotypes in the codominant (CT: OR = 2.99 [CI 95%: 1.71-5.24], p < 0.001; TT: OR = 5.34 [CI 95%: 1.05-2702], p < 0.001), dominant (CT + TT: OR = 3.16 [CI 95%: 1.84-5.43], p < 0.001) and log-additive (OR = 2.78 [CI 95%: 1.70-4.52], p < 0.001) models, and LRP5 4037T allele (OR = 2.88, [CI 95%: 1.78-4.77], p < 0.001) were associated with an increased risk of developing T1DM. LRP5 4037CT and CT+TT carriers in T1DM group showed higher concentrations of serum glucose and glycated hemoglobin when compared with CC carriers. CONCLUSION: The LRP5 4037C>T may represent a candidate for T1DM susceptibility, as well as poor glycemic control.

Cardiometabolic risk factors and hypovitaminosis D in adolescents with overweight from a sunny region in northeast Brazil: a cross-sectional study / Factores de riesgo cardiometabólico e hipovitaminosis D en adolescentes con sobrepeso de una región soleada del noreste de Brasil: un estudio transversal

Background: obesity can influence vitamin D levels, which in turn might be associated with cardiometabolic risk factors.Objectives:this study assessed the association between 25-hydroxyvitamin D [25(OH)D] levels and cardiometabolic risk factors in adolescents with overweight living in a region of northeastern Brazil.Material and methods: a cross-sectional study was carried out by non-probabilistic sampling in adolescents diagnosed with overweight or obesity. The subjects were divided according to their 25(OH) D status into two groups: sufficient vitamin D and hypovitaminosis D. Biodemographic, lifestyle, cardiometabolic, and biochemical factors were evaluated. A logistic regression model was applied to determine the predictors of hypovitaminosis D.Results: we found a high frequency of hypovitaminosis D (45.6 %) in adolescents. Weekly sun exposure was negatively associated with hypovitaminosis D (OR = 0.96; 95 % CI: 0.92-0.99), while significant positive associations were observed between hypovitaminosis D and blood pressure above the 95th percentile (OR = 4.00; 95 % CI: 1.19-13.37), body weight (OR = 1.04; 95 % CI: 1.01-1.07), and fasting insulin (OR = 1.13; 95 % CI: 1.05-1.22).Conclusion: hypovitaminosis D showed a high prevalence in adolescents with overweight living in a sunny region of northeastern Brazil, and cardiometabolic risk factors such as systemic arterial hypertension, high body weight, and hyperinsulinemia are predictors of hypovitaminosis D (AU)

Introducción: la obesidad puede influir en los niveles de vitamina D, lo que a su vez podría estar asociado con factores de riesgo cardiometabólico.Objetivos: este estudio evaluó la asociación entre los niveles de 25-hidroxivitamina D [25(OH)D] y los factores de riesgo cardiometabólico en adolescentes con sobrepeso que viven en una región del noreste de Brasil.Material y métodos: se realizó un estudio transversal mediante muestreo no probabilístico con adolescentes diagnosticados de sobrepeso u obesidad. Los sujetos se dividieron según su estado de 25(OH) D en dos grupos: suficiente vitamina D e hipovitaminosis D. Se evaluaron factores biodemográficos, de estilo de vida, cardiometabólicos y bioquímicos. Se aplicó un modelo de regresión logística para determinar los predictores de la hipovitaminosis D.Resultados:encontramos una alta frecuencia de hipovitaminosis D (45,6 %) en los adolescentes. La exposición semanal al sol se asoció negativamente a la hipovitaminosis D (OR = 0,96; IC 95 %: 0,92-0,99), mientras que se observaron asociaciones positivas significativas entre hipovitaminosis D y presión arterial por encima del percentil 95 (OR = 4,00; IC 95 %: 1,19-13,37), peso corporal (OR = 1,04; IC del 95 %: 1,01-1,07) e insulina en ayunas (OR = 1,13; IC del 95 %: 1,05-1,22).Conclusión: la hipovitaminosis D mostró una alta prevalencia entre los adolescentes con sobrepeso que viven en una región soleada del noreste de Brasil, y los factores de riesgo cardiometabólico, como hipertensión arterial sistémica, peso corporal elevado e hiperinsulinemia, son predictores de hipovitaminosis D (AU)

Effects of zinc supplementation in patients with type 1 diabetes.

The purpose of this study was to identify the effect of oral zinc supplementation in patients with type 1 diabetes (T1DM) on metabolic control and zinc blood concentrations. The sample consisted of 20 patients with T1DM and a control group (n=17). Metabolic control was evaluated by glycemia at fast, 24 h glycosuria, and HbA1c. Zinc concentrations were measured in plasma and erythrocytes. After the first collection of biological material, oral zinc supplementation was initiated and continued for 4 mo in T1MD patients (T1). Daily dosages were established based on Dietary Recommended Intakes (DRIs), considering zinc intake based on data from other studies previously performed with this population. All analyses were repeated after supplementation (T2). Metabolic control was unsatisfactory, with an HbA1c increase at T2. There was no difference in zinc concentrations in plasma and erythrocytes between patients with T1DM and control. Zinc concentrations in plasma were within the normal range in T1MD before and after supplementation and the control. Zinc concentrations in erythrocyte presented lower than normal values for all groups. A zinc increase in erythrocyte after supplementation was observed in T1DM patients, although without statistical significance. More studies are needed to confirm oral zinc supplementation as nutritional management in diabetes.

[Contribution of anthropometric characteristics to pubertal stage prediction in young male individuals]. / Contribuição das características antropométricas na predição dos estádios de maturação puberal de jovens do sexo masculino.

OBJECTIVE: To identify the contribution of anthropometric variables to predict the maturational stage in young males. METHODS: Cross-sectional study that enrolled 190 male subjects aged between eight and 18 years, randomly selected from public and private schools in Natal, Northeast Brazil. Thirty-two anthropometric variables were measured following the recommendations of the International Society for the Advancement of Kineanthropometry (ISAK). The assessment of sexual maturation was based on the observation of two experienced experts, who identified the pubertal development according to Tanner guidelines (1962). RESULTS: The anthropometric variables showed a significant increase of their values during the advancement of pubertal development (p<0.05). The following variables showed the best value for prediction of maturational groups: sitting height, femoral biepicondylar diameter, forearm girth, triceps skinfold, tibiale laterale and acromiale-radiale bone lenghts. These variables were able to estimate the pubertal stages in 76.3% of the sujects. CONCLUSION: The anthropometric characteristics showed significant differences between the moments of maturational stages, being found, representatively, seven variables that best predict the stages of sexual maturation.

The low-density lipoprotein receptor-related protein 5 (LRP5) 4037C>T polymorphism: candidate for susceptibility to type 1 diabetes mellitus

ABSTRACT Objective: The present study has investigated the association between low-density lipoprotein receptor-related protein 5 (LRP5) 4037C>T polymorphism and type 1 diabetes mellitus (T1DM) susceptibility in a Brazilian population. Subjects and methods: A total number of 134 T1DM patients and 180 normoglycemic individuals (NG) aged 6-20 years were studied. Glycated hemoglobin and glucose levels were determined. Genotyping of LRP5 4037C>T (rs3736228) was performed. Results: T1DM patients showed poor glycemic control. Genotypes in the codominant (CT: OR = 2.99 [CI 95%: 1.71-5.24], p < 0.001; TT: OR = 5.34 [CI 95%: 1.05-2702], p < 0.001), dominant (CT + TT: OR = 3.16 [CI 95%: 1.84-5.43], p < 0.001) and log-additive (OR = 2.78 [CI 95%: 1.70-4.52], p < 0.001) models, and LRP5 4037T allele (OR = 2.88, [CI 95%: 1.78-4.77], p < 0.001) were associated with an increased risk of developing T1DM. LRP5 4037CT and CT+TT carriers in T1DM group showed higher concentrations of serum glucose and glycated hemoglobin when compared with CC carriers. Conclusion: The LRP5 4037C>T may represent a candidate for T1DM susceptibility, as well as poor glycemic control.

Relationship between glycemic control and OPG gene polymorphisms with lower bone mineral density in patients with type 1 Diabetes mellitus

ABSTRACT The aim of the present study was to investigate the bone mineral density (BMD) of patients with type 1 Diabetes mellitus (T1DM). We also assessed the association between osteoprotegerin (OPG) genetic polymorphisms and BMD. Genotyping was performed for 1181G>C and 163A>G OPG polymorphisms by allelic discrimination in 119 patients with T1DM and 161 normoglycemic (NG) individuals, aged 6 to 20 years old. Glycemic control, serum parameters of bone metabolism and BMD were evaluated. T1DM patients showed low BMD, poor glycemic control and decreased total calcium values when compared to controls (p < 0.05). For all the polymorphisms studied, the genotype and allele frequencies in patients with T1DM were not significantly different from the controls. In patients with T1DM, carriers of OPG 1181CC showed higher concentrations of ionized calcium compared to patients with GG+GC genotypes. These results suggest that low BMD is associated with poor glycemic control in T1DM. Despite the lack of a detected association between OPG polymorphisms and BMD in these patients, the increased ionized calcium in those carrying OPG 1181CC suggests a possible increase in osteoclastogenesis, a conclusion that may be supported by the lower BMD observed in these subjects.

Eficacia de la educación en el tratamiento de la diabetes mellitus tipo 1 realizado por cuidadores de niños / Eficácia da educação no manejo do diabetes mellitus tipo 1 realizado por cuidadores de crianças / Education effectiveness in diabetes mellitus type 1 management made by children of caregivers

Objetivo: Analizar la eficacia de la educación para la salud en el tratamiento de diabetes mellitus tipo 1 proporcionado por los cuidadores de niños. Métodos: Se trata de un estudio descriptivo con corte transversal y un enfoque cuantitativo. Utilizamos los instrumentos: Examen de Conocimiento Diabetes Mellitus y escala de autoeficacia en Gestión de la Diabetes, adaptado y validado en Brasil. Resultados: En relación con el conocimiento de los cuidadores, el 72% tenía una puntuación satisfactoria. La mayoría consigue realizar el tratamiento ( 80 % ) y el 24% no confía en su habilidad; 72% de los encuestados pueden reconocer la hiperglucemia y el 96%, la hipoglucemia; 80% aplica la técnica correcta de la administración de insulina; 80% logran mantener la dieta recomendada, sin embargo, el 16% dijo que no sabía reemplazarla correctamente. Conclusión: La mayoría de los cuidadores de niños con diabetes mellitus tipo 1 tiene buen conocimiento sobre la enfermedad, y la gestión de la enfermedad realizada por estos cuidadores es satisfactoria en general, sin embargo, hay una necesidad de intervenir de alguna manera, cambiar actitudes para hacer frente de manera más adecuada a la enfermedad, así como también la mejora de la eficacia de la educación en diabetes (AU)

Objetivo: Analisar a eficácia da educação em saúde no manejo do Diabetes Mellitus tipo 1 realizado por cuidadores de crianças. Métodos: Trata-se de um estudo descritivo com recorte transversal e abordagem quantitativa. Utilizaram-se os instrumentos: Questionário de Conhecimento do Diabetes Mellitus e Escala de Autoeficácia no Manejo do Diabetes, adaptados e validados no Brasil. Resultados: Em relação ao conhecimento dos cuidadores, 72% obtiveram escore satisfatório. A maioria consegue realizar o tratamento (80%) e 24% não confia na sua habilidade; 72% dos entrevistados conseguem reconhecer a hiperglicemia e 96%, a hipoglicemia; 80% aplicam a técnica correta de administração da insulina; 80% conseguem manter a dieta recomendada, no entanto 16% afirmaram que não sabiam substituir corretamente. Conclusão: a maioria dos cuidadores de crianças com Diabetes Mellitus tipo 1 possuem bom conhecimento sobre a doença, e o manejo da doença realizado por esses cuidadores é satisfatório de um modo geral, no entanto há a ecessidade de intervenção em alguns aspectos, modificação de atitudes para enfrentamento mais adequado da doença, como também a melhoria da eficácia da educação em diabetes (AU)

Objective: To analyze the effectiveness of health education in the management of type 1 diabetes mellitus provided by caregivers of children. Methods: This is a descriptive study with cross- cut and quantitative approach. We used the instruments: Knowledge Quiz Diabetes Mellitus and Self-efficacy Scale in Diabetes Management, adapted and validated in Brazil. Results: About knowledge of caregivers, 72% had a satisfactory score. Most of them can perform the treatment (80%), and 24% do not trust the skill; 72% of respondents can recognize hyperglycemia and 96% can recognize hypoglycemia; 80% apply the correct technique of insulin administration; 80% manage to keep the recommended diet. However, 16% said they did not know to replace correctly. Conclusion: The majority of caregivers of children with type 1 diabetes mellitus have good knowledge about the disease, and disease management performed by these caregivers is satisfactory in general. However, there is a need to intervene in some ways, changing attitudes to cope more adequately with the disease, as well as improving the effectiveness of diabetes education (AU)

Revisão: aplicativos para dispositivos móveis (?Apps?) na automonitorização em pacientes diabéticos / Review: mobile applications (“Apps”) on self-monitoring in diabetic patients / Revisión: aplicaciones móviles (“Apps”) en la auto-monitorización en pacientes diabéticos

A crescente incidência do diabetes mellitus (DM) na população mundial demanda recursos e atenção ao diagnóstico e seguimento adequados, que reduzam a morbimortalidade. A monitorização glicêmica é uma das chaves para o bom controle, e com a universalização das tecnologias de informação e comunicação (TICs), principalmente através de celulares com acesso à internet e capacidade para processamento de dados (smartphones), e dispositivos portáteis (tablets), vem proporcionando ferramentas para o gerenciamento ambulatorial da doença. Buscando levantar em bases de dados o perfil dos aplicativos (apps) destinados a estes aparelhos, o objetivo principal foi descrever as características básicas destes aplicativos e visualizar a tendência de incorporação de recursos esperada para um futuro próximo. A análise do material obtido, provavelmente devida à atualização dinâmica da área, não permitiu quantificar precisamente os benefícios da mHealth (?saúde móvel?) em diabetes, mas há consenso que as perspectivas são bastante animadoras.

The worldwide increasing incidence of diabetes mellitus (DM) demand resources and attention to proper diagnosis and follow-up, to reduce morbidity and mortality. The glucose monitoring is one of the keys to good control, and the widespread of information and communication technologies (ICT), especially through mobile phones with internet access and capacity for data processing (smartphones), and portable devices (tablets), has been providing tools for the outpatient management of the disease. Seeking to raise the profile databases of applications (apps) for these devices, the main objective was to describe the basic characteristics of these applications and analyze the trend of incorporating features expected for the near future. The analysis of the material obtained, probably due to the dynamic update of the area did not allow precisely quantify the benefits of mHealth (?mobile health?) in diabetes , but there is consensus that the prospects are very encouraging.

El aumento de la incidencia de la diabetes mellitus (DM) los recursos de la demanda en todo el mundo y la atención al correcto diagnóstico y seguimiento, para reducir la morbilidad y la mortalidad. El monitoreo de la glucosa es una de las claves para un buen control, y la universalización de la información y la comunicación (TIC), especialmente a través de los teléfonos móviles con acceso a Internet y capacidad de procesamiento de datos (teléfonos inteligentes) las tecnologías y dispositivos portátiles (tabletas), ha estado proporcionando herramientas para el manejo ambulatorio de la enfermedad. Buscando elevar las bases de datos de perfiles de aplicaciones (apps) para estos dispositivos, el principal objetivo fue describir las características básicas de estas aplicaciones y ver la tendencia de incorporar características que se esperan para el futuro cercano. El análisis del material obtenido, probablemente debido a la actualización dinámica de la zona no permitió cuantificar con precisión los beneficios de mHealth ( ?salud móvil? ) en la diabetes, pero hay consenso en que las perspectivas son muy alentadoras.