Vitamin D deficiency in bedridden elderly people at home.

OBJECTIVE: The aim of this study was to evaluate serum 25(OH)D concentrations in the homebound elderly people and relate them to level of dementia, nutritional risk, and route of dietary administration. METHODS: This is a cross-sectional study involving 207 bedridden elderly people assisted by the Home Care Service in the city of Santo André - SP, from June to December 2016. The following factors were evaluated: dietary intake of vitamin D, arm circumference, triceps skin fold thickness, calf circumference, nutritional risk by Mini-Nutritional Assessment, level of dementia by the adapted Clinical Dementia Rating questionnaire, and laboratory tests such as serum concentrations of 25(OH)D, ultrasensitive C-reactive protein, alkaline phosphatase, serum calcium, and parathormone. RESULTS: The mean age of the elderly people was 81.6 (9.2) years. Deficiency of 25(OH)D was observed in 76.3% of the elderly people. There was an inverse correlation between serum concentrations of 25(OH)D: parathormone (r=-0.418, p<0.001) and alkaline phosphatase (r=-0.188, p=0.006) and a direct correlation with serum calcium (r=-0.158, p=0.022). Logistic regression showed that vitamin D deficiency was directly and independently associated with oral feeding (odds ratio 7.71; 95%CI 2.91-20.40). CONCLUSION: Bedridden households showed high prevalence of vitamin D deficiency without association with nutritional risk and level of dementia. Oral diet was associated with vitamin D deficiency, possibly due to low consumption of source foods.

Vitamin D deficiency in bedridden elderly people at home

SUMMARY OBJECTIVE: The aim of this study was to evaluate serum 25(OH)D concentrations in the homebound elderly people and relate them to level of dementia, nutritional risk, and route of dietary administration. METHODS: This is a cross-sectional study involving 207 bedridden elderly people assisted by the Home Care Service in the city of Santo André - SP, from June to December 2016. The following factors were evaluated: dietary intake of vitamin D, arm circumference, triceps skin fold thickness, calf circumference, nutritional risk by Mini-Nutritional Assessment, level of dementia by the adapted Clinical Dementia Rating questionnaire, and laboratory tests such as serum concentrations of 25(OH)D, ultrasensitive C-reactive protein, alkaline phosphatase, serum calcium, and parathormone. RESULTS: The mean age of the elderly people was 81.6 (9.2) years. Deficiency of 25(OH)D was observed in 76.3% of the elderly people. There was an inverse correlation between serum concentrations of 25(OH)D: parathormone (r=-0.418, p<0.001) and alkaline phosphatase (r=-0.188, p=0.006) and a direct correlation with serum calcium (r=-0.158, p=0.022). Logistic regression showed that vitamin D deficiency was directly and independently associated with oral feeding (odds ratio 7.71; 95%CI 2.91-20.40). CONCLUSION: Bedridden households showed high prevalence of vitamin D deficiency without association with nutritional risk and level of dementia. Oral diet was associated with vitamin D deficiency, possibly due to low consumption of source foods.

Myeloperoxidase as cardiovascular risk marker in pre-pubertal preterm children?

BACKGROUND AND AIMS: To evaluate the biomarkers related to cardiovascular risk in pre-pubertal preterm children with a birth weight of less than 1,500 g and relate them to current nutritional status, insulin resistance, and inflammation. METHODS & RESULTS: This is a cross-sectional, controlled study with pre-pubertal preterm children aged 5-9 years with a birth weight of less than 1500 g (Preterm group, n = 44) compared to full term children of adequate weight for gestational age (Control group, n = 30). Clinical evaluation: anthropometry and pubertal staging. Laboratory tests: total cholesterol and fractions, triglycerides, paraoxonase 1, apolipoproteins A-I and B, myeloperoxidase (MPO), high sensitivity C-reactive protein (hs-CRP), glycemia and insulin (to calculate HOMA-IR). In the preterm group, 19 (43.2%) were male, with mean birth weight and gestational age of 1157 ± 242 g and 30.0 ± 2.3 weeks, respectively. The preterm group showed lower concentrations of HDL-c (60.1 ± 10.1 vs. 69.0 ± 10.0 mg/dL; p < 0.001); higher concentrations of hs-CRP [0.55 mg/dL (0.30; 39.4) vs. 0.30 mg/dL (0.30; 10.80); p = 0.043], of MPO [21.1 ng/mL (5.7; 120.0) vs. 8.1 ng/mL (2.6; 29.6); p < 0.001] and of MPO/HDL-c ratio [0.39 (0.09; 2.07) ng/mg vs. 0.11 (0.05; 0.58)]. The MPO/HDL-c ratio was the variable that showed the best discriminatory power between the groups (AUC = 0.878; 95% CI; 0.795-0.961). MPO concentrations in the preterm group were correlated with those of hs-CRP (r = 0.390; p = 0.009), insulin (r = 0.448; p = 0.002) and HOMA-IR (r = 0.462; p = 0.002). CONCLUSION: Prepubertal preterm children show high MPO concentrations and MPO/HDL-c ratio that are associated with inflammation and oxidative stress, which, in turn, may be associated with atherosclerosis.

Renal function in prepubertal children born with very low birthweight.

OBJECTIVES: The objective of this study was to evaluate estimated glomerular filtration rates (eGFR) and markers of renal function in very low birthweight (VLBW) children and to relate these parameters to current nutritional status. METHODS: A cross-sectional and controlled study was performed with prepubertal children between ages 5 and 10, including 44 VLBW participants and 30 healthy participants born at full term with an adequate birthweight (control group). The following data were collected: perinatal history; current weight, height and waist circumference; blood pressure (three measures); blood creatinine, urea, uric acid, cystatin-C, and neutrophil gelatinase-associated lipocalin levels; and urine albumin, creatinine, and calcium levels. RESULTS: Blood pressure, eGFR, albuminuria, concentrations of cystatin-C, neutrophil gelatinase-associated lipocalin, uric acid, urea, creatinine, and fractional calcium excretion did not differ between VLBW and control groups. Regarding the VLBW group, there was no difference in eGFR, albuminuria, and other markers of renal injury in overweight or obese children compared with children with a normal body mass index. CONCLUSIONS: Prepubertal children born with VLBW did not have altered renal function, regardless of their current nutritional status.

Assessing cardiovascular risk in ATM heterozygotes.

OBJECTIVE: To evaluate the carotid intima-media complex (CIMC) thickness and lipid metabolism biomarkers associated with cardiovascular risk (CR) in parents of patients with ataxia-telangiectasia and verify an association with gender. METHOD: A cross-sectional and controlled study with 29 ATM heterozygotes and 14 healthy controls. Biochemical tests and CIMC thickness measurement were performed. RESULTS: The mean CIMC measurement in heterozygous ATM was 0.72 ± 0.1 mm (minimum: 0.5 mm and maximum: 1.0 mm). Noticed high percentage of amounts above 75 percentile compared to the population referential (16 [76.2%]), without any significant statistical differences between the female and the male gender (11/15 [73.3%] vs. 5/6 [83.3%]; p=0.550). The comparison between heterozygous and controls, stratified by gender, showed that in heterozygous ATMs, women had higher concentrations of HDL-c compared to men, as well as higher values of hs-CRP in relation to the control women. In heterozygous ATMs, stratified by gender, the correlation between HDL-c and hs-CRP was inversely proportional and stronger among women, with a tendency to statistical significance. CONCLUSION: Heterozygous ATMs did not differ from controls in relation to the biomarkers studied related to CR. However, most of them presented increased CIMC, independent predictor of death, risk for myocardial infarction and stroke, compared to the referential for the same age group. This finding suggests CR in the heterozygous ATM and shows to the need to monitor CIMC thickness and nutritional orientations.

Assessing cardiovascular risk in ATM heterozygotes / Avaliação do risco cardiovascular de ATM heterozigotos

Summary Objective: To evaluate the carotid intima-media complex (CIMC) thickness and lipid metabolism biomarkers associated with cardiovascular risk (CR) in parents of patients with ataxia-telangiectasia and verify an association with gender. Method: A cross-sectional and controlled study with 29 ATM heterozygotes and 14 healthy controls. Biochemical tests and CIMC thickness measurement were performed. Results: The mean CIMC measurement in heterozygous ATM was 0.72 ± 0.1 mm (minimum: 0.5 mm and maximum: 1.0 mm). Noticed high percentage of amounts above 75 percentile compared to the population referential (16 [76.2%]), without any significant statistical differences between the female and the male gender (11/15 [73.3%] vs. 5/6 [83.3%]; p=0.550). The comparison between heterozygous and controls, stratified by gender, showed that in heterozygous ATMs, women had higher concentrations of HDL-c compared to men, as well as higher values of hs-CRP in relation to the control women. In heterozygous ATMs, stratified by gender, the correlation between HDL-c and hs-CRP was inversely proportional and stronger among women, with a tendency to statistical significance. Conclusion: Heterozygous ATMs did not differ from controls in relation to the biomarkers studied related to CR. However, most of them presented increased CIMC, independent predictor of death, risk for myocardial infarction and stroke, compared to the referential for the same age group. This finding suggests CR in the heterozygous ATM and shows to the need to monitor CIMC thickness and nutritional orientations.

Resumo Objetivo: Avaliar a espessura do complexo médio-intimal da carótida (CMIC) e os biomarcadores do metabolismo lipídico associados ao risco cardiovascular (RC) em pais de pacientes com ataxia-telangiectasia (AT) e verificar associação com gênero. Método: Estudo transversal prospectivo e controlado com 29 ATM heterozigotos e 14 controles saudáveis. Foram realizados exames bioquímicos e a espessura do CMIC por ultrassonografia. Resultados: A média da medida do CMIC nos ATM heterozigotos foi de 0,72± 0,1 mm (mínimo: 0,5 mm e máximo: 1,0 mm). Observou-se elevado percentual de valores acima do percentil 75 em relação ao referencial populacional (16 [76,2%]), sem diferença estatisticamente significante entre o gênero feminino e o masculino (11/15 [73,3%] vs. 5/6 [83,3%]; p=0.550). A comparação entre os ATM heterozigotos e os controles, estratificados por gênero, mostrou que, nos ATM heterozigotos, as mulheres tinham maiores concentrações de HDL-c em comparação aos homens, e valores mais elevados de PCR-us em relação às mulheres controle. Nos ATM heterozigotos, estratificando segundo gênero, a correlação entre HDL-c e PCR-us foi inversamente proporcional e mais forte entre as mulheres, com tendência à significância estatística. Conclusão: Os ATM heterozigotos não diferiram dos controles em relação aos biomarcadores estudados relacionados ao RC. Entretanto, a maioria deles apresentou aumento na espessura do CMIC, preditor independente de morte, risco para infarto do miocárdio e AVC, quando comparado ao referencial para a mesma faixa etária. Esse achado sugere RC nos ATM heterozigotos e aponta para a necessidade de monitoramento da espessura do CMIC e de orientações nutricionais.

Is age a risk factor for liver disease and metabolic alterations in ataxia Telangiectasia patients?

BACKGROUND: Ataxia telangiectasia (A-T) is a neurodegenerative disease that leads to mitochondrial dysfunction and oxidative stress. Insulin resistance (IR), type 2 diabetes and the risk for development of cardiovascular disease was recently associated as an extended phenotype of the disease. We aimed to assess IR; liver involvement; carotid intima-media thickness (cIMT) and metabolic alterations associated to cardiovascular risk in A-T patients, and relate them with age. RESULTS: Glucose metabolism alterations were found in 54.6% of the patients. Hepatic steatosis was diagnosed in 11/17 (64.7%) A-T patients. AST/ALT ratio > 1 was observed in 10/17 (58.8%). A strong positive correlation was observed between insulin sum concentrations with ALT (r = 0.782, p < 0.004) and age (r = 0.818, p = 0.002). Dyslipidemia was observed in 55.5% of the patients. The apolipoprotein (Apo-B)/ApoA-I ratio (r = 0.619; p < 0.01), LDL/HDL-c (r = 0.490; p < 0.05) and the Apo-B levels (r = 0.545; p < 0.05) were positively correlated to cIMT. CONCLUSIONS: Metabolic disorders implicated in cardiovascular and liver diseases are frequently observed in adolescent A-T patients and those tend to get worse as they become older. Therefore, nutritional intervention and the use of drugs may be necessary.

Lipid profile among girls with systemic lupus erythematosus.

The aim of the study was to describe biomarkers of lipid metabolism associated with increased cardiovascular risk and their correlation with disease variables and markers of inflammation in adolescent females with systemic lupus erythematosus (SLE). This cross-sectional controlled study evaluated 33 adolescent females with juvenile SLE and 33 healthy controls. Anthropometric data, SLE disease activity index (SLEDAI), medications, proteinuria, ultra-sensitive C-reactive protein (us-CRP), lipid profile (total cholesterol, LDL-c, HDL-c and triglycerides), apolipoproteins A and B (Apo A-I and B), paraoxonase, and myeloperoxidase were evaluated. Median age of the patients and the median disease duration were 16.7 years and 54 months, respectively. SLEDAI scores above 4 were observed in 11 (33.3 %) patients. Moreover, 12 (36.4 %) patients were overweight, and 5 (15.2 %) had low height for age ratios. Dyslipidemia was observed in 13 (39.4 %) patients and in 7 (21.2 %) controls with a decrease in HDL-c concentrations in SLE patients even after adjustment for their nutritional status. In the group with SLE, us-CRP concentrations were inversely correlated with LDL-c/ApoB ratio (p = 0.031). After multivariate regression analysis, the SLE group showed lower concentration of Apo A-I and a decreased LDL-c/ApoB ratio. SLE adolescent females with low disease activity, with preserved kidney function and on low dose of corticosteroids, regardless of nutritional status and food intake, have proatherogenic lipid biomarkers, which may contribute to an increased atherosclerotic risk.

Higher Cardiovascular Risk in Common Variable Immunodeficiency and X-Linked Agammaglobulinaemia Patients.

INTRODUCTION: Common variable immunodeficiency and X-linked agammaglobulinaemia are primary immunodeficiencies classified as antibody deficiencies, and they both result in hypogammaglobulinaemia. OBJECTIVE: Evaluate the lipid profile and other cardiovascular risk biomarkers in CVID and XLA patients. METHODS: In total, 24 patients and 12 healthy controls matched by age and gender were included in the study. We evaluated anthropometric measurements, and seric total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides (TG), apo A-I, small dense LDL (sdLDL), C-reactive protein (CRP), and tumour necrosis factor alpha (TNF-alpha), myeloperoxidase (MPO), cholesteryl ester transfer protein (CETP), and lecithin cholesterol acyltransferase (LCAT) were assessed. RESULTS: CRP (p = 0.008) and TNF-alpha (p < 0.001) concentrations were significantly higher, whereas HDL-c (p = 0.025) and apo A-I (p = 0.013) levels were significantly lower in patients than in the controls. In the patient group, a negative and significant correlation was observed between HDL-c and TNF-alpha (r = -0.406; p = 0.049) and between HDL-c and TG (r = -0.641; p = 0.001). CONCLUSION: Common variable immunodeficiency and X-linked agammaglobulinaemia patients presented themselves with increased inflammatory markers associated with a decreased HDL-c and apo A-I levels, which can predispose to a high cardiovascular risk.

Risk of Atherosclerosis in Patients with Ataxia Telangiectasia.

BACKGROUND AND AIMS: Evaluate the nutritional status, plasma concentration of vitamin E and markers of cardiovascular risk in ataxia telangiectasia (AT) patients. METHODS: Cross-sectional study with 13 patients with AT and 22 healthy controls, evaluating the following factors: nutritional status, food intake, lipid profile, plasma concentration of vitamin E, malondialdehyde and high sensitivity C-reactive protein, linking them with atherosclerosis risk in AT patients. RESULTS: Average age was 14.6 in the AT group, 30.8% were malnourished and 23.1% had stunting. A greater impairment of lean body mass was found in these patients. Concentrations of triglycerides (TG), total cholesterol (CT), LDL-c, non-HDL cholesterol (NHDL-c) were significantly higher in patients and HDL-c, lower. Vitamin E/total lipids and vitamin E/TG ratios were lower in the AT group, and significant inverse correlation between these ratios and NHDL-c, CT/HDL-c, and LDL-c/HDL-c, log TG/HDL-c was observed in the AT group. Alanine aminotransferase correlated directly and significantly with NHDL-c, CT/HDL-c and LDL-c/HDL-c, in patients. CONCLUSION: The alterations of lipid metabolism biomarkers suggestive of atherosclerotic risk of male AT patients coupled with lower vitamin E/total lipids ratio and low lean body mass may complicate the clinical course of the disease and emphasizes the importance of multidisciplinary care, routine monitoring of cardiovascular biomarkers and appropriate nutritional guidance.

Sleepiness, inflammation and oxidative stress markers in middle-aged males with obstructive sleep apnea without metabolic syndrome: a cross-sectional study.

BACKGROUND: The simultaneous occurrence of metabolic syndrome and excessive daytime sleepiness are very common in obstructive sleep apnea (OSA) patients. Both conditions, if present in OSA, have been reported to be associated with inflammation and disruption of oxidative stress balance that impair the cardiovascular system. To verify the impact of daytime sleepiness on inflammatory and oxidative stress markers, we evaluated OSA patients without significant metabolic disturbance. METHODS: Thirty-five male subjects without diagnostic criteria for metabolic syndrome (Adult Treatment Panel III) were distributed into a control group (n = 10) (43 ± 10.56 years, apnea-hypopnea index - AHI 2.71 ± 1.48/hour), a non-sleepy OSA group (n = 11) (42.36 ± 9.48 years, AHI 29.48 ± 22.83/hour) and a sleepy OSA group (n = 14) (45.43 ± 10.06 years, AHI 38.20 ± 25.54/hour). Excessive daytime sleepiness was considered when Epworth sleepiness scale score was ≥ 10. Levels of high-sensitivity C-reactive protein, homocysteine and cysteine, and paraoxonase-1 activity and arylesterase activity of paraoxonase-1 were evaluated. RESULTS: Patients with OSA and excessive daytime sleepiness presented increased high-sensitivity C-reactive protein levels even after controlling for confounders. No significant differences were found among the groups in paraoxonase-1 activity nor arylesterase activity of paraoxonase-1. AHI was independently associated and excessive daytime sleepiness tended to have an association with high-sensitivity C-reactive protein. CONCLUSIONS: In the absence of metabolic syndrome, increased inflammatory response was associated with AHI and daytime sleepiness, while OSA was not associated with abnormalities in oxidative stress markers.

Lack of association of homocysteine concentrations with oxidative stress, alterations in carotid intima media thickness and endothelial reactivity in prepubertal children.

BACKGROUND AND AIMS: Our purpose was to assess the presence of risk factors for cardiovascular diseases (alterations in the lipid profile, fasting glycaemia, high arterial pressure values, oxidative stress, increased intima media thickness and impaired endothelium-dependent vasodilation) in prepubertal children with elevated homocysteine (Hcy) levels. METHODS: In a cross-sectional study, 35 children with Hcy levels ≥7.3 µmol/l were matched by gender and age with 29 children with Hcy levels ≤4.1 µmol/l. Our collected data included weight, height, waist circumference, systemic arterial pressure, lipid profile, fasting glycaemia and oxidative stress markers. A Doppler ultrasound was performed to measure the carotid intima media thickness and the endothelium-dependent vasodilation of the brachial artery. RESULTS: There were no statistically significant differences between the groups regarding the lipid profile and fasting glycaemia, blood pressure or oxidative stress. Overweight and obesity (body mass index z-score > +1) were more frequent in the group with Hcy ≥7.3 µmol/l when compared to the group with Hcy ≤4.1 µmol/l [13/35 (37.1%) vs. 4/29 (13.8%); p = 0.035]. After adjusting for nutritional status, there were no differences in the intima media thickness and endothelium-dependent vasodilation between children with high and low Hcy levels. CONCLUSIONS: Among the cardiovascular risk factors investigated in the present study, which was based on prepubertal children, only overweight and obesity were associated with increased Hcy concentrations (≥7.3 µmol/l).

There is no relationship between Paraoxonase serum level activity in women with endometriosis and the stage of the disease: an observational study.

BACKGROUND: Endometriosis is a chronic condition whose pathophysiology is unknown, but there is evidence suggesting a link with oxidative stress. Paraoxonase is a serum enzyme which circulates associated with high-density lipoprotein (HDL). It acts protecting HDL and LDL of lipid peroxidation. We aimed to compare the serum levels of PON-1 activity in women with endometriosis in different stages of the disease (minimal/mild and moderate/severe). METHODS: 80 infertile women with endometriosis diagnosed by laparoscopy/laparotomy with histologic confirmation of the disease were divided according to the American Society for Reproductive Medicine classification in minimal/mild (n = 33) and moderate/severe (n = 47) cases. Paraoxonase activity and arilesterase activity were measured by spectrophotometry. Body mass index and fasting glucose levels were also determined. RESULTS: The paraoxonase activity were 191.29 ± 22.41 U/l in women with minimal/mild endometriosis and 224.85 ± 21.50 U/l in women with moderate/severe disease (P = 0.274). Considering arilesterase level, the results showed 89.82 ± 4.61 U/l in women with minimal/mild endometriosis and 90.78 ± 3.43 U/l in moderate/severe disease (P = 0.888). CONCLUSIONS: Evidence of lower paraoxonase activity in women with endometriosis was not found in this study. Besides, no difference was found considering minimal/mild or moderate/severe endometriosis.

Homocysteine and cysteine levels in prepubertal children: association with waist circumference and lipid profile.

OBJECTIVE: To evaluate homocysteine and total cysteine levels in prepubertal children and to determine the association between these levels and obesity, increased waist circumference, glucose levels, and lipid profile alterations. METHODS: Using a cross-sectional study, 677 prepubertal students 6 to 11 y old were assessed. The weight, height, and waist circumference of the students were measured. Laboratory analyses included triacylglycerols, total cholesterol and its fractions, glucose, vitamin B12, folate, homocysteine, and cysteine. Chi-square tests and logistic regression (forward-stepwise) were used for statistical analysis; the significance level was set at 5%. RESULTS: The median age of the students was 8.9 y (6.5-11.5), and the prevalences of overweight and obesity were 90 in 677 (13.3%) and 81 in 677 (12.0%), respectively. An increase in waist circumference was observed in 180 of 677 children (26.6%). Inadequate levels of low-density lipoprotein cholesterol, triacylglycerols, and high-density lipoprotein cholesterol were found in 95 (14.0%), 129 (19.1%), and 179 (26.4%) of the 677 students, respectively. The median homocysteine and total cysteine plasma levels were 5.6 µmol/L (0.1-11.7) and 365.7 µmol/L (191.5-589.2), respectively. A multivariate analysis showed that children with a waist circumference above the 90th percentile (7.3 µmol/L) were 2.4 times (95% confidence interval 1.4-4.0) more likely to have increased homocysteine levels and that children with increased waist circumferences and those with high low-density lipoprotein cholesterol levels were 2.7 (95% confidence interval 1.6-4.6) and 2.1 (95% confidence interval 1.1-4.0) times more likely, respectively, to have total cysteine levels above the 90th percentile (445.0 µmol/L). CONCLUSION: The association of abdominal obesity in prepuberty with levels of homocysteine and cysteine found in this study of a prepubertal population could be an early and independent predictor of cardiovascular risk.

Homocysteine levels in Takayasu arteritis -- a risk factor for arterial ischemic events.

OBJECTIVE: To evaluate homocysteine levels in patients with Takayasu arteritis (TA) and in controls, and to analyze associations between homocysteine levels and paraoxonase 1 (PON1) activity, cysteine levels, methotrexate use, disease activity, extent of arterial involvement, and ischemic events in patients with TA. METHODS: A cross-sectional study was performed with 29 patients with TA and 30 controls who underwent clinical evaluation and blood sample collection in the fasting state. RESULTS: Among patients with TA, active disease was observed in 9 (31.0%) and previous arterial ischemic events in 10 (34.5%). Therapy with methotrexate was prescribed to 9 (31.0%) patients and it was associated with folic acid in 8 cases. Median homocysteine level was higher in patients with TA [10.9 µmol/l, interquartile range (IQR) 9.6-14.8] than in controls (6.9 µmol/l, IQR 5.1-11.9; p < 0.001). No difference was found regarding mean homocysteine levels between those using methotrexate and those under other therapies (12.8 ± 5.3 µmol/l vs 12.1 ± 3.2 µmol/l, respectively; p = 0.662). TA patients with active disease presented lower homocysteine levels (10.4 ± 2.1 µmol/l) compared to TA patients in remission (13.1 ± 4.2 µmol/l) (p = 0.034). A significant correlation was found between cysteine and homocysteine levels in patients with TA (ρ = 0.676, p < 0.0001), while there was no correlation between homocysteine and PON1 activity (ρ = 0.214, p = 0.265). Median homocysteine levels were higher in patients with ischemic events (13.2 µmol/l, IQR 10.9-17.5) compared to patients with no ischemic events (9.8 µmol/l, IQR 8.7-14.7; p = 0.027) and were associated with arterial ischemia in patients with TA (OR 1.31, 95% CI 1.01-1.71, p = 0.041). CONCLUSION: Patients with TA presented higher homocysteine levels than controls and homocysteine was associated with an increased risk of arterial ischemic events in TA.

Evaluation of chemiluminescence method for the analysis of plasma homocysteine and comparison with HPLC method in children samples / Avaliação do método de quimioluminescência na análise de homocisteína plasmática e sua comparação com o método de HPLC em amostras de crianças

Objective: To compare the results for homocysteine concentration using chemiluminescence and HPLC methods in samples from school-age children. In addition, to determine the reference values for patients of this age group and assess the real prognostic value of homocysteine in healthy children. Methods: A prospective observational study was undertaken to determine plasma levels of homocysteine using two different assays, HPLC and chemiluminescence, in 185 samples from school-age children living in Santo Andre, with no chronic or inflammatory diseases, and absence of pubertal development. Results: The results were presented in percentiles and reference values were determined within this age group (7-9 years old). Homocysteine concentration ranged from 2.0 to 9.9 mumol/l (r = 0.821 and p < 0.001). Conclusions: It was verified that chemiluminescence is comparable to HPLC when both techniques are used to detect homocysteine in school-age children. There is an important correlation between both methods, which allows investigation of this amino acid as a risk factor for heart diseases.

Objetivo: Comparar os resultados da concentração de homocisteína usando os métodos de quimioluminescência e HPLC em amostras de crianças escolares. Determinar os valores de referência desse grupo etário e avaliar o valor prognóstico real da homocisteína em crianças saudáveis. Métodos: Um estudo prospectivo observacional foi executado para determinar os níveis de homocisteína usando dois ensaios diversos, o HPLC e a quimioluminescência, em 185 amostras de crianças em idade escolar moradoras da cidade de Santo André, que não apresentassem doenças crônicas ou inflamatórias, na ausência de desenvolvimento puberal. Resultados: Os resultados foram apresentados em percentis e os valores de referência foram determinados para esse grupo etário (7-9 anos). As concentrações de homocisteína variaram de 2,0 a 9,9 miumol/l (r = 0,821 e p < 0,001). Conclusões: Verificamos que o método da quimioluminescência é comparável ao método HPLC quando as técnicas são usadas para detectar a homocisteína em crianças em idade escolar. Houve importante correlação entre os dois métodos, o que permite a investigação desse aminoácido como um fator de risco para doenças cardíacas.

Lipodystrophy, lipid profile changes, and low serum retinol and carotenoid levels in children and adolescents with acquired immunodeficiency syndrome.

OBJECTIVE: To assess serum retinol and levels of carotenoids in children and adolescents with acquired immunodeficiency syndrome (AIDS) and to correlate low serum retinol and carotenoid levels with the presence of lipodystrophy, lipid profile changes, lipid peroxidation, and insulin resistance. METHODS: A cross-sectional, controlled observational study was carried out with 30 children and adolescents with AIDS (mean age 9.1 y) receiving antiretroviral therapy (median length of treatment 28.4 mo), including 30 uninfected healthy controls matched for age and gender. Clinical and laboratory assessments were performed to determine nutritional status, presence of lipodystrophy, serum concentrations of retinol, beta-carotene, lycopene, lipid profile (high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols), lipid peroxidation (thiobarbituric acid-reactive substances), glycemia, and serum insulin (homeostasis model assessment for insulin resistance, cutoff point >3). Statistical analysis was done with chi-square test and Student's t test. RESULTS: Lipodystrophy was observed in 53.3% of patients with AIDS, and dyslipidemia was detected in 60% and 23% of subjects with human immunodeficiency virus and control subjects, respectively (P = 0.004). A higher prevalence of retinol deficiency (60% versus 26.7%, P = 0.009) and beta-carotene deficiency (23.3% versus 3.3%, P = 0.026) was found in the group with human immunodeficiency virus than in the control group. No correlation was found for low retinol and beta-carotene levels, changes in lipid and glucose metabolism, or lipodystrophy in children and adolescents with AIDS. CONCLUSION: Despite the high frequency of dyslipidemia, lipodystrophy, and retinol and beta-carotene deficiencies, it was not possible to demonstrate a correlation of these findings with lipid peroxidation and insulin resistance. More studies are needed to investigate the causes of retinol and beta-carotene deficiencies in this population and the clinical consequences of these findings.

Evaluation of chemiluminescence method for the analysis of plasma homocysteine and comparison with HPLC method in children samples.

OBJECTIVE: To compare the results for homocysteine concentration using chemiluminescence and HPLC methods in samples from school-age children. In addition, to determine the reference values for patients of this age group and assess the real prognostic value of homocysteine in healthy children. METHODS: A prospective observational study was undertaken to determine plasma levels of homocysteine using two different assays, HPLC and chemiluminescence, in 185 samples from school-age children living in Santo Andre, with no chronic or inflammatory diseases, and absence of pubertal development. RESULTS: The results were presented in percentiles and reference values were determined within this age group (7-9 years old). Homocysteine concentration ranged from 2.0 to 9.9 µmol/l (r = 0.821 and p < 0.001). CONCLUSIONS: It was verified that chemiluminescence is comparable to HPLC when both techniques are used to detect homocysteine in school-age children. There is an important correlation between both methods, which allows investigation of this amino acid as a risk factor for heart diseases.

Non-alcoholic fatty liver disease in overweight children and its relationship with retinol serum levels.

OBJECTIVES: To evaluate the frequency of non-alcoholic fatty liver disease, the retinol serum levels, lipid profile, and insulin resistance in overweight/obese children. To relate these biochemical variables with the risk of this disease in the population studied. METHODS: The study was cross-sectional and prospective, with 46 overweight/obese school children (28 female, 18 male; mean age 8.6 years). The control group consisted of 45 children, paired by age and gender. Hepatic steatosis, evaluated by ultrasound, was classified as normal, mild, moderate, or severe. Also evaluated were serum retinol levels; thiobarbituric acid reactive substances; lipid profile; and fasting glucose and serum insulin levels, used for the calculation of the Homeostasis Model Assessment. RESULTS: Hepatic ultrasound alterations were found in 56.5% and 48,9% of the overweight/obese and control group children, respectively. Presence of obesity was associated with high levels of triglycerides (OR = 4.6; P = 0.002). In the studied children, the risk of steatosis was related to a trend to a higher percentage of retinol inadequacy (OR = 2.8; p = 0.051); there was no association with thiobarbituric acid reactive substances, lipid profile, or insulin resistance. CONCLUSIONS: The high frequency of non-alcoholic fatty liver disease in both groups, evaluated by hepatic ultrasound, in low-socioeconomic level children, independent of nutritional condition and without significant association with insulin resistance, emphasizes that especially in developing countries, other risk factors such as micronutrient deficiencies (e.g. vitamin A) are involved.

Doença hepática gordurosa não alcoólica em escolares obesos / Nonalcoholic fatty liver disease in obese children

OBJETIVO: Avaliar a prevalência de alterações hepáticas ao ultra-som e de elevação da alanina aminotransferase (ALT) em crianças com sobrepeso e obesidade, além de relacionar a presença de alterações com peroxidação lipídica, perfil lipídico e resistência insulínica. MÉTODOS: Estudo transversal, prospectivo e controlado de 67 crianças com sobrepeso/obesidade (38 do sexo feminino e média de idade de 8,6 anos), pareadas por sexo e idade com 65 eutróficas. A avaliação bioquímica consistiu de perfil lipídico (LDL-c, HDL-c e triglicerídeos); ALT; substâncias reativas ao ácido tiobarbitúrico (TBARS); glicemia e insulina, utilizadas para o cálculo do Homeostasis Model Assessment Insulin Resistance (HOMA-IR). A esteatose hepática, avaliada por ultra-sonografia por um único examinador, foi classificada em difusa leve, moderada e grave. RESULTADOS: Elevação de ALT (>40U/L) foi encontrada em 3 por cento e alterações ultra-sonográficas do fígado em 57,4 por cento das crianças com sobrepeso e obesidade. O Grupo Sobrepeso/Obesidade apresentou maior percentual de ALT >18U/L (OR 4,2; p=0,0006) e de hipertrigliceridemia (OR 4,2; p<0,001), em relação ao controle. A ALT associou-se com aumento de triglicerídeos séricos (OR 3,2; p=0,010). Não houve associação entre os níveis de TBARS (estresse oxidativo) e do HOMA-IR com a presença de sobrepeso/obesidade, nem com ALT >18U/L. CONCLUSÕES: A freqüência de ALT >40U/L foi baixa e a de esteatose foi alta. As alterações ultra-sonográficas hepáticas não mostraram associação com o estado nutricional nem com os níveis de ALT. Por sua vez, triglicerídeos aumentados associaram-se com níveis mais elevados de ALT.

OBJECTIVE: To evaluate the prevalence of altered hepatic ultrasound and elevated serum alanine aminotransferase (ALT) in overweight and obese children, as well as to relate them to lipid peroxidation, lipid profile and insulin resistance. METHODS: A prospective, controlled, cross-sectional study was performed with 67 overweight and obese children (38 female, mean age of 8,6 years) paired by gender and age with 65 eutrophic controls. The following parameters were evaluated: lipid profile (LDL-c, HDL-c, triglycerides), ALT, lipid peroxidation measured by thiobarbituric acid reaction substance (TBARS), serum glucose and insulin resistance (Homeostasis Model Assessment). Hepatic steatosis was evaluated by ultrasound by a single professional and classified as diffuse mild, moderate or severe. RESULTS: Elevated ALT (>40 U/L) was observed in 3 percent and altered ultrasound in 57.4 percent of the overweight/obese children. Obese/overweight children showed a higher percentage of ALT >18 U/L (OR 4.2, p=0.0006) and hypertriglyceridemia (OR 4.2, p<0.001). ALT was associated with elevated triglycerides (OR 3,2; p=0,010). There was not association between TBARS (oxidative stress) or HOMA-IR with the presence of overweight/obesity or ALT >18 U/L. CONCLUSIONS: The frequency of altered ALT (>40U/L) was low and of altered hepatic ultrasound was high. There was no association between fatty liver at ultrasound with nutritional status or ALT levels. Elevated triglycerides were associated with higher levels of ALT.