Associação entre deficiência de vitamina D, adiposidade e exposição solar em participantes do sistema de hipertensão arterial e diabetes melito / Association between vitamin D deficiency, adiposity and solar exposure in participants with arterial hypertension and diabetes mellitus

Atualmente, diversos estudos demonstram uma relação entre deficiência de vitamina D e diabetes melito tipo 2, obesidade e hipertensão arterial. A principal causa de deficiência de vitamina D é a falta de exposição solar adequada. O objetivo deste estudo foi avaliar os níveis séricos de vitamina D e sua associação com ingestão de vitamina D, composição corporal e exposição solar em pacientes participantes do Sistema de Hipertensão e Diabetes da cidade de Cascavel, PR. Participaram 304 adultos e idosos, de ambos os sexos, e foram avaliados os dados demográficos e antropométricos, hábitos de vida, presença de doenças prévias, dietética e a dosagem de vitamina D sérica. Utilizou-se do teste qui quadrado para verificação de associação e aderência e o teste de Kruskal-Wallis para comparação de medianas entre as variáveis estudadas. Verificou-se deficiência sérica de 25-hidroxivitamina D [25(OH)D] (<20ng/mL) em 52,6%, excesso de peso em 73,4%, aumento na circunferência abdominal em 77,6% e na percentagem de gordura corporal em 95,6% dos pacientes. Não houve associação entre a ingestão e os níveis séricos de vitamina D. Houve associação significativa entre circunferência abdominal (p<0,05), hipertensão arterial (p>0,001) e exposição solar inadequada (p<0,001) com os diferentes níveis séricos de vitamina D. Os pacientes com níveis séricos desejáveis de vitamina D apresentaram menores valores de índice de massa corpórea (p<0,03), de circunferência abdominal (p<0,01) e maior tempo de exposição solar (p=0,01). Este estudo verificou uma alta frequência de hipovitaminose D, sendo esta, associada com a diminuição de exposição solar e com adiposidade.

Currently, several studies have shown a relationship between vitamin D deficiency and type 2 diabetes mellitus, obesity and hypertension. The major cause of vitamin D deficiency is the lack of adequate sun exposure. The objective of the study was to evaluate serum vitamin D level and to verify its association with vitamin D ingestion, body composition and solar exposure in patients participating in the Hypertension and Diabetes System in Cascavel, PR. A total of 304 adult and elder patients from both genders participated in the study. Demographic and anthropometric data, lifestyle, presence of previous diseases, dietary and serum levels of vitamin D were evaluated. We used the chi square test for association verification and compliance and the Kruskal-Wallis test to compare medians between variables. It was verified serum 25-hydroxyvitamin D (25(OH)D) deficiency (<20ng/mL) in 52.6%, overweight and obesity in 73.4%, increase in abdominal circumference in 77.6% and in body fatpercentage in 95.6% of the patients. There was no association between ingestion and serum vitamin D levels. Significant association was found between abdominal circumference (p<0.05), hypertension (p=0.0006) and inadequate solar exposure (p<0.001) with serum vitamin D different levels. There was a high frequency of hypovitaminosis D and association with lower solar exposure and adiposity.

Evaluation of Agaricus blazei in vivo for antigenotoxic, anticarcinogenic, phagocytic and immunomodulatory activities.

The development of various types of cancer results from the interaction among endogenous, environmental and hormonal factors, where the most notable of these factors is diet. The aim of the present study was to determine the antigenotoxic, anticarcinogenic, phagocytic and immunomodulatory activities of Agaricus blazei. The test antigenotoxicity (Comet Assay) and anticarcinogenic (Test of Aberrant Crypt Foci) assess changes in DNA and/or intestinal mucosa that correlate to cancer development. Tests of phagocytosis in the spleen and differential count in blood cells allow the inference of modulation of the immune system as well as to propose a way of eliminating cells with DNA damage. Supplementation with the mushroom was carried out under pre-treatment, simultaneous treatment, post-treatment and pre-treatment+continuous conditions. Statistical analysis demonstrated that the mushroom did not have genotoxic activity but showed antigenotoxic activity. Supplementation caused an increase in the number of monocytes and in phagocytic activity, suggesting that supplementation increases a proliferation of monocytes, consequently increasing phagocytic capacity especially in the groups pre-treatment, simultaneous and pre-treatment+continuous. The data suggest that A. blazei could act as a functional food capable of promoting immunomodulation which can account for the destruction of cells with DNA alterations that correlate with the development of cancer, since this mushroom was demonstrated to have a preventive effect against pre-neoplastic colorectal lesions evaluated by the aberrant crypt foci assay. According to these results and the literature, it is believed that supplementation with A. blazei can be an efficient method for the prevention of cancer as well as possibly being an important coadjuvant treatment in chemotherapy.

Nitric oxide enhancement and blood pressure decrease in patients with metabolic syndrome using soy protein or fish oil.

OBJECTIVE: To verify the effects of fish oil and soy on nitric oxide (NO) and blood pressure in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: Sixty women with MS were investigated in a parallel randomized design study. The first group maintained their usual diet; the second group received 25 g/day of soy; the third group received 3 g/day of n-3 fatty acids, and the fourth group the same amount previously cited of n-3 fatty acids and soy. RESULTS: Serum nitric oxide metabolites showed significant increase after 90 days in the fish oil and soy groups. Systolic pressure reduced after 45 days of treatment with fish oil, whereas diastolic pressure decreased significantly throughout the study in the soy group. CONCLUSIONS: NO increase and blood pressure reduction with fish oil or soy protein reinforce the importance of the influence of NO on blood pressure in patients with MS.

[Effect of n-3 fatty acids in glycemic and lipid profiles, oxidative stress and total antioxidant capacity in patients with the metabolic syndrome]. / Efeito dos ácidos graxos n-3 no perfil glicêmico e lipídico, no estresse oxidativo e na capacidade antioxidante total de pacientes com síndrome metabólica.

OBJECTIVE: Metabolic syndrome (MS) is a cluster of factors which favors the development of cardiovascular diseases. Previous studies have shown that polyunsaturated fatty acids (PUFAs) can improve some of these factors. This study aimed to evaluate the effect of fish oil on glucose and lipid profiles, oxidative stress and total antioxidant capacity (TRAP) in patients with MS. SUBJECTS AND METHODS: We conducted a clinical trial in 40 patients with the MS (20 controls and 20 patients receiving 3 g/day of PUFAs). SUBJECTS AND RESULTS: The group that received treatment showed a significant decrease in levels of triglycerides and increased in TRAP, but they had a significant increase in LDL, glucose and insulin resistance. CONCLUSION: We conclude that intake of fish oil resulted in decreased levels of triglycerides and increased the TRAP of patients with MS; however, increased LDL levels and insulin resistance, were observed.

Nitric oxide enhancement and blood pressure decrease in patients with metabolic syndrome using soy protein or fish oil / Aumento de óxido nítrico e diminuição da pressão sanguínea em pacientes com síndrome metabólica em uso de proteína de soja ou óleo de peixe

OBJECTIVE: To verify the effects of fish oil and soy on nitric oxide (NO) and blood pressure in patients with metabolic syndrome (MS). SUBJECTS AND METHODS: Sixty women with MS were investigated in a parallel randomized design study. The first group maintained their usual diet; the second group received 25 g/day of soy; the third group received 3 g/day of n-3 fatty acids, and the fourth group the same amount previously cited of n-3 fatty acids and soy. RESULTS: Serum nitric oxide metabolites showed significant increase after 90 days in the fish oil and soy groups. Systolic pressure reduced after 45 days of treatment with fish oil, whereas diastolic pressure decreased significantly throughout the study in the soy group. CONCLUSIONS: NO increase and blood pressure reduction with fish oil or soy protein reinforce the importance of the influence of NO on blood pressure in patients with MS.

OBJETIVO: Verificar o efeito do óleo de peixe e soja sobre o óxido nítrico (NO) e a pressão arterial em pacientes com síndrome metabólica (SM). SUJEITOS E MÉTODOS: Sessenta mulheres com SM foram avaliadas em estudo paralelo randomizado. O primeiro grupo manteve sua dieta habitual, o segundo grupo recebeu 25 g/dia de soja, o terceiro grupo recebeu 3 g/dia de ácidos graxos n-3 e o quarto grupo, a mesma quantidade citada anteriormente de ácidos graxos n-3 e soja. RESULTADOS: Os níveis séricos de metabólitos de NO foram significativamente superiores após 90 dias de intervenção com soja ou óleo de peixe. Somente o grupo que recebeu o óleo de peixe apresentou redução na pressão sistólica após 45 dias. Já a soja reduziu a pressão diastólica em 45 e 90 dias. CONCLUSÕES: O aumento de NO e a redução da pressão arterial com óleo de peixe ou proteína de soja reforçam a influência do óxido nítrico sobre a pressão arterial em pacientes com SM.

[Nutritional and metabolic evaluation of patients after one year of gastric bypass surgery]. / Repercussão da perda de peso sobre parâmetros nutricionais e metabólicos de pacientes obesos graves após um ano de gastroplastia em Y-de-Roux.

OBJECTIVE: To assess nutritional and metabolic evolution and inflammatory activity in severe obese patients submitted to bariatric surgery. METHODS: This prospective study evaluated 56 patients (50 female and 6 male), mean age 40 + or - 9,9 years, submitted to RYGB. Nutritional, metabolic, and inflammatory parameters were assessed prior to and 12 months postsurgery. RESULTS: It was verified significant decreases in weight loss in relation to baseline values from 138 + or - 28,8 to 90 + or - 19,5 kg (p< 0,0001), glucose levels from 116 + or - 47,3 to 84 + or - 9,8 mg/dL (p< 0,0001), triacylglycerol levels from 137 + or - 61,4 to 84 + or - 38,6 mg/dL (p< 0,0001), and also in total cholesterol from 189 + or - 41,6 to 166 + or - 36,4 mg/dL (p< 0,0001) and LDL-cholesterol from 119 + or - 36,1 to 104 + or - 30,7 mg/dL (p< 0,0005). C-reactive protein levels reduced from 11,33 + or - 10,82 to 3,62 + or - 4,49 mg/dL (p< 0,0001). Although maintenance of iron levels was verified after one year, there was a significant decrease in hemoglobin from 13 + or - 1,3 to 12 + or - 1,4 g/dL (p< 0,01), and reduction in ferritin levels, especially in women who showed a decrease from 101,2 + or - 123,3 to 85,0 + or - 101,9 (p< 0,03). CONCLUSION: Therefore, weigh loss in patients with severe obese after RYGB showed improvement in both metabolic and inflammatory status and may reduce substantially co-morbidities associated with increased cardiovascular risk.

Repercussão da perda de peso sobre parâmetros nutricionais e metabólicos de pacientes obesos graves após um ano de gastroplastia em Y-de-Roux / Nutritional and metabolic evaluation of patients after one year of gastric bypass surgery

OBJETIVO: Avaliar a evolução metabólico-nutricional e a atividade inflamatória em pacientes com obesidade grave submetidos à cirurgia bariátrica. MÉTODOS: Realizou-se um estudo prospectivo em 56 pacientes (50 mulheres e seis homens), apresentando média de idade de 40 +/- 9,9 anos, submetidos à RYGB. Avaliação metabólica e nutricional e da atividade inflamatória foram verificadas antes, seis e 12 meses após o procedimento cirúrgico. RESULTADOS: Verificou-se redução significativa nos valores iniciais, em relação à perda de peso de 138 ± 28,8 to 90 ± 19,5 kg (p< 0,0001), glicemia de 116 ± 47,3 to 84 ± 9,8 mg/dL (p< 0,0001), níveis de triacilglicerol de 137 ± 61,4 to 84 ± 38,6 mg/dL (p< 0,0001), colesterol total de 189 ± 41,6 to 166 ± 36,4 mg/dL (p< 0,0001) e LDL-colesterol de 119 ± 36,1 para 104 ± 30,7 mg/dL (p< 0,0005). Os níveis de proteína C-reativa reduziram de 11,33 ± 10,82 para 3,62 ± 4,49 mg/dL (p< 0,0001). Embora os níveis de ferro tenham permanecido dentro do limite de normalidade, após um ano, observou-se diminuição significativa na hemoglobina de 13 ± 1,3 para 12 ± 1,4 g/dL (p< 0,01), e redução nos níveis de ferritina, particularmente nas mulheres, que apresentou queda de 101,2 ± 123,3 para 85,0 ± 101,9 g/dL (p< 0,03). CONCLUSÃO: A melhora verificada no estado metabólico e inflamatório concomitantemente após tratamento cirúrgico pode reduzir substancialmente as co-morbidades associadas com o risco cardiovascular aumentado.

OBJECTIVE: To assess nutritional and metabolic evolution and inflammatory activity in severe obese patients submitted to bariatric surgery. METHODS: This prospective study evaluated 56 patients (50 female and 6 male), mean age 40 ± 9,9 years, submitted to RYGB. Nutritional, metabolic, and inflammatory parameters were assessed prior to and 12 months postsurgery. RESULTS: It was verified significant decreases in weight loss in relation to baseline values from 138 ± 28,8 to 90 ± 19,5 kg (p< 0,0001), glucose levels from 116 ± 47,3 to 84 ± 9,8 mg/dL (p< 0,0001), triacylglycerol levels from 137 ± 61,4 to 84 ± 38,6 mg/dL (p< 0,0001), and also in total cholesterol from 189 ± 41,6 to 166 ± 36,4 mg/dL (p< 0,0001) and LDL-cholesterol from 119 ± 36,1 to 104 ± 30,7 mg/dL (p< 0,0005). C-reactive protein levels reduced from 11,33 ± 10,82 to 3,62 ± 4,49 mg/dL (p< 0,0001). Although maintenance of iron levels was verified after one year, there was a significant decrease in hemoglobin from 13 ± 1,3 to 12 ± 1,4 g/dL (p< 0,01), and reduction in ferritin levels, especially in women who showed a decrease from 101,2 ± 123,3 to 85,0 ± 101,9 (p< 0,03). CONCLUSION: Therefore, weigh loss in patients with severe obese after RYGB showed improvement in both metabolic and inflammatory status and may reduce substantially co-morbidities associated with increased cardiovascular risk.

Increased oxidative stress, decreased total antioxidant capacity, and iron overload in untreated patients with chronic hepatitis C.

The aim of this study was to determine oxidative stress in patients with untreated chronic hepatitis C (CHC), relating the obtained results with iron status and disease activity markers. Two groups (CHC patients and controls) were studied. CHC patients presented significantly higher values than the control group in some parameters: ALT, AST, GGT, iron, ferritin, and transferrin saturation, and also in tert-butyl hydroperoxide initiate chemiluminescence and thiobarbituric acid-reactive substances (TBARS) as well as lower values in total radical-trapping antioxidant parameter (TRAP). TBARS showed a significant correlation with serum AST and with transferrin saturation, whereas TRAP correlated inversely with serum albumin. Serum ferritin correlated with ALT and GGT, whereas serum iron did so with GGT. In conclusion, lower antioxidant capacity, higher levels of pro-oxidants activity, and iron overload occur in untreated patients with CHC. This greater oxidative activity could play an important role in pathogenesis and evolution of hepatitis C and thus further investigations.

Efeito dos ácidos graxos n-3 no perfil glicêmico e lipídico, no estresse oxidativo e na capacidade antioxidante total de pacientes com síndrome metabólica / Effect of n-3 fatty acids in glycemic and lipid profiles, oxidative stress and total antioxidant capacity in patients with the metabolic syndrome

OBJETIVO: A síndrome metabólica (SM) é um conjunto de fatores que favorecem o desenvolvimento de doenças cardiovasculares. Estudos prévios demonstram que os ácidos graxos poliinsaturados (PUFAs) podem melhorar alguns desses fatores. O objetivo foi avaliar o efeito do óleo de peixe rico em PUFAs nos perfis glicêmico e lipídico, no estresse oxidativo e na capacidade antioxidante total (TRAP) no plasma em pacientes com SM. SUJEITOS E MÉTODOS: Foi realizado um ensaio clínico em 40 pacientes com SM (20 controles e 20 pacientes que consumiram 3 g/dia de PUFAs). RESULTADOS: O grupo que recebeu tratamento apresentou redução significativa nos níveis de triacilgliceróis e aumento no TRAP, mas sofreu aumento nos níveis de LDL, glicose e na resistência à insulina. CONCLUSÃO: Conclui-se que a ingestão de óleo de peixe foi capaz de diminuir os níveis de triacilgliceróis e aumentar o TRAP de pacientes com SM, porém verificou-se aumento nos níveis de LDL e na resistência à insulina.

OBJECTIVE: Metabolic syndrome (MS) is a cluster of factors which favors the development of cardiovascular diseases. Previous studies have shown that polyunsaturated fatty acids (PUFAs) can improve some of these factors. This study aimed to evaluate the effect of fish oil on glucose and lipid profiles, oxidative stress and total antioxidant capacity (TRAP) in patients with MS. SUBJECTS AND METHODS: We conducted a clinical trial in 40 patients with the MS (20 controls and 20 patients receiving 3 g/day of PUFAs). SUBJECTS AND RESULTS: The group that received treatment showed a significant decrease in levels of triglycerides and increased in TRAP, but they had a significant increase in LDL, glucose and insulin resistance. CONCLUSION: We conclude that intake of fish oil resulted in decreased levels of triglycerides and increased the TRAP of patients with MS; however, increased LDL levels and insulin resistance, were observed.

Ingestão de lipídios na dieta e indicadores antropométricos de adiposidade em policiais militares / Dietary fats and measures of adiposity in military policemen

OBJETIVO: Investigar se há relação entre a ingestão de lipídios e os indicadores antropométricos de adiposidade em policiais militares do Município de Cascavel, (PR). MÉTODOS: A amostra constituiu-se de 183 policiais militares do sexo masculino do 6º Batalhão da Polícia Militar de Cascavel (PR), com idade entre 21 e 50 anos. Avaliou-se o peso, a estatura, o índice de massa corporal, a circunferência abdominal e a ingestão alimentar, por meio do recordatório de 24horas. Relacionaram-se os resultados de ingestão de lipídios da dieta com os indicadores antropométricos índice de massa corporal, circunferência abdominal e percentual de gordura corporal. RESULTADOS: O diagnóstico nutricional mais freqüente em 117 (63,9 por cento) dos policiais, segundo o índice de massa corporal, foi de sobrepeso e obesidade; 22 (12,0 por cento) apresentaram risco elevado para complicações metabólicas associadas à obesidade pelo indicador circunferência abdominal e 26 (18,6 por cento) elevado percentual de gordura corporal. A ingestão de lipídios se mostrou aumentada em 53 (70,7 por cento) dos 75 inquéritos validados, no entanto apenas 24 (32,0 por cento) ingeriam lipídios saturados acima da recomendação. Houve correlação positiva apenas entre a ingestão de lipídios totais e o indicador antropométrico de adiposidade circunferência abdominal (p=0,03). CONCLUSÃO: Este estudo sugere que a ingestão de lipídios acima das recomendações pode ser um fator relacionado à adiposidade abdominal na população estudada.

OBJECTIVE: The objective of this study was to investigate whether there is any relationship between dietary fats and measures of adiposity in military policemen from Cascavel (PR), Brazil. METHODS: The study evaluated 183 male military policemen from the 6th. Military Police Force of Cascavel (PR), aged from 21 to 50 years. Weight, height, body mass index and waist circumference were measured and food intake was determined by the 24-hour dietary recall. Dietary fats were related with the anthropometric indicators body mass index, waist circumference and percentage of body fat. RESULTS: The most common nutritional diagnoses found in 117 (63.9 percent) of the policemen were overweight and obesity. Waist circumference showed that 22 (12.0 percent) of these men were at high risk of metabolic complications associated with obesity and 26 (18.6 percent) had high body fat percentiles. Fat intake was high in 53 (70.7 percent) of the 75 validated surveys, however, only 24 (32.0 percent) ingested saturated fats above the recommended levels. There was a positive correlation only between total fat intake and the anthropometric indicator waist circumference (p=0.03). CONCLUSION: This study suggests that fat intake above the recommended levels may be associated with abdominal adiposity in this population.

Decreased total antioxidant capacity in plasma, but not tissue, in experimental colitis.

The aim of the present work was to compare colonic mucosa and plasmatic oxidative stress measured concomitantly and with different degrees of injury in rats with colitis induced by trinitrobenzene sulfonic acid. Three groups were studied: control group, colitis group, and colitis exacerbated by diclofenac. Enzymatic markers of colon injury showed enhanced activity in both groups with colitis. The colitis group treated with diclofenac presented higher colonic damage score than the other groups. In both groups with colitis, higher values of tert butyl hydroperoxide-initiated-chemiluminescence and thiobarbituric acid-reactive substances in tissue and decreased total radical-trapping antioxidant potential (TRAP) levels in plasma were found. In conclusion, independently of the degree of colonic mucosa injury and inflammation, oxidative stress in tissue occurs as a consequence of pro-oxidants increase, and is not explained by a reduction of antioxidant defenses. In both conditions, TRAP determination decreases in plasma, but not in tissue.

Effectiveness of fortification of corn flour-derived products with hydrogen-reduced elemental iron on iron-deficiency anaemia in children and adolescents in southern Brazil.

OBJECTIVE: To find the ideal combination of Fe fortifier and its food vehicle is an essential measure in developing countries. However, its cost also plays an important role. In the present study, the effect on blood parameter values of corn flour-derived products fortified with powdered elemental Fe in the form of H2-reduced Fe was investigated in children and adolescents. METHODS: One hundred and sixty-two individuals (eighty-six boys and seventy-six girls) from public educational centres in Londrina, Paraná (southern Brazil) participated in the study. Fe-deficiency anaemia (IDA) was defined when Hb and serum ferritin values fell below 12 g/dl and 20 microg/l, respectively; Fe deficiency (ID) was considered when serum ferritin was below 20 microg/l. RESULTS: The prevalence of ID and IDA decreased from 18.0 % and 14.9 %, values found at the beginning of the study, to respectively 5.6 % and 1.2 % after 6 months. Changes from altered to normal values occurred more often than normal to altered values with transferrin saturation (14.2 % v. 6.8 %; P < 0.04) and ferritin (12.4 % v. 0 %; P < 0.001). Hb, transferrin saturation and ferritin showed differences between normal and altered parameters after 6 months (P < 0.001). CONCLUSION: A pronounced reduction in the prevalence of ID and IDA was observed in children and adolescents following 6 months' ingestion of corn flour-derived products enriched with elemental Fe.

Association between soy and green tea (Camellia sinensis) diminishes hypercholesterolemia and increases total plasma antioxidant potential in dyslipidemic subjects.

OBJECTIVE: To evaluate the hypolipemic and antioxidant effects of soy and green tea alone and/or in association in dyslipidemic subjects. METHODS: One hundred dyslipidemic individuals were allocated into four groups. The soy group ingested 50 g of soy (kinako) daily, and the green tea group ingested 3 g of green tea in 500 mL of water per day. A third group ingested 50 g of soy and 3 g of green tea daily, and the control group had a hypocholesterolemic diet. Evaluations were performed at baseline and after 45 and 90 d. Plasma levels of total cholesterol, high-density lipoprotein, and triacylglycerols were evaluated by automated methods. Low-density lipoprotein (LDL) cholesterol was calculated using the Friedewald equation. LDL was isolated by ultracentrifugation. Total plasma antioxidant capacity and plasma levels of total lipid hydroperoxides and those linked to LDL were evaluated by chemiluminescence. The results were expressed as median values and their 25th to 75th percentiles, with a 5% level of significance. RESULTS: No significant difference occurred in LDL, high-density lipoprotein cholesterol, and triacylglycerol levels across groups. However, a statistically significant difference in total cholesterol occurred within the soy/green tea group 45 and 90 d after intervention. No statistically significant difference occurred in plasma levels of lipid hydroperoxides or those linked to LDL in any of the groups studied. All the groups that used soy and/or green tea presented increased total plasma antioxidant potential. CONCLUSION: Soy and green tea, alone or in combination, increased the total antioxidant potential of hypercholesterolemic patients, whereas only the combination decreased total cholesterol levels.

Influence of uric acid and gamma-glutamyltransferase on total antioxidant capacity and oxidative stress in patients with metabolic syndrome.

OBJECTIVE: Metabolic syndrome (MS) is a cluster of risk factors for cardiovascular disease related mainly to insulin resistance, but also to oxidative stress. Uric acid and gamma-glutamyltransferase (GGT) levels are also associated with MS and oxidative stress. This study was undertaken to assess the role of GGT and uric acid in adult patients with MS and its relation to oxidative stress and antioxidant defense. METHODS: A total of 88 adults (67 with MS and 21 controls) were selected among ambulatory patients and workers of the University Hospital of Londrina, Paraná, Brazil. Oxidative stress was assessed by determination of thiobarbituric acid-reactive substances and tert-butyl hydroperoxide-initiated chemiluminescence and antioxidant defenses by total radical-trapping antioxidant parameter. RESULTS: The MS group presented higher significant results (P < 0.0001) than the control group in all parameters of MS and uric acid and GGT levels and significant lower values (P < 0.0001) in high-density lipoprotein cholesterol levels. Thiobarbituric acid-reactive substances and total radical-trapping antioxidant parameter did not show statistically significant differences between groups. However, lipid hydroperoxides, evaluated by tert-butyl hydroperoxide-initiated chemiluminescence, showed higher significant results in the MS group (P = 0.045) than in the control group. Total antioxidant capacity did not decrease and thiobarbituric acid-reactive substances did not increase, probably due to increased uric acid (r = 0.239, P = 0.04) in the MS group. CONCLUSION: The present study confirmed that GGT is a strong predictor of MS and that lipid peroxide measured by tert-butyl hydroperoxide-initiated chemiluminescence and GGT activity are reliable markers of oxidative stress in this syndrome.

Comparison of ferrous sulfate and ferrous glycinate chelate for the treatment of iron deficiency anemia in gastrectomized patients.

OBJECTIVES: Postgastrectomy iron deficiency anemia has a variable prevalence and occurs in 20-50% of patients. Food fortification reports examining ferrous glycinate chelate have shown that it can be 2.5-3.4 times more bioavailable than ferrous sulfate, with minimal gastrointestinal symptoms. The present study was designed as a controlled experimental study including 18 gastrectomized patients with iron deficiency anemia to compare the effects of ferrous sulfate and ferrous glycinate chelate in the treatment of anemia and to evaluate the presence of side effects. METHODS: Patients were divided in two groups: group 1 received ferrous sulfate (200 mg twice a day, corresponding to 80 mg of elemental iron) and group 2 received ferrous glycinate chelate (250 mg/d, corresponding to 50 mg of elemental iron) for 4 mo. Laboratory measurements were performed at baseline and after 2 and 4 mo. RESULTS: Group 1 showed an apparent recovery in laboratory parameters, with increases in medium corpuscular hemoglobin (P = 0.02), serum iron (P = 0.02), and ferritin (P = 0.04), and a decrease in transferrin (P = 0.002) after 4 mo. Individualized analysis showed that only one patient using ferrous sulfate had anemia at the end of the study in contrast to six patients using ferrous glycinate. In addition, ferritin levels increased above 20 microg/L at the end of the study in seven patients using ferrous sulfate in contrast to one patient using ferrous glycinate. CONCLUSION: Patients with iron deficiency anemia after gastrectomy treated with ferrous sulfate had better results in hematologic laboratory parameters than those who used ferrous glycinate chelate.

Agonia da história clínica e suas conseqüências para o ensino médico / The agony of medical history and its cConsequences for medical education

A história clínica, cada vez mais, vem sendo subestimada como ferramenta indispensável à formação médica. Sendo esta desvalorização multifatorial, dois são os fatores que a tornam menos atraente aos olhos dos recém-egressos das universidades e mesmo para alguns profissionais já graduados: o deslumbramento diante de procedimentos high tech e a lenda intelectualista que valoriza apenas aspectos teórico-contemplativos do saber humano. O presente artigo de revisão tem por objetivo analisar as causas que levaram a esse quadro e contribuir com algumas sugestões para que ele possa ser ao menos minimizado

[Sensibility of anthropometric-laboratory markers of protein-energy malnutrition in cirrhotic patients]. / Sensibilidade de indicadores da desnutrição protéico-energética em cirróticos com vários graus de disfunção hepatocelular.

AIM: The prevalence and severity of protein-energy malnutrition (PEM) were investigated through the anthropometric (body mass index, triceps and subescapular skinfolds and upper arm circumferences) and blood measures in 117 cirrhotic patients. The sensitivity and specificity of single or combined PEM markers were tested among Child A (n=18), Child B (n=42) and Child C (n=57) adults (51+/-13y). RESULTS: Were calculated as z score and considered deficient when z< or =-1.28SD according to local standards. The most deficient markers where albumin (93%), hemoglobin (90%), upper arm circumference (61%), triceps (55%) and subescapular (53%) skinfolds. By combining upper arm circumference with triceps or subescapular skinfolds, PEM were detected in 63% of patients varying from 39-44% (Child A) to 64-68% (Child B or C). CONCLUSION: Thus the pattern of PEM present in cirrhosis is predominantly in their protein compartment and worsened with the severity of hepatocellular insuficiency. Upper arm circumference can be used as sensitive markers of presence and severity of PEM in cirrhotic patients but showing low specificity for discriminate PEM among Child grades (B and C) of hepatocellular dysfunctions.

Sensibilidade de indicadores da desnutrição protéico-energética em cirróticos com vários graus de disfunção hepatocelular / Sensibility of anthropometric-laboratory markers of protein-energy malnutrition in cirrhotic patients

OBJETIVO: A sensibilidade de indicadores antropométricos e laboratoriais, na detecção da desnutrição protéico-energética de cirróticos foi estudada em 117 adultos, com gravidades (Child-Pugh), Child A (18), B (42) e C (57). RESULTADOS: Os indicadores antropométricos mais alterados foram: a circunferência braquial 61 por cento, a prega cutânea tricipital 55 por cento e a prega cutânea subescapular 53 por cento, e os laboratoriais: albumina 93 por cento e hemoglobina 90 por cento. Com a combinação de indicadores circunferência braquial + prega cutânea subescapular + albumina ou hemoglobina, alcançaram-se 29 por cento de déficit, valor idêntico ao da associação apenas de circunferência braquial + prega cutânea subescapular. Essa combinação (circunferência braquial e prega cutânea subescapular) detectou 63 por cento de desnutrição protéico-energética, com predominância das formas moderada e grave em todos os graus Child. CONCLUSAO: A desnutrição protéico-energética na cirrose hepática é predominantemente protéica, podendo ser caracterizada por indicadores laboratoriais (mais sensíveis) ou, com maior especificidade, pela circunferência braquial, embora inespecífica à discriminação da gravidade da desnutrição protéico-energética entre os grupos Child B e C.

Prevalência de anemia em crianças e adolescentes de unidades educacionais na periferia de Londrina, PR / Anemia prevalence in children and adolescents from educational centers in the outskirts of Londrina, PR, Brazil

Iron deficiency anemia is the world most prevalent nutritional problem. To investigate anemia prevalence and its relation to nutritional status, 526 children and adolescents, 284 males and 242 females, aged 7 to 14 years old, were evaluated. The studied subjects take part in a program of the Social Action Departament of the city of Londrina, state of Paraná, and attend Public Education Centers which provides them three daily meals and pedagogic assistance. These individuals belong to deprived areas in the city outskirts, where the per capita income is lower than US$500 a year. The hemoglobin dosage was determined by digital puncture and read by hemocue portable photometer. Anemia prevalence was verified in 41,3 por cento of the assessed population, with no significant statistical differences between males and females (p= 0.412). No association between anemia and malnutrition was found. In conclusion, high prevalence of anemia was observed in this population

Influência do grau de obstruçäo sobre o estado nutricional de pacientes ambulatoriais portadores de doença pulmonar obstrutiva crônica / Influence of obstruction degree in the nutritional status of ambulatory chronic obstructive pulmonary disease patients

Com o objetivo de avaliar o estado nutricional e analisar a sua repercussäo sobre o grau de distúrbio obstrutivo de pacientes portadores de doença pulmonar obstrutiva crônica (DPOC), foram avaliados, de junho de 1997 a agosto de 1998, 40 pacientes(21 mulheres e 19 pacientes do sexo masculino). A média de idade era de 63 mais ou menos 14 anos. A maioria dos pacientes era tabagista (70 porcento) ou ex-fumante. Avaliaçäo do estado nutricional foi realizada por antropometria (índice de massa corpórea, prega cutânea tricipital e circinferência muscular do braço) e exames laboratoriais (albumina sérica e contagem de lifócitos). Classificaçäo do estado nutricional, de acordo com o índice de massa corpórea, mostrou que 21 pacientes eram eutróficos, 11 eram desnutridos e 8 apresentavam sobrepeso ou estavam obesos. Com relaçäo ao grau de insuficiência respiratória, verificado por espirometria, 55 porcento dos pacientes apresentavam obstruçäo pulmonar grave, 32,5 porcento moderada e 12,5 porcento, obstruçäo leve. Verificou-se que, tanto entre os desnutridos quanto entre os neutróficos, havia o mesmo percentual de pacientes (91 porcento) com distúrbio obstrutivo moderado ou grave. Em conclusäo, alteraçäo do estado nutricional é encontrada com freqüência em pacientes ambulatoriais com DPOC, näo havendo correlaçäo entre o comprometimento do estado nutricional e o grau do distúrbio obstrutivo.(au)