Association between Thyroid-Stimulating Hormone Levels and Non-Alcoholic Fatty Liver Disease Is Not Independent from Metabolic Syndrome Criteria.

INTRODUCTION: Thyroid hormones are involved in the regulation of body composition, lipid metabolism, and insulin resistance. Thus, it is possible that they might play a role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). However, the role of thyroid function on NAFLD is not well defined. In this study, we evaluated the relationship between thyroid-stimulating hormone (TSH) levels, within the reference range, and presence of NAFLD in asymptomatic individuals. STUDY DESIGN: We included all individuals evaluated at a preventive clinic of the Hospital Israelita Albert Einstein, between 2014 and 2015. The prevalence of NAFLD (analyzed by abdominal ultrasound), according to TSH quartiles, within the reference range, was determined. The association between TSH quartiles and NAFLD was analyzed by logistic regression adjusted for possible confounders. RESULTS: We evaluated 10,539 individuals (73% male, age 43.4 ± 9.4 years). The prevalence of NAFLD was 34, 38, 38, and 39% in the first to the fourth TSH quartiles (0.46-1.44, 1.45-1.97, 1.98-2.68, and 2.69-4.68 mUI/L, respectively, p for trend < 0.001). At univariate analysis, higher TSH levels were associated with the diagnosis of NAFLD. When data were adjusted for the metabolic syndrome characteristics (waist circumference, HDL-cholesterol and triglycerides levels, presence of diabetes, and systemic arterial hypertension), the association was no longer significant. CONCLUSIONS: Although the TSH variability within the reference range is associated with NAFLD in univariable models, once adjusted for metabolic syndrome factors no significant association is noted.

Physical activity levels and hepatic steatosis: A longitudinal follow-up study in adults.

BACKGROUND AND AIM: This study aimed to evaluate the impact of physical activity (PA) on the course of hepatic steatosis (HS) in adults. METHODS: Hepatic steatosis status (ultrasonography) and PA levels were evaluated in 5860 subjects at baseline and after approximately 2.5 years (range: 19-50 months). At follow up, possible exposures to different PA levels were those who remained inactive, became inactive, became active, and remained active. After follow up, subjects were then classified according to the four possible states (outcomes): "remained without HS," "developed HS" (subjects without HS at baseline), "remained with HS," or "reverted HS." RESULTS: After multivariate adjustments, individuals without HS that became or remained physically active were less likely to develop HS compared with those who remained physically inactive (odds ratio = 0.75, P = 0.04 and 0.75, P = 0.03, respectively). Among those with HS at baseline, becoming and remaining physically active beneficially improved the HS status (odds ratio = 0.64, P = 0.01 and 0.66, P = 0.01, respectively). However, the significance was lost when adjusted for changes in body mass index. CONCLUSION: Higher levels of PA were associated with prevention and treatment of HS, with evidence of effect mediation by changes in body mass index.

Association of subclinical inflammation, glycated hemoglobin and risk for obstructive sleep apnea syndrome.

OBJECTIVE: To investigate the inter-relation between high sensitivity C-reactive protein and glycated hemoglobin in prediction of risk of obstructive sleep apnea. METHODS: We included all individuals participating in a check-up program at the Preventive Medicine Center of Hospital Israelita Albert Einstein in 2014. The Berlin questionnaire for risk of obstructive sleep apnea was used, and the high sensitivity C-reactive protein and glycated hemoglobin levels were evaluated. RESULTS: The sample included 7,115 participants (age 43.4±9.6 years, 24.4% women). The Berlin questionnaire showed changes in 434 (6.1%) individuals. This finding was associated with high sensitivity C-reactive protein and glycated hemoglobin levels (p<0.001). However, only the association between the Berlin questionnaire result and glycated hemoglobin remained significant in the adjusted multivariate analysis, for the traditional risk factors and for an additional model, including high-density lipoprotein cholesterol and triglycerides. CONCLUSION: The glycated hemoglobin, even below the threshold for diagnosis of diabetes, is independently associated with obstructive sleep apnea syndrome, even after adjustment for obesity and C-reactive protein. These findings suggest a possible pathophysiological link between changes in insulin resistance and obstructive sleep apnea syndrome, independently from obesity or low-grade inflammation. OBJETIVO: Investigar a inter-relação entre proteína C-reativa de alta sensibilidade e hemoglobina glicada na predição do risco de apneia obstrutiva do sono. MÉTODOS: Foram incluídos todos os indivíduos participantes do programa de check-up do Centro de Medicina Preventiva Hospital Israelita Albert Einstein em 2014. Foi aplicado o questionário de Berlin sobre risco de apneia do sono, e avaliadas as dosagens de hemoglobina glicada e proteína C-reativa de alta sensibilidade. RESULTADOS: Foram incluídos 7.115 participantes (idade 43,4±9,6 anos, 24,4% mulheres). A prevalência de alteração no questionário de Berlin foi de 434 (6,1%). A alteração do questionário de Berlin associou-se positivamente aos resultados da proteína C-reativa de alta sensibilidade e da hemoglobina glicada (p<0,001). No entanto, apenas a associação entre o resultado do questionário de Berlin e a hemoglobina glicada permaneceu significativa na análise multivariada ajustada tanto para fatores de risco tradicionais quanto para um modelo adicional, que incluiu também lipoproteína de alta densidade-colesterol (HDL-c) e triglicérides. CONCLUSÃO: A hemoglobina glicada, mesmo em valores abaixo do critério diagnóstico para diabetes mellitus, está associada de forma independente ao risco para síndrome da apneia obstrutiva do sono, mesmo após ajuste para obesidade e proteína C-reativa. Estes achados sugerem possível ligação fisiopatológica entre alterações na resistência insulínica e a síndrome da apneia obstrutiva do sono, que independe da obesidade ou inflamação de baixo grau.

Association of subclinical inflammation, glycated hemoglobin and risk for obstructive sleep apnea syndrome / Associação entre inflamação subclínica, hemoglobina glicada e risco de apneia obstrutiva do sono

ABSTRACT Objective To investigate the inter-relation between high sensitivity C-reactive protein and glycated hemoglobin in prediction of risk of obstructive sleep apnea. Methods We included all individuals participating in a check-up program at the Preventive Medicine Center of Hospital Israelita Albert Einstein in 2014. The Berlin questionnaire for risk of obstructive sleep apnea was used, and the high sensitivity C-reactive protein and glycated hemoglobin levels were evaluated. Results The sample included 7,115 participants (age 43.4±9.6 years, 24.4% women). The Berlin questionnaire showed changes in 434 (6.1%) individuals. This finding was associated with high sensitivity C-reactive protein and glycated hemoglobin levels (p<0.001). However, only the association between the Berlin questionnaire result and glycated hemoglobin remained significant in the adjusted multivariate analysis, for the traditional risk factors and for an additional model, including high-density lipoprotein cholesterol and triglycerides. Conclusion The glycated hemoglobin, even below the threshold for diagnosis of diabetes, is independently associated with obstructive sleep apnea syndrome, even after adjustment for obesity and C-reactive protein. These findings suggest a possible pathophysiological link between changes in insulin resistance and obstructive sleep apnea syndrome, independently from obesity or low-grade inflammation.

RESUMO Objetivo Investigar a inter-relação entre proteína C-reativa de alta sensibilidade e hemoglobina glicada na predição do risco de apneia obstrutiva do sono. Métodos Foram incluídos todos os indivíduos participantes do programa de check-up do Centro de Medicina Preventiva Hospital Israelita Albert Einstein em 2014. Foi aplicado o questionário de Berlin sobre risco de apneia do sono, e avaliadas as dosagens de hemoglobina glicada e proteína C-reativa de alta sensibilidade. Resultados Foram incluídos 7.115 participantes (idade 43,4±9,6 anos, 24,4% mulheres). A prevalência de alteração no questionário de Berlin foi de 434 (6,1%). A alteração do questionário de Berlin associou-se positivamente aos resultados da proteína C-reativa de alta sensibilidade e da hemoglobina glicada (p<0,001). No entanto, apenas a associação entre o resultado do questionário de Berlin e a hemoglobina glicada permaneceu significativa na análise multivariada ajustada tanto para fatores de risco tradicionais quanto para um modelo adicional, que incluiu também lipoproteína de alta densidade-colesterol (HDL-c) e triglicérides. Conclusão A hemoglobina glicada, mesmo em valores abaixo do critério diagnóstico para diabetes mellitus, está associada de forma independente ao risco para síndrome da apneia obstrutiva do sono, mesmo após ajuste para obesidade e proteína C-reativa. Estes achados sugerem possível ligação fisiopatológica entre alterações na resistência insulínica e a síndrome da apneia obstrutiva do sono, que independe da obesidade ou inflamação de baixo grau.

Check-up and cardiovascular risk progression: is there a room for innovation?

OBJECTIVE: To evaluate the impact of traditional check-up appointment on the progression of the cardiovascular risk throughout time. METHODS: This retrospective cohort study included 11,126 medical records of asymptomatic executives who were evaluated between January, 2005 and October, 2008. Variables included participants' demographics characteristics, smoking habit, history of cardiovascular diseases, diabetes, dyslipidemia, total cholesterol, HDL, triglycerides, glucose, c-reactive protein, waist circumference, hepatic steatosis, Framingham score, metabolic syndrome, level of physical activity, stress, alcohol consumption, and body mass index. RESULTS: A total of 3,150 patients was included in the final analysis. A worsening was observed in all risk factors, excepting in smoking habit, incidence of myocardial infarction or stroke and in the number of individuals classified as medium or high risk for cardiovascular events. In addition, a decrease in stress level and alcohol consumption was also seen. CONCLUSION: The adoption of consistent health policies by companies is imperative in order to reduce the risk factors and the future costs associated with illness and absenteeism.

Check-up and cardiovascular risk progression: is there a room for innovation? / Check-up e progressão do risco cardiovascular: existe espaço para inovação?

ABSTRACT Objective: To evaluate the impact of traditional check-up appointment on the progression of the cardiovascular risk throughout time. Methods: This retrospective cohort study included 11,126 medical records of asymptomatic executives who were evaluated between January, 2005 and October, 2008. Variables included participants’ demographics characteristics, smoking habit, history of cardiovascular diseases, diabetes, dyslipidemia, total cholesterol, HDL, triglycerides, glucose, c-reactive protein, waist circumference, hepatic steatosis, Framingham score, metabolic syndrome, level of physical activity, stress, alcohol consumption, and body mass index. Results: A total of 3,150 patients was included in the final analysis. A worsening was observed in all risk factors, excepting in smoking habit, incidence of myocardial infarction or stroke and in the number of individuals classified as medium or high risk for cardiovascular events. In addition, a decrease in stress level and alcohol consumption was also seen. Conclusion: The adoption of consistent health policies by companies is imperative in order to reduce the risk factors and the future costs associated with illness and absenteeism. .

RESUMO Objetivo: Avaliar o impacto do modelo tradicional de check-up na progressão do risco cardiovascular ao longo do tempo. Métodos: Estudo coorte-retrospectivo com análise de 11.126 prontuários de executivos assintomáticos, atendidos entre janeiro de 2005 e outubro de 2008. Foram observados dados demográficos, tabagismo, doenças cardiovasculares, diabetes, dislipidemia prévios, valores de colesterol total e frações, triglicérides, glicemia, proteína C-reativa, circunferência de cintura, esteatose hepática, escore de Framingham, síndrome metabólica, nível de atividade física, estresse, consumo de álcool e índice de massa corporal. Resultados: Foram incluídos 3.150 pacientes. Houve piora de todos fatores de risco, com exceção do tabagismo, do aumento na incidência de doenças cardiovasculares e da população com risco médio ou alto para eventos cardiovasculares. Houve ainda redução na prevalência de pouco ativos, estresse e consumo de álcool. Conclusão: É prioritária a adoção de políticas de saúde por parte das empresas, para a melhora da condição de saúde e a redução dos custos advindos das doenças, além do absenteísmo a eles associados. .

Relevance of prehypertension as a diagnostic category in asymptomatic adults.

OBJECTIVE: To assess the association of prehypertension with metabolic, inflammatory and cardiovascular risk profile in asymptomatic individuals. METHODS: Between 2006 and 2009, 11,011 asymptomatic adults (mean age: 43 years; 22% females), underwent a check-up protocol. They were divided into 3 groups: normotensive group (arterial pressure=120/80mmHg), prehypertensive group (arterial pressure >120/80mmHg and <140/90mmHg) and hypertensive group (arterial pressure>140/90mmHg or prior diagnosis of hypertension). Each group metabolic and cardiovascular group profile was assessed. RESULTS: The prevalence of normotension, prehypertension and hypertension was 27.9%, 53.9% and 18.2%, respectively. Prehypertensive individuals were older (mean age: 42.7 versus 40 years; p<0.001) than normotensive patients, and had higher body mass index (mean: 26.7kg/m² versus 24kg/m²; p<0.001), higher plasma triglycerides levels (mean: 139mg/dL versus 108mg/dL; p<0.001), higher LDL-choleterol levels (mean: 128mg/dL versus 117mg/dL; p<0.001), and lower HDL-cholesterol (mean: 46.7mg/dL versus 52.7mg/dL; p<0.001). Prehypertensive individuals were more likely to have impaired fasting glucose (OR: 1.69; 95%CI: 1.39-2.04), overweight and obesity - body mass index >25kg/m² (OR: 2.48; 95%CI: 2.24-2.74), hepatic steatosis: (OR: 2.23; 95%CI: 1.97-2.53), metabolic syndrome (OR: 3.05; 95%CI: 2.67-3.49), and high-sensitivity C-reactive protein levels>2mg/L (OR: 1.52; 95%CI: 1.35-1.71). CONCLUSION: Prehypertension is associated with an increased prevalence of metabolic syndrome, hepatic steatosis and subclinical inflammation.

Relevância da pré-hipertensão como categoria diagnóstica em adultos assintomáticos / Relevance of prehypertension as a diagnostic category in asymptomatic adults

OBJETIVO: Avaliar a associação da pré-hipertensão com perfis metabólico, inflamatório e de risco cardiovascular em indivíduos assintomáticos. MÉTODOS: Entre 2006 a 2009, 11.011 adultos assintomáticos (média de idade de 43 anos; 22% mulheres) foram submetidos a protocolo de check-up, sendo classificados em 3 grupos: normotensos (pressão arterial<120x80mmHg), pré-hipertensos (pressão arterial= 120/80mmHg e <140/90mmHg) e hipertensos (pressão arterial >140/90mmHg ou diagnóstico prévio de hipertensão arterial). Foram avaliados os perfis metabólico e de risco cardiovascular de cada um dos três grupos. RESULTADOS: A prevalência de normotensão, préhipertensão e hipertensão foi, respectivamente, de 27,9%, 53,9% e 18,2%. Quando comparados com os indivíduos normotensos, os pré-hipertensos apresentaram média de idade maior (42,7 versus 40 anos; p<0,001), maior índice de massa corporal (média: 26,7kg/m² versus 24 kg/m²; p<0,001), níveis de triglicérides mais elevados (média: 139mg/dL versus 108mg/dL; p<0,001), níveis de LDL-colesterol mais elevados (média: 128mg/dL versus 117mg/dL; p<0,001) e níveis séricos menores de HDL-colesterol (média: 46,7mg/dL versus 52,7mg/dL; p<0,001). Os pré-hipertensos apresentaram maior prevalência de alterações na glicemia de jejum (OR: 1,69; IC95%: 1,39-2,04), sobrepeso e obesidade - ou seja, índice de massa corporal >25kg/m² (OR: 2,48; IC95%: 2,24-2,74), esteatose hepática (OR: 2,23; IC95%: 1,97-2,53), síndrome metabólica (OR: 3,05; IC95%: 2,67-3,49) e níveis >2mg/L de proteína C-reativa de alta sensibilidade (OR: 1,52; IC95%: 1,35-1,71). CONCLUSÃO: A pré-hipertensão está associada a aumento da prevalência de síndrome metabólica, esteatose hepática e inflamação subclínica.

OBJECTIVE: To assess the association of prehypertension with metabolic, inflammatory and cardiovascular risk profile in asymptomatic individuals. METHODS: Between 2006 and 2009, 11,011 asymptomatic adults (mean age: 43 years; 22% females), underwent a check-up protocol. They were divided into 3 groups: normotensive group (arterial pressure=120/80mmHg), prehypertensive group (arterial pressure >120/80mmHg and <140/90mmHg) and hypertensive group (arterial pressure>140/90mmHg or prior diagnosis of hypertension). Each group metabolic and cardiovascular group profile was assessed. RESULTS: The prevalence of normotension, prehypertension and hypertension was 27.9%, 53.9% and 18.2%, respectively. Prehypertensive individuals were older (mean age: 42.7 versus 40 years; p<0.001) than normotensive patients, and had higher body mass index (mean: 26.7kg/m² versus 24kg/m²; p<0.001), higher plasma triglycerides levels (mean: 139mg/dL versus 108mg/dL; p<0.001), higher LDL-choleterol levels (mean: 128mg/dL versus 117mg/dL; p<0.001), and lower HDL-cholesterol (mean: 46.7mg/dL versus 52.7mg/dL; p<0.001). Prehypertensive individuals were more likely to have impaired fasting glucose (OR: 1.69; 95%CI: 1.39-2.04), overweight and obesity - body mass index >25kg/m² (OR: 2.48; 95%CI: 2.24-2.74), hepatic steatosis: (OR: 2.23; 95%CI: 1.97-2.53), metabolic syndrome (OR: 3.05; 95%CI: 2.67-3.49), and high-sensitivity C-reactive protein levels>2mg/L (OR: 1.52; 95%CI: 1.35-1.71). CONCLUSION: Prehypertension is associated with an increased prevalence of metabolic syndrome, hepatic steatosis and subclinical inflammation.

Ocular changes due to systemic alpha-interferon therapy for hepatitis C

OBJETIVO: Avaliar alterações oculares (em especial lesões fundoscópicas) em pacientes com hepatite C tratados com alfa-interferon (IFN). MÉTODOS: Estudo prospectivo, descritivo e observacional de pacientes com hepatite C do serviço de Gastroenterologia da UNIFESP com indicações de uso de alfa-interferon entre novembro de 1999 e junho de 2000. Esses pacientes foram submetidos a exame oftalmológico completo antes e 1, 3, 6 e 12 meses após o início do tratamento. Pacientes HIV positivos, ou com exposição prévia à droga foram excluídos. RESULTADOS: De um total de 51 pacientes selecionados, 31 foram acompanhados. A relação masculino-feminino foi de 1,55, e a média de idade de 47 anos. A acuidade visual corrigida variou de 20/15 a 20/40. Vinte e dois por cento dos pacientes queixaram-se de sensação de corpo estranho, principalmente nos dois primeiros meses de terapia. Queixas gerais foram: artralgia, cefaléia, depressão, fraqueza muscular. Achados oculares foram: hemorragia retiniana (um olho) e exsudatos moles (três olhos), todos assintomáticos. Em um paciente com história pregressa de tratamento com interferon, observou-se presença de hemorragia vítrea, exsudatos duros e moles e tortuosidade vascular. Um paciente faleceu durante o tratamento por infarto cardíaco. CONCLUSÕES: Existem alterações oculares por uso sistêmico de alfa-interferon. Não existem estudos no nosso país descrevendo essas alterações. Médicos clínicos gerais e gastroenterologistas devem prestar atenção a esse tipo de problema, e encaminhar os pacientes a um serviço de oftalmologia para acompanhamento paralelo.