Evaluation of clinical and inflammatory markers of subclinical carotid atherosclerosis in postmenopausal women.

OBJECTIVE: This study aims to evaluate clinical and inflammatory markers of subclinical carotid atherosclerosis (ATS) in asymptomatic postmenopausal women. METHODS: This cross-sectional study included 268 Brazilian women (aged ≥45 y and amenorrhea ≥12 mo). Subclinical ATS was defined as increased carotid intima-media thickness (>1.0 mm) and/or the presence of plaques evaluated by carotid duplex ultrasound. Inflammatory markers included C-reactive protein (CRP), as well as heat shock protein (HSP) 60 and HSP70 and their antibodies. Pearson's correlation and stepwise logistic regression were used for statistical analysis. RESULTS: Among the women studied, 45.9% (123 of 268) had a diagnosis of ATS, and 54.1% (145 of 268) had normal carotid ultrasound scans (controls). Women with ATS were older (56.6 vs 52.5 y), and their time since menopause was longer (6.0 vs 4.0 y). In addition, higher prevalences of metabolic syndrome (39.0% vs 25.5%), hypertension (52.0% vs 30.3%), and diabetes (11.4% vs 4.8%), and elevated circulating levels of CRP and HSP60, were observed in women with ATS compared with controls (P < 0.05). Intima-media thickness was positively correlated with anti-HSP70 antibodies (r = 0.110, P = 0.049) and CRP (r = 0.167, P = 0.009). ATS risk increased with age at menopause (odds ratio [OR], 1.18; 95% CI, 1.10-1.26), time since menopause (OR, 1.12; 95% CI, 1.02-1.14), and glucose of 100 mg/dL or higher (OR, 2.17; 95% CI, 1.12-4.20). Serum HSP70 levels (OR, 0.71; 95% CI, 0.47-0.98) were associated with a lower ATS risk (P < 0.05). CONCLUSIONS: In postmenopausal women, age, menopause status, and hyperglycemia are associated with a higher prevalence of ATS, whereas elevated serum HSP70 is associated with a lower prevalence of ATS.

The 60- and 70-kDa heat-shock proteins and their correlation with cardiovascular risk factors in postmenopausal women with metabolic syndrome.

We investigated the association between circulating levels of 60 and 70 kDa heat-shock proteins (HSP60 and 70) and cardiovascular risk factors in postmenopausal women with or without metabolic syndrome (MetS). This cross-sectional study included 311 Brazilian women (age ≥45 years with amenorrhea ≥12 months). Women showing three or more of the following diagnostic criteria were diagnosed with MetS: waist circumference (WC) ≥88 cm, blood pressure ≥130/85 mmHg, triglycerides ≥150 mg/dl, high-density lipoprotein (HDL) <50 mg/dl, and glucose ≥100 mg/dl. Clinical, anthropometric, and biochemical parameters were collected. HSP60, HSP70, antibodies to HSP60 and HSP70, and C-reactive protein (CRP) levels were measured in serum. Student's t test, Kruskal-Wallis test, chi-square test, and Pearson correlation were used for statistical analysis. Of the 311 women, 30.9 % (96/311) were diagnosed with MetS. These women were, on average, obese with abdominal fat deposition and had lower HDL values as well as higher triglycerides and glucose levels. Homeostasis model assessment-insulin resistant (HOMA-IR) test values in these women were compatible with insulin resistance (P < 0.05). CRP and HSP60 concentrations were higher in women with MetS than in women without MetS (P < 0.05). HSP60, anti-HSP70, and CRP concentrations increased with the number of features indicative of MetS (P < 0.05). There was a significant positive correlation between anti-HSP70 and WC, blood pressure and HOMA-IR, and between CRP and WC, blood pressure, glucose, HOMA-IR, and triglycerides (P < 0.05). In postmenopausal women, serum HSP60 and anti-HSP70 concentrations increased with accumulating features of the metabolic syndrome. These results suggest a greater immune activation that is associated with cardiovascular risk in postmenopausal women with metabolic syndrome.

Efeito da dieta da suplementação de ômega-3 sobre marcadores metabólicos e inflamatórios em mulheres na pós-menopausa com síndrome metabólica / Effect of dietary omega-3 supplementation on metabolic marfars and inflammatory in post menopausal women with metabolic syndrome

Avaliar o efeito da dieta isolada ou associada à suplementação de Ômega-3 sobre os marcadores metabólicos e inflamatórios em mulheres na pós-menopausa com síndrome metabólica (SM). Estudo prospectivo e aberto, envolvendo 87 mulheres na pós-menopausa (idade 45 anos e amenorréia ≥ 12 meses) com diagnóstico de SM, atendidas em Ambulatório de Especialidades, de junho de 2010 a dezembro de 2011. Critérios de não-inclusão: doença cardiovascular, diabetes insulino-dependente, câncer, doenças autoimunes e uso de estatinas ou terapia hormonal. As pacientes foram randomizadas a dieta isolada (n=43, controle) ou associada à suplementação de Ômega-3, 900mg/dia, via oral (n=44). Todas as pacientes foram submetidas à prescrição dietética individualizada. Foram realizadas avaliações antropométricas, bioquímicas e perfil inflamatório que incluiu proteína C-Reativa (PCR), fator de necrose tumoral alfa (TNF- α) e interleucinas (IL-1β e IL-6). O tempo de intervenção foi de seis meses, com avaliações nos momentos, inicial e final. Para análise estatística foram empregados Teste t-student, ANOVA e Teste de Tukey. O estudo foi concluído com 30 pacientes sob dieta isolada e 33 sob dieta + Ômega-3. Na comparação entre os momentos inicial e após seis meses, encontrou-se redução significativa nos valores do índice de massa corpórea e na circunferência da cintura nos dois grupos (p<0,05), sem mudanças significantes na gordura corporal ou massa muscular (p>0,05). No grupo dieta + Ômega-3 foi observado redução significante na pressão sistólica (-12,2%) e diastólica (-8,2%); e nos valores médios de triglicerídeos (-21,4%), insulina (-11,6%) e na resistência a insulina (-13,1%) (p<0,05). E no perfil inflamatório encontrou-se redução significativa apenas no valor médio de IL-6 (-28,5%) (p=0,034)...

To evaluate the effect of diet alone or combined with omega-3 supplementation on metabolic and inflammatory markers in postmenopausal women with metabolic syndrome (MetS). In this prospective, open, randomized study, 87 women (age ≥ 45 years and amenorrhea ≥ 12 months) with MetS, seeking health care at a public outpatient center of the Botucatu Medical School-UNESP, from June 2010 to December 2011 were included. Exclusion criteria were: cardiovascular disease, insulin-dependent diabetes, cancer, autoimmune diseases and use of statins or hormone therapy. Participants were randomized to diet alone (n = 43, control) or associated with Omega-3 supplementation, 900mg/dia orally (n = 44). All women underwent individualized dietary prescription. Clinic, anthropometric (body mass index, BMI and waist circumference, (WC), biochemical variables were measured. Inflammatory profile included C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α) and interleukins (IL-1β and IL-6). The intervention time was six months, with assessments at initial and final moments. Statistical analysis employed Student’s t-test, ANOVA and Tukey test. In the comparison of baseline clinical characteristics between the groups (diet alone or diet + Omega-3) no significant differences were observed, with aged 55.0 ± 7.3 vs 55.1 ± 6.6 years; duration of menopause 7.0 ± 4.9 vs 7.2 ± 44.9 years; and BMI 32.0 ± 4.6 vs 32.8 ± 4.7 kg/m2, respectively (p>0.05). Of the 87 women, 30 with diet alone and 33 with diet + Omega-3 completed the study...

Evolução da perda de peso entre indivíduos da fila de espera para a cirurgia bariátrica em um ambulatório multidisciplinar de atenção secundária à saúde / Evolution of weight loss among individuals in the waiting line for bariatric surgery in a multidisciplinary secondary healthcare outpatient clinic

Objetivo: Caracterizar o atendimento e analisar a adesão de pacientes ao acompanhamento nutricional na fila de espera para a cirurgia bariátrica em um ambulatório multidisciplinar de atenção secundária à saúde. Métodos: Foi realizado um estudo retrospectivo a partir de prontuários de nutrição referentes a 59 pacientes submetidos à cirurgia bariátrica no Hospital das Clínicas de Botucatu, entre 2001 e 2008. A população estudada foi distribuída e analisada em oito grupos, conforme o tempo de acompanhamento. A análise levou em conta a evolução do peso e o número de retornos no determinado período. A comparação entre os grupos foi realizada pelo teste de Kruskal-Wallis, enquanto as correlações foram testadas pelo coeficiente de Spearman. Resultados: Entre os 59 pacientes estudados, 42 retornaram ao serviço ao menos uma vez (71,2%). Destes, 67,8% perderam peso na fila de espera, sendo que 27,1% dos mesmos tiveram redução maior que 10% no peso corporal. As maiores perdas de peso no pré-operatório foram encontradas nos grupos que tiveram um acompanhamento nutricional maior que seis meses. Constatou-se uma demora mediana de três meses entre os retornos, o que pode ter contribuído para a baixa adesão ao acompanhamento. Conclusão: Os pacientes da fila de espera para a cirurgia, aqui analisados, apresentaram baixa adesão ao acompanhamento em retornos espaçados. Isso indica que para a desejada redução no peso corporal e adequado processo educativo aos candidatos à cirurgia bariátrica há que se dispor de tempo mínimo de seis meses e encontros regulares.

The objective of this study is to characterize the assistance and analyze patient’s adherence to nutritional follow-up while in the waiting line for bariatric surgery in a multidisciplinary, secondary health care out patient clinic. Methods: This retrospective study was based on the nutritional records of 59 patients subjected tobariatric surgery at the Hospital das Clinics de Botucatu, from 2001 to 2008. The population studied was distributed into 8 groups and analyzed according to follow-up duration. The analysis took into account the evolution of body weight and the number of follow-up visits in a given period. The Kruskal-Wallis test was used to compare data between groups while Spearman’s coefficient was used to test correlations. Results: Among the 59 studied patients, 42 (71.2%) returned to the clinic at least once in six months. Of these, 67.8% lost weight while in the waiting line and 27.1% of them lost more than 10% of their body weight. The greatest weight losses in the preoperative period were found in the groups that had more than six months of nutrition follow-up. There was a mean delay of three months between return visits, which could have contributed to the low adherence to follow-up. Conclusion: The patients in the waiting line for surgery analyzed in this study presented low adherence to the long-spaced return visits. The greatest weight losses were observed in groups that had been followed for more than six months. This shows that, to achieve the desired weight loss and an adequate education process before surgery, at least six months of follow-up and regular visits are necessary.

Redução na massa muscular de mulheres na pós-menopausa: efeito do treinamento hipertrófico / Muscle mass reduction in postmenopausal women: effects of strength training

Sarcopenia - perda da massa muscular - associada ao envelhecimento é um processo progressivo e causa direta de redução na força muscular, contribuindo para diminiução funcional e inabilidade física, particularmente em mulheres. Estima-se uma redução de 6 porcento na massa muscular por década de vida a partir dos 50 anos e de 15 porcento na força muscular entre a sexta e sétima décadas. Ao limitar a capacidade física, a sarcopenia predispõe a riscos de queda, fratura e dependência física, com repercussão sobre a qualidade de vida para a mulher na pós-menopausa. Embora a sarcopenia seja multifatorial, a diminuição na atividade física, o aumento nos processos catabólicos e as alterações nos hormônios de crescimento e sexuais têm um importante papel predisponente. Entre os exercícios físicos, o treinamento hipertrófico é um potente interventor na sarcopenia, melhorando a habilidade física pelo aumento gradativo na massa muscular, que contribui para o desenvolvimento de força muscular, importante para um envelhecimento sadio e independente. Mostra-se como uma intervenção efetiva, segura e benéfica à saúde da mulher na pós-menopausa.