ASSOCIATION BETWEEN ACANTHOSIS NIGRICANS AND OTHER CARDIOMETABOLIC RISK FACTORS IN CHILDREN AND ADOLESCENTS WITH OVERWEIGHT AND OBESITY. / ASSOCIAÇÃO ENTRE ACANTOSE NIGRICANS E OUTROS FATORES DE RISCO CARDIOMETABÓLICO EM CRIANÇAS E ADOLESCENTES COM SOBREPESO E OBESIDADE.

OBJECTIVE: To evaluate the presence or absence of acanthosis nigricans and its association with metabolic alterations in a group of obese and overweight children and adolescents. METHODS: A cross sectional study of 161 overweight children and adolescents, who were divided into two groups, according to presence or absence of acanthosis nigricans. Anthropometric measurements (body mass index, skinfolds, abdominal circumference), blood pressure, laboratory tests (fasting glycemia, insulin, lipid profile, triglycerides, uric acid, transaminases) and homeostasis model assessment index. RESULTS: The acanthosis nigricans group represented 51.5% of the sample. The mean age was similar between groups. The group with acanthosis nigricans presented higher body mass index, Z score of body mass index, body fat percentage, abdominal circumference (p<0.0001), systolic (p=0.006) and diastolic blood pressure (p=0.002). There was no significant difference in the analysis of lipid profile, except for the high-density cholesterol, which was lower (p=0.003) in the group with acanthosis. On the other hand, uric acid (p<0.0001), fasting glycemia (p=0.006), insulin (p<0.0001), glutamic oxalacetic transaminase (p<0.0001), and homeostasis model assessment index (p<0.0001) were significantly higher in the group with acanthosis nigricans. CONCLUSIONS: Acanthosis nigricans in overweight and obese children and adolescents is associated with elevation of body fat, blood pressure, insulin and homeostasis model assessment index, indicating that it is a clinical marker associated with the metabolic syndrome.

OBJETIVO: Avaliar em um grupo de crianças e adolescentes com obesidade e sobrepeso a presença ou não de acantose nigricans e sua associação com alterações metabólicas. MÉTODOS: Estudo transversal envolvendo 161 indivíduos com excesso de peso, que foram divididos em dois grupos, segundo a presença ou não de acantose nigricans, e nos quais foram obtidas medidas antropométricas (índice de massa corporal, pregas cutâneas, circunferência abdominal), pressão arterial, análises laboratoriais (glicemia de jejum, insulina, perfil lipídico, triglicerídeos, ácido úrico, transaminases) e o índice homeostasis model assessment. RESULTADOS: O grupo com acantose nigricans representou 51,5% da amostra. A média de idade foi semelhante entre os grupos. O grupo com acantose nigricans apresentou maiores índice de massa corporal, escore Z do índice de massa corporal, percentual de gordura corporal, circunferência abdominal (p<0,0001) e pressão arterial sistólica (p=0,006) e diastólica (p=0,002). Não houve diferença significativa na análise do perfil lipídico, exceto o colesterol de alta densidade, que foi menor (p=0,003) no grupo com acantose. Já o ácido úrico (p<0,0001), a glicemia de jejum (p=0,006), a insulina (p<0,0001), a transaminase glutâmica oxalacética (p<0,0001) e o índice homeostasis model assessment (p<0,0001) foram significativamente maiores no grupo com acantose nigricans. CONCLUSÕES: Acantose nigricans em crianças e adolescentes com sobrepeso e obesidade esteve associada à elevação dos índices de adiposidade corporal, pressão arterial, insulina e homeostasis model assessment, indicando-a como marcador clínico associado à síndrome metabólica.

Associação entre acantose nigricans e outros fatores de risco cardiometabólico em crianças e adolescentes com sobrepeso e obesidade / Association between acanthosis nigricans and other cardiometabolic risk factors in children and adolescents with overweight and obesity

RESUMO Objetivo: Avaliar em um grupo de crianças e adolescentes com obesidade e sobrepeso a presença ou não de acantose nigricans e sua associação com alterações metabólicas. Métodos: Estudo transversal envolvendo 161 indivíduos com excesso de peso, que foram divididos em dois grupos, segundo a presença ou não de acantose nigricans, e nos quais foram obtidas medidas antropométricas (índice de massa corporal, pregas cutâneas, circunferência abdominal), pressão arterial, análises laboratoriais (glicemia de jejum, insulina, perfil lipídico, triglicerídeos, ácido úrico, transaminases) e o índice homeostasis model assessment. Resultados: O grupo com acantose nigricans representou 51,5% da amostra. A média de idade foi semelhante entre os grupos. O grupo com acantose nigricans apresentou maiores índice de massa corporal, escore Z do índice de massa corporal, percentual de gordura corporal, circunferência abdominal (p<0,0001) e pressão arterial sistólica (p=0,006) e diastólica (p=0,002). Não houve diferença significativa na análise do perfil lipídico, exceto o colesterol de alta densidade, que foi menor (p=0,003) no grupo com acantose. Já o ácido úrico (p<0,0001), a glicemia de jejum (p=0,006), a insulina (p<0,0001), a transaminase glutâmica oxalacética (p<0,0001) e o índice homeostasis model assessment (p<0,0001) foram significativamente maiores no grupo com acantose nigricans. Conclusões: Acantose nigricans em crianças e adolescentes com sobrepeso e obesidade esteve associada à elevação dos índices de adiposidade corporal, pressão arterial, insulina e homeostasis model assessment, indicando-a como marcador clínico associado à síndrome metabólica.

ABSTRACT Objective: To evaluate the presence or absence of acanthosis nigricans and its association with metabolic alterations in a group of obese and overweight children and adolescents. Methods: A cross sectional study of 161 overweight children and adolescents, who were divided into two groups, according to presence or absence of acanthosis nigricans. Anthropometric measurements (body mass index, skinfolds, abdominal circumference), blood pressure, laboratory tests (fasting glycemia, insulin, lipid profile, triglycerides, uric acid, transaminases) and homeostasis model assessment index. Results: The acanthosis nigricans group represented 51.5% of the sample. The mean age was similar between groups. The group with acanthosis nigricans presented higher body mass index, Z score of body mass index, body fat percentage, abdominal circumference (p<0.0001), systolic (p=0.006) and diastolic blood pressure (p=0.002). There was no significant difference in the analysis of lipid profile, except for the high-density cholesterol, which was lower (p=0.003) in the group with acanthosis. On the other hand, uric acid (p<0.0001), fasting glycemia (p=0.006), insulin (p<0.0001), glutamic oxalacetic transaminase (p<0.0001), and homeostasis model assessment index (p<0.0001) were significantly higher in the group with acanthosis nigricans. Conclusions: Acanthosis nigricans in overweight and obese children and adolescents is associated with elevation of body fat, blood pressure, insulin and homeostasis model assessment index, indicating that it is a clinical marker associated with the metabolic syndrome.

Interferência nutricional no tratamento de pacientes com diabetes mellitus tipo 1 / Interferencia nutricional en el tratamiento de pacientes con diabetes mellitus tipo 1 / Nutritional interference in the treatment of patients with diabetes mellitus type 1

RESUMO O tratamento do Diabetes Mellitus tipo 1 (DM1) constitui-se na adesão ao tratamento insulínico, na alimentação e na atividade física, visando ao controle glicêmico. O objetivo deste estudo foi observar os efeitos da interferência nutricional no tratamento de pacientes com DM1. Trata-se de estudo quantitativo, prospectivo e longitudinal desenvolvido no Ambulatório de Diabetes da UFTM. A coleta de dados foi realizada entre março de 2013 e setembro de 2014. Foram avaliados 41 crianças e adolescentes entre 6 e 17 anos, quanto à antropometria, controle glicêmico e lipídico em 4 momentos: M1 no início do seguimento; M2 após orientação nutricional convencional; M3 após aprendizagem da contagem de carboidratos (CCHO) e M4 em contagem plena. A análise estatística foi descritiva e inferencial. A antropometria comprovou que a CCHO não resultou em ganho de peso e foi efetiva no sexo masculino, demonstrada pela redução nas concentrações de frutosamina (p=0,050) e HbA1C (p=0,041) no M4 comparado ao M1. Considerando a frutosamina, o grupo com CCHO se diferenciou do grupo sem CCHO M4 (p=0,035). A terapêutica insulínica associada à CCHO demonstrou ser um recurso importante a ser integrado no tratamento do DM1, visando atingir alvos efetivos na redução das complicações.

RESUMEN El tratamiento de la Diabetes Mellitus tipo 1 (DM1) se constituye en la adhesión al tratamiento medicamentoso, en la alimentación y en la actividad física, centrando en el control glucémico. El objetivo de este estudio fue observar los efectos de la interferencia nutricional en el tratamiento de pacientes con DM1. Se trata de estudio cuantitativo, prospectivo y longitudinal desarrollado en el Ambulatorio de Diabetes de la UFTM (Universidade Federal do Triângulo Mineiro). La recolección de datos fue realizada entre marzo de 2013 y septiembre de 2014. Fueron evaluados 41 niños y adolescentes entre 6 y 17 años, en cuanto a la antropometría, control glucémico y lipídico en 4 momentos: M1 en el inicio del seguimiento; M2 tras orientación nutricional convencional; M3 tras aprendizaje del conteo de carbohidratos (CCHO) y M4 en conteo pleno. El análisis estadístico fue descriptivo e inferencial. La antropometría comprobó que el CCHO no resultó en ganancia de peso y fue efectivo en el sexo masculino, demostrado por la reducción en las concentraciones de fructosamina (p=0,050) y HbA1C (p=0,041) en el M4 comparado al M1. Considerando la fructosamina, el grupo con CCHO se diferenció del grupo sin CCHO M4 (p=0,035). La terapéutica insulínica asociada al CCHO demostró ser un recurso importante a ser integrado en el tratamiento del DM1, a fin de alcanzar blancos efectivos en la reducción de las complicaciones.

ABSTRACT The treatment of Diabetes Mellitus Type 1 (DM1) involves adherence to insulin treatment, diet and physical activity, aiming at glycemic control. The objective of this study was to observe the effects of nutritional interference in the treatment of patients with DM1. It is a quantitative, prospective and longitudinal study developed at the UFTM Diabetes Outpatient Clinic. Data collection was performed between March 2013 and September 2014. Thirty-one children and adolescents between 6 and 17 years old were evaluated for anthropometry, glycemic and lipid control in four stages: M1 at the beginning of follow-up; M2 after conventional nutritional counseling; M3 after learning the carbohydrate count (CCHO) and M4 in full count. Statistical analysis was descriptive and inferential. The anthropometry showed that CCHO did not result in weight gain and was effective in males, demonstrated by the reduction in the concentrations of fructosamine (p=0.050) and HbA1C (p=0.041) in M4 compared to M1. Considering the fructosamine, the CCHO group differed from the non-CCHO M4 group (p=0.035). CCHO-associated insulin therapy has been shown to be an important resource to be integrated into the treatment of DM1 to achieve effective targets in reducing complications.

Evaluation of clinical and laboratory markers of cardiometabolic risk in overweight and obese children and adolescents.

OBJECTIVE:: This study analyzed the frequency of cardiometabolic risk markers and metabolic syndrome occurrence in overweight and obese children and adolescents. METHODS:: The participants included 161 overweight (n=65) and obese (n=96) individuals aged between 5 and 19 years. Clinical markers were assessed (body mass index, body fat percentage, waist circumference, acanthosis, systolic and diastolic blood pressures, laboratory parameters [glucose, insulin, cholesterol (total and fractions) and triglyceride levels and homeostasis model assessment of insulin resistance (HOMA-IR) index] and leptin and adiponectin levels). The frequency of changes, odds ratios and correlations among markers were determined. Metabolic syndrome was assessed according to International Diabetes Federation criteria. RESULTS:: A high frequency of acanthosis (51.6%); increased waist circumference (45.4%), systolic blood pressure / diastolic blood pressure (8.1% / 9.3%), glucose (10%), insulin (36.9%) and HOMA-IR (44.3%) values; and reduced high-density lipoprotein levels (47.2%) were observed. Leptin levels were increased in 95% of obese and in 66% of overweight subjects. Adiponectin was decreased in 29.5% of obese and in 34% of overweight subjects. An odd ratio analysis revealed a greater probability of increased waist circumference (9.0), systolic blood pressure (4.1), triglyceride (2.3) and insulin (2.9) levels and HOMA-IR (3.0) in the obese group than in the overweight group. The clinical and laboratory parameters and leptin levels exhibited significant correlations, whereas adiponectin was negatively correlated with systolic blood pressure. The occurrence rate of metabolic syndrome was 13.6%. CONCLUSIONS:: The high frequency of changes in clinical, laboratory and adipokine markers indicates the need for early interventions aimed at preventing cardiometabolic complications in adulthood.

Evaluation of clinical and laboratory markers of cardiometabolic risk in overweight and obese children and adolescents

OBJECTIVE: This study analyzed the frequency of cardiometabolic risk markers and metabolic syndrome occurrence in overweight and obese children and adolescents. METHODS: The participants included 161 overweight (n=65) and obese (n=96) individuals aged between 5 and 19 years. Clinical markers were assessed (body mass index, body fat percentage, waist circumference, acanthosis, systolic and diastolic blood pressures, laboratory parameters [glucose, insulin, cholesterol (total and fractions) and triglyceride levels and homeostasis model assessment of insulin resistance (HOMA-IR) index] and leptin and adiponectin levels). The frequency of changes, odds ratios and correlations among markers were determined. Metabolic syndrome was assessed according to International Diabetes Federation criteria. RESULTS: A high frequency of acanthosis (51.6%); increased waist circumference (45.4%), systolic blood pressure / diastolic blood pressure (8.1% / 9.3%), glucose (10%), insulin (36.9%) and HOMA-IR (44.3%) values; and reduced high-density lipoprotein levels (47.2%) were observed. Leptin levels were increased in 95% of obese and in 66% of overweight subjects. Adiponectin was decreased in 29.5% of obese and in 34% of overweight subjects. An odd ratio analysis revealed a greater probability of increased waist circumference (9.0), systolic blood pressure (4.1), triglyceride (2.3) and insulin (2.9) levels and HOMA-IR (3.0) in the obese group than in the overweight group. The clinical and laboratory parameters and leptin levels exhibited significant correlations, whereas adiponectin was negatively correlated with systolic blood pressure. The occurrence rate of metabolic syndrome was 13.6%. CONCLUSIONS: The high frequency of changes in clinical, laboratory and adipokine markers indicates the need for early interventions aimed at preventing cardiometabolic complications in adulthood.

Puberty in a sample of Brazilian schoolgirls: timing and anthropometric characteristics.

OBJECTIVE: The objective of this study was to determine the age at which puberty begins, age of menarche and anthropometric data of the participants at different stages of puberty. SUBJECTS AND METHODS: This is a cross-sectional study in which we evaluated 665 girls, a sample representing the female schoolchildren population in Uberaba. RESULTS: We found that thelarche, pubarche, underarm hair and menarche were attained at the age of 9.8 ± 1.4, 10.2 ± 1.4, 10.5 ± 1.5 and 11.7 ± 1.3 years, respectively. The mean interval between thelarche and menarche (ITM) was 1.7 ± 1.3 years. The prevalence of overweight and obesity was 31.3% and 95% of the participants began at thelarche between the age of 7 and 12 years. CONCLUSION: These values indicate a secular tendency to the decrease of the age of menarche and an earlier start of puberty. It is very important to understand these parameters to establish public policies aimed at plans to prevent these early events, especially regarding control of the prevalence of obesity.

Puberty in a sample of Brazilian schoolgirls: timing and anthropometric characteristics

Objective The objective of this study was to determine the age at which puberty begins, age of menarche and anthropometric data of the participants at different stages of puberty. Subjects and methods This is a cross-sectional study in which we evaluated 665 girls, a sample representing the female schoolchildren population in Uberaba. Results We found that thelarche, pubarche, underarm hair and menarche were attained at the age of 9.8 ± 1.4, 10.2 ± 1.4, 10.5 ± 1.5 and 11.7 ± 1.3 years, respectively. The mean interval between thelarche and menarche (ITM) was 1.7 ± 1.3 years. The prevalence of overweight and obesity was 31.3% and 95% of the participants began at thelarche between the age of 7 and 12 years. Conclusion These values indicate a secular tendency to the decrease of the age of menarche and an earlier start of puberty. It is very important to understand these parameters to establish public policies aimed at plans to prevent these early events, especially regarding control of the prevalence of obesity. .