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1.
Artigo em Inglês | MEDLINE | ID: mdl-32560441

RESUMO

Critical surgical and medical advances have shifted the focus of congenital heart disease (CHD) patients from survival to achievement of a greater health-related quality of life (HRQoL). HRQoL is influenced, amongst other factors, by aerobic capacity and respiratory muscle strength, both of which are reduced in CHD patients. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on respiratory muscle strength and functional capacity. Fifteen CHD patients, ages 12 to 16, with reduced aerobic capacity in cardiopulmonary exercise testing (CPET) were enrolled in a CPRP involving strength and aerobic training for three months. Measurements for comparison were obtained at the start, end, and six months after the CPRP. A significant improvement of inspiratory muscle strength was evidenced (maximum inspiratory pressure 21 cm H2O, 23%, p < 0.01). The six-minute walking test showed a statistically and clinically significant rise in walked distance (48 m, p < 0.01) and a reduction in muscle fatigue (1.7 out of 10 points, p = 0.017). These results suggest CPRP could potentially improve respiratory muscle function and functional capacity, with lasting results, in children with congenital heart disease, but additional clinical trials must be conducted to confirm this finding.

2.
Acta Diabetol ; 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-32277296

RESUMO

AIMS: Food addiction (FA) is conceptualized as a behavioral pattern that is similar in some ways to addictions to alcohol and other substances. This disorder has not been well studied among patients with type 2 diabetes (T2DM). We aimed to analyze if there is any relationship between FA and clinical or psychological variables among patients with T2DM. METHODS: Three hundred patients with T2DM were analyzed cross-sectionally. Participants were evaluated for the presence of FA by completing the Yale Food Addiction Scale 2.0 questionnaire. RESULTS: 29.3% of patients screened positive for FA. Patients with FA had a greater BMI (33.41 ± 7.5 vs. 31.6 ± 5.9 kg/m2; p = 0.04). HbA1c was higher among individuals with FA (7.9 ± 4.4 vs. 7.6 ± 1.4%, p = 0.008). The proportion of subjects with diabetic retinopathy, neuropathy and nephropathy was greater among patients with criteria for FA compared with patients without this condition (25% vs. 13.2%, 29.5% vs. 21.8% and 32% vs. 22.3%; p = 0.03, p = 0.05 and p = 0.05, respectively). The percentage of patients with FA with significant depressive symptoms was also greater (36.4% vs. 18.5%; p = 0.002). CONCLUSIONS: The presence of FA among T2DM patients implied a worse glycaemic control. Microvascular complications and depressive symptoms were higher among these patients.

3.
Arch Bronconeumol ; 2020 Feb 21.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32094024

RESUMO

BACKGROUND AND OBJECTIVES: Available evidence suggests a familial basis for OSA. The aim of the present study was to assess the potential influences of parental OSA in predicting the diagnosis and severity of OSA in snoring children. METHODS: Observational study, we prospectively enrolled 84 children and their parents. A complete nocturnal polysomnography was performed. Children were categorized into 3 severity groups according to the apnea-hypopnea index (AHI<1h-1, AHI≥1h-1 to AHI<5h-1, and AHI≥5h-1). Adults were grouped according two criteria (AHI≥5h-1 and ≥10h-1). RESULTS: There were no significant differences in age, gender, BMI and BMI z-score among groups. Among the children, 54.7% had an AHI≥1h-1 and 21.4% had an AHI≥5h-1. Overall, we observed that 60.7% of fathers and 23.8% of mothers of our population had OSA (AHI≥5h-1). The prevalence of fathers with OSA increases with the children's severity (83% in the group of children with moderate-severe OSA, p=0.035). The odds of having moderate-severe pediatric OSA (AHI≥5h-1) were more than 4 times higher among children with a father with AHI≥5h-1 (OR: 4.92, 95% CI: 1.27-19.06; p=0.021). There was no evidence of any maternal influence on OSA severity among the children studied. CONCLUSIONS: Our findings suggest a high prevalence of OSA among the family members studied with an increased association of childhood OSA with paternal OSA. Prediction of OSA risk among children can be significantly improved by adding data on paternal OSA status.

4.
Nutrients ; 12(1)2019 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-31881702

RESUMO

The aim of this study of patients with chronic kidney disease (CKD) is to assess the safety of daily consumption of walnuts on the physiological levels of phosphorous, potassium, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF23), and to assess the short-term benefits of this intervention on risk factors associated with cardiovascular events. This led us to perform a prospective, randomized, crossover, pilot clinical trial examined 13 patients with CKD. Subjects were randomly assigned to a diet of 30 g of walnuts per day or the control diet. After 30 days, each group was given a 30-day washout period, and then switched to the alternate diet for 30 days. Urinary and serum levels of phosphorous and potassium, multiple vascular risk factors, and urinary inositol phosphates (InsPs) were measured at baseline and at the end of the intervention period. Our results showed that the walnut dietary supplement led to reduced blood pressure, LDL cholesterol, and albumin excretion, but had no effect on the physiological levels of phosphorous, potassium, PTH, and FGF23. This is the first report to show that daily consumption of walnuts by patients with CKD does not alter their physiological levels of phosphorous, potassium, PTH, and FGF23 when included in a sodium-, protein-, phosphate-, and potassium-controlled diet, and it could be an effective strategy for reducing cardiovascular risk in patients with CKD.

5.
Nutrients ; 11(8)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31344950

RESUMO

Our purpose was to study the relationship of adherence to the Mediterranean diet (MedDiet) with urinary factors that favor the formation of renal calcium and uric acid stones in overweight and obese participants who had metabolic syndrome. This cross-sectional study examined 267 participants. A well-known MedDiet score (range 0-9) was calculated for each patient, and patients were then categorized has having low (≤3), medium (4-5), or high (≥6) adherence to the MedDiet. Baseline characteristics and urinary parameters were also analyzed. High calcium salt urinary crystallization risk (CaUCR) and high uric acid urinary crystallization risk (UrUCR) were calculated from urinary parameters using pre-defined criteria. More than half of patients with MedDiet scores ≤3 had high UrUCR (55.4%) and high CaUCR (53.8%). In contrast, fewer patients with high adherence (≥6) to the MedDiet had high UrUCR (41.2%) and high CaUCR (29.4%). Relative to those with low adherence, individuals with high adherence had a prevalence ratio (PR) of 0.77 for a high UrUCR (95% CI: 0.46-1.12; p for trend: 0.069) and a PR of 0.51 for a high CaUCR (95% CI: 0.26-0.87; p for trend: 0.012) after adjusting for age, sex, body mass index, type 2 diabetes, and total energy intake. Our findings indicate that greater adherence to the MedDiet was associated with a reduced CaUCR and a reduced UrUCR. This suggests that adequate dietary management using the MedDiet patterns may prevent or reduce the incidence and recurrence of calcium salt and uric acid renal stones.


Assuntos
Dieta Saudável , Dieta Mediterrânea , Síndrome Metabólica/dietoterapia , Sobrepeso/dietoterapia , Cooperação do Paciente , Urolitíase/prevenção & controle , Idoso , Biomarcadores/urina , Estudos Transversais , Comportamento Alimentar , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/urina , Pessoa de Meia-Idade , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/urina , Prevalência , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Urolitíase/diagnóstico , Urolitíase/epidemiologia , Urolitíase/urina
6.
Clin Biochem ; 68: 24-29, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30928393

RESUMO

BACKGROUND: Acute coronary syndrome (ACS) is a major cause of death and closely related with obstructive sleep apnea (OSA). Our hypothesis is that several cardiovascular-related biomarkers could have a differential prognostic value for ACS severity in patients with OSA, and could also help (individually or combined) in the detection of OSA in patients after a coronary event. METHODS: Up to 361 consecutive individuals admitted due to ACS were included in the study. All of them were evaluated for ACS severity (Killip score, number of diseased vessels, ejection fraction) and further classified as OSA or non-OSA. Medical records were registered and eleven blood biomarkers were measured, including heart-type fatty acid-binding globulin, N-terminal pro-brain natriuretic peptide, matrix metalloproteinase-9 (MMP9), placental growth factor (PlGF) and high-sensitivity C-reactive protein. Odds ratios of every biomarker for ACS severity-related parameters were calculated and adjusted for age, gender, body-mass index (BMI), hypertension, diabetes, smoking and drinking. The use of clinical measures and biomarkers for the diagnosis of OSA in ACS patients was evaluated both alone and combined using ROC curves. RESULTS: Several biomarkers showed a significant association with ACS severity, which remained after adjusting for OSA and other potentially confounding variables. The mathematical combination of age, BMI, PlGF and MMP9 showed an area under the ROC curve (AUC) for OSA identification of 0.741, which was greater than any individual parameter or combination assessed: AUC(BMI):0.687, AUC(age):0.576, AUC(PlGF):0.584, AUC(MMP9):0.555. CONCLUSIONS: The usefulness of biomarkers in the assessment of ACS severity was independent of OSA and the other variables evaluated. In patients admitted after a coronary event, the combination of clinical measures and biomarkers showed a significant discriminating power for the detection of OSA. CLINICAL TRIAL REGISTRATION: NCT01335087 (clinicaltrials.gov).


Assuntos
Biomarcadores/sangue , Síndromes da Apneia do Sono/sangue , Apneia Obstrutiva do Sono/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/patologia , Algoritmos , Área Sob a Curva , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Feminino , Humanos , Masculino , Prognóstico , Síndromes da Apneia do Sono/patologia , Apneia Obstrutiva do Sono/patologia
7.
Kidney Int ; 95(4): 958-972, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30827513

RESUMO

Children on dialysis have a cardiovascular mortality risk equivalent to older adults in the general population, and rapidly develop medial vascular calcification, an age-associated pathology. We hypothesized that premature vascular ageing contributes to calcification in children with advanced chronic kidney disease (CKD). Vessels from children with Stage 5 CKD with and without dialysis had evidence of increased oxidative DNA damage. The senescence markers p16 and p21 were also increased in vessels from children on dialysis. Treatment of vessel rings ex vivo with calcifying media increased oxidative DNA damage in vessels from children with Stage 5 CKD, but not in those from healthy controls. Vascular smooth muscle cells cultured from children on dialysis exhibited persistent DNA damage, impaired DNA damage repair, and accelerated senescence. Under calcifying conditions vascular smooth muscle cells from children on dialysis showed increased osteogenic differentiation and calcification. These changes correlated with activation of the senescence-associated secretory phenotype (SASP), an inflammatory phenotype characterized by the secretion of proinflammatory cytokines and growth factors. Blockade of ataxia-telangiectasia mutated (ATM)-mediated DNA damage signaling reduced both inflammation and calcification. Clinically, children on dialysis had elevated circulating levels of osteogenic SASP factors that correlated with increased vascular stiffness and coronary artery calcification. These data imply that dysregulated mineral metabolism drives vascular "inflammaging" by promoting oxidative DNA damage, premature senescence, and activation of a pro-inflammatory SASP. Drugs that target DNA damage signaling or eliminate senescent cells may have the potential to prevent vascular calcification in patients with advanced CKD.


Assuntos
Arterite/etiologia , Senescência Celular/genética , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Calcificação Vascular/etiologia , Adolescente , Artérias/citologia , Artérias/diagnóstico por imagem , Artérias/patologia , Arterite/patologia , Proteínas Mutadas de Ataxia Telangiectasia/metabolismo , Células Cultivadas , Criança , Pré-Escolar , Dano ao DNA , Feminino , Humanos , Lactente , Falência Renal Crônica/complicações , Masculino , Músculo Liso Vascular/citologia , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/patologia , Estresse Oxidativo , Cultura Primária de Células , Calcificação Vascular/patologia
8.
Sleep Med ; 53: 101-105, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30504083

RESUMO

OBJECTIVE: Increased blood coagulation might be one important mechanism linking obstructive sleep apnea (OSA) with cardiovascular diseases. We tested the association between several hemostatic parameters and sleep breathing-related variables in a representative pediatric population with a clinical suspicion of OSA. METHODS: Polysomnography was performed in 152 snoring children to diagnose OSA. Anthropometric and clinical data were registered and venous blood samples were collected for the measurement of platelet count, plateletcrit, platelet distribution width (PDW), mean platelet volume (MPV), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and C-reactive protein. RESULTS: Children with OSA had significantly higher platelet count, plateletcrit and PDW compared with those without OSA. After controlling for the anthropometric characteristics (age, gender, body mass index (BMI) z-score), platelet count negatively correlated with minimum SaO2 while the plateletcrit correlated with time with SaO2 <90% and MPV correlated with apnea-hypopnea index. PT and PT international normalized ratio correlated with mean SaO2 and aPTT correlated with the oxygen desaturation index. CONCLUSION: Our findings suggest that different OSA-related effects may be factors contributing to an enhanced coagulability in pediatric OSA. Measures reflecting apnea severity and disrupted sleep were associated with clotting factor changes independent of covariates affecting hemostatic function.


Assuntos
Testes de Coagulação Sanguínea , Protrombina , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/fisiopatologia , Criança , Feminino , Humanos , Masculino , Pediatria , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico
9.
Rev. argent. endocrinol. metab ; 55(3): 31-40, set. 2018. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1041742

RESUMO

RESUMEN Introducción La cantidad y la diversidad bacteriana intestinal están relacionadas con las enfermedades metabólicas e inflamatorias. El objetivo de este trabajo fue caracterizar la composición de la microbiota intestinal en heces y su relación con variables bioquímicas y el patrón de consumo de alimentos en individuos sanos, obesos y pacientes con diabetes mellitus tipo 2, en Mallorca (España). Métodos Las bacterias en heces se caracterizaron por PCR tiempo real. El ADN se aisló a partir de sujetos sanos (23), obesos (no diabéticos) (24) y diabéticos tipo 2 (no obesos) y se amplificó con cebadores específicos para identificar Roseburia, Clostridium leptum, Lactobacillus y Clostridium coccoides-Eubacterium rectale (Firmicutes); Prevotella y Bacteroides (Bacteroidetes); Bifidobacterium (Actinobacteria) y el cebador Universal (para total de bacterias), para la amplificación de la región V4 del gen 16S rRNA. Los resultados se analizaron estadísticamente utilizando SPSS v.21. Resultados En una población rural y urbana de Baleares, se detectaron niveles de insulina significativamente superiores en obesos (12,2 + 1,3 md/dL). En diabéticos, los niveles de triglicéridos, glucosa en sangre, hemoglobina glucosilada y albúmina en orina fueron superiores que en controles y obesos (por encima del rango normal). La mayor dispersión de las variables bioquímicas en sangre se identificó con: Clostridium coccoide-Eubacterium rectale, Bacteroides y Bifidobacterium, como posibles marcadores en obesos y diabéticos y Prevotella y Lactobacillus, como marcadores de salud. El contenido total de bacterias es mayor en controles y la relación entre reinos bacterianos es menor en este grupo. Los patrones de consumo de alimentos fueron diferentes en los tres grupos lo cual está relacionado con la variación en los patrones bacterianos. Conclusión La variabilidad en el consumo de alimentos estuvo relacionada con cinco marcadores bacterianos principales que contribuyeron a la mayor variabilidad de marcadores bioquímicos entre grupos de sujetos: Clostridium coccoide-Eubacterium rectale, Bacteroides, Bifidobacterium, Prevotella y Lactobacillus, en una población de Mallorca (España). Gut microbiota and healthy in human: obesity and type 2 diabetes mellitus.


ABSTRACT Introduction The amount and bacterial diversity in the bowel are associated to metabolic and inflammatory diseases. The aim was to characterize the gut microbiota composition in faeces and food consumption pattern in healthy, obese and Type 2 diabetes mellitus subjects from Majorca (Spain). Methods Bacteria in faeces were characterized by Real-time PCR. DNA was isolated from healthy subjects (23), obese patients (not diabetic) (24) and type 2 diabetic patients (12) and amplified with specific primers for the identification of Roseburia, Clostridium leptum, Lactobacillus and Clostridium coccoides-Eubacterium rectale (Firmicutes); Prevotella and Bacteroides (Bacteroidetes); Bifidobacterium (Actinobacteria); and Universal primer (for all bacteria), referred to amplification of 16S rRNA gene V4 region. Results were statistically analyzed by SPSS v.21. Results A rural and urban population from Balearic Islands was tested. The insulin levels were highest in obese group (12.2 + 1.3 md/dL) while the triglyceride, blood glucose, glycosylated haemoglobin and urine albumin levels were highest in diabetic group. The major dispersion of the blood variables was identified to a bacteria core: Clostridium coccoide-Eubacterium rectale, Bacteroides and Bifidobacterium as possible markers for obese and diabetic patients; and Prevotella and Lactobacillus levels as markers of health. The total amount of bacteria is the highest in control group, such as the ratio between phyla is the lowest. The food consumptiom patterns were different among which is related to the variation in the bacterial patterns. Conclusion The variability in the foods consumption among groups was related to five bacterial markers which contributed to the major variability in blood markers: Clostridium coccoide-Eubacterium rectale, Bacteroides, Bifidobacterium, Prevotella y Lactobacillus; in a population from Majorca, Spain.

10.
Sci Rep ; 8(1): 9619, 2018 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-29941991

RESUMO

Myo-inositol hexaphosphate (phytate; IP6) is a natural compound that is abundant in cereals, legumes, and nuts and it has the ability to chelate metal cations. The binding of IP6 to transition metals suggests that it could be used for the treatment of metal-catalyzed protein glycation, which appears to trigger diabetes-related diseases. Our in vitro studies showed that IP6 reduced the formation of Fe3+-catalyzed advanced glycation end-products (AGEs). This led us to perform a randomized cross-over trial to investigate the impact of the daily consumption IP6 on protein glycation in patients with type 2 diabetes mellitus (T2DM; n = 33). Thus, we measured AGEs, glycated hemoglobin (HbA1c), several vascular risk factors, and urinary IP6 at baseline and at the end of the intervention period. Patients who consumed IP6 supplements for 3 months had lower levels of circulating AGEs and HbA1c than those who did not consume IP6. This is the first report to show that consumption of IP6 inhibits protein glycation in patients with T2DM. Considering that AGEs contribute to microvascular and macrovascular complications in T2DM, our data indicates that dietary supplementation with IP6 should be considered as a therapy to prevent the formation of AGEs and therefore, the development of diabetes-related diseases in patients with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Produtos Finais de Glicação Avançada/metabolismo , Ácido Fítico/farmacologia , Idoso , Glicemia/metabolismo , Estudos Cross-Over , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Fítico/efeitos adversos , Segurança
11.
Nutr Hosp ; 34(1): 81-87, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28244776

RESUMO

INTRODUCTION: Obesity is linked to a low-grade chronic systemic inflammation that improves after weight loss. Depressive disorder has been suggested to be associated with systemic inflammation up regulation. OBJECTIVE: We aimed to explore whether, after a significant weight loss, the presence of depressive symptoms was associated with differences in terms of inflammatory markers and quality of life. METHODS: Sixty patients (78.3%♀, age 46.4 ± 9.9) who underwent bariatric surgery, with a minimum follow up of 18 months, were evaluated. For the screening of depression, the Beck Depression Inventory (BDI) was administered. RESULTS: Ten subjects (16.6%) had a positive screening for depressive disorder. The percentage of patients with weight regain was greater among subjects with symptoms of depression (70% vs. 32%; p = 0.024), although no differences were seen regarding BMI prior to surgery and current BMI. Acute phase reactants were higher among subjects with symptoms of depression: platelets (319 ± 15 x 10^12/L vs. 232 ± 47 x 10 ^ 12/L; p = 0.001), erythrocyte sedimentation rate (24.7 ± 11.3 mm vs.17 ± 10 mm; p = 0.03), fibrinogen (486 ± 107 mg/dL vs. 406 ± 66 mg/dL; p = 0.003), ferritin (106 ± 180 ng/ml vs. 34 ± 44 ng/ml; p = 0.014) and ultrasensitive C-reactive protein (0.96 ± 1.84 mg/dL vs. 0.24 ± 0.26 mg/dL; p = 0.008). All domains of quality of life were significantly lower in the depressive group. CONCLUSIONS: Despite a significant weight loss, inflammatory markers are greater and quality of life lower when associated with depressive symptoms.


Assuntos
Cirurgia Bariátrica/psicologia , Depressão/psicologia , Inflamação/sangue , Qualidade de Vida , Perda de Peso , Adulto , Biomarcadores/sangue , Depressão/epidemiologia , Depressão/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
12.
Nutr. hosp ; 34(1): 81-87, ene.-feb. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-161145

RESUMO

Introduction: Obesity is linked to a low-grade chronic systemic inflammation that improves after weight loss. Depressive disorder has been suggested to be associated with systemic inflammation up regulation. Objective: We aimed to explore whether, after a significant weight loss, the presence of depressive symptoms was associated with differences in terms of inflammatory markers and quality of life. Methods: Sixty patients (78.3%♀, age 46.4 ± 9.9) who underwent bariatric surgery, with a minimum follow up of 18 months, were evaluated. For the screening of depression, the Beck Depression Inventory (BDI) was administered. Results: Ten subjects (16.6%) had a positive screening for depressive disorder. The percentage of patients with weight regain was greater among subjects with symptoms of depression (70% vs. 32%; p = 0.024), although no differences were seen regarding BMI prior to surgery and current BMI. Acute phase reactants were higher among subjects with symptoms of depression: platelets (319 ± 15 x 10


Introducción: la obesidad se asocia a una inflamación crónica de bajo grado que mejora tras la pérdida de peso. El trastorno depresivo también se ha asociado a una inflamación sistémica. Objetivo: determinar si, tras una pérdida de peso significativa, la presencia de síntomas depresivos se asocia a diferencias en los marcadores inflamatorios y la calidad de vida. Métodos: sesenta pacientes (78,3% ♀, edad 46,4 ± 9.9) sometidos a cirugía bariátrica, con un seguimiento mínimo de 18 meses, fueron evaluados. Se autoadministró el test de depresión de Beck (BDI) para el screening de depresión. Resultados: diez sujetos (16,6%) tenían un screening positivo para depresión. El porcentaje de pacientes que ganaron peso fue superior en el grupo de pacientes con síntomas depresivos (70% vs. 32%; p = 0,024), aunque no se evidenciaron diferencias en cuanto al IMC antes de la cirugía ni al IMC actual. Los reactantes de fase aguda fueron mayores entre los sujetos con síntomas depresivos: plaquetas (319 ± 15 x 10


Assuntos
Humanos , Depressão/epidemiologia , Cirurgia Bariátrica/psicologia , Obesidade/psicologia , Perda de Peso , Mediadores da Inflamação/análise , Inflamação/fisiopatologia , Obesidade/cirurgia , Proteínas da Fase Aguda/análise , Qualidade de Vida
13.
J Ren Nutr ; 26(4): 226-36, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26975775

RESUMO

OBJECTIVE: The aim of this study was to evaluate the relationship between physiological levels of myo-inositol hexaphosphate (phytate) and cardiovascular (CV) calcification in patients with chronic kidney disease (CKD). DESIGN AND METHODS: This was a prospective cross-sectional study conducted from December 2012 to June 2013. SUBJECTS: Sixty-nine consecutive patients with CKD who were not undergoing renal replacement therapy. INTERVENTION: All subjects were given lateral lumbar X-rays to quantify abdominal aortic calcification (AAC). Clinical laboratory analyses and phytate food frequency questionnaires were also performed. MAIN OUTCOME MEASURE: Phytate urinary excretion, estimated phytate consumption (based on food frequency questionnaire) and AAC score. Patients were divided into two groups based on median abdominal aortic calcification (AAC) score: no/mild AAC (AAC ≤ 6, n = 35) and moderate/severe AAC (AAC > 6, n = 34). RESULTS: Patients with no/mild AAC were younger, had lower pulse pressure, greater dietary intake of phytate, greater urinary phytate and the prevalence of prior CV disease was significantly lower compared to patients with moderate/severe AAC. Among the top 10 phytate-rich foods, lentil consumption was significantly greater in patients with no/mild AAC than in those with moderate/severe AAC. Multivariate logistic regression analysis indicated that age, prior CV disease, urinary phytate (or lentil consumption) were independently associated to AAC. CONCLUSION: Our results suggest that adequate consumption of phytate can prevent AAC in patients with CKD. Further prospective studies must be performed to elucidate the benefits of a phytate-rich diet and the associated risk of phosphorus bioavailability in these patients.


Assuntos
Aorta Abdominal/patologia , Dieta , Ácido Fítico/administração & dosagem , Insuficiência Renal Crônica/patologia , Calcificação Vascular/patologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Fítico/urina , Prevalência , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Circunferência da Cintura
14.
PLoS One ; 10(8): e0136560, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26322979

RESUMO

Pathological calcification generally consists of the formation of solid deposits of hydroxyapatite (calcium phosphate) in soft tissues. Supersaturation is the thermodynamic driving force for crystallization, so it is believed that higher blood levels of calcium and phosphate increase the risk of cardiovascular calcification. However several factors can promote or inhibit the natural process of pathological calcification. This cross-sectional study evaluated the relationship between physiological levels of urinary phytate and heart valve calcification in a population of elderly out subjects. A population of 188 elderly subjects (mean age: 68 years) was studied. Valve calcification was measured by echocardiography. Phytate determination was performed from a urine sample and data on blood chemistry, end-systolic volume, concomitant diseases, cardiovascular risk factors, medication usage and food were obtained. The study population was classified in three tertiles according to level of urinary phytate: low (<0.610 µM), intermediate (0.61-1.21 µM), and high (>1.21 µM). Subjects with higher levels of urinary phytate had less mitral annulus calcification and were less likely to have diabetes and hypercholesterolemia. In the multivariate analysis, age, serum phosphorous, leukocytes total count and urinary phytate excretion appeared as independent factors predictive of presence of mitral annulus calcification. There was an inverse correlation between urinary phytate content and mitral annulus calcification in our population of elderly out subjects. These results suggest that consumption of phytate-rich foods may help to prevent cardiovascular calcification evolution.


Assuntos
Calcinose/urina , Cardiomiopatias/urina , Doenças das Valvas Cardíacas/urina , Valvas Cardíacas/patologia , Ácido Fítico/urina , Idoso , Envelhecimento , Calcificação Fisiológica , Calcinose/sangue , Cardiomiopatias/sangue , Cardiomiopatias/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Durapatita/metabolismo , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/sangue , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Hipercolesterolemia/epidemiologia , Contagem de Leucócitos , Masculino , Valva Mitral/patologia , Fosfatos/sangue , Fatores de Risco
15.
Sci Rep ; 5: 12052, 2015 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-26169912

RESUMO

Protein aggregation with the concomitant formation of amyloid fibrils is related to several neurodegenerative diseases, but also to non-neuropathic amyloidogenic diseases and non-neurophatic systemic amyloidosis. Lysozyme is the protein involved in the latter, and it is widely used as a model system to study the mechanisms underlying fibril formation and its inhibition. Several phenolic compounds have been reported as inhibitors of fibril formation. However, the anti-aggregating capacity of other heteroaromatic compounds has not been studied in any depth. We have screened the capacity of eleven different hydroxypyridines to affect the acid-induced fibrillization of hen lysozyme. Although most of the tested hydroxypyridines alter the fibrillation kinetics of HEWL, only 3-hydroxy-2-methylpyridine, 3-hydroxy-6-methylpyridine and 3-hydroxy-2,6-dimethylpyridine completely abolish fibril formation. Different biophysical techniques and several theoretical approaches are combined to elucidate their mechanism of action. O-methylated 3-hydroxypyridines bind non-cooperatively to two distinct but amyloidogenic regions of monomeric lysozyme. This stabilises the protein structure, as evidenced by enhanced thermal stability, and results in the inhibition of the conformational transition that precedes fibril assembly. Our results point to o-methylated 3-hydroxypyridines as a promising molecular scaffold for the future development of novel fibrillization inhibitors.


Assuntos
Muramidase/metabolismo , Piridinas/farmacologia , Amiloide/química , Amiloide/metabolismo , Animais , Sítios de Ligação , Concentração de Íons de Hidrogênio , Cinética , Microscopia de Força Atômica/métodos , Modelos Moleculares , Simulação de Acoplamento Molecular , Muramidase/química , Agregados Proteicos/efeitos dos fármacos , Agregação Patológica de Proteínas , Ligação Proteica , Conformação Proteica , Estabilidade Proteica/efeitos dos fármacos , Proteólise , Piridinas/química , Termodinâmica
16.
Trials ; 16: 248, 2015 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-26037626

RESUMO

BACKGROUND: Osteoarthritis of the knee is a major cause of disability among adults. Electro-acupuncture is considered a potentially useful treatment for osteoarthritis. The purpose of this study is to assess the efficacy of electro-acupuncture on pain control, pain perception, plasma cortisol and beta-endorphin levels, patient-perceived quality of life, and pain medication use in patients with chronic knee pain. METHODS/DESIGN: This study is a placebo-controlled, randomized, double-blind, parallel design trial. One hundred sixty out-patients who are more than 50 years old and who have osteoarthritis of the knee will be recruited from the island of Mallorca, Spain. Each participant will be randomly placed into one of two groups: (sham) electro-acupuncture non-insertion technique and real electro-acupuncture. Acupuncture treatments will be the Traditional Chinese Medicine type. The patients will be evaluated after a period of 1 month (with two weekly sessions), 3 months (with one monthly session), 6 months (with one session every 45 days), and 1 year later with follow-up sessions at the end of the study (with one session every 2 months). The primary outcomes will be based on the observed changes from the baseline of the visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain measured at 12 weeks after the end of treatment. Also to be included in the study are the possible changes in the secondary efficacy variables from baseline as assessed by the Short Form 36 version 2 health survey (patient-perceived quality of life), patient plasma cortisol and beta-endorphin levels at the different treatment stages, the Goldberg Anxiety and Depression Scale, pain medication use, functional capacity and stiffness (WOMAC subscales), and a VAS. These variables will be assessed at 1 month, 3 months, 6 months, and 1 year after study commencement. DISCUSSION: The findings from this study will help to determine whether electro-acupuncture is effective for chronic knee pain management in older people and whether electro-acupuncture can deliver results for the improvement of pain relief, stiffness, and disability. The study will therefore be a major step toward understanding the roles of the hypothalamic-pituitary-adrenal axis and the endogenous opioid system in the effectiveness of electro-acupuncture for chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02299713 (11 Nov. 2014).


Assuntos
Artralgia/terapia , Dor Crônica/terapia , Eletroacupuntura , Hidrocortisona/sangue , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/terapia , beta-Endorfina/sangue , Artralgia/sangue , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artralgia/psicologia , Biomarcadores/sangue , Fenômenos Biomecânicos , Dor Crônica/sangue , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Protocolos Clínicos , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/sangue , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/psicologia , Medição da Dor , Qualidade de Vida , Recuperação de Função Fisiológica , Projetos de Pesquisa , Espanha , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
17.
Eat Behav ; 18: 147-50, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26094133

RESUMO

INTRODUCTION/PURPOSE: After bariatric surgery, de novo eating patterns can develop, such as grazing. Although grazing has been associated with poorer weight loss, it has received minimal attention. We aimed to assess the influence of grazing in clinical, biochemical and psychological outcomes in a bariatric surgery sample. MATERIALS AND METHODS: Sixty patients (78.3%♀, age 46.35±9.89, months since BS 46.28±18.1) who underwent BS were evaluated cross-sectionally. Clinical, biochemical and psychological parameters were recorded. A pattern of grazing was assessed in this group of patients through interview. RESULTS: 41.7% met criteria for grazing. Mean time since BS was greater in the group with grazing (57.64±23.7months vs 38.8±26.44months; p=0.008). Although there were no differences in initial and current BMI, the percentage of patients with weight regain was greater among patients with grazing (72% vs 11.7%; p<0.0001) and the percentage of excess weight loss was lower (28.15±6.96% vs 33.35±11.9%; p=0.05). There were more difficulties in following the standardized visits according to our hospital's protocol (17.6% vs 56%; p=0.009). No significant differences were found when assessing presurgical psychiatric comorbidity among patients with a grazing pattern and individuals without this condition (68% vs 55.9%; p=0.423). When assessing quality of life only mental health was lower among patients with grazing (49.6±22.7 vs 64.2±23.3; p=0.02). CONCLUSION: Development of grazing is frequent after BS, especially when weight loss has reached a plateau. Due to its potential association with weight regain, systematic screening of grazing after BS is warranted.


Assuntos
Cirurgia Bariátrica , Comportamento Alimentar/psicologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Risco , Resultado do Tratamento , Perda de Peso
18.
Acta Diabetol ; 52(6): 1037-44, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25841588

RESUMO

AIMS: Data regarding the prevalence of eating disorders (ED) and their influence on clinical outcomes among patients with type 2 diabetes (T2DM) are scarce. Our aim is to investigate the frequency of positive screening for ED, specifically binge eating disorder (BED), in a T2DM sample and analyze whether there are any differences among T2DM subjects with a positive screening for ED or BED. METHODS: Three hundred and twenty subjects with T2DM were recruited randomly. All participants were evaluated for the presence of ED by completing the "Eating Attitudes Test-26" (EAT-26). In addition, the "Questionnaire of Eating and Weight Patterns-Revised" (QEWP-R) for the screening of BED was also implemented. Sociodemographic, clinical and biochemical parameters were also recorded. RESULTS: According to EAT-26, 14 % of subjects screened positive for ED. Regarding QEWP-R, 16 % had a positive screening for ED, with BED having a frequency of 12.2 %, being the most prevalent one. There was a positive correlation between the scores obtained with the EAT-26 and the Beck Depression Inventory (p = 0.0014). Patients with BED were younger (57.5 ± 11.1 vs 63.3 ± 10.3 years; p = 0.004), with a lesser T2DM duration (8.5 ± 6.1 vs 12.1 ± 9.6 years; p = 0.002). Weight and BMI among subjects with BED were greater (89.1 ± 1.3 vs 82.4 ± 16.7 kg; p = 0.04 and 39.4 ± 10.3 vs 30.7 ± 5.5 kg/m(2); p = 0.01). The frequency of subjects with one admission related to T2DM or any other condition during the last year was higher (10 vs 3 %; p = 0.04 and 33 vs 21 %; p = 0.01). CONCLUSIONS: ED among T2DM are frequent. Due to their deleterious effect on different metabolic and psychological outcomes, they should be diagnosed promptly, especially BED.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Idoso , Atitude , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/epidemiologia , Transtorno da Compulsão Alimentar/psicologia , Estudos Transversais , Depressão/complicações , Depressão/psicologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde , Escalas de Graduação Psiquiátrica , Atenção Secundária à Saúde , Fatores Socioeconômicos , Espanha/epidemiologia , Inquéritos e Questionários , Resultado do Tratamento
19.
Nutr. hosp ; 31(3): 1052-1058, mar. 2015. tab
Artigo em Inglês | IBECS | ID: ibc-134396

RESUMO

Introduction: There is an increasing awareness of the strong associations between obesity and adult attention-deficit/hyperactivity disorder (ADHD), with high rates of ADHD (26-61%) in patients seeking weight loss. Aims: To determine the frequency of ADHD in a bariatric surgery (BS) sample and investigate whether there were any differences among clinical, analytical and psychological parameters in individuals with criteria for ADHD. Methods: Sixty patients (78.3% female, age 46.3±9.8, months since BS 46.28±18.1) who underwent BS, with a minimum follow-up of 18 months, were evaluated cross-sectionally. Initial and current BMI, eating patterns, comorbidity, socio-demographic and biochemical parameters were recorded. For the screening of ADHD, ADHD self rating scale-v1.1 was administered. Results: Nineteen individuals (31.6%) had a positive screening for ADHD. This group had higher levels of HDL-cholesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) and Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/ dl; p=0.015), and an increased consumption of lipids (42.2±7.1% vs 36.7±8.3%; p=0.019). Subjects with ADHD symptoms had more difficulties in following visits after BS (52.6% vs 24.3%; p= 0.011).We could not find any differences in achieved BMI, depressive symptoms or quality of life. Conclusions: Patients who met criteria for ADHD face significant difficulties with compliance in follow-up, but we could not find differences in major clinical outcomes. Surprisingly, these patients could have a protective lipid profile (AU)


Introducción: Hay una creciente concienciación de la fuerte asociación entre la obesidad y el trastorno por déficit de atención/hiperactividad del adulto (TDAH), con elevadas tasas de TDAH (26-61%) en los pacientes que consultan por pérdida ponderal. Objetivos: conocer la frecuencia del TDAH en una muestra de sujetos sometidos a cirugía bariátrica (CB) e investigar si existen diferencias clínicas, analíticas y psicológicas en estos sujetos. Métodos: Sesenta pacientes (78.3% mujeres, edad 46.3±9.8, meses desde la CB 46.28±18.1) sometidos a CB, con un seguimiento mínimo desde ésta de 18 meses, fueron evaluados transversalmente. Se recogieron y analizaron el IMC inicial y en el momento de la evaluación, patrones alimentarios, comorbilidades, y parámetros sociodemográficos y bioquímicos. Para el screening del TDAH se administró la versión española del 'ADHD self-rating scale v 1.1'. Resultados: Diecinueve individuos (31.6%) tenían un screening positivo para TDAH. Estos sujetos tenían niveles superiores de HDL colesterol (62.8±17.3mg/dl vs 53.5±9.9mg/dl; p=0.011) y Apo-A (177.7±28.4mg/dl vs 154.9±34.7mg/dl; p=0.015), y un consumo mayor de lípidos en la dieta (42.2±7.1% vs 36.7±8.3%; p=0.019). Estos sujetos tenían más dificultades en seguir las visitas protocolizadas tras la CB (52.6% vs 24.3%; p= 0.011). No se evidenciaron diferencias en el IMC alcanzado, síntomas depresivos o calidad de vida. Conclusiones: Los pacientes sometidos a CB con criterios para TDAH presentan más dificultades en la adherencia al seguimiento, pero no se evidenciaron diferencias en resultados clínicos relevantes. Curiosamente, estos sujetos podrían presentar un perfil lipídico protector (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Cirurgia Bariátrica , Obesidade/cirurgia , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Resultado do Tratamento , Depressão/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Índice de Massa Corporal , HDL-Colesterol/análise
20.
Circ Res ; 116(8): 1312-23, 2015 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-25711438

RESUMO

RATIONALE: Matrix vesicles (MVs), secreted by vascular smooth muscle cells (VSMCs), form the first nidus for mineralization and fetuin-A, a potent circulating inhibitor of calcification, is specifically loaded into MVs. However, the processes of fetuin-A intracellular trafficking and MV biogenesis are poorly understood. OBJECTIVE: The objective of this study is to investigate the regulation, and role, of MV biogenesis in VSMC calcification. METHODS AND RESULTS: Alexa488-labeled fetuin-A was internalized by human VSMCs, trafficked via the endosomal system, and exocytosed from multivesicular bodies via exosome release. VSMC-derived exosomes were enriched with the tetraspanins CD9, CD63, and CD81, and their release was regulated by sphingomyelin phosphodiesterase 3. Comparative proteomics showed that VSMC-derived exosomes were compositionally similar to exosomes from other cell sources but also shared components with osteoblast-derived MVs including calcium-binding and extracellular matrix proteins. Elevated extracellular calcium was found to induce sphingomyelin phosphodiesterase 3 expression and the secretion of calcifying exosomes from VSMCs in vitro, and chemical inhibition of sphingomyelin phosphodiesterase 3 prevented VSMC calcification. In vivo, multivesicular bodies containing exosomes were observed in vessels from chronic kidney disease patients on dialysis, and CD63 was found to colocalize with calcification. Importantly, factors such as tumor necrosis factor-α and platelet derived growth factor-BB were also found to increase exosome production, leading to increased calcification of VSMCs in response to calcifying conditions. CONCLUSIONS: This study identifies MVs as exosomes and shows that factors that can increase exosome release can promote vascular calcification in response to environmental calcium stress. Modulation of the exosome release pathway may be as a novel therapeutic target for prevention.


Assuntos
Cálcio/metabolismo , Exocitose , Exossomos/metabolismo , Músculo Liso Vascular/metabolismo , Miócitos de Músculo Liso/metabolismo , Vesículas Secretórias/metabolismo , Calcificação Vascular/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Células Cultivadas , Citocinas/metabolismo , Exossomos/patologia , Feminino , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Masculino , Pessoa de Meia-Idade , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/patologia , Transporte Proteico , Proteômica/métodos , Interferência de RNA , Vesículas Secretórias/patologia , Esfingomielina Fosfodiesterase/genética , Esfingomielina Fosfodiesterase/metabolismo , Tetraspaninas/metabolismo , Fatores de Tempo , Transfecção , Calcificação Vascular/genética , Calcificação Vascular/metabolismo , Calcificação Vascular/patologia , Adulto Jovem , alfa-2-Glicoproteína-HS/metabolismo
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