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1.
Front Endocrinol (Lausanne) ; 12: 688071, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34489863

RESUMO

Coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to scale and threaten human health and public safety. It is essential to identify those risk factors that lead to a poor prognosis of the disease. A predisposing host genetic background could be one of these factors that explain the interindividual variability to COVID-19 severity. Thus, we have studied whether the rs4341 and rs4343 polymorphisms of the angiotensin converting enzyme (ACE) gene, key regulator of the renin-aldosterone-angiotensin system (RAAS), could explain the different outcomes of 128 COVID-19 patients with diverse degree of severity (33 asymptomatic or mildly symptomatic, 66 hospitalized in the general ward, and 29 admitted to the ICU). We found that G allele of rs4341 and rs4343 was associated with severe COVID-19 in hypertensive patients, independently of gender (p<0.05). G-carrier genotypes of both polymorphisms were also associated with higher mortality (p< 0.05) and higher severity of COVID-19 in dyslipidemic (p<0.05) and type 2 diabetic patients (p< 0.01). The association of G alleles with disease severity was adjusted for age, sex, BMI and number of comorbidities, suggesting that both the metabolic comorbidities and the G allele act synergistically on COVID-19 outcome. Although we did not find a direct association between serum ACE levels and COVID-19 severity, we found higher levels of ACE in the serum of patients with the GG genotype of rs4341 and rs4343 (p<0.05), what could explain the higher susceptibility to develop severe forms of the disease in patients with the GG genotype, in addition to hypertension and dyslipidemia. In conclusion, our preliminary study suggests that the G-containing genotypes of rs4341 and rs4343 confer an additional risk of adverse COVID-19 prognosis. Thus, rs4341 and rs4343 polymorphisms of ACE could be predictive markers of severity of COVID-19 in those patients with hypertension, dyslipidemia or diabetes. The knowledge of these genetic data could contribute to precision management of SARS-CoV-2 infected patients when admitted to hospital.


Assuntos
COVID-19/genética , Diabetes Mellitus/genética , Dislipidemias/genética , Variação Genética/genética , Hipertensão/genética , Peptidil Dipeptidase A/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia
2.
JNMA J Nepal Med Assoc ; 59(236): 305-309, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508529

RESUMO

INTRODUCTION: Dyslipidemia is highly prevalent among type 2 diabetic patients. It increases the risk of atherosclerosis and consequent mortality in diabetic patients. The aim of this study was to find out the prevalence of dyslipidemia among type 2 diabetic patients. METHODS: This was a descriptive cross-sectional study in 355 type 2 diabetic patients at tertiary care hospital from 15th May, 2020 to 15th November, 2020 after taking ethical clearence from Institutional Review Committee (Reference no. IRC-PA-052/2077-78). Convenience sampling was done. Demographic and lipid profile variables were recorded based on the structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Out of total 355 cases of type 2 Diabetes mellitus, prevalence of dyslipidemia was 224 (63.1%). It was more prevalent in male 145 (69.4%) than female 79 (54.1%). Increased Low density Lipoprotein (94.2%) was the most prevalent type followed by mixed dyslipidemia (91.1%). CONCLUSIONS: Dyslipidemia was common among type 2 diabetic patients and was higher in male gender, older age, obesity and longer duration of diabetes. Hence type 2 diabetic patient should undergo the routine monitoring of blood sugar and lipid profile so that any abnormalities can be identified and preventive measures along with interventions can be initiated at the earliest.


Assuntos
Diabetes Mellitus Tipo 2 , Dislipidemias , Idoso , Glicemia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Masculino , Centros de Atenção Terciária
3.
Nutrients ; 13(7)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34371848

RESUMO

In contrast to the decreasing burden related to cardiovascular disease (CVD), the burden related to dysglycemia and adiposity complications is increasing in Czechia, and local drivers must be identified. A comprehensive literature review was performed to evaluate biological, behavioral, and environmental drivers of dysglycemia and abnormal adiposity in Czechia. Additionally, the structure of the Czech healthcare system was described. The prevalence of obesity in men and diabetes in both sexes has been increasing over the past 30 years. Possible reasons include the Eastern European eating pattern, high prevalence of physical inactivity and health illiteracy, education, and income-related health inequalities. Despite the advanced healthcare system based on the compulsory insurance model with free-for-service healthcare and a wide range of health-promoting initiatives, more effective strategies to tackle the adiposity/dysglycemia are needed. In conclusion, the disease burden related to dysglycemia and adiposity in Czechia remains high but is not translated into greater CVD. This discordant relationship likely depends more on other factors, such as improvements in dyslipidemia and hypertension control. A reconceptualization of abnormal adiposity and dysglycemia into a more actionable cardiometabolic-based chronic disease model is needed to improve the approach to these conditions. This review can serve as a platform to investigate causal mechanisms and secure effective management of cardiometabolic-based chronic disease.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Intolerância à Glucose/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Determinantes Sociais da Saúde/etnologia , Adiposidade/etnologia , Adulto , Fatores de Risco Cardiometabólico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doença Crônica/epidemiologia , Doença Crônica/etnologia , República Tcheca/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Dieta/efeitos adversos , Dieta/etnologia , Dislipidemias/epidemiologia , Dislipidemias/etnologia , Comportamento Alimentar/etnologia , Feminino , Intolerância à Glucose/etnologia , Letramento em Saúde , Disparidades nos Níveis de Saúde , Humanos , Hipertensão/epidemiologia , Hipertensão/etnologia , Masculino , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Obesidade/etnologia , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etnologia , Prevalência , Comportamento Sedentário/etnologia
4.
Malawi Med J ; 33(1): 37-47, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422232

RESUMO

Background: Disability is a major determinant of impaired health and nutritional status. This study aims to assess the health and nutritional status of adults with disability and their relationship with socio-demographic factors. Methods: A descriptive cross-sectional study of 323 adults with disability in support-centers/schools of disability in Enugu Metropolis, Nigeria was conducted. The participants' socio-demographic factors, behavioural characteristics and 24-hour dietary recall were recorded. Blood pressure and anthropometric measurements of height, weight, waist and hip circumference were obtained. The height and weight measurements of non-ambulatory participants were estimated from knee height and mid-arm circumference. Biochemical analyses of blood samples were also performed. Multiple logistic regression was used to assess the effect of socio-demographic factors on health and nutritional status. Results: The participants consisted of females (59.3%) within the age of 20 to 30 years (59.1%). The major area of difficulty was in physical mobility (51.1%) and this occurred mostly in females (26.9%). The participants' mean daily intakes of calorie, protein and fat were below the recommended dietary allowances. The participants were overweight (49.2%), obese (4.6%), hypertensive (29.7%) and diabetic (12.1%). Dyslipidemia (81.8%), anemia (63.6%) and zinc deficiency (51.1%) were highly prevalent among the study group. Gender difference was observed in alcohol consumption (p=0.000), smoking habit (p=0.001), waist circumference (WC)(p=0.000), waist-hip-ratio (WHR) (p=0.000), triglyceride (p=0.026) and haemoglobin concentration (p=0.007). Being boarder was a positive predictor of overweight/obesity (OR= 2.974, 95% CI=1.449-6.104), abnormal WHR (OR=2.893, 95% CI = 1.073-7.801) and hypertension (OR=8.381, 95% CI=1.598-13.959). Female gender was associated with abnormal WC (OR=7.219, 95% CI=3.116-14.228) and WHR (OR=3.590, 95% CI=2.095-6.150) whereas older age-group was associated with overweight/obesity (OR=1.908, 95% CI=1.137- 3.202). Being employed was a negative predictor of hypertension. Conclusion: Overweight/obesity, anemia, zinc deficiency and dyslipidemia were highly prevalent among persons living with disability in Enugu Metropolis.


Assuntos
Pessoas com Deficiência , Nível de Saúde , Desnutrição/epidemiologia , Adulto , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Nigéria/epidemiologia , Estado Nutricional , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores Socioeconômicos , Populações Vulneráveis , Circunferência da Cintura , Relação Cintura-Quadril , Adulto Jovem , Zinco/deficiência
5.
Pan Afr Med J ; 39: 11, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394802

RESUMO

Introduction: dyslipidemia and hypertension are independent cardiovascular risk factors that are linked by insulin resistance and commonly coexist as components of the metabolic syndrome. The consequences of dyslipidaemic patterns includes high cardiovascular risk profile and sequalae. Data on lipid patterns amongst hypertensive patients in Abuja, a city with affluent pattern of life style and rising cardiovascular risk profile is very scanty or limited to just levels of total plasma cholesterol. This study was aimed at determining the pattern and frequencies of dyslipidaemic forms among hypertensive patients in Abuja. Methods: this was a retrospective cohort study with the following data collected; socio-demographics, anthropometric measures and certain metabolic parameters from the new and old groups and analyzed using IBM SPSS Statistics, version 23. All decisions were made using the assymp. Two-sided Pearson χ2 probability. Quantitative variables were expressed as means and standard deviations. Qualitative variables were expressed as percentages. A p-value of ≤0.05 was set as significant. Results: eight hundred and fifty eight (858) cases were enrolled for this study, 704 (82.1%) olds and 154 (17.9%) news. There were 251 (29.3%) males and 607 (70.7%) females. The means of the two groups were largely comparable. The commonest dyslipidaemic type was reduced High density lipoprotein, HDL (96.1%), followed by elevated low-density lipoprotein, LDL (78.6%), then, elevated total cholesterol, (62.3%) TCHOL and elevated triglycerides, TG 43.5%. Conclusion: dyslipidemic forms are very common among hypertensive patients in Abuja, Nigeria, particularly reduced HDL. Some observed associations include; middle age, female gender, middle/upper socio-economic classes, low levels of physical activity, overweight/obesity, dysglycaemia and long-standing hypertension.


Assuntos
Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Lipídeos/sangue , Adulto , Idoso , Estudos de Coortes , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos
6.
Artigo em Inglês | MEDLINE | ID: mdl-34360055

RESUMO

Dyslipidemia is associated with lifestyle behaviors, while several lifestyle behaviors exist collectively among some populaitons. This study aims to identify lifestyle behavior clusters and their relations to dyslipidemia. This cross-sectional study was conducted in Wuhai City, China. Cluster analysis combined with compositional data analysis was conducted, with 24-h time-use on daily activities and dietary patterns as input variables. Multiple logistic regression was conducted to compare dyslipidemia among clusters. A total of 4306 participants were included. A higher prevalence of newly diagnosed dyslipidemia was found among participants in cluster 1 (long sedentary behavior (SB) and the shortest sleep, high-salt and oil diet) /cluster 5 (the longest SB and short sleep), relative to the other clusters in both age groups (<50 years and ≥50 years). In conclusion, unhealthy lifestyle behaviors may exist together among some of the population, suggesting that these people are potential subjects of health education and behavior interventions. Future research should be conducted to investigate the relative significance of specific lifestyle behaviors in relation to dyslipidemia.


Assuntos
Análise de Dados , Dislipidemias , China/epidemiologia , Análise por Conglomerados , Estudos Transversais , Dieta , Dislipidemias/epidemiologia , Exercício Físico , Humanos , Estilo de Vida , Pessoa de Meia-Idade
7.
Diabetes Care ; 44(9): 2149-2157, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34253561

RESUMO

OBJECTIVE: Identifying metabolic factors associated with critical disease can help to improve management of patients hospitalized for coronavirus disease 2019 (COVID-19). High triglycerides and low HDL levels characterize the atherogenic dyslipidemia closely related to insulin resistance and diabetes. We examined associations of atherogenic dyslipidemia detected on admission with outcome of COVID-19 during hospitalization. RESEARCH DESIGN AND METHODS: We retrospectively analyzed clinical reports of 118 consecutive patients hospitalized for COVID-19 in Rome, Italy, between March and May 2020. Clinical characteristics, inflammation markers, and glucose and lipid metabolism parameters at admission were collected. Critical disease was defined as in-hospital death or need for endotracheal intubation. Associations were tested using logistic regression analysis. RESULTS: Patients with critical COVID-19 (n = 43) were significantly older than those with noncritical disease (n = 75) and presented higher levels of fasting glucose, triglycerides, C-reactive protein, interleukin-6, procalcitonin, and d-dimer (P < 0.01 for all), whereas HDL levels were lower (P = 0.003). Atherogenic dyslipidemia was more frequent in patients with critical COVID-19 (46 vs. 24%, P = 0.011), as well as diabetes (37 vs. 19%, P = 0.026), and significantly associated with death or intubation (odds ratio 2.53 [95% CI 1.16-6.32], P = 0.018). Triglycerides were significantly associated with selected inflammatory biomarkers (P < 0.05 for all) and poorer outcome of COVID-19 during hospitalization in both the overall population and the subgroup with atherogenic dyslipidemia. CONCLUSIONS: Atherogenic dyslipidemia detected on admission can be associated with critical in-hospital course of COVID-19. Further investigations are needed to elucidate the hypothetical role of insulin resistance and related lipid abnormalities in severe acute respiratory syndrome coronavirus 2 pathogenesis. Assessment of lipid profile should be encouraged in patients hospitalized for COVID-19.


Assuntos
COVID-19 , Diabetes Mellitus , Dislipidemias , Dislipidemias/complicações , Dislipidemias/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
8.
J Stroke Cerebrovasc Dis ; 30(9): 105965, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34247053

RESUMO

OBJECTIVES: Ischemic stroke and hemorrhagic stroke are the most common sequelae of the Moyamoya variants [Moyamoya disease (MMD) and syndrome (MMS)]. We sought to determine the rates of stroke subtypes and the predictive factors of arterial ischemic stroke (AIS) utilizing a large data sample of MMD and MMS patients in the US. MATERIALS AND METHODS: We queried the 2016 and 2017 National Inpatient Sample database for Moyamoya diagnosis plus any of the following associated conditions; sickle cell disease, neurofibromatosis type 1, cranial radiation therapy or Down Syndrome. Multivariate regression determined the risk factors for AIS onset in MMD and MMS. RESULTS: 2323 patients with a diagnosis of Moyamoya were included; 668 (28.8%) patients were classified as MMS and 1655 (71.2%) as MMD. AIS was the most common presentation in both cohorts; however, MMD patients had higher rates of AIS (20.4 vs 6%, p < 0.001), hemorrhagic stroke (7.4vs 2.5%, p < 0.001), and TIA (3.3vs 0.9%, p = 0.001) compared to MMS patients. Multivariate analysis showed that increasing age [OR = 1.017 95%CI: 1.008-1.03, p < 0.001], lipidemia [OR = 1.32 95%CI: 1.02-1.74, p = 0.049], and current smoking status [OR = 1.43 95%CI: 1.04-1.97, p = 0.026] were independent risk factors for AIS in MMD patients, whereas hypertension [OR = 2.61 95%CI: 1.29-5.25, p = 0.007] and African-American race [OR = 0.274, 95%CI: .117-.64, p = 0.003] were independent predictors in the MMS cohort. CONCLUSION: AIS is the most common presentation in both, MMD and MMS. However, MMD patients had higher rates of stroke events compared to MMS. Risk factors for AIS in MMD included increasing age, lipidemia and smoking status, whereas in MMS hypertension was the only independent risk factor.


Assuntos
AVC Hemorrágico/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , AVC Isquêmico/epidemiologia , Doença de Moyamoya/epidemiologia , Adolescente , Adulto , Fatores Etários , Comorbidade , Bases de Dados Factuais , Dislipidemias/epidemiologia , Feminino , AVC Hemorrágico/diagnóstico , Humanos , Hipertensão/epidemiologia , Pacientes Internados , Ataque Isquêmico Transitório/diagnóstico , AVC Isquêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
9.
BMJ Open Respir Res ; 8(1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34272254

RESUMO

BACKGROUND: Although several studies have reported an association between atherosclerosis-related diseases and COVID-19, the relationship between COVID-19 severity and atherosclerosis progression remains unclear. The aim of this study is to determine the coronary artery calcium score (CACS) prognostic value in patients with COVID-19 using indices such as deterioration in oxygenation and CT images of the chest. METHODS: This was a single-centre retrospective study of 53 consecutive patients with COVID-19 in Narita who were admitted to our hospital between March 2020 and August 2020. CACS was calculated based on non-gated CT scans of the chest performed on admission day. The patients were divided into the following two groups based on CACS: group 1 (CACS ≥180, n=11) and group 2 (CACS <180, n=42). Following univariate analysis of the main variables, multivariate analysis of variables that may be associated with COVID-19 progression was performed. RESULTS: Multivariable logistic regression analysis of age, sex, smoking history, diabetes, hypertension, dyslipidaemia, number of days from symptom onset to hospitalisation and CACS of ≥180 was performed. It revealed that unlike CACS of <180, CACS of ≥180 is associated with exacerbation of oxygenation or CT images of the chest during hospitalisation (OR: 12.879, 95% CI: 1.399 to 380.401). Furthermore, this model of eight variables showed good calibration (Hosmer-Lemeshow p=0.119). CONCLUSION: CACS may be a prognosis marker of COVID-19 severity. Although coronary artery calcification is not typically assessed in pneumonia cases, it may provide a valuable clinical indicator for predicting severe COVID-19 outcomes.


Assuntos
COVID-19/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Progressão da Doença , Dislipidemias/epidemiologia , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/epidemiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Calcificação Vascular/epidemiologia
10.
Front Endocrinol (Lausanne) ; 12: 611526, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248834

RESUMO

Background: It has been reported that dyslipidemia is related to coronavirus-related diseases. Critical patients with coronavirus disease 2019 (COVID-19) who suffered from multiple organ dysfunctions were treated in the intensive care unit (ICU) in Wuhan, China. Whether the lipids profile was associated with the prognosis of COVID-19 in critical patients remained unclear. Methods: A retrospective study was performed in critical patients (N=48) with coronavirus disease 2019 in Leishenshan hospital between February and April 2020 in Wuhan. The parameters including lipid profiles, liver function, and renal function were collected on admission day, 2-3days after the admission, and the day before the achievement of clinical outcome. Results: Albumin value and creatine kinase (ck) value were statistically decreased at 2-3 days after admission compared with those on admission day (P<0.05). Low density lipoprotein (LDL-c), high density lipoprotein (HDL-c), apolipoprotein A (ApoA), and apolipoprotein A (Apo B) levels were statistically decreased after admission (P<0.05). Logistic regression showed that HDL-c level both on admission day and the day before the achievement of clinical outcome were negatively associated with mortality in critical patients with COVID-19. Total cholesterol (TC) level at 2-3days after admission was related to mortality in critical patients with COVID-19. Conclusions: There were lipid metabolic disorders in the critical patients with COVID-19. Lower levels of HDL-c and TC were related to the progression of critical COVID-19.


Assuntos
COVID-19/mortalidade , Dislipidemias/epidemiologia , Mortalidade Hospitalar , Insuficiência de Múltiplos Órgãos/mortalidade , Idoso , Idoso de 80 Anos ou mais , Apolipoproteínas A/sangue , Apolipoproteínas B/sangue , COVID-19/sangue , COVID-19/epidemiologia , China/epidemiologia , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estado Terminal , Dislipidemias/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/epidemiologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença
11.
Nutrients ; 13(6)2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34204631

RESUMO

Obesity is among the most alarming health concerns, impacting public health and causing a socioeconomic challenge, especially in developing countries like Brazil, where approximately one quart of the population presents obesity. As an established risk factor for numerous comorbidities with a multifactorial etiology, obesity is a consequence of energy-dense overfeeding, however with significant undernourishment, leading to excessive adipose tissue accumulation and dysfunction, dyslipidemia, and micronutrient deficiencies. About 60% of patients with obesity take statins, a cholesterol-lowering medication, to curb dyslipidemia, with ~10% of these patients presenting various myopathies as side effects. Statins act upon the rate-limiting enzyme of cholesterol biosynthesis in the liver, which is a pathway providing intermediates to the synthesis of selenoproteins, i.e., enzymes containing the micronutrient selenium. Statins have been postulated to negatively impact selenoprotein synthesis, particularly in conditions of selenium deficiency, and potentially implicated in the myopathies occurring as side effects of statins. The Brazilian population is prone to selenium deficiency, hence could be considered more susceptible to statin side effects. This review examines the specific consequences to the Brazilian population of the harmful intersection between obesity development and concomitant micronutrient deficiencies, particularly selenium, combined with statin treatment in the context of nutrition in Brazil.


Assuntos
Dislipidemias/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Obesidade/epidemiologia , Selênio/deficiência , Brasil/epidemiologia , Dislipidemias/tratamento farmacológico , Dislipidemias/etiologia , Humanos , Fígado/metabolismo , Estado Nutricional , Obesidade/complicações , Obesidade/metabolismo , Selenoproteínas/biossíntese
12.
N Engl J Med ; 385(5): 416-426, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34320286

RESUMO

BACKGROUND: The prevalence of type 2 diabetes in youth is increasing, but little is known regarding the occurrence of related complications as these youths transition to adulthood. METHODS: We previously conducted a multicenter clinical trial (from 2004 to 2011) to evaluate the effects of one of three treatments (metformin, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention) on the time to loss of glycemic control in participants who had onset of type 2 diabetes in youth. After completion of the trial, participants were transitioned to metformin with or without insulin and were enrolled in an observational follow-up study (performed from 2011 to 2020), which was conducted in two phases; the results of this follow-up study are reported here. Assessments for diabetic kidney disease, hypertension, dyslipidemia, and nerve disease were performed annually, and assessments for retinal disease were performed twice. Complications related to diabetes identified outside the study were confirmed and adjudicated. RESULTS: At the end of the second phase of the follow-up study (January 2020), the mean (±SD) age of the 500 participants who were included in the analyses was 26.4±2.8 years, and the mean time since the diagnosis of diabetes was 13.3±1.8 years. The cumulative incidence of hypertension was 67.5%, the incidence of dyslipidemia was 51.6%, the incidence of diabetic kidney disease was 54.8%, and the incidence of nerve disease was 32.4%. The prevalence of retinal disease, including more advanced stages, was 13.7% in the period from 2010 to 2011 and 51.0% in the period from 2017 to 2018. At least one complication occurred in 60.1% of the participants, and at least two complications occurred in 28.4%. Risk factors for the development of complications included minority race or ethnic group, hyperglycemia, hypertension, and dyslipidemia. No adverse events were recorded during follow-up. CONCLUSIONS: Among participants who had onset of type 2 diabetes in youth, the risk of complications, including microvascular complications, increased steadily over time and affected most participants by the time of young adulthood. Complications were more common among participants of minority race and ethnic group and among those with hyperglycemia, hypertension, and dyslipidemia. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov numbers, NCT01364350 and NCT02310724.).


Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Adolescente , Criança , Complicações do Diabetes/etnologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dislipidemias/complicações , Dislipidemias/epidemiologia , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipoglicemiantes/uso terapêutico , Masculino , Metformina/uso terapêutico , Fatores de Risco
13.
Front Public Health ; 9: 647661, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34277535

RESUMO

Objectives: Diet quality may be a key modifiable factor for the prevention of non-communicable disease. We aimed to investigate the association between diet quality and prevalence of obesity, dyslipidemia, and insulin resistance among Filipino immigrant women in Korea. Methods: A total of 413 participants from the 2014-2016 baseline population of the Filipino Women's Diet and Health Study (FiLWHEL) were examined. Individual dietary intakes were evaluated through 24-h recalls and then converted into two dietary quality assessments: Minimum Dietary Diversity for Women (MDD-W) developed by the Food and Agriculture Organization (FAO) and the Data Derived Inflammation Index (DDII) originally developed by our group. Fasting blood levels of triglycerides, high-density lipoprotein cholesterols, glucose, and insulin were measured. We used logistic regression models for odds ratios (ORs) with 95% confidence intervals (CIs). Results: We found a statistically significant association between MDD-W scores and decreased prevalence of abdominal obesity; ORs (95% CIs) of the 3rd vs. 1st tertiles were 0.58 (0.36-0.94; p for trend = 0.029). Increased DDII was associated with elevated prevalence of dyslipidemia and insulin resistance; ORs (95% CIs) of the 5th vs. 1-3rd quintiles were 6.44 (2.56-16.20) for triglycerides (TG), 3.90 (1.92-7.90) for low-density lipoprotein (LDL) cholesterol, 3.36 (1.81-6.24) for total cholesterol (TC), 6.25 (2.53-15.41) for abnormal TG/HDL ratios, 3.59 (1.96-6.59) for HbA1c, 2.61 (1.11-6.17) for fasting blood glucose levels, 9.67 (4.16-22.48) for insulin levels, and 9.73 (4.46-21.25) for homeostasis model assessment of insulin resistance (HOMA-IR) (p for trend <0.001 for all, except 0.033 for fasting blood glucose). Conclusions: Greater dietary diversity was inversely associated with the prevalence of abdominal obesity in Filipino immigrant women. Proinflammatory scores based on diet and lifestyle factors were associated with an increased prevalence of dyslipidemia and insulin resistance. Further, epidemiological studies on the relationship between dietary acculturation and chronic disease are warranted.


Assuntos
Dislipidemias , Resistência à Insulina , Dieta , Dislipidemias/epidemiologia , Feminino , Humanos , Obesidade/epidemiologia , Prevalência , República da Coreia/epidemiologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-34069095

RESUMO

Health literacy is the ability to deal with information related to one's health. Patients with low health literacy and chronic diseases, such as chronic kidney disease (CKD), have poor disease-management skills, which could lead to complications. We used logistic regressions and structural equational modeling to assess whether low health literacy is associated with the development of cardiovascular disease and mortality in patients with CKD, and whether this association is mediated by the presence of uncontrolled hypertension, diabetes, dyslipidemia, obesity, or albuminuria. Data from 2742 adult participants with CKD from the Lifelines study were analyzed at baseline and after approximately four years. Low health literacy was associated with cardiovascular disease and mortality in the crude models, with OR and 95%CI of 1.93 (1.46 to 2.55) and 1.59 (1.08 to 2.36), respectively. After adjustment for age and sex, low health literacy was only associated with cardiovascular disease (OR 1.76 (1.31 to 2.23)). This association was mediated by uncontrolled diabetes (27.1%) and obesity (8.0%). Low health literacy is associated with the development of cardiovascular disease after adjustment for age and sex, and this association is mediated by uncontrolled diabetes and obesity.


Assuntos
Diabetes Mellitus , Dislipidemias , Letramento em Saúde , Hipertensão , Insuficiência Renal Crônica , Adulto , Estudos Transversais , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Humanos , Hipertensão/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco
15.
J Clin Hypertens (Greenwich) ; 23(7): 1399-1404, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34092020

RESUMO

Dyslipidemia is an emerging disease in China, especially in the presence of hypertension and diabetes mellitus. We investigated the association of dyslipidemia with the use of antihypertensive and antidiabetic agents. The study participants (n = 2423) were hypertensive and diabetic patients enrolled in a China nationwide registry. Serum mean ± (SD, except for serum triglycerides, median [interquatile range]) concentrations were 1.38 (0.97-2.02) mmol/L, 4.85 ± 1.12 mmol/L, 1.30 ± 0.36 mmol/L, and 2.89 ± 0.92 mmol/L for triglycerides and total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol, respectively. The prevalence of dyslipidemia was 18.9%, 13.5%, 16.6%, and 37.7% for hypertriglyceridemia (serum triglycerides ≥2.3 mmol/L), hypercholesterolemia (total cholesterol ≥6.2 mmol/L or LDL cholesterol ≥4.1 mmol/L), low HDL cholesterol (HDL cholesterol <1.0 mmol/L), and any of the three lipid disorders, respectively. Treated (n = 1647), compared with untreated hypertensive patients (n = 303), had a significantly (P ≤ .0006) lower serum total, LDL, and HDL cholesterol, but similar serum triglycerides (P = .20). Treated (n = 1325), compared with untreated diabetic patients (n = 238), had a significantly (P ≤ .004) lower serum triglycerides, and total and LDL cholesterol, but similar serum HDL cholesterol (P = .81). After adjustment, the odds ratios (OR) were significant for hypercholesterolemia (OR 0.76, 95% confidence interval [CI] 0.58-0.997, P = .048) and low HDL cholesterol (OR 1.56, CI 1.19-2.03, P = .001) in treated versus untreated hypertension, and for low HDL cholesterol (OR 1.50, CI 1.18-1.89, P = .0008) in treated versus untreated diabetes. In conclusion, the prevalence of dyslipidemia differed between treated and untreated hypertension and diabetes.


Assuntos
Anti-Hipertensivos/uso terapêutico , Diabetes Mellitus , Dislipidemias , Hipertensão , Hipoglicemiantes/uso terapêutico , China/epidemiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Dislipidemias/tratamento farmacológico , Dislipidemias/epidemiologia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Triglicerídeos/sangue
16.
Sleep Med ; 84: 63-72, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34111805

RESUMO

OBJECTIVES/BACKGROUND: Little information is available about the association of obstructive sleep apnea (OSA) with atherogenic dyslipidemia and the contribution of sleep characteristics to lipid alterations. We compare dyslipidemia prevalence among non-apneic subjects and mild-severe OSA patients to identify the sleep characteristics that are independently associated with dyslipidemia and serum lipid levels in OSA patients. PATIENTS/METHODS: We recruited 809 consecutive patients who had been referred for polysomnography study by OSA suspicion. Anthropometric characteristics, body composition and comorbidities were recorded. Spirometry and 24-h ambulatory blood pressure monitoring were performed the same day of the sleep study. The day after attended polysomnography, fasting blood samples were drawn to measure the lipid profile. RESULTS: Dyslipidemia prevalence increased with the presence of OSA, from non-OSA subjects to mild, moderate and severe OSA patients (31%, 33%, 42% and 51%, respectively; p < 0.001). After adjusting for sex, age, body mass index and smoking habit, only severe OSA had an independent association with dyslipidemia when compared to non-OSA subjects (adjusted odds ratio 1.71, 95%CI 1.09 to 2.69, p = 0.019). In OSA patients, multivariate logistic regression identified active smoking, apnea-hypopnea index (AHI) and mean nocturnal saturation as variables independently associated with dyslipidemia. However, in these patients, arousal index, slow wave sleep duration and REM latency were also independently associated with cholesterol and low-density lipoprotein levels. CONCLUSIONS: The association between dyslipidemia and OSA is limited to severe patients, with high AHI and nocturnal hypoxemia. However, sleep fragmentation and increased sympathetic activity could also contribute to OSA-related lipid dysregulation.


Assuntos
Dislipidemias , Apneia Obstrutiva do Sono , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Dislipidemias/epidemiologia , Humanos , Sono , Apneia Obstrutiva do Sono/epidemiologia
18.
Arch Cardiovasc Dis ; 114(5): 352-363, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34154953

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a public health crisis. Only limited data are available on the characteristics and outcomes of patients hospitalized for COVID-19 in France. AIMS: To investigate the characteristics, cardiovascular complications and outcomes of patients hospitalized for COVID-19 in France. METHODS: The Critical COVID-19 France (CCF) study is a French nationwide study including all consecutive adults with a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection hospitalized in 24 centres between 26 February and 20 April 2020. Patients admitted directly to intensive care were excluded. Clinical, biological and imaging parameters were systematically collected at hospital admission. The primary outcome was in-hospital death. RESULTS: Of 2878 patients included (mean±SD age 66.6±17.0 years, 57.8% men), 360 (12.5%) died in the hospital setting, of which 7 (20.7%) were transferred to intensive care before death. The majority of patients had at least one (72.6%) or two (41.6%) cardiovascular risk factors, mostly hypertension (50.8%), obesity (30.3%), dyslipidaemia (28.0%) and diabetes (23.7%). In multivariable analysis, older age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.06; P<0.001), male sex (HR 1.69, 95% CI 1.11-2.57; P=0.01), diabetes (HR 1.72, 95% CI 1.12-2.63; P=0.01), chronic kidney failure (HR 1.57, 95% CI 1.02-2.41; P=0.04), elevated troponin (HR 1.66, 95% CI 1.11-2.49; P=0.01), elevated B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide (HR 1.69, 95% CI 1.0004-2.86; P=0.049) and quick Sequential Organ Failure Assessment score ≥2 (HR 1.71, 95% CI 1.12-2.60; P=0.01) were independently associated with in-hospital death. CONCLUSIONS: In this large nationwide cohort of patients hospitalized for COVID-19 in France, cardiovascular comorbidities and risk factors were associated with a substantial morbi-mortality burden.


Assuntos
COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Pacientes Internados/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/terapia , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , França/epidemiologia , Mortalidade Hospitalar , Humanos , Hipertensão/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Fatores de Risco , Resultado do Tratamento
19.
Int J Clin Pract ; 75(9): e14465, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34107128

RESUMO

BACKGROUND: Posttransplant dyslipidemia is a common condition in renal transplantation recipients (RTR) and is related to poor cardiac outcomes. We aimed to demonstrate the value of non-high-density lipoprotein cholesterol (non-HDL-C) in predicting long-term major cardiovascular and cerebrovascular events (MACCE) in RTR with dyslipidemia. METHODS: Patients who had undergone renal transplantation between 2011 and 2019 were retrospectively analysed and were classified as normal non-HDL-C and high non-HDL-C groups based on first year levels. Development of high non-HDL-C levels was used to predict the occurrence of MACCE (a combination of cardiac death, nonfatal myocardial infarction, unstable angina, and nonfatal stroke) and all-cause death during the long-term follow-up. RESULTS: Overall, 674 patients were included, of whom 470 (69.7%) were male; the mean age was 43.6 ± 13.2 years. The mean follow-up duration was 5.5 ± 2.29 years 1 year after the transplant. MACCE occurred during the follow-up in 102 (61.8%) patients in the high non-HDL-C group and 13 (2.6%) patients in the normal non-HDL-C group (P < .001). High non-HDL-C was a predictor of MACCE in the multivariate analysis (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.02, P < .001). Smoking (HR: 1.92, 95% CI 1.16-3.20, P < .001), cadaver graft (HR: 2.55, 95% CI 1.52-4.26, P < .001), and left ventricular ejection fraction (HR: 0.96, 95% CI 0.94-0.98, P < .001) were also predictors of MACCE. Kaplan-Meier analysis revealed that all MACCE components and all-cause mortality were significantly higher in the high non-HDL-C group (P < .001). CONCLUSION: Non-HDL-C was closely related to long-term cardiac outcomes in RTR with dyslipidemia. Non-HDL-C should be among the primary goals in lipid-lowering treatment in post-transplant dyslipidemia.


Assuntos
Dislipidemias , Transplante de Rim , Infarto do Miocárdio , Adulto , Colesterol , HDL-Colesterol , Dislipidemias/epidemiologia , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico , Função Ventricular Esquerda
20.
Curr Opin Lipidol ; 32(4): 231-243, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34116544

RESUMO

PURPOSE OF REVIEW: Coronavirus Disease 2019 (COVID19) has caused significant global morbidity and mortality, especially in persons with underlying cardiovascular disease. There have been concerns that lipid-lowering therapy (LLT) increases angiotensin-converting enzyme 2 levels. Conversely, pleiotropic effects of statins can theoretically protect against severe COVID19 infection, supporting evidence from other respiratory illnesses in which statin use probably confers benefit. RECENT FINDINGS: There is an abundance of studies that show that statins are safe and potentially protect against severe COVID19 infection (critical illness and death), even when adjustment for potential confounders is undertaken. However, the evidence is limited to retrospective cohorts. The benefit for patients with diabetes is less clear. There is a paucity of evidence for other LLT agents. Available clinical guidelines recommend the ongoing use of LLT in patients with COVID19 (unless specifically contra-indicated) and the data from available studies support these. SUMMARY: In patients with COVID19 infection, LLT should be continued. However, the current findings need substantiating in larger prospective clinical studies with specific examination of the possible mechanisms by which LLT confers benefit from COVID19.


Assuntos
Aterosclerose/tratamento farmacológico , COVID-19/tratamento farmacológico , Doenças Cardiovasculares/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Aterosclerose/complicações , Aterosclerose/epidemiologia , Aterosclerose/virologia , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/virologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/virologia , LDL-Colesterol/efeitos dos fármacos , Dislipidemias/complicações , Dislipidemias/epidemiologia , Dislipidemias/virologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/uso terapêutico , SARS-CoV-2/patogenicidade
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