Effects of a dietary supplement on inflammatory marker expression in middle-aged and elderly hypertensive patients

OBJECTIVES: We aimed to explore the effects of diet on the inflammatory response in middle-aged and elderly people with hypertension. METHODS: Thirty overweight or obese patients with stage one hypertension (age range, 45-75 years) were allocated to either the intervention or control group (n=15 per group; age- and sex-matched). Patients in the intervention group consumed a food powder supplement (100 g) instead of a regular meal. The control group maintained their normal dietary habits. This study lasted for six weeks. Blood pressure, inflammatory marker levels, and energy intake were measured before and after the study. RESULTS: After 6 weeks, the diet composition of the intervention group changed significantly (p<0.05). The intake of proteins, dietary fibre, monounsaturated fat, and polyunsaturated fat increased significantly (p<0.05), while the total energy intake trended towards an increase (p>0.05). In the control group, the total energy intake decreased significantly (p<0.05). The levels of nuclear factor-κB (NF-κB), soluble intercellular adhesion molecule-1 (sICAM-1) and high sensitivity C-reactive protein (hs-CRP) decreased, and adiponectin increased significantly in the intervention group (p<0.05); however, no significant changes were observed in the inflammatory marker levels of the control group. In the intervention group, systolic blood pressure decreased significantly (p<0.05), and diastolic blood pressure also exhibited a decreasing trend. No significant change in blood pressure was observed in the control group. CONCLUSION: The consumption of a food powder supplement can improve diet composition, decrease blood pressure and reduce inflammation in middle-aged and elderly overweight or obese hypertensive patients. The food powder supplement may also have an anti-atherosclerotic effect in hypertensive patients.

Adiponectin levels and sleep deprivation in patients with endocrine metabolic disorders

SUMMARY BACKGROUND: Sleep abnormalities are frequent in patients with endocrine metabolic disorders (EMD) such as arterial hypertension, diabetes and obesity. Adiponectin is a peptide largely secreted by adipocytes and has various properties e.g. anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing. Adiponectin inversely relates to body weight and when its concentration decreases, the resistin concentration increases resulting in greater insulin resistance. OBJECTIVE: The objective of this study is to examine factors influencing adiponectin levels in a population with EMD. METHODS: This was a cross-sectional evaluation of 332 patients (18 to 80y) presenting arterial hypertension, pre-diabetes, diabetes, and/or obesity. Investigation included clinical evaluation of comorbidities, general blood tests and adiponectin measures (ELISA). Chronic sleep deprivation was determined if habitual sleep was <6 hours >4 days/week. RESULTS: Arterial hypertension (78.5%), type-2 diabetes (82.3%), and overweight (45.0%)/obesity (38.8%) were frequent. Patients with type-2 diabetes tended to have more chronic sleep deprivation (p=0.05). Adiponectin levels increased with age and were inversely correlated with sagittal abdominal diameter (p=0.04) and fasting insulin (p=0.001). Chronic sleep deprivation was associated with higher adiponectin concentration [OR=1.34; CI=1.13-1.58; p<0.005] and this was maintained after adjustment for gender, age, body mass index, menopause, arterial hypertension, American Diabetes Association classification and physical exercise levels [OR=1.38; 0=1.14-1.66: p=0.001]. CONCLUSION: In patients with EMD, adiponectin is influenced not only by obesity but also by age and sleep deprivation. The latter finding may be explained by a compensatory effect or a counter regulation to minimize the harmful effects of sleep deprivation.

RESUMO INTRODUÇÃO: Problemas de sono são frequentes em pacientes com distúrbios endócrino-metabólicos (DEM), como hipertensão arterial, diabetes e obesidade. A adiponectina é um peptídeo segregado por adipócitos e apresenta diversas propriedades, como por exemplo, anti-inflamatória, antioxidante, antiaterogênica, pró-angiogênica e vasoprotetora. A adiponectina relaciona-se inversamente com o peso corporal. OBJETIVO: Examinar os fatores que influenciam os níveis de adiponectina em uma população com DEM. MÉTODOS: Trata-se de uma avaliação transversal com 332 pacientes (18 a 80 anos) apresentando hipertensão arterial, pré-diabetes, diabetes e/ou obesidade. A investigação incluiu avaliação clínica de comorbidades, exames de sangue e medidas de adiponectina (Elisa). A restrição crônica do sono foi determinada com o sono habitual <6 horas >4 dias/semana. RESULTADOS: Doenças como hipertensão arterial (78,5%), diabetes tipo 2 (82,3%) e sobrepeso (45,0%)/obesidade (38,8%) foram frequentes. Pacientes com diabetes tipo 2 apresentaram uma tendência na restrição crônica do sono (p=0,05). Os níveis de adiponectina aumentaram com a idade e foram inversamente correlacionados com o diâmetro abdominal sagital (p=0,04) e com a insulina em jejum (p=0,001). A restrição crônica do sono foi associada à maior concentração de adiponectina [OR=1,34; CI=1,13-1,58; p<0,005] e isso foi mantido após ajuste por gênero, idade, índice de massa corporal, menopausa, hipertensão arterial, classificação dos níveis da American Diabetes Association e exercício físico [OR=1,38; CI=1,14-1,66: p=0,001]. CONCLUSÕES: Em pacientes com DEM, a adiponectina é influenciada não apenas pela obesidade, mas também pela idade e pela restrição de sono. O último achado pode ser explicado por um efeito compensatório ou por um regulamento contrário para minimizar os efeitos nocivos da restrição do sono.

Adiponectin in Relation to Coronary Plaque Characteristics on Radiofrequency Intravascular Ultrasound and Cardiovascular Outcome / Relação da Adiponectina com as Características da Placa Aterosclerótica ao Ultrassom Intravascular com Radiofrequência e Desfechos Cardiovasculares

Abstract Background: Prospective data on the associations of adiponectin with in-vivo measurements of degree, phenotype and vulnerability of coronary atherosclerosis are currently lacking. Objective: To investigate the association of plasma adiponectin with virtual histology intravascular ultrasound (VH-IVUS)-derived measures of atherosclerosis and with major adverse cardiac events (MACE) in patients with established coronary artery disease. Methods: In 2008-2011, VH-IVUS of a non-culprit non-stenotic coronary segment was performed in 581 patients undergoing coronary angiography for acute coronary syndrome (ACS, n = 318) or stable angina pectoris (SAP, n = 263) from the atherosclerosis-intravascular ultrasound (ATHEROREMO-IVUS) study. Blood was sampled prior to coronary angiography. Coronary plaque burden, tissue composition, high-risk lesions, including VH-IVUS-derived thin-cap fibroatheroma (TCFA), were assessed. All-cause mortality, ACS, unplanned coronary revascularization were registered during a 1-year-follow-up. All statistical tests were two-tailed and p-values < 0.05 were considered statistically significant. Results: In the full cohort, adiponectin levels were not associated with plaque burden, nor with the various VH-tissue types. In SAP patients, adiponectin levels (median[IQR]: 2.9(1.9-3.9) µg/mL) were positively associated with VH-IVUS derived TCFA lesions, (OR[95%CI]: 1.78[1.06-3.00], p = 0.030), and inversely associated with lesions with minimal luminal area (MLA) ≤ 4.0 mm2 (OR[95%CI]: 0.55[0.32-0.92], p = 0.025). In ACS patients, adiponectin levels (median[IQR]: 2.9 [1.8-4.1] µg/mL)were not associated with plaque burden, nor with tissue components. Positive association of adiponectin with death was present in the full cohort (HR[95%CI]: 2.52[1.02-6.23], p = 0.045) and (borderline) in SAP patients (HR[95%CI]: 8.48[0.92-78.0], p = 0.058). In ACS patients, this association lost statistical significance after multivariable adjustment (HR[95%CI]: 1.87[0.67-5.19], p = 0.23). Conclusion: In the full cohort, adiponectin levels were associated with death but not with VH-IVUS atherosclerosis measures. In SAP patients, adiponectin levels were associated with VH-IVUS-derived TCFA lesions. Altogether, substantial role for adiponectin in plaque vulnerability remains unconfirmed.

Resumo Fundamento: Faltam dados prospectivos sobre as associações de adiponectina com medidas in-vivo de grau, fenótipo e vulnerabilidade da aterosclerose coronariana. Objetivo: Investigar a associação da adiponectina plasmática com medidas de aterosclerose derivadas de ultrassonografia virtual intravascular (VH-IVUS) e eventos cardíacos adversos importantes (major adverse cardiac events - MACE) em pacientes com doença arterial coronariana estabelecida. Métodos: Em 2008-2011, a VH-IVUS de um segmento coronariano não estenótico não culpado foi realizado em 581 pacientes submetidos à angiografia coronariana para síndrome coronariana aguda (SCA, n = 318) ou angina pectoris estável (APE, n = 263) a partir do estudo de ultrassonografia aterosclerótica-intravascular (ATHEROREMO-IVUS). Sangue foi amostrado antes da angiografia coronária. Foram avaliados a carga de placa coronária, a composição tecidual, as lesões de alto risco, incluindo fibroateroma de capa fina (FCF) derivado de VH-IVUS. Mortalidade por todas as causas, SCA, e revascularização coronária não planejada foram registradas durante um ano de acompanhamento. Todos os testes estatísticos foram bicaudais e os valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Na coorte completa, os níveis de adiponectina não foram associados à carga de placa, nem a vários tipos de tecido virtual histológico. Entre os pacientes com APE, os níveis de adiponectina (mediana[IIQ]: 2,9(1,9-3,9) µg/mL) foram associados positivamente às lesões FCF derivadas de VH-IVUS, (OR[IC 95%]: 1,78[1,06-3,00], p = 0,030), e inversamente associados a lesões com área luminal mínima (ALM) ≤4,0 mm2 (OR[IC 95%]: 0,55[0,32-0,92], p = 0,025). Em pacientes com SCA, os níveis de adiponectina (mediana[IIQ]: 2,9 [1,8-4,1] µg/mL) não foram associados à carga de placa nem a componentes teciduais. A associação positive de adiponectina ao óbito esteve presente na coorte completa (HR[IC 95%]: 2,52[1,02-6,23], p = 0,045) e (limítrofe) em pacientes com APE (HR[IC 95%]: 8,48[0,92-78,0], p = 0,058). Entre pacientes com SCA, essa associação perdeu significância estatística após ajuste multivariado (HR[IC 95%]: 1,87[0,67-5,19], p = 0,23). Conclusão: Na coorte completa, os níveis de adiponectina foram associados à obito, mas não a medidas de aterosclerose por VH-IVUS. Em pacientes com APE, os níveis de adiponectina foram associados a lesões FCF derivadas de VH-IVUS. Em geral, o papel da adiponectina na vulnerabilidade da placa permanece não confirmado.

Metabolic Syndrome-Related Features in Controlled and Resistant Hypertensive Subjects / Características Relacionadas à Síndrome Metabólica em Indivíduos com Hipertensão Controlada e Hipertensão Resistente

Abstract Background: Metabolic syndrome (MetS) is widespread among hypertensive patients. Clinical features and potential biomarkers of MetS in the presence of hypertension and resistant hypertension (RHTN) represent a great area of interest for investigation. Objective: The purpose of this study was to evaluate the prevalence of MetS and the clinical features associated with it in resistant and mild to moderate hypertensives. Methods: This cross-sectional study included 236 patients, (i) 129 mild to moderate hypertensive patients and (ii) 107 patients with RHTN. We measured blood pressure (BP) and adipokines levels, and performed bioelectrical impedance analysis. Microalbuminuria (MA), cardiac hypertrophy and arterial stiffness were also assessed. The significance level of alpha = 0.05 was adopted. Results: We found a MetS prevalence of 73% in resistant and 60% in mild-to-moderate hypertensive patients. In a multiple regression analysis, MA (odds ratio = 8.51; p = 0.01), leptin/adiponectin ratio (LAR) (odds ratio = 4.13; p = 0.01) and RHTN (odds ratio = 3.75; p = 0.03) were independently associated with the presence of MetS apart from potential confounders. Conclusions: Our findings suggest that both resistant and controlled hypertensive subjects have a high prevalence of MetS. In addition, MetS-related metabolic derangements may cause early renal and hormonal changes. Finally, LAR may be useful as a reliable biomarker for identifying those hypertensive subjects who are at risk for developing MetS.

Resumo Fundamentos: A síndrome metabólica (SM) é comum em pacientes hipertensos. As características clínicas e os potenciais biomarcadores da SM na presença de hipertensão e hipertensão resistente (HR) representam uma ampla área de interesse a ser investigada. Objetivo: O objetivo deste estudo foi avaliar a prevalência de SM e as características clínicas associadas à síndrome em indivíduos com hipertensão resistente e leve a moderada. Métodos: Este estudo transversal incluiu 236 pacientes, (i) 129 pacientes com hipertensão leve a moderada e (ii) 107 pacientes com HR. Medimos a pressão arterial (PA), parâmetros bioquímicos e os níveis de adipocinas dos pacientes, além de microalbuminúria (MA), hipertrofia cardíaca e rigidez arterial. Foi adotado o nível de significância de alfa 0,05. Resultados: A SM esteve presente em 73% dos pacientes com HR e 60% daqueles com hipertensão leve a moderada. Na análise de regressão múltipla, a MA (odds ratio = 8,51; p = 0,01), a razão leptina/adiponectina (RLA) (odds ratio = 4,13; p = 0,01) e a HR (odds ratio = 3,75; p = 0,03) foram independentemente associadas com a presença de SM, excluindo-se potenciais fatores de confusão. Conclusões: Nossos resultados sugerem que tanto hipertensos resistentes como hipertensos controlados apresentam alta prevalência de SM. Além disso, distúrbios metabólicos relacionados à SM podem causar alterações precoces renais e hormonais, e a RLA parece ser útil como biomarcador confiável para identificar indivíduos hipertensos em risco de desenvolverem SM.

Exenatide improves type 2 diabetes concomitant with non-alcoholic fatty liver disease / Exenatide melhora o diabetes tipo 2 de ocorrência concomitante com doença hepática gordurosa não alcoólica

OBJECTIVE: To investigate the effects of exenatide on blood glucose, body weight and hepatic enzymes in patients with type 2 diabetes mellitus (T2DM) and concomitant non-alcoholic fatty liver disease (NAFLD). SUBJECTS AND METHODS: One hundred and seventeen patients with T2DM and NAFLD were randomly divided into exenatide group and metformin group. Patients were treated with exenatide and metformin, respectively, for 12 weeks. RESULTS: After 12 weeks of treatment, body weight, body mass index (BMI), waist-to-hip ratio, HbA1c, FPG, 2-h PPG, ALT, AST, γ-GT, and hs-CRP were significantly reduced, and the AST/ALT ratio and adiponectin were markedly increased in both groups. BMI, waist-to-hip ratio, 2-h PPG, ALT, AST, γ-GT, and hs-CRP were markedly lower, and AST/ALT ratio and adiponectin in the exenatide group were dramatically higher than in the metformin group. CONCLUSION: Compared with metformin, exenatide is better to control blood glucose, reduces body weight and improves hepatic enzymes, attenuating NAFLD in patients with T2DM concomitant with NAFLD.

OBJETIVO: Investigar os efeitos do exenatide sobre a glicose sérica, peso corporal e enzimas hepáticas em pacientes com diabetes melito tipo 2 (T2DM) e doença hepática gordurosa não alcoólica (DHGNA). SUJEITOS E MÉTODOS: Um total de 117 pacientes com T2DM e DHGNA foi aleatoriamente separado em dois grupos, um tratado com exenatide e um tratado com metformina. Os pacientes foram tratados por 12 semanas. RESULTADOS: Após 12 semanas de tratamento, o peso corporal, índice de massa corporal (IMC), relação cintura-quadril, HbA1c, FPG, glicose pós-prandial, ALT, AST, γ-GT e proteína C-reativa foram significativamente reduzidos, e a relação AST/ALT e a adiponectina aumentaram marcadamente nos dois grupos. O IMC, relação cintura-quadril, glicose pós-prandial, ALT, AST, γ-GT e proteína C-reativa foram marcadamente menores, e a relação AST/ALT e a adiponectina foram dramaticamente mais altas no grupo tratado com exenatide do que no grupo tratado com metformina. CONCLUSÃO: Comparado com a metformina, o exenatide controla melhor a glicose sérica, reduz o peso corporal e melhora as enzimas hepáticas, atenuando a DHGNA em pacientes com T2DM de ocorrência concomitante com a DHGNA.

Adiponectina sérica e risco cardiometabólico em pacientes com síndromes coronarianas agudas / Serum adiponectin and cardiometabolic risk in patients with acute coronary syndromes

FUNDAMENTO: O tecido adiposo representa não somente uma fonte de energia estocável, mas principalmente um órgão endócrino que secreta várias citoquinas. A adiponectina, uma nova proteína semelhante ao colágeno, foi descoberta como uma citoquina específica do adipócito e um promissor marcador de risco cardiovascular. OBJETIVO: Avaliar a associação entre os níveis séricos da adiponectina e o risco para a ocorrência de eventos cardiovasculares, em pacientes com síndromes coronarianas agudas (SCA), e as correlações entre adiponectina e os biomarcadores metabólicos, inflamatórios e miocárdicos. MÉTODOS: Foram recrutados 114 pacientes com SCA, com seguimento médio de 1,13 ano para avaliação de desfechos clínicos. Modelos de regressão de risco proporcional de Cox com penalização de Firth foram construídos para determinar a associação independente entre adiponectina e o risco subsequente dos desfechos primário (composto de óbito cardiovascular/IAM não fatal/AVE não fatal) e coprimário (composto de óbito cardiovascular/ IAM não fatal/AVE não fatal/re-hospitalização requerendo revascularização). RESULTADOS: Houve correlações diretas e significantes entre adiponectina e idade, HDL-colesterol e BNP, e inversas e significantes entre adiponectina e circunferência abdominal, peso corporal, índice de massa corporal, índice HOMA, triglicerídeos e insulina. A adiponectina foi associada a maior risco para os desfechos primário e coprimário (HR ajustado 1,08 e 1,07/incremento de 1.000, respectivamente, p = 0,01 e p = 0,02). CONCLUSÃO: Em pacientes com SCA, a adiponectina sérica foi preditor de risco independente para eventos cardiovasculares. De modo adicional às correlações antropométricas e metabólicas, a adiponectina mostrou correlação significante com BNP.

BACKGROUND: The adipose tissue is considered not only a storable energy source, but mainly an endocrine organ that secretes several cytokines. Adiponectin, a novel protein similar to collagen, has been found to be an adipocyte-specific cytokine and a promising cardiovascular risk marker. OBJECTIVES: To evaluate the association between serum adiponectin levels and the risk for cardiovascular events in patients with acute coronary syndromes (ACS), as well as the correlations between adiponectin and metabolic, inflammatory, and myocardial biomarkers. METHODS: We recruited 114 patients with ACS and a mean 1.13-year follow-up to measure clinical outcomes. Clinical characteristics and biomarkers were compared according to adiponectin quartiles. Cox proportional hazard regression models with Firth's penalization were applied to assess the independent association between adiponectin and the subsequent risk for both primary (composite of cardiovascular death/non-fatal acute myocardial infarction (AMI)/non-fatal stroke) and co-primary outcomes (composite of cardiovascular death/non-fatal AMI/non-fatal stroke/rehospitalization requiring revascularization). RESULTS: There were significant direct correlations between adiponectin and age, HDL-cholesterol, and B-type natriuretic peptide (BNP), and significant inverse correlations between adiponectin and waist circumference, body weight, body mass index, Homeostasis Model Assessment (HOMA) index, triglycerides, and insulin. Adiponectin was associated with higher risk for primary and co-primary outcomes (adjusted HR 1.08 and 1.07/increment of 1000; p = 0.01 and p = 0.02, respectively). CONCLUSION: In ACS patients, serum adiponectin was an independent predictor of cardiovascular events. In addition to the anthropometric and metabolic correlations, there was a significant direct correlation between adiponectin and BNP.

Variações nos níveis de adiponectina nos pacientes com doença renal crônica: um estudo prospectivo de 12 meses / Variations in adiponectin levels in patients with chronic kidney disease: a prospective study of 12 months

INTRODUÇÃO: As complicações cardiovasculares permanecem como a principal causa de mortalidade nos pacientes portadores de doença renal crônica (DRC). A adiponectina é uma proteína produzida pelo tecido adiposo que apresenta importante propriedade cardioprotetora. O nosso objetivo foi investigar os determinantes dos níveis de adiponectina nos pacientes com DRC. MÉTODOS: Este estudo prospectivo observacional incluiu 98 pacientes [taxa de filtração glomerular (TFG) 36,1+-14,4 ml/min; 56,5+-10,4 anos; 63% homens; 31% diabéticos e índice de massa corporal (IMC) 27,1+-5,2 kg/m²]. A avaliação da adiponectina (teste imunoenzimático), dos parâmetros laboratoriais, do estado nutricional (avaliação global subjetiva), da gordura corporal total (absortometria de raios-x de dupla energia) e da gordura abdominal visceral e subcutânea (tomografia computadorizada) foi realizada no início e após 12 meses. RESULTADOS: A adiponectina correlacionou-se com a TFG (r = -0,45; p < 0,001), a proteinúria (r = 0,21; p = 0,04), o IMC (r = -0,33; p < 0,01) e a gordura visceral (r = -0,49; p < 0,001). Na análise de regressão múltipla, os determinantes das concentrações de adiponectina foram o sexo (feminino β = 3,8; p < 0,01), a idade (β = 0,14; p = 0,03), a TFG (β = -0,15; p < 0,01) e a gordura visceral (β = -0,04; p < 0,001) (R² = 0,41). Após 12 meses, a progressão da DRC foi evidenciada pela diminuição da TFG (-1,6+-6,3 ml/min; p = 0,01) e aumento da proteinúria (0,3+-0,8 g/d; p < 0,01). Houve um aumento da gordura visceral de 97+-73 cm² para 111+-82 cm² (p < 0,001) e concomitante redução dos níveis de adiponectina, de 27,6+-7,5 mg/l para 22,2+-11,6 mg/l (p < 0,001). O peso corporal, o IMC, a gordura corporal total e a gordura abdominal subcutânea não se alteraram neste período. Ajustando pelos fatores associados à adiponectina, observamos que somente o acúmulo de gordura visceral ao longo do tempo determinou a redução nos níveis de adiponectina (β = -0,04; p = 0,025; R² = 0,21). CONCLUSÃO: A idade, o sexo, a função renal e a gordura visceral estiveram independentemente associados com os níveis de adiponectina nos pacientes com DRC na fase não dialítica. No entanto, a mudança da gordura visceral foi o único preditor das variações nos níveis de adiponectina ao longo de 12 meses.

BACKGROUND: Cardiovascular complications remain the main cause of mortality in patients with chronic kidney disease (CKD). Adiponectin is an adipose tissue-derived protein that carries important cardioprotective properties. We aimed at investigating the determinants of adiponectin levels in CKD patients. METHODS: This prospective observational study included 98 CKD patients [glomerular filtration rate (GFR) 36.1+-14.4 ml/min, 56.5+-10.4 y, 63% male, 31% diabetics, and body mass index (BMI) 27.1+-5.2 kg/m²]. Evaluation of adiponectin (imunoenzimatic assay), laboratory parameters, nutritional status (subjective global assessment), total body fat (dual x-ray energy absorptiometry), and visceral and subcutaneous abdominal fat (computed tomography) was performed at baseline and after 12 months. RESULTS: Adiponectin correlated with GFR (r = -0.45; p < 0.001), proteinuria (r = 0.21; p = 0.04), BMI (r = -0.33; p < 0.01), and visceral fat (r = -0.49; p < 0.001). In the linear regression analysis, the determinants of adiponectin levels were sex (female β = 3.8; p < 0.01), age (β = 0.14; p = 0.03), GFR (β = -0.15; p < 0.01) and visceral fat (β = -0.04; p < 0.001) (R² = 0.41). After 12 months, a progression of the disease was evidenced by the reduction of GFR (-1.6+-6.3 ml/min; p = 0.01) and increase of proteinuria (0.3+-0.8 g/d; p < 0.01). An accumulation of visceral fat was observed, from 97+-73 cm² to 111+-82 cm² (p < 0.001), with a concomitant reduction of adiponectin concentration, from 27.6+-7.5 mg/l to 22.2+-11.6 mg/l (p < 0.001). Body weight, BMI, total body fat, and subcutaneous abdominal fat remained unchanged. After adjustments for the baseline determinants of adiponectin, the increase in visceral fat was independently associated with overtime decrease in adiponectin levels (β = -0.04; p = 0.025; R² = 0.21). CONCLUSION: Age, sex, renal function and visceral fat were independently associated with adiponectin levels in nondialyzed CKD patients. However, variation in visceral fat was the only predictor of variation in adiponectin levels over 12 months.

Adiponectina e baixo risco cardiometabólico em obesas / Adiponectin and low cardiometabolic risk in obese women

OBJETIVO: Investigar a associação entre níveis elevados de adiponectina plasmática (AdipoQ) e baixo risco cardiometabólico (RCM) em obesas (MOb). SUJEITOS E MÉTODOS: Estudo caso-controle, pareado pela idade com 306 MOb, IMC > 30 kg/m², sendo 66 (21,6 por cento) casos - todos não hipertensos, normolipídicos e não diabéticos - realizados em ambulatórios referência do Sistema Único de Saúde (SUS) para obesidade em Salvador. Dados secundários foram coleta-dos dos prontuários médicos, primários e complementares em laboratório de patologia clínica. Valores de AdipoQ > 10,00 µg/mL (> 3º quartil) foram considerados elevados. Foram realizadas análises: descritiva, bivariada e regressão logística condicional. RESULTADOS: Associação positiva, estatisticamente significante (ES), entre baixo RCM e AdipoQ > 10,00 µg/mL em MOb ativas fisicamente (OR= 5,1; IC95 por cento: 1,8-14,3), não fumantes (OR= 3,6; IC95 por cento: 1,6-8,4). CONCLUSÃO: Este estudo sugere que MOb ativas fisicamente, não fumantes e com níveis mais elevados de AdipoQ apresentam mais chances de baixo RCM. Torna-se importante reforçar, por meio de políticas públicas, o estímulo à adoção de comportamentos saudáveis.

OBJECTIVE: To investigate the association between elevated levels of plasmatic adiponectin (AdipoQ) and low cardiometabolic risk (CMR) in obese women (ObW). SUBJECTS AND METHODS: Case-control study, matched by age, of 306 ObW, BMI > 30 kg/m², with 66 cases (21.6 percent) - all non-hypertensive, normolipidemic, and non-diabetic - conducted in SUS (Brazil's Public Health System) outpatient referral services for obesity in the City of Salvador, Brazil. Secondary data were collected from medical records; primary and complementary data were obtained from a clinical pathology laboratory. Values of AdipoQ > 10.00 µg/ml (> 3rd quartile) were considered elevated. Descriptive, bivariate, and conditional logistic regression analyses were performed. RESULTS: A statistically significant positive association between low CMR and AdipoQ > 10.00 µg/ml in physically active (AOR = 5.1; CI95 percent: 1.8-14.3), non-smoking (AOR = 3.6;CI95 percent: 1.6-8.4) ObW was found. CONCLUSION: This study suggests that physically active, non-smoking ObW, with higher AdipoQ levels, present greater chances of a low CMR. It becomes important to reinforce encouragement of the adoption of healthy behaviors, by means of public policies.

Reduced plasma adiponectin levels relative to oxidized low density lipoprotein and nitric oxide in coronary artery disease patients

INTRODUCTION: Adiponectin is a circulating hormone that is produced exclusively by adipocytes and has antiinflammatory and anti-atherogenic properties. The hypothesis that there are differences in adiponectin levels between stable and unstable coronary-artery disease patients remains controversial. Furthermore, the potential relationships between the plasma adiponectin level and the inflammatory and non-inflammatory markers (oxidized low density lipoprotein and nitric oxide) in patients with stable and unstable coronary-artery disease relative to normal subjects have not been assessed. OBJECTIVES: To assess whether plasma adiponectin levels differ among patients with stable and unstable coronary-artery disease and among control subjects, and to correlate plasma adiponectin level with inflammatory and clinical risk factors (such as oxidized-LDL and nitric oxide) in these patients. METHODS: This study included 50 control subjects, 50 stable angina patients and 50 unstable angina patients with angiographically documented coronary-artery disease. Plasma adiponectin and oxidized-LDL levels were determined using an enzyme immunoassay. Plasma nitric oxide, high sensitivity C-reactive protein and lipid profile levels were also measured. RESULTS: Plasma adiponectin levels were lower in the unstable angina patients (4.9 ± 1.30 µg/mL) than in the stable angina patients (6.34 ± 1.0 µg/mL) or in the controls (9.25 ± 1.8 µg/mL); these levels were also significantly lower in stable angina patients versus controls (p<0.001). Plasma adiponectin levels were negatively correlated with oxidized-LDL, high sensitivity C-reactive protein, lipid profile and other clinical risk factors but positively correlated with nitric oxide. CONCLUSION: Plasma adiponectin levels were found to be lower in both stable and unstable angina patients relative to control subjects, and the correlation between plasma adiponectin and cardiovascular markers is weakened in these patients.

Cistatina C y adiponectina en pacientes diabéticos tipo 2 coronarios y no coronarios / Cystatin C and adiponectin in diabetics with and without coronary artery disease

Background: Patients with type 2 diabetes have a high incidence of coronary artery disease, which is even higher among those with renal failure. A serum level of cystatin C are used to assess renal function and is a potential cardiovascular risk factor. Adiponectin is an anti-atherogenic factor. Aim: To measure cystatin C and adiponectin in type 2 diabetic patients with and without coronary artery disease. Material and methods: Nine diabetic patients with coronary artery disease aged 76± 10 years, 20 diabetics without coronary artery disease aged 61 ±5 years and 20 non diabetic subjects aged 57±10 years, were studied. Results: Serum levels of cystatin C (mg/L) were 1.5 (range 0.89-219), 0.81 (range 0.71-1.08) and 0.68 mg/L (range 055-0.75) in diabetics with and without coronary artery disease and controls, respectively (p <0.0001). No differences in adiponectin between groups and no association between cystatin C and adiponectin, were observed. No association between both parameters and body mass index orglycosilated hemoglobin Ale was observed. Cystatin C had a positive correlation with serum creatinine (r =0.57p <0.001). Conclusions: Diabetics with coronary artery disease have higher levels of cystatin C, that are closely correlated with serum creatinine levels.

Adiponectina: elo entre obesidade, resistência à insulina e síndrome do ovário policístico? / Adiponectin: the link between obesity, insulin resistance and polycystic ovary syndrome?

A síndrome do ovário policístico é a endocrinopatia ginecológica mais frequente das mulheres em idade reprodutiva, clinicamente caracterizada pela presença de anovulação crônica hiperandrogênica, hirsutismo e infertilidade. Além das alterações reprodutivas, uma proporção considerável das portadoras da síndrome apresenta anormalidades metabólicas como: resistência à insulina e obesidade, com aumento significativo do risco para o desenvolvimento de intolerância à glicose; diabetes mellitus e doença cardiovascular. No entanto, os mecanismos fisiopatológicos que vinculam a obesidade, a resistência à insulina e os demais distúrbios metabólicos presentes na síndrome do ovário policístico ainda não estão completamente esclarecidos. Estudos recentes sugerem que a adiponectina, uma proteína secretada especificamente pelo tecido adiposo, que apresenta propriedades antiaterogênicas, anti-inflamatórias e sensibilizadora à ação da insulina, poderia apresentar um importante papel integrador na patogênese desses distúrbios metabólicos.

Polycystic ovary syndrome is the most common gynecologic endocrinopathy of reproductive age women. It is clinically characterized by hyperandrogenic chronic anovulation, hisrutism and infertility. In addition to reproductive alterations, a significant proportion of polycystic ovary syndrome women display metabolic abnormalities such as insulin resistance and adiposity, predisposing to greater risk of developing glucose intolerance; diabetes mellitus and cardiovascular disease. However, the physiopathologic mechanisms linking obesity, insulin resistance and the other polycystic ovary syndrome metabolic disturbances are not completely understood. Recent studies suggest that adiponectin, a protein specifically secreted by adipose tissue and which has antiatherogenic, anti-inflammatory and insulin-sensitizing properties, could play an important and integrative role in the pathogenesis of these metabolic disturbances.