Redução da resistência à insulina após resposta virológica sustentada com agentes antivirais diretos: nem toda população melhora / Insulin resistance reduction after sustained virological response with direct acting antiviral: not every population improves

ABSTRACT BACKGROUND: Hepatitis C virus (HCV) infection is a serious public health problem, that affects approximately 170 million people worldwide. Chronic HCV infection is associated with hepatic insulin resistance and an increased risk of diabetes HCV-infected patients has been well documented. OBJECTIVE: To assess the homeostasis model assessment of insulin resistance (HOMA-IR) index in patients treated with direct acting antiviral (DAAs) medication in the sustained virological response (SVR), categorized by the presence or absence of cirrhosis. METHODS: A prospective study was conducted. Data were collected at the beginning of treatment (t-base) and in the twelfth week after the completion of treatment (t-SVR12). The inclusion criteria were presence of: HCV infection (RNA-HCV positive), age ≥18 years, completion of DAAs' therapy, and presence of diabetes with use of oral hypoglycemic agents. All samples were collected during the study period. The exclusion criteria were: presence of HBV/HIV co-infection, hepatocellular carcinoma at baseline, diabetic patients taking insulin and transplanted patients (liver/kidney). Fibrosis was assessed by hepatic elastography or biopsy (METAVIR). Cirrhosis was determined by clinical results or imaging. HOMA-IR was calculated as fasting insulin (μU/mL) × fasting glucose (mmol/L)/22.5) The patients were divided into two groups: the general study population (all patients, including the diabetic patients) and the special population (patients with normal values of HOMA-IR, which is >2.5, and without diabetes). The delta HOMA-IR value was calculated as: HOMA-IR at t-base - HOMA-IR at t-SVR12. For the descriptive statistical analysis, the paired t-test and generalized linear model assuming the log binding function were performed. A P value of < 0.05 was considered significant. RESULTS: We included 150 patients, and 75 were cirrhotic. The mean age was 55.3±9.97 and body mass index was 27.4±5.18. Twenty-two (14.67%) were diabetic patients using oral hypoglycemic agents, and 17 (11%) were cirrhotic. In the general study population, the mean glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. Delta HOMA-IR was negative at t-SVR12, but there was no significant difference. Excluding diabetic patients and those with normal HOMA-IR values (<2.5), mean glucose, insulin and HOMA-IR decreased at t-SVR12. Delta HOMA-IR decreased significantly at t-SVR12 (P: 0.02). CONCLUSION: In the general population, glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. In the special population, glucose, insulin, HOMA-IR and Delta HOMA-IR decreased at t-SVR12.

RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (VHC) é um grave problema de saúde pública, que afeta aproximadamente 170 milhões de pessoas no mundo. A infecção crônica pelo VHC está associada à resistência à insulina hepática e a um risco aumentado de diabetes. Os doentes infetados pelo VHC foram bem documentados. OBJETIVO: Avaliar o modelo de avaliação da homeostase do índice de resistência à insulina (HOMA-IR) em pacientes tratados com medicação antiviral de ação direta na resposta virológica sustentada (RVS), categorizada pela presença ou ausência de cirrose. MÉTODOS: Foi realizado um estudo prospectivo. Os dados foram coletados no início do tratamento (t-base) e na décima segunda semana após o término do tratamento (t-RVS12). Os critérios de inclusão foram presença de: infecção pelo VHC (RNA-VHC positivo), idade ≥18 anos, conclusão da terapia de antivirais de ação direta e presença de diabetes com uso de hipoglicemiantes orais. Todas as amostras foram coletadas durante o período do estudo. Os critérios de exclusão foram: presença de coinfecção VHB/HIV, carcinoma hepatocelular no início do estudo, pacientes diabéticos em uso de insulina e pacientes transplantados (fígado/rim). A fibrose foi avaliada por elastografia hepática ou biópsia (METAVIR). A cirrose foi determinada por resultados clínicos ou exames de imagem. O HOMA-IR foi calculado como insulinemia de jejum (μU/mL) x glicemia de jejum (mmol/L) /22,5). Os pacientes foram divididos em dois grupos: a população geral do estudo (todos os pacientes, incluindo os diabéticos) e a população especial (pacientes com valores normais de HOMA-IR, que é <2,5 e sem diabetes). O valor do delta HOMA-IR foi calculado como: HOMA-IR no t-base - HOMA-IR no t-RVS12. Para a análise estatística descritiva, foram utilizados o teste t pareado e o modelo linear generalizado, assumindo a função de ligação logarítmica. Um valor de P<0,05 foi considerado significativo. RESULTADOS: Foram incluídos 150 pacientes e 75 eram cirróticos. A idade média foi de 55,3±9,97 e o índice de massa corpórea foi de 27,4±5,18. Vinte e dois (14,67%) eram pacientes diabéticos em uso de hipoglicemiantes orais e 17 (11%) eram cirróticos. Na população geral do estudo, os valores médios de glicose e HOMA-IR aumentaram na t-SVR12, mas a insulina diminuiu. O delta HOMA-IR foi negativo em t-SVR12, mas não houve diferença significativa. Excluindo pacientes diabéticos e aqueles com valores normais de HOMA-IR (<2,5), a média de glicose, insulina e HOMA-IR diminuiu no t-RVS12. O delta HOMA-IR diminuiu significativamente em t-RVS12 (P: 0,02). CONCLUSÃO: Na população geral, os valores de glicose e HOMA-IR aumentaram no t-RVS12, mas a insulina diminuiu. Na população especial, glicose, insulina, HOMA-IR e delta HOMA-IR diminuíram no t-RVS12.

Is Lipid Accumulation Product Associated with an Atherogenic Lipoprotein Profile in Brazilian Subjects? / O Produto de Acumulação Lipídica está Associado a um Perfil Aterogênico de Lipoproteínas em Indivíduos Brasileiros?

Abstract Background: Lipid accumulation product (LAP), a simple and low-cost tool, is a novel biomarker of central lipid accumulation and represents a potential surrogate marker for atherogenic lipoprotein profile. However, its association with lipoprotein subfractions has not been described in the literature. Objective: To determine whether LAP index could be used as a marker of low- and high-density lipoprotein (LDL and HDL) size in Brazilian individuals. Methods: This cross-sectional study included patients (n = 351) of both sexes and age between 30-74 years. Clinical and sociodemographic data and family history of diseases were evaluated. Lipoprotein size, and levels of total cholesterol (TC), lipoproteins, apolipoprotein AI and B (APO AI/APO B), glucose, insulin, insulin resistance index (HOMA-IR) and non-esterified fatty acids (NEFA) were assessed in blood samples. LAP was calculated by the formulas [(waist circumference[cm]-58) × (triglycerides[mmol/L]) for women and (waist circumference [cm]-65) × (triglycerides [mmol/L]) for men]. The association between LAP and metabolic parameters were tested by linear trend (general linear model, GLM test) before and after multiple adjustments for potential confounders (sex, age, smoking, statin, fibrate, and hypoglycemic drugs) at significant level p < 0.05. Results: LAP was positively associated with TC, APO B, NEFA, glucose, insulin and HOMA-IR values, and negatively associated with HDL-C. Higher central lipid accumulation was corelated with higher percentage of intermediate HDL and of small LDL and HDL and less amount of large HDL. LDL size was also reduced in greater LAP index values. The negative impact of LAP was maintained after adjustment for multiple variables. Conclusion: LAP was robustly associated with atherogenic profile of lipoprotein subfractions, independently of multiple confounders.

Resumo Fundamento: O produto de acumulação lipídica (LAP), um instrumento simples e de baixo custo, é um novo biomarcador de acúmulo de gordura central e representa um marcador substituto potencial para o perfil aterogênico de lipoproteínas. No entanto, sua associação com subfrações de lipoproteínas ainda não foi descrita na literatura. Objetivo: Determinar se o LAP pode ser usado como um marcador de tamanho da lipoproteína de baixa densidade (LDL) e de alta densidade (HDL) em indivíduos brasileiros. Métodos: Este estudo transversal incluiu 351 pacientes de ambos os sexos e idade entre 30 e 74 anos. Dados clínicos e sociodemográficos e história familiar de doenças foram avaliados. O tamanho das lipoproteínas, e níveis de colesterol total (CT), lipoproteínas, apolipoproteína AI e B (APO AI/APO B), glicose, ácidos graxos não esterificados (AGNEs) e insulina, e índice de resistência insulínica (HOMA-IR) foram avaliados em amostras de sangue. O LAP foi calculado utilizando-se as fórmulas (circunferência da cintura (cm]-58) × (triglicerídeos[mmol/L]) para mulheres e (circunferência da cintura[cm]-65) × (triglicerídeos [mmol/L]) para homens. Associações entre LAP e parâmetros metabólicos foram testadas por tendência linear (modelo linear generalizado, GLM) antes e após ajustes por fatores de confusão (sexo, idade, tabagismo, uso de estatinas, fibratos e hipoglicemiantes) ao nível de significância de p < 0,05). Resultados: LAP apresentou uma associação positiva com CT, APO B, AGNEs, glicose, insulina, HOMA-IR, e uma associação negativa com HDL-C. Maior acúmulo de gordura central correlacionou-se com maior porcentagem de HDL intermediária e de partículas pequenas de LDL e HDL, e menor porcentagem de HDL grande. O tamanho da LDL também era reduzido em valores de LAP mais elevados. O impacto negativo do LAP foi mantido após ajuste para múltiplas variáveis. Conclusão: o LAP esteve fortemente associado com o perfil aterogênico de subfrações de lipoproteínas, independetemente dos fatores de confusão.

Insulin resistance and associated factors: a cross-sectional study of bank employees

OBJECTIVE: Insulin resistance is characterized by the failure of target cells to respond to normal levels of circulating insulin, and this condition is related to cardiovascular disease. This study sought to evaluate the prevalence of insulin resistance and its association with markers of metabolic abnormalities and metabolic syndrome in bank employees. METHODS: A cross-sectional study was performed on 498 working men and women aged ≥20 years old. The Homeostasis Model Assessment (HOMA-IR) was used to determine the presence of insulin resistance based on cut-off values of ≤2.71 for normal insulin levels and >2.71 for insulin resistance, as established for the adult Brazilian population. RESULTS: It was observed that the 52 (10.4%) overweight individuals with insulin resistance were 4.97 times (95%CI 1.31-18.83) more likely to have high HOMA-IR values than the normal-weight participants; among those who were obese, the likelihood increased to 17.87 (95%CI 4.36-73.21). Individuals with large waist circumferences were 3.27 times (95%CI 1.03-10.38) more likely to develop insulin resistance than those who were within normal parameters. The HOMA-IR values differed between subjects with and without metabolic syndrome, with values of 2.83±2.5 and 1.10±0.81 (p=0.001), respectively. The levels of insulin, ultrasensitive C-reactive protein and uric acid were also associated with insulin resistance. CONCLUSION: The prevalence of insulin resistance among bank employees is high, and insulin resistance is associated with and serves as a marker of metabolic syndrome. Cardiovascular disease and metabolic syndrome-associated metabolic abnormalities were observed, and insulin resistance may be a risk factor in this group of professionals.

Bradykinin, insulin, and glycemia responses to exercise performed above and below lactate threshold in individuals with type 2 diabetes

The aim of this study was to analyze the acute responses of bradykinin, insulin, and glycemia to exercise performed above and below lactate threshold (LT) in individuals with type 2 diabetes mellitus (T2D). Eleven participants with a diagnosis of T2D randomly underwent three experimental sessions 72 h apart: 1) 20 min of exercise performed at 120% of LT (120%LT), 2) 20 min of exercise performed at 80% of LT (80%LT), and 3) 20 min of control session. Blood glucose was analyzed before, during, and at 45 min post-exercise. Bradykinin and insulin were analyzed before and at 45 min post-exercise. Both exercise sessions elicited a parallel decrease in glucose level during exercise (P≤0.002), with a greater decrease being observed for 120%LT (P=0.005). Glucose decreased 22.7 mg/dL (95%CI=10.3 to 35, P=0.001) at the 45 min post-exercise recovery period for 80%LT and decreased 31.2 mg/dL (95%CI=18.1 to 44.4, P<0.001) for 120%LT (P=0.004). Insulin decreased at post-exercise for 80%LT (P=0.001) and control (P≤0.035). Bradykinin increased at 45 min post-exercise only for 80%LT (P=0.013), but was unrelated to the decrease in glucose (r=-0.16, P=0.642). In conclusion, exercise performed above and below LT reduced glycemia independently of insulin, but exercise above LT was more effective in individuals with T2D. However, these changes were unrelated to the increase in circulating bradykinin.

Evaluación de una intervención educativa nutricional en trabajadores de la construcción para prevenir enfermedades crónicas no transmisibles en Chile / Assessment of a nutrition education intervention among construction workers

Background: Unhealthy lifestyles and overweight are common among blue collar workers. Aim: To evaluate a nutrition education intervention in construction workers to prevent chronic diseases. Material and Methods: One hundred forty two participants were randomly assigned to an experimental group (n = 69) and or a control group (n = 73). The experimental group received nutrition education consisting in individual lifestyle counseling, group workshop, group counseling in healthy lifestyles, and environmental intervention. At baseline and after one year of intervention, clinical evaluations consisting in laboratory determinations, anthropometry and nutritional assessment evaluation were carried out. Results: The experimental group experienced a significant decrease in waist circumference, total cholesterol, triglycerides, and an increase in HDL cholesterol. A significant reduction in total calorie intake, especially at the evening snack was observed during week-days. The same reduction in total calories occurred at dinner during the week-end. A significant increase was observed in the consumption of fruits, vegetables and fish. In the control group there was a significant increase in weight, waist circumference, body mass index, glucose and insulin, without changes in total calorie intake or healthy food consumption. High soft drink consumption did not change in both groups. Conclusions: In construction workers, integral nutrition intervention at the individual, group and environmental level had an impact in nutritional and biochemical indicators.

The association of autoimmune thyroiditis and non-functional adrenal incidentalomas with insulin resistance

Objective Patients with incidental nonfunctioning adrenal adenoma are associated with increased risk of obesity, impaired glucose tolerance and dyslipidemia. We aimed to investigate the relationship between thyroid function, serum lipids and insulin resistance in patients with nonfunctioning adrenal incidentaloma. Subjects and methods Forty patients who had diagnosed as adrenal incidentaloma (AI) in our department were included in the study. Serum free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), anti-thyroperoxidase antibody (anti-TPO Ab) and anti-thyroglobulin antibody (anti-Tg Ab), lipid profile, hs-CRP, fasting insulin levels were measured and insulin resistance calculated by HOMA-IR. Thyroid volume (TV) was assessed. Results None of the patients showed specific signs and symptoms of hormone excess. TV, TSH and fT3 levels in the patient and control groups did not differ significantly (p > 0.05). The serum fT4, anti-TG Ab, anti-TPO Ab levels in the patient group were significantly higher than in the control group (p = 0.013, p < 0.0001, p = 0.016 respectively). The HOMA-IR, hs-CRP and HDL cholesterol levels in the AI patients were significantly higher than the control group (p = 0.034, p = 0.041, p = 0.002, respectively). Statistically significant relationship was found between HOMA-IR and thyroid volume (r = 0.373, p = 0.018), fT4 (r = 0.382, p = 0.015), hs-CRP (r = 0.512, p = 0.001), HDL cholesterol (r = 0,351 p = 0.026) in AI patients. There were significant correlation between anti-TG Ab, anti-TPO Ab and TSH levels in AI patients (r = 0.431 p = 0.006, r = 0.402 p = 0.012). Conclusions Patients with nonfunctioning adrenal incidentaloma have several metabolic disturbances. At the same time autoimmune thyroid disorders are more frequent in nonfunctioning adrenal incidentaloma patient so that thyroid functions must be evaluated in those patients. Arch Endocrinol Metab. 2015;59(1):42-6 .

Does Homeostasis Model Assessment of Insulin Resistance have a predictive value for post-coronary artery bypass grafting surgery outcomes? / O Modelo de Avaliação da Homeostase da Resistência à Insulina tem valor preditivo para os resultados após a cirurgia de revascularização miocárdica?

Objective: This study aims to investigate whether pre-operative Homeostasis Model Assessment Insulin Resistance (HOMA-IR) value is a predictor in non-diabetic coronary artery bypass grafting patients in combination with hemoglobin A1c, fasting blood glucose and insulin levels. Methods: Eighty one patients who were admitted to Cardiovascular Surgery Clinic at our hospital between August 2012 and January 2013 with a coronary artery bypass grafting indication were included. Patients were non-diabetic with <6.3% hemoglobin A1c and were divided into two groups including treatment and control groups according to normal insulin resistance (HOMA-IR<2.5, Group A; n=41) and high insulin resistance (HOMA-IR>2.5, Group B; n=40), respectively. Pre-operative fasting blood glucose and insulin were measured and serum chemistry tests were performed. The Homeostasis Model Assessment Insulin Resistance values were calculated. Statistical analysis was performed. Results: There was a statistically significant difference in fasting blood glucose and HOMA-IR values between the groups. Cross-clamping time, and cardiopulmonary bypass time were longer in Group B, compared to Group A (P=0.043 and P=0.031, respectively). Logistic regression analysis revealed that hemoglobin A1c was not a reliable determinant factor alone for pre-operative glucometabolic evaluation of non-diabetic patients. The risk factors of fasting blood glucose and cardiopulmonary bypass time were more associated with high Homeostasis Model Assessment Insulin Resistance levels. Conclusion: Our study results suggest that preoperative screening of non-diabetic patients with Homeostasis Model Assessment Insulin Resistance may improve both follow-up visit schedule and short-term outcomes, and may be useful in risk stratification of the high-risk population for impending health problems. .

Objetivo: Este estudo tem como objetivo investigar se a resistência de valor do Modelo de Avaliação da Homeostase da Resistência à Insulina (Homeostasis Model Assessment Insulin Resistance - HOMA-IR) no pré-operatório é um preditor de revascularização do miocárdio para pacientes não diabéticos em combinação com a hemoglobina A1c, glicemia em jejum e insulina. Métodos: Oitenta e um pacientes que foram internados no serviço de Cirurgia Cardiovascular em nosso hospital entre agosto de 2012 e janeiro de 2013, com indicação para cirurgia de revascularização do miocárdio indicação foram incluídos. Os pacientes não diabéticos com <6,3% de hemoglobina A1c foram divididos em dois grupos, incluindo os grupos de tratamento e controle de acordo com a resistência à insulina normal (HOMA-IR <2,5, Grupo A, n=41) e alta resistência à insulina (HOMA-IR> 2,5, Grupo B, n=40), respectivamente. Glicemia de jejum pré-operatório e insulina foram medidas e testes de química do soro foram realizados. Os valores de HOMA-IR foram calculados. A análise estatística foi realizada. Resultados: Houve diferença estatisticamente significativa em jejum de valores de glicose no sangue e HOMA-IR entre os grupos. Tempo de pinçamento e tempo de circulação extracorpórea foi maior no grupo B, em relação ao Grupo A (P=0,043 e P=0,031, respectivamente). A análise de regressão logística revelou que hemoglobina A1c não foi um fator determinante para a avaliação confiável sozinho glicometabólico pré-operatória de pacientes não diabéticos. Os fatores de risco de glicemia de jejum e tempo de circulação extracorpórea foram associados com altos níveis do HOMA-IR. Conclusão: ...

Effects of chronic stress and high-fat diet on metabolic and nutritional parameters in Wistar rats / Efeitos do estresse crônico e da dieta rica em gordura sobre os parâmetros metabólicos e nutricionais em ratos Wistar

OBJECTIVE: The aim of this study was assess the role of chronic stress on the metabolic and nutritional profile of rats exposed to a high-fat diet. MATERIALS AND METHODS: Thirty-day-old male Wistar rats (70-100 g) were distributed into four groups: normal-diet (NC), chronic stress (St), high-fat diet (HD), and chronic stress/high-fat diet (HD/St). Stress consisted at immobilization during 15 weeks, 5 times per week, 1h per day; and exposure to the high-fat diet lasted 15 weeks. Nutritional and metabolic parameters were assessed. The level of significance was 5%. RESULTS: The HD group had final body weight, total fat, as well as insulin and leptin increased, and they were insulin resistant. The St and HD/St had arterial hypertension and increased levels of corticosterone. Stress blocked the effects of the high-fat diet. CONCLUSION: Chronic stress prevented the appearance of obesity. Our results help to clarify the mechanisms involved in metabolic and nutritional dysfunction, and contribute to clinical cases linked to stress and high-fat diet.

OBJETIVO: Avaliar o papel do estresse crônico sobre parâmetros metabólicos e nutricionais de ratos expostos à dieta rica em gordura. MATERIAIS E MÉTODOS: Ratos Wistar machos (30 dias de idade/70-100 g) foram distribuídos em quatro grupos: dieta-normal (NC), estresse crônico (St), dieta rica em gordura (HD) e estresse crônico/dieta rica em gordura (HD/St). O estresse consistiu em imobilização durante 15 semanas, 5 vezes por semana 1h por dia e a dieta rica em gordura foi oferecida por 15 semanas. Parâmetros nutricionais e metabólicos foram avaliados. O nível de significância foi de 5%. RESULTADOS: HD tiveram peso corpóreo, gordura total e níveis de insulina e leptina aumentados e foram resistentes à insulina. Os grupos St e HD/St manifestaram hipertensão e níveis séricos de corticosterona elevados. O estresse bloqueou os efeitos da dieta. CONCLUSÃO: O estresse impediu o surgimento dela. Nossos resultados ajudam compreender os mecanismos envolvidos na disfunção metabólica e nutricional e contribuem para casos clínicos de estresse e dietas ricas em gorduras.

Preoperative glutamine infusion improves glycemia in heart surgery patients / Infusão pré-operatória de glutamina melhora a glicemia em pacientes submetidos à cirurgia cardíaca

PURPOSE: To evaluate the effects of pre-operative L-alanyl-glutamine (L-Ala-Gln) on blood glucose control in patients with coronary obstruction, selected for myocardial revascularization. METHODS: Twenty-two patients (63±8 years) were randomly assigned to receive 250ml of L-Ala-Gln 20 percent plus saline 750 ml (Group L- Ala-Gln, n=11) or saline 1000 ml (Group Saline, n=11) over 3 hours before operation. Pre-operative blood samples were collected 3h before (T-1) and at the beginning of the surgical procedure (T-2). Intra-operative samples were collected immediately before the start (T-3) and the end of extra-corporeal perfusion (T- 4). Post-operative samples were collected 12h (T-12) and 24h later (T-24). RESULTS: Glycemia decreased significantly in L-Ala-Gln treated patients during the intraoperative period. The same effect did not occur in saline patients. As the rate of insulin infusion, administered routinely to patients undergoing surgery with extracorporeal circulation was constant in both groups during surgery, the reduction of blood glucose in group L-Ala-Gln does not seem to be related to exogenous insulin. CONCLUSION: Pre-operative use of L-Ala-Gln improves glycemic control in patients with coronary artery occlusion, submitted to myocardial revascularization.

OBJETIVO: Avaliar os efeitos do uso pré-operatório da L-alanil-glutamina (L-Ala-Gln) no controle glicêmico em pacientes, selecionados para a revascularização do miocárdio. MÉTODOS: Vinte e dois pacientes cardiopatas (63±8 anos) foram randomizados para receber 250 ml de L-Ala-Gln 20 por cento em 750 ml de solução salina (Grupo L-Ala-Gln, n=11) ou soro fisiológico 1000 ml (Grupo Salina, n=11). Amostras de sangue foram coletadas no pré-operatório, três horas antes (T-1: basal) e no início do procedimento cirúrgico (T-2); imediatamente antes do início (T-3) e no final da perfusão extra-corpórea (T-4); 12h (T-12) e 24h após a conclusão do procedimento. As infusões, com duração de 3 horas, foram iniciadas 3 h antes do procedimento operatório. RESULTADOS: Houve redução significativa da glicemia nos pacientes tratados com L-Ala-Gln durante o período intra-operatório (T-3 e T-4). O mesmo efeito não ocorreu nos pacientes do grupo salina. Como a taxa de infusão de insulina, administrada rotineiramente aos pacientes submetidos à cirurgia com circulação extracorpórea, foi constante em ambos os grupos durante o período intra-operatório, a redução da glicemia no grupo L-Ala-Gln não parece estar relacionada à insulina exógena. CONCLUSÃO: O uso pré-operatório de L-Ala-Gln melhora o controle glicêmico em pacientes com obstrução coronariana, submetidos à revascularização miocárdica.

Fatores associados à resistência à insulina em populações rurais / Factors associated with insulin resistence in rural populations

O objetivo deste estudo foi avaliar a associação dos indicadores antropométricos, de composição corporal, bioquímicos e hemodinâmicos com a resistência à insulina em duas comunidades rurais. A amostra foi constituída por indivíduos com idade maior ou igual a 18 anos de ambos os sexos. Foram excluídos os diabéticos e as mulheres grávidas. A coleta de dados incluiu variáveis demográficas, de estilo de vida, hemodinâmicas, antropométricas e bioquímicas. Dos 567 participantes, 50,4 por cento eram homens e 49,6 por cento, mulheres. A maioria das pessoas tinha a cor de pele não-branca (75,7 por cento), vivia com seus cônjuges (69,3 por cento) e possuía baixo nível educacional. Neste trabalho, 17,4 por cento das pessoas apresentavam sobrepeso e 5,5 por cento, obesidade. Pela análise multivariada observou-se que, nos indivíduos adultos, não-diabéticos, com baixo nível socioeconômico e educacional, os fatores associados à resistência à insulina foram o sobrepeso e a obesidade, o aumento da razão cintura/quadril, a proteína C-reativa e a cor de pele.

This study explores the relations of anthropometric, body composition assessments, biochemical and hemodynamic parameters with insulin resistance in two rural communities. Sample was composed by adults aged 18 or older, both sexes. Participants were excluded if pregnant and diabetic. Data collection included demographic lifestyle, hemodynamic, anthropometric and biochemical variables. From the 567 subjects, 50.4 percent were men and 49.6 percent, women. Most of the sample was non-white (75.7 percent), lived with partner (69.3 percent) and had low educational level. Overweight and obesity prevalences were 17.4 percent and 5.5 percent, respectively. Multivariate analysis found risk factors associated to insulin resistance for non-diabetic adults with low income and educational level: overweight, obesity, elevated waist-to-hip ratio, C-reactive protein and skin color.

Metabolic syndrome among Caribbean-born persons living in the U.S. Virgin Islands

OBJETIVOS: Determinar la frecuencia del síndrome metabólico (SM) en cuatro subpoblaciones de residentes de las Islas Vírgenes estadounidenses y calcular el riesgo de sufrir SM asociado con una circunferencia abdominal superior a determinados puntos de corte en personas con sobrepeso y obesidad. MÉTODOS: En un estudio realizado entre 1995 y 1999 se obtuvieron las características demográficas, medidas antropométricas, presión arterial y muestras de sangre de miembros de una cohorte poblacional de 893 personas que pertenecían a cuatro subgrupos poblacionales en Saint Croix (la mayor de las Islas Vírgenes estadounidenses) y que nunca habían recibido un diagnóstico de diabetes. Las cuatro subpoblaciones fueron: 1) hispanos de raza blanca; 2) hispanos de raza negra; 3) personas no hispanas de raza negra nacidas en las Islas Vírgenes estadounidenses y 4) personas no hispanas de raza negra nacidas en otras partes del Caribe. A las muestras de sangre en ayunas se les midieron las concentraciones de glucosa, insulina, triglicéridos y colesterol transportado por lipoproteínas de alta densidad (HDLc). Para identificar el SM se aplicaron las pautas generadas por el Panel III en torno al Tratamiento de Adultos, del Programa Educativo Nacional sobre el Colesterol [National Cholesterol Education Program Adult Treatment Panel III]. La resistencia a la insulina se calculó mediante la valoración de un modelo homeostásico (HOMA-IR). RESULTADOS: La prevalencia general de síndrome metabólico en la muestra fue de 20,5% (intervalo de confianza de 95% [IC95%]: 15,3% a 25,7%). Las personas que se habían clasificado a sí mismas como hispanas y de raza negra tuvieron la frecuencia más alta (27,8% (IC95% = 16,3% a 39,3%)) de SM y los puntajes más altos en el HOMA-IR. Después de hacer ajustes en función de los factores asociados con el estilo de vida y el HOMA-IR, la etnia hispana mostró una asociación independiente con un mayor riesgo de tener SM (razón de posibilidades [RP] = 1,82 (IC95%: 1,07 a 3,07)), triglicéridos séricos elevados (RP = 3,66 (IC95% = 2,18 a 6,15)) y concentraciones séricas bajas de HDLc (RP = 1,60 (IC 95% = 1,04 a 2,45))...

Insuficiência renal crônica e hormônio de crescimento: efeitos no eixo GH-IGF e na leptina / Chronic renal failure and growth hormone: effects on GH-IGF axis and leptin

OBJETIVO: Avaliar as alterações de IGF-1, IGFBP-3, leptina e insulina após o uso de doses de reposição de hormônio de crescimento recombinante humano (rhGH) em crianças baixas pré-púberes com insuficiência renal crônica (IRC). CASUíSTICA E MÉTODOS: Em 11 crianças (3F:8M), com idade média de 9,6 anos, em uso de rhGH (0,23mg/Kg/semana) por 12 meses, foram dosados (antes, 6 e 12 meses após o início do tratamento com rhGH) leptina, insulina, glicemia, IGF-1 e IGFBP-3. RESULTADOS: As concentrações séricas de leptina, insulina e glicemia não variaram significativamente no decorrer do uso do rhGH, sendo observado o padrão de leptina e glicemia normais, com hiperinsulinemia. Houve aumento significativo da IGF-1 e IGFBP-3 durante o uso do rhGH. CONCLUSÕES: O uso de doses de reposição de rhGH durante 12 meses em um grupo selecionado de crianças com IRC propiciou aumento significativo da concentração sérica de IGF-1 e IGFBP-3, com leptinemia normal e resistência insulínica.

Blood glucose and insulin response to intravenous glucose by patients with chronic Chagas' disease and alcoholism

Blood glucose and insulin responses to intravenous glucose 500 mg/kg in a group of alcoholic chagasic patients (Group I, N = 15) were assessed and compared to those of a group of patients with Chagas' disease without alcoholism (Group II, N = 16), a group of alcoholics without Chagas' disease (Group III, N = 22), and a group of non-alcoholics without Chagas' disease (Group IV, N = 15). Determinations of serum glucose and insulin were done under fasting conditions, 5 and 10 min after the injection of 50 per cent glucose. There was no difference in mean serum glucose levels between groups. Mean serum insulin levels at times 5 and 10 min and for the total integrated response were lower (P < 0.05) in Groups I and II as compared to Group IV; at time 10 min the mean was lower (P < 0.05) in Group III as compared to Group IV. There was a nonsignificant trend for a lower insulinemic response in Group I as compared to Group II. These data suggest denervation of or injury to pancreatic B cell by Chagas' disease

Insulin secretion in alcoholics with chagasic infection

1. Níveis plasmáticos de insulina foram estudados após estímulos oral e intravenoso de glicose em alcoólatras com e sem doença de Chagas, comparados com indivíduos sadios. 2. Os valores médios da insulina plasmática foram mais baixos nos alcoólatras que nos controles sadios. Alcoólatras com doença de Chagas apresentaram valores entre os grupos anteriormente citados. O eixo entero-insular estava preservado em todos os grupos. 3. Após estímulo oral, os valores médios dos níveis de insulina plasmática foram mais baixos que os dos alcoólatras chagásicos, a diferença sendo estatisticamente significante (p<0,05). 4. Os resultados sugerem que as lesöes celulares devidas ao alcoolismo e à denervaçäo causada pela doença de Chagas näo se somam na determinaçäo de pouca resposta das células pancreáticas, mas pelo contrário, a doença de Chagas parece prevenie uma queda acentuada nos níveis insulínicos plasmáticos após estímulo pela glicose