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1.
Endocrine ; 80(3): 529-540, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37029854

RESUMO

BACKGROUND AND AIMS: The gut microbiome is associated with obesity, mainly mediated by bacteria-produced short-chain fatty acids (SCFAs). It is unknown how SCFA concentrations are associated with the phenotypes metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obese/overweight (MHO), and metabolically unhealthy obese/overweight (MUO). We compared plasma and fecal SCFA concentrations among adult women categorized according to the metabolic phenotypes mentioned above and examined associations between SCFA and adiposity and components of energy and glucose homeostasis. METHODS: This was a cross-sectional study involving 111 participants. Body composition was assessed by DEXA. Energy and glycemic homeostasis were assessed by the standard mixed-meal tolerance test coupled with indirect calorimetry. SCFAs were quantified by gas chromatography and mass spectrometry. RESULTS: Only plasma propionate was increased in the MHNW phenotype compared to the MHO and MUO phenotypes [p < 0.05]. Fecal propionate and butyrate concentrations and plasma propionate concentrations were inversely associated with total and visceral adiposity [p < 0.05]. Fecal and plasma SCFA concentrations were associated with reduced glucose, insulin and HbA1c levels, increased fasting and postprandial GLP-1 levels; and more preserved beta-cell function [p < 0.05]. Fecal and plasma SCFA concentrations were positively correlated with resting energy expenditure and lipid oxidation rate and inversely correlated with the oxidation rate of carbohydrates [p < 0.05]. CONCLUSION: These findings reinforce the concept that fecal and plasma SCFA concentrations are linked to specific components of energy and glucose homeostasis; and body adiposity. However, it was not possible to discriminate the different metabolic phenotypes of adiposity based on the determination of fecal SCFA concentrations.


Assuntos
Síndrome Metabólica , Nutricionistas , Feminino , Humanos , Sobrepeso/metabolismo , Adiposidade , Propionatos , Estudos Transversais , Obesidade/metabolismo , Ácidos Graxos Voláteis , Fenótipo , Homeostase , Glucose , Índice de Massa Corporal , Síndrome Metabólica/metabolismo
2.
Arch. endocrinol. metab. (Online) ; 67(1): 119-125, Jan.-Feb. 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1420094

RESUMO

ABSTRACT Objectives: To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient - B = −0.087, 95% confidence interval [CI] = −0.135 to −0.040) and postpubertal (B = −0.101, 95% CI, −0.145 to −0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean = −0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion: The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.

3.
Arch. endocrinol. metab. (Online) ; 67(1): 101-110, Jan.-Feb. 2023. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1420102

RESUMO

ABSTRACT Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Materials and methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of pre-conception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (β = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (β = 0.11, p = 0.003) and fat mass index (FMI) (β = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (β = 0.42, p = 0.046), FMI (β = 0.22, p = 0.005) and android-to-gynoid fat ratio (β = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

4.
Arch Endocrinol Metab ; 67(1): 119-125, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36468919

RESUMO

Objective: To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient - B = -0.087, 95% confidence interval [CI] = -0.135 to -0.040) and postpubertal (B = -0.101, 95% CI, -0.145 to -0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean =-0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion: The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.


Assuntos
Resistência à Insulina , Masculino , Feminino , Humanos , Adolescente , Homeostase , Circunferência da Cintura , Análise de Regressão , Insulina , Índice de Massa Corporal , Glicemia/análise
5.
Arch Endocrinol Metab ; 67(1): 101-110, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36155122

RESUMO

Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of preconception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (ß = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (ß = 0.11, p = 0.003) and fat mass index (FMI) (ß = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (ß = 0.42, p = 0.046), FMI (ß = 0.22, p = 0.005) and android-to-gynoid fat ratio (ß = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.


Assuntos
Ganho de Peso na Gestação , Nutricionistas , Adulto Jovem , Feminino , Humanos , Adulto , Índice de Massa Corporal , Estudos Transversais , Obesidade/etiologia , Pais , Composição Corporal
6.
J Clin Endocrinol Metab ; 106(4): e1574-e1585, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33421070

RESUMO

CONTEXT: Congenital adrenal hyperplasia (CAH) patients have potential normal longevity. However, a greater risk for cardiovascular disease has been reported. Insulin resistance and hyperinsulinemia have been described in CAH patients, whereas the prevalence of overt type 2 diabetes is not higher in CAH than in normal population. OBJECTIVE: To examine the contributions of insulin secretion and of hepatic insulin clearance to compensatory hyperinsulinemia in young insulin-resistant adults with classic CAH due to 21-hydroxylase deficiency (21-OHD). DESIGN: Cross-sectional. SETTING: University outpatient clinics. METHODS: Fifty-one participants: 21 controls, and 30 CAH (15 virilizing and 15 salt-wasting phenotypes), female/male (33/18), age (mean [SD]): 24.0 (3.6) years, body mass index: 24.6 (4.9)kg/m2 with normal glucose tolerance, were submitted to a hyperglycemic clamp study. MAIN OUTCOME MEASURES: Insulin sensitivity, beta cell function, and hepatic insulin clearance using appropriate modeling. RESULTS: We found an increased insulin resistance in 21-OHD. The systemic hyperinsulinemia (posthepatic insulin delivery) was elevated in CAH patients. No increases were observed in insulin secretory rate (beta cell function) in the first phase or during the hyperglycemic clamp. The increase in insulin concentrations was totally due to a ~33% reduction in insulin clearance. CONCLUSION: 21-OHD nonobese subjects have reduced insulin sensitivity and beta cell response unable to compensate for the insulin resistance, probably due to overexposure to glucocorticoids. Compensatory hyperinsulinemia is most related with reduced hepatic insulin clearance. The exclusive adaptation of the liver acts as a gating mechanism to regulate the access of insulin to insulin-sensitive tissues to maintain glucose homeostasis.


Assuntos
Hiperplasia Suprarrenal Congênita/metabolismo , Hiperinsulinismo/metabolismo , Resistência à Insulina , Insulina/metabolismo , Hiperplasia Suprarrenal Congênita/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Hiperinsulinismo/complicações , Células Secretoras de Insulina/metabolismo , Masculino , Adulto Jovem
7.
Nutrition ; 83: 111067, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33348107

RESUMO

OBJECTIVES: The aim of this study was to examine whether paternal and maternal body mass indexes (BMIs) were independently associated with obestatin and visfatin levels in adult offspring. METHODS: This cross-sectional analysis included 124 women who participated in the Nutritionists' Health Study (NutriHS) at baseline. Early life events, anthropometry, dual-energy x-ray absorptiometry-determined body composition and blood sample were obtained. Associations of parental BMI with outcomes (obestatin and visfatin) were tested by multiple linear regression, using minimal sufficient adjustments recommended by Directed Acyclic Graph. Participants' mean BMI was 25 ± 5 kg/m2 and 74% were metabolically healthy. Median obestatin and visfatin levels were 56.4 pg/mL (42-72) and 17.7 ng/mL (14-21.8), respectively. Eleven percent of mothers and 39% of fathers were overweight/obese. RESULTS: Daughters born from overweight/obese mothers had higher BMI than those born from normal weight women (P = 0.003). In adjusted regression model, offspring obestatin levels were associated with maternal BMI (ß = -0.03; P = 0.045) and paternal BMI (ß = -0.02; P = 0.048) independently of maternal and paternal education, maternal age, and maternal use of tobacco, alcohol, and/or drugs. No association was detected with visfatin levels. CONCLUSION: Inverse associations of maternal and paternal BMIs with offspring obestatin concentrations in women could suggest a utility of this biomarker of energy regulation determined in early adulthood. Whether obestatin could be an indicator of protection against obesity-related disorders in the life course requires investigation in studies designed to test such hypothesis.


Assuntos
Pai , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Grelina , Humanos , Masculino , Mães , Obesidade
8.
Arq Gastroenterol ; 57(2): 114-120, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32490902

RESUMO

BACKGROUND: Irritable bowel syndrome is a functional and chronic gastrointestinal disorder that may cause abdominal pain and altered bowel habits, affecting the nutritional status and quality of life of its carriers. Its prevalence is high, affecting about 10% to 15% of the general population in developed countries, being more prevalent in women than in men in the proportion 2:1. OBJECTIVE: The aim of our study was to compare the profile of body adiposity, life habits, and the quality of life of women with irritable bowel syndrome with a healthy control group. METHODS: Case-control study on 70 women, 34 with irritable bowel syndrome and 36 healthy. We applied the "Irritable Bowel Syndrome Quality of Life Questionnaire"to assess quality of life. Body adiposity was assessed from body mass index, waist circumference, and waist-to-hip ratio. We investigated the self-reporting of gastrointestinal symptoms with food deemed as problematic for carriers of irritable bowel syndrome and the presence of typical comorbidities. Assessment of life habits included: practice of physical activities, alcoholism, smoking, daytime sleepiness, and exclusion of foods from the feeding routine. For statistical analysis we used the IBM SPSS program, with a significance level at 5%. RESULTS: There was higher volume of central and general adiposity in the case group compared with the control group (P<0.05). Cases presented a higher chance of developing IBS-related comorbidities (P<0.05). About of 80% of patients with irritable bowel syndrome have excluded some food from the diet (P<0.01) and the total amount of troublesome foods varied from 7 to 21 (P<0.01). The case group featured worse quality of life compared with the control (P<0.05). CONCLUSION: Compared to the control group, women with irritable bowel syndrome showed greater body adiposity, higher frequency of comorbidities, greater restriction on the consumption of problematic foods and worse quality of life.


Assuntos
Síndrome do Intestino Irritável , Estudos de Casos e Controles , Feminino , Hábitos , Humanos , Estado Nutricional , Qualidade de Vida
9.
Arq. gastroenterol ; Arq. gastroenterol;57(2): 114-120, Apr.-June 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1131654

RESUMO

ABSTRACT BACKGROUND: Irritable bowel syndrome is a functional and chronic gastrointestinal disorder that may cause abdominal pain and altered bowel habits, affecting the nutritional status and quality of life of its carriers. Its prevalence is high, affecting about 10% to 15% of the general population in developed countries, being more prevalent in women than in men in the proportion 2:1. OBJECTIVE: The aim of our study was to compare the profile of body adiposity, life habits, and the quality of life of women with irritable bowel syndrome with a healthy control group. METHODS: Case-control study on 70 women, 34 with irritable bowel syndrome and 36 healthy. We applied the "Irritable Bowel Syndrome Quality of Life Questionnaire"to assess quality of life. Body adiposity was assessed from body mass index, waist circumference, and waist-to-hip ratio. We investigated the self-reporting of gastrointestinal symptoms with food deemed as problematic for carriers of irritable bowel syndrome and the presence of typical comorbidities. Assessment of life habits included: practice of physical activities, alcoholism, smoking, daytime sleepiness, and exclusion of foods from the feeding routine. For statistical analysis we used the IBM SPSS program, with a significance level at 5%. RESULTS: There was higher volume of central and general adiposity in the case group compared with the control group (P<0.05). Cases presented a higher chance of developing IBS-related comorbidities (P<0.05). About of 80% of patients with irritable bowel syndrome have excluded some food from the diet (P<0.01) and the total amount of troublesome foods varied from 7 to 21 (P<0.01). The case group featured worse quality of life compared with the control (P<0.05). CONCLUSION: Compared to the control group, women with irritable bowel syndrome showed greater body adiposity, higher frequency of comorbidities, greater restriction on the consumption of problematic foods and worse quality of life.


RESUMO CONTEXTO: A síndrome do intestino irritável é uma desordem gastrointestinal crônica e funcional que pode causar dor abdominal e alteração do hábito intestinal, afetando o estado nutricional e a qualidade de vida. Sua prevalência é alta, acomete cerca de 10% a 15% da população geral em países desenvolvidos, sendo mais prevalente em mulheres do que em homens na proporção 2:1. OBJETIVO: O objetivo deste estudo foi comparar o perfil de adiposidade corporal, os hábitos de vida e a qualidade de vida de indivíduos portadores da síndrome do intestino irritável com um grupo controle saudável. MÉTODOS: Estudo caso-controle com 70 mulheres, 34 com a síndrome do intestino irritável e 36 saudáveis. Foi aplicado o Irritable Bowel Syndrome Quality of Life Questionnaire para avaliação da qualidade de vida. A adiposidade corporal foi avaliada a partir do índice de massa corporal, circunferência da cintura e relação cintura-quadril. Foi investigado o auto-relato de sintomas gastrointestinais de alimentos considerados problemáticos para portadores da síndrome do intestino irritável e a presença de comorbidades típicas. A análise do estilo de vida incluiu a prática de atividade física, alcoolismo, tabagismo, sonolência diurna e exclusão de alimentos. Para análise estatística foi utilizado o programa IBM SPSS, com o nível de significância de 5%. RESULTADOS: Houve maior acúmulo de adiposidade central e periférica no grupo caso em comparação ao grupo controle (P<0,05). Os casos apresentaram maior chance de desenvolver comorbidades associadas à síndrome do intestino irritável (P<0,05). Cerca de 80% dos pacientes com a síndrome do intestino irritável excluíram algum alimento da dieta (P<0,01) e o total de alimentos problemáticos pode variar de 7 a 21 alimentos (P<0,01). Grupo caso apresentou pior qualidade de vida para o escore geral e para todos os domínios avaliados (P<0,05). CONCLUSÃO: Em comparação aos controles, as mulheres portadoras da síndrome do intestino irritável apresentaram maior adiposidade corporal, maior frequência de comorbidades, maior restrição ao consumo de alimentos considerados problemáticos e pior qualidade de vida.


Assuntos
Humanos , Feminino , Síndrome do Intestino Irritável , Qualidade de Vida , Estudos de Casos e Controles , Estado Nutricional , Hábitos
10.
Clin Nutr ESPEN ; 35: 12-19, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31987104

RESUMO

BACKGROUND & AIMS: Cancer is one the principal causes of death, and is considered a health issue worldwide. Cancer patients are at high risk of malnutrition due to the disease and the treatment itself. Nutritional therapy is part of a multi-modal treatment and it is important to be aware of the patient's energy expenditure to aid in decision-making for dietotherapeutic prescription. Indirect Calorimetry (IC) is the gold standard method for measuring energy expenditure (EE); but due to its often high cost in clinical practise, equations that measure energy expenditure are usually used. OBJECTIVES: To perform an integrative systematic review, searching in the literature for how predictive equations of EE behave in relation to IC in cancer patients with solid tumors, considering the overall accuracy for cancer patients, the different tumor types, and the type of anti-cancer therapy applied. METHODS: A review was carried out of systematic integrative type literature. The articles were searched for in three databases (Pubmed, Embase, and Web of Science) using descriptors accompanied by Boolean operators. Inclusion and exclusion criteria were determined, and the articles found went through selection, analysis and extraction of their results. RESULTS: A total of 688 articles were identified that underwent a thorough selection, resulting in 15 studies that included in this review. In five studies, the results showed that predictive equations underestimated the EE of cancer patients; in three studies the EE was overestimated by predictive equations, and in seven studies predictive equations underestimated or overestimated the EE. The low accuracy of predictive EE equations was present regardless of tumor type and type of anti-cancer therapy received by patients. CONCLUSION: The predictive energy expenditure equations available to date are generally not in accordance with IC results for cancer patients with solid tumors, since these individuals present clinical situations or are exposed to factors that alter EE and are not considered in these equations.


Assuntos
Calorimetria Indireta , Metabolismo Energético , Desnutrição/terapia , Neoplasias/terapia , Adulto , Feminino , Humanos , Masculino , Desnutrição/complicações , Neoplasias/complicações , Necessidades Nutricionais
11.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 435-441, Oct.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1041361

RESUMO

ABSTRACT Objective: To determine the prevalence of hepatic steatosis (HS) in children and adolescents with cystic fibrosis (CF) and associate it with nutritional status. Methods: Cross-sectional study with children and adolescents with CF diagnosis. Weight and height were used to calculate the body mass index (BMI) and subsequent classification of the nutritional status. The midarm circumference (MAC), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were used to evaluate body composition. Abdominal ultrasonography was performed for diagnosis of HS. The statistical tests used were Student's t test, Mann-Whitney test and chi-square test with significance level of 5%. Results: 50 patients with CF were evaluated, 18 (36%) were diagnosed with HS (Group A) and 32 (64%) without HS (Group B). The mean age of Group A was 13,2±4,9 years old and Group B 11,7±4,9; for BMI, the value for Group A was 18,0±4,1 and Group B was 15,7±3,8; the TSF of Group A was 8,4±3,5 mm and Group B was 7,0±2,5 mm. For these variables, there was no significant difference between the groups. The mean of MAC and MAMC differed significantly between the groups, being higher in the HS group, with p values of 0,047 and 0,043. Conclusions: The frequency of HS in patients with CF is high and it is not related to malnutrition, according to the parameters of BMI, TSF and MAMC. The values of MAC and MAMC indicated a greater reserve of muscle mass in patients with HS.


RESUMO Objetivo: Determinar a prevalência de esteatose hepática (EH) em crianças e adolescentes com fibrose cística (FC) e associá-la com o estado nutricional. Métodos: Estudo transversal com crianças e adolescentes com diagnóstico de FC. Foram aferidos o peso e a altura para o cálculo do índice de massa corpórea (IMC) e classificação do estado nutricional. A circunferência do braço (CB), a dobra cutânea tricipital (DCT) e a circunferência muscular do braço (CMB) foram empregadas para avaliação da composição corporal. A ultrassonografia abdominal foi realizada para o diagnóstico de EH. Os testes estatísticos empregados foram o teste t de Student, o teste de Mann-Whitney e o teste do qui-quadrado, com nível de significância de 5%. Resultados: Dos 50 pacientes avaliados, 18 (36%) apresentaram EH (Grupo A) e 32 (64%) não (Grupo B). Para as médias de idade (Grupo A: 13,3±5,0 anos; e Grupo B: 11,7±5,0 anos), IMC (Grupo A: 18,0±4,1; e Grupo B: 15,7±3,8) e DCT (Grupo A: 8,4±3,5 mm; e Grupo B: 7,0±2,5 mm), não houve diferença significativa entre os grupos. A média da CB e da CMB diferiram significativamente entre os grupos, sendo mais elevada no grupo com EH, com valores p respectivos de 0,047 e 0,043. Conclusões: É alta a frequência de EH em pacientes com FC e ela não está relacionada com a desnutrição, segundo os parâmetros de IMC, DCT e CMB. Os valores de CB e CMB indicaram maior reserva de massa muscular nos pacientes com EH.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Estado Nutricional , Fibrose Cística/complicações , Desnutrição/complicações , Hepatopatia Gordurosa não Alcoólica/etnologia , Gestão de Riscos , Prevalência , Estudos Transversais , Fibrose Cística/fisiopatologia , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia
12.
Rev Paul Pediatr ; 37(4): 435-441, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31241693

RESUMO

OBJECTIVE: To determine the prevalence of hepatic steatosis (HS) in children and adolescents with cystic fibrosis (CF) and associate it with nutritional status. METHODS: Cross-sectional study with children and adolescents with CF diagnosis. Weight and height were used to calculate the body mass index (BMI) and subsequent classification of the nutritional status. The midarm circumference (MAC), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were used to evaluate body composition. Abdominal ultrasonography was performed for diagnosis of HS. The statistical tests used were Student's t test, Mann-Whitney test and chi-square test with significance level of 5%. RESULTS: 50 patients with CF were evaluated, 18 (36%) were diagnosed with HS (Group A) and 32 (64%) without HS (Group B). The mean age of Group A was 13,2±4,9 years old and Group B 11,7±4,9; for BMI, the value for Group A was 18,0±4,1 and Group B was 15,7±3,8; the TSF of Group A was 8,4±3,5 mm and Group B was 7,0±2,5 mm. For these variables, there was no significant difference between the groups. The mean of MAC and MAMC differed significantly between the groups, being higher in the HS group, with p values of 0,047 and 0,043. CONCLUSIONS: The frequency of HS in patients with CF is high and it is not related to malnutrition, according to the parameters of BMI, TSF and MAMC. The values of MAC and MAMC indicated a greater reserve of muscle mass in patients with HS.


Assuntos
Fibrose Cística/complicações , Desnutrição/complicações , Hepatopatia Gordurosa não Alcoólica/etiologia , Estado Nutricional , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Fibrose Cística/fisiopatologia , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Prevalência , Gestão de Riscos , Adulto Jovem
13.
PLoS One ; 14(2): e0211193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817756

RESUMO

Diabetes mellitus type 2 (DM2) patients have higher risk to be infected with parenterally transmitted viruses, like hepatitis B or C virus. This study aims to determine HBV and HCV infection prevalence in DM2 patients from Northeast and Southeast Brazil. A total of 537 DM2 patients were included, 194 (36.12%) males and 343 (63.87%) females, with mean age of 57.13±11.49 years. HBV and HCV markers were determined using serological and molecular analysis, and risk factors were evaluated in a subgroup from Southeast (n = 84). Two HBV acute (HBsAg+/anti-HBc -) and one HBV chronic case (HBsAg+/anti-HBc+) were found. Six individuals (1.1%) were isolated anti-HBc, 37 (6.9%) had HBV infection resolved (anti-HBc+/anti-HBs+), 40 (7.4%) were considered HBV vaccinated (anti-HBc-/anti-HBs+). Thirteen patients (2.42%) had anti-HCV and 7 of them were HCV RNA+. In the subgroup, anti-HBc positivity was associated to age and anti-HCV positivity was associated to age, time of diabetes diagnosis, total bilirubin, indirect bilirubin, alkaline phosphatase at bivariate analysis, but none of them was statistically significant at multivariate analysis. As conclusion, low prevalence of HBV and high prevalence HCV was found in DM2 patients.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Hepatite B/complicações , Hepatite B/epidemiologia , Hepatite C/complicações , Hepatite C/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
14.
PLoS One ; 14(3): e0214081, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30908521

RESUMO

BACKGROUND: Studies on adults have reported inverse association between the homeostatic model assessment (HOMA) of adiponectin (HOMA-Adiponectin) and the insulin resistance assessed by the glucose clamp technique. To our knowledge, in the pediatric population this association has not been previously investigated. OBJECTIVES: To evaluate the association between the HOMA-Adiponectin and the insulin resistance assessed by the glucose clamp technique in adolescents, and to compare the accuracy of HOMA-Adiponectin and HOMA-insulin resistance (HOMA-IR) for identifying insulin resistance. METHODS: This was a cross-sectional study of 56 adolescents (aged 10-18 years). Insulin resistance was assessed using the HOMA-IR, HOMA-Adiponectin and the hyperglycaemic clamp technique. The clamp-derived insulin sensitivity index, HOMA-Adiponectin, and HOMA-IR were log-transformed to get closer to a normal distribution before analysis. RESULTS: In the multivariable linear regression analysis controlling for sex and Tanner stage, HOMA-Adiponectin was inversely associated with the clamp-derived insulin sensitivity index (unstandardized coefficient [B] = -0.441; P < 0.001). After additional adjustment for waist circumference-to-height ratio, this association remained significant (B = -0.349; P = < 0.001). Similar results were observed when HOMA-IR replaced HOMA-Adiponectin in the model (B = -1.049 and B = -0.968 after additional adjustment for waist circumference-to-height ratio); all P < 0.001. The area under the receiver operating characteristic curve for predicting insulin resistance was 0.712 (P = 0.02) for HOMA-Adiponectin and 0.859 (P < 0.0001) HOMA-IR. CONCLUSIONS: The HOMA-Adiponectin was independently associated with insulin resistance and exhibited a good discriminatory power for predicting it. However, it did not show superiority over HOMA-IR in the diagnostic accuracy.


Assuntos
Adiponectina/sangue , Homeostase , Resistência à Insulina , Modelos Biológicos , Adolescente , Criança , Estudos Transversais , Feminino , Técnica Clamp de Glucose , Humanos , Masculino
15.
Eur J Clin Nutr ; 73(4): 637-641, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30327493

RESUMO

This study investigated the association between fermentable oligo-di-mono-saccharides and polyols (FODMAPs) intake, problematic foods, body adiposity, and gastrointestinal symptoms in 44 women with irritable bowel syndrome (IBS). Around 84% reported to have excluded some food from their diet. Adiposity was not associated with the frequency of gastrointestinal symptoms and IBS severity. Controlling for BMI, there were significant correlations between number of problematic foods versus waist circumference (r = 0.306; p = 0.049) and protein intake (r = -0.378; p = 0.014). The IBS severity correlated to the carbohydrate intake (r = -0.320; p = 0.039). Patients with diarrhea demonstrated statistical tendency to restrict the intake of fat (p = 0.058), free fructose (p = 0.07), and oligosaccharides (p = 0.051). Patients with mucus in the stool had higher lactose intake (p = 0.025). The number of food considered problematic was higher for patients who reported stomach burning (p = 0.0001). Associations among adiposity, gastrointestinal symptoms, problematic food, and FODMAPs were identified and reaffirm the role of individualized nutritional treatment in the management of IBS.


Assuntos
Dieta/efeitos adversos , Ingestão de Alimentos/fisiologia , Gastroenteropatias/complicações , Síndrome do Intestino Irritável/etiologia , Sobrepeso/complicações , Adiposidade , Adulto , Dieta/métodos , Feminino , Fermentação , Humanos , Masculino , Pessoa de Meia-Idade , Oligossacarídeos/análise , Índice de Gravidade de Doença
16.
Obes Surg ; 28(2): 378-388, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28776152

RESUMO

BACKGROUND: This study aims to compare the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 among individuals with Crohn's disease (CD), obese individuals before and after bariatric surgery, and healthy controls. METHODS: This an exploratory cross-sectional study that involved five groups of patients (two groups of individuals with CD-active and inactive), bariatric patients (pre- and post-surgery, who were their own controls), and a distinct separated control group of healthy volunteers. C-reactive protein (CRP) levels and the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 curves were assessed and compared. RESULTS: The pre-RYGB group presented significantly higher levels of CRP than the post-RYGB (p = 0.001) and the control group (p = 0.001). The inactive CD group presented a higher post-prandial GLP-1 area under the curve (AUC) than the pre-RYGB group (p = 0.009). The post-RYGB group presented significantly higher AUCs of GLP-2 than the pre-RYGB group (p < 0.0001), both inactive and active CD groups (p < 0.0001 in both situations), and the control group (p = 0.002). The pre-RYGB group presented a significantly higher AUC of glucose than the post-RYGB (p = 0.02) and both active and inactive CD groups (p = 0.019 and p = 0.046, respectively). The pre-RYGB group presented a significantly higher AUC of insulin than the control (p = 0.005) and both CD groups (p < 0.0001). CONCLUSIONS: Obesity is associated with an inflammatory state comparable to the one observed in CD; inflammation may also be enrolled in the blockade of GLP-2. CD individuals present a more incretin-driven pattern of glucose metabolism, as a way to prevent hypoglycemia and compensate the carbohydrate malabsorption and GLP-2 blockade.


Assuntos
Cirurgia Bariátrica , Glicemia/metabolismo , Doença de Crohn/metabolismo , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Peptídeo 2 Semelhante ao Glucagon/metabolismo , Obesidade Mórbida/metabolismo , Obesidade Mórbida/cirurgia , Adulto , Estudos de Casos e Controles , Doença de Crohn/sangue , Estudos Transversais , Feminino , Teste de Tolerância a Glucose , Humanos , Insulina/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Período Pós-Operatório , Período Pós-Prandial/fisiologia , Período Pré-Operatório , Adulto Jovem
17.
Intest Res ; 15(3): 352-357, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28670232

RESUMO

BACKGROUND/AIMS: Lipopolysaccharide (LPS) is a molecule formed by lipids and polysaccharides and is the major cell wall component of gram-negative bacteria. High LPS levels are known to block CD26 expression by activating Toll-like receptor 4. The aim of this study was to correlate the serum levels of LPS and CD26 in Crohn's disease (CD) patients with serum levels of C-reactive protein (CRP), interleukins, CD activity index, and tumor necrosis factor-α (TNF-α). METHODS: Serum samples were collected from 27 individuals (10 with active CD, 10 with inactive CD, and 7 controls) and the levels of LPS, CD26, TNF-α, interleukin-1ß (IL-1ß), IL-6, IL-17, and CRP were determined by enzyme-linked immunosorbent assay. The levels of LPS and CD26 were then tested for correlation with TNF-α, IL-1ß, IL-6, IL-17, and CRP. RESULTS: Serum levels of LPS were significantly elevated in the active CD group (P=0.003). Levels of IL-1ß (P=0.002), IL-6 (P=0.003), and IL-17 (P<0.001) were lower in the CD groups. Serum TNF-α levels were increased in the active CD group. The CRP levels were elevated in the CD groups when compared to controls (P<0.001). The CD26 levels were lower in the CD groups than in the control group (P<0.001). Among the variables analyzed, there was a correlation between LPS and CRP (r=-0.53, P=0.016) in the CD groups. CONCLUSIONS: Individuals with CD exhibited higher serum levels of LPS varying from a 2- to 6-fold increase depending on disease activity, when compared with healthy controls. CD26 levels were lower in the CD groups. Both LPS and CD26 correlated with disease severity and serve as potential CD biomarkers.

18.
Nutr Hosp ; 34(3): 540-547, 2017 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-28627187

RESUMO

BACKGROUND: Selenium is an essential trace element, but critically ill patients using total parenteral nutrition (PN) do not receive selenium because this mineral is not commonly offered. Threfore, the eval uation of plasma selenium levels is very important for treating or preventing this deficiency. Recent studies have shown that transthyretin may reflect the selenium intake and could be considered a biomarker. However, this issue is still little explored in the literature. OBJECTIVE: This study aims to investigate the correlation of transthyretin with the plasma selenium of critically ill patients receiving PN. METHOD: This was a prospective cohort study with 44 patients using PN without selenium. Blood samples were carried out in 3 stages: initial, 7th and 14th day of PN. In order to evaluate the clinical condition and the inflammatory process, albumin, C-reactive protein (CRP), transthyretin, creatinine and HDL cholesterol levels were observed. To assess the selenium status, plasma selenium and glutathione peroxidase (GPx) in whole blood were measured. Descriptive analyses were performed and the ANOVA, Mann-Whitney and Spearman's coefficient tests were conducted; we assumed a significance level of 5%. RESULTS: A positive correlation of selenium with the GPx levels (r = 0.46; p = 0.03) was identified. During two weeks, there was a positive correlation of transthyretin with plasma selenium (r = 0.71; p = 0.05) regardless of the CRP values. CONCLUSION: Transthyretin may have reflected plasma selenium, mainly because the correlation was verified after the acute phase.


Assuntos
Estado Terminal , Pré-Albumina/metabolismo , Selênio/sangue , Idoso , Estudos de Coortes , Feminino , Glutationa Peroxidase/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Nutrição Parenteral , Estudos Prospectivos
19.
Child Obes ; 12(6): 446-454, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27627113

RESUMO

OBJECTIVE: This study aimed to identify cutoff points for detecting hypertriglyceridemic waist phenotype (HTWP) in adolescents and to investigate the association of the HTWP with insulin resistance (IR) and metabolic syndrome components. METHODS: A multicentric cross-sectional study of 861 adolescents (10-19 years of age, 504 girls) was conducted. Pubertal stage, anthropometric, and laboratory parameters were assessed. IR was assessed by Homeostasis Model Assessment for Insulin Resistance (HOMA1-IR) index and hyperglycemic clamp (n = 80). HTWP was defined by the presence of increased plasma triglycerides (TGs) and increased waist circumference (WC) according to cutoff points obtained in ROC curve analysis given the HOMA1-IR index as a reference method. RESULTS: Cutoffs for WC and TGs, with a higher sum of sensitivity (S) and specificity (E), were, respectively: >84 cm (S:65.1%, E:71.9%) and >87 mg/dL (S:65.1%, E:73.4%) in pubertal girls; >88.5 cm (S:80.2%, E:60.2%) and >78 mg/dL (S:60.5%, E:53.2%) in postpubertal girls; >94 cm (S:73.1%, E:83.1%) and >79 mg/dL (S:61.5%, E:60.2%) in pubertal boys; and >99 cm (S:81.3%, E:78.7%) and >86 mg/dL in postpubertal boys (S:68.1%, E:60.7%). HTWP frequency was 27.5%. In the phenotype presence, after adjustment for age and pubertal stage, blood pressure and fasting glucose levels were elevated and high-density lipoprotein cholesterol was lower (p < 0.001). Adolescents with the HTWP showed more IR, evaluated both by the HOMA1-IR and by the clamp test (p < 0.003). CONCLUSION: The findings suggest HTWP as an IR status in adolescents. Cutoff point standardization for gender and pubertal stage, combined with the ease of application of the method, may allow their use for screening adolescents who would most benefit from lifestyle changes.


Assuntos
Cintura Hipertrigliceridêmica , Resistência à Insulina/fisiologia , Adolescente , Pressão Sanguínea , Brasil/epidemiologia , Criança , Estudos Transversais , Feminino , Teste de Tolerância a Glucose , Humanos , Cintura Hipertrigliceridêmica/sangue , Cintura Hipertrigliceridêmica/epidemiologia , Masculino , Obesidade Infantil/sangue , Obesidade Infantil/epidemiologia , Fenótipo , Puberdade/fisiologia , Fatores de Risco
20.
PLoS One ; 11(8): e0158751, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27490249

RESUMO

BACKGROUND: The major adverse consequences of obesity are associated with the development of insulin resistance (IR) and adiposopathy. The Homeostasis Model Assessment-Adiponectin (HOMA-AD) was proposed as a modified version of the HOMA1-IR, which incorporates adiponectin in the denominator of the index. OBJECTIVES: To evaluate the performance of the HOMA-AD index compared with the HOMA1-IR index as a surrogate marker of IR in women, and to establish the cutoff value of the HOMA-AD. SUBJECTS/METHODS: The Brazilian Metabolic Syndrome Study (BRAMS) is a cross-sectional multicenter survey. The data from 1,061 subjects met the desired criteria: 18-65 years old, BMI: 18.5-49.9 Kg/m² and without diabetes. The IR was assessed by the indexes HOMA1-IR and HOMA-AD (total sample) and by the hyperglycemic clamp (n = 49). Metabolic syndrome was defined using the IDF criteria. RESULTS: For the IR assessed by the clamp, the HOMA-AD demonstrated a stronger coefficient of correlation (r = -0.64) compared with the HOMA1-IR (r = -0.56); p < 0.0001. In the ROC analysis, compared with the HOMA1-IR, the HOMA-AD showed higher values of the AUC for the identification of IR based on the clamp test (AUC: 0.844 vs. AUC: 0.804) and on the metabolic syndrome (AUC: 0.703 vs. AUC: 0.689), respectively; p < 0.001 for all. However, the pairwise comparison did not show evidence of superiority for the HOMA-AD in comparison with the HOMA1-IR in the diagnosis of IR and metabolic syndrome (p > 0.05). The optimal cutoff identified for the HOMA-AD for the diagnosis of IR was 0.95. CONCLUSIONS: The HOMA-AD index was demonstrated to be a useful surrogate marker for detecting IR among adult women and presented a similar performance compared with the HOMA1-IR index. These results may assist physicians and researchers in determining which method to use to evaluate IR in light of the available facilities.


Assuntos
Adiponectina/metabolismo , Resistência à Insulina , Síndrome Metabólica/patologia , Adulto , Antropometria , Área Sob a Curva , Composição Corporal , Índice de Massa Corporal , Brasil , Colesterol/sangue , HDL-Colesterol/sangue , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Curva ROC , gama-Glutamiltransferase/sangue
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