Systemic hypertension, diabetes mellitus, and dyslipidemia in relation to body mass index: evaluation of a Brazilian population

Associations between dietary copper intake and hypertriglyceridemia among children and adolescents in the US

BACKGROUND AND AIMS

A relationship exists between dietary copper intake and hypertriglyceridemia in the United States (US). However, children and adolescents have there is limited research data for children and adolescents, who have not been thoroughly investigated. This study aimed to carefully evaluate this relationship.

METHODS AND RESULTS

This cross-sectional study included 3982 children and adolescents who participated in the US National Health and Nutrition Examination Survey 1999-2006. The outcome variable was hypertriglyceridemia, defined as a triglyceride (TG) concentration >150 mg/dL. Multivariate and binary logistic regression models were applied in this study. The median (Q1-Q3) copper intake and TG levels were 0.98 (0.71-1.32) mg/d and 72.00 (53.00-100.00) mg/dL, respectively. The smoothing curve showed an inverted L-shaped relationship between copper intake and the prevalence of hypertriglyceridemia in American children and adolescents. A binary logistic regression model was developed to evaluate the relationship between copper intake and the prevalence of hypertriglyceridemia, and the inflection point was 0.76 mg/d. The odds of developing hypertriglyceridemia significantly increased with increasing levels of copper intake (odds ratio (OR), 2.00; 95% confidence interval (CI): 1.39-2.86) in participants with copper intake >0.76 mg/d (P for log likelihood ratio test = 0.032). The association between high copper intake and increased hypertriglyceridemia risk was significantly stronger in participants with a high body mass index (BMI; ≥23 kg/m²) (OR: 2.09; 95% CI: 1.42-3.07) than in those with a low BMI (tertile 1-2) (p for interaction = 0.048). Moreover, the increase in copper intake in adolescents aged 13-18 years significantly increased the prevalence of hypertriglyceridemia (OR: 1.95; 95% CI: 1.38-2.76; p for interaction = 0.001).

CONCLUSION

Higher dietary copper intake increases the prevalence of hypertriglyceridemia, especially among US adolescents with a BMI ≥23 kg/m².

Evaluation of Dyslipidaemia Using an Algorithm of Lipid Profile Measures among Newly Diagnosed Type II Diabetes Mellitus Patients: A Cross-Sectional Study at Dormaa Presbyterian Hospital, Ghana

Background and Objectives: Dyslipidaemia and its associated complications have been reported to increase mortality among type 2 diabetes mellitus (T2DM) patients. However, there is a dearth of data on the incidence of dyslipidemia among Ghanaian patients with T2DM. This study evaluated dyslipidemia among newly diagnosed T2DM patients at Dormaa Presbyterian Hospital, Ghana. Materials and Methods: This cross-sectional study recruited a total of 215 participants at the Presbyterian Hospital, Dormaa-Ghana. A well-structured questionnaire was administered to collect demographic data. Predisposing factors of dyslipidemia such as BMI, hypertension, and family history of diabetes were also obtained. Lipid profile was performed on the serum obtained from each respondent. Dyslipidaemia was defined as total cholesterol (TC) >200 mg/dL, triglyceride (TG) >150 mg/dL, low density lipoprotein cholesterol (LDL-c) >100 mg/dL, and high-density lipoprotein cholesterol (HDL-c) <40 in males and <50 mg/dL in females. Combinations of the individual parameters of dyslipidaemia were further evaluated. Results: Of the total (215) participants, 86 (40%) were males and 129 (60%) were females, representing a ratio of 1:1.5. High total cholesterol was more prevalent in females (69.0%) than males (53.5%). Generally, dyslipidaemia was predominant among those aged >40 years, with the exception of increased LDL-c (25.1%), which was higher among the 20–40 years age group. The male participants exhibited significantly (p < 0.001) higher percentages of all combined measures of dyslipidaemia—such as high TG and reduced HDL-c (77.9%), high TG and elevated LDL-c (75.6%) and high LDL and low HDL (65.1%). BMI was significantly associated with HDL levels (p = 0.02), whereas family history of diabetes was associated with TC (p = 0.004) and TG levels (p = 0.019). Conclusion: Combined dyslipidaemia is relatively high among newly diagnosed T2DM patients in Ghana, and in those >40 years. Gender is significantly associated with combined dyslipidaemia in T2DM, and males may be at a higher risk than females. BMI and family history of diabetes are potential risk factors of dyslipidaemia in T2DM.

Waist-to-height ratio and the conicity index are associated to cardiometabolic risk factors in the elderly population

The purpose of this study was to determine and compare a magnitude of the association between anthropometric indicators with risk of cardiometabolic risk in the elderly. This is a cross-sectional study with 402 elderly people attended by the Family Health Strategy in the city of Viçosa-MG. Risk factors for excess body fat, hypertension, blood glucose and serum lipid changes. An association between conicity index (CI) and waist-to-height ratio (WtHR) with cardiometabolic risk factors was assessed by multiple linear regression analysis. Sample was composed of 60.4% of women and 36.3% of overweight elderly. The connectivity index and a waist-to-height ratio were higher in 57.2% and 88.1% in the elderly, respectively. The results showed that the increase in body fat, diastolic blood pressure, triglycerides, glycemia and reduction of HDL-cholesterol are related to higher values of anthropometric indices evaluated. However, the waist-to-height ratio presented a greater magnitude of association with the cardiometabolic risk factors than the connectivity index.

Breastfeeding and Maternal Hypertension

BACKGROUND

Little is known about the relationship between breastfeeding and hypertension. We performed this study to identify whether breastfeeding itself influenced maternal hypertension and whether degree of obesity or insulin sensitivity would contribute to the relationship between breastfeeding and hypertension in postmenopausal women.

METHODS

Our study population comprised 3,119 nonsmoking postmenopausal women aged 50 years or above in the 2010-2011 Korea National Health and Nutrition Examination Survey. We performed logistic regression analyses to examine the relationship between breastfeeding and hypertension and mediation analyses to examine the contributions of obesity and insulin sensitivity to the breastfeeding-hypertension relationship.

RESULTS

The odds ratios, with 95% confidence intervals, for hypertension among the highest quintile of number of breastfed children (5-11) and the highest quintile of duration of breastfeeding (96-324 months) were 0.49 (0.31-0.75) and 0.55 (0.37-0.82), respectively, compared to each of lowest quintile groups. The population attributable fractions of hypertension caused by breastfeeding 3 or fewer children and breastfeeding for 56 months or less were 10.2% (P < 0.001) and 6.5% (P = 0.017), respectively. In the mediation analysis, unexpectedly, increased insulin resistance significantly attenuated the protective effect on hypertension of having breastfed more children; additionally, greater obesity and insulin resistance significantly attenuated the protective effects on hypertension of having breastfed for longer.

CONCLUSIONS

More children breastfed and longer duration of breastfeeding were associated with lower risk of hypertension in postmenopausal women, and degree of obesity and insulin resistance moderated the breastfeeding-hypertension association.

Association of sleep quality with excessive daytime somnolence and quality of life of elderlies of community

Background

The progressive increase in the elderly population contributes to the fact that studies on human aging have important attention of health professionals and government agents, since they present a great challenge regarding public health. Our objective is to characterize the profile of older people with poor sleep quality and analyze possible associations with excessive daytime somnolence, quality of life and functional mobility.

Methods

This is a cross-sectional descriptive study, involving elderlies of the community, with the questionnaires Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, WHOQOL-OLD and application of the Timed Up and Go test - TUG. Descriptive statistics, Student’s t test for paired samples and Pearson’s correlation coefficient (p ≤ 0.05) were used.

Results

We recruited 131 elderly people, predominantly female (87%); mean age 68 ± 7 years, low per capita income (84.8% ≤ 2 minimum wage), low education (86.3% ≤ 3 years of study), and mostly staying with relatives (67.9%), married (39.7%) or amassed (35.9%). Seventy-one percent of the sample is above normal weight, 90.1% of women have an abdominal circumference ≥ 80 cm and a high prevalence of chronic and psychosocial diseases was identified in the self-report, and the risk of obstructive sleep apnea in 38.2%. The mean PSQI, Epworth Sleepiness Scale, WHOQOL-OLD and TUG were equal to, respectively, 11.2 ± 3.2; 8.32 ± 2.2; 84.8 ± 10.2 and 8.97 ± 2. An association of sleep quality with excessive daytime somnolence and quality of life, while not with functional mobility, was observed.

Conclusion

The results of the present study allowed to identify a sleep quality associated with excessive daytime somnolence and quality of life and also to characterize the profile of elders with poor sleep quality.

Social jetlag and metabolic control in non-communicable chronic diseases: a study addressing different obesity statuses

Social jetlag – a measure of disruption of the circadian system – has been linked to obesity, but its association with metabolic complications in non-communicable chronic diseases (NCCDs) is unknown in the literature. We examined the associations between social jetlag and obesity status and metabolic parameters among individuals with NCCDs. Patients (n = 792) with NCCDs (obesity, systemic arterial hypertension, type 2 diabetes mellitus or dyslipidaemia) attended clinics of the public health service of the city of Uberlândia, Minas Gerais State, Brazil. They were classified in three obesity statuses: non-obese: BMI < 30 kg/m²; metabolically healthy obese (MHO): BMI ≥ 30 kg/m² and less than three high-risk biomarkers for metabolic syndrome; and metabolically unhealthy obese (MUO): BMI ≥ 30 kg/m² and with high-risk values on three or more biomarkers for metabolic syndrome. After adjustments for confounding variables, social jetlag was positively associated with fasting glucose levels among all subjects (β = 0.08, p = 0.03) and MUO subjects (β = 0.32, p < 0.001). Patients with social jetlag (>1 h) presented a significant odds ratio (OR) of being overweight (OR = 2.0, confidence interval (CI) = 1.2–3.6, p = 0.006) and MUO (OR = 1.8, CI = 1.1–2.8, p = 0.01). These results suggest that social jetlag is associated with a higher risk of overweight and related metabolic complications in individuals with NCCDs.

Age at First Childbirth and Hypertension in Postmenopausal Women

Whether age at first childbirth has an effect on hypertension incidence is unclear. The objectives of this study were to examine the relationship between age at first childbirth and hypertension and to examine whether degree of obesity, measured as body mass index, mediates age at first childbirth-related hypertension in postmenopausal women. This study analyzed 4779 postmenopausal women data from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Logistic regression analyses were used to investigate relationship between age at first childbirth and hypertension. Mediation analysis was performed to examine the contribution of body mass index to age at first childbirth-related hypertension. Mean of participants’ age at first childbirth and current age were 23.8 and 63.4 years, respectively. The prevalence of hypertension was 51.1%. Age at first childbirth was significantly associated with the prevalence of hypertension (odds ratio, 0.963; 95% confidence interval, 0.930–0.998; P =0.036). Women with age at first childbirth ≤19 years had significantly higher risk of hypertension (odds ratio, 1.61; 95% confidence interval, 1.17–2.23; P =0.004) compared with those >19 years. Multivariable-adjusted prevalence of hypertension was significantly lower in women who delivered the first infant at 20 to 24 (45.5%), 25 to 29 (46.1%), and ≥30 (39.9%) years compared with those at ≤19 years (58.4%). Body mass index completely mediated age at first childbirth–hypertension relationship (indirect effect: odds ratio, 0.992; 95% confidence interval, 0.987–0.998; P =0.008). Age at first childbirth was significantly associated with hypertension in postmenopausal women. Body mass index mediated the effects of age at first childbirth on hypertension.

Correlation between anthropometry and lipid profile in healthy subjects of Eastern India

BACKGROUND

Cardiovascular diseases constitute one class of common contributors to morbidity and mortality worldwide. Prevalence of overweight and obesity has dramatically increased in developing countries and is related to cardiovascular risk factors. Anthropometric parameters have the advantages in daily clinical practice of being a simple to measure tool with good reproducibility, especially in a developing country like India. Aim of this study is to correlate some anthropometric variables with lipid parameters in healthy subjects and to assess the anthropometric variable which best reflects the altered lipid profile.

MATERIALS AND METHODS

A hospital based cross-sectional study was conducted after the Institutional Ethical Committee Clearance. Included participants (1187) were subjected to anthropometric measurements such as height, weight, waist circumference (WC), and hip circumference using standard procedures on the same morning of the day, as the blood sample was collected after overnight fast and estimated for fasting blood sugar and lipid profile.

RESULTS

There is a weak correlation between body mass index (BMI) and lipid parameters. Among all the anthropometric variables studied, WC is best correlated to lipid parameters. The mean values of lipid parameters were not significantly different in BMI <25 and BMI ≥25 groups.

CONCLUSIONS

WC remains one of the simple and reliable variables which best reflects the lipid profile. In a developing country like India, where measurement of cardiovascular risk factors such as body fat saturation and lipid profile remains difficult in the rural population, WC may be used as an effective tool, without being used as a substitute.

Comparação do estado nutricional de meninas de acordo com diferentes referências para índice de massa corporal

Objetivos: comparar o estado nutricional de meninas de nove a 17 anos na cidade de Cascavel (PR) segundo três referências para índice de massa corporal (IMC). Métodos: estudo transversal com 2759 meninas. Verificou-se o peso e a estatura obtendo-se o IMC além da avaliação da maturidade sexual e do nível socioeconômico. O estado nutricional foi classificado pelos pontos de corte do IMC propostos por Conde e Monteiro, WHO, e CDC. Resultados: as frequências dos estados nutricionais não diferiram significativamente na mesma referência para IMC por faixa etária, por nível socioeconômico e por tipo de escola. Por nível de maturidade sexual, apenas a referência da WHO apresentou valores de obesidade e sobrepeso maiores para o estadio de mamas grau 5. No entanto, quando comparadas as três referências entre si, o CDC apresentou frequências significativamente menores de sobrepeso e obesidade por faixa etária, por nível de maturidade sexual, por nível socioeconômico e por tipo de escola. Apesar das três referências apresentarem concordância entre si, esta foi maior entre os de Conde e Monteiro, e da WHO. Conclusões: a referência do CDC identificou menor percentual de meninas com sobrepeso e obesidade. As referências propostas por Conde e Monteiro e WHO apresentaram resultados semelhantes.

High Postprandial Triglycerides Serum Levels: Is Obesity a Good Predictor?

The aim of this study was to analyze the correlation between triglyceride (TG) serum levels in obese and non-obese patients in a simulated postprandial state. Both groups showed TG levels < 150 mg/dL when fasting. After 12 h fasting, the subjects ingested a lipid overload diet and blood samples were collected. The variation between fasting and the postprandial TG peak levels were analyzed. The peak of postprandial TG levels occurred 4 h after the lipid overload in both groups. When the subjects were not fasting, the majority of non-obese subjects remained within the range of normal TG values, but the values for the obese group remained elevated. There was a significant correlation between Body Mass Index (BMI) and TG at each time point until 2 h after the meal, but the data did not show a correlation after 3 h. According to the receiver-operating characteristics (ROC) curve, postprandial TG values were not a good predictor of obesity (based on BMI), but they were a predictor of non-obesity. This study reinforces the importance of measuring non-fasting TG levels in obese and non-obese subjects, because some non-obese patients probably had altered fat metabolism, indicating that this examination could be an indicator of metabolic risk.

Pregnancy-induced hypertension syndrome and cardiovascular risk

Objective: to analyze the changes in life expectancy (LE) and disability-free life expectancy (DFLE) in São Paulo's elderly population to assess the occurrence of compression or expansion of morbidity, between 2000 and 2010. Methods: cross-sectional and population survey, based on official data for the city of São Paulo, Brazil, and data obtained from the Health, Well-Being and Aging Survey (SABE). Functional disability was defined as difficulty in performing at least one basic activity of daily living. The Sullivan method was used to calculate LE and DFLE for the years 2000 to 2010. Results: from 2000 to 2010, there was an increase in disabled life expectancy (DLE) in all age groups and both sexes. The proportion of years of life free of disability, at 60 years of age, decreased from 57.94% to 46.23% in women, and from 75.34% to 63.65% in men. At 75 years of age, this ratio decreased from 47.55% to 34.54% in women, and from 61.31% to 56.01% in men. Conclusion: the expansion of morbidity is an ongoing process in the elderly population of the municipality of São Paulo, in the period 2000-2010. These results can contribute to the development of preventive strategies and planning of adequate health services to future generations of seniors.

Efeito do exercício físico sobre a leptinemia e percentual de gordura de adultos

INTRODUÇÃO/OBJETIVO: O presente estudo se propôs a verificar a influência do exercício físico aeróbio associado aos exercícios de resistência sobre os níveis séricos de leptina e percentual de gordura corporal de adultos com sobrepeso ou obesidade.MÉTODOS: O grupo de estudos foi composto por 15 pessoas, cinco homens e 10 mulheres, com média de idade de 52 anos, com sobrepeso ou obesidade de acordo com critérios da Organização Mundial de Saúde. O programa de exercícios físicos foi realizado três vezes na semana, durante 14 semanas. Era constituído de alongamento, 30 minutos de exercício aeróbio de intensidade moderada e exercícios de resistência muscular localizada. Os dados obtidos foram analisados por meio de estatística descritiva e teste "t" de Student, adotando-se um nível de significância de 5%.RESULTADOS: Os resultados demonstraram redução no peso corpóreo, índice de massa corporal (IMC) e leptinemia em resposta às atividades físicas, porém somente a redução na leptinemia foi significativa (p<0,05).CONCLUSÃO: O protocolo de exercícios adotado foi eficaz na redução dos níveis séricos de leptina em adultos com sobrepeso ou obesidade. Acredita-se que um maior tempo de intervenção com exercícios físicos traga melhores resultados sobre a composição corporal e normalização da leptinemia sérica.

Effect of menopause on cardiovascular disease and its risk factors: a 9-year follow-up study

OBJECTIVES

To explore the cardiovascular risk attributable to menopausal status in a 9-year follow-up, population-based study.

METHOD

All middle-aged women who met our eligibility criteria were selected from the Tehran Lipid and Glucose Study cohort. Data were collected by face-to-face interviews, physical examination and biochemical assessments at 3-year intervals. The World Health Organization classification was used to define menopausal status. Cardiovascular events that occurred in the cohort were investigated by a panel of medical specialists.

RESULTS

Based on menopausal status, there were no significant differences in cardiovascular disease after adjustment for age, body mass index and other confounders; however, significant relationships between serum concentrations of low density cholesterol and total cholesterol and menopausal status were observed.

CONCLUSIONS

Menopause, independent of other cardiovascular disease risk factors, incurred cardiometabolic risk.

Alternativas para um produto cárneo mais saudável: uma revisão

Considerando-se a evidente busca por alimentos de rápido e fácil preparo, as comunidades industrial e científica vêm investindo no desenvolvimento de novos produtos que, além de atenderem a essa demanda, possam oferecer benefícios à saúde do consumidor. Dentre os alimentos que não demandam muito tempo para o preparo no domicílio, o hambúrguer merece destaque, em função do seu elevado consumo. No entanto, em razão de conter gordura saturada e por ser submetido a processo de fritura, o consumo demasiado desse produto pode ser prejudicial à saúde humana, podendo causar doenças crônicas, entre as quais, a obesidade e a hipertensão. Estudos têm demonstrado a possibilidade de substituição de ingredientes na formulação de hambúrgueres, com a intenção de incorporar substâncias com propriedades funcionais; portanto, substâncias que possam contribuir para a saúde e o bem-estar dos consumidores. Nesse contexto, esta revisão aborda questões referentes ao hambúrguer, no sentido de conceituar o produto e, à luz da literatura, oferecer alternativas possíveis e que têm sido estudadas para tornar esse alimento mais saudável, com foco na substituição de gordura animal por fibras e na redução do teor de cloreto de sódio.

[Lipid and glucose profiles in outpatients and their correlation with anthropometric indices]

INTRODUCTION AND OBJECTIVE

Obesity is associated with high rates of dyslipidemia and glucose intolerance. The objective of this study was to evaluate the correlation of anthropometric indices with the lipid and glucose profiles of outpatients.

METHODS

We performed a cross-sectional study assessing anthropometric and metabolic parameters in a sample of 550 individuals.

RESULTS

The prevalence of overweight exceeded 80%, with no difference between the sexes. However, 80.9% of women vs. 52.1% of men had waist circumference in the very high risk range (P=000). Glucose and lipid abnormalities were found in over 40% of the sample. In men, no correlation was found between anthropometric indices and metabolic profile. In women, HDL cholesterol was negatively correlated with body mass index waist circumference and waist-to-height ratio. Triglycerides were positively correlated with body mass index, waist circumference and waist-to-height ratio and fasting plasma glucose with waist circumference and waist-to-height ratio. After adjustment for age and nutritional status, the correlations only remained significant between HDL cholesterol and anthropometric indices.

CONCLUSIONS

Among women, the anthropometric indices waist circumference, waist-to-height ratio and body mass index proved good predictors of HDL cholesterol, showing the importance of using these parameters in clinical practice and for screening of cardiovascular risk.

Pressão arterial elevada e obesidade abdominal em adolescentes

OBJETIVO: Analisar a associação entre obesidade abdominal e pressão arterial elevada em adolescentes da rede pública de ensino da região metropolitana da cidade de Londrina (PR). MÉTODOS: Constituiu-se uma amostra de 656 adolescentes com idades entre dez e 13 anos. Foram realizadas análises antropométricas de massa corporal, estatura e circunferência de cintura, além da aferição da pressão arterial de repouso. Para análise e comparação dos dados, foram aplicados Mann-Whitney e o teste t de Student. Também foram analisadas as possíveis associações entre pressão arterial e circunferência de cintura por meio do teste do qui-quadrado. RESULTADOS: Foram identificadas associações entre obesidade abdominal e pressão arterial elevada em ambos os sexos (RP 2,7; IC95% 1,8-4,2). Além disso, verificou-se que, independentemente do grupo etário, a obesidade abdominal associa-se com valores mais elevados de pressão arterial. CONCLUSÕES: A obesidade abdominal está associada à ocorrência de aumento da pressão arterial em adolescentes.

Prevalência e determinantes de obesidade e sobrepeso em mulheres em idade reprodutiva residentes na região semiárida do Brasil

O estudo estimou a prevalência e identificou fatores determinantes do sobrepeso e obesidade em mulheres em idade fértil na região semiárida do Brasil. Na amostra por conglomerados de oito mil domicílios do estado do Ceará, foram pesquisadas 6.845 mulheres. Sobrepeso e obesidade foram medidos pelo Índice de Massa Corporal, utilizando-se a análise multivariada para a identificação dos fatores determinantes. As prevalências de sobrepeso e obesidade foram de 32,6% e 16,1%, respectivamente. Na análise ajustada, a obesidade esteve positivamente associada a: idade >30 anos (RP=1,55), estado civil casada (RP=1,36), escolaridade fundamental (RP=1,40), idade na menarca <12 anos (RP=1,59), ter tido >1 filho (RP=1,65), uso de contraceptivos (RP=1,31). Os fatores relacionados à saúde e à nutrição, referentes à obesidade mórbida, foram: hipertensão arterial (RP=3,11), diabetes (RP=2,08), insatisfação com a imagem corporal (RP=4,26) e procedimentos para perder peso (RP=2,73). Sobrepeso e obesidade são altamente prevalentes na região semiárida. A educação foi o único fator socioeconômico passível de ser modificado. Os fatores reprodutivos identificados apontam para a necessidade de mobilização dos serviços de pré-natal, pós-parto e planejamento familiar na prevenção e no controle da obesidade.

Avaliação antropométrica e bioquímica em pacientes com esquizofrenia usuários de clozapina

OBJETIVO: Avaliar a proporção de sobrepeso/obesidade e alterações em parâmetros bioquímicos sangüíneos em pacientes com esquizofrenia do sexo masculino, usuários de medicação antipsicótica (clozapina). MÉTODOS: Estudo transversal com 40 pacientes do sexo masculino, diagnosticados com esquizofrenia, em uso de clozapina, atendidos no Hospital de Clínicas de Porto Alegre. Foram verificadas as relações entre o índice de massa corporal, a circunferência abdominal, o percentual de gordura corporal, o perfil lipídico e o exame de glicose de jejum e a dosagem da medicação, o acompanhamento dietoterápico e a monoterapia de clozapina. RESULTADOS: Os pacientes apresentaram freqüências de 71,8% de sobrepeso/obesidade, 76,9% de circunferência abdominal aumentada e 94,1% de percentual de gordura elevada. Foram encontrados 56,8% de pacientes com lipoproteína de baixa densidade-colesterol acima do normal e 64,1% com triglicerídeos elevados. Quanto maior a dosagem de clozapina utilizada maiores foram os níveis de lipoproteína de baixa densidade-colesterol (p=0,01). CONCLUSÃO: Pacientes tratados com clozapina apresentam aumento de peso e significante anormalidade lipídica, necessitando de monitoramento freqüente dos níveis plasmáticos e intervenção nutricional precoce, visando à otimização do tratamento.

A randomized double-blind placebo-controlled study of the long-term efficacy and safety of diethylpropion in the treatment of obese subjects

OBJECTIVE

To evaluate the efficacy of diethylpropion on a long-term basis, with emphasis in cardiovascular and psychiatric safety aspects.

DESIGN

Randomized, double-blind, placebo-controlled trial.

MEASUREMENTS

Following a 2-week screening period, 69 obese healthy adults received a hypocaloric diet and were randomized to diethylpropion 50 mg BID (n=37) or placebo (n=32) for 6 months. After this period, all participants received diethylpropion in an open-label extension for an additional 6 months. The primary outcome was percentage change in body weight. Electrocardiogram (ECG), echocardiography and clinical chemistry were performed at baseline and every 6 months. Psychiatric evaluation and application of Hamilton rating scales for depression and anxiety were also performed by experienced psychiatrists at baseline and every 3 months.

RESULTS

After 6 months, the diethylpropion group lost an average of 9.8% (s.d. 6.9%) of initial body weight vs 3.2% (3.7%) in the placebo group (P<0.0001). From baseline to month 12, the mean weight loss produced by diethylpropion was 10.6% (8.3%). Participants in the placebo group who were switched to diethylpropion after 6 months lost an average of 7.0% (7.7%) of initial body weight. The difference between groups at month 12 was not significant (P=0.07). No differences in blood pressure, pulse rate, ECG and psychiatric evaluation were observed. Dry mouth and insomnia were the most frequent adverse events.

CONCLUSION

Diethylpropion plus diet produced sustained and clinically significant weight loss over 1 year. It seems to be safe in relation to cardiovascular and psychiatric aspects in a well-selected population.

Aspectos funcionais das catequinas do chá verde no metabolismo celular e sua relação com a redução da gordura corporal

O chá é uma bebida amplamente utilizada, perdendo apenas para a água como a bebida mais consumida no mundo. O chá verde é rico em polifenóis, principalmente catequinas. Entre uma variedade de efeitos benéficos à saúde atribuídos ao consumo do chá verde, grande atenção tem sido focalizada no seu efeito na redução da gordura corporal. Este estudo tem como objetivo apresentar uma descrição dos estudos com o chá verde e/ou seus compostos bioativos relacionados à biologia celular, estudos experimentais e epidemiológicos associados ao metabolismo lipídico e à redução da gordura corporal. Galato de epigalocatequina é o principal composto bioativo presente no chá verde e seus efeitos anti-obesidade estão sendo investigados. Tais efeitos estão associados a diversos mecanismos bioquímicos e fisiológicos, dentre eles podem-se destacar a estimulação do metabolismo lipídico pela combinação da ingestão de catequinas e a prática de exercícios físicos regulares. Apesar do efeito promissor do chá verde e seus compostos bioativos no tratamento da obesidade, estudos clínicos controlados devem ser conduzidos. Finalmente, um plano alimentar adequado associado à prática regular de atividade física constitui a principal ferramenta para a prevenção da obesidade e de suas comorbidades.

Metabolic syndrome and insulin resistance significantly correlate with body mass index

BACKGROUND

Metabolic syndrome (MetS) is a cluster of metabolic risk factors for cardiovascular disease. This study aimed to compare the prevalence of MetS and its components in different degrees of obesity in Iranian subjects.

METHODS

A total of 2309 adults were divided into four groups according to their body mass index (BMI): 1511 subjects were non-obese (BMI <30 kg/m(2)); 535 were moderately obese (BMI > or =30-<35); 176 were severely obese (BMI > or =35-<40) and 87 were morbidly obese (BMI > or =40). Fasting blood samples were obtained and plasma glucose, lipids, insulin and HbA1c were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The prevalence of MetS, according to the definitions of the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (ATPIII), was compared across increasing grades of BMI.

RESULTS

Prevalence of MetS gradually rose with increasing grades of obesity (p<0.001), from 31.9% in the non-obese to 69.0% in the morbidly obese according to the IDF criteria and from 31.2% to 62.1% according to the ATPIII criteria. After controlling for age and sex, one grade increase in the BMI category was associated with 2.5-3 times higher risk of MetS depending on the definition used. In addition, HOMA-IR was significantly correlated with BMI in all subjects (r=0.343, p<0.001) and in moderately (r=0.184, p<0.01), severely (r=0.147, p<0.01) and morbidly (r=0.101, p<0.05) obese participants separately.

CONCLUSIONS

MetS and its components, including high blood pressure, central obesity, hyperglycemia, IR, hypertriglyceridemia and low high-density lipoprotein-cholesterol increase in parallel with increasing obesity grades.

Avaliação nutricional e prevalência de doenças crônicas não transmissíveis em idosos pertencentes a um programa assistencial

Objetivou-se avaliar o estado nutricional e a prevalência de doenças crônicas não transmissíveis em idosos que participavam de um programa assistencial da Universidade Federal de Alfenas (UNIFAL-MG), Alfenas, MG, Brasil. Foram coletadas variáveis socioeconômicas, antropométricas, bioquímicas e pressão arterial sistêmica de 82 indivíduos de 60 a 87 anos, sendo 90,2% do sexo feminino. Encontrou-se 52,4% de sobrepeso, 28,0% de eutrofia e 19,5% de baixo peso pelo IMC e 37,8% apresentaram percentual de gordura corpórea (%GC) elevada. Relacionando-se Índice de Massa Corpórea (IMC) com %GC, 63,4% dos idosos com sobrepeso, 12,5% dos eutróficos e 11,8% dos com baixo peso apresentavam %GC elevado. A razão da circunferência da cintura e do quadril (RCQ) revelou 40,2% em risco alto e 12,2% em risco muito alto para o desenvolvimento de doenças cardiovasculares. Quanto à pressão arterial, 22,0% eram hipertensos. Em relação aos exames bioquímicos, observou-se que 39,3%, 39,3% e 3,3% dos idosos apresentavam valores plasmáticos elevados de colesterol, triglicerídeos e glicose, respectivamente. Programas de educação nutricional continuada e de monitoramento do estado nutricional e de saúde são necessários para melhoria da qualidade de vida destes indivíduos estudados.

[Metabolic profile according to leptin levels in obese patients]

Increased body mass index and waist circumference are related to cardiovascular risk factors. Leptin is an adipocyte-produced hormone and regulates body weight. Leptin is directly related to body fat. To evaluate the relationship between leptin and metabolic profile in obese subjects, we studied 119 patients. Anthropometric, laboratory, body composition (by bioelectrical impedance) and co-morbidity data were collected. The analysis was performed in the female population (86.6%): average age: 42 +/- 13 years; hypertension, type 2 diabetes and grade III obesity were present in 61.9%, 20.2% and 58.3%, respectively. Leptin levels were positively related to insulin resistance (IR). HOMA-IR was related to metabolic abnormalities of IR. No differences were demonstrated between lipid profile, glycemia, body composition and tertiles of leptin corrected by fat weight. A significant difference in HOMA-IR was present when the 2nd and 3rd tertiles of leptin corrected by fat weight [3.4 (2.8-4.1) vs. 5.3 (4.1-6.5), p=0.011] were compared. In conclusion, leptin corrected by fat weight did not influence lipid profile and glycemia in moderate to severe obese women with similar percent body fat. Leptin should not be considered an independent factor affecting lipid metabolism.

Distúrbios metabólicos e adiposidade em uma população rural

O objetivo deste estudo transversal foi investigar a prevalência de sobrepeso e adiposidade central (AC) e suas relações com alterações no metabolismo de lipídeos, glicose e níveis pressóricos em uma amostra de 287 indivíduos adultos residentes em uma comunidade rural do Estado de Minas Gerais. Foram realizadas comparações de médias dos indicadores metabólicos: lipoproteínas, glicose e níveis pressóricos, segundo categorias de sobrepeso e AC, usando análise de variância e teste de Tukey. A prevalência de sobrepeso foi de 24,8% (37,4% no sexo feminino; 11,5% no sexo masculino). A AC esteve presente em 28,1% das pessoas (50,3% no sexo feminino; 4,3% no sexo masculino). Indivíduos com AC apresentaram maiores valores médios de pressão arterial (HA), colesterol total, LDL, triglicérides e glicemia de jejum; e menores valores médios de HDL. Foram verificadas associações entre AC e HA, dislipidemia e hiperglicemia. Associações significativas entre sobrepeso e HA, dislipidemia e hiperglicemia também foram evidenciadas. Esses resultados confirmam o potencial efeito das alterações na composição corporal, principalmente em nível central, sobre o metabolismo lipídico e de glicose, e também sobre o aumento dos níveis pressóricos em populações da área rural.

Association of serum concentrations of retinol and carotenoids with overweight in children and adolescents

OBJECTIVE

A study was conducted to verify the association between serum concentrations of retinol and carotenoids with overweight in children and adolescents.

METHODS

In total 471 children (7-9.9 y of age) and adolescents (10-17 y of age), living in a poor region of the city of Rio de Janeiro, Brazil, were assessed. Serum concentrations of retinol and carotenoids were assessed by high-performance liquid chromatography, and cutoffs for inadequacy of retinol and carotenoids were <30 and <40 microg/dL, respectively. Overweight was defined by the sex- and age-specific body mass index cutoffs recommended by World Health Organization. The logistic regression model was used to test the association of overweight, gender, and age range with low serum concentrations of retinol and carotenoids.

RESULTS

Prevalences were 10% for low serum concentration of retinol, 55.8% for carotenoids, and 15.3% for overweight. Retinol inadequacy was significantly higher in adolescents (12.6%) than in children (6.8%). The average of carotenoids was significantly lower in overweight subjects (30.40 +/- 16.74 versus 43.06 +/- 25.26 microg/dL, P = 0.001). Overweight children and adolescents presented a greater chance of a decrease in serum concentrations of carotenoids (odds ratio 2.51, 95% confidence interval 1.43-4.39) when compared with non-overweight subjects.

CONCLUSION

An important prevalence of vitamin A deficiency was found. Overweight children, as much as adolescents, may have a greater chance of presenting low concentrations of carotenoids and, hence, a lower antioxidant defense.

Perfil lipídico de obesos antes e após a derivação gástrica a Fobi-Capella

OBJETIVO: Este estudo analisa de forma retrospectiva o perfil lipídico de pacientes submetidos à derivação gástrica a Fobi-Capella, na Santa Casa de Belo Horizonte de setembro de 1999 a setembro de 2003. MÉTODO: Foram avaliados os protocolos de acompanhamento de 143 pacientes, analisando os valores de colesterol total (CT), colesterol associado à lipoproteína de alta densidade (HDL), colesterol associado à lipoproteína de baixa densidade (LDL), triglicérides (TG) e o índice de massa corporal (IMC) no pré-operatório e um ano após a operação. A presença de dislipidemia foi definida como alteração em pelo menos um dos exames. Foi feita a comparação entre os valores do pré-operatório com os do pós-operatório. RESULTADOS: Os valores séricos médios do CT, HDL, LDL e TG foram de 201,7 mg%, 47,9 mg%, 122,6 mg% e 153,7% respectivamente. Não houve diferença nestes valores quando estratificados pelo IMC. A prevalência de dislipidemia foi de 61,5% no pré-operatório. Após um ano da operação, houve queda de 12,5% no CT, 14,3% no LDL, 29,5% nos TG e aumento de 18,5% no HDL. Ocorreu normalização em 73,9% dos pacientes que apresentavam pelo menos uma das dosagens alterada. CONCLUSÃO: A prevalência da dislipidemia foi elevada nos pacientes submetidos à derivação gástrica a Fobi-Capella. Ocorreu melhora dos parâmetros avaliados do perfil lipídico após um ano da operação.