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Delai A, Gomes PM, Foss-Freitas MC, Elias J, Antonini SR, Castro M, Moreira AC, Mermejo LM. Hyperinsulinemic-Euglycemic Clamp Strengthens the Insulin Resistance in Nonclassical Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2022; 107:e1106-e1116. [PMID: 34693966 DOI: 10.1210/clinem/dgab767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Insulin sensitivity evaluation by hyperinsulinemic-euglycemic clamp in nonclassical congenital adrenal hyperplasia (NC-CAH) due to 21-hydroxilase deficiency. DESIGN AND SETTING Cross-sectional study at university hospital outpatient clinics. PATIENTS AND METHODS NC-CAH patients (25 females, 6 males; 24 ± 10 years) subdivided into C/NC (compound heterozygous for 1 classical and 1 nonclassical allele) and NC/NC (2 nonclassical alleles) genotypes were compared to controls. RESULTS At diagnosis, C/NC patients presented higher basal and adrenocorticotropin-stimulated 17-hydroxyprogesterone and androstenedione levels than NC/NC genotype. Patients and controls presented similar weight, body mass index, abdominal circumference, and total fat body mass. NC-CAH patients showed higher waist-to-hip ratio, lower adiponectin and lower high-density lipoprotein cholesterol levels with no changes in fasting plasma glucose, glycated hemoglobin, homeostatic model assessment for insulin resistance, leptin, interleukin 6, tumor necrosis factor alpha, C-reactive protein, and carotid-intima-media thickness. All patients had used glucocorticoid (mean time of 73 months). Among the 22 patients with successful clamp, 13 were still receiving glucocorticoid-3 patients using cortisone acetate, 9 dexamethasone, and 1 prednisone (hydrocortisone equivalent dose of 5.5mg/m²/day), while 9 patients were off glucocorticoid but had previously used (hydrocortisone equivalent dose of 5.9mg/m2/day). The NC-CAH patients presented lower Mffm than controls (31 ± 20 vs 55 ± 23µmol/min-1/kg-1, P = 0.002). The Mffm values were inversely correlated with the duration of glucocorticoid treatment (r = -0.44, P = 0.04). There was association of insulin resistance and glucocorticoid type but not with androgen levels. CONCLUSION Using the gold standard method, the hyperinsulinemic-euglycemic clamp, insulin resistance was present in NC-CAH patients and related to prolonged use and long-acting glucocorticoid treatment. Glucocorticoid replacement and cardiometabolic risks should be monitored regularly in NC-CAH.
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Affiliation(s)
- Ariane Delai
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Patricia M Gomes
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Jorge Elias
- Departments of Medical Imaging, Hematology, and Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Sonir R Antonini
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Margaret Castro
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ayrton C Moreira
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Livia M Mermejo
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
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Ferraz-Bannitz R, Welendorf CR, Coelho PO, Salgado W, Nonino CB, Beraldo RA, Foss-Freitas MC. Bariatric surgery can acutely modulate ER-stress and inflammation on subcutaneous adipose tissue in non-diabetic patients with obesity. Diabetol Metab Syndr 2021; 13:19. [PMID: 33593418 PMCID: PMC7887793 DOI: 10.1186/s13098-021-00623-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), is the most effective and durable treatment option for severe obesity. The mechanisms involving adipose tissue may be important to explain the effects of surgery. METHODS We aimed to identify the genetic signatures of adipose tissue in patients undergoing RYGB. We evaluated 13 obese, non-diabetic patients (mean age 37 years, 100% women, Body mass index (BMI) 42.2 kg/m2) one day before surgery, 3 and 6 months (M) after RYGB. RESULTS Analysis of gene expression in adipose tissue collected at surgery compared with samples collected at 3 M and 6 M Post-RYGB showed that interleukins [Interleukin 6, Tumor necrosis factor-α (TNF-α), and Monocyte chemoattractant protein-1(MCP1)] and endoplasmic reticulum stress (ERS) genes [Eukaryotic translation initiation factor 2 alpha kinase 3 (EIF2AK3) and Calreticulin (CALR)] decreased during the follow-up (P ≤ 0.01 for all). Otherwise, genes involved in energy homeostasis [Adiponectin and AMP-activated protein kinase (AMPK)], cellular response to oxidative stress [Sirtuin 1, Sirtuin 3, and Nuclear factor erythroid 2-related factor 2 (NRF2)], mitochondrial biogenesis [Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α)] and amino acids metabolism [General control nonderepressible 2 (GCN2)] increased from baseline to all other time points evaluated (P ≤ 0.01 for all). Also, expression of Peroxisome proliferator-activated receptor gamma (PPARϒ) (adipogenesis regulation) was significantly decreased after RYGB (P < 0.05). Additionally, we observed that PGC1α, SIRT1 and AMPK strongly correlated to BMI at 3 M (P ≤ 0.01 for all), as well as ADIPOQ and SIRT1 to BMI at 6 M (P ≤ 0.01 for all). CONCLUSIONS Our findings demonstrate that weight loss is associated with amelioration of inflammation and ERS and increased protection against oxidative stress in adipose tissue. These observations are strongly correlated with a decrease in BMI and essential genes that control cellular energy homeostasis, suggesting an adaptive process on a gene expression level during the caloric restriction and weight loss period after RYGB. Trial registration CAAE: 73,585,317.0.0000.5440.
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Affiliation(s)
- Rafael Ferraz-Bannitz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Avenida Bandeirantes, 3900-Vila Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil.
| | - Caroline Rossi Welendorf
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Avenida Bandeirantes, 3900-Vila Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Priscila Oliveira Coelho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Avenida Bandeirantes, 3900-Vila Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Wilson Salgado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - Carla Barbosa Nonino
- Laboratory of Nutrigenomic Studies, Ribeirão Preto Medical School, University of Sao Paulo (USP), Ribeirao Preto, SP, Brazil
| | - Rebeca A Beraldo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Avenida Bandeirantes, 3900-Vila Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Maria Cristina Foss-Freitas
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo (USP), Avenida Bandeirantes, 3900-Vila Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil.
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Zordan AJCM, Bertoncini-Silva C, Joaquim AG, Rodrigues M, Machado CD, Carlos D, Foss-Freitas MC, Suen VMM. Gingerol supplementation does not change glucose tolerance, lipid profile and does not prevent weight gain in C57BL/6 mice fed a high-fat diet. Clinical Nutrition Experimental 2020. [DOI: 10.1016/j.yclnex.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Resende ATP, Martins CS, Bueno AC, Moreira AC, Foss-Freitas MC, de Castro M. Phenotypic diversity and glucocorticoid sensitivity in patients with familial partial lipodystrophy type 2. Clin Endocrinol (Oxf) 2019; 91:94-103. [PMID: 30954027 DOI: 10.1111/cen.13984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 01/07/2023]
Abstract
UNLABELLED Familial partial lipodystrophy type 2 (FPLD2) is characterized by insulin resistance, adipose atrophy of the extremities and central obesity. Due to the resemblance with Cushing's syndrome, we hypothesized a putative role of glucocorticoid in the pathogenesis of metabolic abnormalities in FPLD2. OBJECTIVE To evaluate the phenotypic heterogeneity and glucocorticoid sensitivity in FPLD2 patients exhibiting the p.R482W or p.R644C LMNA mutations. DESIGN, PATIENTS AND MEASUREMENTS Prospective study with FPLD2 patients (n = 24) and controls (n = 24), who underwent anthropometric, body composition, metabolic profile and adipokines/cytokine plasma measurements. Plasma and salivary cortisol were measured in basal conditions and after 0.25, 0.5 and 1.0 mg of dexamethasone (DEX) given at 23:00 hours. Glucocorticoid receptor (GR) and 11βHSD isoforms expression were assessed by qPCR. RESULTS Familial partial lipodystrophy type 2 individuals presented increased waist and neck circumferences, decreased hip circumference, peripheral skinfold thickness and fat mass. Patients presented increased HOMA-IR, triglycerides, TNF-α, IL-1β, IL-6 and IL-10, and decreased adiponectin and leptin plasma levels. FPLD2 patients showed decreased ability to suppress the HPA axis compared with controls after 0.5 mg DEX. The phenotype was more pronounced in patients harbouring the p.R482W LMNA mutation. GRβ overexpression in PBMC was observed in female patients compared with female controls. CONCLUSIONS Familial partial lipodystrophy type 2 patients exhibited anthropometric, clinical and biochemical phenotypic heterogeneity related to LMNA mutation sites and to gender. LMNA mutations affecting both lamin A and lamin C lead to more severe phenotype. FPLD2 patients also showed blunted HPA axis response to DEX, probably due to the association of increased levels of proinflammatory cytokines with GRβ overexpression leading to a more severe phenotype in female.
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Affiliation(s)
- Ana Teresa Prata Resende
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Clarissa Silva Martins
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ana Carolina Bueno
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ayrton Custódio Moreira
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Margaret de Castro
- Department of Internal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
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Massaro JD, Polli CD, Costa E Silva M, Alves CC, Passos GA, Sakamoto-Hojo ET, Rodrigues de Holanda Miranda W, Bispo Cezar NJ, Rassi DM, Crispim F, Dib SA, Foss-Freitas MC, Pinheiro DG, Donadi EA. Post-transcriptional markers associated with clinical complications in Type 1 and Type 2 diabetes mellitus. Mol Cell Endocrinol 2019; 490:1-14. [PMID: 30926524 DOI: 10.1016/j.mce.2019.03.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 01/10/2023]
Abstract
The delayed diagnosis and the inadequate treatment of diabetes increase the risk of chronic complications. The study of regulatory molecules such as miRNAs can provide expression profiles of diabetes and diabetes complications. We evaluated the mononuclear cell miRNA profiles of 63 Type 1 and Type 2 diabetes patients presenting or not microvascular complications, and 40 healthy controls, using massive parallel sequencing. Gene targets, enriched pathways, dendograms and miRNA-mRNA networks were performed for the differentially expressed miRNAs. Six more relevant miRNAs were validated by RT-qPCR and data mining analysis. MiRNAs associated with specific complications included: i) neuropathy (miR-873-5p, miR-125a-5p, miR-145-3p and miR-99b-5p); ii) nephropathy (miR-1249-3p, miR-193a-5p, miR-409-5p, miR-1271-5p, miR-501-3p, miR-148b-3p and miR-9-5p); and iii) retinopathy (miR-143-3p, miR-1271-5p, miR-409-5p and miR-199a-5p). These miRNAs mainly targeted gene families and specific genes associated with advanced glycation end products and their receptors. Sets of miRNAs were also defined as potential targets for diabetes/diabetes complication pathogenesis.
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Affiliation(s)
- Juliana Doblas Massaro
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil.
| | - Claudia Danella Polli
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil
| | - Matheus Costa E Silva
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil
| | - Cinthia Caroline Alves
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil
| | - Geraldo Aleixo Passos
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil; Molecular Immunogenetics Group, Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, 14040-900, Ribeirão Preto, SP, Brazil
| | - Elza Tiemi Sakamoto-Hojo
- Molecular Immunogenetics Group, Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, 14040-900, Ribeirão Preto, SP, Brazil
| | - Wallace Rodrigues de Holanda Miranda
- Division of Endocrinology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil
| | - Nathalia Joanne Bispo Cezar
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil
| | - Diane Meyre Rassi
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil
| | - Felipe Crispim
- Endocrinology and Diabetes Division, Department of Medicine, Federal University of São Paulo, 04039-032, São Paulo, SP, Brazil
| | - Sergio Atala Dib
- Endocrinology and Diabetes Division, Department of Medicine, Federal University of São Paulo, 04039-032, São Paulo, SP, Brazil
| | - Maria Cristina Foss-Freitas
- Division of Endocrinology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil
| | - Daniel Guariz Pinheiro
- Department of Technology, Faculty of Agriculture and Veterinary Sciences, University of the State of São Paulo, 14884-900, Jaboticabal, SP, Brazil
| | - Eduardo Antônio Donadi
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, 14048-900, Ribeirão Preto, SP, Brazil.
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Peres HA, Leira Pereira LR, Viana CM, Foss-Freitas MC. Patient's lack of understanding producing insulin drug-interactions in Southeast Brazilian primary care clinics. Diabetes Metab Syndr 2019; 13:1131-1136. [PMID: 31336455 DOI: 10.1016/j.dsx.2019.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/18/2019] [Indexed: 11/15/2022]
Abstract
UNLABELLED Detrimental drug-drug interactions (DDIs) in Diabetic patients could be from the simultaneous use of multiple drugs, polypharmacy. Brazilian public health studies evaluating the practical knowledge about drug interactions are scarce. This study's objective is to identify drug interactions and prevalence of detrimental DDIs in diabetic patients attending Brazilian basic health system clinics. METHODS Patients using insulin between the age of 18-90 years were selected to complete the MedTake questionnaire, to evaluate the indication, dosage, regimen and drug interaction. The MedTake test was employed. For each medicine, the test was scored as the percentage of correct actions and compared with printed instructions one single researcher downloaded all the data was from the municipality's computerized system. RESULTS The median age of recruits was 60.2 ± 14.3 and MedTake test scores were low 60.3 ± 20. One hundred patients missed the correct dose question, 40 missed why they were prescribed the drug, indication and 65 missed the therapeutic regimen. These diabetes patients did not know the DDIs between insulin combined with other medicines. Drugs that had more interaction with insulin were: acetylsalicylic acid (40%), enalapril (18%), losartan (32%) and hydrochlorothiazide (23%). CONCLUSIONS Diabetes patients without practical knowledge about insulin interacting with other pharmaceutical drugs that can produce DDIs with other medicines illustrates a need to develop education programs for diabetics.
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Affiliation(s)
- Heverton Alves Peres
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
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Peres HA, Leira Pereira LR, Martinez EZ, Viana CM, Foss-Freitas MC. Heart failure is associated with non-adherence to pharmacotherapy in elderly with type 2 diabetes mellitus in public health system Brazilians. Diabetes Metab Syndr 2019; 13:939-946. [PMID: 31336548 DOI: 10.1016/j.dsx.2018.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/19/2018] [Indexed: 11/19/2022]
Abstract
UNLABELLED The rising prevalence of T2DM poses a serious threat to human health and the viability of many health care systems around the world. Non-adherence to therapeutic in the T2DM is high, and Brazilian studies of public heath for to identify new variables are scares. The present study explored cardiovascular consequences associated with compliance and non-adherence among T2DM in Brazilian patients seeking medical care in Brazilian basic health unit clinics. METHODS This is a cross-sectional study carried out in a city the interior of Sao Paulo state, with patients with T2DM, being municipal PHS users. Data were collected from the computerized system of the municipality for a one single researcher and patient records, and analyzed using the IBM SPSS v.18 statistical package. The response variables was categorized in adherent MGT (>80) and non-adherent MGT (≤80). RESULTS The mean age of patients was 63.6 ± 9.5 with predominance for the sex male 66.4% and 42% of patients with T2DM do not adherence to treatment. We found an associated odds ratio (OR) = 2.3 (1.1-5.1) between heart failure and non-adherence in patients with T2DM. CONCLUSION Heart failure is a factor associated with non-adherence to treatment in patients with T2DM and in the practice clinical, the screening for heart failure and interventions may improve adherence to pharmacotherapy.
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Affiliation(s)
- Heverton Alves Peres
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil.
| | - Leonardo Régis Leira Pereira
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Edson Zangiacomini Martinez
- Department of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | | | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
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Gonçalves NB, Bannitz RF, Silva BR, Becari DD, Poloni C, Gomes PM, Foss MC, Foss-Freitas MC. α-Linolenic acid prevents hepatic steatosis and improves glucose tolerance in mice fed a high-fat diet. Clinics (Sao Paulo) 2018; 73:e150. [PMID: 30379219 PMCID: PMC6201146 DOI: 10.6061/clinics/2018/e150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/28/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Dietary omega-3 fatty acids have been efficacious in decreasing serum cholesterol levels and reducing the risk of cardiovascular disease. However, the metabolic and molecular changes induced by the omega-3 fatty acid α-linolenic acid (ALA), which is found in linseed oil, are not fully understood. In this study, we showed a correlation between ALA and insulin resistance, inflammation and endoplasmic reticulum stress (ERS). METHODS We studied 40 male mice (C57/BL6) divided into 4 groups: a control (C) group, a control + omega-3/ALA (CA) group, a high-fat diet (HFD) (H) group and a high-fat diet + omega-3/ALA (HA) group. For 8 weeks, the animals in the H and HA groups were fed a high-fat (60%) diet, while the animals in the C and CA groups received regular chow. The diets of the CA and HA groups were supplemented with 10% lyophilized ALA. RESULTS ALA supplementation improved glucose tolerance and reduced insulin resistance, as measured by intraperitoneal glucose tolerance tests and the homeostasis model assessment for insulin resistance, respectively. In addition, ALA reduced hepatic steatosis and modified the standard fat concentration in the liver of animals fed an HFD. Dietary ALA supplementation reduced the serum levels of interleukin 6 (IL-6), interleukin 1 beta (IL-1β) and monocyte chemoattractant protein-1 (MCP-1), increased the expression of important chaperones such as binding immunoglobulin protein (BIP) and heat shock protein 70 (HSP70) and reduced the expression of C/EBP-homologous protein (CHOP) and X-box binding protein 1 (XBP1) in hepatic tissues, suggesting an ERS adaptation in response to ALA supplementation. CONCLUSIONS Dietary ALA supplementation is effective in preventing hepatic steatosis; is associated with a reduction in insulin resistance, inflammation and ERS; and represents an alternative for improving liver function and obtaining metabolic benefits.
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Affiliation(s)
- Natália Bonissi Gonçalves
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
- *Corresponding author. E-mail:
| | - Rafael Ferraz Bannitz
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
- *Corresponding author. E-mail:
| | - Bruna Ramos Silva
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Danielle Duran Becari
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Carolina Poloni
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Patrícia Moreira Gomes
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Milton Cesar Foss
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | - Maria Cristina Foss-Freitas
- Departamento de Medicina, Divisao de Endocrinologia e Metabolismo, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
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Beraldo RA, Santos APD, Guimarães MP, Vassimon HS, Paula FJAD, Machado DRL, Foss-Freitas MC, Navarro AM. Body fat redistribution and changes in lipid and glucose metabolism in people living with HIV/AIDS. Rev Bras Epidemiol 2018; 20:526-536. [PMID: 29160443 DOI: 10.1590/1980-5497201700030014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/23/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). OBJECTIVE To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. METHODS For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. RESULTS The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). CONCLUSION The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.
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Affiliation(s)
- Rebeca Antunes Beraldo
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - André Pereira Dos Santos
- Programa Interunidades de Doutoramento, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Mariana Palma Guimarães
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | | | | | - Dalmo Roberto Lopes Machado
- Escola de Educação Física e Esporte de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil.,Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Maria Cristina Foss-Freitas
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | - Anderson Marliere Navarro
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
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Gomes LC, Coelho ACM, Gomides DDS, Foss-Freitas MC, Foss MC, Pace AE. Contribution of family social support to the metabolic control of people with diabetes mellitus: A randomized controlled clinical trial. Appl Nurs Res 2017; 36:68-76. [PMID: 28720242 DOI: 10.1016/j.apnr.2017.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 04/11/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
AIM This randomized controlled clinical trial aimed to evaluate the contribution of family social support to the clinical/metabolic control of people with type 2 diabetes mellitus. BACKGROUND Diabetes mellitus is a chronic disease that requires continuous care in order for individuals to reach glycemic control, the primordial goal of treatment. Family social support is essential to the development of care skills and their maintenance. However, there are few studies that investigate the contribution of family social support to diabetes control. METHODS The study was developed between June 2011 and May 2013, and included 164 people who were randomized using simple randomization. The intervention group differed from the control group in that it included a family caregiver, who was recognized by the patient as a source of social support. The educational interventions received by people with diabetes mellitus were used as the basis of the education provided through telephone calls to patients' family members and caregivers, and their purpose was to encourage dialogue between the patients and their relatives about the topics related to diabetes. RESULTS Regarding the clinical impact, the results showed that there was a greater reduction in blood pressure and glycated hemoglobin in the intervention group than in the control group, showing a positive effect on the control of the disease. CONCLUSIONS Families should be incorporated into the care of people with diabetes mellitus and especially in health care programs, in particular those that can promote different forms of social support to strengthen the bond between family members.
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Affiliation(s)
| | | | | | - Maria Cristina Foss-Freitas
- Department of Medical Clinics of the School of Medicine, Ribeirão Preto/USP, Ribeirão Preto, São Paulo, Brazil.
| | - Milton César Foss
- Department of Medical Clinics of the School of Medicine, Ribeirão Preto/USP, Ribeirão Preto, São Paulo, Brazil.
| | - Ana Emilia Pace
- Department of General Nursing and Specialist at EERP/USP, Ribeirão Preto, São Paulo, Brazil.
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Monteiro L, Foss-Freitas MC, Navarro A, Pereira F, Coeli F, Carneseca E, Júnior RM, Foss M. Evaluation of Dietary Intake, Leisure-Time Physical Activity, and Metabolic Profile in Women with Mutation in the LMNA Gene. J Am Coll Nutr 2017; 36:248-252. [PMID: 28443701 DOI: 10.1080/07315724.2016.1262299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Familial partial lipodystrophy (FPL) is a rare genetic disorder characterized by selective lack of subcutaneous fat, which is associated with insulin-resistant diabetes. The Dunnigan variety (FPLD2) is caused by several missense mutations in the lamin A/C (LMNA) gene, most of which are typically located in exon 8 at the codon position 482. OBJECTIVE The aim of this study was to assess and compare the dietary intake, leisure-time physical activity (LTPA), and biochemical measurements (glucose, A1C, and plasma lipids) in women with FPLD2 and without (control group, CG) and to examine the associations between dietary intake and biochemical measurements (BM). METHODS LTPA was measured with a questionnaire and metabolic equivalent (MET) hours per week (hours/week) were calculated. Dietary intake by the 3-day recall method and clinical laboratory parameters were collected. RESULTS Characteristics of women with FPLD2: 35.8 ± 13.9 years, fat mass = 10 ± 2.3 kg and fat free mass = 41.4 ± 4.5 kg (p < 0.05). Women with FPLD2 showed a smaller intake of energy (kcal), lipids, and carbohydrates and a large intake of protein (p < 0.01) compared to CG. Comparing the 2 groups in terms of LTPA, 78% of women with FPLD2 performed insufficient physical activity. In addition, they had a higher levels of glucose, A1C, and triglycerides (TG) and lower levels of high-density lipoprotein (HDL). There was no correlation between dietary intake and biochemical measurements. CONCLUSIONS Women with FPLD2 have a lower intake of energy (kcal), lipids, and carbohydrates and greater changes in biochemical measurements. Because this is a rare disease, future studies are needed with encouragement of the practice of physical activity and of healthy eating habits, preventing the onset of diseases.
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Affiliation(s)
- Luciana Monteiro
- a Division of Endocrinology, Department of Internal Medicine , Medical School of Ribeirão Preto, University of São Paulo , São Paulo , BRAZIL
| | - Maria Cristina Foss-Freitas
- a Division of Endocrinology, Department of Internal Medicine , Medical School of Ribeirão Preto, University of São Paulo , São Paulo , BRAZIL
| | - Anderson Navarro
- b Division of Nutrition and Metabolism, Department of Internal Medicine , Medical School of Ribeirão Preto, University of São Paulo , São Paulo , BRAZIL
| | - Francisco Pereira
- a Division of Endocrinology, Department of Internal Medicine , Medical School of Ribeirão Preto, University of São Paulo , São Paulo , BRAZIL
| | - Fernanda Coeli
- a Division of Endocrinology, Department of Internal Medicine , Medical School of Ribeirão Preto, University of São Paulo , São Paulo , BRAZIL
| | - Estela Carneseca
- c Institute of Education and Research, Foundation Institution Pio XII-Cancer Hospital of Barretos , São Paulo , BRAZIL
| | - Renan Montenegro Júnior
- d Department of Community Health, Service of Endocrinology and Diabetes , University Hospital Walter Cantídio, Fortaleza Medical School, Ceará University , Fortaleza , Ceará , BRAZIL
| | - Milton Foss
- a Division of Endocrinology, Department of Internal Medicine , Medical School of Ribeirão Preto, University of São Paulo , São Paulo , BRAZIL
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de Albuquerque RS, Mendes-Junior CT, Lucena-Silva N, da Silva CLL, Rassi DM, Veiga-Castelli LC, Foss-Freitas MC, Foss MC, Deghaide NHS, Moreau P, Gregori S, Castelli EC, Donadi EA. Association of HLA-G 3′ untranslated region variants with type 1 diabetes mellitus. Hum Immunol 2016; 77:358-64. [DOI: 10.1016/j.humimm.2016.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 11/19/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
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Beraldo RA, Meliscki GC, Silva BR, Navarro AM, Bollela VR, Schmidt A, Foss-Freitas MC. Comparing the Ability of Anthropometric Indicators in Identifying Metabolic Syndrome in HIV Patients. PLoS One 2016; 11:e0149905. [PMID: 26919174 PMCID: PMC4769013 DOI: 10.1371/journal.pone.0149905] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/05/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) can cause side effects in HIV patients, as the metabolic syndrome. Early identification of risk for development of cardiovascular diseases using available reliable and practical methods is fundamental. On this basis, the aim of this study was to compare the effectiveness of anthropometric indicators to identify metabolic syndrome in HIV patients on HAART. METHODS It is a cross-sectional study. A number of 280 stable HIV patients were studied. It measured weight, height, waist circumference (WC), hip circumference (HP), thigh circumference (TC) and calculated body mass index (BMI), body adiposity index (BAI), waist to hip ratio (WHR) and waist to thigh ratio (WTR). There was also a performance of biochemical tests of lipid profile and fasting glucose. Systemic blood pressure was measured. The criteria proposed by the National Cholesterol Education Program III (NCEP-ATP III) to metabolic syndrome classification was used. Individuals were divided in groups with or without metabolic alterations and their anthropometric indicators were compared. Receiver operating characteristic (ROC) curves were designed for each anthropometric indicator using the metabolic syndrome classification to identify sensitivity and specificity. RESULTS WC was a good tool to identify each metabolic disorder separately: total cholesterol (only females, p<0.05), triglycerides (only males, p<0.001), HDL cholesterol (p<0.05), LDL cholesterol (p<005) and fasting glycemic (p<005). WC also showed the best performance to identify metabolic syndrome in both genders (areas under the curve (AUCs): 0.79 and 0.76 for male and female, respectively), while BAI proved to be an inadequate indicator (AUCs: 0.63 and 0.67 for males and females), respectively, in this population. CONCLUSIONS The central adiposity measure (WC) had the best performance to identify metabolic syndrome, and it is a convenient, cheap and reliable tool that can be used in clinical practice routinely to prevent cardiovascular complications in HIV patients.
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Affiliation(s)
- Rebeca Antunes Beraldo
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Cristina Meliscki
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Bruna Ramos Silva
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Anderson Marliere Navarro
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Valdes Roberto Bollela
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - André Schmidt
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Boas LCGV, Foss-Freitas MC, Pace AE. [Adherence of people with type 2 diabetes mellitus to drug treatment]. Rev Bras Enferm 2015; 67:268-73. [PMID: 24861071 DOI: 10.5935/0034-7167.20140036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 01/18/2014] [Indexed: 11/20/2022] Open
Abstract
This cross-sectional and quantitative study aimed to evaluate the adherence to drug treatment of the people with diabetes mellitus and its relation to clinical, treatment and metabolic control variables. Sample consisted of 162 people with type 2 diabetes mellitus on follow-up outpatient care. The Measure of Treatment Adherence and consultation to the participants' medical records were used for data collection. A high adherence to drug treatment was obtained. For a p<0.05, it was obtained an inverse correlation with diastolic blood pressure and a direct correlation with the frequency of daily administration of insulin and oral antidiabetic agents. There were no statistically significant correlations between adherence and metabolic control variables. Results diverge from the literature regarding the adherence to drug treatment in chronic diseases, as well as in the correlation between adherence and complexity of drug regimen, which points to the need for more studies on this theme.
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Affiliation(s)
- Lilian Cristiane Gomes-Villas Boas
- Programa de Pós-Graduação de Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | - Ana Emilia Pace
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Coelho ACM, Boas LCGV, Gomides DDS, Foss-Freitas MC, Pace AE. Self-care activities and their relationship to metabolic and clinical control of people with diabetes Mellitus. Texto contexto - enferm 2015. [DOI: 10.1590/0104-07072015000660014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cross-sectional study with the aim to evaluate self-care in people with type 2 diabetes mellitus and verify its relationship with sociodemographic and clinical characteristics. The sample included 218 patients under outpatient follow-up. Self-care activities were evaluated by means of a questionnaire that was previously translated and validated for Brazil. The questionnaire items that reached the highest means were related to drug therapy, whereas those with the lowest means were related to the practice of physical activity. Age correlated inversely with physical activity and foot care, and elapsed time since the disease diagnosis showed a direct correlation with blood glucose monitoring. Data showed that self-care activities related to behavioral changes are the ones that require greater investments to achieve its goals, and age and time since diagnosis should be considered in the planning of nursing care for people with diabetes mellitus.
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da Silva Santos AF, Souza Santos RD, Foss-Freitas MC, Carvalho da Cunha SF, Marchini JS, Marques Miguel Suen V. URINARY LOSS OF MICRONUTRIENTS IN DIABETIC PATIENTS ATTENDING A TERTIARY HOSPITAL SERVICE. NUTR HOSP 2015; 32:678-82. [PMID: 26268098 DOI: 10.3305/nh.2015.32.2.9074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS micronutrient deficiency may contribute to a poorer control of diabetes. Thus, the objective of the present study was to assess the urinary excretion of micronutrients in patients with type 2 diabetes mellitus. METHODS patients with diabetes and controls were assessed regarding food intake, anthropometry, urinary loss of micronutrients and compared by the nonparametric Mann-Whitney test (p < 0.05). RESULTS nine diabetic volunteers (52 ± 14 years, BMI 30 ± 11 kg/m² and abdominal circumference (AC) of 99 ± 25 cm) and 9 control individuals (51 ± 16 years, BMI 26 ± 5 kg/m² and AC of 90 ± 13 cm) were studied. Higher iron excretion was observed in the diabetic group and higher magnesium excretion in the control group. CONCLUSIONS the type 2 diabetic patients here studied did not show increased micronutrient excretion in urine when compared to controls.
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Affiliation(s)
| | - Roberta Deh Souza Santos
- Departament of Internal Medicine, Faculty of Medicine of Ribeirão Preto, Ribeirao Preto, São Paulo (Brazil)..
| | - Maria Cristina Foss-Freitas
- Departament of Internal Medicine, Faculty of Medicine of Ribeirão Preto, Ribeirao Preto, São Paulo (Brazil)..
| | | | - Júlio Sérgio Marchini
- Departament of Internal Medicine, Faculty of Medicine of Ribeirão Preto, Ribeirao Preto, São Paulo (Brazil)..
| | - Vivian Marques Miguel Suen
- Departament of Internal Medicine, Faculty of Medicine of Ribeirão Preto, Ribeirao Preto, São Paulo (Brazil)..
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Felício JS, de Souza ACCB, Koury CC, Neto JFA, Miléo KB, Santos FM, Motta ARB, Silva DD, Arbage TP, Carvalho CT, de Rider Brito HA, Yamada ES, Cobas RA, Matheus A, Tannus L, Palma CCS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, de Araújo NBC, de Menezes Cordeiro M, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo Arruda Marques M, Calliari LE, de Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, Pires AC, Robles FC, Negrato CA, de Fatima Guedes M, Dib SA, Dualib P, da Silva SC, Sepúlveda J, Sampaio E, Rea RR, de Almeida Faria ACR, Tschiedel B, Lavigne S, Cardozo GA, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, de Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, de Araujo LB, Fonseca RMC, Guedes AD, de Mattos OS, Faria M, Azulay R, e Forti AC, Façanha CFS, Junior RM, Montenegro AP, Melo NH, Rezende KF, Ramos A, Jezini DL, Gomes MB. Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil: data from the Brazilian Type 1 Diabetes Study Group. Diabetol Metab Syndr 2015; 7:87. [PMID: 26448787 PMCID: PMC4596564 DOI: 10.1186/s13098-015-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. METHODS This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. RESULTS We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. CONCLUSIONS Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.
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Affiliation(s)
- João Soares Felício
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Carolina Contente Braga de Souza
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Camila Cavalcante Koury
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - João Felício Abrahão Neto
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Karem Barbosa Miléo
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Flávia Marques Santos
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Ana Regina Bastos Motta
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Denisson Dias Silva
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Thaís Pontes Arbage
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Carolina Tavares Carvalho
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Hana Andrade de Rider Brito
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Elizabeth Sumi Yamada
- />Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, Pará 66073-000 Brazil
| | - Roberta Arnoldi Cobas
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Alessandra Matheus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lucianne Tannus
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Catia Cristina Sousa Palma
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Leticia Japiassu
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - João Regis Ivar Carneiro
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Melanie Rodacki
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | - Lenita Zajdenverg
- />Federal University Hospital of Rio de Janeiro, Rio De Janeiro, Brazil
| | | | | | - Jorge Luiz Luescher
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Renata Szundy Berardo
- />University Hospital Clementino Fraga Filho, Children Institute Martagão Teixeira, Rio De Janeiro, Brazil
| | - Marcia Nery
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | - Catarina Cani
- />Diabetes Unit, University Hospital of São Paulo, São Paulo, Brazil
| | | | | | | | - Thais Della Manna
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Roberta Savoldelli
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Fernanda Garcia Penha
- />Children Institute of Endocrinology, University Hospital of São Paulo, São Paulo, Brazil
| | - Milton Cesar Foss
- />Ribeirão Preto Medical School of São Paulo University, Ribeirão Preto, Brazil
| | | | - Antonio Carlos Pires
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | - Fernando Cesar Robles
- />Department of Internal Medicine, Medical School, State University of São José do Rio Preto, São José Do Rio Preto, Brazil
| | | | | | - Sergio Atala Dib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | - Patricia Dualib
- />Diabetes Unit, Federal University of São Paulo State, São Paulo, Brazil
| | | | - Janice Sepúlveda
- />Endocrinology Unit, Hospital of Santa Casa of Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Emerson Sampaio
- />Diabetes Unit, State University Hospital of Londrina, Paraná, Brazil
| | | | | | - Balduino Tschiedel
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | - Suzana Lavigne
- />Institute of Diabetic Children, Porto Alegre, Rio Grande do Sul Brazil
| | | | - Mirela Azevedo
- />Clinical Hospital of Porto Alegre, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Manuel Faria
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | - Rossana Azulay
- />Federal University of Maranhão, São Luís, Maranhão Brazil
| | | | | | | | | | | | | | - Alberto Ramos
- />Federal University Hospital of Campina Grande, Campina Grande, Paraíba Brazil
| | - Deborah Laredo Jezini
- />Getúlio Vargas University Hospital of Amazonas, Adriano Jorge Hospital, Manaus, Amazonas Brazil
| | - Marilia Brito Gomes
- />Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro, Rio De Janeiro, Brazil
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Donadi EA, Cezar NB, Evangelista AF, Xavier DJ, Assis AF, Arns TC, Foss-Freitas MC, Foss MC, Sakamoto-Hojo ET, Passos GA. P102. Hum Immunol 2014. [DOI: 10.1016/j.humimm.2014.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bueno AC, Sun K, Martins CS, Elias Junior J, Miranda W, Tao C, Foss-Freitas MC, Barbieri MA, Bettiol H, de Castro M, Scherer PE, Antonini SR. A novel ADIPOQ mutation (p.M40K) impairs assembly of high-molecular-weight adiponectin and is associated with early-onset obesity and metabolic syndrome. J Clin Endocrinol Metab 2014; 99:E683-93. [PMID: 24432991 DOI: 10.1210/jc.2013-3009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT The phenotypic effects of ADIPOQ mutations early in life, prior to type 2 diabetes onset, have not been studied. AIM The objective of the study was to characterize the impact of a novel ADIPOQ mutation in vitro and in vivo. DESIGN The design of the study was ADIPOQ screening, adiponectin oligomerization, and cardiometabolic phenotype assessment. SUBJECTS Fourteen hypoadiponectinemic (<3 μg/mL) and 686 normoadiponectinemic young adults (23-25 y) were prospectively followed up since birth. MAIN OUTCOME MEASURES Human and recombinant murine mutant adiponectin oligomerization, the proband's ADIPOQ and ADIPOR1/R2 adipose tissue (AT) expression, and cardiometabolic profile were measured. RESULTS The heterozygous ADIPOQ p.M40K mutation was identified in one hypoadiponectinemic male (2.4 μg/mL) and three other family members. Carriers presented a marked reduction of serum high-molecular weight to total adiponectin ratio when compared with controls (9.4% ± 1% vs 56.6% ± 13%; P < .05) and family noncarriers (9.4% ± 1% vs 42% ± 0.5%; P = .05). Both mRNA and protein levels of adiponectin were increased in the AT of the proband (2.3- and 1.6-fold, respectively). However, the high-molecular weight to total adiponectin ratio of adiponectin was decreased (3.3-fold). Moreover, the expressions of ADIPOR1 and ADIPOR2 were significantly down-regulated in the AT of the proband (6- and 1.2-fold, respectively). The results were confirmed by in vitro studies on the recombinant murine homologous mutation (p.M43K). The proband's cardiometabolic phenotype progression was further characterized: born small for gestational age and adolescence-onset obesity; insulin resistance (homeostasis assessment model of insulin resistance of 4.7), and dyslipidemia at 25 years; decreased high-molecular weight adiponectin (0.24 μg/mL = 10%), hypertension (180/120 mm Hg), steatosis (fat liver = 40% ± 6%), increased carotid intima-media thickness at 31 years, and type 2 diabetes (glycosylated hemoglobin = 6.6%) at 34 years of age. Of note, all of the affected family members presented features of metabolic syndrome. CONCLUSION The newly identified ADIPOQ p.M40K mutation associates with severe cardiometabolic dysfunction due to the impairment of high-molecular weight adiponectin complex formation.
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Affiliation(s)
- Ana Carolina Bueno
- Departments of Pediatrics (A.C.B., M.A.B., H.B., S.R.A.) and Internal Medicine (C.S.M., J.E.J., W.M., M.C.F.-F., M.d.C.), School of Medicine of Ribeirao Preto, University of Sao Paulo, 14049-900, Brazil; and Touchstone Diabetes Center (K.S., C.T., P.E.S.), Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390
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Davison KAK, Negrato CA, Cobas R, Matheus A, Tannus L, Palma CS, Japiassu L, Carneiro JRI, Rodacki M, Zajdenverg L, Araújo NBC, Cordeiro MM, Luescher JL, Berardo RS, Nery M, Cani C, do Carmo A Marques M, Calliari LE, Noronha RM, Manna TD, Savoldelli R, Penha FG, Foss MC, Foss-Freitas MC, de Fatima Guedes M, Dib SA, Dualib P, Silva SC, Sepúlveda J, Sampaio E, Rea RR, Faria ACRA, Tschiedel B, Lavigne S, Cardozo GA, Pires AC, Robles FC, Azevedo M, Canani LH, Zucatti AT, Coral MHC, Pereira DA, Araujo LA, Pedrosa HC, Tolentino M, Prado FA, Rassi N, Araujo LB, Fonseca RMC, Guedes AD, Mattos OS, Faria M, Azulay R, Forti AC, Façanha CFS, Montenegro R, Montenegro AP, Melo NH, Rezende KF, Ramos A, Felicio JS, Santos FM, Jezini DL, Gomes MB. Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil. Nutr J 2014; 13:19. [PMID: 24607084 PMCID: PMC3995939 DOI: 10.1186/1475-2891-13-19] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/25/2014] [Indexed: 11/28/2022] Open
Abstract
Background To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. Methods This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years. Results Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies’, (OR 1.57 [1.02-2.41]) were related to greater patients’ adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients’ adherence (p < 0.01). Conclusions Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.
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Affiliation(s)
- Kariane A K Davison
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil.
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Gomes PM, Foss MC, Foss-Freitas MC. Response to the letter: Is there a higher cardiovascular disease risk in Japanese-Brazilians? Arq Bras Endocrinol Metabol 2013; 57:496. [PMID: 24030194 DOI: 10.1590/s0004-27302013000600016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Mello AL, Cunha SFDCD, Foss-Freitas MC, Vannucchi H. Evaluation of plasma homocysteine level according to the C677T and A1298C polymorphism of the enzyme MTHRF in type 2 diabetic adults. ACTA ACUST UNITED AC 2013; 56:429-34. [PMID: 23108747 DOI: 10.1590/s0004-27302012000700004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/30/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine plasma homocysteine levels during fasting and after methionine overload, and to correlate homocysteinemia according to methylenetetrahydrofolate reductase (MTHFR) polymorphism in type 2 diabetic adults. SUBJECTS AND METHODS The study included 50 type 2 diabetic adults (DM group) and 52 healthy subjects (Control group). Anthropometric data, and information on food intake, serum levels of vitamin B12, folic acid and plasma homocysteine were obtained. The identification of C677T and A1298C polymorphisms was carried out in the MTHFR gene. RESULTS There was no significant difference in homocysteinemia between the two groups, and hyperhomocysteinemia during fasting occurred in 40% of the diabetic patients and in 23% of the controls. For the same polymorphism, there was not any significant difference in homocysteine between the groups. In the Control group, homocysteinemia was greater in those subjects with C677T and A1298C polymorphisms. Among diabetic subjects, those with the A1298C polymorphism had lower levels of homocysteine compared with individuals with C677T polymorphism. CONCLUSION The MTHFR polymorphism (C677T and A1298C) resulted in different outcomes regarding homocysteinemia among individuals of each group (diabetic and control). These data suggest that metabolic factors inherent to diabetes influence homocysteine metabolism.
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Affiliation(s)
- Adriana Lima Mello
- Department of Sciences of Nutrition, School of Nutrition, Universidade Federal da Bahia, Salvador, BA, Brazil
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Motta ACF, Bataglion CAN, Foss-Freitas MC, Foss MC, Komesu MC. Can fasting plasma glucose and glycated hemoglobin levels predict oral complications following invasive dental procedures in patients with type 2 diabetes mellitus? A preliminary case-control study. Clinics (Sao Paulo) 2013; 68:427-30. [PMID: 23644869 PMCID: PMC3611742 DOI: 10.6061/clinics/2013(03)rc01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the effects of the levels of glycemic control on the frequency of clinical complications following invasive dental treatments in type 2 diabetic patients and suggest appropriate levels of fasting blood glucose and glycated hemoglobin considered to be safe to avoid these complications. METHOD Type 2 diabetic patients and non-diabetic patients were selected and divided into three groups. Group I consisted of 13 type 2 diabetic patients with adequate glycemic control (fasting blood glucose levels <140 mg/dl and glycated hemoglobin (HbA1c) levels <7%). Group II consisted of 15 type 2 diabetic patients with inadequate glycemic control (fasting blood glucose levels >140 mg/dl and HbA1c levels >7%). Group III consisted of 18 non-diabetic patients (no symptoms and fasting blood glucose levels <100 mg/dl). The levels of fasting blood glucose, glycated HbA1c, and fingerstick capillary glycemia were evaluated in diabetic patients prior to performing dental procedures. Seven days after the dental procedure, the frequency of clinical complications (surgery site infections and systemic infections) was examined and compared between the three study groups. In addition, correlations between the occurrence of these outcomes and the glycemic control of diabetes mellitus were evaluated. RESULTS The frequency of clinical outcomes was low (4/43; 8.6%), and no significant differences between the outcome frequencies of the various study groups were observed (p>0.05). However, a significant association was observed between clinical complications and dental extractions (p = 0.02). CONCLUSIONS Because of the low frequency of clinical outcomes, it was not possible to determine whether fasting blood glucose or glycated HbA1c levels are important for these clinical outcomes.
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Affiliation(s)
- Ana Carolina Fragoso Motta
- Department of Morphology, Stomatology and Physiology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Gomes PM, Andrade RCGD, Figueiredo RCD, Pace AE, Dal Fabbro AL, Franco LJ, Foss MC, Foss-Freitas MC. Cardiovascular risk in Japanese-Brazilian subjects. ACTA ACUST UNITED AC 2012; 56:608-13. [DOI: 10.1590/s0004-27302012000900002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 08/23/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. SUBJECTS AND METHODS: One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X² test, Fisher's Exact test, Student's t test, and ANOVA, at a 5% significance level. RESULTS: The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-β levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. CONCLUSION: Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR. Arq Bras Endocrinol Metab. 2012;56(9):608-13
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Boas LCGV, Foss MC, Foss-Freitas MC, Torres HDC, Monteiro LZ, Pace AE. Adesão à dieta e ao exercício físico das pessoas com diabetes mellitus. Texto contexto - enferm 2011. [DOI: 10.1590/s0104-07072011000200008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Estudo seccional de abordagem quantitativa que objetivou avaliar a adesão de pessoas com Diabetes Mellitus tipo 2 ao autocuidado, no que se refere à dieta e ao exercício físico, bem como a relação com características sociodemográficas e clínicas. A amostra constituiu-se de 162 pessoas com Diabetes Mellitus tipo 2, em seguimento ambulatorial. Para a coleta dos dados, foram utilizadas a versão brasileira do instrumento Summary of Diabetes Self-care Activities Questionnaire e a consulta aos prontuários dos participantes. Obteve-se baixa adesão ao autocuidado. Para um p<0,05, a correlação foi inversamente proporcional à escolaridade, sugerindo menor adesão para maior escolaridade. Não houve correlações estatisticamente significantes entre adesão ao autocuidado e sexo, idade, estado civil, renda per capita mensal, tempo de diagnóstico, tipo de tratamento medicamentoso e presença de complicações/comorbidades. Os resultados corroboram a literatura, na qual variáveis sociodemográficas e clínicas podem não predizer a adesão ao tratamento de pessoas com Diabetes Mellitus.
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Andrade RCGD, Figueiredo RCD, Foss-Freitas MC, Pace AE, Dal Fabbro AL, Franco LJ, Foss MC. Prevalence of diabetes mellitus in the Japanese-Brazilian community of Mombuca, Guatapará, SP. ACTA ACUST UNITED AC 2011; 55:127-33. [DOI: 10.1590/s0004-27302011000200005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 01/26/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To estimate the prevalence of type 2 diabetes mellitus (DM2) and impaired glucose tolerance (IGT) in the Japanese-Brazilian community of Mombuca in relation to risk factors (FR) for diabetes and cardiovascular disease. SUBJECTS AND METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69% first generation), aged 20 years or more, submitted to socio-cultural, anthropometric, and biochemistry evaluation. RESULTS: Of the individuals studied (n = 131, age = 55.1 ± 15.9 years), 58.8% were women. The prevalence of DM2 and IGT were 13.7% and 14.5%, respectively. Regarding RF, 76.3% presented dyslipidemia, 52.7% abdominal obesity, 48.1% arterial hypertension, and 42.3% whole body obesity. CONCLUSIONS: The prevalence of DM2, IGT, and RF in this Japanese-Brazilian community was higher than in the adult population of the city of Ribeirão Preto-SP, Brazil, suggesting an increase in risk conditions for these morbidities.
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Evaristo-Neto AD, Foss-Freitas MC, Foss MC. Prevalence of diabetes mellitus and impaired glucose tolerance in a rural community of Angola. Diabetol Metab Syndr 2010; 2:63. [PMID: 21040546 PMCID: PMC2987913 DOI: 10.1186/1758-5996-2-63] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 11/01/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a rural community (Bengo) of Angola. METHODS A random sample of 421 subjects aged 30 to 69 years (30% men and 70% women) was selected from three villages of Bengo province. This cross-sectional home survey was conducted using a sampling design of stage conglomerates. First, clinical and anthropometric data were obtained and fasting capillary glucose level was determined. Subjects who screened positive (fasting capillary glucose ≥ 100 mg/dl and < 200 mg/dl) and each sixth consecutive subject who screened negative (fasting capillary glucose < 100 mg/dl) were submitted to the second phase of survey, consisting of the 75-g oral glucose tolerance test. Data was analyzed by the use of SAS statistical software. RESULTS The prevalence rates of diabetes mellitus and IGT were 2.8% and 8.1%, respectively. The age group with the highest prevalence of diabetes was 60 to 69 years (42%). Impaired glucose tolerance prevalence was 38% in the 40 to 49 year age group and it increased with age, considering that the 50 to 59 and 60 to 69 year age groups as a whole represent 50% of all subjects with impaired glucose tolerance. The prevalence of diabetes mellitus did not differ significantly between men (3.2%) and women (2.7%) (p = 0.47). On the other hand, the prevalence of impaired glucose tolerance among women showed almost twice that found in men (9.1% vs. 5.6%, respectively). Overweight was present in 66.7% of the individuals with diabetes mellitus and 26.5% of individuals with impaired glucose tolerance showed overweight or obesity. CONCLUSIONS Although the prevalence of diabetes mellitus was low, the prevalence of impaired glucose tolerance is considered to be within an intermediary range, suggesting a future increase in the frequency of diabetes in this population.
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Affiliation(s)
- Antonio D Evaristo-Neto
- Department of Internal Medicine, Endocrinology and Metabolism Division, Ribeirào Preto School of Medicine, Sào Paulo University, Brazil
| | - Maria Cristina Foss-Freitas
- Department of Internal Medicine, Endocrinology and Metabolism Division, Ribeirào Preto School of Medicine, Sào Paulo University, Brazil
| | - Milton C Foss
- Department of Internal Medicine, Endocrinology and Metabolism Division, Ribeirào Preto School of Medicine, Sào Paulo University, Brazil
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Foss-Freitas MC, de Andrade RCG, Figueiredo RC, Pace AE, Martinez EZ, Dal Fabro AL, Franco LJ, Foss MC. Comparison of venous plasma glycemia and capillary glycemia for the screening of type 2 diabetes mellitus in the Japanese-Brazilian community of Mombuca (Guatapará-SP). Diabetol Metab Syndr 2010; 2:6. [PMID: 20180998 PMCID: PMC2828405 DOI: 10.1186/1758-5996-2-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 01/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify the most appropriate cut-off points of fasting glycemia for the screening of diabetes mellitus type 2 (DM2) with the comparison of the properties of capillary glycemia (CG) and venous blood plasma glycemia (PG) in a population of Japanese origin from the community of Mombuca, Guatapará-SP, Brazil. METHODS This was a population-based descriptive cross-sectional study conducted on a sample of 131 individuals of both genders aged 20 years or more (66.8% of the target population). CG was measured with a glucometer in a blood sample obtained from the fingertip and PG was determined by an enzymatic method (hexokinase) in venous blood plasma, after a 10-14 hour fast in both cases. Data were analyzed by the receiver operating characteristic (ROC) curve in order to identify the best cut-off point for fasting glycemia (CG and PG) for the diagnosis of DM, using the 2-hour plasma glycemia > 200 mg/dl as gold - standard. RESULTS The ROC curve revealed that the best cut-off point for the screening of DM was 110 mg/dl for CG and 105 mg/dl for PG, values that would optimize the relation between individuals with positive and false-positive results. The area under the ROC curve was 0.814 for CG (p < 0.01) and 0.836 for PG (p < 0.01). CONCLUSIONS The cut-off points of 105 mg/dl(5.8 mmol/l) for PG and of 110 mg/dl(6.1 mmol/l) for CG appear to be the most appropriate for the screening of DM2 in the population under study, with emphasis on the fact that the value recommended for CG is 5 mg/dl higher than that for PG, in contrast to WHO recommendations.
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Affiliation(s)
- Maria Cristina Foss-Freitas
- Departamento de Clinica Médica, Faculdade de Medicina de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto-SP(14049-900), Brazil
| | - Regina CG de Andrade
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto-SP(14049-900), Brazil
| | - Roberta C Figueiredo
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto-SP(14049-900), Brazil
| | - Ana Emília Pace
- Escola de Enfermagem de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto - SP (14040-902), Brazil
| | - Edson Z Martinez
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto-SP(14049-900), Brazil
| | - Amaury L Dal Fabro
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto-SP(14049-900), Brazil
| | - Laércio J Franco
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto-SP(14049-900), Brazil
| | - Milton C Foss
- Departamento de Clinica Médica, Faculdade de Medicina de Ribeirão Preto-USP, (Av. Bandeirantes 3900), Ribeirão Preto-SP(14049-900), Brazil
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Santos Tunes R, Foss-Freitas MC, Nogueira-Filho GDR. Impact of periodontitis on the diabetes-related inflammatory status. J Can Dent Assoc 2010; 76:a35. [PMID: 20831852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Wide-ranging activation of the innate immune system causing chronic low-grade inflammation is closely involved not only in the pathogenesis of type 2 diabetes mellitus and its complications, through an ongoing cytokine-induced acute-phase response, but also in the pathogenesis of periodontal diseases, whereby cytokines play a central role in the host's response to the periodontal biofilm. Although there is extensive knowledge about the pathways through which diabetes affects periodontal status, less is known about the impact of periodontal diseases on the diabetes-related inflammatory state. This review attempts to explain the immunobiological connection between periodontal diseases and type 2 diabetes mellitus, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes (thus aggravating insulin resistance) and discussing the impact of periodontal treatment on glycemic control in people living with both diabetes and periodontal disease.
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Affiliation(s)
- Roberta Santos Tunes
- School of Dentistry of Bahiana Medical School and Public Health, Salvador, Brazil
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Boas LCGV, dos Santos CB, Foss-Freitas MC, Pace AE. [The relationship between social support and the social demographic characteristics of people with diabetes mellitus]. Rev Gaucha Enferm 2009; 30:390-396. [PMID: 20187418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
This cross-sectional study aimed at associating the perceived social support with the social demographic characteristics of people with diabetes mellitus, between May and November 2008. The sample consisted of 161 patients with diabetes mellitus and the Social Support Network Inventory was used. High perception of social support was observed in the studied sample, the main source of support were the family members, followed by health professionals. Social support was directly correlated with age and inversely correlated with educational level, both of weak magnitude. The assessment of social support will permit interventions to promote the adaptation of people to the health demands.
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Conti-Freitas LC, Foss-Freitas MC, Lucca LJ, da Costa JAC, Mamede RCM, Foss MC. Dynamics of Parathyroid Hormone Secretion After Total Parathyroidectomy and Autotransplantation. World J Surg 2009; 33:1403-7. [DOI: 10.1007/s00268-009-0057-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rassi DM, Junta CM, Fachin AL, Sandrin-Garcia P, Mello S, Silva GL, Evangelista AF, Magalhães DA, Wastowski IJ, Crispim JO, Martelli-Palomino G, Fernandes APM, Deghaide NNHS, Foss-Freitas MC, Foss MC, Soares CP, Sakamoto-Hojo ET, Passos GAS, Donadi EA. Gene expression profiles stratified according to type 1 diabetes mellitus susceptibility regions. Ann N Y Acad Sci 2009; 1150:282-9. [PMID: 19120314 DOI: 10.1196/annals.1447.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The MHC region (6p21) aggregates the major genes that contribute to susceptibility to type 1 diabetes (T1D). Three additional relevant susceptibility regions mapped on chromosomes 1p13 (PTPN22), 2q33 (CTLA-4), and 11p15 (insulin) have also been described by linkage studies. To evaluate the contribution of these susceptibility regions and the chromosomes that house these regions, we performed a large-scale differential gene expression on lymphomononuclear cells of recently diagnosed T1D patients, pinpointing relevant modulated genes clustered in these regions and their respective chromosomes. A total of 4608 cDNAs from the IMAGE library were spotted onto glass slides using robotic technology. Statistical analysis was carried out using the SAM program, and data regarding gene location and biological function were obtained at the SOURCE, NCBI, and FATIGO programs. Three induced genes were observed spanning around the MHC region (6p21-6p23), and seven modulated genes (5 repressed and 2 repressed) were seen spanning around the 6q21-24 region. Additional modulated genes were observed in and around the 1p13, 2q33, and 11p15 regions. Overall, modulated genes in these regions were primarily associated with cellular metabolism, transcription factors and signaling transduction. The differential gene expression characterization may identify new genes potentially involved with diabetes pathogenesis.
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Affiliation(s)
- Diane Meyre Rassi
- Molecular Immunogenetics Group, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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Foss-Freitas MC, Foss NT, Rassi DM, Donadi EA, Foss MC. Evaluation of cytokine production from peripheral blood mononuclear cells of type 1 diabetic patients. Ann N Y Acad Sci 2009; 1150:290-6. [PMID: 19120315 DOI: 10.1196/annals.1447.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study aims to evaluate the production of cytokines, tumor necrosis factor (TNF), and interleukin 10 (IL-10) in peripheral blood mononuclear cells (PBMCs) from type 1 diabetic (T1D) patients by means of intracellular staining, flow cytometry, and ELISA and to correlate it with inadequate (IN) and adequate (A) metabolic controls. We studied 28 patients with T1D and 20 healthy individuals (C) paired by sex and age. T1D patients were divided in patients with IN and A metabolic control. PBMC cultures were stimulated with LPS to evaluate TNF or were stimulated with PMA/ionomycin or concanavalin A to evaluate IL-10. The TNF levels in supernatant of stimulated cultures, evaluated by ELISA, of diabetic patients were similar to those of healthy individuals, although the percentage of CD 33(+) cells that were positive for TNF was higher in the T1D IN group compared to the T1D A group (P= 0.01). Similarly, the IL-10 levels evaluated by ELISA in stimulated cultures of T1D patients were not different from those in the control group; moreover, the percentage of CD3(+) cells positive for intracellular IL-10 were higher in the T1D IN group compared to C groups (P= 0.007). The increased levels of cytokines in T1D IN diabetic patients, with reduction in the A group, suggests that hyperglycemia stimulates an inflammatory state that can result in a deficient immune cellular response. The data suggest that assessment by intracellular staining seems to be more accurate than the ELISA technique in evaluating diabetic patients.
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Conti-Freitas LC, Foss-Freitas MC, Mamede RCM, Foss NT. Effect of BCG stimulus on proinflammatory cytokine production in laryngeal cancer. Cancer Immunol Immunother 2009; 58:25-9. [PMID: 18421458 PMCID: PMC11030912 DOI: 10.1007/s00262-008-0520-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 04/04/2008] [Indexed: 01/19/2023]
Abstract
BACKGROUND Evaluate the production of TNF and IL-6 in the supernatant of peripheral blood mononuclear cell (PBMC) cultures of patients with supraglottic laryngeal cancer before and after surgical treatment. MATERIALS AND METHODS Adherent cell cultures were stimulated with LPS and BCG. Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cytokine concentration was determined by ELISA in supernatants of mononuclear cell cultures. RESULTS In non-stimulated cultures, lower TNF cytokine levels were detected during the late postoperative (LP) period compared to control (P = 0.02). LP TNF and IL-6 levels were high in cultures stimulated with LPS compared with the preoperative period (PREOP) (P = 0.007; P = 0.008, respectively). Stimulation with BCG led to increased levels of TNF and IL-6 during the LP period compared to control (P = 0.001; P = 0.04, respectively). CONCLUSION BCG is able to modulate the immune response of patients with advanced supraglottic laryngeal cancer in vitro, increasing the secretion of TNF and IL-6 by macrophages during the postoperative period.
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Affiliation(s)
- Luiz Carlos Conti-Freitas
- Department of Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
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Figueiredo RCD, Franco LJ, Andrade RCGD, Foss-Freitas MC, Pace AE, Dal Fabbro AL, Foss MC. Obesidade e sua relação com fatores de risco para doenças cardiovasculares em uma população nipo-brasileira. ACTA ACUST UNITED AC 2008; 52:1474-81. [DOI: 10.1590/s0004-27302008000900011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 10/20/2008] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever associações entre excesso de peso e obesidade abdominal com fatores de risco cardiovascular na população nipo-brasileira de Mombuca, Guatapará, SP. MÉTODOS: Participaram do estudo 131 indivíduos com descendência japonesa (69,2% da primeira e 30,8% da segunda geração), com idade > 20 anos, correspondendo a 66,8% da população residente dessa faixa etária. Os dados foram coletados por meio de questionários padronizados e foram realizados exames clínicos e laboratoriais. RESULTADOS: A prevalência de sobrepeso foi de 29,6% entre os homens e de 25,6% entre as mulheres e a de obesidade foi de 46,3% entre os homens e de 39,0% entre as mulheres. Entre os homens a prevalência de obesidade abdominal foi de 55,6% e entre as mulheres de 20,8%. O índice de massa corpórea foi associado independentemente com triglicérides, circunferência abdominal e idade; a pressão arterial sistólica com a circunferência abdominal. CONCLUSÃO: O presente estudo enfatiza a necessidade de medidas de intervenção para a prevenção da obesidade na população nipo-brasileira de Mombuca.
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Foss-Freitas MC, Foss NT, Donadi EA, Foss MC. Effect of the glycemic control on intracellular cytokine production from peripheral blood mononuclear cells of type 1 and type 2 diabetic patients. Diabetes Res Clin Pract 2008; 82:329-34. [PMID: 18849088 DOI: 10.1016/j.diabres.2008.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 08/22/2008] [Accepted: 09/01/2008] [Indexed: 10/21/2022]
Abstract
AIMS To evaluate the intracellular production of tumor necrosis factor (TNF-alpha), interleukine-6 (IL-6), INF-gamma, IL-8 and IL-10 in peripheral blood lymphomononuclear cells from type 1 and type 2 diabetic patients, stratified according to the glycemic control. METHODS Thirty-five diabetic patients (17 type 1 and 18 type 2) and nine healthy individuals paired to patients in terms of sex and age were studied. Nine patients of each group were on inadequate glycemic controls. Intracellular cytokines were evaluated using flow cytometry. Cell cultures were stimulated with LPS to evaluate TNF-alpha and IL-6 or with PMA and Ionomycin to evaluate IFN-gamma, IL-8 and IL-10 intracellular staining. RESULTS The percentages of CD33(+) cells bearing TNF-alpha and CD3(+) cells bearing IL-10 were increased in type 1 diabetic patients with inadequate glycemic control in relation to those with adequate control. In contrast, the percentage of CD3(+) cells bearing IL-8 was decreased in type 2 patients under inadequate glycemic control. CONCLUSIONS The glycemic control is important for the detection of intracellular cytokines, and may contribute towards the susceptibility to infections in diabetic patients.
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Affiliation(s)
- M C Foss-Freitas
- Division of Endocrinology and Metabolism, Department of Medicine, Ribeirão Preto Medical School, São Paulo University, Brazil
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Abstract
O acometimento patológico do sistema nervoso no diabetes melito é muito amplo e, freqüentemente, bastante grave. A prevalência de neuropatia diabética atinge níveis elevados com a evolução temporal do diabetes, chegando, geralmente, a freqüências acima de 50% de lesão neurológica em diferentes grupos de pacientes analisados em nosso meio e no exterior. A lesão neurológica nesta situação patológica é extensa no organismo humano diabético, envolvendo amplamente todo o sistema nervoso periférico nos seus componentes sensitivo-motor e autonômico: com clínica característica e concordante com as hipóteses patogênicas de natureza metabólica e/ou microvascular. O sistema nervoso autonômico é o elemento fundamental na regulação da função da maior parte dos sistemas ou órgãos no organismo, portanto, a sua lesão pode trazer importantes alterações para as funções cardiovascular, respiratória, digestiva, urinária e genital, podendo influir na função vital de alguns desses órgãos ou sistemas. Este artigo aborda as alterações decorrentes da lesão do sistema nervoso autonômico, especialmente nos pacientes diabéticos tipo 1, procurando dimensionar o risco de morbimortalidade.
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Abstract
Type 1 diabetes mellitus (T1DM) results from the autoimmune destruction of the insulin-producing pancreatic β-cells. The autoimmune response begins years before the presentation of hyperglycemic symptoms. At the time of clinical diagnosis, less than 30% of β-cell mass still remains. The conventional therapeutic option to T1DM is daily insulin injections, which is shown to promote tight glucose control and reduce the majority of chronic diabetic complications. Subgroup analysis of the Diabetes Control and Complication Trial showed another important aspect related to long-term complications of diabetes, that is, patients with initially higher serum levels of C-peptide with sustained levels over the subsequent years suffered less microvascular complications and less hypoglycemic events than those patients with low or undetected C-peptide levels. In face of this, β-cell preservation is another important target in the management of T1DM and its related complications. Along the years, many efforts toward the identification of precursors of β-cells have been made, not only with the aim of understanding the physiology of β-cell preservation, but also as a potential source of β-cell replacement. In this review, we summarize the most important studies related to probable precursor cells implied in the process of regeneration, and the results of various immunomodulatory regimens aiming at blocking autoimmunity against pancreatic β-cells and at promoting β-cell preservation. Finally, we comment on the future perspective related to stem cell therapy in T1DM.
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Affiliation(s)
- Carlos Eduardo Barra Couri
- a Division of Endocrinology, Department of Clinical Medicine, School of Medicine of Ribeirão Preto. University of São Paulo, CEP 14051-140, Ribeirão Preto, Brazil
| | - Maria Cristina Foss-Freitas
- a Division of Endocrinology, Department of Clinical Medicine, School of Medicine of Ribeirão Preto. University of São Paulo, CEP 14051-140, Ribeirão Preto, Brazil
| | - Milton César Foss
- a Division of Endocrinology, Department of Clinical Medicine, School of Medicine of Ribeirão Preto. University of São Paulo, CEP 14051-140, Ribeirão Preto, Brazil
| | - Júlio César Voltarelli
- b Bone Marrow Transplantation Unit, Department of Clinical Medicine, School of Medicine of Ribeirão Preto. University of São Paulo, CEP 14048-900, Ribeirão Preto, Brazil.
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Foss NT, Foss-Freitas MC, Ferreira MAN, Cardili RN, Barbosa CMC, Foss MC. Impaired cytokine production by peripheral blood mononuclear cells in type 1 diabetic patients. Diabetes Metab 2007; 33:439-43. [PMID: 17997340 DOI: 10.1016/j.diabet.2007.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 05/19/2007] [Indexed: 11/26/2022]
Abstract
AIMS The objective of the present investigation was to study the production of IL-1, IL-6, IL-10, IFNgamma and TNFalpha in cultures of peripheral blood mononuclear cells (PBMC) taken from type 1 diabetic patients with inadequate metabolic control. METHODS Seventeen type 1 diabetic patients and a gender- and age-matched group of 17 healthy individuals were studied. PBMC cultures were stimulated with phytohemagglutinin (PHA; 20 microg/ml) and lipopolysaccharide (LPS; 10 microg/ml), and enzyme immunoassay (Elisa) was used to measure IL-1, IL-6, IL-10, IFNgamma and TNFalpha in the cell-culture supernatants. RESULTS IFNgamma levels in PHA-stimulated cultures were lower in the type 1 diabetics than in the non-diabetic controls (P<0.0001) while, in contrast, IL-10 levels were increased in the PHA-stimulated culture supernatants of the diabetics compared with the controls (P<0.0001). In addition, supernatant levels of the cytokines IL-1, IL-6 and TNFalpha released in the presence of LPS in the cell cultures from the diabetic patients were significantly lower than in the non-diabetic subjects (P<0.0001, P<0.0001 and P<0.03, respectively). CONCLUSIONS The impaired production of IL-1, IL-6, TNFalpha and IFNgamma, and the increased production of IL-10, in PBMC cultures from type 1 diabetics with inadequate metabolic control compared with healthy subjects may be an indication of a deficiency in mononuclear cell activation and, consequently, a deficient immune cellular adaptive response that, in turn, may be the cause of the increased incidence of infections in people with type 1 diabetes.
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Affiliation(s)
- N T Foss
- Division of Dermatology, Department of Medicine, Ribeirão Preto Medical School, São Paulo University, Av. Bandeirantes, 3900. Monte Alegre, 14049-900 Monte Alegre, Brazil
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Foss-Freitas MC, Foss NT, Donadi EA, Foss MC. Effect of metabolic control on interferon-gamma and interleukin-10 production by peripheral blood mononuclear cells from type 1 and type 2 diabetic patients. Braz J Med Biol Res 2007; 40:671-7. [PMID: 17464429 DOI: 10.1590/s0100-879x2007000500010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Accepted: 02/27/2007] [Indexed: 11/22/2022] Open
Abstract
The objective of the present study was to evaluate the production of cytokines, interferon-gamma (INF-gamma) and interleukin-10 (IL-10), in cultures of peripheral blood mononuclear cells (PBMC) from type 1 and type 2 diabetic patients and to correlate it with inadequate and adequate metabolic control. We studied 11 type 1 and 13 type 2 diabetic patients and 21 healthy individuals divided into two groups (N = 11 and 10) paired by sex and age with type 1 and type 2 diabetic patients. The PBMC cultures were stimulated with concanavalin-A to measure INF-gamma and IL-10 supernatant concentration by ELISA. For patients with inadequate metabolic control, the cultures were performed on the first day of hospitalization and again after intensive treatment to achieve adequate control. INF-gamma levels in the supernatants of type 1 diabetic patient cultures were higher compared to type 2 diabetic patients with adequate metabolic control (P < 0.001). Additionally, INF-gamma and IL-10 tended to increase the liberation of PBMC from type 1 and 2 diabetic patients with adequate metabolic control (P = 0.009 and 0.09, respectively). The increased levels of INF-gamma and IL-10 released from PBMC of type 1 and 2 diabetic patients with adequate metabolic control suggest that diabetic control improves the capacity of activation and maintenance of the immune response, reducing the susceptibility to infections.
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Affiliation(s)
- M C Foss-Freitas
- Divisão de Endocrinologia e Metabolismo, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Abstract
OBJECTIVES The capacity of cell immunity to act against tumor cells has been presented as a decisive influence in the prognosis of patients with cancer. The aim of this study was to evaluate lymphoproliferation in nonadherent peripheral blood cell cultures of patients with advanced supraglottic laryngeal cancer. STUDY DESIGN Fourteen patients with advanced supraglottic laryngeal cancer were studied prospectively. Lymphoproliferation was quantified by adding 3H-thymidine and measured in counts/minute using liquid scintillation spectrometry. Based on the ratio between stimulated and baseline cultures, the proliferation index was calculated before and 236 +/- 18 days after the surgery. RESULTS Lymphoproliferation was lower in patients than in healthy controls (P = .01) in the preoperative as well as in the late postoperative period (P = .006 and P = .02, respectively). However, there was no change from preoperative to late postoperative. CONCLUSION Pre- and postoperative results show that patients with advanced supraglottic laryngeal cancer present lymphoproliferation diminished before the surgery, and in the late postoperative period, there was no recovery of immune capacity evaluated by lymphoproliferation measurement.
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Affiliation(s)
- Luiz Carlos Conti-Freitas
- Head and Neck Unit, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
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Foss-Freitas MC, Foss NT, Donadi EA, Foss MC. In vitro TNF-alpha and IL-6 production by adherent peripheral blood mononuclear cells obtained from type 1 and type 2 diabetic patients evaluated according to the metabolic control. Ann N Y Acad Sci 2007; 1079:177-80. [PMID: 17130551 DOI: 10.1196/annals.1375.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) levels were evaluated in lipopolysaccharide (LPS)-stimulated cell cultured monocytes obtained from 24 type 1 and type 2 diabetic patients presenting inadequate (IN) or adequate (AD) metabolic control, and in 21 healthy individuals paired to patients for sex and age. The TNF-alpha levels in stimulated cultures of diabetic patients were similar to healthy individuals, and type 1 diabetic patients showed increased IL-6 supernatant levels. The tendency toward increased TNF-alpha and IL-6 levels was observed with metabolic control of type 1 and type 2 diabetic patients, suggesting that the control of diabetes improves the capacity of activation and maintenance of the proinflammatory immune response.
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MESH Headings
- Blood Glucose/analysis
- Case-Control Studies
- Cell Adhesion
- Cells, Cultured
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/genetics
- Diabetes Mellitus, Type 2/immunology
- Fasting
- Female
- Glycated Hemoglobin/analysis
- Humans
- In Vitro Techniques
- Interleukin-16/biosynthesis
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/physiology
- Lipopolysaccharides/pharmacology
- Male
- Tumor Necrosis Factor-alpha/biosynthesis
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Affiliation(s)
- Maria Cristina Foss-Freitas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto (SP), Brazil.
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Rassi DM, Junta CM, Fachin AL, Sandrin-Garcia P, Mello S, Marques MMC, Fernandes APM, Foss-Freitas MC, Foss MC, Sakamoto-Hojo ET, Passos GAS, Donadi EA. Metabolism genes are among the differentially expressed ones observed in lymphomononuclear cells of recently diagnosed type 1 diabetes mellitus patients. Ann N Y Acad Sci 2007; 1079:171-6. [PMID: 17130550 DOI: 10.1196/annals.1375.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The large-scale differential gene expression in lymphomononuclear cells of six patients with recently diagnosed type), and six normal individuals matched to patients for sex and age were studied. Glass slides containing 4608 cDNAs from the IMAGE library were spotted using robotic technology. Statistical analysis was carried out by the SAM program, and gene function assessed by the FATIGO program. Thirty differentially expressed genes (21 induced and 9 repressed) were disclosed when DM-1 patients were compared with controls. Although presenting with distinct biological function, most of the induced or repressed genes were related with protein, phosphate, DNA, RNA, carboxylic acid, and fatty acid metabolism. Although some of these genes have been previously associated with the pathogenesis of T1DM, many other genes were identified for further studies.
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Affiliation(s)
- Diane M Rassi
- Divisão de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 14049-900 São Paulo, S.P., Brazil
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Foss-Freitas MC, Foss NT, Donadi EA, Foss MC. Effect of metabolic control on the in vitro proliferation of peripheral blood mononuclear cells in type 1 and type 2 diabetic patients. SAO PAULO MED J 2006; 124:219-22. [PMID: 17086304 DOI: 10.1590/s1516-31802006000400009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 07/12/2006] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Diabetes mellitus is a clinical syndrome that frequently leads to the development of chronic complications and high susceptibility to infections. It is probably due to defective immunological defense, which may be related to metabolic control of the disease. The aim of this study was to evaluate the effect of metabolic control on immune-cell behavior in type 1 and type 2 diabetic patients. For this, the in vitro proliferation of peripheral blood mononuclear cells (PBMC) was analyzed in patients with inadequate and adequate metabolic control. DESIGN AND SETTING Experimental/laboratory study at a university hospital. METHODS Eleven type 1 and thirteen type 2 diabetic patients were studied, together with 21 healthy individuals divided in two groups (11/10), who were matched by sex and age with those diabetic patients. PBMC cultures stimulated with concanavalin-A (Con-A) were used to measure 3H-thymidine incorporation after 72 hours of cell culturing. For patients with inadequate metabolic control, culturing was performed on the first day of patient hospitalization and again after intensive treatment to achieve adequate control. RESULTS The proliferation index for Con-A-stimulated cultures from type 1 diabetic patients was significantly greater than that for cultures from healthy individuals and type 2 diabetic patients, independent of metabolic control. A negative correlation between the proliferation cell index and body mass index and serum C-reactive protein levels was also observed. CONCLUSION The increase in the proliferation capacity of type 1 diabetic T lymphocytes was probably not caused by hyperglycemia and/or insulinopenia related to inadequate metabolic control.
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Abstract
OBJETIVO: Ainda é desconhecida a relação do diabetes com fatores determinantes ou precipitantes de lesões dermatológicas em pacientes diabéticos. Assim, o objetivo do estudo foi investigar a presença de lesões cutâneas, não referidas pelo paciente diabético e sua relação com o controle metabólico da doença. MÉTODOS: Foram examinados 403 pacientes, dos quais 31% eram diabéticos do tipo 1 e 69% do tipo 2. Em ambulatório de um hospital universitário, os pacientes foram atendidos por endocrinologista para a avaliação endócrino-metabólica e por dermatologista para a avaliação dermatológica. O grau de controle metabólico foi documentado em 136 pacientes por meio da dosagem de hemoglobina glicada. RESULTADOS: Houve predomínio de dermatofitoses (82,6%), seguido de grupo de dermatoses como acne e degeneração actínica (66,7%), piodermites (5%), tumores cutâneos (3%) e necrobiose lipoídica (1%). Entre as dermatoses mais comuns em diabéticos, foram confirmados com exame histológico: dois diagnósticos de necrobiose (0,4%), cinco de dermopatia diabética (1,2%) e três casos de mal perfurante plantar (0,7%). Os valores da hemoglobina glicada foram: 7,2% em pacientes com controle metabólico adequado nos dois tipos de diabetes e de 11,9% e 12,7% nos tipos 1 e 2, respectivamente, com controle inadequado. Nos pacientes com controle metabólico inadequado foi observada freqüência maior de dermatofitoses, em ambos os tipos de diabetes. CONCLUSÕES: Os dados revelaram freqüência elevada de lesão dermatológica nos pacientes diabéticos, especialmente dermatofitoses. Dessa forma, o descontrole metabólico do diabético propicia maior suscetibilidade a infecções cutâneas.
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Affiliation(s)
- N T Foss
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
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Foss-Freitas MC, Foss MC. Comparison of the homeostasis model assessment and quantitative insulin sensitivity check index with data from forearm metabolic studies for the in vivo assessment of insulin sensitivity. Braz J Med Biol Res 2004; 37:663-8. [PMID: 15107927 DOI: 10.1590/s0100-879x2004000500006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study was designed to compare the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) with data from forearm metabolic studies of healthy individuals and of subjects in various pathological states. Fifty-five healthy individuals and 112 patients in various pathological states, including type 2 diabetes mellitus, essential hypertension and others, were studied after an overnight fast and for 3 h after ingestion of 75 g of glucose, by HOMA, QUICKI and the forearm technique to estimate muscle uptake of glucose combined with indirect calorimetry (oxidative and non-oxidative glucose metabolism). The patients showed increased HOMA (1.88 +/- 0.14 vs 1.13 +/- 0.10 pmol/l x mmol/l) and insulin/glucose (I/G) index (1.058.9 +/- 340.9 vs 518.6 +/- 70.7 pmol/l x (mg/100 ml forearm)-1), and decreased QUICKI (0.36 +/- 0.004 vs 0.39 +/- 0.006 ( microU/ml + mg/dl)-1) compared with the healthy individuals. Analysis of the data for the group as a whole (patients and healthy individuals) showed that the estimate of insulin resistance by HOMA was correlated with data obtained in the forearm metabolic studies (glucose uptake: r = -0.16, P = 0.04; non-oxidative glucose metabolism: r = -0.20. P = 0.01, and I/G index: r = 0.17, P = 0.03). The comparison of QUICKI with data of the forearm metabolic studies showed significant correlation between QUICKI and non-oxidative glucose metabolism (r = 0.17, P = 0.03) or I/G index (r = -0.37, P < 0.0001). The HOMA and QUICKI are good estimates of insulin sensitivity as data derived from forearm metabolic studies involving direct measurements of insulin action on muscle glucose metabolism.
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Affiliation(s)
- M C Foss-Freitas
- Divisão de Endocrinologia e Metabologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, Brazil.
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