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- ItemAcesso aberto (Open Access)Are the beneficial cardiovascular effects of simvastatin and metformin also associated with a hormone-dependent mechanism improving insulin sensitivity?(Associação Brasileira de Divulgação Científica, 2007-02-01) Bulcão, Caroline [UNIFESP]; Giuffrida, Fernando de Mello Almada [UNIFESP]; Ribeiro-Filho, Fernando Flexa [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)In addition to lipid-lowering and cardiovascular protective actions, statins may have beneficial effects on insulin sensitivity. The objective of the present study was to evaluate the effect of simvastatin therapy on insulin resistance and on leptin, adiponectin, and C-reactive protein (CRP) levels, as compared to metformin, in overweight pre-diabetic subjects. Forty-one subjects with BMI >25 kg/m² and impaired fasting glucose or impaired glucose tolerance were randomized to take simvastatin, 20 mg/day (N = 20) or metformin, 1.7 g/day (N = 21) for 16 weeks. Blood samples for the determination of metabolic, hormonal, and inflammatory parameters were obtained at baseline and after each treatment. After metformin therapy, significant reductions in mean BMI and waist circumference were observed, and after simvastatin treatment LDL and triglyceride levels were significantly reduced. Insulin resistance determined by the homeostasis model assessment decreased only with metformin. Independently of the type of medication, a significant decrease in CRP levels was detected from baseline to the end of the study. CRP showed a mean reduction of 0.12 ± 0.04 mg/dL (P = 0.002) over time. No change in leptin or adiponectin levels was induced by any therapy. The data suggest that a low dose of simvastatin does not affect insulin resistance in overweight pre-diabetic subjects and has no effect on leptin or adiponectin levels. Further studies including a larger sample size, higher doses of statins, and a placebo control group are necessary to confirm the present data.
- ItemSomente MetadadadosAssessment of fructose overload in the metabolic profile and oxidative/nitrosative stress in the kidney of senescent female rats(Pergamon-Elsevier Science Ltd, 2017) Costalonga Seraphim, Deborah Chianelli [UNIFESP]; Punaro, Giovana Rita [UNIFESP]; Fernandes, Thamires de Oliveira [UNIFESP]; Ginoza, Milton [UNIFESP]; Lopes, Guiomar Silva [UNIFESP]; Suemitsu Higa, Elisa Mieko [UNIFESP]The aging process is a complex phenomenon that leads the body to several changes, affecting its integrity and resulting in chronic pathologies, which compromises health and quality of life of elderly people. Animals supplemented with fructose have been used as an experimental model for induction of insulin resistance. The objective of this study was to evaluate the metabolic effects and the levels of oxidative/nitrosative stress in the kidney of senescent rats with a high fructose intake. The animals were allocated into 4 groups: young control (Y), aged control (A), young fructose (YF) and aged fructose (AF). Groups Y and A received water and groups YF and AF received fructose (100 g/L) in the water, both ad libitum. After 12 weeks of high fructose intake, the animals were sacrificed to collect their kidneys, blood and the thoracic aorta. The results are presented as mean +/- SE, analyzed by the One-Way ANOVA test with Newman-Keuls post-test; significant at p < 0.05. The fructose overload caused metabolic dysfunctions and insulin resistance, confirming the efficacy of the chosen model. In this study, we observed a body weight gain in the studied groups (except in the elderly fructose group), and an increase in general caloric intake, diuresis and adipose tissue; insulin resistance, increased fasting glucose, triglycerides and cholesterol in the fructose groups. We also found a loss of renal function, increased oxidative/nitrosative stress and inflammation, and a reduction of antioxidants and a lower vasodepressor response in the studied groups, especially those who consumed fructose. In summary, our data showed that aging or high fructose intake contributed to the increase of oxidative/nitrosative stress in animals, demonstrating that at the dose and the period of fructose treatment utilized in this study, fructose was not able to aggravate several aspects which were already altered by aging. We believe that the high fructose intake simulates most of the effects of aging, and this understanding would be useful to prevent or minimize many of the alterations caused by this condition.
- ItemSomente MetadadadosThe association between insulin resistance and depression in the Korean general population(Elsevier Science Bv, 2017) Lee, Jae-Hon; Park, Sung Keun; Ryoo, Jae-Hong; Oh, Chang-Mo; Mansur, Rodrigo B. [UNIFESP]; Alfonsi, Jeffrey E.; Cha, Danielle S.; Lee, Yena; McIntyre, Roger S.; Jung, Ju YoungBackground: Previous studies showed that the insulin resistance (IR) could be related to depression. However, this association is still equivocal in the general population. Herein, we aimed to investigate the association between IR and depressive symptoms in a large sample in South Korea. Methods: A cross-sectional study was carried out for 165,443 Korean men and women who received a health checkup including various clinical parameters and the Center for Epidemiologic Studies Depression scales (CES-D). Subjects were stratified into subgroups by CES-D score, sex, age, and presence of diabetes. The odd ratios (ORs) for homeostasis model assessment of insulin resistance (HOMA-IR) were compared between groups using multivariable logistic regression analyses. Results: After adjusting covariates (e.g. smoking, family income, marriage state, unemployment status, average alcohol use, BMI, physical activity, systolic blood pressure, diabetes), increased IR was weakly associated with greater depressive symptoms (adjusted OR=1.01 [95% CI 1.0001-1.03]). Subgroup analysis revealed this association was statistically significant in females (adjusted OR-1.03, [95% CI 1.001-1.06]), non-diabetic group (adjusted OR-1.04, [95% CI 1.02-1.06]), and young participants under the age of thirty (adjusted OR-1.17, [95% CI 1.07-1.27]). But we couldn't find significant association in diabetic and middle to elderly participants. Conclusions: This study demonstrates that there is a relationship between IR and depressive symptoms in the Korean general population. Results from this epidemiological study revealed that young adults and non-diabetic individuals with increased IR may be related with depressive symptoms.
- ItemAcesso aberto (Open Access)Association between insulin resistance and sustained virologic response in hepatitis C treatment, genotypes 1 versus 2 and 3: systematic literature review and meta-analysis(Brazilian Society of Infectious Diseases, 2013-10-01) Laurito, Marcela Pezzoto [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Bristol-Myers Squibb S.ABACKGROUND/AIMS: Controversial results have been found in literature for the association between insulin resistance and sustained virologic response to standard chronic hepatitis C treatment. This study aims to provide a systematic literature review with meta-analysis, in order to evaluate if insulin resistance interferes with sustained virologic response in patients infected by the HCV genotype 1 versus HCV genotypes 2 and 3, undergoing treatment with interferon and ribavirin or pegylated interferon and ribavarin. METHODS: Systematic search was performed on main electronic databases until May 2012. Primary outcome was sustained virologic response, defined as undetectable levels of HCVRNA six months after the end of treatment. Meta-analytic measure was estimated using Dersimonian and Laird's method, using Stata software. RESULTS: Thirteen studies involving 2238 infected patients were included. There was a statistically significant association between insulin resistance and lower sustained virologic response rate, and this difference occurred in HCV genotype G1 (OR: 2.23; 95% 1.59-3.13) and G2/G3 (OR: 4.45; 95% CI: 1.59-12.49). In addition, a difference was seen in the cut-offs used for defining insulin resistance by Homeostasis Model Assessment of Insulin Resistance. To minimize this limitation, sub-analysis that excluded the studies that did not use 2 as a cut-off value was performed and the results still demonstrated association between insulin resistance and sustained virologic response, for both genotypic groups. CONCLUSION: This meta-analysis provides evidence that elevated Homeostasis Model Assessment of Insulin Resistance is associated with a lower sustained virologic response rate in patients with hepatitis C treated with interferon and ribavirin or pegylated interferon and ribavarin, regardless of their genotype.
- ItemAcesso aberto (Open Access)Atividades metabólicas e endócrinas de adipócitos extraídos do tecido adiposo subcutâneo e visceral de animais obesos induzidos por dieta hiperlipídica e suplementados com ácidos graxos ômega-3(Universidade Federal de São Paulo, 2015-04-29) Cunha, Roberta Dourado Cavalcante da [UNIFESP]; Vale, Maria Isabel Cardoso Alonso [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The efforts dedicated to finding the cure for obesity and associated disorders lead to an intense interest in adipocyte metabolism. The consumption of ω-3 fatty acids (ω-3 FA) presents beneficial effects on changes caused by obesity. The aim of this study was to characterize the metabolic and endocrine changes of isolated isolated adipocytes from obese mice induced by high fat (HF) diet, supplemented or not with fish oil rich in ω-3 FA (EPA/DHA, 5:1) with emphasis on the differential response of subcutaneous and visceral adipose deposits, inguinal (ING) and retroperitoneal (RP) region, respectively. For this, C57BL/6 males mice 8 weeks-old, were divided into 4 groups: CO, animals fed with control diet (9% of lipids); CO + ω-3, fed with control diet supplemented with ω-3 FA; HF, fed with HF diet (59% of lipids); and HF + ω-3, fed with HF diet supplemented with ω-3 FA. The animals were evaluated for food intake, body mass, glucose tolerance test (GTT) and insulin (ITT), insulin resistance and plasma lipid profile. From ING and PR isolated adipocytes, we evaluated the glucose uptake, lipogenesis, de novo synthesis of FA, lipolysis and the gene and protein expression of adipokines. The animals fed with the HF diet presented a higher body weight, glucose and insulin intolerance and insulin resistance, increase in liver weight and a higher serum concentrations of total and LDL cholesterol. It was also observed a greater weight of ING and PR adipose tissues, as well as an increament in the size of their cells (hypertrophy). The fish oil per se, administered in a prevention model (i.e., the ω-3 FA supplementation starting 4 weeks before the induction of obesity) in mice fed with CO diet, had no effect on body weight, blood glucose and insulin, or on the metabolic activities (lipolysis, lipogenesis, glucose uptake), as well as on the secretion or gene expression of cytokines, in isolated adipocyes. On the other hand, the fish oil showed an anti-obesogenic action associated to beneficial effects on dyslipidemia, insulin resistance and dysfunction of adipocytes arising from HF diet. HL diet altered differently the functions of RP and ING adipocytes, since RP adipocytes became potentially lipolytics and producers of pro-inflammatory cytokines with a reduced function on the de novo synthesis of FA, while ING adipocytes showed a decrease on glucose uptake and on secretion of the anti-inflammatory cytokine adiponectin, besides contributing on the secretion of TNFα and IL-6 citokines. Moreover, our results show an important and differential role of adipocytes per se, positively correlated with its hypertrophy, on the secretion of cytokines, contesting the exclusive importance given to immune cells that infiltrate the white adipose tissue in conditions of obesity.
- ItemSomente MetadadadosAtypical Generalized Lipoatrophy and Severe Insulin Resistance due to a Heterozygous LMNA p.T101 Mutation(Sbem-soc Brasil Endocrinologia & Metabologia, 2008-11-01) Mory, Patricia Barretto [UNIFESP]; Crispim, Felipe [UNIFESP]; Kasamatsu, Teresa Sayoko [UNIFESP]; Gabbay, Monica Andrade Lima [UNIFESP]; Dib, Sergio Atala [UNIFESP]; Moises, Regina S. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Lipodystrophies are a group of heterogeneous disorders characterized by the loss of adipose tissue and metabolic complications. The main familial forms of lipodystrophy are Congenital Generalized Lipodystrophy and Familial Partial Lipodystrophy (FPLD). FPLD may result from mutations in the LMNA gene. Besides FPLD, mutations in LMNA have been shown to be responsible for other inherited diseases called laminopathies. Here we describe the case of a 15-year-old girl who was referred to our service due to diabetes mellitus and severe hypertriglyceridemia. Physical examination revealed generalized loss of subcutaneous fat, confirmed by DEXA (total body fat 8.6%). As the patient presented with pubertal-onset of generalized lipodystrophy and insulin resistance, molecular analysis of the LMNA gene was performed. We identified a heterozygous substitution in exon 1 (c.29C > T) predicting a p.T101 mutation. In summary, we describe an atypical phenotype of lipodistrophy associated with a de novo appearance of the p.T101 mutation in LMNA gene. (Arq Bras Endocrinol Metab 2008; 52/8:1252-1256)
- ItemAcesso aberto (Open Access)Avaliação da cinética de ferro e inflamação em indivíduos vegetarianos e não vegetarianos(Universidade Federal de São Paulo (UNIFESP), 2020-03-05) Slywitch, Eric [UNIFESP]; Escrivao, Maria Arlete Meil Schimith [UNIFESP]; http://lattes.cnpq.br/2103953406579796; http://lattes.cnpq.br/1756623423214992; Universidade Federal de São PauloIntrodução: A exclusão do ferro heme da dieta leva ao questionamento da possível inadequação dos níveis desse mineral no organismo dos vegetarianos. A adoção de uma dieta vegetariana está associada à redução da prevalência de diversas doenças crônicas não transmissíveis. Esse fato pode ser explicado pelo menor IMC (índice de massa corporal), assim como pela composição da dieta (distribuição equilibrada dos macronutrientes, menor teor de gordura saturada, maior ingestão de antioxidantes e fibras). Porém, não é claro se o ganho de peso acarreta alterações metabólicas diferentes nos vegetarianos, quando comparados aos onívoros. Objetivos: Avaliar, comparativamente, o estado nutricional de ferro em indivíduos vegetarianos e onívoros e verificar a influência do estado inflamatório no diagnóstico da deficiência de ferro. Investigar se o ganho de peso corporal propicia alterações metabólicas similares em vegetarianos e onívoros. Métodos: Foram avaliados 1340 indivíduos de 18 a 60 anos de idade, separados por sexo, dieta seguida, presença ou ausência de menstruação e estado nutricional (IMC). Foram dosados os níveis séricos de hemoglobina (Hb), ferritina, proteína C reativa ultrassensível (PCR-US), ALT (alanina aminotransferase), AST (aspartato aminotransferase), Gama-GT (gamaglutamil transferase), glicemia de jejum, insulinemia e hemoglobina glicada e foram calculados os valores de Homeostatic Model Assessment (HOMA-IR). Resultados: Na população feminina (n=918), as onívoras tiveram maior prevalência de obesidade e as veganas de baixo peso (p=0,0045). Na masculina (n=422), a prevalência de obesidade foi maior nos onívoros (p=0,0001). A prevalência de anemia foi maior em vegetarianas do que em onívoras, mediante perda de sangue menstrual (p=0,0057) ou não (p=0,0124). Valores progressivos de IMC e de HOMA-IR se associaram com elevação de ferritina, independente do hábito alimentar. Após serem excluídos da análise os indivíduos com sobrepeso/obesidade e inflamação, a prevalência de deficiência de ferro foi maior em vegetarianos do que onívoros, apenas mediante perda menstrual de sangue. Valores progressivos de IMC levam ao aumento de diferentes marcadores bioquímicos, mas apenas a relação do IMC com ALT foi dependente do hábito alimentar e observada exclusivamente em mulheres que não menstruavam: esta foi menor em veganas (p = 0,0099). Na análise realizada apenas com indivíduos obesos (IMC ³ 30 kg/m2), foram observadas menores concentrações de GGT e ferritina em indivíduos vegetarianos do que em onívoros, independente de sexo e perda menstrual de sangue (p £ 0,0395). Na avaliação dos níveis de HOMA-IR, observamos maior elevação em homens do que em mulheres (p=0,0173), sem diferenças entre os tipos de dietas. Conclusões: Apenas mulheres que menstruam parecem ter maior risco de deficiência de ferro quando adotam uma dieta vegetariana. Nossos dados sugerem que tanto indivíduos vegetarianos quanto onívoros podem apresentar alterações de parâmetros metabólicos frente ao ganho de peso. Entretanto, na condição de obesidade, indivíduos vegetarianos parecem ser protegidos do desenvolvimento das morbidades associadas ao excesso de peso, ao apresentarem níveis comparativamente menos elevados de GGT e Ferritina.
- ItemAcesso aberto (Open Access)Avaliação da espessura do complexo médio-intimal da carótida em pacientes com ataxia telangiectasia: associação com biomarcadores relacionados ao metabolismo lipídico e da glicose(Universidade Federal de São Paulo (UNIFESP), 2015-06-26) Paulino, Talita Lemos [UNIFESP]; Sarni, Roseli Oselka Saccardo [UNIFESP]; Costa-Carvalho, Beatriz Tavares [UNIFESP]; http://lattes.cnpq.br/1072990929102111; http://lattes.cnpq.br/1760819469047929; Universidade Federal de São Paulo (UNIFESP)Introdução: A ataxia telangiectasia (A-T) é uma doença neurodegenerativa, que cursa com imunodeficiência em graus variáveis, disfunção mitocondrial e estresse oxidativo. Descobertas recentes incluem como fenótipo estendido da doença outras alterações como a resistência à insulina e o risco para o desenvolvimento de diabetes e doenças ateroscleróticas. Objetivo: Avaliar a espessura médio-intimal da carótida e correlacioná-la com biomarcadores do metabolismo lipídico e da glicose em pacientes com A-T. Métodos: Estudo transversal prospectivo e controlado que avaliou 18 pacientes e 17 controles, pareados por sexo, idade e estadiamento puberal, quanto ao estado nutricional, perfil lipídico, apolipoproteínas A-I e B (Apo A-I e Apo B), glicemia e insulinemia basais e após sobrecarga oral de glicose e aferiu a medida da espessura do complexo médio-intimal (CMI) da carótida. Resultados: A mediana de idade do grupo A-T foi de 13,1 anos; 6/18 (33%) eram desnutridos, 3/13 (23,1%) apresentavam baixa estatura para idade e 10/18 (55,5%) comprometimento da massa muscular. Foi observado dislipidemia em 10/18 (55,5%) dos pacientes, no entanto, apenas para o HDL-c foi constatada diferença significante entre os dois grupos (p=0,020). No grupo A-T 1/18 (5,5%) era diabético, 2/11 (18,2%) apresentavam intolerância à glicose e 5/11 (41,2%) resistência à insulina. Na análise bivariada o índice de massa corporal (IMC) e as concentrações de glicemia de jejum foram menores, e as de Apo B e da relação Apo B/ApoA-I foram maiores no grupo A-T. No entanto, na análise multivariada somente o IMC e a relação Apo B/Apo A-I permaneceram no modelo. A mediana da espessura do CMI da carótida apresentou correlação com as relações Apo B/Apo A-I, LDL-c/HDL-c e com a Apo B. A ingestão de energia, macronutrientes e colesterol não diferiu entre os grupos. Conclusão: Pacientes com A-T apresentam risco de aterosclerose e de diabetes que aliado ao comprometimento do estado nutricional pode complicar a evolução da doença.
- ItemEmbargoAvaliação da memória do tipo episódica no modelo experimental da Doença de Alzheimer em animais tratados com Extrato Padronizado de Ginkgo biloba(Universidade Federal de São Paulo, 2022-07-25) Santana, Jacqueline Gonçalves [UNIFESP]; Cerutti, Suzete Maria [UNIFESP]; http://lattes.cnpq.br/9076343601956182; http://lattes.cnpq.br/8498816936418638A memória é um mecanismo biológico fundamental para a vida dos animais e seres humanos, vida em sociedade, tomada de decisões e, no caso de humanos, manter nossa individualidade. A doença de Alzheimer (DA) é caracterizada pelo comprometimento da formação e codificação de novas memórias prejudicando, de maneira precoce, as memórias episódicas. Estudos corroboram que o Diabetes Mellitus pode estar relacionado como um fator de risco para Doença de Alzheimer. Nosso grupo vem demonstrando a capacidade modulatória de substâncias isoladas e/ou compostas, derivadas de plantas, como o extrato padronizado de Ginkgo biloba (EGb) na formação e evocação de memórias de curto e de longo prazo, do tipo episódica. Este estudo avaliou o efeito do tratamento crônico com diferentes doses de EGb (0.25, 0.5 e 1.0 g/kg) na memória de curto e de longo prazo em ratos adultos jovens no modelo da doença de Alzheimer induzido por meio da injeção intracerebroventricular de estreptozotocina (STZ). Foram utilizados ratos Wistar machos de 3-4 meses de idade (pesando 300-350 g) submetidos à tarefa de esquiva discriminativa no labirinto em cruz elevado (do inglês, PM-DAT), que avalia ao mesmo tempo, memória do tipo episódica aversiva, comportamentos do tipo ansioso e atividade motora espontânea. A formação de memória foi avaliada por meio da porcentagem de tempo e de entradas no braço fechado aversivo no treino (short-term memory, STM) e, 24 horas depois, no teste (Long-term memory). Os comportamentos de ansiedade foram avaliados pelo tempo de permanência e porcentagem de tempo no braço aberto, associados a comportamentos de autolimpeza, elevações e de avaliação de risco. Os dados demonstram que a STZ não causou déficit de memória de curto prazo avaliada, entretanto, os dados do teste mostram uma preferência dos animais pelo braço fechado aversivo em relação ao braço fechado não aversivo, o que sugere déficit de memória de longo prazo. O tratamento com EGb na dose de 0,25 g/kg após a injeção de STZ teve um efeito positivo revertendo o déficit de memória verificado. Os dados ainda mostram que o tratamento com EGb, nas três doses (0.25, 0.5 e 1.0 g/kg) reduziram os comportamentos do tipo ansioso
- ItemAcesso aberto (Open Access)Avaliação do risco cardiovascular de pais de pacientes com ataxia telangiectasia(Universidade Federal de São Paulo (UNIFESP), 2016-11-28) Kotchetkoff, Elaine Cristina de Almeida [UNIFESP]; Sarni, Roseli Oselka Saccardo [UNIFESP]; http://lattes.cnpq.br/1760819469047929; http://lattes.cnpq.br/6291344918359532; Universidade Federal de São Paulo (UNIFESP)Introduction: Ataxia telangiectasia (A-T) is a rare neurodegenerative disease, which attends with immunodeficiency in several levels, with mitochondrial dysfunction and oxidative stress. As it is a recessive autosomal disease, patient?s parentes with A-T are carriers of its mutation. Researches suggest that A-T heterozygotes individuals presente higher risk to develop illness. Objective: Objective of the present study was to evaluate the carotid intima-media thickness (IMT) and lipid metabolism biomarkers associated to the cardiovascular in patient?s parentes and verify association to its gender. Methods: A cross-sectional and controlled study involving 29 A-T patients? parentes and 14 healthy controls, paired by gender and age. It was evaluated: lipid profile, apolipoproteins AI and B (Apo AI and Apo B), paraoxonase 1 (PON1), Interleukin 6 (IL-6), glycemia, C-reactive protein ultrasensitive (hs-CRP) and IMT through ultrasound. Results: The average of IMT measure in A-T patient?s parent´s group was 0.72 ± 0.01 mm (minimum: 0.5 mm and maximum: 1.0 mm). Noticed high percentage of amounts above 75 percentile compared to the population referential [16 (76.2%)], without any significant statistics diferences between feminine and masculine gender [11/15 (73.3%) vs 5/6 (83.3%); P = 0.550]. Comparison between the A-T patients? parents and controls, stratified by gender, showed that in the group of A-T patients?s parentes, women had higher HDL-c levels compared to men, and higher hs-CRP related to women control group. In the group of A-T patients? parents, stratified according to gender, correlation between HDL-c and hs-CRP was inversely proportional and stronger among women, with tendency to statistical significance. Conclusion: heterozygotes ATM did not differ from controls in relation to biomarkers studied associated with cardiovascular risk, however, most of them presented na increase in IMT, independente predictor of death and risk for myocardial infarction and stroke compared to the reference for the same age group. This finding suggests a cardiovascular risk in the heterozigous ATM and points to the need to monitor IMT and nutricional orientations and stimulate the practice of physical activity.
- ItemAcesso aberto (Open Access)Bases Genéticas do Diabetes Mellitus Tipo 2(Sociedade Brasileira de Endocrinologia e Metabologia, 2002-08-01) Reis, André Fernandes [UNIFESP]; Velho, Gilberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The pathogenesis of type 2 diabetes mellitus (T2DM) is complex, but it is secondary to a combination of insulin resistance and pancreatic beta-cell dysfunction that manifests itself as inadequate insulin secretion in the face of hyperglycemia. Several studies have established a clear genetic predisposition for T2DM. Some genes for monogenic forms of diabetes have been identified (MODY, mitochondrial diabetes). However, few genes were found to be associated with diabetes in the more common forms of T2DM. In these T2DM forms, a variety of environmental factors play a major role in the clinical expression of disease. This article addresses the clinical and genetic advances in the genetic bases of T2DM.
- ItemSomente MetadadadosBMI gain and insulin resistance among school-aged children: a population-based longitudinal study in the Brazilian Amazon(Cambridge Univ Press, 2014-12-14) Lourenco, Barbara H.; Gimeno, Suely G. A. [UNIFESP]; Cardoso, Marly A.; ACTION Study Team; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Investigation of the determinants of metabolic outcomes associated with non-communicable diseases is increasingly important in developing countries, but such parameters have not been explored extensively during childhood. the present study assessed the impact of weight gain, measured as BMI-for-age Z-scores, on glucose and insulin concentrations, homeostasis model assessment index of insulin resistance (HOMA-IR) values, and systolic and diastolic blood pressure during school years among Amazonian children. A population-based prospective study of 696 children aged >4 to <= 10 years with complete anthropometric information at baseline (51% females and 86% of mixed race) was carried out; 411 children had data on metabolic parameters after a median follow-up period of 2.0 years (range 1.7-2.6 years). During follow-up, there was a significant increase in the proportion of overweight children (BMI-for-age Z-score >1) from 10.1 to 15.8% (P = 0.003). in linear regression models adjusted for the child's sex, age, race/ethnicity, baseline household wealth, birth weight and pubertal development stage, for each unit of BMI-for-age Z-score variation during follow-up, an increase of 8.58 (95% CI 7.68, 9.60) pmol/l in fasting plasma insulin concentrations and 1.47 (95% CI 1.30, 1.66) in HOMA-IR values was observed. There was no significant impact of weight gain on glucose concentrations and systolic and diastolic blood pressure. in conclusion, we found evidence that an increase in BMI during a 2-year period affected insulin resistance during school years. Considering the significant increase in overweight in this age group, special attention should be paid to monitoring increases in BMI in children from the Brazilian Amazon.
- ItemAcesso aberto (Open Access)Body trunk fat and insulin resistance in post-pubertal obese adolescents(Associação Paulista de Medicina - APM, 2008-03-01) Santos, Luana Caroline dos; Cintra, Isa de Pádua [UNIFESP]; Fisberg, Mauro [UNIFESP]; Martini, Lígia Araújo; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)CONTEXT AND OBJECTIVE: Insulin resistance is a metabolic disorder commonly associated with excess body fat accumulation that may increase chronic disease risk. The present study was undertaken to evaluate the relationship between body composition and insulin resistance among obese adolescents. DESIGN AND SETTING: Cross-sectional study, at the Adolescence Center, Pediatric Department, Universidade Federal de São Paulo (UNIFESP). METHODS: Body composition was assessed using dual-energy X-ray absorptiometry. Dietary intake was evaluated using a three-day dietary record. The biochemical evaluation comprised glucose, insulin, serum lipid, leptin and ghrelin measurements. Insulin resistance was calculated by means of the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Forty-nine post-pubertal obese adolescents participated in the study: 12 boys and 37 girls of mean age 16.6 (1.4) years and mean body mass index (BMI) of 35.0 (3.9) kg/m². The mean glucose, insulin and HOMA values were 90.3 (6.4) mg/dl, 16.6 (8.1) µIU/ml and 3.7 (1.9), respectively. Hyperinsulinemia and insulin resistance were observed in 40.2% and 57.1% of the subjects, respectively. Adolescents with insulin resistance had higher BMI and body trunk fat. There was a trend towards higher leptin concentration in obese individuals with insulin resistance. Insulin resistance was positively correlated with body trunk fat, BMI, body fat mass (kg), leptin and body fat percentage. Furthermore, there was a negative correlation between HOMA-IR and lean body mass. The body composition predicted 30% of the HOMA-IR levels, according to linear regression models. CONCLUSION: Body trunk fat was significantly associated with insulin resistance, demonstrating the clinical importance of abdominal obesity during adolescence.
- ItemAcesso aberto (Open Access)Comparação de três tipos de treinamento físico sobre o controle do perfil antropométrico, metabólico e inflamatório de adolescentes obesos submetidos à terapia interdisciplinar de longo prazo(Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Inoue, Daniela Sayuri [UNIFESP]; Dâmaso, Ana Raimunda [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The physical training associated with interdisciplinary therapy is an important tool to obesity control. However, it‟s not clear if the type of exercise and its periodization can influence this pathology control. Therefore, the present study compared the effectiveness of three types of exercise training on obesity control related with anthropometric, metabolic and inflammatory profile in adolescents submitted to a long-term interdisciplinary therapy. Forty-five post-puberty obese adolescents (16.28 ± 1.34y) were randomized in three groups according to exercise training: predominantly aerobic training group (AT n=20), aerobic plus resistance training with linear periodization (LP n=13) and aerobic plus resistance training with daily undulating periodization (DUP n=12). The body composition was evaluated by air-displacement plethysmography and the serum analysis was collected after an overnight fast. Results: The most important finding of this study was that both LP and DUP groups improved total cholesterol (LP=164.4±8.5 to 149.8±8.9; DUP= 167.8±5.9 to 149.7± 5.3), LDL-c (LP=105.1±7.3 to 91.7±6.8; DUP 108.5±6 to 90.3±5.6), HOMA-IR (LP=3.5±0.4 to 1.8±0.2; DUP=4.2±2.1 to 2.1±0.4), insulin (LP=15.7±1.6 to 8.5±1.1; DUP=19.5±2.1 to 10.5±1.7) and adiponectin concentration (LP=10±1.7 to 12.5±1; DUP=8.6±2.7 to12.4±1). The linear regression showed a negative association (β=-0.45) between delta (%) adiponectin and delta (%) insulin (p<0.05). All exercise groups presented a significant reduction in body mass (AT= 99.7±3.8 to 90.6±3; LP=99.4±3.8 to 88.5±3.2; DUP=107.9±3.3 to 91.5±3.3), BMI (AT=35.1±0.9 to 31.8±1.1; LP=36.4±1.6 to 32.2±1.3; DUP= 38.2±1.3 to 32.1±1.5) fat mass (Kg) (AT=40±1.7 to 32.5±2.1; LP=45.7±3.3 to 33.3±2.8; DUP=50.3±3.1 to 32.4±4.3) after short and long-term intervention. There was a negative correlation between percentage of protein oxidation and RMR (r=-0.75) in all groups. Conclusion: The interdisciplinary therapy models that include aerobic plus resistance training was more effective than aerobic training to improve lipid profile and insulin sensitivity, as well as inflammatory state by increasing adiponectin. In all groups it was observed an improvement on anthropometric profile.
- ItemAcesso aberto (Open Access)Consequências metabólicas na SAOS não tratada(Sociedade Brasileira de Pneumologia e Tisiologia, 2010-06-01) Carneiro, Glaucia [UNIFESP]; Fontes, Francisco Hora; Togeiro, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Escola Federal de Medicina de Salvador Departamento de Clínica MédicaThere is a recognized association between obstructive sleep apnea syndrome and metabolic syndrome, designated syndrome Z. The criteria for metabolic syndrome include at least three of the following factors: central obesity (waist circumference > 102 cm for males and > 88 cm for females); triglycerides > 150 mg/dL; HDL cholesterol < 40 mg/dL for males and < 50 mg/dL for females; arterial blood pressure > 130/85 mmHg; and fasting glucose > 100 mg/dL. Central obesity is associated with OSAS and metabolic syndrome, and there is evidence that obstructive sleep apnea is an independent risk factor for obesity, glucose intolerance and insulin resistance. The implied mechanisms result from the activation of the sympathetic nervous system and of the hypothalamus-hypophysis-adrenal axis; activation of pro-inflammatory markers, such as IL-6 and TNF-α; and the reduction in adiponectin levels, principally triggered by intermittent hypoxemia related to apnea. Despite such evidence, the results are controversial regarding the benefits of treating sleep apnea with CPAP in the presence of these metabolic alterations. In addition, the few studies that have addressed sleep apnea as a risk factor for dyslipidemia have presented conflicting results. Population-based, longitudinal controlled studies are necessary in order to elucidate the interaction between sleep apnea and metabolic consequences so that these individuals are properly treated.
- ItemAcesso aberto (Open Access)Consumo alimentar dos portadores de Doença Hepática Gordurosa Não Alcoólica: comparação entre a presença e a ausência de Esteatoepatite Não Alcoólica e Síndrome Metabólica(Núcleo de Editoração SBI, 2016) Crispim, Fany Govetri Sena [UNIFESP]; Elias, Maria Cristina [UNIFESP]; Parise, Edison Roberto [UNIFESP]Objetivo - O objetivo desse estudo foi avaliar o consumo alimentar de portadores de Doença Hepática Gordurosa Não Alcoólica, comparar com as recomendações nutricionais diárias e analisar a correlação da dieta com a presença de Síndrome Metabólica e com a gravidade da doença, uma vez que estudos sobre os hábitos alimentares dos portadores de Doença Hepática Gordurosa Não Alcoólica ainda são escassos na literatura. Métodos - Nesse estudo foram avaliados, inicialmente, 158 pacientes com diagnóstico de Doença Hepática Gordurosa Não Alcoólica. Analisou-se exames laboratoriais, biópsia hepática, dados antropométricos e consumo dietético (registro alimentar de três dias). Dentre os pacientes avaliados, alguns já haviam sido orientados nutricionalmente e foram divididos em dois grupos: "sem dieta" e "com dieta". Para o cálculo de comparações de médias entre os grupos estudados, empregou-se o teste t de Student, considerando o nível de significância de 5% (a£0,05). Resultados - Do total inicial de participantes, 59 apresentavam modificação significativa da dieta a partir de alguma orientação nutricional prévia e, por isso, foram excluídos da análise. Dos 99 pacientes restantes, quando confrontados com a ingestão dietética recomendada, 26% apresentavam maior ingestão energética e 80%, de ácidos graxos saturados, além de deficiente ingestão de ácidos graxos poli-insaturados e monoinsaturados, fibras e vitamina E, confirmando estudos prévios nessa mesma população. Entretanto, não foram encontradas diferenças significativas na dieta desses pacientes quando divididos de acordo com a presença ou ausência de Síndrome Metabólica e Esteatoepatite Não Alcoólica. Conclusão - Esses dados, à luz dos conhecimentos atuais, sugerem que a dieta, especialmente quando rica em ácidos graxos saturados e deficiente em fibras e vitaminas antioxidantes, pode ter importante papel no aparecimento da Doença Hepática Gordurosa Não Alcoólica, mas que outros fatores exercem papel mais relevante na sua progressão para a Esteatoepatite Não Alcoólica.
- ItemAcesso aberto (Open Access)Consumo alimentar dos portadores de Doença Hepática Gordurosa Não Alcoólica: comparação entre a presença e a ausência de Esteatoepatite Não Alcoólica e Síndrome Metabólica(Pontificia Universidade Catolica Campinas, 2016) Sena Crispim, Fany Govetri [UNIFESP]; Elias, Maria Cristina [UNIFESP]; Parise, Edison Roberto [UNIFESP]Objective The objective of this study was to assess the food intake of individuals with Nonalcoholic Fatty Liver Disease, compare it with daily nutritional recommendations, and analyze whether diet correlates with the presence of Metabolic Syndrome and disease severity, because studies about the food habits of these individuals are still scarce in the literature. Methods Initially, this study assessed 158 patients diagnosed with Nonalcoholic Fatty Liver Disease. Laboratory tests, liver biopsy, anthropometric data, and food intake (determined by the three-day food record) were analyzed. Some study patients had already received dietary advice, so the sample was divided into two groups, one "without dietary advice" and another "with dietary advice". The Student's t-test compared the means between the groups at a significance level of 5% (alpha <= 0.05). Results Of the initial sample, 59 patients changed their diet significantly after receiving dietary advice, so they were excluded from the analysis. The other 99 patients consumed 26% more energy and 80% more saturated fatty acids than recommended and presented low intake of polyunsaturated and monounsaturated fatty acids, fibers, and vitamin E, confirming previous studies in this same population. However, the diets of these patients did not differ significantly by presence or absence of Metabolic Syndrome or Nonalcoholic Steatohepatitis. Conclusion In light of current knowledge, these data suggest that diet, especially when high in saturated fatty acids and low in fiber and antioxidant vitamins, can play an important role in the onset of Nonalcoholic Fatty Liver Disease, but other factors play a more important role in its progression to Nonalcoholic Steatohepatitis.
- ItemAcesso aberto (Open Access)Consumo alimentar dos portadores de doença hepática gordurosa não alcoólica: comparação entre a presença e ausência de síndrome metabólica e a gravidade da doença(Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Crispim, Fany Govetri Sena [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To evaluate the dietary intake of subjects with nonalcoholic fatty liver disease (NAFLD) and compare with recommended dietary intake, presence and absence of metabolic syndrome (MS) and disease severity (presence and absence of nonalcoholic steatohepatitis). Methods: We first evaluated 158 patients with a diagnosis of NAFLD by clinical examination, histological analysis, anthropometry (weight, height, BMI, waist circumference) and dietary intake (3 days food record) with analysis of protein, carbohydrates and lipids, including saturated fatty acids (SFA), monounsaturated (MUFA), polyunsaturated (PUFA) and cholesterol, micronutrients (vitamins A, C and E) and total dietary fiber. Of these, 59 presented dietary changes as a result of previous nutritional instruction and were excluded from the analysis. Results: Among the remaining 99 patients, when compared to the recommended dietary intake, we observed a higher intake of cholesterol and saturated fatty acids in 59,5% and 87,8%, respectively, in addition to deficient ingestion of mono- and polyunsaturated fatty acids, fibers, and vitamin E in 98,9 %, 76,7%, 64,6% and 68,6% of these patients, respectively. These findings agree with previous studies involving this population. No significant differences in diet were observed when these patients were divided according to the presence or absence of metabolic syndrome and nonalcoholic steatohepatitis (NASH). Conclusions: In this study, we observed that individuals with NAFLD presented inadequate intake of MUFA, PUFA, vitamin E and fiber and excessive consumption of SFA and cholesterol. However, no significant differences were found in diet of these patients when divided according to presence or absence of MS and NASH.
- ItemAcesso aberto (Open Access)Cranial radiotherapy predisposes to abdominal adiposity in survivors of childhood acute lymphocytic leukemia(Biomed Central Ltd, 2013-02-21) Siviero-Miachon, Adriana Aparecida [UNIFESP]; Spinola-Castro, Angela Maria [UNIFESP]; Lee, Maria Lucia de Martino; Andreoni, Solange [UNIFESP]; Geloneze, Bruno; Lederman, Henrique [UNIFESP]; Guerra-Junior, Gil; Universidade Federal de São Paulo (UNIFESP); IOP GRAACC; Universidade Estadual de Campinas (UNICAMP)Background: Advances in treatment of acute lymphocytic leukemia increased the likelihood of developing late treatment-associated effects, such as abdominal adiposity, increasing the risk of cardiovascular disease in this population. Cranial radiotherapy is one of the factors that might be involved in this process. the aim of this study was to determine the effect of cranial radiotherapy on adiposity indexes in survivors of acute lymphocytic leukemia.Methods: A comparative cross-sectional study of 56 acute lymphocytic leukemia survivors, chronological age between 15 and 24 years, assigned into two groups according to the exposure to cranial radiotherapy (25 irradiated and 31 non-irradiated), assessed according to body fat (dual energy X-ray absorptiometry), computed tomography scan-derived abdominal adipose tissue, lipid profile, and insulin resistance.Results: Cranial radiotherapy increased body fat and abdominal adipose tissue and altered lipid panel. Yet, lipids showed no clinical relevance so far. There were significantly more obese patients among those who received cranial radiotherapy (52% irradiated versus 22.6% non-irradiated), based on dual energy X-ray absorptiometry body fat measurements. Nonetheless, no association was observed between cranial radiotherapy and body mass index, waist circumference, waist-to-height ratio or insulin resistance.Conclusions: Adolescent and young adult survivors of childhood acute lymphocytic leukemia showed an increase in body fat and an alteration of fat distribution, which were related to cranial radiotherapy. Fat compartment modifications possibly indicate a disease of adipose tissue, and cranial radiotherapy imports in this process.
- ItemSomente MetadadadosDesenvolvimento de um método imuno-enzimático para detecção de anticorpos anti-insulina(Universidade Federal de São Paulo (UNIFESP), 1987) Moises, Regina Celia Mello Santiago [UNIFESP]; Russo, Ewaldo Mario Kuhlmann [UNIFESP]