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- ItemSomente MetadadadosCalcium intake and its relationship with adiposity and insulin resistance in post-pubertal adolescents(Wiley-Blackwell, 2008-04-01) Santos, L. C. dos; Cintra, I. de Padua [UNIFESP]; Fisberg, M. [UNIFESP]; Martini, L. A.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Background Dietary calcium intake has been described as being a negative contributor to adiposity. in adolescents, this relationship is not well established. the objectives of the present study were to compare the calcium intake of normal-weight and obese adolescents and to evaluate its relationship with adiposity and insulin resistance.Methods A cross-sectional analysis of 96 post-pubertal adolescents; 47 normal weight and 49 obese, mean age 16.6 (SD +/- 1.3) years. Body composition was assessed by dual-energy X-ray absorptiometry. Dietary intake was evaluated using a 3-day dietary record. the biochemical evaluation comprised the measurements of serum lipids, lipoproteins, glucose and insulin. Insulin resistance was calculated using the Homeostasis Model Assessment of Insulin resistance (HOMA-IR).Results the mean calcium intake, adjusted for energy, was lower in obese adolescents, 585.2 (+/- 249.9) mg, than in normal weight adolescents, 692.1 (+/- 199.5) mg. Only 4% of adolescents had an adequate intake of calcium. Calcium intake was inversely associated with body trunk fat, insulin and HOMA-IR in the obese group. the quartile analysis of calcium intake provided evidence that girls in the highest quartile had decreased adiposity and insulin resistance.Conclusions This study showed a negative relationship between calcium intake and body fat and insulin resistance, mainly in obese girls, and demonstrates the importance of an increased dietary calcium intake.
- ItemSomente MetadadadosCan the Insulin Sensitivity Index (ISI) in Association with Insulin-like Growth Factor Binding Protein-1 Identify Insulin Resistance Early in Overweight Children?(Walter De Gruyter Gmbh, 2009-04-01) Malaquias, Alexsandra C.; Bezzan, Paula C.; Montenegro, Renan; Daneluzzi, Julio C.; Ricco, Rubens G.; Del Ciampo, Luis A.; Ferraz, Ivan S.; Elias, Jorge; Martinelli, Ana L. C.; Martinelli, Carlos E.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Association between insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) has been reported. This prompted us to evaluate the power of the insulin sensitivity index (ISI) in association with IGFBP-1 to identify IR early in obese children/adolescents. OGTT was performed in 34 obese/overweight children/adolescents. Glucose, insulin and IGFBP-1 were measured in serum samples and ISI was calculated. Considering the presence of three or more risk factors for IR as a criterion for IR, ISI <4.6 showed 87.5% sensitivity and 94.5% specificity in diagnosing IR. IGFBP-1 was lower in the group with ISI <4.6 (p <0.01). In this group, three patients had higher than expected IGFBP-1, suggesting hepatic IR, while three patients with ISI >4.6 showed very low IGFBP-1 levels. Conclusion: ISI <4.6 is a good indicator of early peripheral IR and, associated with IGFBP-1, can identify increased risk of hepatic IR. Low IGFBP-1 levels among non-IR children may indicate increased portal insulin levels.
- ItemAcesso aberto (Open Access)Doença hepática gordurosa não alcoólica em escolares obesos(Sociedade de Pediatria de São Paulo, 2008-06-01) Souza, Fabíola Isabel S.; Amancio, Olga Maria Silverio [UNIFESP]; Sarni, Roseli Oselka Saccardo [UNIFESP]; Pitta, Tassiana Sacchi; Fernandes, Ana Paula; Fonseca, Fernando Luiz Affonso [UNIFESP]; Hix, Sonia; Universidade Federal de São Paulo (UNIFESP); Faculdade de Medicina do ABCOBJECTIVE: To evaluate the prevalence of altered hepatic ultrasound and elevated serum alanine aminotransferase (ALT) in overweight and obese children, as well as to relate them to lipid peroxidation, lipid profile and insulin resistance. METHODS: A prospective, controlled, cross-sectional study was performed with 67 overweight and obese children (38 female, mean age of 8,6 years) paired by gender and age with 65 eutrophic controls. The following parameters were evaluated: lipid profile (LDL-c, HDL-c, triglycerides), ALT, lipid peroxidation measured by thiobarbituric acid reaction substance (TBARS), serum glucose and insulin resistance (Homeostasis Model Assessment). Hepatic steatosis was evaluated by ultrasound by a single professional and classified as diffuse mild, moderate or severe. RESULTS: Elevated ALT (>40 U/L) was observed in 3% and altered ultrasound in 57.4% of the overweight/obese children. Obese/overweight children showed a higher percentage of ALT >18 U/L (OR 4.2, p=0.0006) and hypertriglyceridemia (OR 4.2, p<0.001). ALT was associated with elevated triglycerides (OR 3,2; p=0,010). There was not association between TBARS (oxidative stress) or HOMA-IR with the presence of overweight/obesity or ALT >18 U/L. CONCLUSIONS: The frequency of altered ALT (>40U/L) was low and of altered hepatic ultrasound was high. There was no association between fatty liver at ultrasound with nutritional status or ALT levels. Elevated triglycerides were associated with higher levels of ALT.
- ItemAcesso aberto (Open Access)Early and current physical activity: relationship with intima-media thickness and metabolic variables in adulthood(Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia, 2014-10-01) Lima, Manoel C. S.; Barbosa, Maurício F.; Diniz, Tiego A.; Codogno, Jamile S.; Freitas Júnior, Ismael F.; Fernandes, Rômulo A.; Universidade Estadual Paulista (UNESP); Universidade Federal de São Paulo (UNIFESP)Background:It is unclear whether early physical activity has a greater influence on intima-media thickness and metabolic variables than current physical activity.Objective: To analyze the relationship between current and early physical activity, metabolic variables, and intima-media thickness measures in adults.Method: The sample was composed of 55 healthy subjects of both sexes (33 men and 22 women). Total body fat and trunk fat were estimated by dual-energy X-ray absorptiometry. Carotid and femoral intima-media thickness were measured using a Doppler ultrasound device. A 12-hour fasting blood sample collection was taken (fasting glucose and lipid profile). Early physical activity was assessed through face-to-face interview, and the current physical activity was assessed by pedometer (Digi-Walker Yamax, SW200), which was used for a period of seven days.Results: Current physical activity was negatively related to total cholesterol (rho=-0.31), while early physical activity was negatively related to triglycerides (rho=-0.42), total cholesterol (rho=-0.28), very low density lipoprotein (rho=-0.44), and carotid intima-media thickness (rho=-0.50). In the multivariate model, subjects engaged in sports activities during early life had lower values of very low density lipoprotein (b=-8.74 [b=-16.1; -1.47]) and carotid intima-media thickness (b=-0.17 [95%CI: -0.28; -0.05]).Conclusion: Early 95%CI physical activity has a significant influence on carotid intima-media thickness, regardless of the current physical activity.
- ItemAcesso aberto (Open Access)Efeito da associação entre obesidade neuroendócrina e exócrina experimental sobre a pressão arterial de cauda e o metabolismo de glicose de ratos Wistar(Sociedade Brasileira de Nefrologia, 2010-06-01) Pastore, Andréa Paula [UNIFESP]; Cesaretti, Mario Luis Ribeiro [UNIFESP]; Ginoza, Milton [UNIFESP]; Voltera, Aline Francisco [UNIFESP]; Kohlmann Junior, Osvaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); PUC-SPOBJECTIVE: To study two different models of obesity, exocrine and endocrine, and its association on tail arterial pressure (TAP), body weight (BW), glucose metabolism and visceral fat content. METHODS: Male Wistar rats were studied. The MSG group was composed by rats that received of MSG in neonatal period. At the 3rd month of life, part of these animals received cafeteria diet. Animals received saline control in the neonatal period. In the 12 weeks of study, body weight and blood pressure were measured twice a week. In the end of this period on, Oral Glucose Tolerance Test (OGTT) was performed and the Insulin Sensitivity Index (ISI) was calculated, also the left Relative Ventricular Weight (RLW) and Relative Epididimal Fat Weight (REFW) were obtained. RESULTS: No changes on BW and TAP were verified. The obesity induced by MSG and CAF, individually, let to increases on insulin resistance (WST = 23,25 ± 9,31; CAF = 15,92 ± 9,10*; MSG = 13,41 ± 3,84* mg-1mU-1, p < 0,05 vs WST) and relative epididimal fat content (WST = 6,20 ± 0,57; CAF = 8,27 ± 1,53*; MSG = 8,23 ± 1,98* g/100 g, *p < 0,05) when these rats were compared to control rats. An enhanced effect upon these parameters was observed with the association of both obesity models (MSG+CAF = 9,34 ± 5,77 mg-1mU-1, p < 0,05 vs MSG and CAF) and visceral fat content (MSG+CAF = 11,12 ± 3,85 g/100g, p < 0,05 vs MSG and CAF). CONCLUSION: The association of these two experimental models of obesity aggravates insulin resistance that probably is due at least in part to the increase of visceral fat content.
- ItemAcesso aberto (Open Access)Efeitos da suplementação de potássio via sal de cozinha sobre a pressão arterial e a resistência à insulina em pacientes obesos hipertensos em uso de diuréticos(Pontifícia Universidade Católica de Campinas, 2005-02-01) Pereira, Maria Alice De Gouveia [UNIFESP]; Galvão, Roberto [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The objectives of the present study were to evaluate the effects of oral potassium supplementation, associated with a hypocaloric diet and aerobic exercises, on plasma potassium levels, blood pressure and insulin resistance, in centrally obese, not well controlled hypertensive patients on diuretic therapy; waist to hip ratio >0.85 in women, and >0.95 in men; systolic blood pressure >140mmHg and <160mmHg and/or diastolic blood pressure >90mmHg and <105mmHg. METHODS: This was a prospective double-blind randomized study including 22 patients divided in 2 groups: sodium chloride n=10, and potassium chloride n=12. For 12 weeks, each group received cooking salt containing, either 100% sodium chloride, or 50% sodium chloride and 50% potassium chloride. All patients were submitted to a hypocaloric diet and advised to increase their physical activity; a 40-minute walk three times a week. Before and after the study period, all patients were submitted to determinations of body mass index, body composition, waist circumference, sodium and potassium urinary excretions, sodium and potassium serum levels, 24h ambulatory blood pressure monitoring, oral glucose tolerance test with serum insulin measurements at fasting and 120 minutes after glucose load, and serum lipid profile. RESULTS: In both groups, no changes were observed in serum sodium and potassium levels, in blood glucose and insulin levels, insulin resistance indexes and serum lipid profile. The body mass index decreased similarly in both groups; 3.5±2.0% in sodium Chloride, and 2.7±3.2% in Potassium Chloride, as well as 24 h systolic ambulatory blood pressure monitoring mean; from 134.7 ±14.8 to 130.2±12.6mmHg (p<0.05) in group sodium chloride, and from 128.2±7.4 to 122.9±5.7mmHg (p<0.05) in potassium, and 24h diastolic ambulatory blood pressure monitoring from 84.4±10.2 to 81.4 ± 8.9mmHg in sodium chloride, and from 84.0±5.7 to 79.5±3.9mmHg (p<0.05) in group potassium (p<0.05). Changes in 24h systolic ambulatory blood pressure monitoring correlated with changes in the waist circumference, but not with changes in bory mass index when all patients were analyzed together. Serum lipid profile, blood glucose levels and insulin resistance indexes did not differ between groups and did not change during the study. CONCLUSION: Weight reduction induced by life style changes, promotes reductions in blood pressure, which are proportional to reductions in abdominal fat. Potassium supplementation through cooking salt was insufficient to avoid serum potassium falling during diuretic therapy and did not show any additional beneficial effect on blood pressure or insulin resistance in hypertensive patients with central obesity.
- ItemSomente MetadadadosEffects of fluvastatin on insulin resistance and cardiac morphology in hypertensive patients(Nature Publishing Group, 2011-08-01) Teixeira, A. A. [UNIFESP]; Buffani, A. [UNIFESP]; Tavares, A. [UNIFESP]; Ribeiro, A. B. [UNIFESP]; Zanella, M. T. [UNIFESP]; Kohlmann, O. [UNIFESP]; Batista, M. C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Among hypertensive patients, cardiovascular disease morbidity is common, even in those who are adequately treated. New pharmacological strategies to mitigate the burden of arterial hypertension are needed. This 12-month, randomized, double-blind placebo-controlled study investigated the effect of statin (fluvastatin) treatment on ambulatory blood pressure (ABP), exercise blood pressure (EBP), myocardial structure, endothelial function and insulin resistance in 50 hypertensive patients. At baseline, the groups were comparable in terms of demographic characteristics, ABP, EBP, endothelial function and homeostasis model assessment of insulin resistance (HOMA-IR). At the end of the study, there was no difference between groups in terms of resting systolic blood pressure. However, maximum systolic EBP was lower in the treatment group than in the placebo group (175 +/- 18 vs 192 +/- 23 mm Hg, P<0.05), as was left ventricular mass index (LVMI; 82 +/- 15 vs 100 +/- 23, P<0.05), and HOMA-IR index was lower after fluvastatin treatment (2.77 +/- 1.46 vs 3.33 +/- 1.73, P<0.05). Changes in lipid profile were not correlated with blood pressure, endothelial function, LVMI or HOMA-IR data. in hypertensive patients, fluvastatin can improve maximum systolic EBP, myocardial remodelling and insulin resistance, independently of lipid profile variations and endothelial function. Journal of Human Hypertension (2011) 25, 492-499; doi: 10.1038/jhh.2010.87; published online 9 September 2010
- ItemSomente MetadadadosEffects of sibutramine on abdominal fat mass, insulin resistance and blood pressure in obese hypertensive patients(Blackwell Publishing Ltd, 2005-05-01) Faria, A. N.; Ribeiro Filho, F. F.; Kohlmann, N. E.; Gouvea Ferreira, SR; Zanella, M. T.; Universidade Federal de São Paulo (UNIFESP)Objective: the objective of this study is to assess the effects of sibutramine on body weight, body fat distribution, insulin resistance, plasma leptin, lipid profile and blood pressure profiles in hypertensive obese patients.Methods: Eighty-six central obese hypertensive patients (BMI = 39 +/- 5 kg/m(2), 84% of women, 48 +/- 8.5 years old) were placed on a hypocaloric diet and placebo therapy for 4 weeks. They were then randomized to receive sibutramine (10 mg) or placebo for 24 weeks. Both, before therapy and at the end of the study, the waist and hip circumferences were measured and the waist/hip ratio (WHR) was calculated; abdominal ultrasonography was performed in order to estimate the amount of subcutaneous fat ( SF) and visceral fat (VF), and the visceral/subcutaneous ratio. Beyond HOMA-r, another insulin resistance index (IRIp) was calculated by means of the formula: peak of blood glucose after oral glucose load x plasma insulin level/10(4). Fasting plasma leptin and lipid levels were also determined.Results: Sibutramine induced greater weight reduction than placebo (6.7 vs. 2.5%, p < 0.001). Reductions in WHR (0.97 +/- 0.08 vs. 0.94 +/- 0.07, p < 0.01), IRIp (0.11 +/- 0.07 vs. 0.09 +/- 0.06 mmol mu/l(2)) and VF (6.4 +/- 2.4-6.0 +/- 2.4 cm, p < 0.01) were observed only with sibutramine. Plasma leptin decreased with placebo (24 +/- 15 vs. 18 +/- 10 UI/l, p < 0.01), but not with sibutramine (18.8 +/- 8.4 vs. 18.2 +/- 13.2 UI/l). No clinically significant change in lipid profile was observed in both groups. Moreover, office and 24-h blood pressure values did not change during placebo or sibutramine therapy, whereas a significant increase in office heart rate, from 78.3 +/- 7.3-82 +/- 7.9 b.p.m., p = 0.02, was observed with sibutramine.Conclusions: Sibutramine therapy induced greater body weight loss than placebo in hypertensive obese patients. This was associated with WHR reduction, decreases in VF and insulin resistance. the maintenance of leptin levels during sibutramine therapy may be important to avoid weight recovery, although this finding must be confirmed by other prospective studies.
- ItemEmbargoEstudo duplo-cego, placebo-controlado, do uso da fluvastatina sobre a pressão arterial, a sensibilidade à insulina e a morfologia cardiovascular em pacientes portadores de hipertensão arterial(Universidade Federal de São Paulo (UNIFESP), 2009-01-27) Teixeira, Andrei Alkmim [UNIFESP]; Tavares, Agostinho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Among hypertensive patients, cardiovascular disease morbidity is common, even in those who are adequately treated. New pharmacologic strategies to mitigate the burden of arterial hypertension are needed. This 12-month, randomized, double-blind placebocontrolled study investigated the effect of statin (fluvastatin) treatment on ambulatory blood pressure (ABP), exercise blood pressure (EBP), myocardial structure, endothelial function and insulin resistance in 50 hypertensive patients. At baseline, the groups were comparable in terms of demographic characteristics, ABP, EBP, endothelial function and homeostasis model assessment of insulin resistance (HOMAIR). At the end of the study, there was no difference between groups in terms of resting systolic blood pressure. However, maximum systolic EBP was lower in the treatment group than in the placebo group (175 ± 18 mmHg vs. 192 ± 23 mmHg, P < 0.05), as was left ventricular mass index (LVMI; 82 ± 15 vs. 100 ± 23, P < 0.05) and HOMA-IR index was lower after fluvastatin treatment (2.77 ± 1.46 vs. 3.33 ± 1.73, P < 0.05). Changes in lipid profile were not correlated with blood pressure, endothelial function, LVMI, or HOMA-IR data. In hypertensive patients, fluvastatin can improve maximum systolic EBP, myocardial remodeling and insulin resistance, independently on lipid profile variations and endothelial function.
- ItemAcesso aberto (Open Access)Evolução das alterações no metabolismo energético cerebral ao longo dos diferentes estágios do transtorno bipolar(Universidade Federal de São Paulo (UNIFESP), 2015-12-18) Mansur, Rodrigo Barbachan [UNIFESP]; Brietzke, Elisa Macedo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Metabolic comorbidities are frequent in individuals with bipolar disorder (BD), including a high prevalence of diabetes mellitus and metabolic syndrome in this population. Several biological systems related to energy metabolism have been shown to be altered in BD, but the pathophysiology of metabolic changes in BD remains largely unknown. Recent theories postulate that the brain prioritizes its own energy supply, modulating the peripheral metabolism through the regulation of allocation and nutrient intake ("selfish brain? theory). The studies that compose this thesis were based on the hypothesis that the metabolic changes observed in BD are the result of an inefficient regulation of brain energy supply and its compensatory responses. The aim was to investigate the relationship between energy metabolism and clinical and biological characteristics of BD over the course of the illness. Towards this aim we conducted a casecontrol study comparing three groups: 30 patients with BD in the early stages (defined as less than 5 episodes of mania or depression), 30 patients with BD in late stages (defined as more than 5 episodes of mania or depression) and 30 healthy volunteers. All subjects were submitted to standardized psychiatric interview and blood sampling for analysis of markers of glucose metabolism, oxidative stress, stress response, lipids and regulatory hormones. The results demonstrate that the presence of metabolic comorbidities moderate clinical and biological features of the disease. Patients in the late stages of BD had a higher prevalence of metabolic comorbidities, when compared to patients in the early stages and healthy controls. Conversely, the presence of metabolic abnormalities (e.g. insulin resistance and dyslipidemia) was associated with an unfavorable course of BD, characterized by a higher number of previous mood episodes and poor psychosocial functioning. Furthermore, the stages of BD and the presence of impaired glucose metabolism or diabetes mellitus impacted the activity levels of the antioxidant enzymes 17 glutathione peroxidase and superoxide dismutase. Finally, it was also documented that in patients with BD, broad changes in energy metabolism, such as abnormalities in glucose metabolism, leptin levels and activity of antioxidant enzymes were associated with activation of the stress response system, assessed by levels of the biomarker copeptin. All results described herein were independent of keys confounders such as socio-demographic characteristics, smoking and use of psychotropic medications. In conclusion, not only BD is frequently associated with metabolic comorbidities, but they also affect several different domains of the illness, as demonstrated by the results of the studies that comprise this thesis. The differences in course, psychosocial functioning and pathophysiological substrates observed among patients with BD in the late and early stages, as well as between patients and controls, indicate that metabolic systems are, in fact, prominently involved in BD pathophysiology and are therefore promising targets for the development of future clinical and therapeutic investigations.
- ItemSomente MetadadadosExtreme Subcutaneous, Intramuscular and Inhaled Insulin Resistance Treated by Pancreas Transplantation Alone(Wiley-Blackwell, 2010-01-01) Sá, J. R. [UNIFESP]; Alvarenga, Marcelo A. [UNIFESP]; Rangel, Erika B. [UNIFESP]; Melaragno, Claudio S. [UNIFESP]; Gonzalez, Adriano M. [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Salzedas, A. [UNIFESP]; Carmona, Adriana K. [UNIFESP]; Tonetto-Fernandes, Vania [UNIFESP]; Gabbay, Monica Andrade Lima [UNIFESP]; Pestana, Jose Osmar Medina [UNIFESP]; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Infantil Darcy VargasDiabetes mellitus with resistance to insulin administered subcutaneously or intramuscularly (DRIASM) is a rare syndrome and is usually treated with continuous intravenous insulin infusion. We present here two cases of DRIASM in 16 and 18 years female patients that were submitted to pancreas transplantation alone (PTA). Both were diagnosed with type 1 diabetes as young children and had labile glycemic control with recurrent episodes of diabetic ketoacidosis. They had prolonged periods of hospitalization and complications related to their central venous access. Exocrine and endocrine drainages were in the bladder and systemic, respectively. Both presented immediate graft function. in patient 1, enteric conversion was necessary due to reflux pancreatitis. Patient 2 developed mild postoperative hyperglycemia in spite of having normal pancreas allograft biopsy and that was attributed to her immunosuppressive regimen. Patient 1 died 9 months after PTA from septic shock related to pneumonia. in 8 months of follow-up, Patient 2 presented optimal glycemic control without the use of antidiabetic agents. in conclusion, PTA may be an alternative treatment for DRIASM patients.
- ItemSomente MetadadadosFibrinolytic dysfunction after gestation is associated to components of insulin resistance and early type 2 diabetes in latino women with previous gestational diabetes(Elsevier B.V., 2007-12-01) Morimitsu, Lilian K.; Fusaro, Annunciata S.; Sanchez, Victor H.; Hagemann, Cristiane C. F.; Bertini, Anna Maria; Dib, Sergio A.; Universidade Federal de São Paulo (UNIFESP)Among patients with metabolic syndrome (MS), atherosclerosis and abnormal fibrinolytic function are frequently present, mostly owing to an increase in plasminogen activator inhibitor-1(PAI-1). We analyze PAI-1 in pregnant women, both normal and with gestational diabetes (GDM) and postpartum regarding its correlation to MS surrogates. Clinical characteristics, glucose tolerance (100 g-OGTT), lipids, PAI-1 antigen, insulin sensitivity (HOMA-S), and pancreatic P-cell function (HOMA-B) were investigated in 34 women. Eleven had normal glucose tolerance (NGT) during pregnancy and 23 had GDM (all GAD antibodies-negative). All patients were studied at 28-34 weeks of gestation and 16-24 weeks after delivery (75 g-OGTT). Parameters of interest were determined using commercial test systems. During pregnancy, PAI-1 was not statistically different between NGT and GDM (47 +/- 25 ng/ml versus 47 +/- 28 ng/ml, p = 0.9). After gestation, 19 (56%) women had NGT (11 of them from previous NGT A group) and 15 (44%) had impaired glucose tolerance (IGT) or DM. the IGT (IGT + DM) group had higher PAI-1 (p = 0.01), which did not decreased after delivery NGT-NGT before and after delivery (47 +/- 25 ng/ml versus 6 +/- 5 ng/ml; p < 0.001), GDM-NGT (62 +/- 36 ng/ml versus 14 +/- 15 ng/ml; p = 0.001) and GDM-IGT (39 +/- 20 ng/ml versus 27 +/- 23 ng/ml; p = 0. 15). PAI-1 levels were positively correlated (p < 0.05) to total cholesterol (r, = 0.37), triglycerides (r,, = 0.48), fasting plasma glucose (r(s), = 0.52), 2-h plasma glucose in the OGTT (r(s) = 0.58) and were negatively correlated (p < 0.05) with HOMA-S (rs = -0.42) and HOMA-B (r, = -0.38). Fibrinolytic dysfunction is still present in GDM women and is associated with early development of IGT or T2DM. PAI correlated with surrogate markers of MS levels and may identify a group of women at risk for macroangiopathy. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
- ItemAcesso aberto (Open Access)Freqüência de síndrome metabólica em crianças e adolescentes com sobrepeso e obesidade(Sociedade de Pediatria de São Paulo, 2007-09-01) Buff, Caroline de Gouveia; Ramos, Eliete; Souza, Fabíola Isabel S. [UNIFESP]; Sarni, Roseli Oselka Saccardo [UNIFESP]; Faculdade de Medicina do ABC; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Evaluate metabolic syndrome in overweight/obese children and adolescents and to study the association between this syndrome and socioeconomic variables, physical activity and familiar cardiovascular risk. METHODS: This cross-sectional study enrolled 59 children and adolescents with overweight/obesity in an outpatient university clinic, from January 2004 to June 2006. The following variables were studied: socioeconomic level, maternal schooling, familiar cardiovascular risk and physical activity. Body mass index (BMI) percentile was used to classify the nutritional status. Metabolic syndrome was considered when three or more of the following were present: triglycerides >110mg/dL or HDL-c <40mg/dL, waist circumference >90th percentile, insulin resistance (glucose level >100mg/dL) and blood pressure BP >90th percentile. Descriptive statistical analysis was applied. RESULTADOS: Out of the 59 children, mean age was 10.9±0.48 years and 52.5% were male. Metabolic syndrome was present in 42.4%. Altered components of the metabolic syndrome were: abdominal circumference in 88.1%, blood pressure 47.5%, insulin resistance 23.7%, triglycerides 42.4% and HDL-c 6.8%. No significant association was found between the presence of metabolic syndrome and gender, age, pubertal development, per capita income, maternal schooling, daily hours of TV viewing, weekly hours of physical activity (p=0.942) or familiar cardiovascular risk. CONCLUSIONS: The prevalence of metabolic syndrome is high among the evaluated overweight/obese children and adolescents. Altered abdominal circumference and high blood pressure were the most frequent components of the syndrome.
- ItemSomente MetadadadosGlimepiride as insulin sensitizer: increased liver and muscle responses to insulin(Wiley-Blackwell, 2008-07-01) Mori, R. C. T.; Hirabara, S. M.; Hirata, A. E. [UNIFESP]; Okamoto, M. M.; Machado, U. F.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Aim: Glimepiride, a low-potency insulin secretagogue, is as efficient on glycaemic control as other sulphonylureas, suggesting an additional insulin-sensitizer role. the aim of the present study was to confirm the insulin-sensitizer role of glimepiride and to show extra-pancreatic effects of the drug.Methods: Three-month-old monosodium glutamate (MSG)-induced obese insulin-resistant rats were treated (OG) or not treated (O) with glimepiride for 4 weeks and compared with age-matched non-obese rats (C). Insulin sensitivity in whole body, glucose transporter 4 (GLUT4) protein content, glucose uptake and glycogen synthesis in oxidative skeletal muscle and phospho-glycogen synthase kinase (p-GSK3) and glycogen content in liver were analysed.Results: Insulin sensitivity, analysed by the insulin tolerance test, was 30% lower in O than in C rats (p < 0.05), and OG rats recovered this parameter (p < 0.05). in oxidative muscle, glimepiride increased the GLUT4 protein content (50%, p < 0.001) and recovered the obesity-induced reduction (similar to 20%) of the in vitro insulin-stimulated glucose uptake and incorporation into glycogen. in liver, glimepiride increased p-GSK3 (p < 0.01) and glycogen (p < 0.05) contents.Conclusion: the increased GLUT4 protein expression and glucose utilization in oxidative muscle and the increased insulin sensitivity and glycogen storage in liver evidence the insulin-sensitizer effect of glimepiride, which must be important to enable the glimepiride drug to promote an efficient glycaemic control.
- ItemAcesso aberto (Open Access)Impact of abdominal fat and insulin resistance on arterial hypertension in non-obese women(Sociedade Brasileira de Endocrinologia e Metabologia, 2009-04-01) Silva, Eliana A. [UNIFESP]; Ribeiro Filho, Fernando Flexa [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the impact of abdominal fat and insulin resistance on arterial hypertension of non-obese women. METHODS:Thirty-five non-obese women (NO), age 35-68 years were studied, and divided into two groups according to the presence of hypertension (BP > 140 x 90 mmHg) ( HT = hypertensive; NT = normotensive). Leptin measurement and oral glucose tolerance test (OGTT) to assess insulin were performed in these patients. A CT-scan was used to evaluate visceral (VF) and subcutaneous abdominal fat (SCF). The Central fat distribution index (CDI) was proposed to evaluate the impact of subcutaneous abdominal fat on central fat distribution in hypertensive patients. RESULTS: When compared to NT-NO (n = 17) group, HT-NO (n = 18) showed higher blood pressure levels (systolic and diastolic), greater VF area (84.40 ± 55.70 versus 37.50 ± 23.00 cm²; p = 0.036), greater SCF area (174.30 ± 83.00 versus 79.80 ± 27.40 cm²; p = 0.030), higher HOMAr index (1.59 ± 0.72 versus 0.93 ± 0.48 mmol.mU/L²; p = 0.006), higher CDI index (12.67 ± 7.04 versus 6.19 ± 2.57 cm²/kg) and higher leptin level (19.1 ± 9.6 versus 7.4 ± 3.5 ng/mL; p = 0.028). CONCLUSIONS: Arterial hypertension in non-obese women is associated with insulin resistance, central fat distribution and higher leptin levels.
- ItemAcesso aberto (Open Access)Impacto da perda de peso nas adipocitocinas, na proteína C-reativa e na sensibilidade à insulina em mulheres hipertensas com obesidade central(Sociedade Brasileira de Cardiologia - SBC, 2007-12-01) Borges, Rodolfo Leão [UNIFESP]; Ribeiro-filho, Fernando Flexa [UNIFESP]; Carvalho, Kenia Mara Baiocchi [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de BrasíliaOBJECTIVE: To assess the impact of weight reduction on serum adipocytokines, C-reactive protein (CRP), and insulin sensitivity in hypertensive female patients with central obesity. METHODS: This study was performed using the database and stored serum samples of female patients who had participated in an intervention study focused on weight loss. Thirty hypertensive women aged 18 to 65, body mass index (BMI) > 27 kg/m², and central obesity were selected. They were randomly assigned to receive either a low-calorie diet plus orlistat 120 mg three times daily or a low-calorie diet alone for 16 weeks. Patients who experienced weight loss greater than 5% (n = 24) were assessed for blood pressure, anthropometric parameters, visceral fat, insulin resistance (HOMA-R - homeostasis model assessment of insulin resistance) and sensitivity (ISI - Insulin Sensitivity Index) indices, plus serum lipids, adipocytokines (adiponectin, leptin, IL-6, and TNF-a) and CRP levels. RESULTS: After BMI had been reduced by approximately 5% in both groups, visceral fat, fasting glucose, triglycerides, and TNF-a decreased. Only the orlistat group, which was more insulin resistant at baseline, showed a significant reduction in blood glucose after oral glucose load, in addition to increased insulin sensitivity. CONCLUSION: This study's findings indicate that a weight loss greater than 5% is associated with improved inflammatory status and decreased insulin resistance, regardless of changes in adiponectin and TNF-a levels. The greatest improvements in insulin sensitivity experienced by the orlistat-treated patients could not be attributed to the use of this drug because of the higher number of insulin-resistant subjects in this group.
- ItemSomente MetadadadosImpaired glucose tolerance plus hyperlipidaemia induced by diet promotes retina microaneurysms in New Zealand rabbits(Wiley-Blackwell, 2011-02-01) Helfenstein, Tatiana [UNIFESP]; Fonseca, Francisco A. [UNIFESP]; Ihara, Silvia S. [UNIFESP]; Bottos, Juliana M. [UNIFESP]; Moreira, Flavio T. [UNIFESP]; Pott, Henrique; Farah, Michel E. [UNIFESP]; Martins, Maria C. [UNIFESP]; Izar, Maria C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)P>With the increasing prevalence of diabetes mellitus and metabolic syndrome worldwide, experimental models are required to better understand the pathophysiology and therapeutic approaches to preserve pancreatic beta cells, attenuate atherosclerosis and protect target organs. the aims of this study were to develop an experimental model of impaired glucose tolerance combined with hypercholesterolaemia induced by diet and assess metabolic alterations and target organ lesions. New Zealand male rabbits were fed high-fat/high-sucrose (10/40%) and cholesterol-enriched diet for 24 weeks, when they were sacrificed. Biochemistry, fundus photographs with fluorescein angiography and pathological analyses were performed. Cholesterol-fed and normal animals of same age were compared. Results: the animals with diet-induced impaired glucose tolerance combined with hypercholesterolaemia gained weight, increased blood glucose, total cholesterol, LDL-C and triglycerides and decreased HDL-C (P < 0.05 vs. baseline). Fructosamine levels and the homeostasis model assessment of insulin resistance (HOMA-IR) index were increased, while there was a reduction in the HOMA-beta (P < 0.05 for all vs. baseline). Histomorphologic findings of this model were aortic atherosclerosis, hepatic steatofibrosis and glomerular macrophage infiltration. Early clinical features of diabetic retinopathy with hyperfluorescent dots consistent with presence of retina microaneurysms were seen since week 12, progressing up to the end of the experiment (P < 0.0005 vs. baseline and 12 weeks). Our model reproduced several metabolic characteristics of human diabetes mellitus and promoted early signs of retinopathy. This non-expensive model is suitable for studying mechanistic pathways and allowing novel strategic approaches.
- ItemSomente MetadadadosIncreased dietary sodium partially blunts the amelioration of insulin resistance induced by dietary potassium supplementation in a neuroendocrine model of visceral obesity(Elsevier B.V., 2005-05-01) Cesaretti, Mario LR [UNIFESP]; Ginoza, Milton [UNIFESP]; Zanella, Maria T. [UNIFESP]; Ribeiro, Artur B. [UNIFESP]; Kohlmann, Osvaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemSomente MetadadadosInspiratory training increases insulin sensitivity in elderly patients(Wiley-Blackwell, 2012-04-01) Silva, Mayra dos Santos [UNIFESP]; Martins, Ana Claudia; Cipriano Junior, Gerson [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Lopes, Guiomar Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Inst Med Assistance State Publ Server São PauloAim: Physiological degeneration in the aging process can cause a notable decline in carbohydrate metabolism. Respiratory training has been recommended to elderly patients in an attempt to prevent or minimize the alterations to the cardiorespiratory, metabolic and cognitive systems and to improve their quality of life. the objective of this work was to investigate the influence of inspiratory muscular training, with Threshold, on insulin resistance in elderly people.Methods: This study included 14 insulin resistant elderly volunteers, ranging in age from 61 to 82 years old. Insulin resistance was confirmed using the homeostatic model assessment. the patients were divided into two groups: experimental and control. the program lasted 12 weeks, with 30-min training daily using Threshold to train the inspiratory muscles.Results: the experimental group had improved insulin resistance, with decreased glycemia and insulin requirements, a lower homeostatic model assessment of insulin resistance, and increased respiratory force and performance.Conclusion: the small sample does not allow for conclusions, but we can suggest that inspiratory muscular training improves insulin sensitivity in elderly patients with insulin resistance. Geriatr Gerontol Int 2012; 12: 345-351.
- ItemSomente MetadadadosInsulin Resistance and Glucose and Lipid Concentrations in a Cohort of Perinatally HIV-infected Latin American Children(Lippincott Williams & Wilkins, 2013-07-01) Hazra, Rohan; Hance, Laura Freimanis; Monteiro, Jacqueline Pontes; Ruz, Noris Pavia; Machado, Daisy Maria [UNIFESP]; Saavedra, Mariza; Motta, Fabrizio; Harris, D. Robert; NISDI Pediat Study Grp; Eunice Kennedy Shriver Natl Inst Child Hlth & Hum; WESTAT Corp; Universidade de São Paulo (USP); Hosp Infantil Mexico Dr Federico Gomez; Universidade Federal de São Paulo (UNIFESP); Hosp Fed Servidores Estado; Irmandade Santa Casa Misericordia Porto AlegreWe measured glucose, insulin and lipids in 249 perinatally HIV-infected Latin American children. Only 1 subject had impaired fasting glucose; 6.8% had insulin resistance. Abnormalities in total, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides were reported for 13%, 13%, 21% and 34%, respectively. Continued follow-up of this population is necessary to characterize the evolution and clinical consequences of these findings.