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- ItemSomente MetadadadosAnalysis of criteria for metabolic syndrome in a population-based study of Japanese-Brazilians(Blackwell Publishing, 2005-07-01) Rosenbaum, P.; Gimeno, SGA; Sanudo, A.; Franco, L. J.; Ferreira, SRG; Japanese-Brazilian Diabetes Grp; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Objective: Criteria for metabolic syndrome (MS) differ particularly regarding the definition of central obesity and consequently, there could be differences in the assessment of cardiovascular risk. We estimated the prevalence of metabolic syndrome, compared the agreement of the World Health Organization (WHO) criteria with the standard and a modified National Cholesterol Education Program (NCEP) criterion and investigated whether additional factors were associated with the diagnosis of the syndrome in a Japanese descendant population.Methods: in this cross-sectional, population-based survey, 1166 Japanese-Brazilians (533 men, 633 women) aged 57.4 +/- 12.4 years with mean body mass index (BMI) and waist of 25.2 +/- 4.0 kg/m(2) and 84.5 +/- 10.6 cm, respectively, were included. McNemar and kappa statistics were used to assess the concordance between WHO criteria with the standard and a modified NCEP criteria (waist of 90 and 80 cm, for men and women, respectively). in logistic regression analysis, a number of metabolic variables and albumin-to-creatinine ratio were included to test independent associations with metabolic syndrome defined by the modified NCEP criteria.Results: According to WHO, 55.4% (95% Cl 52.5-58.2%) of the subjects had MS and to NCEP 47.4% (95% Cl 44.6-50.0%). WHO criterion detected 48.3% of central obese subjects while NCEP only 14.0%. Kappa statistics showed a good strength of agreement (k = 0.67, p < 0.01) between WHO and NCEP standard definitions of MS. Using the modified NCEP criterion for Asians, more subjects with metabolic syndrome were identified (58%) and agreement with WHO was improved (k = 0.72, p < 0.001). However, similar Framingham risk scores were attributed to the subsets of subjects classified by any of the three criteria. Areas under the receiver operating characteristic curves, obtained for the modified waist values to diagnose metabolic syndrome according to WHO, were > 0.80 and corresponded, respectively, to sensitivity and specificity of 63 and 83% for men and 77 and 72% for women. in final logistic regression model, age, male sex, BMI and homeostasis model assessment-insulin resistance but not with albumin-to-creatinine ratio (ACR) were independently associated with the syndrome.Conclusions: High prevalence of MS, independent of the criterion considered, was found in this Japanese-Brazilian population. the replacement of waist cutoff by those proposed by WHO for Asians lead to this diagnosis in a higher number of subjects with elevated cardiovascular risk. Our data did not support that ACR should be included in the classical definition of MS in Japanese descendants as previously suggested by WHO.
- ItemAcesso aberto (Open Access)Associação do eletrocardiograma com diabete melito e síndrome metabólica em nipo-brasileiros(Sociedade Brasileira de Cardiologia - SBC, 2009-05-01) Brollo, Luigi [UNIFESP]; Bombig, Maria Teresa Nogueira [UNIFESP]; Mazzaro, Cleber do Lago [UNIFESP]; Francisco, Yoná Afonso [UNIFESP]; Fonseca, Francisco Antonio Helfenstein [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Harima, Helena [UNIFESP]; Hirai, Amélia [UNIFESP]; Póvoa, Rui Manuel dos Santos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Japanese-Brazilian Diabetes Study GroupBACKGROUND: When the Japanese immigrated to the Americas, they were subjected to Westernization, with a great change in lifestyle, specially in dietary habits, and this may explain the increase in the incidence of diabetes mellitus (DM), metabolic syndrome (MS) and cardiovascular disease among them. OBJECTIVE: To study the presence of myocardial necrosis and left ventricular hypertrophy (LVH) in a population of Japanese-Brazilians, using the ECG and its relationship with DM and MS. METHODS: This was a cross-sectional study which evaluated 1,042 Japanese-Brazilians aged 30 or over, 202 of them born in Japan (Issei) and 840 of them born in Brazil (Nissei), from the second phase of the Japanese-Brazilian Diabetes Study Group initiated in 2000. MS was defined according to the NCEP-ATP III criteria modified for the Japanese. DM and MS were associated with the presence of myocardial necrosis (according to the Minnesota criteria) and LVH (according the Perugia score on the ECG). The statistic chi square method was used to reject the null hypothesis.? RESULTS: Of the 1,042 participants, 35.3% had DM (38.6% of the Issei and 34.5% of the Nissei); 51.8% had MS (59.4% of the Issei and 50.0% of the Nissei). The presence of an inactive zone in the diabetic Issei group was not statistically significant when compared to the non-diabetic group, but among the diabetic Nissei group an inactive zone was present in 7.5% of them. There was a statistically significant correlation between MS and LVH in the Issei and Nissei groups. CONCLUSION: Metabolic disorders presented a high prevalence in Japanese-Brazilians with significant correlations with necrosis and hypertrophy on the ECG.
- ItemSomente MetadadadosAutoimmunity does not contribute to the highly prevalent glucose metabolism disturbances in a Japanese Brazilian population(Int Soc Hypertension Blacks-ishib, 2007-12-01) Hashimoto, Silvia Mizue [UNIFESP]; Gimeno, Suely Godoy Agostinho [UNIFESP]; Matsumura, Luiza Kimiko [UNIFESP]; Franco, Laercio Joel [UNIFESP]; Miranda, Walkiria Lopes [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP; Japanese Brazilian Diabetes; Universidade Federal de São Paulo (UNIFESP)The Japanese Brazilian population has one of the highest prevalences of diabetes worldwide. Despite being non-obese according to standard definitions, their body fat distribution is typically central. We investigated whether a subset of these subjects had autoantibodies that would suggest a slowly progressive form of type 1 diabetes. A total of 721 Japanese Brazilians (386 men) in the 30- to 60-year age group underwent clinical examination and laboratory procedures, including a 75-g oral glucose tolerance test and determinations of serum autoantibodies. Antibodies to glutamic acid decarboxylase (GADab) were determined by radioimmunoassay and to thyroglobulin (TGab) and thyroperoxidase (TPOab) by flow-cytometry assays. Mean body mass index was 25.2 +/- 3.8 kg/m(2), but waist circumference was elevated according to the Asian standards. Diabetes, impaired glucose tolerance, and impaired fasting glycemia were found in 31%, 22%, and 22%, respectively, and 53% of the subjects had metabolic syndrome. Glutamic acid decarboxylase (GADab) was positive in 4.72%, TGab in 9.6%, and TPOab in 10% of the whole sample. When participants were stratified according to the presence of thyroid antibodies, similar frequencies of GADab were found in positive and negative groups. The prevalence rates of glucose metabolism disturbances did not differ between GADab positive and negative groups. Our data did not support the view that autoimmune injury could contribute to the high prevalence of diabetes seen in Japanese Brazilians, and the presence of co-morbidities included in the spectrum of metabolic syndrome favors the classification as type 2 diabetes.
- ItemSomente MetadadadosAutoimmunity does not contribute to the highly prevalent glucose metabolism disturbances in a Japanese Brazilian population(Int Soc Hypertension Blacks-ishib, 2006-12-01) Hashimoto, Silvia Mizue [UNIFESP]; Gimeno, Suely Godoy Agostinho [UNIFESP]; Matsumura, Luiza Kimiko [UNIFESP]; Franco, Laercio Joel [UNIFESP]; Miranda, Walkiria Lopes [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; JBD Study Grp; Universidade Federal de São Paulo (UNIFESP)The Japanese Brazilian population has one of the highest prevalences of diabetes worldwide. Despite being non-obese according to standard definitions, their body fat distribution is typically central. We investigated whether a subset of these subjects had autoantibodies that would suggest a slowly progressive form of type 1 diabetes. A total of 721 Japanese Brazilians (386 men) in the 30- to 60-year age group underwent clinical examination and laboratory procedures, including a 75-g oral glucose tolerance test and determinations of serum autoantibodies. Antibodies to glutamic acid decarboxylase (GADab) were determined by radioirnmunoassay and to thyroglobulin (TGab) and thyroperoxidase (TPOab) by flowcytometry assays. Mean body mass index was 25.2 +/- 3.8 kg/m(2), but waist circumference was elevated according to the Asian standards. Diabetes, impaired glucose tolerance, and impaired fasting glycemia were found in 31%, 22%, and 22%, respectively, and 53% of the subjects had metabolic syndrome. Glutamic acid decarboxylase (GADab) was positive in 4.72%, TGab in 9.6%, and TPOab in 10% of the whole sample. When participants were stratified according to the presence of thyroid antibodies, similar frequencies of GADab were found in positive and negative groups. The prevalence rates of glucose metabolism disturbances did not differ between GADab positive and negative groups. Our data did not support the view that autoimmune injury could contribute to the high prevalence of diabetes seen in Japanese Brazilians, and the presence of co-morbidities included in the spectrum of metabolic syndrome favors the classification as type 2 diabetes.
- ItemSomente MetadadadosEffects of weight loss induced by gastric surgery on left ventricular mass and blood pressure in severe obese patients(Elsevier B.V., 2003-05-01) Aranha, Luciana Silveira [UNIFESP]; Faria, Alessandra Nunes [UNIFESP]; Matos, Maria Isabel Rodrigues de [UNIFESP]; Arasaki, Carlos Haruo [UNIFESP]; Carvalho, Kenia Mara [UNIFESP]; Ferreira, Sandra Roberta Gouveia [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemAcesso aberto (Open Access)Grau de atividade física e síndrome metabólica: um estudo transversal com a etnia Khisêdjê do Parque Indígena do Xingu, Brasil.(Universidade Federal de São Paulo (UNIFESP), 2012) Santos, Kennedy Maia dos [UNIFESP]; Gimeno, Suely Godoy Agostinho [UNIFESP]Este estudo teve como objetivo verificar a existencia de associacao entre o grau de atividade fisica e a presenca de sindrome metabolica (SM) entre indigenas Khisedje com 20 anos ou mais. Por meio de abordagem epidemiologica do tipo transversal, foram avaliados individuos Khisedje, do Parque Indigena do Xingu, Brasil. Formularios (dados sociodemograficos), testes (resistencia cardiorrespiratoria, forca e resistencia muscular, flexibilidade e nivel de atividade fisica segundo o numero de passos/dia utilizando o pedometro) e analise de material biologico (glicose e lipoproteinas sericas) foram utilizados para obtencao das informacoes de interesse. A existencia de associacao entre atividade fisica e a presenca de SM foi avaliada pela estatistica qui-quadrado (p < 0,05) e pelas razoes de prevalencias (por ponto e por intervalo com 95% de confianca) brutas e ajustadas. Empregou-se, na comparacao dos valores medios das variaveis biologicas segundo sexo ou idade, o teste t de Student. No teste de resistencia cardiorrespiratoria, 90,7% dos sujeitos apresentaram desempenho bom ou excelente; no de flexibilidade, 98,7% obtiveram desempenho excelente. Quanto ao numero de passos/dia, 70,0% foram classificados como ativos ou muito ativos. Nos testes de flexao do braco e do tronco, 50,6% e 33,3% foram classificados com desempenho acima da media ou excelente, respectivamente. No teste de impulso horizontal, 1,1% obtiveram desempenho bom. A prevalencia de SM foi de 27,8%, sendo maior entre as mulheres e entre os sujeitos das faixas etarias de 39 u 49 anos e ≥ 50 anos, quando comparado com a faixa etaria de 20 u 29 anos. A frequencia de SM tambem foi maior entre aqueles que tiveram desempenho fraco ou regular no teste de resistencia cardiorrespiratoria (RP= 2,52; IC95%: 1,26 u 5,03) e entre os classificados como obaixo ativo ou sedentarioo na avaliacao do nivel de atividade fisica segundo o numero de passos/dia; esta ultima associacao perdeu a significancia estatistica quando ajustada por sexo e idade. Medias menores no teste de impulso horizontal foram identificadas entre os sujeitos com SM quando comparados aos indigenas sem essa condicao. Com excecao do teste de forca explosiva de membros inferiores (impulso horizontal), os Khisedje apresentaram desempenho satisfatorio nos testes fisicos. O pior desempenho nos testes fisicos associou-se a presenca de SM, indicando a necessidade de maior vigilancia no controle e prevencao dos fatores de risco que compoe a SM
- ItemAcesso aberto (Open Access)Impact of self-reported fasting duration on lipid profile variability, cardiovascular risk stratification and metabolic syndrome diagnosis(Sbem-Soc Brasil Endocrinologia & Metabologia, 2018) Janovsky, Carolina Castro Porto Silva [UNIFESP]; Laurinavicius, Antonio; Cesena, Fernando; Valente, Viviane; Ferreira, Carlos Eduardo; Mangueira, Cristovao; Conceicao, Raquel; Santos, Raul D.; Bittencourt, Marcio SommerObjective: We sought to investigate the impact of self-reported fasting duration times on the lipid profile results and its impact on the cardiovascular risk stratification and metabolic syndrome diagnosis. Subjects and methods: We analyzed data from all consecutive individuals evaluated in a comprehensive health examination at the Hospital Israelite Albert Einstein from January to December 2015. We divided these patients in three groups, according to the fasting duration recalled (< 8h, 8-12h and > 12h). We calculated the global cardiovascular risk and diagnosed metabolic syndrome according to the current criteria and estimated their change according to fasting duration. Results: A total of 12,196 (42.3 +/- 9.2 years-old, 30.2% females) patients were evaluated. The distribution of cardiovascular risk was not different among groups defined by fasting duration in both men and women (p = 0.547 for women and p = 0.329 for men). Similarly, the prevalence of metabolic syndrome was not influenced by the fasting duration (p = 0.431 for women and p = 0.166 for men). Conclusion: Self-reported fasting duration had no significant impact on the lipid profile results, including triglyceride levels. Consequently, no changes on the cardiovascular risk stratification using the Framingham risk score nor changes on the prevalence of metabolic syndrome were noted.
- ItemAcesso aberto (Open Access)Impacto de um programa de intervenção sobre o estilo de vida nos perfis metabólico, antropométrico e dietético em nipo-brasileiros com e sem síndrome metabólica(Sociedade Brasileira de Endocrinologia e Metabologia, 2011-03-01) Damião, Renata; Sartorelli, Daniela Saes; Hirai, Amélia [UNIFESP]; Bevilacqua, Marselle Rodrigues [UNIFESP]; Salvo, Vera Lúcia Morais Antonio de [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Gimeno, Suely Godoy Agostinho [UNIFESP]; Universidade Federal do Triângulo Mineiro Departamento de Nutrição; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: We evaluated the changes in biochemical and nutritional profiles of Japanese-Brazilians with and without metabolic syndrome after two years of participation in the intervention program. MATERIALS AND METHODS: It was a non-controlled experimental study. The biochemical and clinical assessments were conducted at baseline (2005), after a year (2006) and after two years (2007) of intervention. On the present study, data of 360 individuals, who participated on the three assessments were considered. RESULTS: Both groups presented improvements on the anthropometric and metabolic profile, after two years of intervention. It was observed reduction in the intake of total fat, saturated fat, and dietary cholesterol, and increased intake of fiber among men without metabolic syndrome. It was observed reduction in the intake of total fat (p = 0,003) and monounsaturated fatty acid (p = 0,002). CONCLUSION: The results showed a positive impact of the lifestyle intervention program in metabolic and nutritional profile of Japanese-Brazilians with and without metabolic syndrome.
- ItemSomente MetadadadosIndependent impact of glycemia and blood-risk subjects pressure in albuminuria on high for metabolic syndrome(Dustri-verlag Dr Karl Feistle, 2004-06-01) Rosenbaum, P.; Gimeno, Suely Godoy Agostinho [UNIFESP]; Sañudo, Adriana [UNIFESP]; Franco, Laercio Joel [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Japanese Brazilian Diabet Study; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Background: Microalbuminuria may reflect diffuse endothelial damage. Considering that diabetes and hypertension cause vasculopathy, we investigated associations of albumin-to-creatinine ratio (ACR) with plasma glucose and blood pressure levels in high-risk subjects for metabolic syndrome. Methods: A sample of 519 (246 men) Japanese-Brazilians (aged 60 +/- 11 years), who participated in a population-based study, had their ACR determined in a morning urine specimen. Backward models of multiple linear regression were created for each gender including log-transformed values of ACR as dependent variable; an interaction term between diabetes and hypertension was included. Results: Macroalbuminuria was found in 18 subjects. ACR mean values for subjects with normal glucose tolerance, impaired fasting glycemia, impaired glucose tolerance and diabetes were 9.9 +/- 6.0, 19.0 +/- 35.4, 20.7 +/- 35.4, and 33.9 +/- 55.0 mg/g, respectively. Diabetic subjects showed higher ACR than the others (p < 0.05). An increase in the proportion of albuminuric subjects was observed as glucose metabolism deteriorated (4.9, 17.0, 23.0 and 36.0%). Stratifying into 4 groups according to postchallenge glycemia (< 7.8 mmol/l, n = 91; greater than or equal to 7.8 mmol/l, n = 410) and hypertension, hypertensive and glucose-intolerant subgroups showed higher ACR values. ACR was associated with gender, waist circumference, blood pressure, plasma glucose and triglyceride (p < 0.05); albuminuric subjects had significantly higher levels of such variables than the normoalbuminuric ones. In the final models of linear regression, systolic blood pressure and 2-hour glycemia were shown to be independent predictors of ACR for both genders (p < 0.05). In men, also waist was independently associated with ACR. No interaction was detected between diabetes and hypertension. Conclusions: These findings suggest that both glucose intolerance and hypertension could have independent but not synergistic effects on endothelial function reflected by albumin loss in urine. Such hypothesis needs to be confirmed in prospective studies.
- ItemSomente MetadadadosMacrovascular disease in a Japanese-Brazilian population of high prevalence of metabolic syndrome: Associations with classical and non-classical risk factors(Elsevier B.V., 2007-11-01) Siqueira, Antonela F. A.; Franco, Laercio J.; Gimeno, Suely G. A.; Matsumura, Luiza K.; Abdalla, Dulcineia S. P.; Barros, Newton de; Ferreira, Sandra R. G.; JBDSG; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Background: the Japanese-Brazilian Diabetes Study detected high prevalence of metabolic syndrome (MS) in a population of Japanese ancestry living in Brazil. We describe the prevalence of macrovascular disease (MVD) and its association with classical and non-classical cardiovascular risk factors in this population.Methods: An overall of 1163 individuals were studied; diagnosis of MVD was based on a score obtained from medical history, ankle-brachial pressure index and electrocardiogram, defining three groups: no MVD, possible MVD and definite MVD.Results: Prevalence of MVD was 14.3% (possible MVD: 11.2%; definite MVD: 3.1%). Individuals with MS had higher rates of MVD (16.9% versus 11.2%; p < 0.05). Comparing to no MVD, age, 2 It plasma glucose, anti-LDL(+) and anti-LDL(-) levels, and urinary albumin-to-creatinine ratio were higher in both categories with MVD; waist-to-hip ratio, fasting plasma glucose, HbAlc, total-to-HDL cholesterol ratio and triglycerides were higher in that with definite MVD; systolic blood pressure and homocysteine were higher in that with possible MVD. Using logistic regression, systolic blood pressure, smoking habit and anti-LDL(+) were independently associated with MVD.Conclusion: MVD is highly prevalent in Japanese-Brazilians and its association with MS was confirmed. A novel marker of lipoprotein modifications-anti-LDL(+) antibody-could be useful in identifying individuals at higher risk. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
- ItemSomente MetadadadosMetabolic syndrome among prepubertal Brazilian schoolchildren(Sage Publications Ltd, 2008-11-01) Strufaldi, Maria Wany Louzada [UNIFESP]; Silva, Edina Mariko Koga da [UNIFESP]; Puccini, Rosana Fiorini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This was a two-stage cross-sectional study that assessed metabolic syndrome and associated factors among prepubertal schoolchildren. in the first stage, nutritional status, blood pressure, personal (low birth weight) and family antecedents for cardiovascular disease (CVD) were collected. in the second stage, schoolchildren with at least one of these criteria participated: obesity, personal or family history. Metabolic syndrome (MS) was defined by ATP III and WHO definitions. Among 929 (6-10 year old) schoolchildren, 27.7% presented with over-weight/obesity, 12.2% hypertension, and personal (9.4%) and family (35.3%) antecedents. 205 children finished the second stage. the frequencies of MS-ATP and MS-WHO were 9.3% and 1.9%. Among the obese, MS was present in 25.8% (ATP) and 5.2% (WHO). Children with normal weight presented: low HDL (23.6%), hyperglycaemia (3.6%), HOMA-IR (0.9%) and MS-ATP (0.9%). in conclusion, overweight/obesity was associated with metabolic syndrome in schoolchildren. It was found that children with normal weight with personal and/or family antecedents presented with HOMA-IR and MS-ATR.
- ItemSomente MetadadadosMethods of estimation of visceral fat: Advantages of ultrasonography(North Amer Assoc Study Obesity, 2003-12-01) Ribeiro, Fernando Flexa [UNIFESP]; Faria, Alessandra Nunes [UNIFESP]; Azjen, Sergio [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To compare methods for the assessment of visceral fat with computed tomography (CT) and establish cutoffs to define visceral obesity based on such alternative methods.Research Methods and Procedures: One hundred women (50.4 +/- 7.7 years; BMI 39.2 +/- 5.4 kg/m(2)) underwent anthropometric evaluation, bioelectrical impedance, DXA, abdominal ultrasonography (US), and CT scan.Results: Waist circumference, waist-to-hip ratio (WHR), and US-determined visceral fat values showed the best correlation coefficients with visceral fat determined by CT (r = 0.55, 0.54, and 0.71, respectively; p < 0.01). Fat mass determined by DXA was inversely correlated with visceral-to-subcutaneous-fat ratio (r = -0.47, p < 0.01). Bioimpedance-determined fat mass and skinfolds were correlated with only subcutaneous abdominal fat quantified by CT. Linear regression indicated US visceral-fat distance and WHR as the main predictors of CT-determined visceral fat (adjusted r(2) = 0.51, p < 0.01). A waist measurement of 107 cm (82.7% specificity, 60.6% sensitivity) and WHR of 0.97 (78.8% specificity, 63.8% sensitivity) were chosen as discriminator values corresponding with visceral obesity diagnosed by CT. A value of 6.90 cm for visceral fat US-determined diagnosed visceral obesity with a specificity of 82.8%, a sensitivity of 69.2%, and a diagnostic concordance of 74% with CT.Discussion: US seemed to be the best alternative method for the assessment of intra-abdominal fat in obese women. Its diagnostic value could be optimized by an anthropometric measurement. Prospective studies are needed to establish CT and US cutoffs for defining visceral-fat levels related to elevated cardiovascular risk.
- ItemAcesso aberto (Open Access)Obesidade e síndrome metabólica na infância e adolescência(Pontifícia Universidade Católica de Campinas, 2004-06-01) Oliveira, Cecília Lacroix de [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Cintra, Isa de Pádua [UNIFESP]; Fisberg, Mauro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The prevalence of obesity is increasing all over the world in the last decades. This is a concerning fact since the excess of body fat, especially abdominal fat, is directly related to the lipidic profile that is altered, to the increase of arterial pressure and hyperinsulinemia. All of these are considered risk factors to the onset of chronic-degenerative diseases such as type 2 diabetes and cardiovascular disease. High levels of leptin and the alterations of fibrinolytic factors have also been observed in obese individuals. These modifications are described as metabolic syndrome or insulin resistance syndrome, since hyperinsulinemia has an important role in the development of other components of the metabolic syndrome. However, the question is if these alterations are already present in these children and adolescents. This paper describes the physiopathology of the metabolic syndrome components and aims at clarifying how this process takes place in youth.
- ItemAcesso aberto (Open Access)Obstructive Sleep Apnea A Cardiometabolic Risk in Obesity and the Metabolic Syndrome(Elsevier B.V., 2013-08-13) Drager, Luciano Ferreira; Togeiro, Sonia Maria [UNIFESP]; Polotsky, Vsevolod Y.; Lorenzi-Filho, Geraldo; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Johns Hopkins UnivObstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. in patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (similar to 60%). in this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients. (C) 2013 by the American College of Cardiology Foundation
- ItemAcesso aberto (Open Access)Perfil glicometabólico inicial em pacientes com síndrome coronariana aguda e síndrome metabólica(Sociedade Brasileira de Cardiologia - SBC, 2009-02-01) Monteiro, Carlos Manoel de Castro [UNIFESP]; Oliveira, Luciene [UNIFESP]; Izar, Maria Cristina de Oliveira [UNIFESP]; Helfenstein, Tatiana [UNIFESP]; Santos, Andreza Oliveira dos [UNIFESP]; Fischer, Simone M. [UNIFESP]; Barros, Sahana W. [UNIFESP]; Pinheiro, Luiz Fernando Muniz [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Fonseca, Francisco Antonio Helfenstein [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: Patients with metabolic syndrome (MetS) are at high coronary risk and beta-cell dysfunction or insulin resistance might predict an additional risk for early cardiovascular events. OBJECTIVE: This study aimed to evaluate early glucometabolic alterations in patients with MetS, but without previously known type 2 diabetes, after acute coronary syndrome. METHODS: A total of 114 patients were submitted to an oral glucose tolerance test (OGTT) 1-3 days after hospital discharge due to myocardial infarction or unstable angina. Based on the OGTT, we defined three groups of patients: normal glucose tolerance (NGT; n=26), impaired glucose tolerance (IGT; n=39), or diabetes (DM; n=49). The homeostasis model assessment (HOMA-IR) was used to measure insulin resistance; beta-cell responsiveness was assessed by the insulinogenic index at 30 min (ΔI30/ΔG30). RESULTS: Based on the HOMA-IR, patients with DM were more insulin-resistant than those with NGT or IGT (p<0.001). According to the insulinogenic index, the beta-cell responsiveness was also impaired in subjects with DM (p<0.001 vs NGT or IGT). CONCLUSION: High rates of glucometabolic alterations were found after acute coronary syndrome in patients with MetS. As these abnormalities markedly increase the risk for adverse outcomes, early OGTT among MetS patients might be used to identify those at the highest coronary risk.
- ItemSomente MetadadadosPrevalence of metabolic syndrome in elderly Japanese-Brazilians(Int Scientific Literature, Inc, 2012-02-01) Xavier, Natasha Priscilla; Chaim, Rita Cristina; Agostinh Gimeno, Suely Godoy [UNIFESP]; Gouvea Ferreira, Sandra Roberta; Hirai, Amelia Toyomi [UNIFESP]; Rosa, Camila Moreno; Padovani, Carlos Roberto; Okoshi, Marina Politi; Okoshi, Katashi; Universidade de São Paulo (USP); Univ Cattolica Sacro Cuore; Universidade Federal de São Paulo (UNIFESP); Biosci InstBackground: Prevalence of individuals with a high cardiovascular risk is elevated in elderly populations. Although metabolic syndrome (MS) increases cardiovascular risk, information is scarce on the prevalence of MS in the elderly. In this study we assessed MS prevalence in a population of elderly Japanese-Brazilians using different MS definitions according to waist circumference cutoff values.Material/Methods: We studied 339 elderly subjects, 44.8% males, aged between 60 to 88 years (70.1 +/- 6.8). MS was defined according to criteria proposed by the Joint Interim Statement in 2009. As waist circumference cutoff point values remain controversial for Asian and Japanese populations, we employed 3 different cutoffs that are commonly used in Japanese epidemiological studies: 1) >90 cm for men and >80 cm for women; 2) >85 cm for men and >90 cm for women; 3) >85 cm for men and >80 cm for women.Results: MS prevalence ranged from 59.9% to 65.8% according to the different definitions. We observed 90% concordance and no statistical difference (p>0.05) in MS prevalence between the 3 definitions. MS diagnosis according to all 3 cutoff values was found in 55.8% of our population, while in only 34.2% was MS discarded by all cutoffs. The prevalence of altered MS components was as follows: arterial blood pressure 82%, fasting glycemia 65.8%, triglyceride 43.4%, and HDL-C levels 36.9%.Conclusions: Elderly Japanese-Brazilians present high metabolic syndrome prevalence independent of waist circumference cutoff values. Concordance between the 3 definitions is high, suggesting that all 3 cutoff values yield similar metabolic syndrome prevalence values in this population.
- ItemAcesso aberto (Open Access)Relationships between adiponectin levels, the metabolic syndrome, and type 2 diabetes: a literature review(Sbem-Soc Brasil Endocrinologia & Metabologia, 2017) von Frankenberg, Anize Delfino; Reis, Andre F. [UNIFESP]; Gerchman, FernandoElevated hepatic glucose production, impaired insulin secretion, and insulin resistance - abnormalities of glucose metabolism typically found in subjects with obesity - are major factors underlying the pathogenesis of type 2 diabetes (DM2) and the metabolic syndrome (MS). Adiponectin is a major regulator of glucose and lipid homeostasis via its insulin-sensitizing properties, and lower levels seems to be associated with the development of DM2 and MS. The purpose of this review is to clarify the mechanisms whereby adiponectin relates to the development of DM2 and MS and the association between polymorphisms of the adiponectin gene, circulating levels of the hormone, and its relationships with DM2. In addition, the impact of dietary lipids in the circulating levels of adiponectin will be addressed. According to the literature, circulating adiponectin levels seem to decrease as the number of MS components increases. Lower adiponectin concentrations are associated with higher intra-abdominal fat content. Therefore, adiponectin could link intra-abdominal fat with insulin resistance and development of MS. Therapeutic strategies that target the MS and its components, such as lifestyle modification through physical activity and weight loss, have been shown to increase adiponectin concentrations. Possible roles of diets containing either low or high amounts of fat, or different types of fat, have been analyzed in several studies, with heterogeneous results. Supplementation with n-3 PUFA modestly increases adiponectin levels, whereas conjugated linoleic acid supplementation appears to reduce concentrations when compared with unsaturated fatty acid supplementation used as an active placebo.
- ItemAcesso aberto (Open Access)Riscos cardiovasculares em adolescentes com diferentes graus de obesidade(Sociedade Brasileira de Cardiologia - SBC, 2011-03-01) Lavrador, Maria Silvia Ferrari [UNIFESP]; Abbes, Priscila Trapp; Schimith Escrivão, Maria Arlete Meil [UNIFESP]; Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do AmazonasBACKGROUND: There have been few studies on cardiovascular risk factors in adolescents with different degrees of obesity. OBJECTIVE: To evaluate metabolic effects associated with different degrees of obesity in adolescents and their impact on cardiovascular risks. METHODS: Cross-sectional study of 80 obese adolescents, divided in two groups: 22.5, classified as obese with lower or higher degree of obesity, respectively. Physical examination was carried out, as well as biochemical and body composition assessment. The statistical analysis was performed with t-Student and Chi-square tests, aiming at comparing both groups. A multiple logistic model was used to verify the associations between the biochemical variables and the degree of obesity. Risk scores were developed for cardiovascular disease, according to the number of alterations found in the following variables: fasting glycemia, triglycerides, HDL and blood pressure. Association between these scores and degree of obesity were verified. RESULTS: The two groups differed regarding weight, waist circumference, fasting glycemia and insulin, HOMA-IR, triglycerides, HDL, blood pressure (BP) and body composition measurements (p<0.05). The adolescents with the higher degree of obesity presented higher frequencies of alterations for glycemia, HOMA-IR, triglycerides, HDL and BP (p<0.05). The logistic model showed associations between the degree of obesity and the variables: HDL (OR=5.43), BP (OR=4.29), TG (OR=3.12). The risk score demonstrated that 57.7% of the adolescents with higher degrees of obesity had two or more metabolic alterations versus 16.7% from the other group (p<0.001). CONCLUSION: The degree of obesity influenced the onset of alterations that comprise the metabolic syndrome, increasing the cardiovascular risk.
- ItemAcesso aberto (Open Access)Síndrome metabólica: comparação de critérios diagnósticos(Sociedade Brasileira de Pediatria, 2010-08-01) Cavali, Monica de Lima Raeder [UNIFESP]; Schimith Escrivão, Maria Arlete Meil [UNIFESP]; Brasileiro, Rosana Sarmento [UNIFESP]; Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To propose a new criterion for the diagnosis of metabolic syndrome (MS) in adolescents and to check its consistency with those proposed by Jolliffe and Janssen and by the International Diabetes Federation (IDF). METHOD: This is a cross-sectional study of 80 obese adolescents aged 14 to 19 years. Anthropometric (weight, height, and waist circumference) and laboratory (fasting triglycerides, HDLc, glucose, and insulin) parameters, as well as blood pressure were evaluated. The HOMA-IR index was used to characterize insulin resistance, and the presence of steatosis was assessed by hepatic ultrasound. Agreement analyses across the three criteria were made using the kappa coefficient. RESULTS: The prevalence of MS was 13.5, 15, and 25% for IDF and Jolliffe and Janssen's criteria and the proposed method, respectively. A nearly perfect agreement between Jolliffe and Janssen's and IDF (kappa = 0.94) criteria and a moderate agreement between the new criteria and the previous two (kappa = 0.46 and 0.41, respectively) were observed. CONCLUSIONS: The highest prevalence of MS was observed with the criterion proposed in this study, which included steatosis and insulin resistance as parameters, thus being able to diagnose a larger number of adolescents at metabolic risk.
- ItemSomente MetadadadosWaist circumference and visceral fat in CKD: A cross-sectional study(Elsevier B.V., 2008-07-01) Sanches, Fabiana M. R. [UNIFESP]; Avesani, Carla M. [UNIFESP]; Kamimura, Maria Ayako [UNIFESP]; Lemos, Marcelo M. [UNIFESP]; Axelsson, Jonas; Vasselai, Priscila [UNIFESP]; Draibe, Sergio A. [UNIFESP]; Cuppari, Lilian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Karolinska InstBackground: in the general population, waist circumference was noted to be a reliable predictor of visceral fat. in addition, increased waist circumference was strongly associated with risk factors for cardiovascular disease. in patients with chronic kidney disease (CKD), the association of waist circumference with visceral fat was never tested.Study Design: Cross-sectional study.Setting & Participants: 122 patients with CKD not yet on dialysis therapy (75 men; diabetes mellitus, 30%; age, 55.3 +/- 11.3 years; body mass index, 27.1 +/- 5.2 kg/m(2); estimated glomerular filtration rate, 35.4 +/- 15.2 mL/min/1.73 m(2)) were studied.Predictor: Waist circumference.Outcomes & Measurements: Anthropometry, abdominal visceral fat measured by means of computed tomography, and cardiovascular disease risk factors.Results: Waist circumference strongly correlated with visceral fat (r = 0.75 for men, r = 0.81 for women; P < 0.01). K Statistic was 0.56, indicating relatively good agreement between methods. Body mass index showed a lower correlation coefficient (r = 0.68 for men, r = 0.76 for women; P < 0.01) and poor agreement (0.36) with visceral fat in comparison to waist circumference. in men, waist circumference and visceral fat similarly correlated with high-density lipoprotein cholesterol level, triacylglycerol level, and Homeostasis Model Assessment Index (P < 0.05). in women, waist circumference correlated with age, C-reactive protein level, and Homeostasis Model Assessment Index, whereas visceral fat also correlated with low-density lipoprotein cholesterol and triacylglycerol levels (P < 0.05).Limitations: Findings are restricted to patients with CKD not yet on dialysis therapy from a single center.Conclusions: Waist circumference was strongly associated with visceral fat in patients with CKD. Associations between waist circumference and cardiovascular disease risk factors were similar to those observed for visceral fat, particularly in men. These findings suggest that waist circumference may be a simple and inexpensive too] to be used in epidemiological studies.