ABSTRACT
O advento da utilização da terapia anti-retroviral de alta atividade (HAART), a partir de 1996, representou um profundo impacto na história natural da infecção pelo HIV, promovendo uma importante e sustentada supressão na replicação viral, elevando a sobrevida e a qualidade de vida dos pacientes soropositivos. No entanto, gradualmente, foi se observando que a terapia antiretroviral é acompanhada de alterações metabólicas, como dislipidemia, principalmente hipertrigliceridemia, resistência insulínica, hiperglicemia elipodistrofia, isto é, redistribuição da gordura corporal. Ensaios epidemiológicos demonstram correlação entre os níveis elevados de triglicerídeos (TG) e maior incidência de doença arterial coronariana (DAC). Autores sugerem a intervenção dietética como parte do tratamento da hiperlipidemia, incluindo aumento da ingestão de fibra solúvel (10g-25g/dia). Há estudos demonstrando que tanto o colesterol quanto os triglicerídeos séricos diminuem com a utilização de fibra alimentar. Alguns observaram redução apenas nos níveis séricos de triglicerídeos, enquanto que outros não verificaram alteração no metabolismo lipídico. O objetivo do presente estudo foi avaliar o efeito da fibra solúvel® (goma guar parcialmente hidrolisada) suplementar sobre a hipertrigliceridemia e o perfil imunológico de indivíduos HIV positivo em tratamento com HAART. Foram estudados 19 pacientes HIV positivo com hipertrigliceridemia (níveis séricos maior ou igual a 150 a menor que 500mg/dL), sendo 63,16% do sexo masculino e 36,84% feminino, com média de idade de 43,52 mais ou menos 9,22 anos. Esses indivíduos utilizavam o mesmo esquema HAART há pelo menos seis meses, sem mudança da terapia durante o estudo e receberam 20g de fibra solúvel® por dia, durante quatro meses, em horários pré-definidos...
Subject(s)
Humans , Male , Female , Adult , Acquired Immunodeficiency Syndrome , Antiretroviral Therapy, Highly Active , Dietary Fiber/therapeutic use , Hypertriglyceridemia/chemically inducedABSTRACT
Chagas disease (CD), caused by the protozoan Trypanossoma cruzi, affects approximately 18 million individuals in the Americas, 5 million of which live in Brazil. Most chronic sufferers have either the indeterminate form of the disease, without organic compromise, or the cardiac or digestive forms. Despite the importance of this disease, there is no information on the effect of nutrition on CD evolution. We evaluated the clinical-nutritional profile of individuals with CD treated at the Tropical Diseases Nutrition Out-Patient Clinic of the Botucatu School of Medicine, UNESP. A retrospective cohort study was performed between 2002 and 2006, on 66 patients with serum and parasitological diagnosis of CD. Epidemiological, clinical, nutritional, and biochemical data were collected, including gender, age, skin color, smoking, alcoholism, physical activity, weight, stature, body mass index, abdominal circumference, glycemia, and lipid profile. Fifty-three percent were male and 47 percent female; 96 percent were white skinned. Mean age was 49.6±6.36 years. The predominant form was indeterminate in 71 percent; smoking and drinking were recorded in 23 percent and 17 percent, respectively. Sedentariness predominated in 83 percent, and 55 percent presented increased abdominal circumference. Most, 94 percent, were overweight or obese. The biochemical exams revealed hyperglycemia in 12 percent and dyslipidemia in 74 percent. These findings suggest that the Chagas population presents co-morbidities and risk factors for developing chronic non-transmissible diseases, including cardiovascular diseases, making CD evolution even worse.
Subject(s)
Animals , Female , Humans , Male , Middle Aged , Chagas Disease/complications , Dyslipidemias/complications , Nutritional Status , Obesity/complications , Body Mass Index , Chronic Disease , Cohort Studies , Cardiovascular Diseases/etiology , Chagas Disease/blood , Dyslipidemias/diagnosis , Life Style , Obesity/diagnosis , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
The use of highly active antiretroviral therapy (HAART) in HIV-infected patients has been associated with the development of risk factors for cardiovascular diseases (CD) including dyslipidemia and insulin resistance, hypertriglyceridemia being the most frequent metabolic disturbance in these patients. Fibrates are indicated when hypertriglyceridemia is accentuated and persists for over six months. We evaluated the efficacy and safety of bezafibrate for the treatment of hypertriglyceridemia in HIV-infected individuals on HAART. All patients received 400mg/day of bezafibrate and were evaluated three times: Mo (pre-treatment), M1 (one month after treatment), and M2 (six months after treatment). Fifteen adult individuals, eight males and seven females with mean age = 41.2 ± 7.97 years and triglyceride serum levels > 400mg/dL were included in the study. Smoking, alcohol ingestion and sedentarism rates were 50 percent, 6.66 percent and 60 percent, respectively. Family history of CD, hypertension and diabetes mellitus was reported in 33.3 percent, 40 percent and 46.7 percent of the cases, respectively, while dyslipidemia was reported by only 13.3 percent. More than half of the patients were using a protease inhibitor plus a nucleotide analog transcriptase inhibitor. Eutrophy and tendency toward overweight were observed at all three study time points. There were significant reductions in triglyceride serum levels from Mo to M1 and from Mo to M2. No significant changes were observed in the serum levels of creatine phosphokinase, hepatic enzymes, CD4+, CD8+ and viral load. Therefore, bezafibrate seems to be safe and effective for the reduction of hypertriglyceridemia in HIV-infected patients on HAART.
Subject(s)
Adult , Female , Humans , Male , Hypolipidemic Agents/therapeutic use , Antiretroviral Therapy, Highly Active/adverse effects , Bezafibrate/therapeutic use , HIV Infections/drug therapy , Hypertriglyceridemia/drug therapy , HIV Infections/blood , Hypertriglyceridemia/chemically induced , Treatment Outcome , Viral LoadABSTRACT
O aumento do colesterol plasmatico total e, especialmente, de sua fraçao LDL colesterol constituem fatores fundamentais no desenvolvimento do risco de doenças cardiovasculares. O uso de determinados tipos de oleos altera a composiçao de lipideos plasmaticos. Com o objetivo de verificar o efeito dos diferentes tipos de oleos sobre o perfil lipidico de pacientes normocolesterolemicos com artrite reumatoide foram estudados 43 pacientes com idade media de 49 =-12 anos, sendo 34 pacientes do sexo feminino e 9 pacientes do sexo masculino. Os pacientes foram divididos em tres grupos: grupo 1 que recebeu 20 capsulas diarias de 500mg de oleo de soja, grupo 2 que recebeu 20 capsulas diarias de 500mg de oleo de peixe e grupo 3 que recebeu alem do oleo de peixe 9,6ml de oleo de oliva em flaconetes e foi solicitada a substitui~çao do oleo de sua alimentaçao diaria por oleo de canola. A avaliaçao laboratorial foi realizada mediante glicemia e colesterol plasmatico total e suas fraçoes LDL colesterol, HDL colesterol e a triacilglicerol e a avaliaçao nutricional mediante peso, indice de massa corporea e inquerito alimentar. Os pacientes foram avaliados no inicio do estudo e apos 12 e 24 semanas. Verificou-se apos 12 semanas de estudo a diminuiçao significativa (p<0,05) do colesterol total no grupo 1 em relaçao ao grupo 2 e tambem diminuiçao significativa (p<0,05) do LDL colesterol do grupo 1 comparado aos grupos 2 e 3. Entretanto, nao houve doferença significativa entre os grupos apos 24 semanas de estudo. O grupo 3 apresentou maior peso, indice de massa corporea e ingestao energetica total que os demais grupos, mas os resultados nao foram significativos. Em conclusao, o uso de oleo de soja parece ser uma opçao para pacientes que necessitam diminuir os niveis de colesterol plasmatico.