Valores de LDL-Colesterol Estimados pela Equação de Friedewald são Afetados pelo Controle do Diabetes / Low-Density Lipoprotein Values Estimated by Friedewald Equation are Affected by Diabetes Control

Fundamento: A equação de Friedewald (EF) é amplamente utilizada para estimar o LDL-c sem utilizar ultracentrifugação. Entretanto, a equação tem limitações em determinados cenários clínicos. Objetivo: O nosso objetivo era investigar a possível importância das diferenças entre a EF e a medição direta de LDL-c em pacientes com diabetes. Métodos: Realizamos um estudo transversal entre 466 pacientes com doença coronária estável. Colesterol total, triglicérides, HDL-c e LDL-c foram coletados, e a EF foi calculada. A acurácia foi calculada como percentagem de estimativas dentro de 30% (P30) do LDL medido. O viés foi calculado como a diferença média entre o LDL-c medido e o estimado. A concordância entre os métodos foi avaliada utilizando gráficos de Bland-Altman. Resultados: O viés foi de 3,7 (p=0,005) e 1,1 mg/dl (p=0,248), e a acurácia foi de 86% e 93% em pacientes diabéticos e não-diabéticos, respectivamente. Entre os pacientes com diabetes, o viés foi de 5 mg/dl (p=0,016) e 1,93 mg/dl (p=0,179), e a acurácia foi de 83% e 88% em indivíduos com hemoglobina A1c superior a 8 mg/dl versus abaixo do ponto de corte, respectivamente. O viés foi similar em pacientes sem diabetes comparados com pacientes com diabetes e HbA1C < 8 (1,1 e 1,93 mg/dl). Conclusão: A EF é imprecisa entre indivíduos gerais com diabetes. Porém, ao estratificar pacientes com diabetes em bom e mau controle da doença, o primeiro grupo se comporta como se não tivesse diabetes, com uma boa correlação entre o LDL-c calculado e o mensurado. É importante saber quando é razoável usar a EF, porque uma estimativa imprecisa dos níveis de LDL-c pode resultar no subtratamento da dislipidemia e predispor estes pacientes a eventos agudos

Background: Friedewald equation (FE) is widely used to estimate the LDL-c without the use of ultra-centrifugation. However, the equation has limitations in some clinical settings. Objective: Our goal was to investigate the potential importance of differences between FE and direct measurement of LDL-c in patients with diabetes. Methods: We conducted a cross-sectional study among 466 patients with stable coronary disease. Total cholesterol, triglycerides, HDL-c and LDL-c were collected, and FE was calculated. Accuracy was calculated as the percentage of estimates within 30% (P30) of measured LDL. Bias was calculated as the mean difference between measured and estimated LDL-c. Agreement between methods was evaluated using BlandAltman plots.Results: Bias was 3.7 (p=0.005) and 1.1 mg/dl (p=0.248), and accuracy was 86% and 93% in diabetic and non-diabetic patients, respectively. Among patients with diabetes, bias was 5 mg/dl (p=0.016) and 1.93 mg/dl (p=0.179), and accuracy was 83% and 88% in subjects with Hemoglobin A1C above 8 mg/dl versus below cutoff point, respectively. Bias was similar in patients without diabetes compared to patients with diabetes and HbA1C < 8 (1.1 and 1.93 mg/dl). Conclusion: FE is inaccurate among overall individuals with diabetes. However, when stratifying patients with diabetes into good and poor disease control, the first group behaves as if it does not have diabetes, with a good correlation between calculated and measured LDL-c.It is important to know when is it reasonable to use FE because an inaccurate estimation of LDL-c levels could result in undertreatment of dyslipidemia and predispose these patients to acute events

Associação entre comportamento sedentário e perfil antropométrico e metabólico entre adolescentes / Asociación entre sedentarismo y los perfiles metabólicos y antropométricos en adolescentes / Association between sedentary behavior and anthropometric and metabolic profiles among adolescents

The purpose of this study was to establish the association between sedentary behavior and the anthropometric and metabolic profiles within a sample group of 572 adolescents from public schools in the city of Curitiba, State of Paraná, Brazil. Approximately 8 ml of blood was drawn to measure total cholesterol (TC), LDL-c, HDL-c, triglycerides, and glucose. Stature and body mass were measured to calculate the body mass index. Information about the subjects' socioeconomic status, physical activity level, sedentary behavior, eating frequency, as well as personal information was obtained through questionnaires. Descriptive statistics, measures of central tendency and percentage score, and Binary Logistic Regression were used to obtain the odds ratio with a CI of 95% and p<0.05. Half of the girls had TC levels classified as borderline or altered, and total screen time presented a significant association between the metabolic variables analyzed in the study. We conclude that girls had TC levels less favorable than that of the boys and that screen time is associated with some metabolic variables.

O objetivo deste estudo foi verificar a associação entre o comportamento sedentário e o perfil antropométrico e metabólico em uma amostra de adolescentes de Curitiba, Paraná. Participaram da pesquisa 572 adolescentes da rede pública de ensino. Coletou-se aproximadamente 8 ml de sangue para determinar o colesterol total (CT), lipoproteína de baixa densidade, lipoproteína de alta densidade, triglicerídeos e glicemia. Mensurou-se a estatura e massa corporal para cálculo do índice de massa corporal. Obteve-se dados sobre informações pessoais, nível socioeconômico, nível de atividade física, comportamento sedentário e frequência alimentar através de questionários auto preenchidos. Utilizou-se estatística descritiva, medidas de tendência central e proporção, e a Regressão Logística Binária para obtenção do razão de chances com intervalo de confiança de 95% e p<0,05. Metade das moças apresentou alterações no CT e houve uma associação positiva significativa entre o tempo total de tela e as variáveis metabólicas avaliadas no estudo. Conclui-se que as meninas mostraram valores de CT menos favorável que os rapazes e, existe uma correlação entre o tempo de tela e algumas variáveis metabólicas.

El objetivo fue investigar la asociación entre el comportamiento sedentario y el perfil antropométrico y metabólico en adolescentes en la ciudad de Curitiba, Paraná. Los participantes fueron 572 adolescentes matriculados en las escuelas públicas. Se recogieron 8 ml de sangre para determinar el colesterol total (CT), LDL-c, HDL-c, triglicéridos y glucosa. Se midió la altura y el peso para calcular el índice de masa corporal. Los datos sobre la información personal, el nivel socioeconómico, el nivel de actividad física, el sedentarismo y el consumo alimentario se recogieron a través de cuestionarios auto-completados. Se empleó la estadística descriptiva, medidas de tendencia central y de proporción, y la regresión logística binaria para obtener la odds ratio con intervalo de confianza del 95% y p<0,05. La mitad de las chicas tenían el colesterol alto y existe una asociación positiva significativa entre el tiempo total de pantalla y las variables metabólicas evaluadas en el estudio. Llegamos a la conclusión de que las chicas presentan el CT menos favorable que los niños y el tiempo total de pantalla corresponde a las variables metabólicas.

Modificaciones de las lipoproteínas del plasma en voluntarios sometidos a dietas preparadas con aceite de girasol solo o mezclado con oleína de palma / Changes in the content of plasma lipoproteins in persons subjected to diets prepared with sunflower oil alone or mixed with palm olein

En 31 comensales regulares del Comedor Universitario de la Universidad Central de Venezuela (CUUCV), en Caracas. Se observó el efecto de la sustitución del aceite de girasol que se utiliza corrientemente en la preparación de las comidas en ese comedor, por un aceite obtenido de la mezcla de aceite de girasol y oleína de palma, en la proporción 70/30 (v/v) respectivamente. Después de 40 días continuos de la sustitución no hubo cambios significativos en las concentraciones de colesterol total (CT), ni del colesterol de las lipoproteínas de baja densidad (LDL) y muy baja densidad (VLDL). La concentración del colesterol de las lipoproteínas de alta densidad (HDL) aumentó significativamente (p<0,05). Los triglicéridos (TG) del plasma aumentaron en un 30%. La resistencia a la oxidación de las LDL aumentó considerablemente (p< 0,01). Hoy se considera a esta resistencia como un factor protector de gran importancia en la prevención del inicio del proceso aterogénico. Tomando en cuenta las modificaciones favorables como el aumento de colesterol de HDL sin modificación de la LDL y el claro aumento de la resistencia a la oxidación de la LDL, se considera que la oleína de palma es un aceite vegetal que puede ser utilizado sin mayores riesgos en mezcla con otros aceites que tengan una relación linoleico/palmítico más elevada como los aceites de girasol, maíz, soja y otros.

We analyzed in 31 subjects, regular guests of the University food service of the Central University of Venezuela (UCVFS), in Caracas, the effects of replacing sunflower oil, commonly used in the preparation of meals, by a mix of sunflower oil and palm olein 70/30 (v/v) respectively. Plasma concentrations of total cholesterol, low and very low density lipoproteins were not changed after 40 days of the substitution. On the contrary, concentrations of high density lipoprotein and total triglycerides increased. The resistance to the oxidation of low-density lipoproteins increased considerably (p<0, 01). Today this resistance is considered as a protective factor of great importance in the prevention of the initiation of the atherogenic process. Taking into account the favorable modifications of HDL cholesterol and the clear increased resistance to the oxidation of LDL, we think that palm olein, mixed with other oils with a high ratio linoleic/palmític (sunflower, corn, soya an the likes), can be used as a healthy alternative in human nutrition.

Lipoprotein changes in women taking low-dose combined oral contraceptive pills: a cross-sectional study in Basra, Iraq

We assessed lipid and lipoprotein levels in 100 women taking low-dose COCs and a control group of 100 non-users attending the family planning centre Basra Maternity and Child Hospital, Iraq. Venous blood was collected after 12-14 hours fasting, and serum triglyceride [TG], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C] and very low-density lipoprotein [VLDL] levels were measured. Serum TG, HDL-C and VLDL levels were significantly higher and LDL-C levels lower in users than non-users but TC levels did not differ between the 2 groups. TG, HDL-C and VLDL levels rose with age and duration of use while LDL-C levels decreased; TC levels did not change

Effect of cyamopsis tetragonoloba [GUAR] on lipid profile in diabetic and non-diabetic subjects

To compare the effect of Guar fiber in Roasted and cooked vegetable form on lipid profile in diabetic as well as in normal healthy subjects. This study was conducted at Department of Medicine, Sardar Patel Medical College, Bikaner, India on 120 subjects in which 60 were diabetic and 60 non diabetic. Blood samples were withdrawn before and after 15 and 30 days of consumption of 10.0 and 20.0 gm of roasted and cooked guar fiber per day and analyzed for sugar, cholesterol, triglyceride, HDL, LDL and VLDL-cholesterol by standard technique using semi-auto analyzer. The Blood sugar, cholesterol, triglyceride, LDL and VLDL showed highly significant results [t=4.33 and p < .001] after supplementation of roasted guar fiber for 30 days as compare to that of cooked vegetable guar fiber in normal as well as in diabetic subjects in daily routine diet, Blood sugar level [96.9 +/- 2.49%] after 30 days consumption of 20 gm roasted guar fiber per day in normal subjects and in Diabetics [154.3 +/- 15.38%] where as HDL showed no significant change when 20 gm roasted fiber given for 15 days [49.7 +/- 7.10],after 30 days range is [55.5 +/- 8.16], p value [p<.05]. Roasted guar, as compared to cooked guar, significantly reduces Blood sugar, serum cholesterol,triglyceride, LDL and VLDL level not HDL, in both diabetic and non diabetic adults.Roasted guar fiber diet is beneficial for Diabetic as well as Cardiac patients

Variabilidad análitica entre laboratorios clínicos en la determinación de lípidos séricos (colesterol total, HDL, LDL y VLDL) en Venezuela / Analytical variability among clinical laboratories in Venezuela assessing serum total cholesterol: HDL: LDL and VLDL

El perfil de lípidos séricos es indispensable para el proceso de decisión clínica actual, pero el equipo de salud conoce poco sobre el concepto y la magnitud de la variabilidad inter e intra-laboratorio en su determinación. Para determinar colesterol total, HDL, LDL y VLDL se enviaron alícuotas congeladas de un mismo pool de sueros, a una muestra de laboratorios clínicos venezolanos (LCV), que realizaron las determinaciones como un servicio regular (procedimientos, reactivos y equipos de su rutina diaria). Participaron 180 LCV de 29 ciudades, resultados en (ml/dL) promedio (rango): Colesterol 181,9 (145 a 330), LDL 106,6 (48,5 a 241,2); HDL 43,8 (16 a 93) y VLDL 32,5 (5,2 a 90). El promedio del grupo se considero el valor de referencia. La prevalencia (%) de determinaciones con diferencias mayor e igual 10%(en más o en menos) del promedio: Colesterol total 18,9%, LDL 48,6%, HDL 52,5% y VLDL 39,1%. Según ATP-III; 8,5% reportaron LDL alto y 31,6% reportaron HDL bajo. Se demostró que la variabilidad inter-laboratorio existente permitiría clasificar a un mismo paciente en cualquiera de las categorías del ATP-III, esta información es muy valiosa para el clínico a la hora de tomar decisiones sobre el riesgo de su paciente, y evidencia la necesidad de promover en Venezuela un sistema de vigilancia epidemiológica que promueva la calidad, reduciendo la variabilidad inter-laboratorio a niveles aceptables.

The current clinical decision making process needs no take into consideration a patient's lipid profile. However, the health team in seldom aware of the concept and magnitude of inter and intra laboratory variability. Frozen aliquots of the same pool of serums were sent to a sample of clinical laboratories (CL) in Venezuela, which carry out such analyses as a regular service (with the same procedures, reactants and equipment). One hundred and eighty CL from 29 cities participated. The group results in milligrams/deciliters were, mean (range): total cholesterol 181,9 (145 to 330), LDL 106.6 (48.5 to 241.2); HDL 43.8 (16 to 93) and VLDL 32.5 (5.2 to 90). The group mean was selected as reference value. The prevalence rates of differences of major and equal ± 10% (as a percentage of the mean) were: total cholesterol 18.9%, LDL 48.6%, HDL 52.5% and VLDL 39.1%. According to ATP-III; 8.5% of LC reported high LDL and 31.6% reported low HDL. The results show that the same patient could be classified into every ATP-III category. This information is important for clinicians assessing the cardiovascular disease risk of patients, and it show the need to promote a national health surveillance system to assure quality control and to reduce inter labortory variability to acceptable levels.

Perfis antropométrico, lipídico e glicêmico em adolescentes de uma instituição filantrópica no noroeste do Paraná / Anthropometric, lipids and blood glucose profiles in adolescents of a philanthropic institution in the northwest Paraná

INTRODUÇÃO: A obesidade na adolescência é um fator preditivo da obesidade no adulto. A prevalência em crianças e adolescentes tem aumentado na maior parte dos países e tem-se traduzido em um dos mais significativos problemas nutricionais da atualidade. OBJETIVOS: Este estudo teve por objetivo verificar os perfis antropométrico, lipídico e glicêmico em adolescentes de baixo nível socioeconômico de uma instituição filantrópica no noroeste do Paraná. MATERIAL E MÉTODOS: A população estudada foi composta por 92 adolescentes, com idade entre 10 e 17 anos. Foi utilizado o índice de massa corporal (IMC) para verificar o estado nutricional dos adolescentes, considerando normal 24,9 kg/m² e sobrepeso > 25 kg/m². A razão cintura-quadril (RCQ) foi mensurada por meio do quociente da cintura pelo quadril, e as concentrações de glicose, triglicerídeos, colesterol total, frações HDL-C, LDL-C e VLDL-C foram determinadas segundo o método enzimático colorimétrico. RESULTADOS: Encontraram-se 9,79 por cento de sobrepeso nos adolescentes e 9,78 por cento de RCQ e colesterol inadequados para a idade. Baixa correlação foi encontrada entre IMC e sobrepeso, glicemia, hipercolesterolemia, hipertrigliceridemia, LDL-C, VLDL-C e HDL-C, enquanto idade (razão de chance [RC] = 49,16) e RCQ (RC = 13,99) apresentaram correlação significativa (p < 0,05) com IMC. CONCLUSÃO: O resultado demonstra a necessidade de políticas públicas de saúde no âmbito escolar como fator preventivo da obesidade e seus fatores de risco.

INTRODUCTION: Obesity in adolescence is a predictive factor of obesity in adulthood. The prevalence in children and adolescents has increased in most countries and has become one of the most significant nutritional problems nowadays. OBJECTIVES: This study aimed at verifying the anthropometric, lipid and glycemic profiles in lower class adolescents from a philanthropic institution located in the Northeast of Paraná State. MATERIAL AND METHOD: The studied population consisted of 92 adolescents, from 10 to 17 years of age. The Body Mass Index (BMI) was used to verify their nutritional status, considering < 24.9 kg/m² normal and > 25 kg/m² overweight. The waist-to-hip measurement was calculated through waist-to-hip ratio (WHR) and glucose concentrations, triglycerides, total cholesterol, HDL-c, LDL-c and VLDL-c fractions were determined through enzymatic methods. RESULTS: 9.79 percent were overweight and 9.78 percent of WHR and cholesterol levels were inadequate to the age group. BMI (overweight), blood glucose, hypercholesterolemia, hypertriglyceridemia, LDL-c, VLDL-c and HDL-c showed low correlation, whereas age (OR = 49.16) and WHR (OR = 13.99) showed significant correlation p < 0.05. CONCLUSION: The result evidenced the necessity of health public policies in educational scope in order to prevent obesity and its risks factors in adolescence.

Impact of plasmatic lipids in glycemic control and its influence in the cardiometabolic risk in morbidly obese subjects / Impacto dos lipídios plasmáticos no controle glicêmico e sua influência no risco cardiometabólico em pacientes obesos mórbidos

OBJECTIVES: To evaluate whether biochemical parameters are associated with a good glycemic control and to identify the occurrence of cardiometabolic risk variables. MATERIAL AND METHODS: One hundred forty Brazilians were evaluated. The subjects were characterized with regard to glycemic control as good, fair and poor and were divided into tertiles by TG and HbA1c. We use the ROC curve to determine which variables were predicted of poor glycemic control and the factor analyses to identify the domains that segregated among the risk variables. RESULTS: Fasting glucose and insulin levels, TG level, VLDL-C and HOMA-IR increased significantly across HbA1c tertiles. The best marker for identification of poor glycemic control was triglycerides. The presence of cardiometabolic abnormalities did not alter the glycemic control, but HOMA-IR was significantly higher in subjects with abnormalities. CONCLUSION: The use of TG levels offers a reasonable degree of clinical utility. In morbidly obese subjects insulin resistance is associated with individual cardiometabolic factors.

OBJETIVOS: Avaliar o quanto os lipídios plasmáticos, o IMC e a glicemia de jejum estão associados com um bom controle glicêmico e identificar a ocorrência de variáveis do risco cardiometabólico. MÉTODO: Cento e quarenta brasileiros foram avaliados. Os pacientes foram caracterizados, de acordo com o controle glicêmico, como tendo bom controle, moderado controle e controle ruim e foram divididos em tercis de TG e HbA1c. Utilizou-se a curva ROC para determinar quais variáveis predizem um controle glicêmico inadequado e a análise fatorial para identificar os domínios que segregam as diferentes variáveis. RESULTADOS: A glicemia de jejum e os níveis de insulina, os níveis de TG, VLDL-C e HOMA-IR aumentaram significativamente de acordo com os tercis de HbA1c. O melhor marcador para identificação de indivíduos com um controle glicêmico ruim foi o triglicérides. A presença de anormalidades cardiometabólicas não alterou significativamente o controle glicêmico, mas o HOMA-IR foi significativamente maior nestes indivíduos. CONCLUSÃO: O uso dos níveis de TG oferece uma boa utilidade clínica. Em pacientes obesos mórbidos, a resistência à insulina esta associada com fatores de risco cardiometabólico.

Evaluation of lipid and lipoprotein profile in patients with insulin dependent diabetes mellitus

Dyslipoproteinaemia is one of the several risk factors linked to diabetic complications. To determine the changes in lipid and lipoprotein profile in patients with insulin dependent diabetes mellitus [IDDM]. Sixty-four IDDM patients [28 males and 36 females] and 120 control subjects [35 males and 85 females] were included in this prospective study. In patients and controls, serum concentrations of glucose [fasting blood sugar [FBS]], total cholesterol [TC], high density lipoprotein-cholesterol [HDL-C], low density lipoprotein-cholesterol [LDL-C], triglyceride [TG], and very low density lipoprotein- cholesterol [VLDL-C] were measured. In patients with IDDM,TC [p 0.01] LDL-C TG, VLDL-C serum levels [P< 0.05] and LDL-C / HDL-C ratio [P< 0.001] were significantly higher, and serum HDL-C level [P < 0.001] was significantly lower in comparison to control subjects. In males, serum HDL-C concentration [P< 0.05] was significantly lower in IDDM patients compared to controls, whereas, no significant differences seen in TC,LDL-C, TG,VLDL-C and LDL-C /HDL-C ratio among patients and control subjects [P> 0.05]. In females, IDDM patients have significantly higher serum levels of TC,TG [P< 0.05], VLDL-C [P< 0.05], LDL-C [p 0.01] and LDL-C/ HDL-C ratio [P< 0.001], and significantly lower serum HDL-C level [P< 0.001] compared to controls. IDDM patients are at a greater risk of dyslipidemia than normal individuals, and females are more prone than males, and hence, would be more susceptible to atherosclerosis and coronary artery disease [CAD]

The cholesterol lowering property of coriander seeds (Coriandrum sativum): mechanism of action.

Coriandrum sativum (Coriander) has been documented as a traditional treatment for cholesterol and diabetes patients. In the present study, coriander seeds incorporated into diet and the effect of the administration of coriander seeds on the metabolism of lipids was studied in rats, fed with high fat diet and added cholesterol. The seeds had a significant hypolipidemic action. In the experimental group of rats (tissue) the level of total cholesterol and triglycerides increased significantly There was significant increase in beta-hydroxy, beta-methyl glutaryl CoA reductase and plasma lecithin cholesterol acyl transferase activity were noted in the experimental group. The level of low density lipoprotein (LDL) + very low density lipoprotein (VLDL) cholesterol decreased while that of high density lipoprotein (HDL) cholesterol increased in the experimental group compared to the control group. The increased activity of plasma LCAT enhanced degradation of cholesterol to fecal bile acids and neutral sterols appeared to account for its hypocholesterolemic effect.

Triglyceride profile in dyslipidemia of type 2 diabetes mellitus

To evaluate ratios of serum triglycerides and cholesterol levels which may indicate postprandial lipid handling and to assess their role as prospective markers of dyslipidaemia in type 2 diabetes mellitus. Comparative, observational study. Bismillah Taqee Hospital, Karachi from July 2002 till December 2003. The study comprised 160 subjects, including 83 known type 2 diabetics [45 males, 38 females] and 77 age-matched controls [45 males, 32 females]. Fasting blood samples were analysed for serum triglycerides and total cholesterol, using automated chemistry analyzer. HDL-C was determined by precipitation method and LDL-C and VLDL-C were estimated by Friedewalds formula. LDL/HDL ratio and TG/HDL ratios were also calculated. The mean values for male and female diabetics were compared with that for the male and female non-diabetics respectively and tested for significance by paired t-test. Serum triglycerides and VLDL were raised in both male and female diabetics. No significant differences were observed in levels of serum total cholesterol, LDL, HDL and the LDL/HDL ratio. The mean value of the TG/HDL ratio for male diabetics was higher than that for the male non-diabetics [p=0.39]. A statistically significant difference was found in the TG/HDL ratios for the female diabetics and non-diabetics [p < 0.05]. In this study, type 2 diabetics showed marked hypertriglyceridaemia and raised TG/HDL ratio. The dyslipidaemia of diabetes predisposes to development of coronary heart disease and, therefore, evaluation of the TG:HDL ratio may provide a good tool to monitor and manage the lipid abnormalities in diabetics

Aumento do índice de massa corporal em relação a variáveis clínicas e laboratoriais quanto ao sexo em indivíduos sem evidências de cardiopatia / Gender-related associations of increased body mass index with clinical and laboratory variables in individuals with no evidence of heart disease

FUNDAMENTO: Na prática clínica, atendemos pacientes com diversos índices de massa corporal (IMC), desde pacientes com sobrepeso até pacientes obesos. Esse achado pode ser a única anormalidade clínica aparente. OBJETIVO: Avaliar as variáveis clínicas e laboratoriais associadas com aumento do IMC em mulheres e homens assintomáticos, sem qualquer indício de cardiopatia, a fim de obter dados para substanciar recomendações médicas, em uma amostra de estudo da nossa prática diária. MÉTODOS: Foram estudados indivíduos entre 14 e 74 anos de idade (média de 40,5 anos); 295 eram homens (43,1 por cento) e 389 eram mulheres (56,9 por cento). As relações entre IMC estratificado por sexo e as variáveis clínicas e laboratoriais foram analisadas por meio do coeficiente de correlação de Spearman e regressão linear múltipla. RESULTADOS: A média do IMC das mulheres (26,15 kg/m²) e dos homens (26,33 kg/m²) não apresentou diferença estatisticamente significante. No modelo de regressão linear múltipla, a relação colesterol total/fração HDL-colesterol (CT/HDL-C) (beta= 1,1320; p < 0,001) e a glicose sérica (beta= 0,0233; p = 0,023) foram independentemente correlacionadas com o IMC em mulheres. Nos homens, as variáveis que apresentaram correlação independente com o IMC foram a relação CT/HDL-C (beta= 0,793; p < 0,001) e a idade (beta = 0,0464; p = 0,030). CONCLUSÃO: Em mulheres e homens sem nenhum indício de cardiopatia, a relação CT/HDL-C aumentou com o IMC em ambos os sexos. Outros índices associados ao IMC foram glicose sérica nas mulheres e idade nos homens. As variáveis clínicas e laboratoriais associadas ao índice de massa corporal podem diferir quanto ao sexo.

BACKGROUND: In clinical practice, the patients we care for display a wide range of body mass indices, from lean to obese. This finding may be the sole apparent clinical abnormality. OBJECTIVE: To evaluate clinical and laboratory variables that might be associated with increased body mass index in asymptomatic men and women with no evidence of heart disease, to provide data to substantiate medical recommendations in a study sample from our everyday practice. METHODS: The subjects aged 14 to 74 years (mean 40.6 years), 295 men (43.1 percent) and 389 women (56.9 percent) The associations between body mass index stratified by gender and clinical and laboratory variables were analyzed using the Spearman correlation coefficient and multiple linear regression. RESULTS: The mean body mass index (BMI) did not differ significantly between women (26.15 Kg/m²) and men (26.33 Kg/m²). In the multiple linear regression model, the ratios of total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) (beta = 1.1320; p < 0.001) and serum glucose (beta= 0.0233; p = 0.023) were independently correlated with body mass index in women. In men, the variables independently correlated with BMI were the TC/HDL-C (beta = 0.793; p < 0.001) and age (beta = 0.0464; p = 0.030). CONCLUSION: In men and women with no evidence of heart disease, TC/HDL-C increased with body mass index in both genders. Other indices associated with BMI included serum glucose in women and age in men. Clinical and laboratory variables associated with body mass index may differ in relation to gender.

Apolipoproteínas B e A-I: fatores de risco cardiovascular? / Apolipoprotein B and A-I: cardiovascular risk factor?

A apolipoproteína (apo) B faz parte das frações lipídicas aterogênicas (Qm e VLDL remanescentes, LDL,Lp (a)) e a apo A-I da fração não-aterogênica (HDL). A determinação dessas apos é direta, automatizada, padronizada, com coeficiente de variação pequeno e não requer jejum. Os autores revisaram os principais estudos clinico-epidemiológicos e de intervenção terapêutica nas hiperlipidemias nos quais as apos B e A-I foram avaliadas. Esses estudos sinalizaram a importância das apos B e A-I no prognóstico de risco e permitiram que especialistas recomendassem a relação apo B / apo A-I como alternativa à já utilizada CT / HDL-c no cálculo de risco. Aguarda-se posicionamento futuro das Diretrizes para incluir as apos na avaliação do risco individual e objetivo terapêutico a ser atingido. Os autores sugerem que, na prática clínica, a determinação de apo B deve ser reservada ao coronariopatas com valores desejáveis de LDL-c ou na impossibilidade de seu cálculo e a de apo A-I, quando os valores de HDL-c são muito baixos.

Apolipoprotein (apo) B is present in atherogenic lipoproteins (remnant Qm and VLDL, LDL and Lp (a)) and apo A is present in non-atherogenic lipoprotein (HDL). Measurement of the apos is automated, standardized, with a small variation of coefficient and does not require fasting blood samples. The authors reviewed clinical, epidemiological and therapeutic trials on hyperlipidemia with apo B and A-I evaluation. These works showed the importance of apo B and A-I as cardiovascular risk factors. Experts recommended apo B / apo A-I ratio as an alternative to TC / HDL-c ratio for risk estimate. Future positioning from the Guidelines is expected to include apos in individual risk prediction and as a therapeutic target. The authors suggest that, in clinical practice, measurement of apo B is necessary for coronary heart disease patients with desirable LDLc levels or when this assessment is not possible and the measurement of apo A-I if HDL-c values are very low.

Association of lipid profile and body mass index (bmi) in hypertensive patients of Eastern Nepal.

Dyslipidemia is closely associated with hypertension. Out of different fractions of lipoprotein, definite association of elevated LDL-Cholesterol (LDLc) and other lipid parameters has been well observed in hypertensive patients. The present cross sectional study was undertaken at BP Koirala Institute of Health Sciences with the aim to find out association of different lipid parameters and Body Mass Index (BMI) among newly diagnosed hypertension without any medications in Eastern Nepal. 80 hypertensive patients fulfilling JNC-7 criteria and 80 healthy controls were enrolled in this study. Lipid parameters (TC, TG, LDLc, VLDLc, HDLc) were estimated by Enzymatic Colorimetric test. Quetlet's formula was used to calculate BMI. Results were analyzed with student's 't' test and Pearson correlation analysis. Mean age of patients and controls were 36.30 +/- 7.73 yrs & 32.13 +/- 7.21 yrs respectively. There was significant increase in different lipid parameters namely TC (170.18 22.53 vs 145.23 21.13,P<0.005), TG (146.60 53.87 vs 119.77 35.61, P<0.005), LDLc (100.71 23.74 vs 79.25 20.10,P<0.05) and VLDLc (29.32 1077 vs 23.92 7.12, P<0.05) in patients as compared to the healthy controls. However there was no any significant difference in HDLc value. Pearson correlation analysis shows positive correlation of BMI with all the four lipid parameters even though it was not statistically significant. Thus this study shows direct association of BMI, dyslipidemia in hypertensive patients of the Eastern Nepal.

Lípides plasmáticos em ratos após cirurgia esplênica - efeito de dois tipos de dieta / Effects of two types of diet on plasma lipids in rats submitted to splenic surgery

OBJETIVO: Verificar o efeito da esplenectomia total e da ligadura dos vasos esplênicos principais nos lípides plasmáticos de ratos alimentados com dieta controle ou dieta acrescida de 2,5 por cento de colesterol. MÉTODOS: Foram utilizados 99 ratos Wistar, machos, pesando entre 273 g e 427 g (MA 349,46; DP 35,54), distribuídos aleatoriamente em quatro grupos: grupo 1, controle (n=19), não operado; grupo 2 (n=19), manipulação do baço; grupo 3 (n=31), esplenectomia total; grupo 4 (n=30), ligadura simultânea da artéria e veia esplênicas. Após a dosagem dos lípides plasmáticos, os ratos foram distribuídos em dois subgrupos, de acordo com a dieta prescrita após o início do experimento (subgrupo A, dieta controle; subgrupo B, dieta acrescida de 2,5 por cento de colesterol). Depois de 90 dias, foi realizada nova coleta de sangue para dosagem de lípides. RESULTADOS: Não houve diferenças significantes nos níveis de lípides entre os quatro grupos, no início do experimento (p>0,05). Nos subgrupos 1A, 2A e 4A, não ocorreram alterações significantes da HDL-colesterol, da VLDL-colesterol e triglicérides. A LDL-colesterol caiu significantemente nos subgrupos 1A e 2 A (p<0,05), e não significantemente no 4A (p>0,05). Nos subgrupos 1B, 2B e 4B, houve aumento significante do colesterol total, LDL-colesterol, VLDL-colesterol (p<0,05), e não significante da HDL-colesterol. No grupo 3, houve aumento significante dos lípides (p<0,01), principalmente no subgrupo 3B, exceto a HDL-colesterol, cujo aumento não foi significante. Nesse grupo, o colesterol total e a LDL-colesterol foram significantemente maiores que os dos grupos 1, 2 e 4. CONCLUSÃO: A esplenectomia total provoca aumento do colesterol total, da LDL-colesterol, da VLDL-colesterol e dos triglicérides, que é mais significante nos animais alimentados com a dieta acrescida de colesterol. A ligadura simultânea da artéria e da veia esplênicas previne contra as alterações dos níveis de lípides plasmáticos...

OBJECTIVE: The objective was to verify the effect of total splenectomy and ligature of the splenic vessels on the plasma lipid levels in rats fed a control diet or a diet supplemented with 2.5 percent cholesterol. METHODS: Ninety-nine male Wistar rats weighting between 273 and 427g (arithmetic mean: 349.46 ± 35.54) were randomly divided into four groups: group 1- control (N=19), nonoperated; group 2 - sham (N=19), laparotomy with spleen manipulation; group 3 -TS (N=31), total splenectomy; group 4 (N=30) simultaneous ligature of the splenic artery and vein. Blood was collected from all animals for determination of plasma lipids at the beginning of the experiment. Rats were than divided into two subgroups receiving either control diet (subgroup A) or diet supplemented with 2.5 percent cholesterol (subgroup B). Another blood sample was collected 90 days later for a new determination. RESULTS: No significant difference in plasma lipids between the four groups was observed at the beginning (p>0.05). In subgroups 1A, 2A and 4A, there was no significant difference in the values of HDL, VLDL and triglycerides, except LDL that dropped significantly in subgroup 1A and 2A (p<0.05) and not significantly in subgroup 4A. In subgroup 1B, 2B and 4B there was a significant increase in late postoperative plasma total cholesterol, LDL, VLDL (p<0.05) and a not significant increase of HDL. In total splenectomy, at late postoperative there was a significant increase of cholesterol, LDL, VLDL and triglycerides, especially in subgroup B. In group 3 the cholesterol, LDL and triglycerides were more significant than in groups 1, 2 and 4. CONCLUSION: Total splenectomy caused a more significant increase of cholesterol, LDL, VLDL and triglycerides in rats fed a cholesterol diet. The simultaneous ligature of vein and artery prevented alterations in plasma lipids observed in rats submitted to total splenectomy and maintained lipid levels similar to those of the...

Effects of tamoxifen therapy on plasma lipid profile in patients of breast cancer.

AIM: To evaluate the effects of tamoxifen therapy on plasma lipid profile in patients of breast cancer. METHOD: A total of 55 postoperative patients of breast cancer were given tablet tamoxifen 20mg orally daily for 6 months. Estimation of plasma lipid by standard method was carried out in both pre-menopausal and postmenopausal new patients of early stage breast cancer at 0 day, 3rd month and 6th months of therapy. RESULTS: Suggested that in pre-menopausal and postmenopausal patient's TC and LDL-c levels were reduced significantly, whereas, TG, VLDL-c and HDL-c were not altered. Comparison of the effects of tamoxifen in pre-menopausal and postmenopausal patients on lipid profile revealed that fall in TC and LDL-c was significantly higher at both 3 and 6 months in postmenopausal patients. CONCLUSION: The study demonstrates that tamoxifen to favorably alter the markers of cardiovascular risk in both pre-menopausal and postmenopausal patients of breast cancer.

Long-term treatment of N-3 PUFAS on plasma lipoprotein levels and fatty acid composition of total serum and erythrocyte lipids in hypertriglyceridemic patients.

The low incidence of coronary heart disease in Greenland Eskimos and Japanese fishermen who have high consumption of fish and seafood has called the attention in the role of eicosapentaenoic (EPA = 20:5n-3) and docosahexaenoic (DHA = 22: 6n-3) acids, the major n-3 polyunsaturated fatty acids (PUFAs) in fish oils, in reducing cardiovascular risk. N-3 PUFAs may reduce serum lipids by promoting fatty acid oxidation and decrease VLDL producing from the liver, depress tissue arachidonate synthesis and alter the composition and tissue PUFAs. Plasma lipoprotein and fatty acid composition of total serum and erythrocyte lipids in 9 hypertriglyceridemic patients consisting of 4 males and 5 females aged 39-72 yr who attended the Nutrition Clinic, Ramathibodi Hospital were investigated. The study period consisted of 4 wks of dietary advice only followed by 48 wks of dietary advice with a daily intake of 6 g of fish oil capsules (FOC). Six grams of FOC provided 1080 mg of 2:5n-3 and 720 mg of 22:6n-3. Their plasma triglyceride (TG) levels at wk 0, 12, 24, 36, 48 were 356.7, 230.1, 209.7, 192.9, 22 7.4 mg/dL and M-particle (equivalent to very low density lipoprotein, VLDL) were 484.4, 354.8, 383.1, 349.7, 453.2 mg/dL respectively that decreased significantly, whereas their plasma low density lipoprotein cholesterol (LDL-C) levels at the same periods were 139.4, 164.9, 171.0, 157.1, 158.3 mg/dL that increased significantly. Serum and erythrocyte 20:5n-3 and 22:6n-3 in these subjects were significantly higher than those at wk 0 throughout the study. These findings indicate the bioavailability of 20: 5n-3 and 22:6n-3 in TG lowering effect of FOC. Fatty acids from fish oil have a remarkable effect on the synthesis and clearance of TG-rich lipoproteins, especially VLDL and chylomicrons. Though daily treatment with 6 g of FOC has a striking effect in increasing plasma LDL-C levels.

Association of small dense LDL with coronary artery disease and diabetes in urban Asian Indians - the Chennai Urban Rural Epidemiology Study (CURES-8).

OBJECTIVE: Earlier studies in Europeans have identified small dense LDL to be associated with coronary artery disease and diabetes. In this study we assessed the association of small dense LDL with diabetes and CAD in Asian Indians. METHODS: Study subjects were selected from the Chennai Urban Rural Epidemiology Study (CURES), a population based study on representative sample of Chennai city in southern India. Group 1:non-diabetic subjects (n = 30); Group 2: diabetic subjects without CAD (n = 30); Group 3:diabetic subjects with CAD (n = 30). LDL subfractions were estimated using LipoPrint LDL system. LDL subfractions 3 and above, defined as small dense LDL was summed up to determine the overall small LDL. 75th percentile of the overall small dense LDL in non-diabetic subjects was used as a cut-off for defining elevated levels of small dense LDL. RESULTS: The mean age of the study subjects was not significantly different among groups. Overall small dense LDL was significantly higher in diabetic subjects with CAD (16.7 +/- 11.1 mg/dl, p < 0.05) and without CAD (11.1 +/- 8.0 mg/dl, p < 0.05) compared to non-diabetic subjects without CAD (7.2 +/- 6.8 mg/dl). Small dense LDL showed a positive correlation with fasting plasma glucose (r = 0.252, p = 0.023), HbA1c (r = 0.281, p = 0.012), total cholesterol (r = 0.443, p < 0.001), triglycerides(r = 0.685, p < 0.001), LDL(r = 0.342, p = 0.002), total cholesterol/HDL ratio (r = 0.660, p = < 0.001) and triglycerides/HDL ratio(r = 0.728, p < 0.001) and a negative correlation with HDL cholesterol (r = -0.341, p = 0.002) and QUICKI values (r = -0.260, p = 0.019). ROC curves constructed to predict elevated small dense LDL ((9.0 mg/dl) revealed that triglycerides/HDL ratio and total cholesterol/HDL ratio had higher AUC values compared to other parameters. A triglycerides/HDL ratio of 3.0 had the optimum sensitivity (80.0%) and specificity (78.0%) for detecting elevated small dense LDL. CONCLUSION: This data suggests that in Asian Indians, small dense LDL is associated with both diabetes and CAD and that a triglycerides/HDL ratio (3.0 could serve a surrogate marker of small dense LDL.

Lipid profile and the effect of some metabolic hormones on diabetic elderlies

Physiological systems have substantial reserves in younger individuals to maintain the vital activities of the body. The process of aging and intercurrent pathologic process gradually eliminates these reserves. The prevalence of type 2 diabetes is age related. Because elderly patients with diabetes are living longer and are likely to use increasing amount of scarce health care resources in the next several decades, diabetes in age adults may ultimately prove to be the most important epidemic of the 21st century. The aim of this study is to investigate the interrelation between diabetes and some metabolic hormones in elderly people in order to improve status of patients with various metabolic defects of diabetes, because elderly patients with diabetes use almost twice as many inpatients and outpatients resources as elderly people without diabetes. This study was performed on 51 elderly subjects. Hormones studied included serum T3, T4 and cortisol. Other biochemical parameters included lipid profile and glucose. Results revealed increased prevalence of hypercholesterolemia, as well as increased levels of serum triglycerides in diabetic elderly than in normals. T3 and T4 showed values in patients less than in the control group, while cortisol appeared to be higher in the former. Furthermore nutritional recommendations for healthy lifestyle for elderly type 2 diabetes are very important because many persons with type 2 diabetes are overweight and insulin resistant medical nutrition therapy should emphasize lifestyle changes that result in reduced energy intake and increases expenditure through physical activity

Assessment of metformin effect on lipid profile in induced hyperlipidimic rats

Diabetes mellitus and hyperlipidemia both are independent risk factors for coronary heart disease, which is a major killer world wide. This study explains the effect of metformin [anti-diabetic drug] on lipid profile in rats. Thirty rats were allocated randomly into 3 groups each group included 10 rats. One group was put on normal chow diet for 16 W Ks and served as normal control group. The other 2 groups were given high cholesterol diet for 3 weeks. The blood samples were collected from these 3 groups before commencing treatment. Serum lipid profile namely T.G, TC, LDL, VLDL and HDL were measured. The result revealed that all 2 groups revert to hyperlipidimic condition. One of the two group received distilled water and served as hyperlipidimic control. The 2[nd] group received metformin at the same time the two groups kept on cholesterol rich diet for another 8 weeks. The serum lipid value were checked again after 8. weeks of treatment. In concerning triglyeeride metfoormin caused highly significant reduction in its serum level [P<0.01], and it caused significant reduction of total cholesterol [P<0.05] as well as metformine induced highly significant reduction in value of LDL, VLDL, but it increased significantly the level of serum HDL-cholesterol [P<0.01]