Análisis clínicos en pediatría: la necesidad de minimizar las horas de ayuno / Clinical analysis in pediatrics: the need to minimize fasting hours

Los informes de laboratorio tienen impacto en las decisiones médicas. El ayuno es un factor preanalítico "controlable" que influye en los distintos parámetros bioquímicos. El objetivo del presente trabajo es poner en discusión la realización en pediatría de análisis clínicos con la indicación de un ayuno fisiológico , analizando resultados obtenidos por diferentes autores y evaluando las diferencias clínicas encontradas según los criterios de calidad establecidos por el laboratorio de Química Clínica. La mayoría de los individuos durante el día se encuentran en estado postprandial. Los resultados del perfil lipídico en ayunas no representan las concentraciones reales promedios de los lípidos plasmáticos de un paciente. El ayuno no sería crítico en la etapa de pesquisa , pero puede ser relevante para establecer un diagnóstico certero o inicio de tratamiento. En el caso de la glucemia si se indica en el control rutinario del paciente, y no hay sospecha de alteraciones en el metabolismo de los hidratos de carbono la glucemia sin ayuno puede ser solicitada comparando la misma con valores de corte adecuado. Las diferentes guías nacionales e internacionales recomiendan que la elección de la métrica para la evaluación, control y seguimiento de pacientes con diagnóstico de diabetes se realicen según el objetivo terapéutico. En los trabajos analizados, observamos que varios parámetros bioquímicos presentaron diferencias estadísticas, aunque las diferencias clínicas no fueron relevantes y permanecieron dentro de los intervalos de referencia. El factor limitante para evaluar parámetros bioquímicos sin ayuno es la falta de valores de referencia adecuados. Hay evidencia suficiente para que tanto el perfil lipídico, la glucemia como el resto de los parámetros bioquímicos del laboratorio de química clínica, sean solicitados con la indicación de un ayuno fisiológico de 2, 4 o 6 horas, dependiendo siempre del motivo de consulta y/o la edad del paciente. Es esencial extender la evaluación a otros analitos en población pediátrica, así como evaluar nuevos puntos de corte para parámetros bioquímicos sin ayuno (AU)

Laboratory reports have an impact on medical decision-making. Fasting is a "controllable" preanalytical factor that influences the different biochemical parameters. The aim of this study is to discuss the performance of clinical analyses in pediatrics with the indication of physiological fasting, analyzing results obtained in different disciplines, and evaluating the clinical differences found according to the quality criteria established by the clinical chemistry laboratory. During the day, most patients are in a postprandial state. Fasting lipid profile results do not represent the actual average plasma lipid concentrations of a patient. Fasting would not be critical in the screening stage, but it may be relevant to establish an accurate diagnosis or initiate treatment. Regarding glycemia, if it is indicated in the routine control of the patient and there is no suspicion of alterations in carbohydrate metabolism, non-fasting glycemia can be requested, comparing it with adequate cut-off values. Different national and international guidelines recommend that the choice of metrics for the evaluation, control, and follow-up of patients with diabetes should be made according to the therapeutic objective. In the studies analyzed, we found that several biochemical parameters presented statistical differences, although the clinical differences were not relevant and remained within the reference range. The limiting factor in the evaluation of biochemical parameters without fasting is the lack of adequate reference values. There is sufficient evidence that the lipid profile, glycemia, and the remaining biochemical parameters of the clinical chemistry laboratory should be requested with the indication of a physiological fast of 2, 4, or 6 hours, always depending on the reason for consultation and/or the patient's age. It is essential to extend the evaluation to other analytes in the pediatric population, as well as to evaluate new cut-off points for biochemical parameters without fasting (AU)

A descriptive analysis of hyperlipidemia in adult twins in China / 中华流行病学杂志

Objective: To describe the distribution characteristics of hyperlipidemia in adult twins in the Chinese National Twin Registry (CNTR) and explore the effect of genetic and environmental factors on hyperlipidemia. Methods: Twins recruited from the CNTR in 11 project areas across China were included in the study. A total of 69 130 (34 565 pairs) of adult twins with complete information on hyperlipidemia were selected for analysis. The random effect model was used to characterize the population and regional distribution of hyperlipidemia among twins. The concordance rates of hyperlipidemia were calculated in monozygotic twins (MZ) and dizygotic twins (DZ), respectively, to estimate the heritability. Results: The age of all participants was (34.2±12.4) years. This study's prevalence of hyperlipidemia was 1.3% (895/69 130). Twin pairs who were men, older, living in urban areas, married,had junior college degree or above, overweight, obese, insufficient physical activity, current smokers, ex-smokers, current drinkers, and ex-drinkers had a higher prevalence of hyperlipidemia (P<0.05). In within-pair analysis, the concordance rate of hyperlipidemia was 29.1% (118/405) in MZ and 18.1% (57/315) in DZ, and the difference was statistically significant (P<0.05). Stratified by gender, age, and region, the concordance rate of hyperlipidemia in MZ was still higher than that in DZ. Further, in within-same-sex twin pair analyses, the heritability of hyperlipidemia was 13.04% (95%CI: 2.61%-23.47%) in the northern group and 18.59% (95%CI: 4.43%-32.74%) in the female group, respectively. Conclusions: Adult twins were included in this study and were found to have a lower prevalence of hyperlipidemia than in the general population study, with population and regional differences. Genetic factors influence hyperlipidemia, but the genetic effect may vary with gender and area.

Difference of lipid-lowering efficacy of "Xinjianqu" before and after fermentation and its mechanism based on LKB1-AMPK pathway and 16S rDNA sequencing technology / 中国中药杂志

On the basis of establishing the prescription of Xinjianqu and clarifying the increase of the lipid-lowering active ingredients of Xinjianqu by fermentation, this paper further compared the differences in the lipid-lowering effects of Xinjianqu before and after fermentation, and studied the mechanism of Xinjianqu in the treatment of hyperlipidemia. Seventy SD rats were randomly divided into seven groups, including normal group, model group, positive drug simvastatin group(0.02 g·kg~(-1)), and low-dose and high-dose Xinjianqu groups before and after fermentation(1.6 g·kg~(-1) and 8 g·kg~(-1)), with ten rats in each group. Rats in each group were given high-fat diet continuously for six weeks to establish the model of hyperlipidemia(HLP). After successful modeling, the rats were given high-fat diet and gavaged by the corresponding drugs for six weeks, once a day, to compare the effects of Xinjianqu on the body mass, liver coefficient, and small intestine propulsion rate of rats with HLP before and after fermentation. The effects of Xinjianqu before and after fermentation on total cholesterol(TC), triacylglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), alanine aminotransferase(ALT), aspartate aminotransferase(AST), blood urea nitrogen(BUN), creatinine(Cr), motilin(MTL), gastrin(GAS), and the Na~+-K~+-ATPase levels were determined by enzyme-linked immunosorbent assay(ELISA). The effects of Xinjianqu on liver morphology of rats with HLP were investigated by hematoxylin-eosin(HE) staining and oil red O fat staining. The effects of Xinjianqu on the protein expression of adenosine 5'-monophosphate(AMP)-activated protein kinase(AMPK), phosphorylated AMPK(p-AMPK), liver kinase B1(LKB1), and 3-hydroxy-3-methylglutarate monoacyl coenzyme A reductase(HMGCR) in liver tissues were investigated by immunohistochemistry. The effects of Xinjianqu on the regulation of intestinal flora structure of rats with HLP were studied based on 16S rDNA high-throughput sequencing technology. The results showed that compared with those in the normal group, rats in the model group had significantly higher body mass and liver coefficient(P<0.01), significantly lower small intestine propulsion rate(P<0.01), significantly higher serum levels of TC, TG, LDL-C, ALT, AST, BUN, Cr, and AQP2(P<0.01), and significantly lower serum levels of HDL-C, MTL, GAS, Na~+-K~+-ATP levels(P<0.01). The protein expression of AMPK, p-AMPK, and LKB1 in the livers of rats in the model group was significantly decreased(P<0.01), and that of HMGCR was significantly increased(P<0.01). In addition, the observed＿otus, Shannon, and Chao1 indices were significantly decreased(P<0.05 or P<0.01) in rat fecal flora in the model group. Besides, in the model group, the relative abundance of Firmicutes was reduced, while that of Verrucomicrobia and Proteobacteria was increased, and the relative abundance of beneficial genera such as Ligilactobacillus and Lachnospiraceae＿NK4A136＿group was reduced. Compared with the model group, all Xinjianqu groups regulated the body mass, liver coefficient, and small intestine index of rats with HLP(P<0.05 or P<0.01), reduced the serum levels of TC, TG, LDL-C, ALT, AST, BUN, Cr, and AQP2, increased the serum levels of HDL-C, MTL, GAS, and Na~+-K~+-ATP, improved the liver morphology, and increased the protein expression gray value of AMPK, p-AMPK, and LKB1 in the liver of rats with HLP and decreased that of LKB1. Xinjianqu groups could regulate the intestinal flora structure of rats with HLP, increased observed＿otus, Shannon, Chao1 indices, and increased the relative abundance of Firmicutes, Ligilactobacillus(genus), Lachnospiraceae＿NK4A136＿group(genus). Besides, the high-dose Xinjianqu-fermented group had significant effects on body mass, liver coefficient, small intestine propulsion rate, and serum index levels of rats with HLP(P<0.01), and the effects were better than those of Xinjianqu groups before fermentation. The above results show that Xinjianqu can improve the blood lipid level, liver and kidney function, and gastrointestinal motility of rats with HLP, and the improvement effect of Xinjianqu on hyperlipidemia is significantly enhanced by fermentation. The mechanism may be related to AMPK, p-AMPK, LKB1, and HMGCR protein in the LKB1-AMPK pathway and the regulation of intestinal flora structure.

Discovery of biomarkers related to abnormal lipid metabolism in liver and serum and intervention mechanism of ginsenoside Rb_1 in hyperlipidemia rats based on non-targeted metabolomics / 中国中药杂志

Through the non-targeted metabolomics study of endogenous substances in the liver and serum of hyperlipidemia rats, the biomarkers related to abnormal lipid metabolism in hyperlipidemia rats were found, and the target of ginsenoside Rb_1 in improving hyperlipidemia was explored and its mechanism was elucidated. The content of serum biochemical indexes of rats in each group was detected by the automatic biochemical analyzer. The metabolite profiles of liver tissues and serum of rats were analyzed by HPLC-MS. Principal component analysis(PCA) and orthogonal partial least squares-discriminant analysis(OPLS-DA) were used to compare and analyze the metabolic data in the normal group, the hyperlipidemia group, and the ginsenoside Rb_1 group, and screen potential biomar-kers. The related metabolic pathways were further constructed by KEGG database analysis. The results showed that hyperlipemia induced dyslipidemia in rats, which was alleviated by ginsenoside Rb_1. The non-targeted metabolomics results showed that there were 297 differential metabolites in the liver tissues of hyperlipidemia rats, 294 differential metabolites in the serum samples, and 560 diffe-rential metabolites in the hyperlipidemia rats treated by ginsenoside Rb_1. Perillic acid and N-ornithyl-L-taurine were common metabolites in the liver and serum samples, which could be used as potential biomarkers for ginsenoside Rb_1 in the improvement of hyperlipidemia. As revealed by pathway enrichment in the liver and serum, ginsenoside Rb_1 could participate in the metabolic pathway of choline in both the liver and serum. In addition, ginsenoside Rb_1 also participated in the ABC transporter, alanine, aspartic acid, and glutamate metabolism, protein digestion and absorption, β-alanine metabolism, taurine and hypotaurine metabolism, caffeine metabolism, valine, leucine, and isoleucine biosynthesis, arachidonic acid metabolism, and methionine and cysteine metabolism to improve dyslipidemia in rats.

Mechanism of Didang Decoction in prevention of anti-atherosclerosis and hyperlipidemia by HPLC-Q-TOF-MS/MS and network pharmacology based on theory of "nutrients return to heart and fat accumulates in channels" / 中国中药杂志

Atherosclerosis(AS) is caused by impaired lipid metabolism, which deposits lipids in the intima, causes vascular fibrosis and calcification, and then leads to stiffening of the vascular wall. Hyperlipidemia(HLP) is one of the key risk factors for AS. Based on the theory of "nutrients return to the heart and fat accumulates in the channels", it is believed that the excess fat returning to the heart in the vessels is the key pathogenic factor of AS. The accumulation of fat in the vessels over time and the blood stasis are the pathological mechanisms leading to the development of HLP and AS, and "turbid phlegm and fat" and "blood stasis" are the pathological products of the progression of HLP into AS. Didang Decoction(DDD) is a potent prescription effective in activating blood circulation, removing blood stasis, resolving turbidity, lowering lipids, and dredging blood vessels, with the functions of dispelling stasis to promote regeneration, which has certain effects in the treatment of atherosclerotic diseases. This study employed high-performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry(HPLC-Q-TOF-MS/MS) to screen the main blood components of DDD, explored the targets and mechanisms of DDD against AS and HLP with network pharmacology, and verified the network pharmacological results by in vitro experiments. A total of 231 blood components of DDD were obtained, including 157 compounds with a composite score >60. There were 903 predicted targets obtained from SwissTargetPrediction and 279 disease targets from GeneCards, OMIM, and DisGeNET, and 79 potential target genes of DDD against AS and HLP were obtained by intersection. Gene Ontology(GO) analysis suggested that DDD presumably exerted regulation through biological processes such as cholesterol metabolism and inflammatory response, and Kyoto Encyclopedia of Genes and Genomes(KEGG) analysis suggested that signaling pathways included lipid and atherosclerosis, insulin resistance, chemo-carcinogenesis-receptor activation, and AGE-RAGE signaling pathways in diabetic complications. In vitro experiments showed that DDD could reduce free fatty acid-induced lipid accumulation and cholesterol ester content in L02 cells and improve cellular activity, which might be related to the up-regulation of the expression of PPARα, LPL, PPARG, VEGFA, CETP, CYP1A1, and CYP3A4, and the down-regulation of the expression of TNF-α and IL-6. DDD may play a role in preventing and treating AS and HLP by improving lipid metabolism and inflammatory response, and inhibiting apoptosis with multi-component, multi-target, and multi-pathway characteristics.

Antioxidant, Antidiabetic and Lipid Profiling of Spermadicyton Suaveolens in Streptozotocin (STZ) Induced Diabetic Rats

ABSTRACT Diabetes is a life-threatening disease, and currently available synthetic medicines for treating diabetes are associated with various side effects. Therefore, there is an unmet need to develop herbal remedies against diabetes as an alternative to synthetic medicines. Although local healers use the roots of Spermadicyton suaveolens (SS) to manage diabetes, there is negligible research to validate its antidiabetic properties. The present investigation aims to the assess the antioxidant, antidiabetic, and antihyperlipidemic potential of the ethanolic extract of S. Suaveolen's roots (EESS) on streptozotocin (STZ) induced diabetic rats. The extract was screened for in vitro antioxidant and antidiabetic activity. The in vivo antidiabetic potential of EESS (at 200 and 400 mg/kg) was studied on STZ-induced diabetic rats for 20 days. The EESS displayed significant (p<0.05) antidiabetic and antioxidant properties. The administration of 200 mg/kg and 400 mg/kg EESS in STZ-induced diabetic rats significantly reduced hyperglycemia, and restored antioxidant enzymes and lipid profile-a high density lipoprotein (HDL) increased by the administration of a single dose of streptozotocin. Thus, EESS could be a promising herbal medicine in the treatment of diabetes and hyperlipidemia

Asociación entre factores de riesgo de enfermedad aterogénica en pacientes geriátricos / Association among risk factors for atherogenic disease in geriatric patients

RESUMEN Introducción: Las alteraciones del metabolismo lipídico constituyen un problema de salud muy frecuente, que se incrementan con la edad del individuo. Objetivo: Determinar la asociación entre factores de riesgo de enfermedad aterogénica en pacientes geriátricos atendidos en consulta del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro¼. Métodos: Se realizó un estudio observacional, descriptivo, transversal, durante el período de septiembre de 2018 a septiembre de 2019. La muestra quedó conformada por 198 pacientes geriátricos, elegidos por muestreo probabilístico sistemático. Resultados: Predominó el sexo masculino; la edad de 60 a 69 años para ambos sexos, y el color de la piel blanca. Los factores clínicos de riesgo aterogénico más frecuentes fueron la hipertensión arterial y la diabetes mellitus. El perfil lipídico se caracterizó por valores elevados de colesterol total, VLDLc, LDLc, triglicéridos, apolipoproteína B, ambos índices lipídicos, y bajos de HDLc y apolipoproteínas A1. Conclusiones: Todas las determinaciones lipídicas mostraron significación estadística al relacionarlas con la edad, no siendo así con el sexo. La hipertensión arterial y la cardiopatía isquémica se asociaron de forma significativa con valores no deseables de colesterol total, VLDLc, LDLc, triglicéridos, apoproteína B y ambos índices lipídicos. La diabetes mellitus y el alcoholismo se asociaron con alteraciones de todas las fracciones lipídicas, excepto HDLc y apoproteína A1, respectivamente. Los pacientes fumadores presentaron valores no deseados de VLDLc, LDLc, e índice aterogénico, y los obesos de colesterol total, LDLc, triglicéridos y apoproteína B.

ABSTRACT Introduction: alterations in lipid metabolism are a very frequent health problem, which increase with the age of the individual. Objective: to determine the association among risk factors for atherogenic disease in geriatric patients treated in the consultation from "Arnaldo Milián Castro" Clinical and Surgical University Hospital. Methods: an observational, descriptive and cross-sectional study was carried out from September 2018 to September 2019. The sample was made up of 198 geriatric patients, chosen by systematic probabilistic sampling. Results: male gender, age from 60 to 69 years for both genders and white skin color predominated. The most frequent clinical atherogenic risk factors were arterial hypertension and diabetes mellitus. The lipid profile was characterized by high values of total cholesterol, VLDLc, LDLc, triglycerides, apolipoprotein B, both lipid indices, and low levels of HDLc and apolipoproteins A1. Conclusions: all lipid determinations showed statistical significance when relating them to age, but not to gender. Arterial hypertension and ischemic heart disease were significantly associated with undesirable values ​​of total cholesterol, VLDLc, LDLc, triglycerides, apoprotein B and both lipid indices. Diabetes mellitus and alcoholism were associated with alterations in all lipid fractions, except HDLc and apoprotein A1, respectively. Smokers had undesirable values ​​of VLDLc, LDLc, and atherogenic index, and obese patients of total cholesterol, LDLc, triglycerides, and apoprotein B.

Lipoprotein apheresis efficacy and challenges: single center experience

Abstract Introduction Lipoprotein apheresis (LA) is an extracorporeal therapy which removes apolipoprotein B-containing particles from the circulation. We evaluated techniques and efficiency of lipoprotein apheresis procedures applied to patients with familial and non-familial hypercholesterolemia (FH) at our center. Methods We retrospectively evaluated 250 LA procedures applied to 27 patients with dyslipidemia between March 2011 and August 2019. Results A total of 27 patients, of whom 19 (70.4%) were male and 8 (29.6%), female, were included. Eighteen (66.7%), 6 (22.2%) and 3 (11.1%) patients were diagnosed with non-FH, homozygous FH (HoFH) and heterozygous FH (HeFH), respectively. Two different apheresis techniques, direct adsorption of lipoproteins (DALI) (48.8%) and double filtration plasmapheresis (DFPP) (51.2%), were used. The change in the serum total cholesterol (TC) level was the median 302 mg/dl (171-604 mg/dl) (60.4%) in HoFH patients, 305 mg/dl (194-393 mg/dl) (60.8%) in HeFH patients and 227 mg/dl (75-749 mg/dl) (65.3%) in non-FH patients. The change in the serum low-density lipoprotein (LDL) level was the median 275 mg/dl (109-519 mg/dl) (64.2%), 232 mg/dl (207-291 mg/dl) (64.5%) and 325 mg/dl (22-735 mg/dl) (70.9%) in patients with HoFH, HeFH and non-FH, respectively. A significantly effective reduction in serum lipid levels, including TC, LDL and triglycerides, was achieved in all patients, regardless of the technique, p< .001. The decrease in the serum TC and LDL levels was significantly higher in the DFPP, compared to the DALI, being 220 mg/dl (-300 to 771) vs 184 mg/dl (64-415), p< .001 and 196 mg/dl (11-712) vs 157 mg/dl (54-340), p< .001, respectively. Conclusions Our results showed that LA is a highly effective treatment in reducing serum lipid levels and safe, without any major adverse event.

Performance, meat quality, and lipidemia of meat-type quails fed with diets containing essential oils / Desempenho, qualidade da carne e lipidemia de codornas de corte alimentadas com rações contendo óleos essenciais

This study evaluated the effect of essential oil (ESOL) of Mentha piperita and Melaleuca alternifolia on meat-type quails. To examine performance, a completely randomized design was used, with four treatments and eight repetitions each, using seven birds per repetition. To assess lipidemia, a completely randomized design in a 4 × 2 factorial scheme was used, with four treatments and two collection conditions using eight repetitions and one bird per repetition. Weight gain, feed intake, feed conversion, carcass yield, cholesterol, high-density lipoporteins, triglycerides, pH, and brightness of quail breast meat were assessed. The data were analyzed for homoscedasticity and normality, and the means were subjected to analysis of variance. Adding M. piperita and M. alternifolia ESOL to the diets of meat-type quails can improve performance, carcass yield, and meat quality characteristics, comparable to the use of performance-enhancing antibiotics. The use of zinc bacitracin, M. piperita, and M. alternifolia under different collection conditions did not increase the serum levels of low-density and very low-density lipoproteins. The variation coefficients measured after 12 hours of fasting were 86% lower than without fasting.

Objetivou-se com este estudo avaliar o efeito do uso dos óleos essenciais (OLES) de Mentha piperita e Melaleuca alternifolia em codornas de corte. Para o estudo do desempenho foi utilizado o delineamento inteiramente ao acaso, com quatrotratamentos e oito repetições, sendo sete aves por repetição. Para o estudo da lipidemia utilizou-se o delineamento inteiramente casualizado em esquema fatorial: 4x2, consistindo em quatro tratamentos e duas condições de coleta, com oito repetições, sendo uma ave por repetição. As variáveis analisadas foram: ganho de peso, consumo ração, conversão alimentar, rendimento de carcaça, colesterol, HDL, triglicerídeos, pH, capacidade de retenção de água, perda de peso por cozimento, luminosidade na carne do peito de codornas. Os dados obtidos foram analisados quanto à homocedasticidade e normalidade, as médias foram submetidas à análise de variância. O uso de OLES de M. piperita e M. alternifolia na dieta de codornas de corte pode proporcionar desempenhos zootécnicos, rendimentos de carcaça e características de qualidade da carne comparáveis ao uso de antibióticos melhoradores de desempenho. A redução no nível de colesterol HDL foi notada nas aves tratadas com Bacitracina de zinco e com os OLES de M. piperita e M. alternifolia, em 8,12; 16,52 e 3,36% respectivamente. O uso da Bacitracina de zinco, da M. piperita e da M. alternifolia associado às diferentes condições de coleta não aumentaram os valores séricos de LDL, VLDL. Os coeficientes de variação aferidos na condição "após 12 horas de jejum" apresentaram-se 86% inferiores à condição "sem jejum".

Ocorrência de dislipidemias e fatores associados em adultos: um estudo de prevalência / Incidencia de dislipidemias y factores asociados en adultos: un estudio de prevalencia / Occurrence of dyslipidemia and associated factors in adults: a prevalence study

RESUMO Objetivo: estimar a prevalência de dislipidemias e os fatores associados em adultos de Rio Branco, Acre. Métodos: estudo de delineamento seccional, populacional, que avaliou adultos (18 a 59 anos) residentes nas zonas urbana e rural de Rio Branco em 2014. As dislipidemias foram definidas conforme os critérios da Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Ateroscle rose. Empregou-se regressão logística para estimar as odds ratio (OR) e intervalos de confiança de 95% (IC95%). Resultados: a prevalência de dislipidemia, HDL-c baixo, hipertrigliceridemia isolada, hipercolesterolemia isolada e hiperlipidemia mista foi de 56,1%, 37,4%, 23,6%, 9,8% e 3,5%, respectivamente. No modelo final multivariado, apenas a obesidade (OR = 1,86; IC95%: 1,12;3,10) manteve associação estatisticamente significativa com a dislipidemia. Entre os subtipos de dislipidemias, associaram-se à hipertrigliceridemia isolada as variáveis: faixa etária de 40 a 49 anos (OR = 2,17; IC95%: 1,53;4,80); hipercolesterolemia isolada (OR = 2,52; IC95%: 1,23;5,15); HDL-c baixo (OR = 2,53; IC95%: 1,65;3,86); obesidade (OR = 2,10; IC95%: 1,25;3,53); e diabetes mellitus (OR = 5,41; IC95%: 1,46;20,4). Conclusão: a prevalência de alterações lipídicas foi elevada entre adultos. Estratégias de intervenções para diagnóstico, tratamento e intensificação de medidas preventivas e orientações de estilo de vida saudáveis são importantes nessa população.

RESUMEN Objetivo: estimar la prevalencia de dislipidemias y los factores asociados en adultos de Rio Branco, Acre-Brasil. Métodos: estudio de investigación seccional, poblacional, que evaluó adultos (18 a 59 años) residentes en las zonas urbana y rural de Rio Branco en 2014. Las dislipidemias fueron definidas conforme a los criterios de la Actualización de la Directriz Brasileña de Dislipidemias y Prevención de la Aterosclerosis. Se empleó regresión logística para estimar las odds ratio (OR) e intervalos de confianza del 95% (IC95%). Resultados: la prevalencia de dislipidemia, HDL-c bajo, hipertrigliceridemia aislada, hipercolesterolemia aislada e hiperlipidemia mixta fue de 56,1%, 37,4%, 23,6%, 9,8% y 3,5%, respectivamente. En el modelo final multivariado, solo la obesidad (OR = 1,86; IC95%: 1,12;3,10) mantuvo una asociación estadísticamente significativa con la dislipidemia. Entre los subtipos de dislipidemias, se asociaron a la hipertrigliceridemia aislada las variables: franja etaria de 40 a 49 años (OR = 2,17; IC95%: 1,53;4,80); hipercolesterolemia aislada (OR = 2,52; IC95%: 1,23;5,15); HDL-c bajo (OR = 2,53; IC95%: 1,65;3,86); obesidad (OR = 2,10; IC95%: 1,25;3,53); y diabetes mellitus (OR = 5,41; IC95%: 1,46;20,4). Conclusión: la prevalencia de cambios lipídicos fue elevada entre adultos. Estrategias de intervenciones para el diagnóstico, tratamiento e intensificación de medidas preventivas y orientaciones de estilo de vida saludables son importantes en esa población.

ABSTRACT Objective: to estimate the prevalence of dyslipidemia and associated factors in adults in Rio Branco, Acre. Methods: a cross-sectional, population-based study that assessed adults (age 18 to 59 years) living in urban and rural areas of Rio Branco in 2014. Dyslipidemias were defined according to the criteria of the Brazilian Guidelines Update on Dyslipidemias and Prevention of Atherosclerosis. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI95%). Results: the prevalence of dyslipidemia, low HDL-c, isolated hypertriglyceridemia, isolated hypercholesterolemia and mixed hyperlipidemia was 56.1%, 37.4%, 23.6%, 9.8% and 3.5%, respectively. In the final multivariate model, only obesity (OR = 1.86; CI95%: 1.12; 3.10) maintained a statistically significant association with dyslipidemia. Among the dyslipidemia subtypes, the following variables were associated with isolated hypertriglyceridemia: age group 40 to 49 years (OR = 2.17; CI95%: 1.53; 4.80); isolated hypercholesterolemia (OR = 2.52; CI95%: 1.23; 5.15); low HDL-c (OR = 2.53; CI95%: 1.65; 3.86); obesity (OR = 2.10; CI95%: 1.25;3.53); and diabetes mellitus (OR = 5.41; CI95%: 1.46; 20.4). Conclusion: the prevalence of lipid alterations was high among adults. Intervention strategies for diagnosis, treatment and intensification of preventive measures and healthy lifestyle guidelines are important in this population.

Proteomics: a tool to investigate of composition and function of HDL in hyperlipidemia / Proteômica: uma ferramenta para a investigação da composição e função da HDL em hiperlipidemia

The inverse relationship between HDL-C (high-density lipoprotein cholesterol) and cardiovascular disease is well established. However, it is consensus that the cholesterol content present in HDL does not capture its complexity, and other metrics need to be explored. HDL is a heterogeneous, protein-enriched particle with functions going beyond lipid metabolism. In this way, its protein content seems to be attractive to investigate its behavior in the face of pathologies. Many of the proteins with important function in HDL are in low abundance (<1% of total proteins), which makes their detection challenging. Quantitative proteomics allows detecting proteins with high precision and robustness in complex matrix. However, quantitative proteomics is still poorly explored in the context of HDL. In this sense, in the second chapter of this thesis, the analytical performance of two quantitative methodologies was carefully investigated. These methods achieved adequate linearity and high precision using labeled peptides in a pool HDL, in addition to comparable ability to differentiate proteins from HDL subclasses of healthy subjects. Another bottleneck that waits for a solution in proteomics is the lack of standardization in data processing and analysis after mass spectrometry acquisition. In addition, interest in the cardioprotective properties of omega-3 is growing, but little is known about its effects on the HDL proteome. Thus, in the third chapter of this thesis, we compared five protein quantification strategies using Skyline and MaxDIA software platforms in order to investigate the HDL proteome from mice submitted to a high-fat diet supplemented or not with omega-3. MaxDIA with label-free quantification (MaxLFQ) achieved high precision to show that polyunsaturated fatty acids remodel the HDL proteome to a less inflammatory profile. Therefore, the two studies presented in this thesis begin to open new paths for a deeper and more reliable understanding of HDL, both at the level of protein quantification by mass spectrometry and after data acquisition

A inversa relação entre HDL-C (do inglês, high-density lipoprotein cholesterol) e doenças cardiovasculares é bem estabelecida. No entanto, é consenso que o conteúdo de colesterol presente na HDL não captura sua complexidade, e outras métricas precisam ser exploradas. A HDL é uma partícula heterogênea, enriquecida em proteínas, com funções que vão além do metabolismo de lipídeos. Dessa forma, seu conteúdo proteico parece ser mais atrativo para exprimir seu comportamento frente às patologias. Muitas das proteínas com função importante estão em baixa abundância (<1% do total de proteínas), o que torna a detecção desafiadora. Métodos quantitativos de proteômica permitem detectar proteínas com alta precisão e robustez em matrizes complexas. No entanto, a proteômica quantitativa ainda é pouco explorada no contexto da HDL. Nesse sentido, no segundo capítulo dessa tese, a performance analítica de dois métodos quantitativos foi criteriosamente investigada, os quais alcançaram adequada linearidade e alta precisão usando peptídeos marcados em um pool de HDL, além de comparável habilidade em diferenciar as proteínas das subclasses da HDL de indivíduos saudáveis. Outro gargalo que aguarda por solução em proteômica é a falta de padronização no processamento e análise de dados após a aquisição por espectrometria de massas. Além disso, é crescente o interesse das propriedades cardioprotetivas do ômega-3, porém pouco se conhece sobre seus efeitos no proteoma da HDL. Então, no terceiro capítulo dessa tese, comparamos cinco estratégias de quantificação de proteínas utilizando os softwares Skyline e MaxDIA com o intuito de comparar o proteoma da HDL de camundongos submetidos a uma dieta hiperlipídica suplementados ou não com ômega-3. MaxDIA com quantificação label-free (MaxLFQ) apresentou alta precisão para mostrar que o ômega-3 remodela o proteoma da HDL para um perfil menos inflamatório. Portanto, os dois estudos apresentados nessa tesa começam a abrir novos caminhos para o entendimento mais profundo e confiável da HDL tanto por meio da quantificação das proteínas por espectrometria de massas quanto após à aquisição dos dados

Synthesis and In Vivo Hypolipidemic Effect of Some N-(Benzoylphenyl)-Carboxamide Derivatives in Triton WR-1339-Induced Hyperlipidemic Rats

A series of N-(benzoylphenyl)-carboxamide derivatives (2a, 2b, 3a, 3b, 4a, 4b, 5a, 5b, 6a and 6b) was prepared with good yields by reacting the corresponding carbonyl chlorides with aminobenzophenones at room temperature. This was followed by evaluating the hypotriglyceridemic and hypocholesterolemic effects of 3b, 5a and 5b. Triton WR-1339 (300 mg/kg) was intraperitoneally administered to overnight-fasted rats to induce hyperlipidemia. Rats were divided into six groups: control, hyperlipidemic, hyperlipidemic plus compounds 3b, 5a and 5b and hyperlipidemic plus bezafibrate. Results showed that after 18 h of treatment at a dose of 15 mg/kg body weight of each of the test compounds, the elevated plasma levels of triglycerides (TG) and total cholesterol (TC) were significantly lowered by compounds 5b and 3b (p < 0.001) and by 5a (p < 0.0001), compared to the hyperlipidemic control group. Compounds 3b and 5a significantly increased levels of high-density lipoprotein cholesterol (HDL-C) by 58 and 71%, respectively. In addition, compounds 3b and 5a caused significant reduction (p < 0.0001) of low-density lipoprotein cholesterol (LDL-C) levels compared to the control group. These results suggest a promising potential for compounds 3b, 5a and 5b as lipid-lowering agents, which may contribute to reducing the risk of atherosclerosis and cardiovascular disease

Presentation and character for adult patients with diabetes in Libya

Diabetes is a global issue, the diabetes epidemic is expected to continue, and the burden of diabetes causes catastrophic expenditure for healthcare system. The current study aimed to determine the presentation, the clinical feature and cardio-vascular risk factors in patients with diabetes. A retrospective observational study had been conducted in out-patients department at Almustaqpal Almosherq Centre during September, 2013 till September, 2020, the total number of attended out-patients department were 1 024, 820 patients who were selected for this study. A special perform was completed for every patient, which included details about patient's demographics, points in clinical history, relevant investigations and clinical examinations were recorded. The study reported that out of 820 patients, 66% (n = 538) was female and their age range was between 14 - 87 years with a mean age of 56.53 ± 13.49 years, 96% (n = 791) were clinically diagnosed as type II diabetes, 07% of the patients were diagnosed as pre-diabetes, the duration of diabetes ranged from newly diagnosed to more than 10 years, with 46% (n = 379) of the studied population were more than 10 years diabetes duration, 70% (581) were presented with classical symptoms of diabetes. Initial treatment for diabetes also different in the studied sample, were absent of anti-diabetic medications in 30% (n = 248) of the patients, they refused to start glucose lowering drugs, 34.6% (n = 284) of them have morbid obesity (body mass index is more than 40), 80% (n = 662) have high HBA1c (more than 8 g%), 40.3% (n = 240/596) were uncontrolled hypertension on anti-hypertension drugs, 95.6% (n = 682/713) were controlled on treatment of lipid lowering drugs. This study showing the presentation of diabetes were the common, type II diabetes, at age group between 41 - 66 years about 65%, female sex, with high body mass index, high glycated hemglobulin and uncontrolled hypertension. There is concern that diabetic patients were occurring at a high frequency in younger adults, where longer duration of illness could increase the risk of developing more complications in later life. The rate of coexist cardiovascular risk factors (hypertension, dyslipidaemia and obesity) in Libyan patients with diabetes is highlighted.

Anti-hyperlipidemic and anti-diabetic evaluation of ethanolic leaf extract of Catharanthus roseus alone and in combination therapy

The use of plants in disease treatment is cost effective and relatively safe. This study was designed to investigate anti-hyperlipidemic and anti-diabetic activity of ethanolic leaf extract of Catharanthus roseus alone and in combination therapy in hyperlipidemic & diabetic mice. Eight groups comprising five mice each were used. Group A was hyperlipidemic control, group B, C, D received atorvastatin (20 mg/kg), leaf extract (200 mg/kg) and leaf extract in combination with atorvastatin (200 mg/kg and 20 mg/kg) orally for 15 days. Group E was diabetic control. Group F, G, H received sitagliptin (40 mg/kg), leaf extract (200 mg/kg) and extract in combination with sitagliptin (200 mg/kg and 40 mg/kg) orally for 7 days. Blood cholesterol levels were measured at 1st, 5th, 10th and 15th day and fasting blood sugar levels were measured at 2, 12, 24, 72 and 168 hours during treatment. One-way ANOVA with tukey- kramer multiple comparison test was used. The chemical characterization of ethanolic extract of Catharanthus roseus leaves showed presence of alkaloids, saponins, tannins and flavonoids. Ethanolic extract of Catharanthus roseus has significant anti-hyperlipidemic & anti-diabetic effects (p<0.05, p<0.01) when compared with control but had not cause significantly increase in anti-hyperlipidemic effects of atorvastatin. While significantly increased the antidiabetic effect of sitagliptin (p<0.05)

Tyramine exerts hypolipidemic and anti-obesity effects in vivo

Abstract Obesity and dyslipidemia are conditions often associated with cardiovascular risk, inflammation, oxidative stress, and death. Thus, a new approach has been highlighted to promote research and development of pharmacological tools derived from natural sources. Among the most widely studied groups of substances, polyphenols such as tyramine stand out. This study investigated hypolipidemic and anti-obesity properties of tyramine. Oral toxicity evaluation, models of dyslipidemia and obesity were used. To induce dyslipidemia, Poloxamer-407 (P-407) was administered intraperitoneally. In the hypercholesterolemic and obesity model, specific diet and oral tyramine were provided. After 24h of P-407 administration, tyramine 2 mg/kg (T2) decreased triglycerides (TG) (2057.0 ± 158.5 mg/dL vs. 2838 ± 168.3 mg/dL). After 48h, TG were decreased by T2 (453.0 ± 35.47 vs. 760.2 ± 41.86 mg/dL) and 4 mg/kg (T4) (605.8 ± 26.61 760.2 ± 41.86 mg/dL). T2 reduced total cholesterol (TC) after 24h (309.0 ± 11.17 mg/dL vs. 399.7 ± 15.7 mg/dL); After 48h, 1 mg/kg (T1) (220.5 ± 12.78 mg/dL), T2 (205.8 ± 7.1 mg/dL) and T4 (216.8 ± 12.79 mg/dL), compared to P-407 (275.5 ± 12.1 mg/dL). The treatment decreased thiobarbituric acid reactive substances and nitrite in liver, increased superoxide dismutase, reduced the diet-induced dyslipidemia, decreasing TC around 15%. Tyramine reduced body mass, glucose, and TC after hypercaloric feed. Treatment with 5 mg/L (0.46 ± 0.04 ng/dL) and 10 mg/L (0.44 ± 0.02 ng/dL) reduced plasma insulin (1.18 ± 0.23 ng/dL). Tyramine increased adiponectin at 5 mg/L (1.02 ± 0.02 vs. 0.83 ± 0.02 ng/mL) and 10mg/L (0.96 ± 0.04 ng/mL). In conclusion, tyramine has low toxicity in rodents, has antioxidant effect, reduces plasma triglycerides and cholesterol levels. However, further studies should be conducted in rodents and non-rodents to better understand the pharmacodynamic and pharmacokinetic properties of tyramine

Cholesterolemia and triglyceridemia changes in adult with malaria in a hypo-endemic malaria region, Butembo-DR Congo

changes occur commonly among patients affected with malaria. This study aimed to assess lipid changes in blood among patients with malaria in Butembo, a hypoendemic region. Methods: This cross-sectional study, conducted in the Departments of Internal and Parasitology of Matanda Hospital, located in Butembo, from July 1st, 2020, to November 2, 2020; involved 100 patients diagnosed with malaria. Biochemical analyses carried out by three lab technicians were performed among patients who had positive malaria using positive thick film. Plasmodial species, the parasite density, the triglycerides, the total cholesterol, the HDL-cholesterol, the LDL-cholesterol were assessed. Results: Cholesteroleamia and HDLemia demonstrated a low level in 93% and in 61% of participants respectively; whereas 73% of cases showed an increased level of triglycerides in the blood. Lipidemia profile was independently associated with parasite density among patients with malaria. Conclusion: Although the lipid changes in the blood are not specific in the diagnosis of malaria, this study highlighted their status among patients with malaria. Further researches should be conducted to determine their impact on malaria outcomes. Therefore, dyslipidemia could be used in malaria screening.

The Influence of Diabetes, Hypertension, and Hyperlipidemia on the Onset of Age-Related Macular Degeneration in North China: The Kailuan Eye Study / 生物医学与环境科学（英文）

Objective@#To analyze the prevalence of dry and wet age-related macular degeneration (AMD) in patients with diabetes, hypertension and hyperlipidemia, and to analyze the risk factors for AMD.@*Methods@#A population-based cross-sectional epidemiologic study was conducted involving 14,440 individuals. We assessed the prevalence of dry and wet AMD in diabetic and non-diabetic subjects and analyzed the risk factors for AMD.@*Results@#The prevalence of wet AMD in diabetic and non-diabetic patients was 0.3% and 0.5%, respectively, and the prevalence of dry AMD was 17% and 16.4%, respectively. The prevalence of wet AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 0.5%, 0.3%, 0.2%, and 0.7%, respectively. The prevalence of dry AMD in healthy, hypertensive, hyperlipidemic, and hypertensive/hyperlipidemic populations was 16.6%, 16.2%, 15.2%, and 17.2%, respectively. Age, sex, body mass index, and use of hypoglycemic drugs or lowering blood pressure drugs were corrected in the risk factor analysis of AMD. Diabetes, diabetes/hypertension, diabetes/hyperlipidemia, and diabetes/hypertension/hyperlipidemia were analyzed. None of the factors analyzed in the current study increased the risk for the onset of AMD.@*Conclusion@#There was no significant difference in the prevalence of wet and dry AMD among diabetic and non-diabetic subjects. Similarly, there was no significant difference in the prevalence of wet and dry AMD among subjects with hypertension and hyperlipidemia. Diabetes co-existing with hypertension and hyperlipidemia were not shown to be risk factors for the onset of dry AMD.

Interaction between Abnormal Prepregnancy Body Mass Index and Hyperlipidemia during Pregnancy on the Risk of Gestational Diabetes Mellitus / 中国医学科学院学报

Objective To explore the interaction between abnormal prepregnancy body mass index(pBMI)and high blood lipid level during pregnancy on the risk of gestational diabetes mellitus(GDM). Methods A total of 235 patients with GDM and no blood lipid-related diseases before pregnancy were selected from Hangzhou Women's Hospital during March 2017 to July 2018 as the GDM group.At a ratio of 1∶3,a total of 705 individual age-matched pregnant women with normal glucose metabolism during prenatal examination from the same hospital were selected as the control group.The generalized multifactor dimension reduction(GMDR)method was employed to characterize the possible interaction between pBMI-blood lipid and GDM.The cross-validation consistency,equilibrium test accuracy,and P value were calculated to evaluate the interaction of each model. Results GMDR model analysis showed that the second-order model including pBMI and gestational blood lipid level had the best performance(P=0.001),with the cross-validation consistency of 10/10 and the equilibrium test accuracy of 64.48%,suggesting that there was a potential interaction between pBMI and gestational high blood lipid level.After adjustment of confounding factors,the model demonstrated that overweight/obesity patients with high triglyceride(TG) level had the highest risk of developing GDM(OR=14.349,95%CI=6.449-31.924,P<0.001).Stratified analysis showed that overweight/obesity patients under high TG level group had a higher risk of developing GDM than normal weight individuals(OR=2.243,95%CI=1.173-4.290,P=0.015). Conclusions Abnormal pBMI and high blood lipid level during pregnancy are the risk factors of GDM and have an interaction between each other.Overweight/obese pregnant women with high TG levels are more likely to develop GDM.

Retinal lipemia as expression of hyperchylomicronemia syndrome / Lipemia retinalis como manifestación de un síndrome de hiperquilomicronemia

Abstract Case description: Case of lipemia retinalis secondary to hyperchylomicronemia in a 40-year-old man with a history of total body irradiation and immunosuppressive treatment that was attended in this hospital due to decreased visual acuity and abdominal pain. Clinical findings: Hyperchylomicronemia caused the development of acute pancreatitis and lipemia retinalis. The latter is an infrequent ocular manifestation that reflects excessive triglyceride blood levels in the organism (>2,000 mg/dL). Lipemia retinalis is characterized by the accumulation of chylomicrons in the retinal vessels, which gives them a white and creamy appearance in direct retinal ophthalmoscopy. The initial clinical suspicion of hyperchylomicronemia was based on the visualization of the supernatant in the analytical tube. Treatment and result: In the absence of definitive biochemical results, and owing to the need for special processing of the sample, lipid-lowering treatment and serum therapy were established after ophthalmological confirmation of lipemia retinalis, with subsequent full recovery of visual acuity. Clinical relevance: Given the initial difficulty to determine the accurate triglyceride levels in this kind of patient, early visualization of milky-colored retinal vessels on a salmon-colored eye fundus can help develop an early clinical suspicion of severe hyperchylomicronemia and contribute to limit the severity of complications.

Resumen Descripción del caso: Caso de lipemia retinalis secundaria a hiperquilomicronemia en varón de 40 años con antecedentes de irradiación corporal total y medicación inmunosupresora que acude al hospital por disminución de agudeza visual y dolor abdominal. Hallazgos clínicos: La hiperquilomicronemia contribuyó al desarrollo de pancreatitis aguda y lipemia retinalis. Esta última es una manifestación ocular infrecuente que refleja unos parámetros excesivos de triglicéridos en el organismo (>2,000 mg/dL). La Lipemia Retinalis consiste en la acumulación de quilomicrones en los vasos retinianos lo que les confiere un aspecto blanco y cremoso en la oftalmoscopia retiniana directa. La sospecha clínica inicial de hiperquilomicronemia se produjo por la visualización de sobrenadante en el tubo analítico. Tratamiento y resultado: Sin tener resultados definitivos bioquímicos, por necesidad de procesamiento especial de la muestra, se instauró tratamiento hipolipemiante y sueroterapia tras la confirmación oftalmológica de Lipemia Retinalis con recuperación total de la agudeza visual. Relevancia clínica: Dada la dificultad inicial para determinar las cifras reales de triglicéridos en este tipo de pacientes, la visualización precoz de vasos retinianos de color lechoso sobre lecho de color asalmonado en el fondo de ojo puede ser de ayuda para elaborar una sospecha clínica temprana de hiperquilomicronemia severa que contribuya a limitar la gravedad de las complicaciones.