Activación de sensores del estrés del retículo endoplásmico por dietas asociadas a enfermedades metabólicas y COVID-19 / Activation of endoplasmic reticulum stress sensors by metabolic disease-associated diets and COVID-19

El retículo endoplásmico es un organelo abundante, dinámico y sensor de energía. Sus abundantes membranas, rugosa y lisa, se encuentran distribuidas en diferentes proporciones dependiendo del linaje y requerimiento celular. Su función es llevar a cabo la síntesis de proteínas y lípidos, y es el almacén principal de Ca2+ intracelular. La sobrecarga calórica y la glucolipotoxicidad generada por dietas hipercalóricas provoca la alteración del retículo endoplásmico, activando la respuesta a proteínas mal plegadas (UPR, Unfolded Protein Response, por sus siglas en inglés) como reacción al estrés celular relacionado con el retículo endoplásmico y cuyo objetivo es restablecer la homeostasis del organelo al disminuir el estrés oxidante, la síntesis de proteínas y la fuga de Ca2+. Sin embargo, durante un estrés crónico, la UPR induce formación de especies reactivas de oxígeno, inflamación y apoptosis, exacerbando el estado del retículo endoplásmico y propagando un efecto nocivo para los demás organelos. Es por ello que el estrés del retículo endoplásmico se ha considerado un inductor del inicio y desarrollo de enfermedades metabólicas, incluido el agravamiento de COVID-19. Hasta el momento, existen pocas estrategias para reestablecer la homeostasis del retículo endoplásmico, las cuales son dirigidas a los sensores que desencadenan la UPR. Por tanto, se justifica con urgencia la identificación de nuevos mecanismos y terapias novedosas relacionadas con mitigar el impacto del estrés del retículo endoplásmico y las complicaciones asociadas.

The endoplasmic reticulum is an abundant, dynamic and energy-sensing organelle. Its abundant membranes, rough and smooth, are distributed in different proportions depending on the cell lineage and requirement. Its function is to carry out protein and lipid synthesis, and it is the main intracellular Ca2+ store. Caloric overload and glycolipotoxicity generated by hypercaloric diets cause alteration of the endoplasmic reticulum, activating the Unfolded Protein Response (UPR) as a reaction to cellular stress related to the endoplasmic reticulum and whose objective is to restore the homeostasis of the organelle by decreasing oxidative stress, protein synthesis and Ca2+ leakage. However, during chronic stress, the UPR induces reactive oxygen species formation, inflammation and apoptosis, exacerbating the state of the endoplasmic reticulum and propagating a deleterious effect on the other organelles. This is why endoplasmic reticulum stress has been considered an inducer of the onset and development of metabolic diseases, including the aggravation of COVID-19. So far, few strategies exist to reestablish endoplasmic reticulum homeostasis, which are targeted to sensors that trigger UPR. Therefore, the identif ication of new mechanisms and novel therapies related to mitigating the impact of endoplasmic reticulum stress and associated complications is urgently warranted.

Complicações metabólicas relacionadas à terapia de nutrição parenteral em pacientes hospitalizados / Metabolic complications related to parenteral nutrition therapy in hospitalized patients

Investigar as complicações metabólicas relacionadas à administração da terapia nutricional parenteral (TNP) e sua relação com o desfecho clínico de pacientes hospitalizados. Métodos: Estudo longitudinal retrospectivo realizado com pacientes internados em hospital público referência no atendimento de urgências e emergências da cidade de Goiânia no período de setembro de 2020 a fevereiro de 2021. A coleta de dados foi realizada por meio de consulta aos prontuários eletrônicos. As informações foram coletadas após o primeiro dia de uso da NP até o desfecho clínico -alta, óbito ou descontinuidade da NP. Resultados: A amostra foi constituída por 28 pacientes em uso de nutrição parenteral no hospital durante a etapa de coleta dedados. Desses pacientes a maioria era do sexo masculino, com média de idade de 46,78 anos. As indicações mais frequentes para o uso da terapia nutricional parenteral foram: repouso,abdome agudo e pós-operatório. As complicações mais prevalentes foram a hipocalemia, hipomagnesemia, uremia e a hiponatremia e o desfecho clínico mais frequente foi o óbito. Encontrou-se relação entre desfecho clínico e presença de hipernatremia (p=0,010), ocorrendo a alta hospitalar exclusivamente naqueles pacientes que não apresentaram hipernatremia. E ainda houve relação marginal (p=0,053) entre desfecho clínico e local da internação, sendo que foi mais frequente o óbito naqueles admitidos na unidade de terapia intensiva. Conclusão: Não houve associação entre a TNP e as complicações metabólicas. Todavia, observou-se relação entre hipernatremia e mortalidade, sendo esta mais prevalente em pacientes internados nas unidades de terapia intensiva (UTIs). Nessa amostra, a complicação metabólica mais observada foi a hipocalemia

To investigate the metabolic complication related to administration of the Parenteral Nutrition Therapy (PNT) and their relation to the clinical outcome of hospitalized patients. Methods: retrospective longitudinal study carried with interned patients at a public hospital of standart in the urgency and emergency care from the Goiânia city during the period from september2020 to february 2021. The data capture was realized through consultation to the electronic record. The information was collected after the first day use of NP to clinical outcome -discharge, death or discontinuation of NP. Results: The sample was composed by 28 patients in use of parenteral nutrition at hospital during the data capture. The majority of these patients were male, with mean age of 46-78 anos. The indications more frequent to the use of parenteral nutrition therapy were: rest, acute abdomen and pos-operative. The complications more prevalent were hypokalemia, hypomagnesemia, uremia and hyponatremia. And the clinical outcome more frequent was death. A relationship between clinical outcome and hypernatremia presence (p=0,010) was found, occurring the hospitalar discharge exclusively in those patients which did not submit to hypernatremia. And there was still a marginal relationship (p=0,053) between clinical outcome and hospitalization, which was more frequent the death in those admitted in intensive care units. Conclusion: There was no association between the PNT and the metabolic complications. However, there was an observed relationship between hypernatremia and mortality, while more prevalent in patients staying in the intensive care unit (ICU). In this sample, the metabolic complication most observed was hypokalemia

Joint Association of Metabolic Health and Obesity with Ten-Year Risk of Cardiovascular Disease among Chinese Adults / 生物医学与环境科学（英文）

OBJECTIVE@#This study aims to investigate the association of metabolic phenotypes that are jointly determined by body mass index (BMI) or fat mass percentage and metabolic health status with the ten-year risk of cardiovascular disease (CVD) among Chinese adults.@*METHODS@#Data were obtained from a cross-sectional study. BMI and body fat mass percentage (FMP) combined with the metabolic status were used to define metabolic phenotypes. Multiple linear regression and logistic regression were used to examine the effects of metabolic phenotypes on CVD risk.@*RESULTS@#A total of 13,239 adults aged 34-75 years were included in this study. Compared with the metabolically healthy non-obese (MHNO) phenotype, the metabolically unhealthy non-obese (MUNO) and metabolically unhealthy obese (MUO) phenotypes defined by BMI showed a higher CVD risk [odds ratio, OR (95% confidence interval, CI): 2.34 (1.89-2.89), 3.45 (2.50-4.75), respectively], after adjusting for the covariates. The MUNO and MUO phenotypes defined by FMP showed a higher CVD risk [ OR (95% CI): 2.31 (1.85-2.88), 2.63 (1.98-3.48), respectively] than the MHNO phenotype. The metabolically healthy obese phenotype, regardless of being defined by BMI or FMP, showed no CVD risk compared with the MHNO phenotype.@*CONCLUSION@#General obesity without central obesity does not increase CVD risk in metabolically healthy individuals. FMP might be a more meaningful factor for the evaluation of the association of obesity with CVD risk. Obesity and metabolic status have a synergistic effect on CVD risk.

Calidad de vida de personas con Diabetes Mellitus monitoreadas por la Unidad Básica de Salud / Qualidade de vida de pessoas com Diabetes Mellitus acompanhadas pela Unidade Básica de Saúde / Quality of Life in People with Diabetes Mellitus Followed by the Basic Health Unit

Introducción: La diabetes mellitus es una enfermedad metabólica que afecta a la población y requiere la evaluación de la calidad de vida para la formulación de estrategias de atención específicas y así minimizar o prevenir su deterioro. Objetivo: Evaluar la calidad de vida de personas con diabetes mellitus monitoreadas por la Unidad Básica de Salud. Métodos: Estudio transversal realizado con 82 diabéticos en una Unidad Básica de Salud. Se utilizaron cuestionarios que contenían variables sociodemográficas y clínicas y las áreas clínica y Problem Areas in Diabetes para la evaluación evaluar de la calidad de vida. En el análisis de datos, se utilizaron la prueba de Kruskal-Wallis, la prueba U de Mann-Whitney, la prueba t de Student y el analysis of variance. La mayoría de los participantes fueron mujeres, ancianas, casadas, con educación primaria completa, morenas, jubiladas, con su propio hogar, con un ingreso familiar de hasta un salario mínimo, diabéticos tipo 2, no fumadores, que usan antidiabéticos orales como una forma de tratamiento, sedentarios, no alcohólico, con dos comorbilidades asociadas a diabetes y entre seis y 10 años de diagnóstico. La puntuación total mostró un promedio de 32,36, lo que indica una buena calidad de vida para la mayoría de los participantes, y aquellos que sufren un impacto negativo presentan el factor emocional más afectado. Conclusión: Los datos obtenidos con este estudio permitirán la planificación de acciones específicas dirigidas a esta población para promover una mejor adherencia a las prácticas que influyen positivamente en la calidad de vida(AU)

Introdução: O Diabetes mellitus é uma doença metabólica que acomete a população, sendo necessária a avaliação da qualidade de vida para a formulação de estratégias de cuidado específicas para minimizar ou prevenir o seu comprometimento. Objetivo: Avaliar a qualidade de vida de pessoas com Diabetes Mellitus acompanhados pela Unidade Básica de Saúde. Métodos: Estudo transversal realizado com 82 diabéticos em uma Unidade Básica de Saúde. Utilizou- se questionários contendo variáveis sociodemográficas e clínicas e o Problem Areas in Diabetes para avaliação da qualidade de vida. Na análise dos dados, utilizaram-se os testes Kruskal-Wallis, U de Mann-Whitney, teste t de Student e Analysis of variance. Resultados: A maioria dos participantes são mulheres, idosas, casadas, com ensino fundamental completo, pardas, aposentadas, com casa própria, com renda familiar de até um salário mínimo, diabéticos tipo 2, não fumantes, que utilizam os antidiabéticos orais como forma de tratamento, sedentários, não etilistas, com duas comorbidades associadas ao diabetes e entre seis a 10 anos de diagnóstico. O escore total apresentou média de 32,36 , indicando boa qualidade de vida para a maioria dos participantes, e aqueles que sofrem impacto negativo apresentam o fator emocional como domínio mais acometido. Conclusão: Os dados obtidos com este estudo possibilitará o planejamento de ações específicas voltadas a essa população de modo a promover melhor adesão a práticas que influenciem positivamente na qualidade de vida(AU)

Introduction: Diabetes mellitus is a metabolic disease that affects population health and requires quality of life assessment to formulate specific care strategies to minimize or prevent its deterioration. Objective: To assess the quality of life of people with diabetes mellitus monitored by the basic health unit. Methods: Cross-sectional study carried out with 82 diabetic patients in a basic health unit. Questionnaires containing sociodemographic and clinical variables, as well as the problem areas in diabetes, were used to assess quality of life. In the data analysis, the Kruskal-Wallis test, the Mann-Whitney U test, the Student's t test and variance analysis were used. Results: Most of the participants were women, elderlies and had black skin. They were nonsmokers and nonalcoholic patients, had completed primary education and were retired. They had their own homes and a family income of up to a minimum wage. They had type 2 diabetes, apart from two comorbidities associated with diabetes, and between six and ten years of diagnosis. They used oral antidiabetics as a sedentary form of treatment. The total score showed an average of 32.36, which indicates a good quality of life for most of the participants, while those who suffered a negative impact had the emotional factor as the most affected domain. Conclusion: The data obtained from this study will allow planning specific actions targeted at this population to promote better adherence to practices that positively influence quality of life(AU)

Complicaciones cardiovasculares en relación con la programación fetal / Cardiovascular complications related to fetal programming

Introducción: la programación fetal ofrece nuevas perspectivas sobre el origen de las enfermedades cardiovasculares, relacionando su aparición con factores perinatales. Objetivo: exponer evidencia que vincule las alteraciones gestacionales con las enfermedades cardiovasculares en la vida adulta del feto. Metodología: búsqueda en las bases de datos EBSCO, COCHRANE, MEDLINE, PROQUEST y SciELO de los artículos de revisión e investigaciones originales en inglés publicados en los últimos diez años. Se utilizaron términos MeSH para búsqueda controlada y se evaluaron los estudios con STROBE y PRISMA según correspondía. Resultados: los hallazgos sugieren que nacer con menos de 2600 k guarda relación con diabetes mellitus (OR de 1.607 IC 95% 1.324-1.951), hipertensión arterial (OR de 1.15 IC 95% 1.043-1.288) y menor función endotelial (1.94+0.37 vs 2.68+0.41, p: 0.0001) en la adultez. La prematuridad se asocia con mayores presiones arteriales sistólicas (4.2 mmHg IC 95%; 2.8 - 5.7 p 0.001) y diastólicas (2.6 mmHg IC 95%; 1.2-4.0; p 0.001). Las alteraciones nutricionales maternas y la diabetes gestacional aumentan el riesgo de síndrome metabólico (OR 1.2 IC 95% 0.9-1.7) y sobrepeso en la edad escolar (OR 1.81 IC 95% 1.18 - 2.86). Conclusión: los resultados adversos en la gestación están relacionados con el desarrollo de enfermedades cardiovasculares en la vida adulta del feto expuesto.

Introduction: fetal programming offers new perspectives on the origin of cardiovascular diseases, relating their appearance with perinatal factors. Objective: to show the evidence associating gestational alterations with cardiovascular diseases in the offspring in adult life. Methodology: an EBSCO, COCHRANE, MEDLINE, PROQUEST and SciELO databases search of original review and research articles published in English in the last ten years was conducted. MeSH terms were used to perform a controlled search. The studies were analyzed accordingly using the STROBE and PRISMA reporting guidelines. Results:The findings suggest that a birth weight of less than 2600 kg is related with diabetes mellitus (OR = 1.607, 95% CI 1.324 to 1.951), hypertension (OR = 1.15, 95% CI 1.043 to 1.288) and impaired endothelial function (1.94+0.37 vs 2.68+0.41, p: 0.0001) in adulthood. Prematurity is related with higher systolic blood pressure (4.2 mmHg 95% CI; 2.8 to 5.7 p 0.001) and diastolic blood pressure (2.6 mmHg 95% CI; 1.2 to 4.0; p 0.001). Maternal nutritional alterations and gestational diabetes increase the risk of metabolic syndrome (OR = 1.2 95% CI 0.9 to 1.7) and overweight in school-age (OR = 1.81 95% CI 1.18 to 2.86). Conclusion: adverse results during pregnancy are related with the development of cardiovascular diseases in the exposed fetus in adult life.

Fructose and metabolic diseases: too much to be good / 中华医学杂志(英文版)

Excessive consumption of fructose, the sweetest of all naturally occurring carbohydrates, has been linked to worldwide epidemics of metabolic diseases in humans, and it is considered an independent risk factor for cardiovascular diseases. We provide an overview about the features of fructose metabolism, as well as potential mechanisms by which excessive fructose intake is associated with the pathogenesis of metabolic diseases both in humans and rodents. To accomplish this aim, we focus on illuminating the cellular and molecular mechanisms of fructose metabolism as well as its signaling effects on metabolic and cardiovascular homeostasis in health and disease, highlighting the role of carbohydrate-responsive element-binding protein in regulating fructose metabolism.

Patrones morfológicos asociados a factores de riesgo metabólico en población de adolescentes escolarizados / Morphological patterns associated with metabolic risk factors in the adolescent school population

RESUMEN: El aumento sostenido en la prevalencia de sobrepeso y obesidad en niños, niñas y adolescentes, causa alarma en la comunidad científica, que observa incrementos importantes en las enfermerdades asociadas a Síndrome Metabólico (SM), en la vida adulta. Chile presenta un 75 % con sobrepeso y obesidad en la población adulta y un 50,9 % en la población estudiantil, con un 66,2 % de sedentarismo. Los objetivos de este trabajo fueron determinar los perfiles antropométricos y su asociación a riesgo metabólico en adolescentes de colegio particular subvencionado de Arica-Chile. El total de los alumnos de enseñanza media, n= 810 (mujeres n= 437 y hombres n= 373), fueron evaluados según: peso, talla, perímetro de cintura, índice cintura-talla (ICT), índice de masa corporal (IMC). A todos ellos se les calculó el riesgo metabólico según protocolos de Ashwell & Gibson (2016) y el IMC según fórmula de Quetelet. Los datos fueron analizados en estadístico para tendencia central, dispersión y porcentajes. Para correlación se utilizó test de Pearson (r>0,5). Los resultados muestran que un 44,1 % de las mujeres y un 37,2 % de los hombres presentan sobrepeso y obesidad. El riesgo metabólico general de la población en estudio fue de 24,6 % (24,7 % y 24,4 % en mujeres y hombres respectivamente). Se observó una alta correlación entre PC / ICT (r= 0,92), IMC / ICT (r= 0,86) y Peso / PC (r= 0,87). Se concluye que las y los adolescentes presentan valores antropométricos alterados que indican altos índices de riesgos metabólicos. Los parámetros más alterados se observan en el segundo año de enseñanza media con porcentajes de sobrepeso y obesidad de 49,1 % en las mujeres versus 33,8 % en los hombres. Independientemente, los hombres presentaron mejores índices morfométricos que las mujeres. Se observaron altas correlaciones (r> 0,5) en todos los parámetros en estudio, asociados a riesgo metabólico. Se sugiere enfocar las intervenciones educativas según sello de vida saludable, incentivando la actividad física y mejorar los hábitos alimenticios en las y los adolescentes escolarizados.

SUMMARY: The sustained increase in the prevalence of overweight and obesity in children and adolescents causes alarm in the scientific community, who observe significant increases in diseases associated with Metabolic Syndrome (MS), in adult life. Chile presents 75 % with overweight and obesity in the adult population and 50.9 % in the student population and with 66.2 % of sedentary lifestyle. The objectives of this work were to determine the anthropometric profiles and their association with metabolic risk in adolescents from a subsidized private school in Arica-Chile. The total of high school students, n = 810 (women n = 437 and men n = 373), were evaluated according to: weight, height, waist circumference, waist-height index (WHI), body mass index (BMI). Metabolic risk was calculated for all of them according to Ashwell & Gibson protocols and BMI according to Quetelet's formula. The data were analyzed in statistics for central tendency, dispersion, and percentages. Pearson test (r> 0.5) was used for correlation. The results show that 44.1 % of women and 37.2 % of men are overweight and obese. The general metabolic risk of the study population was 24.6 % (24.7 % and 24.4 % in women and men, respectively). A high correlation was observed between WC / WHI (r = 0.92), BMI / WHI (r = 0.86) and Weight / WC (r = 0.87). It is concluded that adolescents present altered anthropometric values that indicate high rates of metabolic risks. The most altered parameters were observed in the second year of secondary education with percentages of overweight and obesity of 49.1 % in women versus 33.8 % in men. Regardless, males presented better morphometric indices than females. High correlations (r> 0.5) were observed in all the parameters under study, associated with metabolic risk. It is suggested to focus educational interventions according to the seal of healthy living, encouraging physical activity and improving eating habits in school adolescents.

Obesidad, tejido adiposo y cirugía bariátrica / Obesity, adipose tissue, and bariatric surgery

Resumen En las últimas décadas, la prevalencia de la obesidad ha aumentado a escala mundial y ha provocado complicaciones metabólicas tales como diabetes de tipo 2, esteatosis, problemas cardiovasculares, entre otras. Su desarrollo puede estar influenciado por factores genéticos y ambientales, incluyendo la microbiota intestinal. En México, el 33.3% de la población adulta padece de este problema. La obesidad involucra un incremento excesivo del tejido adiposo que produce su disfunción. Se ha demostrado que la remodelación del tejido adiposo, dada por angiogénesis, hipoxia e inflamación, otorga susceptibilidad a desarrollar obesidad y conlleva a modificaciones metabólicas. La cirugía bariátrica ha sido el procedimiento más utilizado y más exitoso para tratar la obesidad mórbida en cuanto a la pérdida de peso corporal a largo plazo y a la remisión de comorbilidades como la diabetes tipo 2. En este artículo se revisan los aspectos moleculares por medio de los cuales la cirugía bariátrica provoca cambios metabólicos que se reflejan en la pérdida de peso y las mejoras metabólicas. Por lo tanto, se resumen aspectos genéticos, de microbioma y moleculares (remodelación del tejido adiposo) que influyen en el desarrollo de la obesidad. También se explican los aspectos moleculares a través de los cuales se puede modular la pérdida de peso y la mejoría de comorbilidades metabólicas.

Abstract Obesity prevalence has increased in the last decades worldwide leading to metabolic complications, such as type 2 diabetes, steatosis, cardiovascular disease, among others; its development is influenced by genetic factors and environmental factors, such as intestinal microbiome. In Mexico, 33.3% of the adults present this disease. Obesity is defined as an excessive adipose tissue accumulation, provoking its dysfunction. Adipose tissue remodeling, which involves angiogenesis, hypoxia and inflammation, is implicated in the developing of obesity and metabolic modifications. Bariatric surgery is the most used and successful intervention to control morbid obesity, leading a maintained loss of weight and remission of some of its comorbidities as type 2 diabetes. Here, we review some of the molecular aspects of the metabolic changes provoked by bariatric surgery and its impact in weight loss and comorbidities remission. In summary, this article reviews the genetic aspects, microbiome and molecular facts (adipose tissue remodeling) that are involved in obesity development. In addition, some of the molecular aspects about bariatric surgery are described and the mechanisms that are regulated to control obesity and its comorbidities.

High-Lard and High-Cholesterol Diet, but not High-Lard Diet, Leads to Metabolic Disorders in a Modified Dyslipidemia Model / Dieta Rica em Banha e Colesterol, mas não Dieta Rica em Banha, Leva a Distúrbios Metabólicos em um Modelo Modificado de Dislipidemia

Abstract Background: In view of the increased global prevalence of cardiovascular and hepatic diseases, the diet lipid content and its relationship with the accumulation of fat in hepatocytes have been investigated as key factors in preventing these diseases. Objective: To evaluate the metabolic effects of a high-lard diet supplemented or not with cholesterol on a modified dyslipidemia model. Methods: We divided 24 adult male Wistar rats into three groups: standard diet (STD - 4% lipids), high-lard diet (HLD - 21% lard), and high-lard and high-cholesterol diet (HL/HCD - 20% lard, 1% cholesterol, 0.1% cholic acid). After six weeks of treatment, blood and liver were collected for biochemical (serum lipid profile and liver enzymes) and morphological analyses. Statistical analysis included one-way analysis of variance (ANOVA), followed by Tukey test for mean comparisons, and a 5% probability was considered statistically significant. Results: Animals fed HL/HCD showed increased total cholesterol, triacylglycerol, LDL-c, non-HDL-c, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) serum levels compared to those fed STD. In addition, the HL/HCD animals presented higher relative liver weight, with moderate macrovesicular hepatic steatosis and inflammatory infiltrate. Conclusion: A high-fat diet with lard (20%) and cholesterol (1%) triggered dyslipidemia with severe liver damage in rats in a shorter experimental time than the previously reported models. The high-lard diet without supplementation of cholesterol led to body weight gain, but not to dyslipidemia.

Resumo Fundamento: Tendo em vista o aumento da prevalência global de doenças cardiovasculares e hepáticas, o conteúdo lipídico da dieta e sua relação com o acúmulo de gordura nos hepatócitos têm sido investigados como fatores-chave na prevenção dessas doenças. Objetivo: Avaliar os efeitos metabólicos de uma dieta rica em banha suplementada com colesterol ou não, em um modelo modificado de dislipidemia. Métodos: Foram divididos 24 ratos Wistar machos adultos em três grupos: dieta padrão (DP - 4% de lipídios), dieta rica em banha (DRB - 21% de banha) e dieta rica em banha e colesterol (DRB/RC - 20% de banha, 1% de colesterol e 0,1% de ácido cólico). Após seis semanas de tratamento, o sangue e o fígado foram coletados para análises bioquímicas (perfil lipídico sérico e enzimas hepáticas) e morfológicas. A análise estatística incluiu análise de variância unidirecional (ANOVA), seguida do teste de Tukey para comparações de médias. Uma probabilidade de 5% foi considerada estatisticamente significativa. Resultados: Animais alimentados com DRB/RC apresentaram um aumento nos níveis séricos de colesterol total, triacilglicerol, LDL-c, não-HDL-c, alanina aminotransferase (ALT) e aspartato aminotransferase (AST) em comparação com aqueles alimentados com DP. Além disso, os animais tratados com DRB/RC apresentaram um peso relativo do fígado maior, com esteatose hepática macrovesicular moderada e infiltrado inflamatório. Conclusão: Uma dieta rica em gordura com banha (20%) e colesterol (1%) desencadeou dislipidemia com danos graves ao fígado em ratos em um tempo experimental menor do que os modelos previamente relatados. A dieta rica em banha sem suplementação de colesterol levou ao ganho de peso corporal, mas não à dislipidemia.

Obesidad: ¿Factor de riesgo o enfermedad? / Obesity: risk factor or primary disease?

Obesity is a global health problem. Its worldwide prevalence has tripled between 1975 and 2016, reaching a prevalence in Chile of 34.4%, according to the National Health Survey 2016-2017. If this condition corresponds to a risk factor or primary disease is a widely discussed issue. It is recognized as a disease by the American Medical Association and World Health Organization, based on its metabolic and hormonal features, such as dysregulation of appetite, abnormal energy balance and endocrine dysfunction, among others. Its main environmental risk factors are the consumption of ultra-processed foods and sedentariness. Preventive measures at the population level are fundamental, emphasizing promotion and prevention using a transdisciplinary approach. The individual approach in the management of obesity should improve the quality of life, avoid early mortality, reduce cardiovascular risk, and reduce the progression to type 2 diabetes and incidence of cancer. Thus, an adequate management and control of obesity would have a great impact in our society.

Relação cintura/estatura e índice de conicidade estão associados a fatores de risco cardiometabólico em idosos / Waist-to-height ratio and the conicity index are associated to cardiometabolic risk factors in the elderly population

Resumo O objetivo deste estudo foi determinar e comparar a magnitude da associação entre indicadores antropométricos com fatores de risco cardiometabólico em idosos. Trata-se de estudo transversal com 402 idosos atendidos pela Estratégia Saúde da Família no município de Viçosa-MG. Os fatores de risco considerados foram o excesso de gordura corporal, hipertensão arterial, alteração da glicemia e dos lipídeos séricos. A associação entre o índice de conicidade (IC) e a relação cintura/estatura (RCE) com os fatores de risco cardiometabólico foi avaliada pela análise de regressão linear múltipla. A amostra foi composta por 60,4% de mulheres e 36,3% de idosos com excesso de peso. O índice de conicidade e a relação cintura/estatura estiveram elevados em 57,2% e 88,1% dos idosos, respectivamente. Os resultados demonstraram que o aumento da gordura corporal, da pressão arterial diastólica, dos triglicerídeos, da glicemia e a redução do HDL-colesterol estão relacionados a maiores valores dos índices antropométricos avaliados. No entanto, a relação cintura/estatura apresentou maior magnitude de associação com os fatores de risco cardiometabólico do que o índice de conicidade.

Abstract The purpose of this study was to determine and compare a magnitude of the association between anthropometric indicators with risk of cardiometabolic risk in the elderly. This is a cross-sectional study with 402 elderly people attended by the Family Health Strategy in the city of Viçosa-MG. Risk factors for excess body fat, hypertension, blood glucose and serum lipid changes. An association between conicity index (CI) and waist-to-height ratio (WtHR) with cardiometabolic risk factors was assessed by multiple linear regression analysis. Sample was composed of 60.4% of women and 36.3% of overweight elderly. The connectivity index and a waist-to-height ratio were higher in 57.2% and 88.1% in the elderly, respectively. The results showed that the increase in body fat, diastolic blood pressure, triglycerides, glycemia and reduction of HDL-cholesterol are related to higher values of anthropometric indices evaluated. However, the waist-to-height ratio presented a greater magnitude of association with the cardiometabolic risk factors than the connectivity index.

Adiponectin levels and sleep deprivation in patients with endocrine metabolic disorders

SUMMARY BACKGROUND: Sleep abnormalities are frequent in patients with endocrine metabolic disorders (EMD) such as arterial hypertension, diabetes and obesity. Adiponectin is a peptide largely secreted by adipocytes and has various properties e.g. anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing. Adiponectin inversely relates to body weight and when its concentration decreases, the resistin concentration increases resulting in greater insulin resistance. OBJECTIVE: The objective of this study is to examine factors influencing adiponectin levels in a population with EMD. METHODS: This was a cross-sectional evaluation of 332 patients (18 to 80y) presenting arterial hypertension, pre-diabetes, diabetes, and/or obesity. Investigation included clinical evaluation of comorbidities, general blood tests and adiponectin measures (ELISA). Chronic sleep deprivation was determined if habitual sleep was <6 hours >4 days/week. RESULTS: Arterial hypertension (78.5%), type-2 diabetes (82.3%), and overweight (45.0%)/obesity (38.8%) were frequent. Patients with type-2 diabetes tended to have more chronic sleep deprivation (p=0.05). Adiponectin levels increased with age and were inversely correlated with sagittal abdominal diameter (p=0.04) and fasting insulin (p=0.001). Chronic sleep deprivation was associated with higher adiponectin concentration [OR=1.34; CI=1.13-1.58; p<0.005] and this was maintained after adjustment for gender, age, body mass index, menopause, arterial hypertension, American Diabetes Association classification and physical exercise levels [OR=1.38; 0=1.14-1.66: p=0.001]. CONCLUSION: In patients with EMD, adiponectin is influenced not only by obesity but also by age and sleep deprivation. The latter finding may be explained by a compensatory effect or a counter regulation to minimize the harmful effects of sleep deprivation.

RESUMO INTRODUÇÃO: Problemas de sono são frequentes em pacientes com distúrbios endócrino-metabólicos (DEM), como hipertensão arterial, diabetes e obesidade. A adiponectina é um peptídeo segregado por adipócitos e apresenta diversas propriedades, como por exemplo, anti-inflamatória, antioxidante, antiaterogênica, pró-angiogênica e vasoprotetora. A adiponectina relaciona-se inversamente com o peso corporal. OBJETIVO: Examinar os fatores que influenciam os níveis de adiponectina em uma população com DEM. MÉTODOS: Trata-se de uma avaliação transversal com 332 pacientes (18 a 80 anos) apresentando hipertensão arterial, pré-diabetes, diabetes e/ou obesidade. A investigação incluiu avaliação clínica de comorbidades, exames de sangue e medidas de adiponectina (Elisa). A restrição crônica do sono foi determinada com o sono habitual <6 horas >4 dias/semana. RESULTADOS: Doenças como hipertensão arterial (78,5%), diabetes tipo 2 (82,3%) e sobrepeso (45,0%)/obesidade (38,8%) foram frequentes. Pacientes com diabetes tipo 2 apresentaram uma tendência na restrição crônica do sono (p=0,05). Os níveis de adiponectina aumentaram com a idade e foram inversamente correlacionados com o diâmetro abdominal sagital (p=0,04) e com a insulina em jejum (p=0,001). A restrição crônica do sono foi associada à maior concentração de adiponectina [OR=1,34; CI=1,13-1,58; p<0,005] e isso foi mantido após ajuste por gênero, idade, índice de massa corporal, menopausa, hipertensão arterial, classificação dos níveis da American Diabetes Association e exercício físico [OR=1,38; CI=1,14-1,66: p=0,001]. CONCLUSÕES: Em pacientes com DEM, a adiponectina é influenciada não apenas pela obesidade, mas também pela idade e pela restrição de sono. O último achado pode ser explicado por um efeito compensatório ou por um regulamento contrário para minimizar os efeitos nocivos da restrição do sono.

Valoración del riesgo cardiometabólico determinado por variables antropometricas en niños escolares con diversidad étnica / Assessment of cardiometabolic risk determined by anthropometric variables in school children with ethnic diversity

El aumento progresivo de la obesidad en la población escolar chilena es preocupante, los niños mapuches, corren un riesgo alto de ser obesos, debido a la rápida transculturación y el acceso deficiente a información de salud pública. El propósito del estudio fue comparar variables antropometricas y su relación con el riesgo cardiometabólico en niños Mapuches y no-Mapuches, pertenecientes a colegios rurales de la IX Región de Chile. Se evaluaron 239 escolares (118 niñas y 121 niños) entre 6 y 12 años, pertenecientes a 3 colegios de rurales de la comuna de Cholchol, Imperial y Galvarino de la región de la Araucanía Chile, perteneciendo 177 escolares a la etnia mapuche, participaron de la investigación de forma voluntaria. Se recolectaron datos respecto a descendencia étnica (mapuche, no mapuche), edad, peso, talla, circunferencia cintura (CC), relación cintura estatura (RCE) y el índice de masa corporal (IMC). En la comparación por sexo y etnia no existieron diferencias significativas (p>0,05). Las variables Antropométricas de peso, CC, RCE, IMC fueron mayores en los sujetos con obesidad y presentaron significancia (p<0.001). El IMC presentó elevada correlación con el CC y presentó significancia (p<0,001). El resultado de la correlación de variables en población Mapuche del IMC con el CC fue mayor (0,909, p<0,001), en comparación a los no-Mapuches. En esta investigación reportó una elevada prevalencia de malnutrición por exceso 43,9% del grupo total estudiado y una alta relación entre el IMC, el CC y la RCE, siendo mayor está en los niños con etnia mapuche(AU)

The progressive increase of obesity in the Chilean school population is worrisome, Mapuche children are at high risk of being obese, due to rapid transculturation and poor access to public health information. The purpose of the study was to compare anthropometric variables and their relationship with cardiometabolic risk in Mapuche and non-Mapuches children, belonging to rural schools of the IX Region of Chile. A total of 239 schoolchildren (118 girls and 121 boys) between 6 and 12 years of age were evaluated, belonging to 3 rural schools in the Cholchol, Imperial and Galvarino communes of the Araucanía region of Chile, belonging to 177 Mapuche students. the investigation on a voluntary basis. Data were collected regarding ethnic descent (Mapuche, non-Mapuche), age, weight, height, waist circumference (WC), waist height ratio (SBC) and body mass index (BMI). In the comparison by sex and ethnic group, there were no significant differences (p> 0.05). The anthropometric variables of weight, CC, ROSC, BMI were higher in subjects with obesity and presented significance (p <0.001). The BMI showed high correlation with CC and presented significance (p <0.001). The result of the correlation of variables in Mapuche population of BMI with CC was higher (0.909, p <0.001), compared to non-Mapuches. This study reported a high prevalence of malnutrition due to excess of 43.9% of the total group studied and a high relationship between BMI, CC and RCE, being higher in children with Mapuche ethnicity(AU)

Autocuidado y adherencia al tratamiento en pacientes con diabetes mellitus del servicio de medicina interna del hospital universitario Dr. Ángel Larralde / Self-care and adherence to treatment in patients with diabetes mellitus of internal medicine, university hospital Dr. Angel Larralde

La diabetes mellitus afecta a gran parte de la población mundial, por lo que educar al paciente con medidas de autocuidado y manejo de la enfermedad es hoy en día la primera opción en los pasos de la terapéutica. Objetivo: Determinar la relación entre el autocuidado y la adherencia al tratamiento en pacientes con diabetes, que acuden al servicio de medicina interna, del Hospital Universitario Dr. Ángel Larralde. Materiales y Métodos: investigación no experimental, descriptiva, muestra no probabilística. Se empleó el instrumento "Summary of Diabetes Self-Care Activities measure (SDSCA)", en pacientes que cumplían criterios de inclusión. Se realizó análisis estadístico empleando el programa estadístico SPSS versión 20. Resultados: se aplicó el instrumento a 100 pacientes, durante el periodo de enero a julio del año 2016, con una edad promedio de 55,35 ± 12,52 años y distribución según el sexo de 57% sexo masculino y 43% femenino, con una tasa de adherencia a la medicación de 76,86% ± 32,1 en la población de estudio. Un 63,33% de los pacientes refiere no conocer qué representa la hemoglobina glicada (HbA1c), así como la frecuencia de su determinación (96,67%). Conclusión: En el grupo de estudio de pacientes con diabetes se determinó buena relación entre el autocuidado y la tasa de adherencia al tratamiento, así como el buen cumplimiento de la alimentación y medidas de automonitoreo de glicemia. Se evidenció tener un nivel de conocimiento bajo respecto al test de HbA1c y las metas de buen control glicémico(AU)

Diabetes mellitus affects a broad part of the worldwide population, which is why to educate and inform the patient ways of self-care and self-management is nowadays the first option in the therapeutic approach. Objective: to determine the relation between self-care and treatment adherence in patients with diabetes in the Internal Medicine Service of the University Hospital Dr. Ángel Larralde. Methods and Materials: non experimental, descriptive investigation with non probabilistic sample. The "Summary of Diabetes Self-Care Activities measure (SDSCA)" was used as instrument, applied to patients who met the inclusion criteria. The statistic analysis was made using SPSS statistics software, version 20. Results: the instrument was applied to 100 patients, in the period of January to July of 2016, with an average age of 55,35 ± 12,52 years and sex distribution of 57% men and 43% female, with an adherence to treatment rate of 76,86% ± 32,1 in the study population. A 76% of patients refered not to know what glicosilated hemoglobin represents, neither frequency of its determination (96%). Conclusions: The studied population had a good relation between selfcare and adherence to treatment, as with the implementation of a good diet regimen, and realization of self-monitoring of capillary glucose, with a low level of knowledge about Hb A1c test and treatment goals in the population of patients with diabetes(AU)

Relationship Between Neck Circumference and Epicardial Fat Thickness in a Healthy Male Population / Relação Entre Circunferência do Pescoço e Espessura da Gordura Epicárdica em Uma População de Homens Saudáveis

Abstract Background: Epicardial fat is an upper body visceral fat depot that may play a significant role in the development of adverse metabolic and cardiovascular risk profiles. There is a significant direct relationship between the amount of epicardial fat and general body adiposity (body mass index, BMI), but data regarding subcutaneous adiposity is limited. Objective: We conducted a study to determine the association between neck circumference and epicardial fat thickness in healthy young male individuals, and assess their individual correlations with general body adiposity and cardiometabolic risk factors. Methods: One hundred consecutive male patients aged 18 years or older with no known major medical conditions were included in the study. All participants underwent detailed physical examination including measurement of blood pressure, weight, height, waist/hip ratio, and neck circumference. Blood was collected to determine fasting glucose and lipid parameters. A standard echocardiographic examination was performed with additional epicardial fat thickness determination. Results: Among 100 study participants, neck circumference correlated significantly with weight, waist circumference, BMI, blood glucose, serum total cholesterol, low-density (LDL)-cholesterol, and triglycerides levels. No significant correlation was found between neck circumference and high-density lipoprotein (HDL)-cholesterol levels. Neck circumference correlated moderately and positively with echocardiographic epicardial fat thickness. Conclusion: Among patients with low cardiometabolic risk, increased neck circumference was associated with increased epicardial fat thickness.

Resumo Fundamentos: A gordura epicárdica é um depósito de gordura visceral na parte superior do organismo que pode desempenhar um papel importante no desenvolvimento de perfis cardiovasculares e metabólicos adversos. Há uma relação direta significativa entre a quantidade de gordura epicárdica e a adiposidade corporal geral (índice de massa corporal, IMC), mas dados sobre a adiposidade subcutânea são limitados. Objetivos: Realizamos um estudo para determinar a associação entre a circunferência do pescoço e a espessura da gordura epicárdica em jovens saudáveis do sexo masculino, além de avaliar as suas correlações individuais com a adiposidade corporal geral e fatores de risco cardiometabólicos. Métodos: Cem pacientes consecutivos do sexo masculino com idade igual ou superior a 18 anos e sem nenhuma condição médica importante e conhecida foram incluídos no estudo. Todos os participantes foram submetidos a um exame físico detalhado que incluiu medida da pressão arterial, peso, altura, razão cintura/quadril e circunferência do pescoço. Sangue foi coletado para determinação da glicemia de jejum e parâmetros lipídicos. Um exame ecocardiográfico padrão foi realizado com determinação adicional da espessura da gordura epicárdica. Resultados: Entre os 100 participantes do estudo, a circunferência do pescoço mostrou correlação significativa com o peso, circunferência de cintura, IMC, glicemia e níveis séricos de colesterol total, lipoproteína de baixa densidade (LDL-colesterol) e triglicerídeos. Não foi observada correlação significativa entre a circunferência do pescoço e níveis de colesterol de alta densidade (HDL-colesterol). A circunferência do pescoço correlacionou moderadamente e positivamente com a espessura da gordura epicárdica à ecocardiografia. Conclusão: Entre pacientes com baixo risco cardiometabólico, o aumento da circunferência do pescoço foi associado a um aumento da espessura da gordura epicárdica.

Fitness cardiorrespiratorio se asocia a una mejora en marcadores metabólicos en adultos chilenos / Inverse association of cardiorespiratory fitness with cardiovascular risk factors in Chilean adults

Background: A high level of cardiorespiratory fitness (CRF) is an important protector against cardiovascular and metabolic diseases. Aim: To explore the association of CRF with several metabolic markers and estimate the variation of these parameters by an increase of 1 MET change in CRF. Material and Methods: Cross-sectional study of 447 adults (56% women) without medical history of cardiometabolic diseases. Physical activity evaluated using accelerometry, body mass index (BMI), blood pressure, blood glucose and insulin and lipid profile were measured. HOMA-IR was calculated with fasting glucose and insulin levels. The submaximal Chester Step Test was used to measure CRF. Results: CRF was significantly associated with the level and intensity of physical activity, and all metabolic markers (p-trend < 0.05), except with diastolic blood pressure. It was estimated that 1-MET increase in CRF is associated with waist circumference (β -0.32 cm), fat mass (β -0.22%), insulin (β -0.67 pmol.l-1), HOMA-IR (β -0.17) and HDL cholesterol (β +1.46 mg.dl-1). All these associations were independent of main covariates such as age, sex, education, smoking and body mass index. Conclusions: A higher level of CRF is inversely associated with several metabolic markers that are risk factors for cardiovascular disease.

Índice cintura-estatura como indicador de riesgo metabólico en niños / Waist-to-height ratio is an indicator of metabolic risk in children

Introducción La grasa abdominal, especialmente la visceral, está asociada con un riesgo alto de complicaciones metabólicas. El índice cintura-estatura es usado para evaluar grasa abdominal en individuos de todas las edades. Objetivo Identificar la capacidad del índice cintura-estatura (ICE) para detectar riesgo metabólico en niños mexicanos de edad escolar. Pacientes y método Se estudiaron niños entre 6 y 12 años. Se diagnosticó obesidad con un índice de masa corporal (IMC) ≥ percentil 85, y obesidad abdominal con ICE ≥0,5. Se midieron niveles sanguíneos de glucosa, colesterol y triglicéridos. Se determinó sensibilidad, especificidad, valor predictivo positivo y negativo, área bajo la curva, coeficiente de verosimilitud positivo y negativo de la RCE e IMC para identificar alteraciones metabólicas. Se compararon ICE e IMC para determinar cuál tiene mejor eficiencia diagnóstica. Resultados Se estudiaron 223 niños, 51 presentaron hipertrigliceridemia, 27 hipercolesterolemia y 9 hiperglucemia. Comparando la eficiencia diagnóstica del ICE contra el IMC se encontró sensibilidad del 100 vs.56% para hiperglucemia, del 93% contra 70% para hipercolesterolemia y del 76% contra 59% para hipertrigliceridemia, especificidad, valor predictivo negativo, valor predictivo positivo, coeficiente de verosimilitud positivo, coeficiente de verosimilitud negativo y área bajo la curva fueron superiores para ICE. Conclusiones El ICE es un indicador más eficiente que el IMC para identificar riesgo metabólico en niños mexicanos de edad escolar.

Introduction Abdominal fat, particularly visceral, is associated with a high risk of metabolic complications. The waist-height ratio (WHtR) is used to assess abdominal fat in individuals of all ages. Objective To determine the ability of the waist-to-height ratio to detect metabolic risk in mexican schoolchildren. Patients and Method A study was conducted on children between 6 and 12 years. Obesity was diagnosed as a body mass index (BMI) ≥ 85th percentile, and an ICE ≥0.5 was considered abdominal obesity. Blood levels of glucose, cholesterol and triglycerides were measured. The sensitivity, specificity, positive predictive and negative value, area under curve, the positive likelihood ratio and negative likelihood ratio of the WHtR and BMI were calculated in order to identify metabolic alterations. WHtR and BMI were compared to determine which had the best diagnostic efficiency. Results Of the 223 children included in the study, 51 had hypertriglyceridaemia, 27 with hypercholesterolaemia, and 9 with hyperglycaemia. On comparing the diagnostic efficiency of WHtR with that of BMI, there was a sensitivity of 100% vs. 56% for hyperglycaemia, 93 vs. 70% for cholesterol, and 76 vs. 59% for hypertriglyceridaemia. The specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and area under curve were also higher for WHtR. Conclusions The WHtR is a more efficient indicator than BMI in identifying metabolic risk in mexican school-age.

Carotid body Thermoreceptors, sympathetic neural activation, and cardiometabolic disease

The carotid body (CB) is the main peripheral chemoreceptor that senses the arterial PO2, PCO2 and pH. In response to hypoxemia, hypercapnia and acidosis, carotid chemosensory discharge elicits reflex respiratory, autonomic and cardiovascular adjustments. The classical construct considers the CB as the main peripheral oxygen sensor, triggering reflex physiological responses to acute hypoxemia and facilitating the ventilatory acclimation to chronic hypoxemia at high altitude. However, a growing body of experimental evidence supports the novel concept that an abnormally enhanced CB chemosensory input to the brainstem contributes to overactivation of the sympathetic nervous system, and consequent pathology. Indeed, the CB has been implicated in several diseases associated with increases in central sympathetic outflow. These include hypertension, heart failure, sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome. Indeed, ablation of the CB has been proposed for the treatment of severe and resistant hypertension in humans. In this review, we will analyze and discuss new evidence supporting an important role for the CB chemoreceptor in the progression of autonomic and cardiorespiratory alterations induced by heart failure, obstructive sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome.

Obesidade e fatores de risco cardiometabólicos durante a gravidez / Obesity and cardiometabolic risk factors during pregnancy

OBJETIVO: Avaliar fatores de risco cardiometabólicos durante a gestação normal, observando a influência da obesidade materna sobre os mesmos. MÉTODOS: Estudo realizado com 25 gestantes sadias com gestação única e idade gestacional inferior a 20 semanas. Foi feita análise longitudinal de pressão arterial, peso, índice de massa corporal (IMC), concentrações séricas de leptina, adiponectina, cortisol, colesterol total e frações, triglicérides, ácido úrico, glicose de jejum, teste oral de tolerância à glicose, HOMA-IR e relação insulina/glicose nos três trimestres da gestação. Para avaliação da influência da obesidade, as gestantes foram divididas em dois grupos baseados no IMC do primeiro trimestre: grupo com peso normal (Gpn) para gestantes com IMC<25 kg/m2 e grupo com sobrepeso/obesidade (Gso) para IMC≥25 kg/m2. Foram utilizados testes ANOVA de um fator para medidas repetidas ou teste de Friedman e os testes t de Student ou de Mann-Whitney para análises estatísticas comparativas e teste de Pearson para correlações. RESULTADOS: A média de idade foi de 22 anos. Os valores médios para o primeiro trimestre foram: peso 66,3 kg e IMC 26,4 kg/m2, sendo 20,2 kg/m2 do Gpn e 30,7 kg/m2 do Gso. A média do ganho de peso foi de 12,7 kg (10,3 kg para Gso e 15,2 Kg para Gpn). Os níveis de cortisol, ácido úrico e lipidograma elevaram-se nos trimestres, com exceção do HDL-colesterol que não se alterou. A pressão arterial, insulina e HOMA-IR sofreram elevação apenas no terceiro trimestre. O grupo Gso mostrou tendência a maior ganho de peso, apresentou concentrações de leptina, colesterol total, LDL-colesterol, VLDL-colesterol, TG, glicemia jejum e insulina mais elevados, maior HOMA-IR, além de reduzida ...

PURPOSE: To assess cardiometabolic risk factors during normal pregnancy and the influence of maternal obesity on them. METHODS: This study included 25 healthy pregnant women with a single pregnancy and a gestational age of less than twenty weeks. Longitudinal analysis of blood pressure, body weight, body mass index (BMI), serum concentrations of leptin, adiponectin, cortisol, total cholesterol and fractions, triglycerides, uric acid, fasting glucose, oral glucose tolerance test, HOMA-IR and insulin/glucose ratio was performed each trimester during pregnancy. In order to evaluate the impact of obesity, pregnant women were divided into two groups based on BMI for the first quarter of pregnancy: Gpn for pregnant women with BMI<25 kg/m2 and Gso for BMI≥25 kg/m2. One-Way ANOVA for repeated measurements or Friedman test and Student-t or Mann-Whitney tests for statistical comparisons and Pearson correlations test were used for statistical analysis. RESULTS: The mean values for the first quarter of pregnancy for the following parameters were: age: 22 years; weight: 66.3 kg and BMI 26.4 kg/m2, with 20.2 and 30.7 kg/m2 for the Gpn and Gso groups, respectively. Mean weight gain during pregnancy was ±12.7 kg with 10.3 kg for the Gso group and 15.2 kg for the Gpn group. Regarding plasma determinations, cortisol, uric acid and lipid profile increased during all trimesters of pregnancy, except for HDL-cholesterol, which did not change. Blood pressure, insulin and HOMA-IR only increased in the third quarter of pregnancy. The Gso group tended to gain more weight and to show higher concentrations of leptin, total cholesterol, LDL-cholesterol, VLDL-cholesterol, TG, glucose, insulin, HOMA-IR, besides lower HDL-cholesterol and greater diastolic blood pressure in the 3rd quarter of pregnancy. Three pregnant women developed gestational hypertension, presented prepregnancy obesity, excessive weight gain, hyperleptinemia and an insulin/glucose ...