Aumento do risco cardiovascular em mulheres com síndrome do ovário policístico / Increased cardiovascular risk in women with polycystic ovary syndrome

Objetivo: A síndrome dos ovários policísticos (SOP) é uma alteração endócrina comum em mulheres que estão em fase reprodutiva. Essa patologia pode estar relacionada a fatores de risco para o desenvolvimento de complicações cardiometabólicas, o que a torna um tema relevante para discussão, visto sua grande prevalência na população feminina. Trata-se de uma revisão integrativa da literatura com o objetivo de identificar os fatores de risco associados à SOP e verificar se há maior risco cardiovascular para as mulheres com essa síndrome. Fonte de dados: Foi realizada uma busca nas bases de dados Biblioteca Virtual de Saúde, National Library of Medicine, Scientific Eletronic Library Online e EbscoHost, com os seguintes descritores: "Síndrome do ovário policístico e riscos cardiovasculares"; "Mulheres, policístico e riscos cardiovasculares"; "Ovário policístico e riscos" e "Mulheres, ovários policísticos"; "Polycystic ovary and risks"; "Polycystic ovary syndrome and cardiovascular risk" e "Polycystic ovaries and cardiovascular". Seleção de estudos: Foram encontrados 21 artigos, dos quais 15 atenderam aos critérios de inclusão previamente estabelecidos. Foram incluídos os artigos originais e as publicações entre o período de 2014 e 2021 que relacionavam diretamente a síndrome aos riscos cardiovasculares, síndromes metabólicas e alterações lipídicas. Coleta de dados: A estratégia de seleção dos artigos foi realizada mediante busca nas bases de dados selecionadas, leitura dos títulos de todos os artigos encontrados e exclusão daqueles que não abordavam o assunto, leitura crítica dos resumos dos artigos e leitura na íntegra dos artigos selecionados nas etapas anteriores. Síntese de dados: Todos os autores afirmam que a síndrome é um distúrbio ovulatório e metabólico, uma vez que a resistência à insulina e a consequente hiperinsulinemia compensatória podem ser exacerbadas pela coexistência da obesidade, presente em muitas mulheres com SOP. Além disso, foram identificados os fatores de risco tradicionais para o desenvolvimento de doenças cardiovasculares, e 93,33% dos artigos analisados demonstraram que, entre as mulheres com a síndrome, alguns fatores de risco para o desenvolvimento de tais doenças parecem apresentar uma chance maior de estarem presentes. Conclusão: Ao final dessa revisão, foi possível responder à pergunta clínica proposta, pois todos os artigos pesquisados concluíram e trouxeram estudos comprovando que mulheres com a SOP possuem maiores chances de desenvolver algum problema cardiovascular precoce, devido a fatores como o hiperandrogenismo e o aumento da gordura visceral e da resistência insulínica.(AU)

Objective: Polycystic ovary syndrome is an endocrine disorder, common in women who are in the reproductive phase. This pathology may be related to risk factors for the development of cardiometabolic complications, which makes it a relevant topic for discussion, given its high prevalence in the female population. This is an integrative literature review with the aim of identifying the risk factors associated with polycystic ovary syndrome and verifying whether there is a higher cardiovascular risk for women with this syndrome. Data source: A search was performed in the Virtual Health Library databases; National Library of Medicine; Scientific Electronic Library Online and EbscoHost, with the following descriptors: "Polycystic ovary syndrome and cardiovascular risks"; "Women, polycystic and cardiovascular risks"; "Polycystic ovaries and risks" and "Women, polycystic ovaries"; "Polycystic ovary and risks"; "Polycystic ovary syndrome and cardiovascular risk" and "Polycystic ovaries and cardiovascular". Study selection: Twenty-one articles were found, of which 15 met the previously established inclusion criteria. Original articles and publications between the period 2014 and 2021 that directly related the syndrome to cardiovascular risks, metabolic syndromes and lipid disorders were included. Data collect: The article selection strategy was performed by searching the selected databases; reading the titles of all articles found and excluding those that did not address the subject; critical reading of the abstracts of the articles and full reading of the articles selected in the previous steps. Data synthesis: All authors state that the Syndrome is an ovulatory and metabolic disorder, since insulin resistance and consequent compensatory hyperinsulinemia can be exacerbated by the coexistence of obesity, present in many women with polycystic ovary syndrome. In addition, traditional risk factors for the development of cardiovascular diseases were identified, with 93.33% of the articles analyzed showing that, among women with the syndrome, some risk factors for the development of such diseases seem to have a chance greater than being present. Conclusion: At the end of this review, it was possible to answer the proposed clinical question, as all the researched articles concluded and brought studies proving that women with polycystic ovary syndrome are more likely to develop an early cardiovascular problem, due to factors such as hyperandrogenism, the increase in visceral fat and insulin resistance.(AU)

NLRP3 inflammasome in metabolic syndrome

Metabolic syndrome (MS) is a serious health problem worldwide; it is characterized by a group of metabolic disorders, including central obesity, insulin resistance/type 2 diabetes, hyperlipidemia with accelerated atherosclerosis, hypertension, non-alcoholic fatty liver disease, and elevated uric acid with increased risk of gout. The incidence of MS has increased considerably in recent decades and has attracted considerable attention. A number of clinical and translational laboratory studies have implicated the activation of nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3) inflammasome in the development of MS, therefore establishing a strong link between chronic inflammation and metabolic diseases. This paper aims to review new developments on NLRP3 inflammasome in MS for better understanding of chronic inflammation in metabolic diseases. We will also provide new insights into using NLRP3 inflammasome as an innovative therapeutic target.

Microalbuminuria y proteína C reactiva como índices de riesgo cardiovascular en pacientes con síndrome metabólico / Microalbuminuria and C reactive protein as cardiovascular risk indices in patients with metabolic syndrome

Se realizó una investigación cuantitativa de tipo correlacional con el objeto de evaluar la asociación entre microalbuminuria (MA), proteína C reactiva ultrasensible (PCR-us) y riesgo cardiovascular (RCV) de acuerdo a la escala de Framingham en pacientes con síndrome metabólico (SM) que asistieron a la consulta del Servicio de Medicina Interna del Hospital Universitario Dr. Luis Gómez López durante el período junio 2017-junio 2018. La muestra la conformaron 30 pacientes con una edad promedio de 49,53 ± 13,35 años y predominio del sexo femenino. El 53,3% de los pacientes no tenía tratamiento. El 73,3% de los pacientes presentaron RCV muy alto y alto de acuerdo a la escala de Framingham. La mayor parte de los pacientes con RCV muy alto presentaron valores elevados de PCR-us. Se observó una correlación positiva entre los valores de PCR-us y el RCV (R=0,533, p < 0.05). Es importante la identificación temprana del SM como factor de riesgo para el desarrollo de enfermedades cardiovasculares(AU)

A correlation-type quantitative investigation was carried out with the aim to evaluate the association between microalbuminuria (MA), high-sensitive C-reactive protein (hs-CRP) and cardiovascular risk (CVR) determined by the Framingham scale in patients with Metabolic Syndrome (MS) who attended the Internal Medicine Service of the Hospital Universitario Dr. Luis Gómez López during the period June 2017-June 2018. Thirty patients were included with an average age of 49.53 ± 13.35 years and female sex predominance. According to the Framingham scale, 73.3% of patients had very high and high CVR. Most patients with very high CVR had elevated levels of hs-CRP. There was a positive and significant correlation between hs-CRP levels and CVR (R=0.533, p <0.05). An early diagnosis of MS is important as a risk factor for the development of cardiovascular disease(AU)

Diâmetro abdominal sagital de adolescentes obesos e sua associação com os critérios da síndrome metabólica / Sagittal abdominal diameter of obese adolescents and its association with the criteria of metabolic syndrome

INTRODUÇÃO: O diâmetro abdominal sagital (DAS) é uma medida antropométrica relacionada com a gordura visceral e utilizada para avaliar a obesidade abdominal, uma variável associada à síndrome metabólica (SM). Sua utilização é indicada na prática clínica para avaliação de risco cardiometabólico em adolescentes obesos. Este estudo consiste em verificar a correlação entre o DAS e a circunferência abdominal (CA) na avaliação da obesidade central e sua associação com os critérios da SM e Home-ostatic Model Assessment Insulin Resistance (HOMA-IR) em adolescentes obesos. MÉTODO: Estudo de corte transversal constituído por adolescentes obesos matriculados nos ambulatórios das Unidades de Endocrinologia Pediátrica e de Adolescentes do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. As variáveis antropométricas avaliadas foram: índice de massa corporal (IMC), Escore Z do IMC, %GC, CA, DAS. As variáveis laboratoriais e clínicas foram: HDL-c, triglicérides, glicemia e insulina para o cálculo do HOMA-IR e pressão arterial sistólica e diastólica. RESULTADOS: De acordo com os critérios utilizados pelo IDF, 27,7% dos 83 adolescentes, com idade entre 14 e 18 anos apresentaram SM e o DAS demonstrou estar significantemente associado com as variáveis pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e HOMA-IR nos grupos geral, feminino e masculino. A concordância entre a CA e o DAS é significante nos grupos geral (Kappa 0,511; p<0,001), feminino e masculino com SM (Kappa 1,00; p<0,001) e o DAS oferece vantagem metodológica na sua mensuração. Conclusão: Nas condições deste estudo, conclui-se que as medidas antropométricas CA e DAS se equivalem para o grupo avaliado na classificação da SM. O DAS é preditor de PAS, PAD e de HOMA-IR e é forte indicador de risco cardiometabólico em adolescentes obesos

Variáveis antropométricas e de composição corporal como preditores de risco cardiovascular e da síndrome metabólica em adolescentes / Anthropometric and body composition variables as predictors of cardiovascular risk and metabolic syndrome in adolescents

Introdução: Na triagem de indivíduos em risco de desenvolvimento de fatores de risco cardiovasculares e da síndrome metabólica, a antropometria surge como uma alternativa ao Índice de Massa Corporal (IMC), que pode ser utilizada para avaliar a composição corporal e perímetros. Assim, objetivou-se verificar a capacidade das medidas antropométricas, principalmente o perímetro do pescoço (PP) em predizer fatores de risco cardiovascular e síndrome metabólica em adolescentes. Método: Coletaram-se dados referentes à glicemia, colesterol total e frações, triglicerídeos e pressão arterial em 85 adolescentes de 11 a 15 anos, de escolas públicas de Alegre (ES). O percentual de gordura corporal (%GC) foi avaliado pela bioimpedância vertical bipolar. Resultados: Com base na curva ROC, as variáveis antropométricas perímetro do pescoço (PP), PC, IMC e %GC demonstraram ser eficazes no diagnóstico da síndrome metabólica, principalmente o PP. Quanto ao estado nutricional, 76%, 21% e 30%, respectivamente, apresentaram eutrofia, excesso de peso e alto %GC. O %GC, o perímetro da cintura (PC) e relação cintura-estatura (RCE) apresentaram valores mais elevados no sexo feminino em relação ao masculino. O colesterol total foi o que apresentou maior percentual de inadequação (37%), seguido dos triglicerídeos (18%). A prevalência geral da síndrome metabólica foi de 2,35%, sendo observada somente no sexo masculino (6,25%). Conclusão: O PP, o IMC, o %GC, o PC e a RCE são bons preditores de alterações metabólicas em adolescentes. Assim, essas medidas devem ser usadas em conjunto na avaliação nutricional deste grupo.(AU)

Introduction: In the screening of individuals at risk of developing cardiovascular risk factors and metabolic syndrome, anthropometry emerges as an alternative to the Body Mass Index (BMI), which can be used to evaluate body composition and perimeters, the ability of anthropometric measures, especially the neck circumference (PP) to predict cardiovascular risk factors and metabolic syndrome in adolescents, was verified. Methods: Data on glycemia, total cholesterol and fractions, triglycerides and blood pressure were collected from 85 adolescents aged 11 to 15 from public schools in Alegre (ES). The percentage of body fat (%GC) was evaluated by bipolar vertical bioimpedance. Results: Based on the ROC curve the anthropometric variables perimeter of the neck (CP), PC, BMI and %GC were shown to be effective in the diagnosis of the metabolic syndrome, mainly PP. Regarding nutritional status, 76%, 21% and 30%, respectively, presented eutrophy, excess weight and high% GC. The %GC, waist circumference (PC) and waist-to-height ratio (RCE) were higher in females than in males. Total cholesterol presented the highest percentage of inadequacy (37%), followed by triglycerides (18%). The overall prevalence of the metabolic syndrome was 2.35%, being observed only in the male sex (6.25%). Conclusion: PP, BMI, %GC, PC and CER are good predictors of metabolic changes in adolescents, so these measures should be used together in the nutritional assessment of this group.(AU)

Relação entre SNP rs4730153 e Nível de Glicemia, Triglicérides, HDL e Índice de Massa Corporal de Brasileiros Acima do Peso / Association between rs4730153 Gene SNP and Fasting Glucose, Triglyceride, HDL and Body Mass Index Levels Iin Overweight Brazilian Adults

A síndrome metabólica é uma comorbidade relacionada à obesidade com crescentes níveis mundiais. Além dos fatores ambientais, especula-se que as variáveis incluídas na síndrome metabólica (cintura, glicemia de jejum, HDL, triglicérides e valores pressóricos) possam ser moduladas por variantes genéticas. Recentemente foi reportado que alguns polimorfismos do gene do fator de crescimento de células pré-beta podem ter um papel modulador no metabolismo de glicose e lipídeos, além de influências no índice de massa corporal. Objetivo: Investigar a influência do polimorfismo rs4730153 do gene do fator de crescimento de células pré-beta nos níveis de glicemia, triglicérides, HDL e índice de massa corporal de indivíduos sedentários acima do peso. Métodos: Incluíram-se homens e mulheres brasileiros com índice de massa corporal > 24,9 kg/m², acima de 18 anos de idade, que não faziam uso de medicamentos para glicemia ou hipercolesterolemia. O polimorfismo rs4730153 foi amplificado por reação em cadeia de polimerase em tempo real utilizando kit de genotipagem. Os genótipos AA, AG e GG foram avaliados separadamente. Resultados: Foram incluídos 112 indivíduos com idade média de 40,52 ± 10,30 anos, sendo 77% mulheres. A frequência genotípica foi de 29,5, 41,0 e 29,5% (AA, AG e GG, respectivamente). Não foi observada nenhuma relação entre os valores de glicemia, triglicérides, HDL e índice de massa corporal nos diferentes alelos do SNP estudado. Conclusões: Apesar de relatos em estudos em outras etnias, no presente estudo não foi encontrada relação entre o polimorfismo rs4730153 do gene do fator de crescimento de células pré-beta nos níveis séricos de glicemia, triglicérides, HDL e índice de massa corporal em uma amostra da população brasileira com sobrepeso/obesidade.

Metabolic syndrome is an obesity-related comorbidity with increasing worldwide occurrence. In addition to environmental factors, it is speculated that the variables included in the metabolic syndrome (waist, fasting glycemia, HDL, triglycerides and blood pressure values) can be modulated by genetic variants. It has recently been reported that some polymorphisms of the pre-beta cell growth factor gene may play a modulatory role in glucose and lipid metabolism, as well as influence body mass index. Objective: To investigate the influence of the rs4730153 polymorphism of the pre-beta cell growth factor gene on the levels of glycemia, triglycerides, HDL and body mass index of overweight and sedentary individuals. Methods: Brazilian men and women with a body mass index >24.9 kg/m², over 18 years of age, who did not use medication for glycemia or hypercholesterolemia were included. The rs4730153 polymorphism was amplified by real-time polymerase chain reaction using a genotyping kit. Genotypes AA, AG and GG were evaluated separately. Results: A total of 112 individuals with a mean age of 40.52 ± 10.30 years were included, of which 77% were women. Genotype frequency was 29.5, 41.0 and 29.5% (AA, GA and GG, respectively). No association was observed between glycemia, triglycerides, HDL and body mass index in the different alleles of the studied SNP. Conclusions: Despite reports of studies in other ethnicities, in the present study no association was found between the rs4730153 polymorphism of the pre-beta cell growth factor gene and serum levels of glycemia, triglycerides, HDL and body mass index in a sample of the Brazilian population with overweight/obesity.

Consumo alimentar dos portadores de Doença Hepática Gordurosa Não Alcoólica: comparação entre a presença e a ausência de Esteatoepatite Não Alcoólica e Síndrome Metabólica / Dietary intake of patients with Nonalcoholic Fatty Liver Disease: Comparison between the presence and absence of Nonalcoholic Steatosis and Metabolic Syndrome

RESUMO Objetivo O objetivo desse estudo foi avaliar o consumo alimentar de portadores de Doença Hepática Gordurosa Não Alcoólica, comparar com as recomendações nutricionais diárias e analisar a correlação da dieta com a presença de Síndrome Metabólica e com a gravidade da doença, uma vez que estudos sobre os hábitos alimentares dos portadores de Doença Hepática Gordurosa Não Alcoólica ainda são escassos na literatura. Métodos Nesse estudo foram avaliados, inicialmente, 158 pacientes com diagnóstico de Doença Hepática Gordurosa Não Alcoólica. Analisou-se exames laboratoriais, biópsia hepática, dados antropométricos e consumo dietético (registro alimentar de três dias). Dentre os pacientes avaliados, alguns já haviam sido orientados nutricionalmente e foram divididos em dois grupos: "sem dieta" e "com dieta". Para o cálculo de comparações de médias entre os grupos estudados, empregou-se o teste t de Student, considerando o nível de significância de 5% (a£0,05). Resultados Do total inicial de participantes, 59 apresentavam modificação significativa da dieta a partir de alguma orientação nutricional prévia e, por isso, foram excluídos da análise. Dos 99 pacientes restantes, quando confrontados com a ingestão dietética recomendada, 26% apresentavam maior ingestão energética e 80%, de ácidos graxos saturados, além de deficiente ingestão de ácidos graxos poli-insaturados e monoinsaturados, fibras e vitamina E, confirmando estudos prévios nessa mesma população. Entretanto, não foram encontradas diferenças significativas na dieta desses pacientes quando divididos de acordo com a presença ou ausência de Síndrome Metabólica e Esteatoepatite Não Alcoólica. Conclusão Esses dados, à luz dos conhecimentos atuais, sugerem que a dieta, especialmente quando rica em ácidos graxos saturados e deficiente em fibras e vitaminas antioxidantes, pode ter importante papel no aparecimento da Doença Hepática Gordurosa Não Alcoólica, mas que outros fatores exercem papel mais relevante na sua progressão para a Esteatoepatite Não Alcoólica.

ABSTRACT Objective The objective of this study was to assess the food intake of individuals with Nonalcoholic Fatty Liver Disease, compare it with daily nutritional recommendations, and analyze whether diet correlates with the presence of Metabolic Syndrome and disease severity, because studies about the food habits of these individuals are still scarce in the literature. Methods Initially, this study assessed 158 patients diagnosed with Nonalcoholic Fatty Liver Disease. Laboratory tests, liver biopsy, anthropometric data, and food intake (determined by the three-day food record) were analyzed. Some study patients had already received dietary advice, so the sample was divided into two groups, one "without dietary advice" and another "with dietary advice". The Student's t-test compared the means between the groups at a significance level of 5% (a£0.05). Results Of the initial sample, 59 patients changed their diet significantly after receiving dietary advice, so they were excluded from the analysis. The other 99 patients consumed 26% more energy and 80% more saturated fatty acids than recommended and presented low intake of polyunsaturated and monounsaturated fatty acids, fibers, and vitamin E, confirming previous studies in this same population. However, the diets of these patients did not differ significantly by presence or absence of Metabolic Syndrome or Nonalcoholic Steatohepatitis. Conclusion In light of current knowledge, these data suggest that diet, especially when high in saturated fatty acids and low in fiber and antioxidant vitamins, can play an important role in the onset of Nonalcoholic Fatty Liver Disease, but other factors play a more important role in its progression to Nonalcoholic Steatohepatitis.

Frequency of nonalcoholic fatty liver disease and non-alcoholic steatohepatitis in patients with metabolic syndrome

Obesity and metabolic syndrome is an epidemic seen in the developed, as well as developing countries. Early recognition of this disorder may prevent major non-communicable diseases such as type 2 diabetes mellitus, hypertension and dyslipidemia. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are the hepatic manifestations of metabolic syndrome. Prospective, observational, cross-sectional study was conducted in Endocrine Clinic of Jinnah Postgraduate Medical Centre, Karachi from June 2008 to September 2010. This study was conducted in patients suspected to have metabolic syndrome, as defined by International Diabetes Federation. Patients fitting the clinical consensus definition, having either palpable liver or ultrasound evidence of fatty infiltration were enrolled. Detailed history, physical examination, anthropometrics and biochemical measurements were recorded. Liver biopsies were performed where possible and were assessed according to Brunt et al's classification. A total of 101 patients who met the inclusion criteria were enrolled in the study. Liver biopsy was done in 31 patients. On biopsy, non-alcoholic fatty liver disease was confirmed in 28 [90%], non-alcoholic steatohepatitis in 18 [58%] and fibrosis in 8 [25%] patients. Of the biopsied cases, fatty infiltration on ultrasound was seen in 14 [87.5%] cases. Alanine aminotransferase was higher in patients having fibrosis. There was a direct correlation of histopathological changes with rising waist circumference, total cholesterol, triglyceride, low density lipoprotein and alanine aminotransferase. There was high prevalence of non-alcoholic fatty liver disease / non-alcoholic steatohepatitis in patients with metabolic syndrome and liver biopsy confirmed this in 90.3% patients who consented to this procedure

Asociación entre enfermedad metabólica y severidad de aterosclerosis coronaria evaluada por Score de Gensini / Association between metabolic disease and the severity of coronary artery disease measured by Gensini Score

Introducción: La asociación entre cardiopatía coronaria (CC) y estados de disglicemia está bien establecida. Sin embargo, aún cuando la diabetes mellitus (DM) corresponde a uno de los principales factores de riesgo para CC, la asociación con el síndrome metabólico (SM) parece menos clara. Nuestro objetivo fue evaluar el grado de compromiso aterosclerótico del árbol coronario de acuerdo a la existencia de SM y DM. Pacientes y método: Se analizó los datos de 413 pacientes sometidos a coronariografía electiva en el período de un año. Se dividió la muestra en 3 grupos: pacientes diabéticos, pacientes con SM (no diabéticos) y pacientes sin enfermedad metabólica (no SM, no DM). Se consideró como portador de CC a todo paciente con estenosis >50 por ciento en cualquier arteria coronaria, la severidad de la enfermedad coronaria fue medida por el Score de Gensini. Se utilizó análisis de varianza (Barlett) con comparación múltiple de Scheffe y prueba no paramétrica de Krus-kal-Wallis en aquellos grupos con varianzas distintas. El protocolo fue aprobado por el Comité Ético Científico del Servicio de Salud Araucanía Sur. Resultados: La edad promedio fue 63.8 +/- 11,17 años. La prevalencia de SM fue 38 por ciento (n=158), DM 45 por ciento (n=186) y no tenían alteraciones metabólicas 17 por ciento de los pacientes (n=69). La prevalencia global de enfermedad coronaria fue 52,7 por ciento. La prevalencia en los distintos grupos fue 33.9 por ciento en aquellos sin enfermedad metabólica, 52.2 por ciento en los portadores de SM y 62.2 por ciento en los pacientes con DM (p=0.001). En cuanto a la severidad de la CC, el score de Gensini fue 18, 22,04 y 29,6 respectivamente (p=0,04). Conclusiones: Este estudio observacional sugiere que, comparados con sujetos sin enfermedad metabólica tanto la prevalencia de CC, como su severidad son mayores en pacientes con SM aislado y mayores aún en portadores de DM.

Introduction: The association between coronary artery (CAD) and dysglicemia is well established. Diabetes (DM) is recognized as one of the most important coronary risk factors, but the association of CAD and metabolic syndrome (MS) is less well defined. Our objective was to evaluate the degree of coronary atherosclerotic disease in relation to the presence of MS and DM . Patients and Method: The data of 413 patients electively studied with coronary angiography over a period of one year was analyzed. Patients were divided into three groups: Patients with DM, patients with MS (without DM) and patients without a metabolic disorder (no DM, no MS). The severity of CAD was measured by the Gensini Score. Results: Mean age was 63,8 +/-11,17 years. The prevalence of patients with MS was 38 percent (n=158), with DM 45 percent (n=186) and without a metabolic disorder 17 percent (n=69). The global prevalence of CAD was 52,7 percent. The prevalence of CAD in the different groups was as follows: Absence of metabolic disease 33.9 percent, patients with MS 52.2 percent and patients with DM 62.2 percent (p< 0.001). Conclusions: This observational study suggests that, compared to subjects without metabolic disease, the prevalence and severity of CAD are higher in patients with MS and even higher in patients with DM.

Epicardial adipose tissue thickness and its association with adiponectin in metabolic syndrome patients from Mérida, Venezuela / Associação entre a espessura do tecido adiposo epicárdico e a adiponectina em pacientes com síndrome metabólica em Mérida, Venezuela

Objective: To study the relationship between epicardial adipose tissue (EAT) thickness and plasma levels of adiponectin in Venezuelan patients. Subjects and methods: Thirty-one patients diagnosed with metabolic syndrome (study group) and 27 controls were selected and tested for glycemia, lipids, and adiponectin. EAT thickness, ejection fraction, diastolic function, left ventricular mass (LVM), and left atrial volume (LAV) were determined by transthoracic echocardiography. Results: EAT thickness was greater in metabolic syndrome patients (5.69 ± 1.12 vs. 3.52 ± 0.80 mm; p = 0.0001), correlating positively with body mass index (BMI) (r = 0.661; p = 0.0001); waist circumference (WC) (r = 0.664; p = 0.0001); systolic (SBP) (r = 0.607; p = 0.0001), and diastolic blood pressure (DBP) (r = 0.447; p = 0.0001); insulin (r = 0.505; p = 0.0001); Tg/HDL-C ratio (r = 0.447; p = 0.0001), non-HDL-C (r = 0.353; p = 0.007); LAV (r = 0.432; p = 0.001), and LVM (r = 0.469; p = 0.0001). EAT thickness correlated negatively with adiponectin (r = -0.499; p = 0.0001). Conclusion: A significant association exists between EAT thickness and both metabolic syndrome components and adiponectin concentration, a link that might be used as a biomarker for this disease. .

Objetivo: Estudar a relação entre a espessura do tecido adiposo epicárdico (TAE) e os níveis plasmáticos de adiponectina em pacientes venezuelanos. Sujeitos e métodos: Foram selecionados 31 pacientes com diagnóstico de síndrome metabólica (SM) (grupo de estudo) e 27 controles. Foram medidos a glicose, os lipídios e a adiponectina. Foram determinados a espessura do TAE, a fração de ejeção, a função diastólica, a massa ventricular esquerda (MVE) e o volume atrial esquerdo (VAI) pela ecocardiografia transtorácica. Resultados: A espessura do TAE foi maior em pacientes com SM (5,69 ± 1,12 contra 3,52 ± 0,80 mm; p = 0,0001) com uma correlação positiva com o índice de massa corporal (IMC) (r = 0,661; p = 0,0001), circunferência da cintura (CC) (r = 0,664; p = 0,0001), pressão arterial sistólica (PAS) (r = 0,607; p = 0,0001), diastólica (PAD) (r = 0,447; p = 0,0001), insulina (r = 0,505; p = 0,0001), com a relação TG/HDL-C (r = 0,447; p = 0,0001), com o colesterol HDL (r = 0,353; p = 0,007), VAI (r = 0,432; p = 0,001) e MVI (r = 0,469; p = 0,0001). A espessura do TAE se correlacionou negativamente com a adiponectina (r = -0,499; p = 0,0001). Conclusão: Existe uma relação significativa entre a espessura do TAE, os componentes do SM e a concentração plasmática de adiponectina, o que poderia ser utilizado como um biomarcador para essa doença. .

Riesgo de obesidad en pacients coronarios medicados con antipsicóticos atípicos / Risk for Obesity in Coronary Patients Receiving Atypical Antipsychotics

Introducción: A pesar de que la obesidad es un evento adverso frecuente en el tratamiento con antipsicóticos atípico, no ha sido suficientemente elucidado el grado de su contribución independiente al riesgo de enfermedad coronaria en estos pacientes. Objetivo: Determinar si la obesidad inducida por antipsicóticos de segunda generación o atípicos es un factor de riesgo independiente para el aumento de incidencia de enfermedad arterial coronaria y eventos cardíacos. Método: Se utilizó un modelo similar al usado en el estudio de Framingham basado en estimar los siguientes parámetros: edad, género, presión arterial, consumo de cigarrillo y niveles de lipoproteínas de colesterol de alta densidad, con el objetivo de determinar el riesgo prospectivo de padecer enfermedad arterial coronaria en aquellos pacientes tratados con antipsicóticos atípicos que cursaban un cuadro de obesidad (N=33; edad media 38.1, 54 % hombres) comparados con aquellos con peso normal (N=33; edad media 39.9 años, 47.0 % hombres). Se excluyeron aquellos pacientes con síndrome metabólico, medicados con drogas antihipertensivas, hipoglucemiantes o estatinas. Resultados: El riesgo de enfermedad arterial coronaria fue mayor para la muestra de pacientes obesos comparado con la muestra de pacientes con peso normal (5.3±2.7 vs. 2.1±0.62, RR=2.17 IC 95%=1.94-2.39; p=0.017), incluyendo un aumento de 12 unidades de IMC (p<0.0001) y 16 cm de circunferencia de cintura mayor (p<0.0001) en la población con obesidad inducida por antipsicóticos atípicos. El riesgo fue mayor para hombres (5.9±2.9 vs. 2.8±0.4, RR=2.98, IC 95%=1.97-3.16; p=0.0034) comparados con las mujeres (3.1±1.2 vs. 1.2±0.5; RR=1.78, IC 95 %=1.58-1.94; p=0.011). Limitaciones: la validez predictiva para el riesgo de enfermedad coronaria en pacientes psiquiátricos basada en el sistema de clasificación de Framingham requiere una confirmación prospectiva...

Obesity is an adverse effect frequently observed during second generation antipsychotics treatment. In spite of that, its independent contribution to coronary artery disease in patients treated with this class of drugs remains unsolved. Objective: assess whether antipsychotics induced obesity is an independent risk factor contributing to an increase in cardiac events and coronary artery disease. Methods: a similar model to that used in Framingham Study was used based on an estimate of following parameters: age, gender, blood pressure, cigarette use, high density cholesterol lipoproteins levels with the goal of estimate prospective risk of suffering coronary artery disease between those patients treated with second generation antipsychotics which also had obesity (N=33; average age 38.1 years, 54% men) compared with those on normal weight (N=33; average age 39.9 years, 47.0% men). Excluded were those patients with metablic Syndrome treated with antihypertensive drugs, hypoglycemic drugs and statins. Results: risk of coronary artery diseases was higher for obese patients compared with normal wight ones (5.3 ±2.7 vs. 2.1±0.62, RR=2.17 IC 95%=1.94 - 2.39; p=0.017), including an increase of 12 units in BMI (p<0.0001) and 16 cm in abdominal waist (p<0.0001) in antipsychotic drugs induced obesity sample...

Síndrome metabólica em adultos: prevalência e concordância entre critérios diagnósticos / Metabolic syndrome in adults: prevalence and concordance between criteria diagnoses

Introdução: A síndrome metabólica (SM) é caracterizada poralterações fisiopatológicas que aumentam o risco de doenças cardiovasculares.Objetivo: Avaliar a frequência de síndrome metabólicaem adultos de acordo com critérios diagnósticos e analisar qualparâmetro a identificou melhor. Método: Estudo de 124 pacientesdo ambulatório de nutrição clínica de um Instituto de Cardiologia deSão Paulo. O diagnóstico de síndrome metabólica foi determinadode acordo com os critérios do National Cholesterol Education Program- Adult Treatment Panel III (NCEP/ATPIII) e da InternationalDiabetes Federation (IDF) para todos os pacientes. Utilizou-se testequi-quadrado para análise das diferenças entre as variáveis categóricas.A média das variáveis numéricas foi comparada por teste deMann Whitney para amostras independentes com nível de significânciade 0,05 ou 5%. Para testar a concordância entre os critérios,utilizou-se o coeficiente Kappa. Resultados: Participaram do estudo61 homens e 63 mulheres. O grupo apresentou percentuais elevadosde pré-obesidade (31,5%), obesidade (64,5%) e alterações do perfilglicídico (62,9%). Diferenças estatísticas significantes entre os sexosforam encontradas nas frequências de hipertensão arterial (p = 0,01)e circunferência elevada (p = 0,00). A concordância geral entre oscritérios foi muito boa (Kappa = 0,897; p = 0,000). Observou-seque 92,6% dos pacientes que foram diagnosticados com SM peloATPIII também o foram pela IDF. Conclusão: A concordância entreos critérios para diagnósticos da SM indicou que ambos podem serutilizados na prática clínica.

Introduction: Metabolic Syndrome (MS) is characterized by pathophysiologicalchanges that increase the risk of cardiovascular disease.Objective: To evaluate the frequency of metabolic syndrome inadults according to criteria diagnoses and analyze which parameterbest identified it. Method: The study of 124 patients from the ClinicalNutrition Institute of Cardiology in São Paulo. The diagnosis ofmetabolic syndrome was determined according to the criteria of theNational Cholesterol Education Program - Adult Treatment Panel III(NCEP/ATPIII) and International Diabetes Federation (IDF) for allpatients. The chi-square analysis of differences between categoricalvariables was used. The average numerical variables were comparedby Mann-Whitney test for independent samples with significancelevel of 0.05 or 5%. The Kappa coefficient was used to evaluate theconcordance between both criteria. Results: The study included 61men and 63 women. The group had high percentages of pre-obesity(31.5%), obesity (64.5%) and abnormal glucose profile (62.9%).Statistically significant differences between sexes were found inthe frequencies of hypertension (p = 0.01) and high circumference(p = 0.00). The overall agreement between the criteria was verygood (Kappa = 0.897, p = 0.000). It was observed that 92.6% ofpatients who were diagnosed with MS by ATPIII were also by IDF.Conclusion: The agreement between the criteria for diagnosis ofMS indicated that both can be used in clinical practice.

¿Sirven los marcadores de riesgo no tradicionales en la diferenciación del riesgo cardiovascular en adultos jóvenes con exceso de peso? / Carotid intima media thickness and C reactive protein among overweight or obese subjects without metabolic syndrome

Background: Recognizing cardiovascular risk in overweight adults is challenging, as they usually have a low Framingham risk score (FRAM). In these subjects, non-traditional biomarkers could improve risk stratification. Aim: To assess carotid intima media thickness (CIMT) and ultrasensitive C-reactive protein (usCRP) among overweight and obese subjects without metabolic syndrome (MetSyn). Subjects and Methods: In 1558 asymptomatic participants (816 women, 45 ± 11 years) we measured body mass index (BMI), waist circumference, blood pressure, lipid profile, blood glucose, FRAM, usCRP and CIMT. For analytical purposes, we divided the subjects in three groups according to BMI and number of ATPIII-MetSyn risk factors (RF): 1) BMI < 25 and < 3RF, 2) BMI ≥ 25 and < 3RF and 3) BMI ≥ 25 and ≥ 3RF. Results: Participants of group 2 (BMI ≥ 25 and < 3RF) had a low FRAM (8%). Compared with participants of group 1, they had a higher CIMT (0.61 ± 0.1 and 0.57 ± 0.09 mm, respectively, p < 0.01) and usCRP (2.1 ± 2.1 and 1.5 ± 1.9 mg/L respectively, p < 0.01). Conclusions: This study shows that although subjects with overweight/obesity without MetSyn have low cardiovascular risk based on FRAM, they have higher CIMT and usCRP than their normal weight counterparts.

Argyrophil cell density in the oxyntic mucosa is higher in female than in male morbidly obese patients

Obesity is a multifactorial disorder often associated with many important diseases such as diabetes, hypertension and other metabolic syndrome conditions. Argyrophil cells represent almost the total population of endocrine cells of the human gastric mucosa and some reports have described changes of specific types of these cells in patients with obesity and metabolic syndrome. The present study was designed to evaluate the global population of argyrophil cells of the gastric mucosa of morbidly obese and dyspeptic non-obese patients. Gastric biopsies of antropyloric and oxyntic mucosa were obtained from 50 morbidly obese patients (BMI >40) and 50 non-obese patients (17 dyspeptic overweight and 33 lean individuals) and processed for histology and Grimelius staining for argyrophil cell demonstration. Argyrophil cell density in the oxyntic mucosa of morbidly obese patients was higher in female (238.68 ± 83.71 cells/mm2) than in male patients (179.31 ± 85.96 cells/mm2) and also higher in female (214.20 ± 50.38 cells/mm2) than in male (141.90 ± 61.22 cells/mm2) morbidly obese patients with metabolic syndrome (P = 0.01 and P = 0.02, respectively). In antropyloric mucosa, the main difference in argyrophil cell density was observed between female morbidly obese patients with (167.00 ± 69.30 cells/mm2) and without (234.00 ± 69.54 cells/mm2) metabolic syndrome (P = 0.001). In conclusion, the present results show that the number of gastric argyrophil cells could be under gender influence in patients with morbid obesity. In addition, gastric argyrophil cells seem to behave differently among female morbidly obese patients with and without metabolic syndrome.

Metabolic syndrome in obese adolescents: what is enough? / Síndrome metabólica em adolescentes obesos: o que é suficiente?

OBJECTIVE: To study the agreement among three distinct criteria for metabolic syndrome (MS) adapted to adolescents, and to identify associated factors for MS. METHODS: Cross-sectional study with 65 obese subjects aged 10 to 18 years, attended to at the Outpatient Clinic for Obese Children and Adolescents at the Clinical Hospital of the Universidade Estadual de Campinas (Unicamp). MS was defined using the criteria of the World Health Organization (WHO), the International Diabetes Federation (IDF), and the Adult Treatment Panel III (ATP III). Clinical, anthropometrical, and laboratorial data were associated to MS. RESULTS: From the 65 subjects, none had MS according to the WHO criteria, while 18 were diagnosed with MS (27.6%) according to the IDF, and 19 (29.2%) according to the ATP III. Agreement between IDF and ATP III was excellent (kappa 81%). In this study, puberty and triglycerides levels showed significant statistical difference when comparing subjects with and without MS, the first for ATP III (p = 0.03), and the second for IDF (p = 0.005) and ATP III (p = 0.001) criteria. CONCLUSION: The WHO criteria does not seem to be adequate for adolescents. IDF and ATP III criteria had an excellent agreement. Puberty and triglycerides were associated with MS.

OBJETIVO: Avaliar a correlação de três critérios de síndrome metabólica (SM) para adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal com 65 pacientes obesos entre 10 e 18 anos do Ambulatório de Crianças e Adolescentes Obesos do HC-Unicamp. SM foi definida de acordo com a Organização Mundial da Saúde (OMS), International Diabetes Federation (IDF) e Adult Treatment Panel III (ATP III). Buscaram-se fatores associados a SM em dados clínicos, antropométricos e laboratoriais. RESULTADOS: Dos 65 pacientes, nenhum foi diagnosticado como SM pela OMS, sendo 18 (27.6%) pelo IDF e 19 (29.2%) pelo ATP III. A correlação entre IDF e ATP III foi excelente (kappa 81%). Neste estudo, a puberdade e os triglicérides apresentaram diferença estatisticamente significativa entre pacientes com e sem SM, sendo a primeira para o ATP III (p = 0.03) e o segundo para IDF (p = 0.005) e ATPIII (p = 0.001). CONCLUSÃO: O critério da OMS não parece ser adequado para adolescentes. Há correlação excelente entre os critérios do IDF e ATP III. Puberdade e triglicérides foram fatores associados à SM.

Obesidad: ¿es una realidad en Venezuela?: epidemiología: pandemia del siglo XXI / Obesity: ¿is it a reality in Venezuela?: epidemiology:ç

La obesidad es una de las afeccines metabólicas más frecuentes en la actualidad. Más de mil millones de personas padecen obesidad o sobrepeso en todo el mundo. Además de las acumulación adiposa, su elevada morbi-mortalidad la convierten en uno de los principales problemas de salud a los que enfrenta la sociedad actual. Se estudia la obesidad, su definición. clasificación y el síndrome metabólco. En Venezuela se han publicado cuatro estudios de prevalencia del síndrome metabólico: Estado Zulia (2001), Gran Caracas, incluyendo los Estados Miranday Vargas (2006), Estado Lara (2007) y Estado Mérida (2007). El Estado Zulia tiene el mayor número de sujetos estudiados, 3.018, con cuatro grupos étnicos diferentes, seguidos de Caracas con 658, Lara y Mérida con 339 y 118 respectivamente. La participación de hombres siempre fue menor en todas las investigaciones. En el Estado Zulia se usó el estudio ATP III (2001), mientras que en las otras se utilizó el modificado de 2005 y el de la Federación Internacional de Diabetes. Los hallazgos arrojan unas cifras globales de promedio de 33,7% con LC 95% entre 32,3%-35,2% para adultos. Se encontraron diferencias importantes entre grupos de edad y sexo. En Venezuela, en el Estado Vargas (nivel del mar), en casi 2.500 madres, el sobrepeso alcanzó 31,4% y la obesidad 16,6%, aumentando con la edad; para los 30 años el sobrepeso llegó al 34,1% y la obesidad a 23,4% y los hijos de madres obesas, mostraron un sobre peso en todas las edades de un 23% a 35%. En el Área Metropolitana de Caracas (1000 m sobre nivel del mar), en las mujeres, el sobre-peso alcanzó 31% y la obesidad 14,6%. Los hombres presentaron un 40% de sobrepeso y 6,2% de obesidad aumentando con la edad. Con respecto a la obesidad en los niños y adolescentes en un total de 17.791 entre 7 y 14 años con sobre peso evaluados, se encontró 19,31% por encima del percentil 90. En el Distrito Capital a 23,26% que fue el valor más alto...

Obesity is one of the common metabolic diseases today. More than one billion people suffer from obesity or overweight worldwide. In addition to the fat accumulation, the high morbidity and mortality make it one of the major health problems facing the society. Obesity are studied. Their definition, classification and the metabolic syndrome. Venezuela has published four studies on the prevalence of the metabolic syndrome: state of Zulia (2001). Greater Caracas, including the states of Miranda and Vargas (2006). Lara State (2007) and Mérida (2007). Zulia state has the larges number of subjects studied, 3018. with four different ethnic groups, followed by Caracas with 658, Lara and Mérida with 339 and 118 respectively. The participation of men was always lower in all investigation. In Zulia state will use the ATP III study (2001), while in the other used the modified 2005 and the International Diabetes Federation version was used. The overall prevalence was 33.7% with 95% confidence limits (CL) 32.3% to 35.2% for adults. Important differences were found between age groups and sex. In Venezuela, in Vargas (sea level) in almost 2.500 mothers reached 31.4% overweight and obesity 16.6%, increasing with age, to 30 years., reached a 34.1% overweight and obesity and 23.4% and obese mothers showed an overweight in all age groups from 23% to 35%. In the metropolitan area of Caracas (1000 ms above sea level), in women, overweight reached 31% and obesity 14.6%. In men they had 40.6% of overweight and obesity 6.2% respectively, increasing age. With respect to obesity in children and adolescent in a total of 17.791 between 7 and 14 years evaluated overweight. 19.31% were found above the 90th percentile. In the Capital District amounted to 23.26% which was the highest value. Et the end of the paper we focus on the treatment of obesity and morbid obesity

Metabolic syndrome in patients with chronic hepatitis C virus genotype 1 infection who do not have obesity or type 2 diabetes

OBJECTIVE: The individual components of metabolic syndrome may be independent predictors of mortality in patients with liver disease. We aimed to evaluate the prevalence of metabolic syndrome and its related components in hepatitis C virus-infected patients who are not obese and do not have type 2 diabetes. METHODS: This cross-sectional study included 125 patients infected with hepatitis C virus genotype 1. Metabolic syndrome was defined according to the International Diabetes Federation. Anthropometric data were measured according to standardized procedures. Bioimpedance analysis was performed on all patients. RESULTS: Metabolic syndrome was diagnosed in 21.6% of patients. Of the subjects with metabolic syndrome, 59.3% had hypertension, 77.8% had insulin resistance, 85.2% were overweight, 48.1% had a high waist circumference, 85.2% had an increased body fat percentage, and 92.3% had an elevated waist:hip ratio. In the bivariate analysis, female sex (OR 2.58; 95% CI: 1.09-6.25), elevated gamma-glutamyl transferase (γGT) (OR 2.63; 95% CI: 1.04-7.29), elevated fasting glucose (OR 8.05; 95% CI: 3.17-21.32), low HDL cholesterol (OR 2.80; 95% CI: 1.07-7.16), hypertriglyceridemia (OR 7.91; 95% CI: 2.88-22.71), elevated waist circumference (OR 10.33; 95% CI: 3.72-30.67), overweight (OR 11.33; 95% CI: 3.97-41.07), and increased body fat percentage (OR 8.34; 95% CI: 2.94-30.08) were independent determinants of metabolic syndrome. Using the final multivariate regression model, similar results were observed for abdominal fat (OR 9.98; 95% CI: 2.63-44.41) and total body fat percentage (OR 8.73; 95% CI: 2.33-42.34). However, metabolic syndrome risk was also high for those with blood glucose >5.55 mmol/L or HDL cholesterol <0.9 mmol/L (OR 16.69; 95% CI: 4.64-76.35; OR 7.23; 95% CI: 1.86-32.63, respectively). CONCLUSION: Metabolic syndrome is highly prevalent among hepatitis C virus-infected patients without type 2 diabetes or obesity. Metabolic syndrome was significantly associated with hypertension, insulin resistance, increased abdominal fat, and overweight.