Summary of the best evidence of diet and physical activity management in patients with metabolic syndrome / 浙江大学学报·医学版

To evaluate and summarize the evidence of diet and physical activity management in patients with metabolic syndrome (MS). BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) database, Agency for Healthcare Research and Quality (AHRQ) network, National Institute for Health and Clinical Excellence (NICE) network, Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), Medlive, Registered Nurses' Association of Ontario (RNAO) network, American Diabetes Association (ADA) network, New Zealand Guideline Group (NZGG) network, Canadian medical association clinical practice guidelines network, PubMed, EmBase, Web of Science, CINAHL, Cochrane Library, CNKI, China Science and Technology Journal Database, Wanfang Knowledge Data Service Platform and Chinese biomedical database were searched systematically to obtain guidelines, evidence summary, expert consensus, best practice information book, clinical decision-making, recommended practice, and systematic review on diet and physical activity management in patients with MS. The retrieval period is from the establishment of database to November 2021. Two researchers with evidence-based medicine background evaluated the quality and evidence level of the included literature. A total of 36 articles met the criteria, including 3 guidelines, 5 expert consensus, 1 clinical decision and 27 systematic reviews. We summarized 49 pieces of evidence related to diet and physical activity in patients with MS, involving 15 aspects, namely diet goals, diet patterns, diet time, carbohydrate intake, fat intake, fiber intake, salt intake, fruits, vegetables and grains intake, coffee intake, effects of diet, principle of physical activity, intensity, form, time of physical activity, effects of physical activity, physical activity prescription of patients with MS and cardiovascular disease, and the joint effects of diet and physical activity. Diet and physical activity management can effectively improve the health outcomes of patients with MS. Health professionals should choose and apply the best evidence with consideration of the clinical situation and patient preference.

Design and development of a Wechat applet for intelligent health management of metabolic syndrome / 浙江大学学报·医学版

: To design and develop a Wechat applet for intelligent health management of metabolic syndrome. Based on the needs and requirements of individuals undergoing health check-up, patients with metabolic syndrome and medical workers, a Wechat applet for metabolic syndrome management was designed and developed, which involving health data collection, health risk prediction, health management knowledge base fusion and intelligent recommendation, data privacy and security. The platform consists of three user ports: individuals undergoing health check and patients with metabolic syndrome, the medical workers and the system administrators. The main functions of the platform included metabolic syndrome risk prediction, intelligent recommendation of health management strategies, health behavior record and supervision, experts' consultation and health knowledge guide. The Wechat applet developed in this study can be used for metabolic syndrome risk prediction for general population, and health management for patients with metabolic syndrome, which helps them to enhance health management awareness and health behavior adherence.

Desórdenes del metabolismo glucídico y síndrome metabólico en pacientes de covid-19 / Glucide metabolism disorders and metabolic syndrome in COVID-19 patients

RESUMEN El síndrome metabólico comprende un conjunto de factores de riesgo cardiovascular asociado a resistencia a la insulina, que propicia la aparición de enfermedad cardiovascular y de diabetes mellitus tipo 2. Su etiología se atribuye a la combinación de factores genéticos y ambientales, asociados al estilo de vida, que favorecen un estado proinflamatorio y protrombótico que empeora el cuadro clínico de los pacientes con covid-19. El objetivo de la revisión consistió en analizar el estado actual del conocimiento científico en las investigaciones sobre la interrelación entre los desórdenes del metabolismo glucídico y el síndrome metabólico, asociados a la condición proinflamatoria exacerbada en pacientes de covid-19. Se hicieron búsquedas en las bases de datos PubMed, SciELO, ClinicalKey y LILACS. Al proceso proinflamatorio generado por malos hábitos alimentarios, la sobrealimentación calórica de alto índice glicémico, y estilos de vida sedentarios, se atribuye un papel relevante en la patogénesis del síndrome metabólico, así como en sus posibles complicaciones en pacientes de covid-19 con comorbilidades asociadas. Es posible reducir la condición inflamatoria del síndrome metabólico mediante modificaciones en el estilo de vida y hábitos alimentarios, que prevengan la obesidad y sus efectos en la resistencia a la insulina, lo cual propicia reducir la gravedad asociada a los procesos inflamatorios inherentes (AU).

ABSTRACT Metabolic syndrome includes a set of cardiovascular risk factors associated with resistance to insulin, favoring the appearance of cardiovascular disease and diabetes mellitus type 2. Its etiology is attributed to the combination of genetic and environmental factors, associated to lifestyle, and favoring a proinflammatory and prothrombotic status that worsens the clinical characteristics of the patients with COVID-19. The objective of the review was to analyze the current state of the scientific knowledge in research on the interrelationship between glucide metabolism disorders and metabolic syndrome, associated with the exacerbated proinflammatory condition in COVID-19 patients. Searches were conducted in PubMed, SciELO, CinicalKey, and LILACS databases. A relevant role in the metabolic syndrome pathogenesis is attributed to the inflammatory process generated by poor eating habits, high caloric overfeeding, and to sedentary lifestyle, and also to possible complications with associated comorbidities in COVID-19 patients. It is possible to reduce the metabolic syndrome inflammatory condition through life style and alimentary habits changes that prevent obesity and its effects on insulin resistance and propitiate the reduction of the disease severity associated with the inherent inflammatory processes (AU).

Exercício Físico Melhora as Funções das Células Progenitoras Endoteliais em Pacientes com Síndrome Metabólica / Exercise Training Improves Functions of Endothelial Progenitor Cells in Patients with Metabolic Syndrome

Resumo Fundamento As células progenitoras endoteliais (CPEs) desempenham um papel importante na manutenção da função endotelial. A síndrome metabólica (SM) está associada à disfunção das CPEs. Embora o exercício físico tenha um impacto benéfico na atividade das CPEs, seu mecanismo ainda não está completamente esclarecido. Objetivo O objetivo deste estudo é investigar os efeitos do exercício físico nas funções das CPEs e os mecanismos subjacentes em pacientes com SM. Métodos Os voluntários com SM foram divididos em grupo exercício (n=15) e grupo controle (n=15). Antes e após 8 semanas de treinamento físico, as CPEs foram isoladas do sangue periférico. Foram feitos o ensaio de unidades formadoras de colônias (UFC), o ensaio de formação de tubos, a expressão proteica do óxido nítrico sintase endotelial (eNOS), da fosfatidilinositol-3-quinase (PI3-K) e da proteína quinase B (AKT). Considerou-se um valor de probabilidade <0,05 para indicar significância estatística. Resultados Após 8 semanas, o número de UFCs aumentou significativamente no grupo exercício em comparação com o grupo controle (p<0,05). Além disso, observamos uma diminuição significativa do modelo de avaliação da homeostase da resistência à insulina (HOMA-IR), endotelina-1, proteína C reativa de alta sensibilidade e dos níveis de homocisteína no grupo exercício. A intervenção com exercícios também pode aumentar a capacidade de formação de tubos de CPEs e aumentar o nível de fosforilação de eNOS, PI3-K e AKT. Conclusão O exercício físico aprimorou as funções das CPEs. O mecanismo pode estar relacionado ao exercício, ativando a via PI3-K/AKT/eNOS.

Abstract Background Endothelial progenitor cells (EPCs) play an important role in maintaining endothelial function. Metabolic syndrome (MetS) is associated with EPC dysfunction. Although physical exercise has a beneficial impact on EPC activity, its mechanism is not completely clear yet. Objective The purpose of this study is to investigate the effects of physical exercise on the functions of EPCs and the underlying mechanisms in patients with MetS. Methods Volunteers with MetS were divided into exercise group (n=15) and control group (n=15). Before and after 8 weeks exercise training, EPCs were isolated from peripheral blood. Colony forming unit (CFU) assay, tube-formation assay, the protein expression of endothelial nitric oxide synthase (eNOS), phosphatidylinositol-3-kinase (PI3-K) and protein kinase B (AKT) were determined. A probability value <0.05 was considered to indicate statistical significance. Results After 8 weeks, the number of CFUs was significantly increased in the exercise group compared to the control group (p<0.05). In addition, we observed a significant decrease of homeostasis model assessment for insulin resistance (HOMA-IR), endothelin-1, high-sensitive C-reactive protein, and homocysteine levels in the exercise group. Exercise intervention could also enhance tube-formation capacity of EPCs and increase phosphorylation level of eNOS, PI3-K and AKT. Conclusion Physical exercise enhanced the functions of EPCs. The mechanism may be related to exercise, activating the PI3-K/AKT/eNOS pathway.

Síndrome metabólico, hígado graso no alcohólico y hepatocarcinoma / Metabolic syndrome, nonalcoholic fatty liver disease and hepatocellular carcinoma

En las últimas décadas, los cambios en el estilo de vida pro-vocaron un incremento en la prevalencia del síndrome meta-bólico y que la enfermedad por hígado graso no alcohólico (nonalcoholic fatty liver disease, NAFLD sus siglas en inglés) se convierta en la enfermedad hepática crónica más fre-cuente en todo el mundo. Los componentes del síndrome metabólico no son sólo altamente prevalentes en pacientes con hígado graso no alcohólico, sino que a la vez aumentan el riesgo de desarrollarlo. Esta relación bidireccional ha sido claramente establecida. Asimismo se considera que NAFLD podría ser el componente hepático del síndrome metabólico. Aunque NAFLD se considera principalmente una enfermedad benigna, puede progresar a fibrosis hepática grave y carcino-ma hepatocelular (CHC), incluso se encontraría este último en hígados no cirróticos. El objetivo de esta revisión es determinar los procesos fisio-patológicos comunes a estas entidades, cuáles son las estra-tegias diagnósticas recomendadas y cuáles las intervenciones terapéuticas actualmente aprobadas.

Evaluation of Prevalence of the Metabolic Syndrome: In the Kirkuk Hospitals Reviewers from Employees Associated with H. Pylori AB Test as a Case Study

The metabolic syndrome (MetS) or insulin resistance syndrome is widespread and multi-factorial disorder. This article aims to assess and observe samples with the MetS to start efforts to take the proper treatments to minimize the risk of cardiovascular diseases. Additionally, we evaluate the association of Helicobacter pylori (H. Pylori) Ab tests with MetS. To meet this goal, 350 reviewers of K1 Hospital are participated in this work for six months from October 2016 to March 2017. The patients (N=350) are divided into two groups, a group subjects with MetS (N=109), whereas the latter is without MetS (N=241). A venous blood sample is taken after 8 hours of fasting to measure fasting blood glucose, H. Pylori Ab test and other required biochemical assays. Additionally, blood pressure (BP), Body Mass Index (BMI) (i.e. weight and height), and waist circumference are measured. The assays revealed that the frequency of MetS is 31.1% as per the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP: ATPIII) criteria. Furthermore, a statistically significant age (p=0.02) corresponded higher rate of MetS cases is larger than 40 years old (i.e. 69%). Moreover, BMI recorded as (27.6 ± 4.4 vs 31.4 ± 4.5, p <0.001), height (169 ± 8.4 vs 168.1 ± 8.5, p ≤ 0.11), weight (78.8 ± 12.3 vs 88.6 ± 13.2, p<0.01) and waist circumference (83.3 ± 16.1 vs 96.3 ± 11.6, p<0.001). Besides, BP showed positively correlation with systolic (120.3 ± 10.6 vs 130.6 ± 10.8, p<0.04) and diastolic (70.9 ± 0.9 vs 80.8 ± 10, p<0.01). The biochemical assays for employees with and without MetS are mean values of fasting Serum glucose (5.3 ± 1.4 vs 7.5 ± 3.2, p ≤ 0.001). The highest average total cholesterol recorded as (4.3 ± 1.3 vs 4.9 ± 1.3, p ≤ 0.001), serum triglyceride (2 ± 1.5 vs 2.8 ± 1.2, p ≤ 0.001) and lower HDL levels (1.2 ± 0.5 vs 0.8 ± 0.1, p ≤ 0.001). Accordingly, the results showed that H. Pylori infection is associated significantly with metabolic syndrome. In consequence, the outcome demonstrated high rates of obesity and overweight in MetS cases

Síndrome metabólico en pacientes hospitalizados en Servicio de Geriatría / Metabolic syndrome in patients hospitalized in Geriatric Services

RESUMEN Introducción: la prevalencia del síndrome metabólico, a nivel mundial, es muy elevada y continúa en aumento vertiginosamente en los últimos años. Por lo que se puede considerar una pandemia de la época contemporánea, se estima que el 25 % de la población adulta la padece. Objetivo: determinar la prevalencia del síndrome metabólico e identificar otras formas clínicas de enfermedad vascular ateroesclerótica, en gerontes hospitalizados en Servicios de Geriatría del Hospital Provincial Clínico Quirúrgico Docente "Celia Sánchez Manduley", Manzanillo, Granma; en el período comprendido entre junio 2015 a junio 2016. Materiales y métodos: se realizó estudio observacional, descriptivo, de corte transversal. Se incluyeron los 120 senescentes que ingresaron en los Servicios de Geriatría. Resultados: se estableció el diagnóstico de síndrome metabólico en 105 individuos de 120 sujetos estudiados. El grupo de 70-79 años de edad y el sexo masculino fueron los más afectados por la endocrinopatía. Las otras formas clínicas de enfermedad vascular ateroesclerótica que se identificaron en los senescentes estudiados, fueron: cardiopatía isquémica, enfermedad cerebrovascular y cardiopatía hipertensiva. Conclusiones: existe una alta prevalencia del síndrome metabólico en los adultos mayores estudiados.

ABSTRACT Introduction: the prevalence of the metabolic syndrome is very high around the world and is still vertiginously increasing in the last years. Therefore, it can be considered a pandemic of the current times. It is thought that 25 % of the adult population suffers it. Objective: to determine the prevalence of the metabolic syndrome and to identify other clinical forms of the atherosclerotic vascular disease in elder people who entered the Service of Geriatrics of the Provincial Teaching Clinical Surgical Hospital "Celia Sanchez Manduley", of Manzanillo, Granma, in the period from June 2015 to June 2016. Materials and methods: a cross-sectional, observational, descriptive study was carried out with the inclusion of the 120 elder people who the Service of Geriatrics. Results: 105 individuals of 129 studied were diagnosed with metabolic syndrome. The 79-79 age group and male sex were the most affected by endocrinopathy. Other clinical forms of the arteriosclerotic vascular disease identified in the studied elder people were ischemic heart disease, cerebrovascular disease and hypertensive heart disease. Conclusions: there is a high prevalence of the metabolic syndrome among the studied elder people.

Students' knowledge of metabolic syndrome after educational intervention / Conocimiento de estudiantes sobre síndrome metabólico tras intervención educative / Conhecimento de estudantes sobre síndrome metabólica após intervenção educativa

ABSTRACT Objective: To analyze the knowledge of children and adolescents about risk factors for metabolic syndrome (MS) before and after educational interventions. Method: A quasi-experimental, comparative, prospective and intervention study conducted in 2015 and 2016 with 43 students in the city of Picos (state of Piauí-PI). Five health education meetings were held. For the knowledge analysis, was applied a questionnaire at three different moments. Results: Participants' mean age was 12.6 years (± 2.1), of which 60.5% were female. The 'More than good' level of knowledge went from 20.9% to 55.8% after interventions. When evaluated late, students maintained a higher level of knowledge compared to before the interventions. Most said they were able to change their lifestyle after educational meetings. Conclusion: The educational intervention promoted increase of knowledge and stimulated changes in attitudes related to risk factors associated with MS.

RESUMEN Objetivo: Analizar el conocimiento de niños y adolescentes acerca de los factores de riesgo para el síndrome metabólico (SM) antes y después de intervenciones educativas. Método: Estudio casi experimental, comparativo, prospectivo y de intervención, realizado en 2015 y 2016, con 43 estudiantes en Picos, estado del Piauí (PI). Se realizaron cinco encuentros de educación en salud. Para el análisis del conocimiento, se utilizó un cuestionario aplicado en tres momentos distintos. Resultados: Los participantes tenían en promedio 12,6 años (± 2,1), siendo el 60,5% del sexo femenino. El nivel de conocimiento 'Más que bueno' pasó del 20,9% al 55,8% después de las intervenciones. Cuando evaluados tardíamente, los estudiantes mantuvieron un nivel de conocimiento mayor comparado con antes de las intervenciones. La mayoría refirió haber logrado cambiar actitudes en cuanto al estilo de vida después de los encuentros. Conclusión: La intervención educativa promovió aumento del conocimiento y estímulo a los cambios de actitudes acerca de los factores de riesgo asociado al SM.

RESUMO Objetivo: Analisar o conhecimento de crianças e adolescentes acerca dos fatores de risco para síndrome metabólica (SM) antes e após intervenções educativas. Método: Estudo do tipo quase experimental, comparativo, prospectivo e de intervenção, realizado em 2015 e 2016, com 43 estudantes em Picos-PI. Realizaram-se cinco encontros de educação em saúde; para a análise do conhecimento, foi utilizado um questionário aplicado em três momentos distintos. Resultados: Os participantes tinham em média 12,6 anos (± 2,1), sendo 60,5% do sexo feminino. O nível de conhecimento "Mais que bom" passou de 20,9% para 55,8% após as intervenções. Quando avaliados tardiamente, os estudantes mantiveram um nível de conhecimento maior quando comparados antes das intervenções. A maioria referiu ter conseguido mudar atitudes quanto ao estilo de vida após os encontros. Conclusão: A intervenção educativa promoveu aumento do conhecimento e estímulo às mudanças de atitudes acerca dos fatores de risco associado à SM.

Lifestyle Intervention on Metabolic Syndrome and its Impact on Quality of Life: A Randomized Controlled Trial / Intervenção de Estilo de Vida na Síndrome Metabólica e seu Impacto na Qualidade de Vida: Um Estudo Controlado Randomizado

Abstract Background: Lifestyle intervention programs can reduce the prevalence of metabolic syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of the main public health problems nowadays. Objective: The aim of this study was to compare the effects of three types of approach for lifestyle change programs in the reduction of metabolic parameters, and to identify its impact on the quality of life (QOL) of individuals with MetS. Methods: A randomized controlled trial included 72 individuals with MetS aged 30-59 years. Individuals were randomized into three groups of multidisciplinary intervention [Standard Intervention (SI) - control group; Group Intervention (GI); and Individual Intervention (II)] during 12 weeks. The primary outcome was change in the metabolic parameters, and secondarily, the improvement in QOL measures at three moments: baseline, 3 and 9 months. Results: Group and individual interventions resulted in a significant reduction in body mass index, waist circumference, systolic blood pressure at 3 months and the improvement of QOL, although it was significantly associated with the physical functioning domain. However, these changes did not remain 6 months after the end of intervention. Depression and anxiety were significantly associated with worse QOL, although they showed no effect on the response to intervention. Conclusion: Multidisciplinary intervention, especially in a group, might be an effective and economically feasible strategy in the control of metabolic parameters of MetS and improvement of QOL compared to SI, even in a dose-effect relationship.

Resumo Fundamento: Programas de intervenção em estilo de vida podem reduzir a prevalência de síndrome metabólica (SM) e, portanto, diminuir o risco de doença cardíaca, um dos principais problemas de saúde pública da atualidade. Objetivo: Comparar os efeitos de três tipos de abordagem para programas de mudança no estilo de vida visando à redução dos parâmetros metabólicos, assim como identificar seu impacto na qualidade de vida (QV) de indivíduos com SM. Métodos: Estudo randomizado controlado incluindo 72 indivíduos com SM com idade de 30 a 59 anos, que foram randomizados em três grupos de intervenção multidisciplinar [Intervenção Padrão (IP) - grupo controle; Intervenção em Grupo (IG); e Intervenção Individual (II)] por 12 semanas. O desfecho primário foi a mudança nos parâmetros metabólicos, e o secundário, a melhora nas medidas de QV em três momentos: condição basal, aos 3 e aos 9 meses. Resultados: As intervenções IG e II resultaram em uma significativa redução em índice de massa corporal, circunferência abdominal e pressão arterial sistólica, e em melhoras da QV aos 3 meses, embora significativamente associadas com o domínio 'capacidade funcional'. Tais mudanças, entretanto, não permaneceram 6 meses após o final da intervenção. Depressão e ansiedade associaram-se significativamente com pior QV, embora sem efeito na resposta à intervenção. Conclusão: A intervenção multidisciplinar, em especial em grupo, pode ser uma estratégia efetiva e economicamente possível para controlar os parâmetros metabólicos de SM e melhorar a QV quando comparada à IP, mesmo em uma relação de dose-efeito.

Frecuencia de síndrome metabólico en niños y adolescentes del Paraguay / Frequency of metabolic syndrome in children and adolescents in Paraguay

La intención de la elección del tema de Síndrome Metabólico surge a raíz de la epidemia mundial de obesidad en la infancia y adolescencia observada en las últimas décadas, y que ha supuesto la aparición en pediatría de alteraciones hasta ahora más propias de la edad adulta, como el Síndrome Metabólico (SM) y que generen día a día numerosas complicaciones de salud como las Enfermedades Cardiovasculares (ECV) y Diabetes tipo 2. Se tienen como objetivo determinar la frecuencia de SM en niños y adolescentes del Paraguay y sus componentes. Se ha encontrado que el sobrepeso y la obesidad abdominal son los factores principales que contribuyen a las manifestaciones del Síndrome Metabólico en niños y adolescentes del Paraguay, por ese motivo corren mayor riesgo de sufrir enfermedades cardiovasculares y diabetes tipo 2 en el futuro y de forma más precoz. Se ha visto en estudios realizados en América que los componentes más prevalentes fueron la obesidad y la dislipidemia, mientras que; alrededor del 7% con hiperglucemia y síndrome metabólico de manera general. Según estudios realizados en Paraguay, se vio que la frecuencia de sobrepeso y obesidad es muy alta al igual que la incidencia del síndrome metabólico

The purpose of the choice of the Metabolic Syndrome issue arises from the worldwide epidemic of obesity in infancy and adolescence observed in the last decades, and which has led to the appearance in pediatrics of alterations that have hitherto been more typical of adulthood, Such as Metabolic Syndrome (MS) and that generate daily complications of health such as Cardiovascular Diseases (CVD) and Type 2 Diabetes. Its objective is to determine the frequency of MS in children and adolescents in Paraguay and its components. It has been found that overweight and abdominal obesity are the main factors that contribute to the manifestations of the Metabolic Syndrome in children and adolescents of Paraguay, for that reason they are at greater risk of suffering cardiovascular diseases and type 2 diabetes in the future and in a more early. It has been seen in studies carried out in America that the most prevalent components were obesity and dyslipidemia, whereas; around 7% with hyperglycemia and metabolic syndrome in general. According to studies in Paraguay, it was found that the frequency of overweight and obesity is very high, as is the incidence of the metabolic syndrome

Síndrome metabólica, aterosclerose e inflamação: tríade indissociável? / Metabolic syndrome, atherosclerosis and inflammation: an inseparable triad?

Observa-se, nas populações mundiais, aumento do sedentarismo e aumento do consumo de gorduras e açúcares, sendo estes vinculados normalmente aos alimentos industrializados. A consequência disso rapidamente se manifestou no aumento do sobrepeso/obesidade e na instalação de alterações fisiológicas e metabólicas, como a Síndrome Metabólica, que é representada por alterações na glicemia, nos lipídeos e na pressão arterial. Há evidências de ligação estreita entre estas alterações e os processos inflamatórios, que também podem estar associados ao estresse oxidativo. Estas condições levam à patogênese das alterações vasculares ou intensificam os processos metabólicos que acompanham a Síndrome Metabólica. O objetivo desta revisão foi comparar as inúmeras referências literárias que mostram correlação entre os componentes da Síndrome Metabólica e o aumento dos mediadores de inflamação. Para isso, utilizou-se Pubmed, Scopus, Lilacs e Scielo como base de dados, sendo que os artigos selecionados dataram principalmente dos últimos cinco anos.

Populations all over the world are increasingly inactive and are consuming increasing quantities of fats and sugars, which is generally linked to industrially processed foods. The consequences have rapidly manifest as an increase in overweight/obesity and in physiological and metabolic changes, such as the Metabolic Syndrome, which is a series of changes in glycemia, lipids and blood pressure. There is evidence of a close relationship between these changes and inflammatory processes, which can also be linked to oxidative stress. These conditions lead to the pathogenesis of vascular abnormalities or intensify metabolic processes that accompany the metabolic syndrome. The objective of this review is to compare the large number of bibliographic references that show correlations between components of the Metabolic Syndrome and increases in the mediators of inflammation. The publications reviewed were located using the Pubmed, Scopus, Lilacs and Scielo databases and the majority of the articles selected were published within the last 5 years.

Metabolic syndrome resolution by Roux-en-Y gastric bypass in a real world: a case control study / Resolução da síndrome metabólica pela gastroplastia Roux-em-Y em um mundo real: estudo caso-controle

Summary Objectives: the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). Methods: two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. Results: at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 - 1.4). Conclusion: in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS. .

Resumo Objetivo: o objetivo deste estudo foi avaliar a eficácia do bypass gástrico em Y de Roux (BGYR), em comparação a um tratamento não cirúrgico (grupo NC), como instrumento para induzir remissão da síndrome metabólica (SMet) em pacientes com obesidade graus 2 e 3 (Ob2, 3). Métodos: duzentos e cinquenta e oito pacientes com Ob2,3 foram selecionados para análise retrospectiva em estudos de caso e controle. SMet foi definida como descrita pela Federação Internacional de Diabetes. Dos pacientes, 129 foram submetidos ao BGYR (grupo C), e 129 formaram o grupo NC. Resultados: antes dos tratamentos, os grupos C e NC não diferiram em IMC, idade, sexo feminino e prevalência de SMet (p>0,05). No grupo C, houve uma redução no IMC de 38,1% (p<0,001), circunferência da cintura de 28,6% (p<0,001), glicemia de jejum de 10,5% (p<0,001), LDL colesterol sérico de 21,9% (p<0,001) e em 85% dos casos de SMet (p<0,001). As diferenças observadas no grupo NC foram uma diminuição nos níveis de triglicérides, de 4,12% (p=0,047), e na pressão arterial diastólica, de 5,9% (p=0,031). No grupo NC, 98,6% dos pacientes persistiram com SMet. O número necessário para tratar (NNT) com a cirurgia, para resolver um caso de SMet, foi de 1,2 (IC 95%: 1,1 - 1,4). Conclusão: em um mundo real, no Sul do Brasil, em comparação ao tratamento NS e após 1 ano de observação, BGYR foi altamente eficaz para diminuir a prevalência de SMet. .

Cardio Protective Effect of Dark Chocolate Components: Mechanisms of Actions.

Chocolate is made from the seeds of a tropical rainforest tree called “Theobroma cacao”. When compared with other food sources based on oxygen radical absorbance capacity (ORAC) measurement, dark chocolate is a major source of flavonols with highest antioxidant levels. Some of the health benefits of cocoa consumption include antioxidant properties such as polyphenolic compounds, among others are monomeric flavanols, epicatechin, catechin and oligomeric procyanidins. Both experimental and observational studies have suggested that chocolate consumption has a positive influence on human health, with antioxidant, antihypertensive, anti-inflammatory, anti-atherogenic, and antithrombotic effects as well as influence on insulin sensitivity, vascular endothelial function, and bioavailability of nitric oxide. In addition, dark chocolate consumption may alter lipid effects, by lowering total and low density lipoproteins and increasing high density lipoprotein cholesterol levels. The antioxidants found in chocolate have been shown to inhibit plasma lipid oxidation probably by scavenging free radical species. There are some experimental studies to prove that flavonoids could prevent LDL oxidation in vitro by scavenging radical species or sequestering metal ions. Dark chocolate (DC) has beneficial effects in the prevention of cardiovascular diseases (CVD) due to its antiinflammatory and antioxidant properties. Polyphenols rich dark chocolate showed progress in insulin sensitivity and decreased blood pressure in healthy subjects. Dark Chocolate has a dual effect on platelets by decreasing platelet aggregation and also it reduces platelet adhesion. Chocolate extends its great beneficial effect from being by and large a palatable pleasant and hence sustainable therapeutic option. Thus, dark chocolate may be suggested as a potential delicacy and one of the agents for the prevention and control of cardiometabolic syndrome.

El entrenamiento aeróbico de intervalo de alta intensidad mejora el consumo de oxígeno peak en pacientes con síndrome metabólico: CAT / High intensity aerobic interval training improves peak oxygen consumption in patients with metabolic syndrome: CAT

Introducción El síndrome metabólico consiste en una serie de factores de riesgo cardiovasculares, que se caracterizan por un mayor depósito de grasa a nivel abdominal, resistencia a la insulina, bajo nivel de lipoproteinas de alta densidad y triglicéridos elevados. Uno de los principales déficits que presentan los sujetos que la padecen es una disminución de su consumo de oxígeno. Objetivo Comprobar la validez y aplicabilidad de los resultados con respecto a la efectividad del entrenamiento aeróbico de intervalos de alta intensidad en sujetos con síndrome metabólico. También se busca responder la siguiente interrogante ¿puede el entrenamiento aeróbico de intervalos de alta intensidad mejorar el consumo de oxígeno peak? Método Se analizó el artículo “Efecto del entrenamiento aeróbico de intervalos sobre capacidad del ejercicio y los factores de riesgo metabólico en personas con trastornos cardiometabólicos”, revisión sistemática. Resultados El entrenamiento aeróbico de intervalos de alta intensidad podría incrementar el consumo de oxígeno peak presentando una diferencia media estandarizada de 3,60 mL/kg-1/min-1 (IC 95 por ciento; 0,28–4,91). Conclusión A pesar de las limitaciones metodológicas que presentan los estudios primarios incluidos en la revisión sistemática, se encuentra razonable la aplicación del entrenamiento aeróbico de intervalos de alta intensidad en pacientes con síndrome metabólico para mejorar el consumo de oxígeno peak.

Introduction A number of cardiovascular risk factors characterizes the metabolic syndrome: insulin resistance (IR), low HDL cholesterol and high triglycerides. The aforementioned risk factors lead to elevated levels of abdominal adipose tissue, resulting in oxygen consumption deficiency. Purpose To verify the validity and applicability of using high intensity interval training (HIIT) in subjects with metabolic syndrome and to answer the following question: Can HIIT improve peak oxygen consumption? MethodThe systematic review "Effects of aerobic interval training on exercise capacity and metabolic risk factors in individuals with cardiometabolic disorders" was analyzed. Results Data suggests high intensity aerobic interval training increases peak oxygen consumption by a standardized mean difference of 3.60 mL/kg-1/min-1 (95 percent confidence interval, 0.28-4.91). Conclusion In spite of the methodological shortcomings of the primary studies included in the systematic review, we reasonably conclude that implementation of high intensity aerobic interval training in subjects with metabolic syndrome, leads to increases in peak oxygen consumption.

Consenso latino-americano de hipertensão em pacientes com diabetes tipo 2 e síndrome metabólica / Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome

O presente documento foi preparado por um grupo de especialistas, membros das Sociedades de Cardiologia, Endocrinologia, Medicina Interna, Nefrologia e Diabetes dos países da América Latina, para que sirva de diretriz para médicos que cuidam de pacientes com diabetes, hipertensão e fatores de risco concomitantes ou complicações de ambas as condições. Embora o conceito de síndrome metabólica seja atualmente muito discutido, a alta prevalência na América Latina do conjunto de alterações metabólicas que a compõem sugere que a síndrome metabólica é uma entidade nosográfica útil no contexto da medicina latino-americana. Devido a isso, no presente documento presta-se especial atenção a essa síndrome com a finalidade de alertar aos médicos sobre uma população particularmente de alto risco, que, por ser subestimada, não é tratada de forma adequada para os fatores de risco que constituem a síndrome metabólica. As recomendações deste documento são o resultado de apresentações e debates que ocorreram durante um encontro de dois dias em Bucaramanga (Colômbia), em outubro de 2012. Todos os participantes aprovaram as decisões finais. Os autores reconhecem que a publicação e difusão das diretrizes não serão suficientes para alcançar as mudanças recomendadas tanto em estratégias diagnósticas como terapêuticas, por isso programaram intervenções que permitirão identificar as barreiras do conhecimento, as atitudes e comportamento, o que permitirá tanto aos médicos como aos pacientes uma adequada adesão às recomendações sugeridas nestas diretrizes. Arq Bras Endocrinol Metab. 2014;58(3):205-25.

The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations. Arq Bras Endocrinol Metab. 2014;58(3):205-25.

Development of a Standardized Job Description for Healthcare Managers of Metabolic Syndrome Management Programs in Korean Community Health Centers

PURPOSE: This study aimed to develop a job description for healthcare managers of metabolic syndrome management programs using task analysis. METHODS: Exploratory research was performed by using the Developing a Curriculum method, the Intervention Wheel model, and focus group discussions. Subsequently, we conducted a survey of 215 healthcare workers from 25 community health centers to verify that the job description we created was accurate. RESULTS: We defined the role of healthcare managers. Next, we elucidated the tasks of healthcare managers and performed needs analysis to examine the frequency, importance, and difficulty of each of their duties. Finally, we verified that our job description was accurate. Based on the 8 duties, 30 tasks, and 44 task elements assigned to healthcare managers, we found that the healthcare managers functioned both as team coordinators responsible for providing multidisciplinary health services and nurse specialists providing health promotion services. In terms of importance and difficulty of tasks performed by the healthcare managers, which were measured using a determinant coefficient, the highest-ranked task was planning social marketing (15.4), while the lowest-ranked task was managing human resources (9.9). CONCLUSION: A job description for healthcare managers may provide basic data essential for the development of a job training program for healthcare managers working in community health promotion programs.

Prognostic Usefulness of Metabolic Syndrome Compared with Diabetes in Korean Patients with Critical Lower Limb Ischemia Treated with Percutaneous Transluminal Angioplasty

PURPOSE: Metabolic syndrome (MS) is a clinical condition that shares many common characteristics with diabetes. However, unlike diabetes, the usefulness of MS as a prognostic entity in peripheral arterial disease is uncertain. This study evaluated the prognostic usefulness of MS in critical lower limb ischemia (CLI) patients. MATERIALS AND METHODS: We compared the 2-year clinical outcomes in 101 consecutive CLI patients (66+/-14 years; 78% men) with 118 affected limbs treated with percutaneous transluminal angioplasty (PTA) according to the presence of MS and diabetes. RESULTS: The number of MS patients was 53 (52%), of which 45 (85%) had diabetes. During a 2-year follow-up, the incidence of clinical outcomes, including reintervention, major amputation, minor amputation, and survival, was not significantly different between MS and non-MS patients; however, the incidence of minor amputation was significantly higher in diabetic than in non-diabetic patients (42% vs. 17%; p=0.011). Cox regression analysis for the 2-year primary patency demonstrated no association between MS and 2-year primary patency [hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.45-2.30; p=0.961], whereas there was a significant association between diabetes and 2-year primary patency (HR, 2.81; 95% CI, 1.02-7.72; p=0.046). Kaplan-Meier analysis revealed no significant difference in the 2-year primary patency between MS and non-MS patients; however, the 2-year primary patency was lower in diabetic than in non-diabetic patients (p=0.038). CONCLUSION: As a prognostic concept, MS might conceal the adverse impact of diabetes on the prognosis of CLI patients treated with PTA.

Diabetes, síndrome metabólica e disfunção endoltelial / Diabetes, metabolic syndrome and endothelial dysfunction

A disfunção endotelial é um dos mecanismos fisiopatológicosprecoces para o desenvolvimento da aterosclerose e é preditorindependente de doença cardiovascular em pacientes comsíndrome metabólica e diabetes tipo 2. A fisiopatologiada síndrome metabólica e do diabetes tipo 2 envolvediversos mecanismos que acarretam perda do equilíbrioentre fatores vasodi latadores e vasoconstritores, estresseoxidativo e inflamação, levando à disfunção endotelial e,consequentemente, à aterosclerose. A função endotelial podeser avaliada por uma série de métodos que incluem a disfunçãoendotelial, a avaliação e o dano tecidual, diagnosticados pormétodos de imagem ou por dosagens séricas. O tratamentoadequado dos componentes da síndrome metabólica e dodiabetes tipo 2, incluindo mudanças no estilo de vida e ouso de medicamentos, é fundamental para melhorar a funçãoendotelial e, assim, reduzir o risco de eventos cardiovascularesfuturos...

Endothelial dysfunction is an early pathophysiologicalmechanism for the development of atherosclerosis and is anindependent predictor of cardiovascular disease in patients withmetabolic syndrome and type 2 diabetes. The pathophysiologyofthe metabolic syndrome and type 2 diabetes involves severalmechanisms that lead to an imbalance between vasodilatorand vasoconstrictor factors, oxidati ve stress and inflammationleading to endothelial dysfunction and consequently toatherosclerosis. Endothelial function may be assessed by avariety of methods including endothelial dysfunction andtissue damage evaluation, diagnosis by imaging methods orserum dosage. Proper treatment of the components of metabolicsyndrome and type 2 diabetes including changes in lifestyleand the use of drugs is crucial to improve endothelial functionand thereby reducing the risk of future cardiovascular events...