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Electron. j. biotechnol ; 52: 67-75, July. 2021. tab, graf, ilus
Article in English | LILACS | ID: biblio-1283594


BACKGROUND: Adipogenesis and fibrogenesis can be considered as a competitive process in muscle, which may affect the intramuscular fat deposition. The CCAAT/enhancer-binding protein beta (C/EBPb) plays an important role in adipogenesis, which is well-characterized in mice, but little known in bovine so far. RESULTS: In this study, real-time qPCR revealed that the level of C/EBPb was increased during the developmental stages of bovine and adipogenesis process of preadipocytes. Overexpression of C/EBPb promoted bovine fibroblast proliferation through mitotic clonal expansion (MCE), a necessary process for initiating adipogenesis, by significantly downregulating levels of p21 and p27 (p < 0.01). Also, the PPARc expression was inhibited during the MCE stage (p < 0.01). 31.28% of transfected fibroblasts adopted lipid-laden adipocyte morphology after 8 d. Real-time qPCR showed that C/EBPb activated the transcription of early stage adipogenesis markers C/EBPa and PPARc. Expression of ACCa, FASN, FABP4 and LPL was also significantly upregulated, while the expression of LEPR was weakened. CONCLUSIONS: It was concluded C/EBPb can convert bovine fibroblasts into adipocytes without hormone induction by initiating the MCE process and promoting adipogenic genes expression, which may provide new insights into the potential functions of C/EBPb in regulating intramuscular fat deposition in beef cattle.

Cattle/metabolism , Adipocytes/metabolism , CCAAT-Enhancer-Binding Protein-beta/metabolism , Fibroblasts/metabolism , Adipose Tissue/metabolism , Clone Cells , Cell Proliferation , Adipogenesis , Real-Time Polymerase Chain Reaction , Mitosis , Muscles
Arch. endocrinol. metab. (Online) ; 64(1): 71-81, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088771


ABSTRACT Objective Provide a comprehensive view of the events surrounding the sugar consumption, under conditions of energy equivalence; through the analysis of behavioral aspects of intake, and of biochemical, metabolic and physiological parameters, as well as the effect of this nutrient on the plasticity of adipose tissue. Materials and methods Newly weaned male Wistar rats were classified in two groups and subjected to the following normocaloric diets: standard chow diet or to high-sugar diet (HSD) ad libitum for 18 weeks. Results The animals submitted to the HSD were associated with a lower caloric intake during the 18 weeks of experimentation. However, the HSD induced a significant increase in body weight, white adipose tissue weight, adiposity index, Lee index, and the levels of triglycerides and very low-density lipoprotein in the serum. In addition, it induced glucose intolerance, insulin resistance and compensatory increase of insulin secretion by pancreatic β-cells. Also increased heart rate and induced hyperplasia, and hypertrophy of retroperitoneal visceral adipose tissue. In the liver, the HSD was associated with increased hepatic lipid content (i.e., triglycerides and cholesterol) and hepatomegaly. Conclusion The post-weaning consumption of HSD induces an adaptive response in metabolism; however, such an event is not enough to reverse the homeostatic imbalance triggered by the chronic consumption of this macronutrient, leading to the development of metabolic syndrome, irrespective of caloric intake. These findings corroborate recent evidence indicating that sugar is a direct contributor to metabolic diseases independent of a positive energy balance. Arch Endocrinol Metab. 2020;64(1):71-81

Animals , Male , Rats , Energy Intake , Adipose Tissue/metabolism , Energy Metabolism , Dietary Sugars/metabolism , Metabolic Diseases/metabolism , Obesity/metabolism , Rats, Wistar , Dietary Sugars/adverse effects , Dietary Sugars/blood , Metabolic Diseases/blood
J. Health Biol. Sci. (Online) ; 8(1): 1-10, 20200101. ilus
Article in Portuguese | LILACS | ID: biblio-1130010


Objetivo: avaliar os parâmetros morfométricos e a quantidade de tecidos adiposos de ratos alimentados com resíduos da lichia. Métodos: na etapa 1, os animais foram divididos em grupo C (controle) e grupo H (dieta hipercalórica); enquanto, na etapa 2, os animais do grupo C permaneceram neste grupo, e os demais foram divididos no grupo H, grupo HCL (10% de farinha da casca de lichia), e o grupo HSL (10% de farinha da semente de lichia). Avaliaram-se os Índices de Massa Corporal (IMC) e de Lee; o consumo alimentar, o Coeficiente de Eficiência Alimentar e a Digestibilidade Aparente; os Índices Hepato-Somático, de Gordura Visceral e de Gordura Epididimal. Compararam-se os dados pelo Teste de Tukey a 5%. Resultados: não houve diferença estatística quanto o peso corporal, o IMC, o consumo alimentar, e o Índice Hepato-Somático. O grupo HCL não diferiu do grupo C quanto ao Coeficiente de Eficiência Alimentar e à quantidade dos tecidos adiposos (visceral e epididimal). Os grupos que receberam as farinhas de lichia não diferiram do grupo C quanto ao ganho de peso e ao Índice de Lee; entretanto, apresentaram menor Índice de Gordura Epididimal que o grupo H e maior que o grupo C, embora o grupo controle (C) apresentasse menor Digestibilidade Aparente das dietas nas duas avaliações. Conclusão: a farinha da casca de lichia apresentou os melhores resultados, uma vez que não diferiu do grupo controle (C) para alguns parâmetros morfométricos e a quantidade dos tecidos adiposos, sugerindo que as fibras e os polifenóis dessa farinha promoveram os efeitos identificados neste estudo.

Objective: to evaluate the morphometric parameters and the amount of adipose tissue of rats fed lychee residues. Methods: in stage 1, the animals were divided into group C (control) and group H (hypercaloric diet); while in stage 2, the animals from group C remained in this group, and the others were divided into group H, group LPF (10% lychee peel flour), and group LSF (10% lychee seed flour). Body Mass Index (BMI) and Lee Index; dietary intake, Food Efficiency Coefficient and Apparent Digestibility; Hepato-Somatic, Visceral Fat (VFI) and Epididymal Fat Indexes (EFI) were evaluated. The data were compared by the Tukey Test at 5%. Results: there was no statistical difference regarding body weight, BMI, food intake, and Hepato-Somatic Index. The LPF group did not differ from group C (p>0.05) regarding the Food Efficiency Coefficient and the amount of adipose tissues (visceral and epididymal). The groups that received the lychee flours did not differ from group C regarding weight gain and Lee Index, however they presented lower Epididymal Fat Index than group H and higher than group C, and the control group (C) presented lower Apparent Dietary Digestibility in both evaluations. Conclusion: lychee peel flour showed the best results, since it did not differ from the control group (C) for some morphometric parameters and the amount of adipose tissues, suggesting that the fibers and polyphenols of this flour promoted the effects identified in this study.

Body Mass Index , Litchi , Rats , Waste Products , Adipose Tissue/metabolism , Diet , Reference Standards/methods
Rev. bras. ginecol. obstet ; 42(1): 43-50, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092627


Abstract Objective The present article aims to evaluate the impact of testosterone treatment on the expansion of visceral, subcutaneous and intramedullary adipose tissue of ovariectomized rats and the visceral and subcutaneous fat expression of peroxisome proliferator-activated receptors (PPARs) gamma. Methods In total 48 female Wistar rats were castrated and randomly divided into 6 treatment groups: group E2 was submitted to estradiol 5 μg/day; group T, to testosterone 5 μg/day; group E2+ T, to estradiol 5 μg/day + testosterone 5 μg/day; group TT, to testosterone 30 μg/day; group E2+ TT, to estradiol 5 μg/day+ testosterone 30 μg/day; and placebo was administered to group P. After 5 weeks, the rats were euthanized, the inguinal and visceral adipose tissues were harvested, weighted, and had their PPAR gamma expression evaluated by reverse transcription quantitative polymerase chain reaction (RTqPCR). The right femurs were harvested and histologically prepared to performthe number count of the intramedullary adipocytes. Results The expansion of visceral fat tissue was much higher in the TT group when compared with other treated groups (p < 0.001). The TT group also showed a higher expansion of inguinal fat (p < 0.01), and groups E2 +T and E2+ TT presented lower growth compared to the P group (p < 0.01). The number of femur intramedullary adipocytes only showed significant differences between groups TT and E2 + TT (p < 0.05). The expression of PPAR gamma showed no differences among the groups. Conclusion The use of testosterone in high doses leads to an important expansion in both visceral and inguinal adipose tissues. Association with estradiol exerts an expansion-repressive effect on the visceral and inguinal adipose tissues.

Resumo Objetivo Este artigo tem como objetivo avaliar o impacto do tratamento com testosterona na expansão dos tecidos adiposos visceral, subcutâneo e intramedular de ratas ovariectomizadas e a expressão de receptores ativados por proliferadores de peroxissoma (RAPPs) gama nas gorduras visceral e subcutânea. Métodos No total, 48 ratas Wistar foram castradas e divididas aleatoriamente em 6 grupos de tratamento: o grupo E2 recebeu estradiol 5 μg/dia; o grupo T, testosterona 5 μg/dia; o grupo E2 + T, estradiol 5 μg/dia + testosterona 5 μg/dia; o grupo TT, testosterona 30 μg/dia; o grupo E2 + TT, estradiol 5 μg/dia + testosterona 30 μg/dia; e o grupo P recebeu placebo. Após 5 semanas, as ratas foram submetidas a eutanásia, o tecido adiposo inguinal e visceral foi coletado, pesado, e se avaliou a expressão dos RAPP gama por reação em cadeia da polimerase via transcriptase reversa quantitativa (RCP-TRq). Os ossos do fêmur direito foram colhidos e processados histologicamente para contagem de números de adipócitos intramedulares. Resultados A expansão do tecido adiposo visceral foi muito maior no grupo TT quando comparado a outros grupos tratados (p < 0,001). O grupo TT também apresentou maior expansão da gordura inguinal (p < 0,01), e os grupos E2 +T e E2 + TT apresentaram menor crescimento em relação ao grupo P (p < 0,01). O número de adipócitos intramedulares no fêmur mostrou apenas diferenças significativas entre os grupos TT e E2 + TT (p < 0,05). A expressão de RAPP gama não mostrou diferenças entre os grupos. Conclusão O uso de testosterona emaltas doses leva a uma importante expansão nos tecidos adiposos visceral e inguinal. A associação com o estradiol exerce um efeito repressivo de expansão nos tecidos adiposos visceral e inguinal.

Animals , Female , Rats , Testosterone/pharmacology , Menopause , Hormone Replacement Therapy , Testosterone/metabolism , Ovariectomy , Adipose Tissue/metabolism , Rats, Wistar , Disease Models, Animal
Arq. neuropsiquiatr ; 77(9): 601-608, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038743


ABSTRACT Objective: Hypothalamic inflammation and glial fibrillary acidic protein (GFAP) overexpression in astrocytes are well described in obese animals, as are some cognitive and memory deficits. As the hippocampus plays important roles in the consolidation of information, this investigation aimed to observe the memory function and the astrocyte expression of GFAP in the hippocampus of rats that received either a hypercaloric or a normocaloric diet. Methods: Adult male Wistar rats received a high-fat (cafeteria) or a standard diet for 60 days. On the 61st day, the rats were submitted to the novel object recognition (NOR) test at three and 24 hours after the first contact with objects, to assess short-term and long-term memory, respectively. Thereafter, the rats were euthanized and their brains were collected for GFAP immunohistochemical investigation in the hippocampus (CA1, CA2, CA3 areas) and hypothalamus (periventricular and arcuate nuclei). Astrocytic reactivity was assessed by morphometry. Different white adipose tissue depots and brown adipose tissue were weighed to calculate the adiposity index. Results: The hypercaloric diet increased body weight gain, adiposity index, white adipose tissue weight (epididymal, subcutaneous and retroperitoneal) and brown adipose tissue weight. Rats fed with the hypercaloric diet showed short-term and long-term memory impairments in the NOR test, as well as increased GFAP expression in astrocytes from all analyzed hypothalamic and hippocampal areas. Conclusion: This astrogliosis suggests that the neuroinflammatory response also occurs in the hippocampus and may be involved in the memory losses observed in obese/overweight animals.

RESUMO Objetivo: A inflamação hipotalâmica e a superexpressão da proteína glial fibrilar ácida (GFAP) em astrócitos são bem descritas em animais obesos, assim como déficits cognitivos e de memória. Como o hipocampo desempenha importante papel na consolidação de informações, esta investigação teve como objetivo observar a função da memória e a expressão astrocitária da GFAP no hipocampo de ratos que receberam dieta hipercalórica ou normocalórica. Métodos: Ratos Wistar machos adultos receberam dieta rica em gordura (cafeteria) ou dieta padrão por 60 dias. No 61º dia, os ratos foram submetidos ao teste de reconhecimento de objetos (NOR) 3 e 24 horas após o primeiro contato com os objetos, para avaliação da memória de curto e de longo prazo, respectivamente. Após, os ratos foram eutanasiados e os encéfalos coletados para pesquisa imuno-histoquímica da expressão astrocitária de GFAP no hipocampo (áreas CA1, CA2 e CA3) e no hipotálamo (núcleos periventricular e arqueado). A reatividade astrocitária foi avaliada por morfometria. Diferentes depósitos de tecido adiposo branco e marrom foram pesados para calcular o índice de adiposidade. Resultados: A dieta hipercalórica aumentou o ganho de peso corporal, o índice de adiposidade, o peso do tecido adiposo branco (epididimal, subcutâneo e retroperitoneal) e marrom. Ratos alimentados com dieta hipercalórica apresentaram prejuízos na memória de curto e longo prazo no teste NOR e aumento da expressão de GFAP em astrócitos de todas as áreas hipotalâmicas e hipocampais analisadas. Conclusão: Esta astrogliose sugere que a resposta neuroinflamatória também ocorre no hipocampo, podendo estar envolvida nas perdas de memória observadas em animais obesos/com sobrepeso.

Animals , Male , Astrocytes/chemistry , Diet, High-Fat/adverse effects , Glial Fibrillary Acidic Protein/analysis , Hippocampus/cytology , Memory Disorders/etiology , Obesity/complications , Reference Values , Time Factors , Immunohistochemistry , Adipose Tissue/metabolism , Rats, Wistar , Glial Fibrillary Acidic Protein/metabolism , Memory Disorders/metabolism , Obesity/metabolism
Ciênc. Saúde Colet ; 24(4): 1299-1308, abr. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1001777


Resumo O objetivo deste estudo foi estimar a prevalência de insatisfação com a imagem corporal e verificar a associação entre a insatisfação pela magreza e pelo excesso de peso e componentes da aptidão física relacionada à saúde em adolescentes. Participaram 1.058 adolescentes (570 moças e 488 rapazes), com média de idade de 16,3(± 1,0) anos. As variáveis investigadas foram a insatisfação com a imagem corporal (escala de silhuetas), e as relativas à aptidão física relacionada à saúde: adiposidade corporal (dobras cutâneas), força muscular (preensão manual) e aptidão cardiorrespiratória (teste mCAFT). A associação entre a imagem corporal e as variáveis de aptidão física foi testada por meio da Regressão Multinomial. A prevalência de insatisfação corporal foi de 75,2% (moças = 79,5%; rapazes = 70,3%). Moças e rapazes com adiposidade corporal elevada tiveram menor chance de insatisfação pela magreza e maior chance de insatisfação pelo excesso de peso. Os que necessitavam melhorar a força muscular e a aptidão cardiorrespiratória tiveram maior chance de insatisfação pela magreza e pelo excesso de peso, respectivamente. Conclui-se que a aptidão física relacionada à saúde esteve associada à imagem corporal, sendo que os adolescentes com níveis menos saudáveis dos diferentes componentes foram os mais insatisfeitos.

Abstract The scope of this study was to estimate the prevalence of dissatisfaction with body image and verify the association between dissatisfaction with thinness or with overweight and health-related physical fitness components among adolescents. Participants included 1058 adolescents (570 girls and 488 boys), with mean age of 16.3 (±1.0) years. The investigated variables were dissatisfaction with body image (Figure Rating Scale), and health-related physical fitness: body fat (skin folds), muscle strength (handgrip strength) and cardiorespiratory fitness (mCAFT test). The association of body image and the health-related physical fitness variables was tested by Multinomial Regression analysis. The prevalence of body dissatisfaction was 75.2% (girls = 79.5%; boys = 70.3%). Girls and boys with high body fat were less likely to be dissatisfied with thinness and more likely to be dissatisfied with overweight. Those who needed to improve muscle strength and cardiorespiratory fitness were more likely to be dissatisfied with thinness and with overweight, respectively. In conclusion, physical fitness was associated with body image, with the adolescents with less healthy conditions of the components being more dissatisfied.

Humans , Male , Female , Adolescent , Young Adult , Thinness/psychology , Body Image/psychology , Physical Fitness/psychology , Pediatric Obesity/psychology , Thinness/epidemiology , Sex Factors , Adipose Tissue/metabolism , Muscle Strength/physiology , Pediatric Obesity/epidemiology , Cardiorespiratory Fitness/physiology
Braz. j. biol ; 79(2): 165-168, Apr.-June 2019. tab
Article in English | LILACS | ID: biblio-989437


Abstract Neotropical nectar-feeding bats consume large amounts of sugar and use most of their energy-rich diet directly from the bloodstream, suggesting an adaptation towards lower body energy reserves. Here we tested the hypothesis that bats Glossophaga soricina spare the energy costs of storing energy reserves, even if this would represent a risky susceptibility during fasting. Blood glucose concentrations in 18 h fasted bats showed a 40% decrease. Breast muscle and adipose tissue lipids, as well as carcass fatty acids and liver glycogen, were also decreased following fasting. The inability to keep normoglycemia following a short-term fasting (i.e. 28 h) confirm that nectar bats invest little on storing energy reserves and show a severe fasting susceptibility associated to this pattern. Our study also support the general hypothesis that evolutionary specializations towards nectar diets involve adaptations to allow a decreased body mass, which reduces the energy costs of flight while increases foraging time.

Resumo Morcegos nectarívoros que ocorrem na região Neotropical consomem grandes quantidades de carboidratos, e usam a energia obtida da dieta diretamente, a partir da glicose na circulação sanguínea. Esta adaptação sugere que morcegos nectarívoros tenham evoluído no sentido de apresentar adaptações fisiológicas que permitam o baixo armazenamento de reservas energéticas corporais. Nós testamos a hipótese de que morcegos Glossophaga soricina poupam o gasto energético envolvido com a formação de reservas energéticas teciduais, mesmo que isso represente uma arriscada suscetibilidade da espécie frente ao jejum. As concentrações de glicose apresentaram uma diminuição de 40% após 18 h de jejum. As concentrações de lipídios do músculo peitoral e do tecido adiposo, bem como as de ácidos graxos da carcaça e glicogênio hepático também diminuíram após 18 h de jejum. A incapacidade de manter a normoglicemia observada após o jejum de curto-prazo confirma que morcegos nectarívoros desta espécie não investem na formação de reservas energéticas, e apresentam, consequentemente, uma severa susceptibilidade ao jejum. Este estudo suporta a hipótese de que adaptações evolucionárias da espécie envolvem diminuição da massa corporal, reduzindo o custo energético do voo e aumentado o tempo de forrageamento.

Animals , Chiroptera/physiology , Fasting/physiology , Energy Metabolism/physiology , Plant Nectar/metabolism , Blood Glucose/physiology , Adipose Tissue/metabolism , Adipose Tissue/chemistry , Muscle, Skeletal/metabolism , Muscle, Skeletal/chemistry , Feeding Behavior
J. appl. oral sci ; 27: e20180088, 2019. tab, graf
Article in English | LILACS, BBO | ID: biblio-975894


Abstract Obesity is considered a risk factor for periodontal health due to the low- grade inflammation promoted by the increased adipose tissue. Objective: This study aimed to determine correlations and associations between gingival inflammation (Simplified Oral Hygiene Index, and Gingival Index), salivary immunoglobulin A (s-IgA), and salivary parameters (salivary flow and osmolality) in normal-weight and overweight/obese children. Material and Methods: Ninety-one children, aged 6 to 12 years old (8.6±1.9 years), were divided into two groups according to their body mass index (BMI), circumferences, skinfold measurements and body fat percentage: normal- weight group (NWG; n =50) and overweight/obese group (OG; n =41). A calibrated examiner performed the clinical examination using the Simplified Oral Hygiene Index, Gingival Index, and salivary collection. Data analysis included descriptive statistics and association tests ( p <0.05). Results: OG presented statistically higher s-IgA values compared with NWG, especially among the obese children ( p <0.05). Significant positive correlations between s-IgA and salivary osmolality in OG ( p <0.05), and between s-IgA and BMI values ( p <0.05) and body fat percentage ( p <0.05) were observed among all the children. Effect size varied from moderate for s-IgA values ( d =0.57) to large for BMI ( d =2.60). Conclusion: Gingival inflammation and salivary parameters were similar for NWG and OG; however, s-IgA presented higher values in OG, with correlations between BMI and body fat percentage.

Humans , Animals , Male , Female , Child , Saliva/metabolism , Body Mass Index , Overweight/blood , Pediatric Obesity/blood , Gingivitis/blood , Reference Values , Case-Control Studies , Linear Models , Periodontal Index , Adipose Tissue/metabolism , Cross-Sectional Studies , Risk Factors , Statistics, Nonparametric , Overweight/complications , Pediatric Obesity/complications , Gingivitis/etiology
Braz. j. med. biol. res ; 52(1): e8150, 2019. tab, graf
Article in English | LILACS | ID: biblio-974270


High caloric intake promotes chronic inflammation, insulin resistance, and chronic diseases such as type-2 diabetes, which may be prevented by food restriction (FR). The effect of FR on expression of pro-inflammatory and anti-inflammatory genes in adipose tissue, liver, muscle, and brain was compared. Male Swiss mice were submitted to FR (FR group) or had free access to food (control group) during 56 days. The liver, gastrocnemius muscle, brain, and epididymal white adipose tissue (WAT) were collected for analysis of gene expressions. FR attenuated inflammation in the liver, brain, and gastrocnemius muscle but did not markedly change inflammatory gene expression in epididymal WAT. We concluded that adipose tissue was less responsive to FR in terms of gene expression of pro-inflammatory and anti-inflammatory genes.

Animals , Male , Rabbits , Brain/metabolism , Adipose Tissue/metabolism , Muscle, Skeletal/metabolism , Diet, High-Fat , Liver/metabolism , Triglycerides/blood , Blood Glucose/analysis , Gene Expression , Cholesterol/blood
Ciênc. Saúde Colet ; 23(12): 4129-4142, Dec. 2018. tab
Article in Portuguese | LILACS | ID: biblio-974766


Resumo O objetivo deste estudo foi investigar a relação entre maus-tratos na família e excesso de peso, de gordura corporal e de gordura abdominal dos adolescentes da rede pública de ensino de município do Rio de Janeiro - Brasil. Trata-se de um estudo transversal que utiliza dados do Sistema de Vigilância de Fatores de Risco e Proteção à Saúde de Adolescentes, realizado em 2007, pelo município do Rio de Janeiro. A amostra foi composta por 1.628 escolares de 13 a 19 anos, de ambos os sexos, cursando o 9˚ ano do ensino fundamental. O excesso de peso, de gordura corporal e de gordura abdominal (desfechos) e os maus-tratos familiares (a agressão física e verbal) foram avaliados. A associação entre os maus-tratos e os desfechos foi realizada via modelos de regressão logística. Os maus-tratos apresentaram uma relação inversa com o excesso de peso e o de gordura para as meninas, mas somente a agressão física se associou significativamente com o excesso de peso (RC = 0,499; IC = 0,212-0,951). Já para os meninos, os resultados apontaram para o excesso de peso e de gordura mas sem significância estatística. Políticas de saúde devem considerar as diferenças existentes entre os gêneros no enfrentamento às experiências de violência que possam influenciar a saúde e o bem-estar do adolescente.

Abstract This study sought to investigate the relationship between domestic maltreatment and excess weight, body fat and abdominal fat among adolescents from the public schools in the city of Rio de Janeiro - Brazil. It involved a cross-sectional study using data from the Risk Factor Surveillance System and Protection of Health of Adolescents, held in 2007 by the municipality of Rio de Janeiro. The sample consisted of 1628 students aged 13 to 19 years, of both sexes, in the 9th year of school. Excess weight, body fat and abdominal fat (outcome variables) and domestic maltreatment (physical and verbal aggression) were evaluated. The association between domestic maltreatment and outcome variables was conducted via logistic regression models. Domestic maltreatment showed an inverse relationship to excess weight and fat for girls, but only physical aggression was significantly associated with excess weight (OR = 0.499, CI = 0.212 to 0.951). As for the boys, the results pointed to excess weight and fat but without statistical significance. Health policies must consider the differences between the genders in coping with experiences of violence that may influence the health and well-being of adolescents.

Humans , Male , Female , Adolescent , Young Adult , Students/statistics & numerical data , Domestic Violence/statistics & numerical data , Adiposity , Obesity/epidemiology , Schools , Brazil/epidemiology , Sex Factors , Adipose Tissue/metabolism , Cross-Sectional Studies , Abdominal Fat/metabolism
J. pediatr. (Rio J.) ; 94(4): 425-431, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-954631


Abstract Objective: To analyze the association between the Trp64Arg polymorphism of the ADRB3 gene, maximal fat oxidation rates and the lipid profile levels in non-obese adolescents. Methods: 72 schoolchildren, of both genders, aged between 11 and 17 years, participated in the study. The anthropometric and body composition variables, in addition to total cholesterol, HDL-c, LDL-c, triglycerides, insulin, and basal glycemia, were evaluated. The sample was divided into two groups according to the presence or absence of the polymorphism: non-carriers of the Arg64 allele, i.e., homozygous (Trp64Trp: n = 54), and carriers of the Arg64 allele (Trp64Arg + Arg64Arg: n = 18), in which the frequency of the Arg64 allele was 15.2%. The maximal oxygen uptake and peak of oxygen uptake during exercise were obtained through the symptom-limited, submaximal treadmill test. Maximal fat oxidation was determined according to the ventilatory ratio proposed in Lusk's table. Results: Adolescents carrying the less frequent allele (Trp64Arg and Arg64Arg) had higher LDL-c levels (p = 0.031) and lower maximal fat oxidation rates (p = 0.038) when compared with non-carriers (Trp64Trp). Conclusions: Although the physiological processes related to lipolysis and lipid metabolism are complex, the presence of the Arg 64 allele was associated with lower rates of FATMAX during aerobic exercise, as well as with higher levels of LDL-c in adolescents.

Resumo Objetivo: Analisar a associação entre o polimorfismo Trp64Arg do gene ADRB3, as taxas de oxidação máxima de gorduras e as concentrações do perfil lipídico em adolescentes não obesos. Métodos: Participaram do estudo 72 escolares, de ambos os sexos, com idade entre 11 e 17 anos. Foram avaliadas as variáveis antropométricas e de composição corporal, além do colesterol total, lipoproteina de alta densidade, lipoproteina de baixa densidade, triglicerídeos; insulina e glicemia basal. A amostra foi dividida em dois grupos, segundo a presença ou não do polimorfismo: não portadores do alelo Arg64, ou seja, homozigotos (Trp64Trp: n = 54) e portadores do alelo Arg64 (Trp64Arg + Arg64Arg: n = 18), em que a frequência do alelo Arg64 foide 15,2%. O consumo máximo de oxigênio e pico de consumo máximo de oxigênio durante o exercício foram obtidos por meio do teste aeróbio submáximo de sintoma limitado em esteira. A oxidação máxima de gorduras foi determinada de acordo com a razão de trocas ventilatórias propostas na Tabela de Lusk. Resultados: Os adolescentes portadores do alelo menos frequente (Trp64Arg e Arg64Arg) apresentaram maiores concentrações de lipoproteina de baixa densidade (p = 0,031) e menores taxasde oxidação máxima de gorduras (p = 0,038) quando comparados aos não portadores (Trp64Trp). Conclusões: Embora os processos fisiológicos relacionados à lipólise e ao metabolismo de lipídeos sejam complexos, a presença do alelo Arg64 associou-se a menores taxas de FATMAX durante exercício aeróbio, bem como maiores níveis de lipoproteina de baixa densidade em adolescentes.

Humans , Male , Female , Child , Adolescent , Oxidation-Reduction , Polymorphism, Genetic/genetics , Adipose Tissue/metabolism , Receptors, Adrenergic, beta-3/genetics , Cholesterol, LDL/blood , Body Composition , Cross-Sectional Studies , Alleles , Genotype
Arch. endocrinol. metab. (Online) ; 62(2): 179-186, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-887646


ABSTRACT Objective Adipose tissue, particularly visceral adipose tissue, secretes a variety of cytokines, among which progranulin is a glycoprotein related to the immune system. Along with other secreted proteins, progranulin may be associated with bone mineral density. The aim of this study was to find out whether there are associations between the progranulin and bone mineral density among obese people. Subjects and methods This cross-sectional study was conducted on 244 obese participants (aged 22-52). Serum progranulin, high sensitive C-reactive protein, oxidised-low dencity lipoprotein, tumor necrosis factor-α, parathormone, vitamin D, and interleukins of 1 β, 4, 6, 10, 13, and 17 concentrations were measured. Anthropometric measurements, body composition and bone mineral density were also assessed. Results Serum progranulin was directly associated with interleukin-6 and interleukin-1β, while it had a negative association with interleukin-17 and tumor necrosis factor-α. We also observed a statistically significant direct association between progranulin concentration and visceral fat, abdominal fat, waist, abdominal and hip circumferences, hip T-score, and Z-score and T-score for the lumbar region. A partial correlation test has also shown a significant positive correlation regarding serum progranulin and the hip Z-score. Moreover, progranulin level is inversely associated with ospteopenia (P = 0.04 and CI: 0.17,0.96). Conclusion Our study revealed that central obesity may be related to increased progranulin concentration. In addition, progranulin concentration was directly related to bone formation parameters, which indicates the protective effects of progranulin on bone density. Further studies are needed to clarify the exact mechanisms underlying these associations.

Humans , Male , Female , Adult , Middle Aged , Young Adult , Bone Density/physiology , Intercellular Signaling Peptides and Proteins/blood , Obesity/blood , Osteoporosis/blood , Parathyroid Hormone/blood , Reference Values , Vitamin D/blood , Body Composition , C-Reactive Protein/analysis , Absorptiometry, Photon , Sex Factors , Anthropometry , Adipose Tissue/metabolism , Cross-Sectional Studies , Interleukins/blood , Tumor Necrosis Factor-alpha/blood , Progranulins , Lipoproteins, LDL/blood
Braz. j. med. biol. res ; 51(5): e6964, 2018. tab, graf
Article in English | LILACS | ID: biblio-889089


The aim of this study was to test the hypothesis that reduced pre-exercise carbohydrate (CHO) availability potentiates fat oxidation after an exhaustive high-intensity exercise bout. Eight physically active men underwent a high-intensity exercise (∼95% V̇O2max) until exhaustion under low or high pre-exercise CHO availability. The protocol to manipulate pre-exercise CHO availability consisted of a 90-min cycling bout at ∼70% V̇O2max + 6 × 1-min at 125% V̇O2max with 1-min rest, followed by 48 h under a low- (10% CHO, low-CHO availability) or high-CHO diet (80% CHO, high-CHO availability). Time to exhaustion was shorter and energy expenditure (EE) lower during the high-intensity exercise in low- compared to high-CHO availability (8.6±0.8 and 11.4±1.6 min, and 499±209 and 677±343 kJ, respectively, P<0.05). Post-exercise EE was similar between low- and high-CHO availability (425±147 and 348±54 kJ, respectively, P>0.05), but post-exercise fat oxidation was significantly higher (P<0.05) in low- (7,830±1,864 mg) than in high-CHO availability (6,264±1,763 mg). The total EE (i.e., exercise EE plus post-exercise EE) was similar between low- and high-CHO availability (924±264 and 1,026±340 kJ, respectively, P>0.05). These results suggest that a single bout of high-intensity exercise performed under low-CHO availability increased post-exercise fat oxidation, and even with shorter exercise duration, both post-exercise EE and total EE were not impaired.

Humans , Male , Adult , Adipose Tissue/metabolism , Carbohydrate Metabolism/physiology , Dietary Carbohydrates/metabolism , Energy Metabolism/physiology , Physical Exertion/physiology , Adipose Tissue/physiology , Dietary Carbohydrates/administration & dosage , Exercise Test/methods , Oxidation-Reduction , Time Factors
Rev. argent. endocrinol. metab ; 54(4): 185-195, dic. 2017. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-957988


En esta parte de la revisión se describe la relación funcional entre el metabolismo de los lípidos y los hidratos de carbono y su interdependencia, desde el ciclo glucosa-ácido grasos y la hipótesis portal de la insulinorresistencia a los nuevos conocimientos sobre los adipocitos marrones y beiges, con énfasis en el normal funcionamiento de un patrón endocrino cuya disfunción es clave en la fisiopatología de la DMT2 y la obesidad. Se discute la ectopia o el asiento de grasa en el tejido magro por incapacidad del tejido adiposo para seguir acopiando lípidos y la actividad endocrina del adipocito, con la producción de moléculas (adipoquinas) que influyen sobre los mecanismos inductores de insulinorresistencia (leptina, adiponectina, TNF-α, resistina, etc.) y disfunción de la célula beta. Se describen la disminución de la capacidad oxidativa en la cadena respiratoria mitocondrial y el renacer del concepto de lipogénesis de novo, ambas favoreciendo el acopie de lípido intracelular. En tejidos magros existen pequeñas reservas intracelulares de lípidos que mantienen la regulación de funciones esenciales, aunque si aparece una sobrecarga lipídica el fenómeno conduciría a una disfunción (lipotoxicidad) y a la muerte celular (lipoapoptosis). La tormentosa relación entre los lípidos y el islote de Langerhans va más allá del esfuerzo funcional que impone la insulinorresistencia periférica sobre la célula β, por efectos directos de los lípidos o de sus derivados sobre la función del islote pancreático. Sin déficit de insulina no se desarrolla diabetes.

In this part of the review, the functional relationship between lipid and carbohydrate metabolisms and their interdependence is described, from the glucose-fatty acid cycle and the portal hypothesis of insulin resistance to the new knowledge on brown and beige adipocytes, with emphasis on the normal functioning of an endocrine pattern in which its dysfunction is a key factor in the pathophysiology of T2DM and obesity. Ectopic fat deposition in lean tissues due to the inability of the adipose tissue to continuously collect lipids and the endocrine activity of adipocytes is discussed. The production of molecules (adipokines) influencing some of the mechanisms involved in the development of insulin resistance (leptin, adiponectin, TNF-α, resistin, etc.) and beta cell dysfunction is also revisited. The decrease in the oxidative capacity in the mitochondrial respiratory chain and the rebirth of the concept of de novo lipogenesis are described, both effects favouring intracellular lipid accumulation. In lean tissues there are small intracellular lipid reserves that help to maintain the regulation of essential functions; however, when a lipid overload occurs the phenomenon could lead to severe cell dysfunction (lipotoxicity), and death (lipo-apoptosis). The stormy relationship between lipids and the Langerhans' islets goes beyond the functional effort imposed by peripheral insulin-resistance on the β cells, either by the direct effect of lipids or by their derivatives on overall pancreatic islet function. Within a scenario of no insulin deficit, diabetes does not develop.

Adipose Tissue/metabolism , Diabetes Mellitus, Type 2/physiopathology , Adipogenesis , Lipid Metabolism/physiology , Adipokines/metabolism
Rev. argent. endocrinol. metab ; 54(3): 109-123, set. 2017. ilus
Article in Spanish | LILACS | ID: biblio-957976


Se describe la relación funcional del metabolismo de las grasas y los hidratos de carbono y su interdependencia, desde los tradicionales conceptos del ciclo glucosa-ácidos grasos (Randle) y la hipótesis portal de la insulinorresistencia hasta los nuevos sobre los adipocitos marrones y beiges, con énfasis en el normal funcionamiento de un patrón endocrino cuya disfunción es clave en la fisiopatología: el eje adipoinsular, vinculado funcionalmente incluso con el hipotálamo, la hipófisis y las adrenales, que involucra 2 hormonas adipogénicas (insulina y glucocorticoide) que facilitarían el desarrollo de la grasa omental perivisceral, con fuertes consecuencias metabólicas. Se discute la ectopia o asiento de grasa en tejido magro por incapacidad del tejido adiposo para seguir atesorando grasas y la actividad endocrina del adipocito, con la producción de moléculas que influyen sobre los mecanismos productores de insulinorresistencia (leptina, adiponectina, TNF-α, resistina, etc.) y disfunción insular. Se describe la disminución de la capacidad oxidativa en la cadena respiratoria mitocondrial y el renacer del concepto de lipogénesis de novo, ambas favorecedoras del atesoramiento de grasas intracelular. En tejidos magros existen pequeñas reservas intracelulares de grasas que mantienen una regulación de funciones esenciales, aunque si aparece una sobrecarga lipídica, el fenómeno conduciría a disfunción (lipotoxicidad) y muerte celular (lipoapoptosis). La tormentosa relación entre las grasas y el islote de Langerhans va más allá del esfuerzo funcional que impone la insulinorresistencia periférica sobre la célula β, por efectos directos de los lípidos o sus derivados sobre la función del islote pancreático. Sin déficit de insulina no hay diabetes.

A review is presented on a functional relationship between fat and carbohydrate metabolism and inter-dependence from the traditional concepts of glucose-fatty acids cycle (Randle), and from the insulin resistance portal hypothesis up to the new aspects on brown and beige adipocytes. Emphasis is placed on the normal function of an endocrine pattern, in which its malfunction is the key in the pathophysiology of these conditions: the adipoinsular axis, with a functional link with the hypothalamic-pituitary-adrenal axis, which involves 2 adipogenic hormones (insulin and glucocorticoid). This has an influence on the development of omental peri-visceral fat, with severe metabolic consequences. A discussion is also presented on the concept of ectopic fat on non-adipose tissues that results in the incapacity of fatty tissue for storing lipids and the considerations about the endocrine activity of adipocyte producing substances that influence several mechanisms that could result in insulin resistance (leptin, adiponectin, TNF-α, resistin, etc.). New aspects are considered regarding the decrease in the oxidative capacity in the mitochondrial respiratory chain, and the rebirth of the concept of de novo lipogenesis that increases the storing of intra-cellular fat. In non-adipose tissues there are small intra-cellular fat quantities for essential functions, but lipid overloading leads to cell dysfunction (lipo-toxicity) and death (lipo-apoptosis). The stormy relationship between fat and Langerhans' Islets goes beyond the functional effort as consequence of peripheral insulin-resistance and the pancreatic beta cell suffers a direct lipid (or derivatives) functional effect. Without insulin deficiency diabetes does not appear.

Humans , Diabetes Mellitus, Type 2/physiopathology , Energy Metabolism/physiology , Adipose Tissue/metabolism , Diabetes Mellitus, Type 2/metabolism , Adipogenesis/physiology , Lipid Metabolism , Adipokines/metabolism
Ciênc. saúde coletiva ; 22(5): 1539-1552, maio 2017. tab, graf
Article in English | LILACS | ID: biblio-839980


Abstract Adipose tissue is a vital component of the human body, but in excess, it represents a risk to health. According to the World Health Organization, one of the main factors determining excessive body adiposity is the dietary habit. This systematic review investigated longitudinal studies that assessed the association between diet and body fat in adolescents and young adults. Twenty-one relevant papers published between 2001 and 2015 were selected. The most used method for estimating body fat was the body mass index (15 studies). Diet was most commonly assessed by estimating the consumption of food groups (cereals, milk and dairy products) and specific foods (sugar-sweetened beverages, soft drinks, fast foods, milk, etc.). Ten studies found a direct association between diet and quantity of body fat. During adolescence, adhering to a dietary pattern characterized by high consumption of energy-dense food, fast foods, sugar-sweetened beverages and soft drinks, as well as low fiber intake, appears to contribute to an increase in body fat in early adulthood. The findings of the present study suggest that the frequent consumption of unhealthy foods and food groups (higher energy density and lower nutrient content) in adolescence is associated with higher quantity of body fat in early adulthood.

Resumo O tecido adiposo é um componente vital do corpo humano, mas em excesso representa risco à saúde. Conforme a Organização Mundial da Saúde, um dos principais fatores determinantes do excesso de peso é o hábito alimentar. Essa revisão sistemática investigou estudos longitudinais que avaliaram a relação entre dieta e gordura corporal em adolescentes e adultos jovens. Vinte e um artigos publicados de 2001 a 2015 foram selecionados. O método mais utilizado para estimar gordura corporal foi o índice de massa corporal (15 estudos). A dieta foi avaliada principalmente pelo consumo de grupos alimentares (cereais, leite e produtos lácteos) e alimentos específicos (bebidas açucaradas, refrigerantes, “fast foods”, leite e etc.). Dez estudos encontraram uma associação direta entre dieta e quantidade de gordura corporal. Um padrão alimentar com alto consumo energético e de gordura e baixo de fibras e o hábito de consumir “fast foods”, bebidas açucaradas e refrigerantes na adolescência, contribuíram para um aumento da gordura corporal no início da vida adulta. Os achados deste estudo sugerem que o consumo de alimentos específicos e grupos de alimentos não saudáveis (alta densidade energética e baixo conteúdo de nutrientes) na adolescência e início da vida adulta estão associados com maior quantidade de gordura corporal.

Humans , Adolescent , Young Adult , Adipose Tissue/metabolism , Diet/standards , Feeding Behavior/physiology , Age Factors , Body Mass Index
Arch. endocrinol. metab. (Online) ; 61(2): 137-144, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838425


ABSTRACT Objective The aim of this study was to verify the effects of glycemic index (GI) on body composition, and on inflammatory and metabolic markers concentrations in patients with type 2 diabetes. Subjects and methods In this randomized controlled parallel trial, twenty subjects (aged 42.4 ± 5.1 years, BMI 29.2 ± 4.8 kg.m-2) were allocated to low GI (LGI) (n = 10) or high GI (HGI) (n = 10) groups. Body composition, inflammatory and metabolic markers were assessed at baseline and after 30 days of intervention. Food intake was monitored during the study using three-day food records completed on two non-consecutive weekdays and on a weekend day. Results Body fat reduced after the LGI intervention compared with baseline (P = 0.043) and with the HGI group (P = 0.036). Serum fructosamine concentration (P = 0.031) and TNF-α mRNA expression (P = 0.05) increased in the HGI group. Serum non-esterified fatty acids were greater in the HGI than in the LGI group (P = 0.032). IL-6 mRNA expression tended to decrease after the consumption of the LGI diet compared to baseline (P = 0.06). Conclusion The LGI diet reduced body fat and prevented the negative metabolic and inflammatory responses induced by the HGI diet.

Humans , Male , Female , Adult , Middle Aged , Adipose Tissue/metabolism , Glycemic Index/physiology , Diabetes Mellitus, Type 2/diet therapy , Diabetes Mellitus, Type 2/metabolism , Reference Values , Time Factors , Blood Glucose/metabolism , Body Composition , Dietary Fiber/analysis , Anthropometry , Reproducibility of Results , Interleukin-6/blood , Tumor Necrosis Factor-alpha/blood , Treatment Outcome , Statistics, Nonparametric , Fructosamine/blood , Eating/physiology , Real-Time Polymerase Chain Reaction , Inflammation/metabolism
Clinics ; 71(8): 464-469, Aug. 2016. tab, graf
Article in English | LILACS | ID: lil-794629


OBJECTIVES: Bone marrow adipose tissue has been associated with low bone mineral density. However, no data exist regarding marrow adipose tissue in primary hyperparathyroidism, a disorder associated with bone loss in conditions of high bone turnover. The objective of the present study was to investigate the relationship between marrow adipose tissue, bone mass and parathyroid hormone. The influence of osteocalcin on the homeostasis model assessment of insulin resistance was also evaluated. METHODS: This was a cross-sectional study conducted at a university hospital, involving 18 patients with primary hyperparathyroidism (PHPT) and 21 controls (CG). Bone mass was assessed by dual-energy x-ray absorptiometry and marrow adipose tissue was assessed by 1H magnetic resonance spectroscopy. The biochemical evaluation included the determination of parathyroid hormone, osteocalcin, glucose and insulin levels. RESULTS: A negative association was found between the bone mass at the 1/3 radius and parathyroid hormone levels (r = -0.69; p<0.01). Marrow adipose tissue was not significantly increased in patients (CG = 32.8±11.2% vs PHPT = 38.6±12%). The serum levels of osteocalcin were higher in patients (CG = 8.6±3.6 ng/mL vs PHPT = 36.5±38.4 ng/mL; p<0.005), but no associations were observed between osteocalcin and insulin or between insulin and both marrow adipose tissue and bone mass. CONCLUSION: These results suggest that the increment of adipogenesis in the bone marrow microenvironment under conditions of high bone turnover due to primary hyperparathyroidism is limited. Despite the increased serum levels of osteocalcin due to primary hyperparathyroidism, these patients tend to have impaired insulin sensitivity.

Humans , Male , Female , Adult , Middle Aged , Bone Marrow/metabolism , Insulin Resistance/physiology , Osteocalcin/blood , Adipose Tissue/metabolism , Hyperparathyroidism, Primary/metabolism , Parathyroid Hormone/blood , Reference Values , Blood Glucose/analysis , Bone Marrow/diagnostic imaging , Magnetic Resonance Spectroscopy , Absorptiometry, Photon , Bone Density/physiology , Case-Control Studies , Adipose Tissue/diagnostic imaging , Calcium/blood , Cross-Sectional Studies , Hyperparathyroidism, Primary/etiology , Hyperparathyroidism, Primary/diagnostic imaging , Adipogenesis/physiology , Homeostasis
Arch. endocrinol. metab. (Online) ; 60(2): 152-162, Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782159


ABSTRACT Body weight is regulated by the ability of hypothalamic neurons to orchestrate behavioral, endocrine and autonomic responses via afferent and efferent pathways to the brainstem and the periphery. Weight maintenance requires a balance between energy intake and energy expenditure. Although several components that participate in energy homeostasis have been identified, there is a need to know in more detail their actions as well as their interactions with environmental and psychosocial factors in the development of human obesity. In this review, we examine the role of systemic mediators such as leptin, ghrelin and insulin, which act in the central nervous system by activating or inhibiting neuropeptide Y, Agouti-related peptide protein, melanocortin, transcript related to cocaine and amphetamine, and others. As a result, modifications in energy homeostasis occur through regulation of appetite and energy expenditure. We also examine compensatory changes in the circulating levels of several peripheral hormones after diet-induced weight loss.

Humans , Body Weight/physiology , Energy Intake/physiology , Energy Metabolism/physiology , Adipose Tissue/metabolism , Medical Illustration , Obesity/etiology , Obesity/metabolism
Arch. endocrinol. metab. (Online) ; 60(2): 95-100, Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782155


Objective Our objective in this study was to determine the relationship between irisin hormone, which has a similar effect with thyroid hormones on adipose tissue and the metabolism, and the thyroid functions and the obesity secondary to thyroid disease. Subjects and methods Seventy-four patients were included in the study, of the patients, 37 were newly diagnosed with Hashimoto’s thyroiditis related hypothyroidism but not started on a treatment yet, and the remaining 37 were healthy volunteers without a known disease. Serum thyroid stimulating hormone (TSH), free thyroxin (fT4), anti-thyroglobulin and anti-thyroid peroxidase were measured and thyroid ultrasonography was performed in both groups. Serum irisin levels were measured using the commercially available ELISA kit. The hypothyroidism group had higher levels of irisin compared to the control group (2.77 ng/mL vs. 2.15 ng/mL respectively; p = 0.017). Results The hypothyroidism group had higher median levels of irisin in the obese patients than those in the control group (3.10 ng/mL vs. 2.10 ng/mL respectively; p = 0.013). Irisin level was negatively correlated with age in the whole population and patients with hypothyroidism (r = -0.255, p = 0.028; r = -0.346, p = 0.036 respectively). Irisin level was positively correlated with TSH (r = 0.247, p = 0.034) but negatively correlated with the fT4 (r = -0.316, p = 0.006) in the whole population. Obesity, fT4 and irisin levels were identified to be independent predictors in the diagnosis of hypothyroidism in the multivariable logistic regression analysis. Conclusion To the best of our knowledge, this study is the first in literature to identify that obesity, irisin level and fT4 level are independent risk factors for hypothyroidism.

Humans , Adult , Middle Aged , Fibronectins/blood , Hashimoto Disease/physiopathology , Hashimoto Disease/blood , Hypothyroidism/physiopathology , Hypothyroidism/blood , Obesity/physiopathology , Autoantibodies/blood , Thyroid Gland/physiopathology , Blood Pressure/physiology , Enzyme-Linked Immunosorbent Assay , Case-Control Studies , Logistic Models , Adipose Tissue/metabolism , Risk Factors , Hashimoto Disease/complications , Hypothyroidism/complications