Estrategias para mitigar hipoglucemias y variabilidad glucémica / Strategies to mitigate hypoglycemia and glycemic variability

La última década se ha destacado por los importantes avances en el desarrollo de nuevas tecnologías para pacientes que viven con diabetes mellitus (DM). Las innovaciones han estado orientadas principalmente a: mejorar la calidad de vida, reducir el impacto que genera la ocurrencia de hipoglucemias y reducir la carga de la enfermedad colaborando en la toma diaria de decisiones1. El monitoreo continuo de glucosa (MCG) es una herramienta que ha experimentado un importante avance al aportar información dinámica del estado metabólico en los pacientes y permitir la toma de decisiones, demostrado por un control metabólico estable, menores excursiones glucémicas, y una reducción significativa en la aparición y gravedad de las hipoglucemias2-5. Las presentes recomendaciones tienen como objetivo brindar herramientas rápidas para la interpretación de datos metabólicos y la consiguiente toma de decisiones terapéuticas. A tal fin se realizó una exhaustiva revisión de las principales guías y recomendaciones vigentes; posteriormente, el Grupo de Trabajo adaptó esa información según una serie de preguntas con criterio clínico práctico. El avance de los MCG es innegable, no solo en el desarrollo tecnológico, sino que se han convertido en una herramienta educativa para las personas con DM, su entorno y el equipo de salud al posibilitar un ajuste dinámico del tratamiento, prevenir complicaciones agudas y mejorar la calidad de vida. En esta ecuación enfatizamos la importancia de la educación diabetológica continua de la persona con DM y su entorno, participando activamente en la toma de decisiones para, de esta manera, cumplir con los objetivos propuestos: mejorar la calidad de vida, reducir la carga de la enfermedad y disminuir las excursiones glucémicas agudas.

The last decade has been highlighted by important advances in the development of new technologies for patients living with diabetes. The innovations have been oriented above all to improve the quality of life, reduce the impact generated by the occurrence of hypoglycemia and reduce the burden of the disease by collaborating in daily decision-making1. Continuous glucose monitoring (CGM) is a tool that has undergone significant progress, providing dynamic information on the metabolic status of patients, allowing decision making, demonstrated by stable metabolic control, lower glycemic excursions and a significant reduction in the occurrence and severity of hypoglycemia2-5. The purpose of these recommendations, developed by members of the Innovation Committee of the Argentine Society of Diabetes, is to provide rapid tools for the interpretation of metabolic data and the subsequent therapeutic decisionmaking. To this end, an exhaustive review of the main current guidelines and recommendations has been carried out, later the working group adapted this information according to a series of questions with practical clinical criteria. The progress of CGMs is undeniable, not only in technological development, but it has become an educational tool for people with diabetes, their environment, and the health team, offering the possibility of a dynamic adjustment of treatment, prevention of acute complications and improving quality of life. In this equation, we emphasize the importance of continuous diabetes education for the person with diabetes and their environment, actively participating in decision-making, and in this way, meeting the proposed objectives: improving quality of life, reducing the burden of disease, and decreasing acute glycemic excursions.

Índice leucoglucémico en pacientes con infarto miocárdico con elevación del ST / Leuko-glycemic index in patients with ST elevation myocardial infarction

Introducción: la mortalidad asociada a infarto del miocardio (IM) no solo se debe a complicaciones cardiovasculares, sino también a complicaciones intrahospitalarias no cardiovasculares (CIHNC). El índice leuco-glucémico (ILG) se ha utilizado como un marcador pronóstico para el desarrollo de complicaciones cardiovasculares en el IM. Centramos este estudio en identificar el punto de corte de ILG para el desarrollo de CIHNC en pacientes con infarto de miocardio con elevación del segmento ST (IAMCEST). Material y métodos: en este diseño de un solo centro y transversal, incluimos pacientes con IAMCEST. El análisis bioquímico incluyó glucosa y leucocitos; se calculó ILG. Se realizaron análisis univariados y bivariados, curva ROC y análisis multivariado para el desarrollo de IAMCEST. Resultados: incluimos 1294 pacientes, 79.8% hombres y 20.2% mujeres. Las principales comorbilidades fueron: hipertensión arterial sistémica, diabetes mellitus y dislipidemia. Seiscientos cuarenta y cuatro pacientes (49.8%) presentaron CIHNC. El ILG > 1200 con área bajo la curva (AUC) 0.817 predice el desarrollo de CIHNC en pacientes con IAMCEST. Las variables que aumentaron el desarrollo de CIHNC fueron: ILG > 1200, creatinina > 0.91 mg/dL, diabetes mellitus y edad > 65 años. La neumonía intrahospitalaria y las complicaciones cardiovasculares aumentaron el riesgo de muerte entre los pacientes con IAMCEST. Conclusión: un LGI > 1200 aumentó más de nueve veces el riesgo de desarrollo de CIHNC en pacientes con IAMCEST.

Background: The myocardial infarction-associated (MI) mortality is not only due cardiovascular complications, but intrahospital non-cardiovascular complications (IHnCVCs). The leuko-glycemic index (LGI) has been used as a prognostic marker for the development of cardiovascular complications in MI. We focused this study on identifying the cut-off point of LGI for the IHnCVCs development in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods: In this single-center and cross-sectional design, we included patients with STEMI. The biochemical analysis included glucose and leucocytes; with them we calculated the LGI. Receiver operating characteristic curve, univariate and bivariate analysis, and multivariate analysis for IHnCVCs development were performed. A p < 0.05 was considered statistically significant. Results: We included 1294 patients, 79.8% were men and 20.2% women. The main comorbidities were hypertension, diabetes mellitus and dyslipidemia. Six hundred forty-four (49.8%) patients presented IHNCVCs. The LGI > 1200 (AUC 0.817) predict the IHNCVCs development in STEMI patients. The variables that increased the IHNCVCs development were LGI > 1200, creatinine > 0.91 mg/dL, diabetes mellitus and age > 65 years. Hospital acquired pneumonia and cardiovascular complications increase the risk of death among STEMI patients. Conclusion: A LGI > 1200 increased, just over nine times, the risk of IHnCVC development in STEMI patients.

Avaliação do consumo de frutas em pacientes com diabetes mellitus tipo 2 / Fruit consumption in patients with type 2 diabetes mellitus

Introdução: O impacto do consumo de frutas sobre a saúde de pacientes com diabetes mellitus tipo 2 (DM2) requer investigações. O objetivo deste estudo foi avaliar o consumo de frutas em pacientes com DM2 e identificar a sua associação com parâmetros de controle glicêmico.Métodos: Foram incluídos 197 pacientes ambulatoriais com DM2, submetidos à avaliação clínica, sociodemográfica, antropométrica, laboratorial e de consumo alimentar. A ingestão alimentar total e o consumo de frutas foram avaliados por questionário quantitativo de frequência alimentar. Os pacientes com menor e maior consumo de frutas (de acordo com a mediana) foram comparados.Resultados: A média do consumo de frutas foi de 593,66 ± 330,74 g/dia. Entre os menores e maiores consumidores de frutas, os valores de glicemia (169,42 ± 70,83 vs. 158,62 ± 64,56 mg/dL; p = 0,273) e hemoglobina glicada (8,39 ± 1,68 vs. 8,68 ± 2,38%; p = 0,319) não foram diferentes, assim como as demais variáveis. Os pacientes com maior consumo de frutas apresentaram maior ingestão de energia (p < 0,001), carboidratos (p < 0,001) e fibras (p = 0,006) e uma menor ingestão de proteínas (p = 0,015), lipídeos totais (p = 0,040) e seus tipos. O grupo que mais consumiu frutas apresentou uma maior ingestão de vitamina C (p < 0,001) e potássio (p < 0,001) e um menor consumo de sódio (p = 0,001). Foi observado ainda uma correlação negativa entre o consumo de frutas e o índice glicêmico da dieta (p = 0,05).Conclusão: Não houve diferença na glicemia em jejum e no valor de hemoglobina glicada entre os pacientes com DM2 com maior e menor consumo de frutas.

Introduction: The impact of fruit consumption on the health of patients with type 2 diabetes mellitus (T2DM) warrants investigation. The aim of this study was to evaluate fruit consumption in patients with T2DM and to identify its association with glycemic control parameters.Methods: We included 197 outpatients with T2DM who underwent clinical, sociodemographic, anthropometric, laboratory, and food consumption assessments. A food frequency questionnaire was used to assess total food intake and fruit consumption. Patients with lower and higher fruit consumption (according to the median) were compared.Results: Average fruit consumption was 593.66 ± 330.74 g/day. Blood glucose (169.42 ± 70.83 vs. 158.62 ± 64.56 mg/dL; p = 0.273) and glycated hemoglobin (8.39 ± 1.68% vs. 8.68 ± 2.38%; p = 0.319) levels did not differ between the lower and higher fruit consumption groups, nor did the other variables. Patients with higher fruit consumption had a higher intake of energy (p < 0.001), carbohydrates (p < 0.001), and fibers (p = 0.006) but a lower intake of proteins (p = 0.015) and total and different types of lipids (p = 0.040). The higher consumption group had higher vitamin C (p < 0.001) and potassium (p < 0.001) intake and lower sodium intake (p = 0.001). We identified a negative correlation between fruit consumption and the diet's glycemic index (p = 0.05).Conclusion: Fasting blood glucose and glycated hemoglobin levels did not differ between the higher and lower fruit consumption groups.

Prognostic Value of the Leuko-Glycaemic Index in the Postoperative Period of Coronary Artery Bypass Grafting

Abstract Introduction: High leuko-glycaemic index (LGI) (> 2000) has been associated with poor prognosis in many critical care settings. However, there is no evidence of LGI's prognostic value in the postoperative period of coronary artery bypass grafting (CABG). This study aims to analyze the prognostic value of LGI in the postoperative period of CABG. Methods: Single-center retrospective analysis of prospectively collected data was performed. Consecutive adult patients undergoing CABG between 2007 and 2019 were included. Blood glucose levels and white blood cells count were evaluated in the immediate postoperative period. LGI was calculated by multiplying both values and dividing them by 1,000 and analyzed in quartiles. Receiver operating characteristic curve was used to determine the best cutoff value. The primary combined endpoint was in-hospital mortality, low cardiac output (LCO), or acute kidney injury (AKI). Secondary endpoints included in-hospital death, AKI, atrial fibrillation, and LCO. Results: The study evaluated 3,813 patients undergoing CABG (88.5% male, 89.8% off-pump surgery, aged 64.6 years [standard deviation 9.6]). The median of LGI was 2,035. Presence of primary endpoint significantly increased per LGI quartile (9.2%, 9.7%, 11.8%, and 15%; P<0.001). High LGI was associated with increased occurrence of in-hospital mortality, LCO, AKI, and atrial fibrillation. The best prognostic cutoff value for primary endpoint was 2,000. In a multivariate logistic regression model, high LGI was independently associated with in-hospital death, LCO, or AKI. Conclusion: High LGI was an independent predictor of in-hospital mortality, LCO, or AKI in postoperative period of CABG. It was also associated with higher in-hospital death.

Índice leucoglucémico como marcador pronóstico de complicaciones en pacientes con infarto agudo de miocardio / Leukoglucemic index as a prognostic marker for complications in patients with acute myocardial infarction

Resumen Introducción:: El índice leucoglucémico es un factor pronóstico, poco conocido y utilizado, que relaciona la glucemia y los leucocitos registrados al ingreso hospitalario. Su importancia radica en la determinación del riesgo de complicaciones y la mortalidad en pacientes con infarto agudo de miocardio. Objetivo: Establecer al índice leucoglucémico como factor predictor de complicaciones durante la evolución intrahospitalaria en los pacientes con infarto agudo de miocardio. Método: Estudio de tipo epidemiológico, analítico, observacional y de corte transversal, en una cohorte de pacientes que ingresaron con infarto agudo de miocardio durante un período de un año y tres meses. Resultados: Se incluyó en el estudio a 205 pacientes con infarto agudo de miocardio, cuyo promedio de edad fue de 62.99 ± 12.2 años, con predominio en varones con 69.3%. El infarto agudo de miocardio con elevación del segmento ST predominó en frecuencia con 63.9% y mayor tasa de complicaciones (p < 0.001). El promedio del índice leucoglucémico fue de 1,578.41 ± 1,208.1 y el punto de corte establecido fue de 656.8, de acuerdo con la curva ROC, con sensibilidad del 95.8% y especificidad del 73% para la predicción de complicaciones intrahospitalarias, con OR de 7.89. Conclusión: Un índice leucoglucémico > 656.8 representa un riesgo de 7.89 veces de desarrollar complicaciones en la población estudiada.

Abstract Introduction: Leukoglycemic index is a poorly known and used prognostic factor that correlates blood glucose and leukocytes which are taken at hospital admission. Its importance lies in determining complications and mortality risks in patients with acute myocardial infarction. Objective: To establish the leukoglycemic index as a predictor of complications during the in-hospital evolution in patients with acute myocardial infarction. Methods: Epidemiological, observational, cross-sectional, crosssectional study on a cohort of patients admitted with acute myocardial infarction during a period of 1 year 3 months. Results: 205 patients with acute myocardial infarction were included in this study. The mean age was 62.99 ± 12.2 years old, more frequently in males by 69.3%. It was determined that acute myocardial infarction with ST elevation predominated both in frequency with 63.9%, as well as with a higher rate of complications (p < 0.001). The average of leukoglycemic index was 1578.41 ± 1208.1 and the cut-off point was 656.8, according to ROC curve, with sensitivity of 95.8% and specificity of 73% for the prediction of inhospital complications, OR 7.89. Conclusions: A leukoglycemic index greater than 656.8 represents a 7.89-fold risk of developing complications in the study population.

Subclinical ketosis risk prediction in dairy cows based on prepartum metabolic indices / [Previsão do risco de cetose subclínica em vacas de leite, baseado nos índices metabólicos pré-parto]

Ketosis can seriously impair cow performance. This study detected changes in prepartum blood metabolic parameters for predicting postpartum ketosis occurrence in dairy cows. Body condition score (BCS) was assessed before and after delivery. Blood samples of 63 cows were collected from 10 days before calving to 10 days after calving to measure metabolic parameters including ß-hydroxybutyric acid (BHBA), non-esterified fatty acid (NEFA), glucose (GLU), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total protein (TP), albumin (ALB), globulin (GLO), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). There was a postpartum subclinical ketosis incidence of 42.25%. Compared with prepartum, plasma, levels of BHBA, AST, and NEFA significantly increased postpartum, and prepartum AST (R=0.57) and NEFA (R=0.45) showed a significant positive correlation with ketosis postpartum. Plasma GLU level significantly decreased postpartum and was significantly negatively correlated with ketosis (R=-0.21). Receiver operating characteristic curve analysis revealed prepartum BSC < 2.88, and prepartum plasma AST > 68.0 U/L, GLU < 3.97mmol/L, NEFA > 0.27mmol/L, and BHBA > 0.43mmol/L, indicating a high risk of subclinical ketosis postpartum. These levels can be used as risk indicators to predict the occurrence of subclinical ketosis in postpartum cows.(AU)

A cetose pode trazer sérios prejuízos ao desempenho da vaca. Este estudo detectou alterações nos parâmetros metabólicos do sangue pré-parto para prever a cetose pós-parto que ocorre em vacas leiteiras. O escore de condição corporal (ECC) foi avaliado antes e após o parto. Foram coletadas amostras de sangue de 63 vacas entre 10 dias antes e 10 dias após o parto para medir os parâmetros metabólicos, incluindo ácido ß-hidroxibutírico (BHBA), ácido graxo não esterificado (NEFA), glicose (GLU), bilirrubina total (TBIL), bilirrubina direta (DBIL), bilirrubina indireta (IBIL), proteína total (TP), albumina (ALB), globulina (GLO), alanina aminotransferase (ALT) e aspartato aminotransferase (AST). Houve uma incidência de cetose subclínica pós-parto de 42,25%. Em comparação com o pré-parto, o plasma, os níveis de BHBA, AST e NEFA aumentaram significativamente no pós-parto, e AST no pré-parto (R = 0,57) e NEFA (R = 0,45) mostraram uma correlação significativa positiva com cetose pós-parto. O nível plasmático de GLU diminuiu significativamente no pós-parto e foi negativamente correlacionado com a cetose de forma significativa (R = -0,21). A análise da curva característica de operação do receptor revelou BSC pré-parto <2,88 e AST plasmático pré-parto> 68,0 U / L, GLU <3,97mmol / L, NEFA> 0,27mmol / L e BHBA> 0,43mmol / L, indicando um alto risco de cetose subclínica pós-parto. Esses níveis podem ser usados ​​como indicadores de risco para prever a ocorrência de cetose subclínica em vacas no pós-parto.(AU)

Inverted U-Shaped Associations between Glycemic Indices and Serum Uric Acid Levels in the General Chinese Population: Findings from the China Cardiometabolic Disease and Cancer Cohort (4C) Study / 生物医学与环境科学（英文）

Objective@#The relationship between serum uric acid (SUA) levels and glycemic indices, including plasma glucose (FPG), 2-hour postload glucose (2h-PG), and glycated hemoglobin (HbA1c), remains inconclusive. We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.@*Methods@#The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study. A total of 105,922 community-dwelling adults aged ≥ 40 years underwent the oral glucose tolerance test and uric acid assessment. The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.@*Results@#A total of 30,941 men and 62,361 women were eligible for the current analysis. Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels, but with different inflection points in men and women. The thresholds for FPG, 2h-PG, and HbA1c for men and women were 6.5/8.0 mmol/L, 11.0/14.0 mmol/L, and 6.1/6.5, respectively (SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).@*Conclusion@#An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes, while the inflection points were reached earlier in men than in women.

The effects of kefir in mixed meals on appetite and food intake: a randomized cross-over trial / Os efeitos do quefir em refeições mistas sobre o apetite e a ingestão de alimentos: um estudo randomizado cruzado

ABSTRACT Objective The natural probiotic kefir is fermented milk, and may have effects on satiety and voluntary energy intake. This randomized crossover trial aimed to determine whether kefir, consumed with low- or high-glycemic index meals, affects appetite and subsequent food intake. Methods Twenty four healthy females aged 21-24 years, were recruited from Erciyes University and the surrounding community. The participants were submitted to three different breakfasts: a low glycemic index accompanied by milk, a low glycemic index with kefir, and a high glycemic index with kefir, with a 1-week washout period between meals. At 0, 15, 30, 60, 90, 120, 150, and 180 minutes after the meal, appetite ratings were measured by the visual analog scale, and then ad libitum lunch was served. Results No differences in appetite scores and voluntary energy intake were detected between the test meals. Furthermore, palatability ratings were similar between test meals, except for the higher score of high glycemic index kefir for overall palatability. Conclusion This study demonstrated that adding kefir to a high glycemic index meal may prevent increases in appetite and food intake, resulting in postprandial responses similar to those of a low glycemic index meal. These findings might enable the development of novel dietary strategies based on appetite regulation to treat or prevent obesity, particularly for Western societies. This trial was registered at ClinicalTrials.gov under the process NCT03636217.

RESUMO Objetivo O quefir probiótico natural é um leite fermentado, e pode ter alguns efeitos sobre a saciedade e a ingestão voluntária de energia. Este ensaio cruzado randomizado teve como objetivo determinar se o quefir consumido com uma refeição de baixo ou alto índice glicêmico teria afetado o apetite e a ingestão de alimentos subsequente. Métodos Vinte e quatro mulheres saudáveis, com idades entre 21 e 24 anos, foram recrutadas na Universidade de Erciyes e na comunidade circundante. Todas as participantes foram submetidas a três cafés da manhã diferentes: um baixo índice glicêmico e leite, um baixo índice glicêmico e quefir, e um alto índice glicêmico e quefir, com um período de lavagem de 1 semana entre as refeições. Aos 0, 15, 30, 60, 90, 120, 150 e 180 minutos após a refeição, as classificações de apetite foram medidas por escala analógica visual e, em seguida, o almoço ad libitum foi servido. Resultados Não foram detectadas diferenças nos escores do apetite e na ingestão voluntária de energia entre as refeições do teste. Além disso, as classificações de palatabilidade foram semelhantes entre as refeições de teste, exceto o maior escore de alto índice glicêmico quefir para palatabilidade geral. Conclusão Este estudo demonstrou que a adição de quefir a uma refeição com alto teor de índice glicêmico pode impedir o aumento do apetite e da ingestão de alimentos, resultando em respostas pós-prandiais semelhantes a uma refeição com baixo teor de índice glicêmico. Esses achados poderiam permitir o desenvolvimento de novas estratégias dietéticas baseadas na regulação do apetite para tratar ou prevenir a obesidade, particularmente para a sociedade ocidental. Esse julgamento foi registado na ClinicalTrials.gov como NCT03636217.

Efectos de un programa de entrenamiento multicomponente sobre indicadores de salud física y cognitiva de mujeres mayores / Effects of a multicomponent training program on physical and cognitive health indicators of older women

RESUMEN: Objetivo: Analizar el efecto de un programa de Entrenamiento MultiComponente (EMC) sobre autonomía funcional, fuerza muscular, composición corporal, capacidad cognitiva y perfil glucémico de mujeres mayores. Material y Métodos: 13 mujeres con edad 61,0 ± 6,0 años, participaron del estudio durante 12 semanas, siendo ­ Entrenamiento Resistido (ER); martes y viernes ­ Entrenamiento Funcional (EF) y Entrenamiento de Judo Adaptado (EJA), en la misma sesión; se utilizó el protocolo de autonomía funcional ­ GDLAM, Mini Examen del Estado Mental (MEEM), test de predicción de 1RM, índices: glicémico, masa corporal (IMC), relación cintura-cadera (IRCQ), relación cintura-estatura (RCE) y siete pliegues cutáneos. Resultados:Hubo mejora (p<0,05) para todos los test del GDLAM y el índice general (∆% = -21,31%; p-valor = 0,0006). Para el MEEM fue identificado mejoría en el puntaje general (∆%=8,98%; p-valor= 0,002), atención, cálculo y lenguaje. También hubo mejora (p<0,05) para todos los ejercicios de fuerza. Para composición corporal: porcentaje de grasa (%G) (∆%= -11,8%; p-valor= 0,001). Conclusión: El programa de EMC realizado cuatro veces en la semana, durante 12 semanas fue eficaz para mejorar la autonomía funcional, la fuerza muscular, la función cognitiva, para variables % G, masa magra y grasa de las mujeres estudiadas.

BSTRACT: Objective: To analyze the effect of a Multi-Component Training (CMT) program on functional autonomy, muscle strength, body composition, cognitive capacity and glycemic profile of older women. Material and Methods: 13 women aged 61.0 ± 6.0 years, participated in the study for 12 weeks, being -Resisted Training (ER); Tuesday and Friday - Functional Training (EF) and Adapted Judo Training (EJA), in the same session; The functional autonomy protocol was used - GDLAM, Mini Mental State Examination (MMSE), 1RM prediction test, glycemic index, body mass (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR) and seven skin folds. Results:There was improvement (p <0.05) for all GDLAM tests and the general index (Δ% = -21.31%; p-value = 0.0006). For the MMSE, an improvement was identified in the general score (Δ% = 8.98%; p-value = 0.002), attention, calculation and language. There was also improvement (p <0.05) for all resistance exercises. For body composition: fat percentage (% G) (Δ% = -11.8%; p-value = 0.001). Conclusion:The CME program performed four times a week for 12 weeks was effective in improving functional autonomy, muscle strength, cognitive function, for variables % F, lean mass and fat of the women studied.

Avaliação da correlação diagnóstica dos níveis de HbA1c e microalbuminúria em pacientes com Diabetes mellitus tipo 2 como marcador de prevenção de complicações renais / Evaluation of the diagnostic correlation of HbA1c and microalbuminuria levels in type 2 Diabetes mellitus patients as a marker of prevention of renal complications

Objetivo: Avaliar a correlação entre os níveis de hemoglobina glicada A1c (HbA1c) e os valores de microalbuminúria como parâmetro auxiliar no diagnóstico precoce de dano renal. Métodos: Analisaram-se 56 pacientes que apresentaram os exames de glicemia de jejum, HbA1c e microalbuminúria, durante o período de um ano em um laboratório do município de Videira-SC. A análise dos dados foi realizada pelo teste de correlação de Pearson's estabelecendo como valores estatisticamente significativos p < 0,05. Resultados: Os valores de glicose de jejum se apresentaram alterados em ambos os sexos e faixa etária. Na hemoglobina glicada indivíduos do sexo feminino com faixa etária de até 60 anos de idade demostraram maiores alterações no controle glicêmico. Para os resultados de micro­albuminúria, 68% dos participantes apresentaram valores normais e 32% exibiram valores acima dos de referência, indicando presença de microalbuminúria e possível dano renal. Os valores mostraram correlação entre microalbuminúria e HbA1c em mulheres e homens respectivamente (p < 0,0001). Conclusão: Quando os valores de HbA1c apresentaram-se aumentados consequentemente os valores de microalbuminúria também estavam elevados. Portanto, a utilização desses marcadores na busca de identificar danos renais é fundamental.

Objective:This study aimed to evaluate the correlation between the levels of glycated hemoglobin A1c (HbA1c) and the values of microalbuminuria as an auxiliary parameter in the early diagnosis of kidney damage. Methods: Fifty-six patients who had fasting blood glucose, HbA1c and microalbuminuria tests were analyzed during a period of one year in a laboratory in the municipality of Videira-SC. Data analysis was performed using Pearson's correlation test, establishing as statistically significant values p < 0.05. Results: Fasting glucose values were altered in both sexes and age groups. In glycated hemoglobin, female individuals aged up to 60 years old showed greater changes in glycemic control. For the results of microalbuminuria, 68% of the participants had normal values and 32% showed values above those of reference, indicating the presence of microalbuminuria and possible kidney damage. The values showed a correlation between microalbuminuria and HbA1c in women and men respectively (p <0.0001). Conclusion: When the HbA1c values were consequently increased, the microalbuminuria values were also high. Therefore, the use of these markers in the search to identify kidney damage is essential.

Valores de riesgo vascular de indicadores metabólicos en adolescentes y ancianos de La Habana / Vascular Risk Values of Metabolic Indicators in Adolescents and Elderlies from Havana

Introducción: Durante el ciclo de vida de los individuos son imprescindibles intervenciones para detectar y reducir el riesgo y las complicaciones de las enfermedades crónicas. Objetivo: Determinar la prevalencia de valores de riesgo vascular de los principales indicadores del metabolismo glucídico y lipídico en adolescentes y ancianos de La Habana. Métodos: Se realizó un estudio transversal en una muestra conformada por adolescentes (469 de 12-16 años) aparentemente sanos y ancianos (395 de 65-100 años) sin diagnóstico de enfermedades asociadas a la alteración marcada del estado nutricional y metabólico. Ambas poblaciones fueron evaluadas para glucosa, triglicéridos, colesterol total, colesterol de lipoproteinas de alta densidad y colesterol de lipoproteínas de baja densidad, séricos, mediante métodos enzimáticos convencionales. Se usaron rangos de riesgo referentes. Los resultados se analizaron mediante estadística descriptiva. Resultados: En los adolescentes evaluados, los triglicéridos (35,6 por ciento) y el colesterol total (23,9 por ciento) mostraron las mayores frecuencias de valores de riesgo. En las hembras ambos marcadores se mantuvieron como los más elevados en ese orden, mientras que, en los varones, la glucosa (25,5 por ciento) secundó a los triglicéridos como indicadores más alterados. En ancianos, al colesterol de lipoproteínas de baja densidad (58,2 por ciento) y al colesterol total (48,6 por ciento) correspondieron las mayores frecuencias de cifras de riesgo, patrón que se repitió en cada sexo. Los valores promedio de los indicadores fueron marcadamente superiores en ancianos que, en adolescentes, excepto para glucosa y colesterol de lipoproteínas de alta densidad. Conclusiones: Los resultados obtenidos muestran una elevada prevalencia de valores de riesgo vascular de varios indicadores metabólicos evaluados en adolescentes y ancianos, lo que sugiere la necesidad de monitorear los indicadores analizados e implementar intervenciones modificadoras de sus valores hacia la reducción del riesgo asociado, desde etapas tempranas, como las previas a la adolescencia(AU)

Introduction: During the life cycle of individuals, interventions are essential to detect and reduce the risk and complications of chronic diseases. Objective: To determine the prevalence of vascular risk values of the main indicators of carbohydrate and lipid metabolism in adolescents and elderlies in Havana. Methods: A cross-sectional study was carried out with a sample made up of apparently healthy adolescents (469; aged 12-16 years) and elderlies (395 aged 65-100 years) without a diagnosis of diseases associated with marked alteration of nutritional and metabolic status. Both populations were evaluated regarding serum glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol using conventional enzymatic methods. Reference risk ranges were used. The results were analyzed using descriptive statistics. Results: In the evaluated adolescents, triglycerides (35.6 percent) and total cholesterol (23.9 percent) showed the highest frequencies of risk values. In females, both markers remained the highest in that aspect; while in males, glucose (25.5 percent) accounted second after triglycerides as the most altered indicators. In the elderlies, low-density lipoprotein cholesterol (58.2 percent) and total cholesterol (48.6 percent) corresponded to the highest frequencies of risk values, a pattern that was repeated in each sex. The average values of the indicators were markedly higher in the elderlies than in adolescents, except for glucose and high-density lipoprotein cholesterol. Conclusions: The results obtained show high prevalence of vascular risk values of several metabolic indicators evaluated in adolescents and elderlies, which suggests the need to monitor the analyzed indicators and implement interventions to modify such values, in view of reducing the associated risk, from stages early, such as the pre-adolescence stage(AU)

El efecto agudo sobre niveles de glucemia en adultos mayores con el Entrenamiento Interválico de Alta Intensidad / Acute effect of High-Intensity Interval Training on glycemia levels in elderly people

Introducción: El Entrenamiento Interválico de Alta Intensidad durante los últimos años ha sido postulado como tratamiento no farmacológico para enfermedades como la diabetes tipo II en diferentes poblaciones, sin embargo, son pocos los estudios que se han realizado en adultos mayores. Objetivo: Determinar el efecto agudo de una sesión de Entrenamiento Interválico de Alta Intensidad sobre los niveles de glucosa en adultos mayores físicamente activos. Métodos: Se realizó un estudio experimental. La muestra estuvo conformada por 19 adultos mayores (60-85 años). El grupo fue sometido a una sesión de Entrenamiento Interválico de Alta Intensidad, en la que se combinaron ejercicios de fuerza con resistencia cardiovascular, y se realizaron 12 ejercicios con duración de 30 segundos de trabajo por 10 de descanso. La intensidad de la sesión fue controlada a través de la Escala de Percepción del Esfuerzo OMNI-GSE. Se midió la talla (cm), el peso (kg) e índice de masa corporal. Los niveles de glucosa en sangre fueron determinados antes y después de la sesión. Resultados: Se obtuvo una disminución significativa en los niveles de glucosa en sangre posterior a la realización de la sesión de Entrenamiento Interválico de Alta Intensidad (pre: 140,5 mg/dL y post: 116,1 mg/dL; p < 0,01) Conclusiones: El Entrenamiento Interválico de Alta Intensidad reduce en una sola sesión los niveles de glucosa en sangre en adultos mayores(AU)

Introduction: in recent years, High-Intensity Interval Training has been recognized as a non-pharmacological treatment for diseases like type II diabetes in a variety of populations. However, few studies about this topic have been conducted with elderly people. Objective: determine the acute effect of a High-Intensity Interval Training session on glucose levels in physically active elderly people. Methods: an experimental study was conducted. The sample was 19 elderly people aged 60-85 years. The group participated in a High-Intensity Interval Training session in which strength and cardiovascular resistance exercises were combined. The 12 exercises performed had a duration of 30 seconds' work and 10 seconds' rest. The intensity of the session was controlled with the OMNI-GSE Effort Perception Scale. Measurements were taken of the height (cm), weight (kg) and body mass index of participants. Blood glucose levels were gauged before and after the session. Results: a significant reduction in blood glucose levels was obtained after the conduct of the High-Intensity Interval Training session (pre: 140.5 mg/dl and post: 116.1 mg/dl; p < 0.01). Conclusions: in only one session, High-Intensity Interval Training reduces blood glucose levels in elderly people(AU)

Índice glucosa-triglicéridos como marcador de resistencia a la insulina en pacientes con diagnóstico de hipertensión arterial esencial / Glycemia-triglyceride index as marker of insulin resistance in essential hypertensive patients

Introducción: El índice glucemia-triglicéridos se utiliza para el diagnóstico presuntivo de la resistencia insulínica, que en los pacientes hipertensos se relaciona con la severidad de la hipertensión arterial. Objetivo: Determinar la utilidad del índice glucemia-triglicéridos como marcador de resistencia a la insulina en pacientes adultos con diagnóstico de hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo transversal en 232 pacientes con diagnóstico de hipertensión arterial esencial. Se calculó el índice glucemia-triglicéridos y se comparó con el índice HOMA. Para este análisis se utilizó la curva ROC, la correlación de Pearson y el Índice de Kappa, se consideró significativo un valor de p menor a 0,05. Resultados: Se obtuvo un punto de corte de 8,1 que mostró una sensibilidad de 98,6 con una especificidad de 41,4. La curva ROC mostró un área bajo la curva con valor de 0,694 ≈ 0,7. Se observó correlación positiva (p=0,008) Índice de Kappa=88,4 por ciento. Conclusiones: El índice glucemia-triglicéridos resulto ser útil en pacientes con hipertensión arterial como marcador de resistencia a la insulina con un punto de corte de 8,1(AU)

Introduction: The glycemia-triglyceride index is used for the presumptive diagnosis of insulin resistance, which in hypertensive patients is related to the severity of high blood pressure. Objective: To determine the utility of the glycemia-triglyceride index as a marker of insulin resistance in adult patients diagnosed with essential arterial hypertension. Methods: A descriptive cross-sectional study was carried out in 232 patients diagnosed with essential arterial hypertension. The glycemia-triglyceride index was calculated and compared with HOMA index. For this analysis, ROC curve, Pearson correlation and Kappa index were used, p value less than 0.05 was considered significant. Results: We obtained an 8.1 cut-off point, showing 98.6 sensitivity and 41.4 specificity. The area below the ROC curve showed 0.694 ≈ 0.7 value. Positive correlation was observed (p = 0.008). Kappa index = 88.4 percent. Conclusions: The glycemia-triglyceride index turned out to be useful in patients with essential hypertension as a marker of insulin resistance with a cut-off point of 8.1(AU)

Restrição de carboidratos no manejo do diabetes mellitus tipo 2: revisão crítica de ensaios clínicos randomizados / Carbohydrate restriction in the management of diabetes mellitus type 2: critical review of randomized clinical tests

O diabetes mellitus tipo 2 (DM2) é considerado um dos principais distúrbios metabólicos relacionados ao desenvolvimento de doenças cardiovasculares e outras comorbidades, com elevada incidência e prevalência no Brasil e no mundo. Apesar dos avanços em seu tratamento, a projeção mundial é de aumento no número de diagnósticos. No Brasil, o total de pessoas com a doença cresceu mais de 60% em 10 anos. Como o manejo dietético é um dos pilares no tratamento do DM2, este trabalho objetivou analisar os estudos que compararam as dietas restritas em carboidratos com outras abordagens dietéticas a fim de elucidar se esta seria a opção mais adequada para os pacientes com DM2. Assim, fez-se uma revisão de ensaios clínicos randomizados por meio das plataformas de pesquisa PubMed e Cochrane Library em outubro de 2018, selecionando os estudos segundo a estratégia PICO de pesquisa. Dos 398 artigos encontrados, 19 atenderam os critérios de elegibilidade. Após a análise, demonstrou-se que as dietas restritas em carboidratos favorecem o controle glicêmico, melhora do perfil lipídico e redução dos medicamentos para DM2 em relação às outras opções dietéticas, no entanto, os trabalhos apresentam vieses metodológicos e são, em geral, de curto prazo. Sendo assim, é precipitado afirmar que essas dietas são mais efetivas para o tratamento do DM

Type 2 diabetes mellitus (T2DM) is considered one of the primary metabolic disorders related to the development of cardiovascular diseases and other comorbidities, with high incidence and prevalence in Brazil and in the world. Despite advances in its treatment, an increase in the number of diagnoses is estimated worldwide. In Brazil, the total number of people with the disease has grown more than 60% in 10 years. As dietary management is one of the mainstays in the treatment of T2DM, this study aimed to analyze the studies that compared carbohydrate-restricted diets with other dietary approaches to elucidate if this would be the most appropriate option for patients with T2DM. Thus, randomized clinical trials were reviewed through the PubMed and Cochrane Library research platforms in October 2018, selecting the studies according to the PICO research strategy. Of the 398 articles found, 19 met the eligibility criteria and had their data collected. After the analysis, it was demonstrated that carbohydrate-restricted diets support glycemic control, loss of body mass, improvement of lipid profile and reduction of medications for T2DM compared to other dietary options. However, a significant part of the studies has methodological biases and is generally short-term. Therefore, the level of evidence supporting dietary restriction of carbohydrates in the management of T2DM is considered moderate. Thus, according to the principle of the null hypothesis, it is unwise to affirm that these diets are superior in the treatment of DM2

Esteatosis hepática en pacientes con diabetes tipo 2 y su relación con el control glucémico / Hepatic steatosis in type 2 diabetes patients and its relationship with glycemic control

Introducción: La esteatosis hepática no alcohólica es la enfermedad con mayor frecuencia en el mundo, esta se asocia a diabetes mellitus tipo 2; padecimiento con gran impacto económico-social. Objetivo: Describir el comportamiento de esteatosis hepática en una población de pacientes con diagnóstico de diabetes mellitus tipo 2. Métodos: Se realizó un estudio observacional, descriptivo, transversal en 94 pacientes diabéticos atendidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, en el periodo comprendido entre febrero 2016- febrero 2018. Resultados: La esteatosis fue leve en 42,6 por ciento, moderada (44,7 por ciento) y severa en 12,8 por ciento, en ambos casos, con un NAFLD score principalmente indeterminado (72,3 por ciento). Se detectó fibrosis F0-1 en 58,5 por ciento de los pacientes, F2 (29,8 por ciento) y significativa (F3 y F4) en 11,7 por ciento). Se detectó asociación entre ecogenicidad hepática aumentada, patrón hepático difuso y grado severo de esteatosis por ecografía con mayor grado de fibrosis según elastografía. Se detectó relación significativa de niveles elevados de HBA1C con fibrosis significativa medida tanto por NAFLD score como por elastografía. Conclusiones: La esteatosis hepática presente en los pacientes con diabetes mellitus fue principalmente leve a moderada con prevalencia de fibrosis leve, el grado de fibrosis significativa se asoció con ecogenicidad hepática aumentada, patrón hepático difuso, grado severo de esteatosis por ecografía y niveles elevados de hemoglobina glucosilada(AU)

Introduction: Non-alcoholic liver steatosis is the most frequent disease in the world. It is associated with type 2 diabetes mellitus, representing great economic-social impact. Objective: To describe the behavior of hepatic steatosis in a population of patients diagnosed with type 2 diabetes mellitus. Methods: An observational, descriptive, cross-sectional study was conducted in 94 diabetic patients treated at Hermanos Ameijeiras Clinical Surgical Hospital, from February 2016 to February 2018. Results: Steatosis was mild in 42.6 percent, moderate (44.7 percent) and severe in 12.8 percent, with a mainly indeterminate NAFLD score (72.3 percent). F0-1 fibrosis was detected in 58.5 percent of the patients, F2 (29.8 percent) and significant (F3 and F4) in 11.7 percent). Association between increased liver echogenicity, diffuse liver pattern and severe degree of steatosis were ostensible by ultrasound with higher degree of fibrosis according to elastography. Significant relationship of elevated levels of HBA1C with significant fibrosis was detected, measured both by NAFLD score and by elastography. Conclusions: Hepatic steatosis present in patients with diabetes mellitus was mainly mild to moderate with prevalence of mild fibrosis, the degree of significant fibrosis was associated with increased liver echogenicity, diffuse liver pattern, severe degree of steatosis by ultrasound and high levels of hemoglobin. glycosylated(AU)

Daily intake of a bean-fiber fortified bar reduces oxidative stress

as been proposed that the consumption of common beans (Phaseolus vulgaris L.) reduces cardiovascular risk, and prevents and controls both chronic and degenerative diseases. The aim of this study was to compare the antioxidant capacity of a bean-fiber fortified bar (BFB) versus a commercial bar (CB) in 60 Mexican men and women (18-65 years old), who were randomly distributed in two groups: BFB or CB; individuals consumed a bar a day for one month. Anthropometric data, food intake and blood samples were collected. Glucose tolerance (GTT), lipid profile (PL), and lipid peroxidation (TBARS) tests were performed; carbonyls groups in serum oxidized proteins were also measured. GTT and PL were not different between both groups in either the 15 or 30-day follow-up of bar consumption assessments. There were no significant differences in either TBARS or carbonyl concentration between groups; BFB group showed higher levels of serum lipid peroxidation in basal and fifteen days measurements; these levels decreased at the final evaluation: No differences were detected on carbonyl levels between groups. In conclusion, 30 days of fiber bean bar consumption did not alter glucose or PL levels, while, in the BFF group, oxidative stress decreased within 30 days of the consumption of the fortified bar(AU)

Se ha propuesto que el consumo de frijol común (Phaseolus vulgaris L.) reduce el riesgo cardiovascular, y previene y controla las enfermedades crónicas y degenerativas. El objetivo del presente estudio fue comparar la capacidad antioxidante de una barra fortificada con fibra de frijol (BFB) versus una barra comercial (CB) en 60 hombres y mujeres mexicanos (18-65 años de edad), quienes aleatoriamente fueron distribuidos en dos grupos: El grupo BFB y el CB que consumieron la barras fortificada con frijol y la barra comercial, respectivamente, durante un mes. Se recopilaron datos antropométricos, ingesta de alimentos y muestras de sangre. Se realizó prueba de tolerancia a la glucosa (GTT), el perfil de lípidos (PL), la peroxidación de lípidos (TBARS) y la cuantificación de carbonilos en proteínas oxidadas como pruebas de bioquímica sanguínea. GTT y PL no fueron diferentes entre ambos grupos en la evaluación de seguimiento de 15 y 30 días del consumo de la barra. No hubo diferencias significativas en los TBARS o la concentración de carbonilo entre los grupos, el grupo BFB mostró niveles más altos de peroxidación de lípidos en suero en la fase basal y a los quince días del consumo de la barra; curiosamente, estos niveles disminuyeron en la evaluación final. No se detectaron diferencias en los niveles de carbonilo entre los grupos. En conclusión, 30 días de consumo de barras de fibra de frijol no alteraron los niveles de glucosa o PL; mientras que, en el grupo BFB, el estrés oxidativo disminuyó a los 30 días del consumo de la barra fortificada(AU)

Changes in Cardiac Autonomic Modulation in Women with Breast Cancer Using Aromatase Inhibitors and the Relation with Biochemical Variables / Alterações na Modulação Autonômica Cardíaca em Mulheres com Câncer de Mama em Uso de Inibidores de Aromatase e sua Relação com Variáveis Bioquímicas

Abstract Background: The use of autonomic modulation as a predictor of cardiovascular risk in women with breast cancer is important. Objective: To evaluate the cardiac autonomic modulation of postmenopausal women using aromatase inhibitors for breast cancer treatment, as well as its relation with the following biochemical variables. Methods: Postmenopausal women who did not have breast cancer (n = 33) and postmenopausal women with breast cancer (n = 15). For evaluation of the autonomic modulation the heart rate was recorded beat-to-beat for 30 minutes and the series of RR intervals obtained were used to calculate the following heart rate variability indices: Mean RR ms, SDNN (standard deviation of all normal RR intervals, expressed in milliseconds) ms, Mean HR, RMSSD (square root of the mean of the squared differences between adjacent normal RR interval) ms, NN50 (number of pairs of successive NNs that differ by more than 50 ms) count, pNN50% (proportion of NN50 divided by total number of NNs), RRtri (RR triangular), TINN (triangular interpolation of NN interval) ms, SD1 ms, SD2 ms, LF ms2, HF ms2, LH/HF ms2. The values of biochemical variables (fasting glycemia, triglycerides, HDL-cholesterol, and C-reactive protein) were analyzed by blood sample. Results: Lower values of heart rate variability indices were observed in postmenopausal women with breast cancer in relation to postmenopausal women who did not have breast cancer: Mean RR (p = 0.03); SDNN (p = 0.03); RMSSD (p = 0.03); NN50 count (p = 0.03); pNN50 % (p = 0.03); RRtri (p = 0.02); SD1 (p = 0.01); SD2 (p = 0.02); LF ms2 (p = 0.01); HF ms2 (p = 0.03).There was an inversely proportional correlation between the indices SDNN, SD2, and HFms2 with triglycerides (SDNN p = 0.04; SD2 p = 0.04; HF ms2 p = 0.04). No statistically significant correlations were found between heart rate variability indices and others variables. Statistical significance was set at 5% for all analyses. Conclusion: Women with breast cancer present reduced autonomic modulation and in these women of heart rate variability indices are inversely correlated with triglyceride values.

Resumo Fundamentos: A modulação autonômica como um preditor de risco cardiovascular em mulheres com câncer de mama é importante. Objetivos: Avaliar a modulação autonômica em mulheres pós-menopausa em uso de inibidores de aromatase como tratamento de câncer de mama, e sua relação com algumas variáveis bioquímicas. Métodos: Foram avaliadas mulheres pós-menopausa sem câncer de mama (n = 33) e mulheres pós-menopausa com câncer de mama (n = 15). Para avaliação da modulação autonômica, a frequência cardíaca (FC) foi registrada batimento a batimento por 30 minutos, e as séries de intervalos RR obtidas foram usadas para o cálculo dos seguintes índices de variabilidade da frequência cardíaca: média de RR ms, SDNN (desvio padrão de todos os intervalos RR normais) ms, FC, RMSSD (raiz quadrada da média das diferenças ao quadrado entre os intervalos RR normais adjacentes) ms, contagem NN50 (número de pares de NNs sucessivos que se diferem em mais de 50 ms), pNN50% (proporção de NN50 dividida pelo número total de NNs), RRtri (RR triangular), TINN (interpolação triangular do intervalo NN) ms, DP1 ms, DP2 ms, LF (baixa frequência) ms2, HF (alta frequência) ms2, LH/HF ms2. Os valores das variáveis bioquímicas (glicemia de jejum, triglicerídeos, HDL-colesterol, e proteína C reativa) foram analisadas das amostras de sangue. O nível de significância adotado nas análises estatísticas foi de 5%. Resultados: As mulheres pós-menopausa com câncer de mama apresentaram menores índices de variabilidade da frequência cardíaca em comparação àquelas sem câncer de mama: média de RR (p = 0,03); SDNN (p = 0,03); RMSSD (p = 0,03); contagem NN50 (p = 0,03); pNN50% (p = 0,03); RRtri (p = 0,02), DP1 (p = 0,01), DP2 (p = 0,02); LF ms2 (p = 0,01); HF ms2 (p = -0,03). Observou-se uma correlação inversamente proporcional dos índices SDNN, DP2 e HF ms2 com triglicerídeos (SDNN p = 0,04, DP2 p = 0,04; HF ms2 0,04). Não houve correlação significativa entre os índices de variabilidade da frequência cardíaca e as demais variáveis. Conclusão: Mulheres com câncer de mama apresentam modulação autonômica diminuída e índices de variabilidade da FC inversamente correlacionados com valores de triglicerídeos.

Hipovitaminose D e índices glicêmicos em trabalhadores de turno alternante de empresa de mineração / Hypovitaminosis D and glycemic index in individuals working in rotate shifts of a mining company

Objetivo: Demonstrar a prevalência da hipovitaminose D em trabalhadores de turno de uma empresa de mineração e verificar se, nesta população, há correlação entre as variáveis glicêmicas (hemoglobina glicada e glicemia de jejum) e os níveis séricos de vitamina D. Métodos: Estudo transversal observacional realizado por 2 anos consecutivos com trabalhadores de turno. No primeiro ano, foram analisados os níveis séricos de vitamina D (25(OH)D) e glicemia de jejum, excluindo indivíduos que realizavam tratamento para controle glicêmico, suplementação de vitamina D e/ou participantes do sexo feminino, totalizando 548 trabalhadores. No ano seguinte, foram selecionados da amostra anterior apenas os indivíduos que apresentaram hipovitaminose D (25(OH) D<30ng/mL). Nestes, foram analisados os níveis de 25(OH)D, glicemia de jejum e hemoglobina glicada. Foram aplicados o teste de normalidade Kolmogorov-Smirnov e a correlação de Spearman. Resultados: A idade média dos participantes foi de 38,2 anos. No primeiro ano, 80,8% dos trabalhadores apresentaram hipovitaminose D e 10,8% apresentavam glicemia de jejum fora dos níveis de normalidade. Dentre a amostra do ano seguinte, 81,1% permaneceram com hipovitaminose D, 18,2% apresentaram glicemia de jejum fora dos níveis de normalidade e 15,8% apresentaramhemoglobina glicada alterada. Não foram encontradas correlações significativas entre a 25(OH)D e a glicemia de jejum e hemoglobina glicada. Conclusão: Foi observada alta prevalência de hipovitaminose nos trabalhadores de turno. Diferentemente de outros estudos, não foram encontradas correlações significativas entre as variáveis glicêmicas e a concentração sérica da vitamina D. (AU)

Objective: To demonstrate the prevalence of hypovitaminosis D in shift workers of a mining company, and to check whether, in this population, there is a correlation between glycemic variables (glycosylated hemoglobin and fasting plasma glucose)- and serum levels of vitamin D. Methods: These are cross-sectional observational studies performed in two consecutive years with shift workers. In the first year, the serum levels of vitamin D (25(OH)D) and fasting plasma glucose were analyzed, with people who underwent treatment for glycemic control, vitamin D supplementation, and/or female participants being excluded, totalizing 548 workers. In the following year, only those individuals who presented hypovitaminosis D (25 (OH) D <30 ng/dL) were selected from the previous sample. The levels of 25 (OH) D, fasting plasma glucose, and HbA1C of these individuals were analyzed. The Kolmorogov-Smirnov normality test and the Spearman correlation were applied. Results: Th e m ean a ge o f participants was 38.2 years. In the first year, 80.8% (n=442) of the workers presented hypovitaminosis D, and 10.8% had fasting plasma glucose out of normal levels. Among the sample of the following year, 81.1% remained with hypovitaminosis D, 18.2% (n=51) had fasting glycemia out of normal levels, and 15.8% (n=44) had altered glycosylated hemoglobin. Conclusion: A high prevalence of hypovitaminosis in shift workers was observed. Differently from other studies, no significant correlations were found between glycemic variables and serum vitamin D concentration. (AU)

Association between dietary glycemic index and excess weight in pregnant women in the first trimester of pregnancy / Associação entre o índice glicêmico dietético e o excesso de peso em gestantes no primeiro trimestre de gestação

Abstract Objective To assess the association between dietary glycemic index (GI) and excess weight in pregnant women in the first trimester of pregnancy. Methods A cross-sectional study in a sample of 217 pregnant women was conducted at the maternal-fetal outpatient clinic of the Hospital Geral de Fortaleza, Fortaleza, state of Ceará, Brazil, for routine ultrasound examinations in the period between 11 and 13 weeks + 6 days of gestation.Weight and height were measured and the gestational body mass index (BMI) was calculated. The women were questioned about their usual body weight prior to the gestation, considering the prepregnancy weight. The dietary GI and the glycemic load (GL) of their diets were calculated and split into tertiles. Analysis of variance (ANOVA) or Kruskal-Walls and chi-squared (χ2) statistical tests were employed. A crude logistic regression model and a model adjusted for confounding variables known to influence biological outcomes were constructed. A p-value < 0.05 was considered significant for all tests employed. Results The sample group presented a high percentage of prepregnancy and gestational overweight (39.7% and 40.1%, respectively). InthetertilewiththehigherGIvalue, therewasa lower dietary intake of total fibers (p = 0.005) and of soluble fibers (p = 0.008). In the third tertile, the dietary GI was associated with overweight in pregnant women in the first trimester of gestation, both in the crude model and in the model adjusted for age, total energy intake, and saturated fatty acids. However, this association was not observed in relation to the GL. Conclusion A high dietary GI was associated with excess weight in women in the first trimester of pregnancy.

Resumo Objetivo Avaliar a associação entre índice glicêmico (IG) dietético e presença de excesso de peso em gestantes no primeiro trimestre de gestação. Métodos Estudo transversal realizado com 217 gestantes atendidas no Ambulatório de Medicina Materno-Fetal do Hospital Geral de Fortaleza, Fortaleza, CE, para realização de exames ultrassonográficos de rotina no período entre 11 e 13 semanas e 6 dias de gestação. Peso e altura foram obtidos para o cálculo do índice de massa corporal (IMC) gestacional. As mulheres foram questionadas quanto ao peso corporal habitual anterior à gestação, considerado o peso pré-gestacional. O IG e a carga glicêmica (CG) das suas dietas foram calculados e divididos em tercis. As associações foram investigadas por análise de variância (ANOVA, na sigla em inglês) ou pelos testes Kruskal-Walls e qui-quadrado (χ2). Resultados O grupo tinha alto percentual de excesso de peso pré-gestacional (39,7%) e gestacional (40,1%). Houve menor consumo de fibras totais (p = 0,005) e fibras insolúveis (p = 0,008) no tercil de maior valor de IG. No terceiro tercil, o IG da dieta foi associado ao excesso de peso dasmulheres no primeiro trimestre de gestação, tanto no modelo bruto como no modelo ajustado para idade, consumo total de energia e de ácidos graxos saturados. No entanto, não se observou esta associação emrelação à CG. Conclusão O alto IG da dieta consumida foi associado ao excesso de peso das mulheres no primeiro trimestre da gestação.