Síndrome metabólica, consumo de alimentos ultraprocessados e bebidas adoçadas em adolescentes / Metabolic syndrome, consumption of ultra-processed foods and sweetened beverages in adolescents

A síndrome metabólica é caracterizada pela presença concomitante de alteração na glicemia, dislipidemia, elevação da pressão arterial e adiposidade excessiva, os quais elevam o risco cardiovascular. O objetivo deste trabalho foi analisar os parâmetros da síndrome metabólica e a associação com o consumo de alimentos ultraprocessados e bebidas adoçadas em adolescentes com excesso de peso. Realizou-se um estudo transversal, conduzido com 67 adolescentes com excesso de peso, de um ambulatório pediátrico de um hospital público no município de São Paulo. A avaliação antropométrica consistiu na aferição de peso, estatura e circunferência da cintura. Foram coletados dados de glicose, triglicérides, HDL-c, e pressão arterial, e a síndrome metabólica (SM) analisada de acordo com critérios da Associação Brasileira de Nutrologia. O consumo alimentar foi avaliado pelo questionário de frequência alimentar semiquantitativo. A prevalência de síndrome metabólica foi de 56,7%. Os parâmetros mais prevalentes foram redução de HDL-c (71,6%), elevação da pressão arterial sistólica (70,1%) e da glicemia de jejum (64,2%). Observou-se correlação positiva entre a glicemia de jejum e o consumo de alimentos ultra processados e bebidas adoçadas.

Metabolic syndrome is characterized by the concomitant presence of changes in blood glucose, dyslipidemia, elevated blood pressure and excessive adiposity, which increase cardiovascular risk. The objective of this study was to analyze the parameters of metabolic syndrome and the association with the consumption of ultra-processed foods and sweetened beverages in overweight adolescents. A cross-sectional study was carried out with 67 overweight adolescents from a pediatric outpatient clinic of a public hospital in the city of São Paulo. The anthropometric assessment consisted of measuring weight, height and waist circumference. Data on glucose, triglycerides, HDL-c, and blood pressure were collected, and metabolic syndrome (MS) was analyzed according to criteria from the Brazilian Association of Nutrology. Food consumption was assessed using the semi-quantitative food frequency questionnaire. The prevalence of metabolic syndrome was 56.7%. The most prevalent parameters were a reduction in HDL-c (71.6%), and an increase in systolic blood pressure (70.1%) and fasting blood glucose (64.2%). Blood glucose was positively associated with the sweetened beverage consumption score and BMI. It is concluded that there is a high prevalence of metabolic syndrome in adolescents, with glycemia being associated with the consumption of sweetened beverages.

Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus / Avaliação das características do sono em crianças e adolescentes portadores de diabetes melito tipo 1

ABSTRACT Objective: To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control. Methods: A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics. Results: The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex. Conclusions: Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.

RESUMO Objetivo: Avaliar as características do sono em crianças e adolescentes portadores de diabetes melito tipo 1 (DM1) e sua relação com o controle glicêmico. Métodos: Estudo transversal realizado em um hospital público de São Paulo. A amostra foi composta de 86 portadores de DM1 entre 10 e 18 anos, aderentes à insulinoterapia, com monitoração mínima de três glicemias capilares ao dia e função tireoidiana normal. Foram avaliados os dados clínicos, antropométricos e laboratoriais de cada paciente. Utilizaram-se a Escala de Sonolência Diurna Pediátrica (ESDP) e o Questionário de Cronotipo de Munique (QCTM). Resultados: A média de hemoglobina glicada (HbA1c) foi 9,2±2,1%, sendo maior em adolescentes. A média do escore da ESDP foi 13,9±4,7. Pacientes com HbA1c<7,5% tiveram menor escore na ESDP e maior duração do sono em dias de semana do que pacientes com HbA1c≥7,5%. Verificaram-se correlações negativas da HbA1c com valores do cronotipo e com duração do sono em dias de semana e correlação positiva da HbA1c com jet lag social. Pacientes com tempo de DM1 menor que três anos tiveram maior prevalência de sonolência diurna. A análise de regressão apontou que, quanto maior a HbA1c e menor o tempo de diagnóstico de DM1, maior a chance de sonolência diurna, independentemente de idade e sexo. Conclusões: Pacientes com HbA1c mais elevada apresentaram mais sonolência diurna, cronotipo matutino, menor duração do sono em dias de semana e maior jet lag social. O menor tempo de diagnóstico de DM1 e HbA1c≥7,5% aumentaram a chance de maior sonolência diurna.

Characteristics of type 1 diabetes mellitus in children and adolescents with Down's syndrome in an admixed population

ABSTRACT Objective: People with Down's syndrome (DS) have a higher risk of developing type 1 diabetes mellitus (T1D) and may have specific clinical features compared to T1D patients without DS. This study evaluated the clinical and laboratory aspects of T1D in children and adolescents with DS in an admixed population. Subjects and methods: A case-control study comparing patients with T1D and DS (T1D+DS) to patients with T1D without DS (T1D controls) from two tertiary academic Hospitals in São Paulo, Brazil. Results: The sample consisted of 9 patients with T1D+DS and 18 T1D age and sex-matched controls. Anti-glutamic acid decarboxylase 65 antibodies were positive in 7/7 of the 9 T1D+DS patients, confirming the presence of diabetes autoimmunity in this group. Mean age at diagnosis of T1D was 4.9 ± 3.9 years in the T1D+DS group and 6.4 years ± 3 in the T1D control group; early diagnosis (<2 years old) occurred in three T1D+DS patients but only in one T1D control patients, both suggesting lower age of diagnosis in T1D+DS group, although without statistical significance (p = 0.282 and p = 0.093, respectively). The T1D+DS group presented lower total insulin dose (0.7 IU/kg/day ± 0.2) and HbA1c (7.2% ± 0.6) than the control group (1.0 IU/kg/day ± 0.3 and 9.1% ± 0.7, respectively) (p = 0.022 and p = 0.047, respectively). Conclusion: We confirmed the autoimmune etiology of diabetes in people with DS in this admixed population. T1D+DS patients developed diabetes earlier and achieved better metabolic control with a lower insulin dose than T1D controls. These findings are in agreement with previous studies in Caucasian populations.

Aplicação da cromatografia líquida de alta eficiência para quantificação direta da 17`alfa'-hidroxiprogesterona sérica / Application of reversed-phase liquid-cromatography (RP-HPLC) to direct quantification of 17-`alpha'-hydroxyprogesterone in serum

A determinação dos níveis séricos de 17`alfa'-hidroxiprogesterona (17OHP) é essencial no diagnóstico laboratorial da hiperplasia adrenal congênita (CAH) por deficiência de 21-hidroxilase. Essa condição é responsável por pseudo-hermaffroditismo em meninas e precocidade sexual em ambos os sexos. A 17OHP foi quantificada diretamente empregando-se cromatografia líquida de alta eficiência no modo fase reversa (RP-HPLC) em amostras de soro previamente extraídas com éter. Utilizou-se coluna ODS-Hypersil® e fase móvel composta de água-metanol (4:6 v/v) com vazão de 1,0 mL/min. A determinação deu-se em 246 nm. A 17OHP apresentou tempo de retenção de 5,6 min. O método mostrou-se eficaz e eficiente com sensibilidade e linearidade (r²=0,9993) na faixa de concentração estudada de 500 a 100.000 ng/dL...