Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study

Abstract Background: There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly. Objectives: To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease. Methods: Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%. Results: In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls.

Relationship between skeletal muscle mass loss and metabolic dysfunction-associated fatty liver disease among Chinese patients with metabolic dysregulation

SUMMARY OBJECTIVE: The aim of this study was to explore the correlation between skeletal muscle content and the presence and severity of metabolic dysfunction-associated fatty liver disease in patients with metabolic dysregulation in China. METHODS: A cross-sectional study was conducted among patients from the endocrinology outpatient department at Ningbo First Hospital, in Ningbo, China, in April 2021. Adult patients with metabolic dysregulation who accepted FibroScan ultrasound were included in the study. However, those without clinical data on skeletal muscle mass were excluded. FibroScan ultrasound was used to noninvasively evaluate metabolic dysfunction-associated fatty liver disease. The controlled attenuation parameter was used as an evaluation index for the severity of liver steatosis. Bioelectrical impedance analysis was used to measure the skeletal muscle index. RESULTS: A total of 153 eligible patients with complete data were included in the final analysis. As the grading of liver steatosis intensifies, skeletal muscle index decreases (men: Ptrend<0.001, women: Ptrend=0.001), while body mass index, blood pressure, blood lipid, uric acid, aminotransferase, and homeostatic model assessment of insulin resistance increase (Ptrend<0.01). After adjusting for confounding factors, a negative association between skeletal muscle index and the presence of metabolic dysfunction-associated fatty liver disease was observed in men (OR=0.691, p=0.027) and women (OR=0.614, p=0.022). According to the receiver operating characteristic curve, the best cutoff values of skeletal muscle index for predicting the metabolic dysfunction-associated fatty liver disease presence were 40.37% for men (sensitivity, 87.5%; specificity, 61.5%) and 33.95% for women (sensitivity, 78.6%; specificity, 63.8%). CONCLUSION: Skeletal muscle mass loss among patients with metabolic dysregulation was positively associated with metabolic dysfunction-associated fatty liver disease severity in both sexes. The skeletal muscle index cutoff value could be used to predict metabolic dysfunction-associated fatty liver disease.

Use of FGF21 analogs for the treatment of metabolic disorders: a systematic review and meta-analysis

ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far.

Efectividad del uso de la entrevista motivacional en la consulta de nutrición sobre el riesgo cardiometabólico de pacientes con trastorno bipolar / Effectiveness of the motivational interviewing on cardiometabolic indicators of patients with bipolar disorder

Resumen El propósito de este trabajo fue evaluar la efectividad de la entrevista motivacional en la consulta de nutrición sobre indicadores de riesgo cardiometabólico en pacientes con trastorno bipolar. Se realizó un estudio experimental en que el grupo control recibió orientación nutricional basada en planes de alimentación y el grupo de intervención recibió consulta nutricional incorporando los principios y habilidades de la entrevista motivacional. Los participantes fueron seguidos por tres meses y se realizaron evaluaciones de hábitos alimenticios, actividad física, riesgo cardiometabólico, composición corporal y calidad de vida. El grupo de entrevista motivacional redujo el consumo de carnes (B=-0.45, p=0.032) y embutidos (B=-0.60, p=0.002). Asimismo, la presión arterial diastólica (B=-6.97, p=0.029) y glucemia (B=-9.27, p=0.097) de estos pacientes tendieron a disminuir. La entrevista motivacional promueve cambios que pueden hacer una diferencia clínica; aun en reducidos periodos de tiempo. Los nutriólogos capacitados para su implementación disponen de una herramienta adicional para el manejo de comorbilidad cardiometabólica en población vulnerable.

Abstract The purpose of this work was to assess the effectiveness of the motivational interviewing in the nutrition consultation on indicators of cardiometabolic risk in patients with bipolar disorder. An experimental study was conducted in which the control group receives nutritional guidance based on feeding plans and the intervention group received nutritional consultation incorporating the principles and skills of the motivational interviewing. Participants were followed by three months and evaluations of eating habits, physical activity, cardiometabolic risk, body composition and quality of life were carried out. The motivational interviewing group reduced the consumption of meats (B=-0.45, p=0.032) and sausages (B=-0.60, p=0.002). Likewise, the diastolic blood pressure (B=-6.97, p=0.029) and glycemia (B=-9.27, p=0.097) of these patients tended to decrease. Motivational interviewing promotes changes that can make a clinical difference, even in short periods of time. Nutritionists trained for its implementation have an additional tool for the management of cardiometabolic comorbidity in a vulnerable population.

Experiencias infantiles adversas y síndrome metabólico en adultos de una unidad de medicina familiar en Michoacán, México / Adverse childhood experiences and metabolic syndrome in adults in a family medicine unit Michoacán, Mexico

Introducción: las experiencias infantiles adversas (EIA) aumentan el riesgo de enfermedades metabólicas en la edad adulta; no obstante, esta relación ha sido poco estudiada en la población mexicana Objetivos: determinar la frecuencia de experiencias infantiles adversas (EIA) y su relación con el síndrome metabólico en personas mayores de 19 años de edad en una unidad de medicina familiar urbana en Michoacán, México. Metodología: se realizó un estudio observacional, retrospectivo, transversal y analítico en 127 participantes mayores de 19 años. Se evaluaron sus medidas antropométricas, y cuantificamos los niveles de glucosa en ayuno, triglicéridos y colesterol HDL en sangre. Aplicamos el cuestionario internacional de experiencias infantiles adversas (ACE-IQ). Utilizamos estadística descriptiva y la prueba de Chi cuadrada. Resultados: el 95% de la muestra reportó al menos una EIA, y la más frecuente fue la violencia doméstica. El 45% de los individuos presentaron síndrome metabólico. No se encontró asociación entre el síndrome metabólico ni los componentes con la exposición a las EIA. No obstante, observamos que el divorcio o pérdida de uno de los padres fue más frecuente en los participantes con síndrome metabólico (p = 0.03). Conclusiones: la frecuencia de EIA fue mucho más alta que lo previamente reportado, pero no se observó una asociación con el síndrome metabólico... (AU)

Introduction: Adverse childhood experiences (ACE) increase the risk of metabolic diseases in adulthood; however, this relationship has been scarcely studied in the Mexican population. Objective: To determine the frequency of adverse childhood experiences and their relationship to metabolic syndrome in an urban Primary Care Unit from Michoacán, México. Methods: An observational, retrospective, cross-sectional and analytical study was performed in 127 participants older than 19 years. Their anthropometric measurements were evaluated, and we quantified the blood levels of fasting glucose, triglycerides, and HDL cholesterol. The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was utilized. We used descriptive statistics and the Chi square test. Results: 95% of the sample reported at least one EIA, and the most frequent was domestic violence. 45% of individuals presented metabolic syndrome. No association was found between the metabolic syndrome or its components with the exposure to EIA. However, we observed that divorce or loss of one of the parents was more frequent in the participants with metabolic syndrome (p = 0.03). Conclusions: The frequency of EIA was much higher than previously reported, however, we did not observe an association of ACE with metabolic... (AU)

Frecuencia de síndrome metabólico en adultos mayores de la ciudad El Alto-Bolivia, gestión 2019 / Frequency of metabolic syndrome among elderly people in the city of El Alto, Bolivia, in 2019

INTRODUCCIÓN: el síndrome metabólico es una entidad compleja, compuesta por factores de riesgo cardiaco como: Obesidad, Diabetes. Hipertensión, dislipemia etc. OBJETIVO: determinar la frecuencia de síndrome metabólico en adultos mayores de la ciudad El Alto, durante la gestión 2019. METODOLOGÍA: investigación transversal cuantitativa, se evaluaron a 124 individuos, reclutados en Auki Utas por el gobierno autónomo municipal de El Alto, mediante coordinación con la Unidad de Protección al Adulto Mayor, durante la gestión 2019. Previo consentimiento informado, se determinó antropometría, tensión arterial, toma de muestra de sangre venosa, para procesamiento de pruebas bioquímicas, (glucemia, triglicéridos, colesterol total, HDL colesterol y LDL colesterol). RESULTADOS: el 62% (77/124) de la población estudiada se encuadra dentro del diagnóstico de síndrome metabólico, presentando datos alterados en por lo menos tres de los criterios evaluados. CONCLUSIONES: la población estudiada presenta altos porcentajes de síndrome metabólico, con mayor tendencia a la obesidad e hipertensión, por lo que es importante la promoción y prevención, ya que el sobrepeso y obesidad son factores de riesgo para la resistencia a la insulina, determinante de los demás criterios (marcadores), actividades de promoción y prevención son necesarias en la ciudad de El Alto, para evitar morbimortalidad por síndrome metabólico

INTRODUCTION: metabolic syndrome is a complex entity, composed of cardiac risk factors such as: obesity, diabetes. hypertension, dyslipidemia, etc. OBJECTIVE: determine a baseline regarding metabolic syndrome in older adults in the El Alto city, which can be used in the future to carry out potential preventive interventions. METHODOLOGY: quali-quantitative research, studied 124 individuals, recruited in Auki Utas by the Autonomous Municipal Government of El Alto city, through coordination with the Protection Unit for the Elderly, during the 2019 administration. Prior informed consent, anthropometry was determined blood pressure, venous blood sampling, for processing biochemical tests (blood glucose, triglycerides, cholesterol, HDL and LDL). RESULTS: 62% (77/124) of the studied population falls within the diagnosis of metabolic syndrome, presenting altered data in at least three of the evaluated entities. CONCLUSIONS: the population studied presents high percentages of metabolic syndrome, with a greater tendency to obesity and hypertension, so promotion and prevention is important, since overweight and obesity are risk factors for insulin resistance, a determinant of the other criteria (markers), promotion and prevention activities are necessary in the El Alto city, to avoid morbidity and mortality due to metabolic syndrome

Repercusión del síndrome metabólico sobre el crecimiento de fetos de ratas Wistar / Repercussion of the metabolic syndrome on the growth of Wistar rat fetuses

Introducción: El síndrome metabólico es un conjunto de anomalías metabólicas como obesidad, dislipidemia, intolerancia a la glucosa e hipertensión arterial. Se realizó estudio experimental, longitudinal prospectivo en la Unidad de Toxicología Experimental de Villa Clara, periodo septiembre del 2016 y julio del 2019. Objetivo: Evaluar las modificaciones del crecimiento de los fetos de ratas con síndrome metabólico, con respecto al grupo control. Métodos: Se crearon dos grupos, uno de control y otro de estudio con síndrome metabólico inducido. Las variables estudiadas fueron: peso, talla y diámetros craneanos. Se utilizó el programa Excel 2010 y el SPSS versión 15.0 para Windows, la prueba Chi Cuadrado, y como estadístico de decisión, la significación de Monte Carlo. Resultados: Los fetos de ratas con síndrome metabólico inducido tuvieron mayor peso y talla. Conclusiones: El síndrome metabólico influyó en la ganancia del peso y la talla en los fetos en vida prenatal, al incrementar la probabilidad de macrosomía al momento del nacimiento.

Introduction: metabolic syndrome is a group of metabolic abnormalities such as obesity, dyslipidemia, glucose intolerance and arterial hypertension. An experimental, longitudinal and prospective study was carried out in the Villa Clara Experimental Toxicology Unit from September 2016 to July 2019. Objective: to evaluate the changes in the growth of rat fetuses with metabolic syndrome, with respect to the control group. Methods: two groups with induced metabolic syndrome were created, one for control and the other for study. Weight, height and cranial diameters were the studied variables. The Excel 2010 program and SPSS version 15.0 for Windows and the Chi Square test were used, as well as the Monte Carlo significance as statistical decision. Results: rat fetuses with induced metabolic syndrome had greater weight and height. Conclusions: the metabolic syndrome influenced the weight and height gain in prenatal fetuses, increasing the probability of macrosomia at birth.

The Role of Metabolic Syndrome Components in Sensorineural Hearing Loss in Adolescents: A Case-Control Study

Abstract Introduction Metabolic syndrome (MetS) and its associated components were reported as a possible cause of inner ear dysfunction. However, research about the influence of cardiovascular risk factors on hearing thresholds are conducted mainly in adult patients. Objective The aim of the present study was to investigate auditory function in adolescents with MetS compared with healthy controls. Methods One hundred adolescents with metabolic syndrome and 200 sex- and age-matched controls were recruited from a university pediatric endocrine clinic from May 2018 to July 2020. Hearing loss was defined as hearing level ≥ 15 dB at speech frequency (SFHL) or high frequency (HFHL) in one or both ears. A multivariable conditional logistic regression analysis examined the correlation between MetS components and several important demographic characteristics, and hearing loss. Results A total of 165 (55.0%) boys and 135 (45.0%) girls participated in this study. The rates of SFHL and HFHL in adolescents with MetS were 32.0% and 51.0%, respectively. Those values for controls were 5.0% and 15.5%, respectively. The regression analysis showed high triglycerides as a significant predictor for SFHL (odds ratio 10.87; 95% confidence interval: 1.98, 59.74). Neither predictor of interest was significant for HFHL. Conclusion Hypertriglyceridemia may be an important factor in the pathogenesis of SFHL. However, the strength of the association was not significant with a wide confidence interval. Also, we were unable to find an association between predictors and HFHL with the current sample size. Larger and prospective studies are recommended.

Asma em adolescentes: o que o estudo ERICA nos mostrou? / Asthma in adolescents: what did ERICA study show us?

A asma é uma doença heterogênea caracterizada pela história de sintomas respiratórios que variam de intensidade e ao longo do tempo. Devido à sua alta prevalência, constitui um problema mundial de saúde pública, atingindo todas as faixas etárias, em especial crianças e adolescentes. O objetivo deste artigo foi analisar as produções científicas sobre asma baseadas no Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). Trata-se de uma revisão narrativa incluindo os artigos originais sobre asma baseados nos dados do ERICA, publicados em periódicos indexados em inglês e português. O ERICA foi um estudo multicêntrico nacional realizado em 2013 e 2014, que investigou a prevalência de asma e fatores de risco cardiovascular, incluindo obesidade, diabetes mellitus, hipertensão arterial sistêmica, dislipidemia, tabagismo, sedentarismo, hábitos alimentares inadequados, e a associação entre esses fatores, em adolescentes de 12 a 17 anos, estudantes de escolas públicas e privadas de municípios brasileiros com mais de 100.000 habitantes. Nos cinco estudos selecionados, foi possível demonstrar que a prevalência de asma foi significativamente maior entre adolescentes do sexo feminino em todas as capitais e macrorregiões do Brasil, com predomínio da doença na região Sudeste do nosso país. Além disso, a asma esteve fortemente associada ao tabagismo (passivo e ativo) e foi associada à duração curta do sono. Por outro lado, não esteve associada com os níveis séricos de vitamina D. Em relação aos parâmetros metabólicos, foi observado que a síndrome metabólica e alguns de seus componentes, como a circunferência abdominal, estiveram significativamente associados à asma grave em adolescentes brasileiros.

Asthma is a heterogeneous disease characterized by a history of respiratory symptoms that vary in intensity and over time. Due to its high prevalence, asthma is considered a global public health problem affecting all age groups, especially children and adolescents. This study aimed to analyze scientific papers on asthma based on the Study of Cardiovascular Risks in Adolescents (ERICA). We provide a narrative review of original articles on asthma based on ERICA data published in indexed journals in English and Portuguese. ERICA was a national multicenter study conducted in 2013 and 2014 that investigated the prevalence of asthma and cardiovascular risk factors, including obesity, diabetes mellitus, systemic arterial hypertension, dyslipidemia, smoking, sedentary lifestyle, and inadequate eating habits, and the association between these factors in adolescents aged 12 to 17 years, students from public and private schools in Brazilian cities of more than 100,000 population. In the 5 selected studies, the prevalence of asthma was significantly higher in female adolescents in all capitals and macro-regions of Brazil, occurring predominantly in the southeast region of the country. In addition, asthma was strongly associated with smoking (passive and active) as well as with short sleep duration, but not with serum vitamin D levels. Regarding metabolic parameters, metabolic syndrome and some of its components, such as waist circumference, were significantly associated with severe asthma in Brazilian adolescents.

Índices de fibrosis en el seguimiento de la enfermedad hepática grasa no alcohólica / Fibrosis indices in non-alcoholic fatty liver disease follow-up

Introducción: La enfermedad hepática grasa no alcohólica es una afección clínica- morfológica que se caracteriza por una infiltración grasa del hígado en más de un 5 %; tiene dos estadios: esteatosis simple y esteatohepatitis, la cual puede progresar a: fibrosis, cirrosis y hepatocarcinoma. Objetivo: Determinar la relación entre las variables clínicas y epidemiológicas con esta enfermedad, así como los índices de fibrosis y su relación. Métodos: Se realizó un estudio descriptivo con diseño transversal en los pacientes atendidos en la consulta de hígado y vías biliares del Hospital Universitario « Dr. Celestino Hernández Robau», en la etapa de enero- diciembre de 2017. Se trabajó con una población conformada por 60 pacientes, mayores o igual a 20 años de edad, con diagnóstico de enfermedad hepática grasa no alcohólica primaria, sobrepesos u obesos. Resultados: Predominó el grupo etario entre 50-59 años de edad, del sexo femenino, obesos y con esteatosis grado I. Se constató que el 73,33% de los pacientes tenían síndrome metabólico y en ellos prevaleció el grado II de esteatosis. Al relacionar los riesgos de fibrosis se encontraron 28 pacientes con riesgo indeterminado y alto en las clasificaciones FIB-4 y NFS, respectivamente, y 5 presentaron alto riesgo en ambas variables. Los índices de FIB-4 y NFS tuvieron una correlación significativa, directamente proporcional y considerable. Conclusiones: La correlación detectada entre los índices FIB-4 y NFS reafirmó el valor en la detección de sospecha de fibrosis y orientó, en la práctica clínica, la conducta ante los diferentes pacientes con esta afección.

Introduction: non-alcoholic fatty liver disease is a clinical and morphological condition characterized by fatty infiltration of the liver in more than 5%; it has two stages: simple steatosis and steatohepatitis, which can progress to fibrosis, cirrhosis and hepatocellular carcinoma. Objective: to determine the relationship between clinical and epidemiological variables with this disease, as well as fibrosis indices and their relationship. Methods: a cross-sectional descriptive study was carried out in patients seen in the liver and biliary tract consultation at " Dr. Celestino Hernández Robau" University Hospital from January to December 2017. We worked with a population made up of 60 overweight or obese patients older than or equal to 20 years who were diagnosed with primary non-alcoholic fatty liver disease. Results: the age group between 50-59 years of age, female gender, obese ones and with grade I steatosis prevailed. We found that 73.33% of the patients had metabolic syndrome and grade II steatosis prevailed in them. A number of 28 patients were found with indeterminate and high risk in the FIB-4 and NAFLD classifications, respectively, when relating the risks of fibrosis, as well as 5 had high risk in both variables. The FIB-4 and NAFLD indices had a significant, directly proportional, and considerable correlation. Conclusions: the correlation detected between the FIB-4 and NAFLD indices reaffirmed the value in the detection of suspected fibrosis and guided, in clinical practice, the conduct of different patients with this condition.

Características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico: Serie de casos / Clinical-epidemiologic characteristics of patients with non-alcoholic fatty liver disease: Case series

Fundamento: El hígado graso no alcohólico es la enfermedad hepática por depósito de grasa en ausencia de un consumo significativo de alcohol. La mayoría de los pacientes tienen un nexo epidemiológico común asociado a factores de riesgo metabólico. Objetivo: Describir características clínico epidemiológicas de pacientes con enfermedad por hígado graso no alcohólico. Metodología: Se realizó un estudio descriptivo de una serie de casos en la consulta de Gastroenterología del Hospital General Provincial "Camilo Cienfuegos" de Sancti Spíritus, durante el período 6 de mayo de 2019 al 6 de mayo de 2020. Se consideró un total de 1167 pacientes pertenecientes a la provincia Sancti Spíritus; a 346 pacientes se le diagnosticó esteatosis hepática por ultrasonido; la muestra se conformó por 114 pacientes que cumplieron con los criterios de inclusión. Resultados: La mayoría de los pacientes con la enfermedad eran sintomáticos, hombres y tenían comorbilidad como la hipertensión arterial y obesidad, el índice de masa corporal y el índice de cintura abdominal/cadera estaban elevados en el sexo femenino, las alteraciones en la química sanguínea fueron colesterol y triacilglicéridos. Conclusiones: Predominó en el sexo masculino y la comorbilidad con la HTA y la obesidad, y la dislipidemia, además los hábitos alimenticios inadecuados y el sedentarismo; las medidas antropométricas resultaron elevadas en el sexo femenino.

Background: Nonalcoholic fatty liver disease is a resulting from fat accumulation in the absence of significant alcohol consumption. Most patients have a common epidemiologic link associated with metabolic risk factors. Objective: To describe the clinical and epidemiologic characteristics of patients with nonalcoholic fatty liver disease. Methodology: A descriptive study of a series of cases was carried out in the Gastroenterology consultation of the "Camilo Cienfuegos" Provincial General Hospital of Sancti Spíritus, during the period from May 6, 2019 through May 6, 2020. A total of 1167 patients belonging to the province of Sancti Spiritus were included in the study; 346 patients were diagnosed with hepatic steatosis by means of ultrasound; the sample consisted of 114 patients who fulfilled the inclusion criteria. Results: Most patients with the disease were symptomatic, men, and had comorbidities including hypertension and obesity, the body mass index and the waist-to-hip ratio of the abdomen were increased in women., the blood chemistry changes were cholesterol and triacylglycerides. Conclusions: It predominated in the male sex and comorbidity with HBP and obesity and dyslipidemia, in addition to inadequate dietary habits and sedentary lifestyle; in women, the anthropometric measurements were high.

Clinical and metabolic characteristics of males with early-onset androgenetic alopecia

Background: Men with early-onset androgenetic alopecia (AGA) often have an abnormal hormonal milieu. Objective: To ascertain the clinico-phenotypic characteristics and the prevalence of hormonal and metabolic changes in men with early-onset AGA. Methods: Consecutive male patients less than 30 years of age with a Norwood-Hamilton grade ?3 AGA were recruited in this comparative cross-sectional study. After endocrine evaluation they were classified into two groups, that is, Group A consisting of subjects with an altered hormonal profile and Group B with normal hormonal profiles. The groups were assessed for differences in disease phenotype and severity (Norwood-Hamilton grade), insulin resistance and parameters of metabolic syndrome (ATP III guidelines). Results: Altered hormonal profiles were seen in 34 of the 100 subjects with AGA, while insulin resistance and metabolic syndrome were noted in 44 and 26 respectively. Altered hormonal profiles were significantly associated with insulin resistance and severe alopecia (grade 4 and above Hamilton-Norwood Scale). Insulin resistant Group A patients had a significantly higher prevalence of severe alopecia (>grade 4) (P = 0.0036). The prevalence of metabolic syndrome was similar in both groups. Limitation: The cross sectional study design was a drawback of this study. Further, a control arm without AGA was not included and the sample size of 100 was selected arbitrarily. Conclusion: An altered hormonal profile and insulin resistance was noted in a third of the males with early-onset AGA. Subjects with altered hormonal profiles had a higher prevalence of insulin resistance and were likely to have severe grades of AGA

Association of acanthosis nigricans with metabolic syndrome - An analytic cross-sectional study

Abstract Background: Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. Objectives: To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. Material and methods: This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. Results: The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. Study limitations: The small sample size and single-center data are the limitations of the present study. Conclusion: AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.

Effect of clinical treatments for metabolic syndrome on albuminuria: a systematic review protocol

Introduction:Metabolic syndrome (MetS) predicts cardiovascular disease, and patients with this condition and type 2 diabetes have increased albuminuria, significantly impacting cardiovascular mortality and kidney disease progression. A considerable number of interventions to control MetS exist and are considered efficient, including the use of medication and changes in lifestyle. However, which approaches are effective in controlling albuminuria remains unclear. This systematic review protocol aims to map in the available literature whether lifestyle, medication, and surgical intervention for MetS have an impact on reducing albuminuria in adult patients. Methods: The Joanna Briggs Institute methodology for systematic reviews will be followed. Cochrane Database of Systematic Reviews, Scopus, Embase, and MEDLINE/PubMed databases will be used. For the Gray Literature, the DART-Europe E-theses Portal. There will be no language restriction. Studies written after 2009 will be included due to the consensus and definition of metabolic syndrome. This review will include studies considering pharmacological and non-pharmacological treatments for controlling albuminuria in patients with MetS. Studies where MetS is described in children and adolescents, animals, pregnant women, and patients with type 1 diabetes will be excluded. First, the selection will be based on reading the title and summary of the texts retrieved in the search strategy, followed by reading the relevant texts in full by two reviewers. After the selection of the studies, the extraction of the data, analysis, and synthesis will be conducted according to the JBI methodology

USPSTF and ISPAD Guidelines on Screening for Prediabetes and Type 2 Diabetes in Children and Adolescents

The rising trends of obesity, metabolic syndrome and diabetes in adults are worrisome globally. The majority of antecedents to adult noncommunicable diseases begin in childhood. Type 2 diabetes is recognized as one of the major diseases that contribute to the NCD burden in childhood. Recently, the US Preventive Services Task Force (USPSTF) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) released their guidelines on diagnosis and management of prediabetes and diabetes in children targeted screening for youth-onset type 2 diabetes is suggested in at-risk children (obese, positive family history of type 2 diabetes, etc.), while the role of screening asymptomatic children is not substantiated. Obesity and insulin resistance are important risk factors for type 2 diabetes. The cutoffs of fasting plasma glucose for the diagnosis of prediabetes and diabetes are >100 to 125 and ?126 mg/dL, respectively. This update briefly summarizes the recommendations on screening for youth-onset prediabetes and type 2 diabetes.

Association of Dietary Inflammatory Potential in Metabolically Healthy and Metabolically Unhealthy Obese Individuals

Abstract Introduction: Currently, two types of phenotypes have been recognized in individuals who are obese. Among the factors related to lifestyle, diet has a relevant influence, although there is no consensus regarding the role of diet in metabolic phenotypes; furthermore, diet is a strong moderator of chronic systemic inflammation. Objective: Investigate dietary inflammatory potential between metabolic phenotypes and to compare the differences between anti-inflammatory and pro-inflammatory diets in individuals with the same phenotype. Methods: This is a cross-sectional observational study that utilized the database of 533 individuals divided into 4 groups, according to metabolic phenotype and dietary inflammatory characteristic. Sociodemographic, clinical, anthropometric and biochemical characteristics were evaluated and the inflammatory index of the diet was calculated. Results: The mean Dietary Inflammatory index (DII) of the total sample was 0.974±1.02, with a maximum of 4.34 and a minimum of −1.74. In the metabolically unhealthy groups, we found a statistical difference in relation to systolic blood pressure when comparing the anti-inflammatory [median 120 (110.0-130.0)] and pro-inflammatory diets [median 130 (120.0-140.0); p = 0.022], and mean isoprostane concentrations were lower in the metabolically healthy group with anti-inflammatory diet. In regression analysis, the only variable that demonstrated a higher risk of alterations in all groups when compared to the metabolically healthy and anti-inflammatory group were isoprostane concentrations. Conclusion: We are able to conclude that an anti-inflammatory diet is associated with lower oxidative stress in metabolically healthy obese, and a pro-inflammatory diet is associated with higher systolic blood pressure values.

One Size Does Not Fit All: The Need to Rethink the Metabolic Syndrome in Women

Abstract Metabolic syndrome (MetS) is increasing at epidemic proportions worldwide. MetS and its components are frequent among Brazilian women (41.8%). Women are affected by changes in adipose tissue distribution, lipid profile, insulin resistance (IR), and vascular remodeling during their lives. These changes result from the lack of estrogen after menopause. There have been various attempts to propose a uniform origin for the clustering of the MetS components, including genetics, IR, obesity, lifestyle, sleep disturbances, inflammation, fetal and neonatal programming, and disturbed circadian rhythm of the body functions. The proinflammatory and prothrombotic state in MetS is well-defined. Socioeconomic and lifestyle-related factors are also essential triggers of MetS, which is associated with a higher risk for coronary artery diseases (CAD) and stroke in women. Population measures in health and community medicine, such as continuing education on the importance of lifestyle change to reduce cardiovascular risks from early childhood, are fundamental strategies. Statins reduce high-sensitivity C-reactive protein blood levels and treat high cholesterol. According to the patient, hypoglycemic agents, such as dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1(GLP-1a), and sodium-glucose transport protein 2 (SGLT2) inhibitors, in addition to metformin, have their indication due to their beneficial cardiometabolic and vascular effects. Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) should be the first choice to treat hypertension in postmenopausal womem. The recognition of the different gender- and age-specific risk factors, allowing for specific and targeted interventions, is fundamental, especially for women.

Riesgo de desarrollar diabetes mellitus tipo 2 según escala Finnish Diabetes Risk Score en atención primaria / Risk of Developing Type 2 Diabetes Mellitus According to the Finnish Diabetes Risk Score in Primary care

Introducción: La diabetes mellitus tipo 2, representa 90-95 por ciento de todas las diabetes, es una enfermedad crónica potencialmente prevenible, la escala Finnish Diabetes Risk Score es uno de los instrumentos más utilizados a nivel mundial para evaluar el riesgo de presentar diabetes en 10 años con enfoque fácil y económico. Objetivo: Determinar el riesgo de desarrollar diabetes en los próximos 10 años según escala Finnish Diabetes Risk Score en pacientes en una Unidad Médica Familiar de México. Métodos: Estudio transversal analítico, se aplicó la escala Finnish Diabetes Risk Score a 383 pacientes y se analizaron las variables implicadas en dicha escala, las variables edad e índice de masa corporal se describieron con medidas de tendencia central, las variables sexo, escolaridad, así como aquellas dicotómicas y de intervalo, mediante razones y proporciones. Se midió asociación mediante Odds Ratio para dicotómicas y coeficiente de Spearman para numéricas. Resultados: La mediana de edad fue de 47 años, predominó el sexo femenino, el 71,5 por ciento reportó sedentarismo, el 51,9 por ciento refirió un familiar de primer grado con diabetes, se determinó probabilidad del 67 por ciento de tener peso normal al realizar actividad física diaria; se determinó una probabilidad del 65 por ciento de presentar prediabetes si se tiene sobrepeso u obesidad, se determinó asociación lineal entre índice de masa corporal y edad, el riesgo predominante para desarrollar diabetes mellitus tipo 2 en 10 años fue alto. Conclusiones: El riesgo de desarrollar diabetes en 10 años en la población estudiada fue elevado y se relacionó con falta de actividad física, antecedentes familiares y sobrepeso(AU)

Introduction: Type 2 diabetes mellitus, accounts for 90-95 percent of all diabetes. It is a potentially preventable chronic disease. The Finnish Diabetes Risk Score is one of the most widely used instruments worldwide to assess the risk of developing diabetes in 10 years with an easy and inexpensive approach. Objective: To determine the risk of developing diabetes in the next 10 years according to the Finnish Diabetes Risk Score in patients in a Family Medical Unit in Mexico. Methods: Analytical cross-sectional study. The Finnish Diabetes Risk Score was applied to 383 patients and the variables involved in this scale were analyzed. The variables age and body mass index were described with measures of central tendency, while the variables gender, schooling, as well as dichotomous and interval variables, were described by ratios and proportions. Association was measured by Odds Ratio for dichotomous variables and Spearman's coefficient for numerical variables. Results: The average age was 47 years and female gender predominated. Sedentary lifestyle was reported by 71.5 percent and 51.9 percent reported a first-degree relative with diabetes. A 67percent probability of having a normal weight was determined when performing daily physical activity. In addition, a 65percent probability of having prediabetes was established if overweight or obese, and a linear association was found between body mass index and age. The predominant risk for developing type 2 diabetes mellitus in 10 years was high. Conclusions: The risk of developing diabetes in 10 years in the studied population was high and was related to lack of physical activity, family history and overweight(AU)

Impacto do treinamento físico no perfil inflamatório e redox renal no desenvolvimento de síndrome metabólica / Impact of exercise training on inflammatory and redox renal profiles in metabolic syndrome development

Objetivo: Investigar o efeito do treinamento físico aeróbio (TF) no perfil inflamatório e de estresse oxidativo renal em modelo experimental de desenvolvimento de síndrome metabólica (SM). Métodos: Ratos Wistar e espontaneamente hipertensos (SHR) distribuídos nos grupos: controle (C), hipertenso (H), hipertenso frutose (HF) e hipertenso frutose treinado (HFT). Os grupos HF e HFT foram submetidos à sobrecarga de frutose (10%, 60 dias) desde o desmame. O TF foi realizado em esteira por 60 dias (5dias/semana, 40-60% velocidade máxima do teste de esforço). Resultados: O TF promoveu redução de ânion superóxido, peróxido de hidrogênio e proteínas oxidadas comparado ao grupo HF. Além disso, o grupo HFT apresentou aumento de FRAP e nitritos comparado aos grupos H e HF. No perfil inflamatório, o TF proporcionou aumento de IL-10 e redução da razão TNFα/IL-10. Conclusão: Os resultados demostraram que o treinamento aeróbio atenuou o estresse oxidativo e favoreceu um perfil anti-inflamatório no tecido renal em um modelo de desenvolvimento de SM.

Objective: To investigate the effect of aerobic exercise training (ET) on renal inflammatory and oxidative stress profiles in an experimental model of metabolic syndrome (MS) development. Methods: Wistar and spontaneously hypertensive (SHR) rats were distributed into control (C), hypertensive (H), hypertensive fructose (HF) and trained hypertensive fructose (THF) groups. The HF and THF groups were submitted to fructose overload (10%, 60 days) since weaning. The ET was performed on a treadmill for 60 days (5 days/week, 40-60% maximum speed of the exercise test). Results: The ET promoted reduction in renal superoxide anion, hydrogen peroxide and oxidized proteins compared to the HF group. In addition, the THF group showed an increase in FRAP and in nitrites compared to the H and HF groups. In the inflammatory profile, ET provided an increase in IL-10 and a reduction in TNFα/IL-10 ratio. Conclusion: The results showed that aerobic training attenuated oxidative stress and favored an anti-inflammatory profile in renal tissue in a model of MS development.