Relación entre biometría fetal, producto de acumulación de los lípidos y condición trófica al nacer / Relationship between fetal biometry, lipid accumulation product and the trophic condition at birth

Fundamento: Las alteraciones del estado nutricional materno generalmente se relacionan con desviaciones del crecimiento fetal, que pueden detectarse por los parámetros biofísicos fetales e identifican la posible condición trófica al nacer. Objetivo: Determinar la posible relación entre los parámetros biométricos fetales, la condición trófica al nacer y el producto de acumulación de los lípidos. Metodología: Se realizó un estudio transversal en el Policlínico Chiqui Gómez Lubian del municipio Santa Clara, durante el año 2019, en una población de 253 gestantes normopeso supuestamente sanas al inicio de la gestación. La muestra no probabilística fue de 144 gestantes. Las variables de estudio fueron: producto de acumulación de los lípidos, biometría fetal y condición trófica al nacer. Se utilizaron métodos teóricos, empíricos y estadísticos. Resultados: En el segundo trimestre ningún parámetro biométrico coincidió con la condición al nacer de pequeño, mientras que para el grande coincidieron las circunferencias cefálica y abdominal. En el tercer trimestre la longitud del fémur y la circunferencia abdominal coinciden en la identificación del pequeño y del grande. El PAL se correlacionó con la circunferencia abdominal del tercer trimestre y con el peso al nacer; presentando mayor frecuencia de valores en el tercer tertil para los nacimientos grandes. Conclusiones: La circunferencia abdominal fue el parámetro biométrico con mayor coincidencia con la condición trófica al nacer, la que se asoció con valores en el tercer tertil del PAL para la detección de nacimientos grandes, relacionándose el fenotipo normopeso metabólicamente obeso con el crecimiento fetal por exceso.

Background: Maternal nutritional status disorders are usually related to fetal growth deviations, which can be detected by fetal biophysical parameters and identify the possible trophic condition at birth. Objective: To determine the possible relationship between fetal biometric parameters, the birth trophic state and lipid accumulation product. Methodology: A cross-sectional study was conducted at the Chiqui Gómez Lubian Polyclinic in Santa Clara municipality, during 2019, in a population of 253 normal-weight pregnant women who were apparently healthy at the beginning of their gestation. The non-probability sample was made up of 144 pregnant women. Study variables were: lipid accumulation product, fetal biometry and trophic condition at birth. Theoretical, empirical and statistical methods were used. Results: In the second trimester, none of the biometric parameters matched the condition at birth as a small child, while in the large one the head and abdominal circumferences matched. In the third trimester, femoral length and abdominal circumference coincide in identifying the small one and the large one. LAP correlated with third trimester abdominal circumference and birth weight, presenting higher frequency of values in the third tertile for large births. Conclusions: Abdominal circumference was the biometric parameter with the highest coincidence with trophic condition at birth, associated with values in the third tertile of the LAP for detecting large births, relating the metabolically obese normal weight phenotype with excessive fetal growth.

Vulnerabilidad cardiometabólica e indicadores bioquímicos en el momento de la captación de la embarazada y en el posparto / Cardiometabolic vulnerability and biochemical indicators during recruitment of pregnant women and in the postpartum period

Introducción: Son escasos los estudios sobre acumulaciones excesivas de tejido adiposo y su asociación con cambios en indicadores bioquímicos estudiados durante el embarazo y el posparto. Objetivo: Determinar asociaciones de la vulnerabilidad cardiometabólica por adiposidad corporal con indicadores bioquímicos en el momento de la captación de la embarazada y el posparto. Métodos: Se realizó estudio observacional prospectivo de la vulnerabilidad cardiometabólica por adiposidad corporal e indicadores bioquímicos en 773 mujeres captadas como sanas de peso adecuado, de ellas 119 al posparto, en el policlínico Chiqui Gómez Lubián. Se estudiaron por grupo de vulnerabilidad cardiometabólica indicadores bioquímicos a la captación y el posparto. Se aplicó prueba estadística de Kruskal-Wallis. Resultados: Gestantes captadas con vulnerabilidad global por adiposidad general intermedia y central alta tuvieron valores medios más bajos del ácido úrico (238,78 mmol/L), más altos de triglicéridos (1,37 mmol/L), colesterol (4,70 mmol/L) y resistencia a la insulina (8,32). Mujeres con vulnerabilidad global por adiposidad general intermedia y central alta al posparto presentaron valores medios más elevados de triglicéridos (1,18 mmol/L) y lipoproteínas de muy baja densidad (0,54 mmol/L), más bajos de lipoproteínas de alta densidad (1,06 mmol/L); mujeres con vulnerabilidad global extrema por adiposidad general y central alta, tuvieron valores medios más elevados: glicemia (4,90 mmol/L), colesterol (4,30 mmol/L), lipoproteínas de baja densidad (2,76 mmol/L), producto de acumulación de lípidos (42,63 mmol/L) e índice de adiposidad visceral (2,32 mmol/L). Conclusiones: Evaluar vulnerabilidad cardiometabólica por técnicas antropométricas, complementadas con indicadores bioquímicos, facilita orientar acciones preventivas sobre daños cardiometabólicos progresivos en la gestación y su posparto(AU)

Introduction: Few studies are available about excessive accumulation of adipose tissue and its association to changes in biochemical indicators in pregnancy and the postpartum period. Objective: Determine the association between cardiometabolic vulnerability due to body adiposity and biochemical indicators during recruitment of pregnant women and in the postpartum period. Methods: An observational prospective study was conducted of cardiometabolic vulnerability due to body adiposity and biochemical indicators in 773 women recruited as healthy and adequate weight, 119 of them in the postpartum period, at Chiqui Gómez Lubián polyclinic. Biochemical indicators were studied by cardiometabolic vulnerability group at recruitment and in the postpartum period. Statistical analysis was based on the Kruskal-Wallis test. Results: Pregnant women recruited with overall vulnerability due to high general intermediate and central adiposity had lower uric acid mean values (238.78 mmol/l), higher triglyceride mean values (1.37 mmol/l), cholesterol (4.70 mmol/l) and insulin resistance (8.32). Women with overall vulnerability due to high general intermediate and central adiposity in the postpartum period had higher triglyceride mean values (1.18 mmol/l), very low density lipoproteins (0.54 mmol/l), and lower high density lipoprotein mean values (1.06 mmol/l). Women with extreme overall vulnerability due to high general and central adiposity had higher mean values: glycemia (4.90 mmol/l), cholesterol (4.30 mmol/l), low density lipoproteins (2.76 mmol/l), lipid accumulation product (42.63 mmol/l) and visceral adiposity index (2.32 mmol/l). Conclusions: Evaluating cardiometabolic vulnerability using anthropometric techniques complemented with biochemical indicators, facilitates aiming preventive actions at progressive cardiometabolic damage during pregnancy and the postpartum period(AU)

Association of measures of central fat accumulation indices with body fat distribution and metabolic, hormonal, and inflammatory parameters in women with polycystic ovary syndrome

ABSTRACT Objective To investigate the associations among visceral adiposity index (VAI), lipid accumulation product (LAP), body fat percentage (%), and android/gynoid ratio (A/G ratio) in women with polycystic ovary syndrome (PCOS) and verify if the parameters representative of visceral obesity correlate with and exhibit the same frequency as body composition variables; anthropometric indices; and metabolic, hormonal, and inflammatory parameters. Subjects and methods This was a cross-sectional study that included 94 women with PCOS. Hormonal, metabolic, and inflammatory parameters were analyzed in all women. Free androgen index (FAI) and homeostasis model assessment (HOMA-IR), as well as LAP, VAI, and anthropometric indices, were calculated. The regions of interest (ROIs) in body composition and body composition indices were evaluated using a dual X-ray absorptiometry (DXA). Overall, 32 variables were selected as markers of body fat distribution. Results Among the 32 markers evaluated, 29 correlated with LAP, whereas 25 correlated with VAI, 19 with body fat (%), and 30 with A/G ratio. Additionally, some markers correlated with the four adiposity indices evaluated: ROIs, except for total mass and leg fat (%); body composition (body mass index, waist circumference, and hip circumference) indices; fasting insulin; and C-reactive protein. Conclusion LAP and VAI may be sensitive measures for screening and preventing metabolic syndrome and insulin resistance in PCOS, with LAP being more sensitive than VAI, and the A/G ratio may be more sensitive than body fat percentage.

Cardiovascular risk assessment using the lipid accumulation product index among primary healthcare users: a cross-sectional study

ABSTRACT BACKGROUND: The lipid accumulation product (LAP) index is an abdominal adiposity marker. OBJECTIVE: The aim of this study was to describe the cardiovascular risk of primary healthcare users through the LAP index and correlate it with anthropometric and biochemical indicators. DESIGN AND SETTING: Cross-sectional study in primary care units in a city in northeastern Brazil. METHODS: The subjects responded to a structured questionnaire that contained questions about their sociodemographic condition, and then underwent an anthropometric nutritional assessment. The LAP index values were expressed as three degrees of cardiovascular risk intensity: high risk (above the 75th percentile), moderate risk (between the 25th and 75th percentiles) and low risk (below the 25th percentile). RESULTS: The median LAP index was 52.5 cm.mmol/l (range: 28.2-86.6), and there was no statistically significant difference between the sexes: 57.7 cm.mmol/l (24.5-91.1) and 49.5 cm.mmol/l (29.8-85.2) for females and males, respectively (P = 0.576). Among all the subjects, 67.2% were overweight and there was a statistically significant difference in mean LAP index between those who were and those who were not overweight. Statistically significant differences in anthropometric and biochemical markers for cardiovascular risk were observed among individuals who had higher LAP index values. There were significant correlations between the LAP index and all of the biochemical variables. CONCLUSIONS: These significant correlations between the LAP index and the traditional biochemical risk markers may be useful within conventional clinical practice, for cardiovascular risk screening in primary healthcare.

Indicators of Abdominal Adiposity and Carotid Intima-Media Thickness: Results from the Longitudinal Study of Adult Health (ELSA-Brazil) / Indicadores de Adiposidade Abdominal e Espessura Médio-Intimal de Carótidas: Resultados do Estudo Longitudinal de Saúde do Adulto - ELSA-Brasil

Abstract Background: Abdominal adiposity is a risk factor for cardiovascular disease. Objective: To determine the magnitude of the association between abdominal adiposity, according to five different indicators, and the carotid intima-media thickness (CIMT). Methods: Data from 8,449 participants aged 35 to 74 years from the ELSA-Brazil study were used. The effect of waist circumference (WC), waist-to-hip ratio (WHR), conicity index (C index), lipid accumulation product (LAP) and visceral adiposity index (VAI) on CIMT were evaluated. Data were stratified by gender and analyzed using multivariate linear and logistic regressions. A significance level of 5% was considered. Results: Participants with CIMT > P75 showed a higher frequency of abdominal adiposity (men >72% and women >66%) compared to those with CIMT < P75. Abdominal adiposity was associated with the mean CIMT, mainly through WC in men (0.04; 95%CI: 0.033; 0.058). The abdominal adiposity identified by the WC, WHR, LAP, and VAI indicators in women showed an effect of 0.02 mm on the CIMT (WC: 0.025, 95%CI: 0.016, 0.035; WHR: 0.026, 95%CI: 0.016, 0.035; LAP: 0.024, 95%CI: 0.014; 0.034; VAI: 0.020, 95%CI: 0.010, 0.031). In the multiple logistic regression, the abdominal adiposity diagnosed by WC showed an important effect on the CIMT in both genders (men: OR = 1.47, 95%CI: 1.22-1.77, women: OR = 1.38; 95%CI: 1.17-1.64). Conclusion: Abdominal adiposity, identified through WC, WHR, LAP, and VAI, was associated with CIMT in both genders, mainly for the traditional anthropometric indicator, WC.

Resumo Fundamento: A adiposidade abdominal é um fator de risco para doença cardiovascular. Objetivo: Determinar a magnitude da associação entre a adiposidade abdominal, segundo cinco diferentes indicadores, e a espessura médio-intimal de carótidas (EMI-C). Métodos: Usou-se dados de 8.449 participantes de 35 a 74 anos do ELSA-Brasil. Foi avaliado o efeito da circunferência da cintura (CC), razão cintura quadril (RCQ), índice de conicidade (Índice C), produto da acumulação lipídica (LAP) e índice de adiposidade visceral (IAV) sobre EMI-C. Os dados foram estratificados por sexo e analisados por meio de regressões linear e logística multivariadas. Foi adotado nível de significância de 5%. Resultados: Participantes com EMI-C acima do P75 mostraram maior frequência de adiposidade abdominal (homens acima de 72% e mulheres acima de 66%) em comparação aos participantes com EMI-C abaixo do P75. A adiposidade abdominal foi associada com a média da EMI-C, principalmente por meio da CC entre homens (0,04 IC95%: 0,033; 0,058). A adiposidade abdominal identificada pelos indicadores CC, RCQ, LAP e IAV entre as mulheres mostrou efeito de 0,02 mm sobre a EMI-C (CC: 0,025 IC95%: 0,016; 0,035; RCQ: 0,026 IC95%: 0,016; 0,035; LAP: 0,024 IC95%: 0,014; 0,034; IAV: 0,020 IC95%: 0,010; 0,031). Na regressão logística múltipla a adiposidade abdominal diagnosticada pela CC mostrou importante efeito sobre a EMI-C em ambos os sexos (homens: OR = 1,47; IC95%: 1,22-1,77; mulheres: OR = 1,38; IC95%: 1,17-1,64). Conclusão: A adiposidade abdominal, identificada por meio da CC, RCQ, LAP e IAV, foi associada à EMI-C em ambos os sexos, com destaque para o tradicional indicador antropométrico CC.

Association of serum levels of vascular endothelial growth factor and thrombospondin-1 to body mass index in polycystic ovary syndrome: a case-control study

PURPOSE: Polycystic ovary syndrome (PCOS) is a gynecological endocrine disorder that is characterized by disturbances in ovarian blood flow and angiogenesis. The aim of this study was to determine the association of vascular endothelial growth factor (VEGF) and thrombospondin-1 (TSP-1) serum levels with the body mass index (BMI) in patients with PCOS compared with healthy subjects. METHODS: The study was conducted with 80 subjects in 3 PCOS groups, including normal weight, overweight, and obese PCOS groups, and a control group of healthy subjects (n=20). The participants in all groups completed a questionnaire comprising sociodemographic and obstetric questions. The PCOS diagnosis in the study subjects was confirmed based on the Rotterdam criteria, BMI was determined according to the World Health Organization guidelines, and the lipid accumulation product index was calculated for all groups. Venous blood samples were collected from all participants after fasting to measure the serum levels of fasting blood glucose (FBG), lipids, insulin, VEGF, TSP-1, and leptin. RESULTS: Our findings showed that the serum VEGF level was significantly higher in the normal BMI PCOS group than that in the control group (P=0.03), and the TSP-1 level was significantly lower in the obese PCOS group than that in the control group (P=0.04). CONCLUSIONS: Our study demonstrated that alterations in VEGF and TSP-1 concentrations are dependent on BMI. Because abnormal ovarian angiogenesis is considered to be the main feature of PCOS, the study of ovarian angiogenic imbalance is proposed as a new tool for PCOS diagnosis and management.

A systematic review on the association between Lipid Accumulation Product Index and Type 2 Diabetes Mellitus / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Excess fat accumulation contributes to the development of type 2 diabetes mellitus (T2DM). Lipid accumulation product (LAP) is an index computed from waist circumference and triglycerides, which represents increased lipotoxicity. We aim to study the relationship of LAP index and T2DM and its utility as a predictor for T2DM development.@*Methodology@#A literature search in PubMed and Cochrane database was performed to retrieve and review studies reporting the association between LAP and T2DM@*Results@#Two cross-sectional studies from Japan and the United States, and one cohort study from Iran were obtained. A high LAP was associated with a higher risk of T2DM [odds ratio (OR) 19.1, 95% confidence interval (CI) (6.6-55.5) for women; and OR 7.4, 95% CI (5.1-10.8) for men].@*Conclusion@#LAP was strongly associated with T2DM. Its utility in predicting the development of T2DM needs to be confirmed.

Lipid accumulation product is a predictor of nonalcoholic fatty liver disease in childhood obesity / 소아과

BACKGROUND: Lipid accumulation product (LAP) is associated with the presence and severity of nonalcoholic fatty liver disease (NAFLD) in adults.PURPOSE: Here we evaluated the ability of LAP to predict NAFLD in obese children.METHODS: Eighty obese children (38 girls; age 6–18 years) were included. Anthropometric measurements and biochemical values were obtained from the patients’ medical records. LAP was calculated as [waist circumference (WC) (cm) – 58]×triglycerides (mmol/L) in girls; [WC (cm) – 65]×triglycerides (mmol/L) in boys. The minLAP and adjLAP were described (3% and 50% of WC values, respectively) and the total/high-density lipoprotein cholesterol index (TC/HDL-C) was calculated. NAFLD was observed on ultrasound, and patients were divided into 3 groups by steatosis grade (normal, grade 0; mild, grade 1; moderate-severe, grade 2–3). The area under the curve (AUC) and appropriate index cutoff points were calculated by receiver operator characteristic analysis.RESULTS: LAP was positively correlated with puberty stage (rho=0.409; P<0.001), fasting insulin (rho=0.507; P<0.001), homeostasis model assessment of insulin resistance (rho=0.470; P<0.001), uric acid (rho=0.522; P<0.001), and TC/HDL-C (rho=0.494; P<0.001) and negatively correlated with HDL-C (rho=-3.833; P<0.001). LAP values could be used to diagnose hepatosteatosis (AUC=0.698; P=0.002). The LAP, adjLAP, and minLAP cutoff values were 42.7 (P=0.002), 40.05 (P=0.003), and 53.47 (P=0.08), respectively. For LAP, the differences between the normal and mild groups (P=0.035) and the normal and moderate-severe groups were statistically significant (P=0.037), whereas the difference between the mild and moderate-severe groups was not (P>0.005). There was a statistically significant difference between the normal and mild groups for adjLAP (P=0.043) but not between the other groups (P>0.005). There was no significant intergroup difference in minLAP (P>0.005).CONCLUSION: LAP is a powerful and easy tool to predict NAFLD in childhood. If LAP is ≥42.7, NAFLD should be suspected. This is the first study to assess LAP diagnostic accuracy for childhood obesity.

Effects of different exercise modalities on novel hepatic steatosis indices in overweight women with type 2 diabetes

BACKGROUND/AIMS: Fatty liver is a clinical and pathologic condition in individuals with type 2 diabetes (T2D). The purpose of this study is to examine the effects of different exercise modalities on non-alcoholic fatty liver indices (fatty liver index [FLI], lipid accumulation product [LAP], hepatic steatosis index [HSI], and Framingham Steatosis Index [FSI]) in women with T2D. METHODS: Fifty-two women with T2D and a mean age of 55.07±5.92 yrs, body mass index (BMI) 28.94±4.09 kg/m² , and hemoglobin A1c (HbA1c) 9.41±0.82% were randomized to a sprint interval training (SIT) (n=17), combined aerobic and resistance (A+R) training (n=17), or control group (n=18) for 10 weeks. Two-way repeated analysis of variance (ANOVA) was used to find differences between groups and the effects of time and Time×Group interactions after 10 weeks on non-alcoholic fatty liver indices. After this, ANOVA models were constructed to determine the effects of group allocation and change in non-alcoholic fatty liver indices. RESULTS: There were significant time interactions for FLI (P<0.001), HSI (P<0.001), and LAP (P<0.001). Also, there were significant Time×Group interactions for fasting blood glucose (P=0.034), and HbA1c (P=0.006). CONCLUSIONS: Results highlight that exercise training, independent of mode of training, is an effective strategy to improve some indices related to hepatic steatosis and blood glucose profiles in women with T2D.

Lipid accumulation product index in HIV-infected patients: a marker of cardiovascular risk

ABSTRACT The lipid accumulation product (LAP) index is an emerging cardiovascular risk marker. We aimed to assess the accuracy of this index as a marker of cardiovascular risk in HIV-infected patients. A cross-sectional study of 133 HIV-infected patients on antiretroviral drugs and 20 non-infected controls was conducted at the outpatient clinic of a referral center of infectious and parasitic diseases. Evaluations included LAP index, homeostasis model assessment (HOMA) index, anthropometric measurements, blood pressure, glucose tolerance test, and cholesterol and triglyceride levels. Body mass index (BMI) was similar in both groups; however, waist circumference was greater in the HIV-infected patients. Triglyceride levels were significantly higher (p < 0.001) and HDL cholesterol levels were lower in HIV-infected patients (p < 0.001). Plasma glucose (p = 0.01) and insulin (p = 0.005) levels two hours after a glucose load, HOMA-IR index (p < 0.001) and LAP index (p < 0.001) were higher in the HIV-infected patients. A positive and significant correlation was found between HOMA-IR index and LAP (r = 0.615; p < 0.01), BMI (r = 0.334; p < 0.01) and waist circumference (r = 0.452; p < 0.01) in the HIV-infected patients. In male HIV-infected patients and controls, ROC curve analyses revealed that the best cut-off value of LAP to define the presence of insulin resistance was 64.8 (sensitivity 86%, specificity 77% and area under the curve 0.824). These results confirm that insulin resistance is more common in HIV-patients on antiretroviral drugs than in HIV-negative controls. A positive and significant correlation was found between the LAP index and the HOMA index, with LAP ≥ 64.8 constituting an additional risk factor for cardiovascular disease in male HIV patients.

Is Lipid Accumulation Product Associated with an Atherogenic Lipoprotein Profile in Brazilian Subjects? / O Produto de Acumulação Lipídica está Associado a um Perfil Aterogênico de Lipoproteínas em Indivíduos Brasileiros?

Abstract Background: Lipid accumulation product (LAP), a simple and low-cost tool, is a novel biomarker of central lipid accumulation and represents a potential surrogate marker for atherogenic lipoprotein profile. However, its association with lipoprotein subfractions has not been described in the literature. Objective: To determine whether LAP index could be used as a marker of low- and high-density lipoprotein (LDL and HDL) size in Brazilian individuals. Methods: This cross-sectional study included patients (n = 351) of both sexes and age between 30-74 years. Clinical and sociodemographic data and family history of diseases were evaluated. Lipoprotein size, and levels of total cholesterol (TC), lipoproteins, apolipoprotein AI and B (APO AI/APO B), glucose, insulin, insulin resistance index (HOMA-IR) and non-esterified fatty acids (NEFA) were assessed in blood samples. LAP was calculated by the formulas [(waist circumference[cm]-58) × (triglycerides[mmol/L]) for women and (waist circumference [cm]-65) × (triglycerides [mmol/L]) for men]. The association between LAP and metabolic parameters were tested by linear trend (general linear model, GLM test) before and after multiple adjustments for potential confounders (sex, age, smoking, statin, fibrate, and hypoglycemic drugs) at significant level p < 0.05. Results: LAP was positively associated with TC, APO B, NEFA, glucose, insulin and HOMA-IR values, and negatively associated with HDL-C. Higher central lipid accumulation was corelated with higher percentage of intermediate HDL and of small LDL and HDL and less amount of large HDL. LDL size was also reduced in greater LAP index values. The negative impact of LAP was maintained after adjustment for multiple variables. Conclusion: LAP was robustly associated with atherogenic profile of lipoprotein subfractions, independently of multiple confounders.

Resumo Fundamento: O produto de acumulação lipídica (LAP), um instrumento simples e de baixo custo, é um novo biomarcador de acúmulo de gordura central e representa um marcador substituto potencial para o perfil aterogênico de lipoproteínas. No entanto, sua associação com subfrações de lipoproteínas ainda não foi descrita na literatura. Objetivo: Determinar se o LAP pode ser usado como um marcador de tamanho da lipoproteína de baixa densidade (LDL) e de alta densidade (HDL) em indivíduos brasileiros. Métodos: Este estudo transversal incluiu 351 pacientes de ambos os sexos e idade entre 30 e 74 anos. Dados clínicos e sociodemográficos e história familiar de doenças foram avaliados. O tamanho das lipoproteínas, e níveis de colesterol total (CT), lipoproteínas, apolipoproteína AI e B (APO AI/APO B), glicose, ácidos graxos não esterificados (AGNEs) e insulina, e índice de resistência insulínica (HOMA-IR) foram avaliados em amostras de sangue. O LAP foi calculado utilizando-se as fórmulas (circunferência da cintura (cm]-58) × (triglicerídeos[mmol/L]) para mulheres e (circunferência da cintura[cm]-65) × (triglicerídeos [mmol/L]) para homens. Associações entre LAP e parâmetros metabólicos foram testadas por tendência linear (modelo linear generalizado, GLM) antes e após ajustes por fatores de confusão (sexo, idade, tabagismo, uso de estatinas, fibratos e hipoglicemiantes) ao nível de significância de p < 0,05). Resultados: LAP apresentou uma associação positiva com CT, APO B, AGNEs, glicose, insulina, HOMA-IR, e uma associação negativa com HDL-C. Maior acúmulo de gordura central correlacionou-se com maior porcentagem de HDL intermediária e de partículas pequenas de LDL e HDL, e menor porcentagem de HDL grande. O tamanho da LDL também era reduzido em valores de LAP mais elevados. O impacto negativo do LAP foi mantido após ajuste para múltiplas variáveis. Conclusão: o LAP esteve fortemente associado com o perfil aterogênico de subfrações de lipoproteínas, independetemente dos fatores de confusão.

Visceral adiposity index and prognosis among patients with ischemic heart failure / Índice de adiposidade visceral e prognóstico em pacientes com insuficiência cardíaca isquêmica

ABSTRACT: CONTEXT AND OBJECTIVES: The obesity paradox has already been established in relation to heart failure, but it is not known which obesity indicator best reflects this phenomenon. The aim of this study was to evaluate the association between obesity indexes and mortality among patients with heart failure. DESIGN AND SETTING: Cohort study conducted in the Department of Cardiology of Hospital Nossa Senhora da Conceição (Brazil). METHODS: Clinical, demographic, socioeconomic, biochemical and anthropometric data on 116 patients aged 30 to 85 years with a diagnosis of heart failure were evaluated. Arm fat area, body mass index, body surface area, body adiposity index, lipid accumulation product (LAP) and visceral adiposity index (VAI) were calculated. Cox regression was used to perform survival analyses. RESULTS: At baseline, the individuals with ischemic heart failure who remained alive showed higher VAI (3.60 ± 3.71 versus 1.48 ± 1.58; P = 0.04) and a trend towards higher LAP, in comparison with the individuals who died. After an average follow-up of 14.3 months, ischemic heart failure patients who had VAI > 1.21 showed 78% lower risk of death (HR 0.12; 95% CI: 0.02-0.67; P = 0.02) and the Kaplan-Meier survival curves showed better prognosis for these individuals (P = 0.005; log-rank test). CONCLUSION: Our results suggest that VAI is a good predictor of better prognosis among ischemic heart failure patients.

RESUMO CONTEXTO E OBJETIVOS: O paradoxo da obesidade já está consolidado na insuficiência cardíaca, mas não se sabe qual indicador de obesidade melhor reflete esse fenômeno. Este estudo teve como objetivo avaliar a associação entre índices de obesidade e a mortalidade entre pacientes com insuficiência cardíaca. TIPO DE ESTUDO E LOCAL: Estudo de coorte realizado no Departamento de Cardiologia do Hospital Nossa Senhora da Conceição (Brasil). MÉTODOS: Foram incluídos 116 pacientes com diagnóstico de insuficiência cardíaca de 30 a 85 anos. Dados clínicos, demográficos, socioeconômicos, bioquímicos e antropométricos foram avaliados. Área de gordura do braço, índice de massa corporal, área de superfície corporal, índice de adiposidade corporal, produto da acumulação lipídica e índice de adiposidade visceral foram calculados; regressão de Cox foi usada para realizar análises de sobrevida. RESULTADOS: No início do estudo, indivíduos com insuficiência cardíaca isquêmica que se mantiveram vivos mostraram valores mais elevados de índice de adiposidade visceral (3,60 ± 3,71 contra 1,48 ± 1,58, P = 0,04) e uma tendência para produto da acumulação lipídica maior quando comparados com os indivíduos que morreram. Após acompanhamento médio de 14,3 meses, os pacientes com insuficiência cardíaca isquêmica que apresentaram índice de adiposidade visceral > 1,21 tiveram 78% menor risco de morrer (HR 0,12; IC 95% 0,02-0,67, P = 0,02) e as curvas de Kaplan-Meier para sobrevida mostraram melhor prognóstico nesses indivíduos (P = 0,005, teste log-rank). CONCLUSÃO: Nossos resultados sugerem que o índice de adiposidade visceral é um bom preditor de melhor prognóstico em pacientes com insuficiência cardíaca isquêmica.

Association between Lipid Accumulation Product and Hirsutism in Patients with Polycystic Ovary Syndrome / Associação entre lipid accumulation product (LAP) e hirsutismo na síndrome do ovário policístico

Objective Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause. Clinical hyperandrogenism is the most important diagnostic criterion of the syndrome, which manifests as hirsutism in 70% of cases. Hirsute carriers of PCOS have high cardiovascular risk. Lipid accumulation product (LAP) is an index for the evaluation of lipid accumulation in adults and the prediction of cardiovascular risk. The aim of this study was to evaluate the association between LAP and hirsutism in women with PCOS. Methods This was a cross-sectional observational study of a secondary database, which included 263 patients who had visited the Hyperandrogenism Outpatient Clinic from November 2009 to July 2014. The exclusion criteria were patients without Ferriman-Gallwey index (FGI) and/or LAP data. We used the Rotterdam criteria for the diagnosis of PCOS. All patients underwent medical assessment followed by measurement and recording of anthropometric data and the laboratory tests for measurement of the following: thyroid-stimulating hormone, follicle-stimulating hormone, prolactin, total testosterone, sex hormone binding globulin, 17-α-hydroxyprogesterone (follicular phase), glycohemoglobin A1c, and basal insulin. In addition, the subjects underwent lipid profiling and oral glucose tolerance tests. Other laboratory measurements were determined according to clinical criteria. LAP and the homeostatic model assessment index (HOMA-IR) were calculated using the data obtained. We divided patients into two groups: the PCOS group with normal LAP (< 34.5) and the PCOS group with altered LAP (> 34.5) to compare the occurrence of hirsutism. For statistical analysis, we used SPSS Statistics for Windows(r) and Microsoft Excel programs, with descriptive (frequencies, percentages, means, and standard deviations) and comparative analyses (Student's t-test and Chi-square test). We considered relations significant when the p-value was≤0.05. Results LAP was high in most patients (n = 177; 67.3%) and the FGI indicated that 58.5% of the patients (n = 154) had hirsutism. The analysis by LAP quartiles showed a positive correlation (p = 0.04) among patients with a high FGI and an upper quartile LAP (> 79.5) when compared with those with LAP < 29.0 (lower quartile). Conclusion This study demonstrated an association between high LAP and hirsutism. The FGI could represent a simple and low-cost tool to infer an increased cardiovascular risk in women with PCOS.

Objetivo A síndrome dos ovários policísticos (SOP) é o distúrbio endócrino mais comumemmulheres entre amenarca e a menopausa. O hiperandrogenismo clínico é o critério diagnóstico mais importante da síndrome, que se manifesta como hirsutismo em70% dos casos. Portadores de SOP hirsutas têmelevado risco cardiovascular. O Lipid accumulation product (LAP) é um índice para a avaliação da acumulação de lípidos nos adultos e é um preditor de risco cardiovascular. O objetivo deste estudo é avaliar a associação entre LAP e hirsutismo em portadoras da SOP. Métodos Estudo observacional transversal de banco de dados secundário, que incluiu 263 pacientes do Ambulatório de Hiperandrogenismo no período de novembro de 2009 a julho de 2014. Foram excluídas pacientes sem o índice de Ferriman-Gallwey e/ ou LAP. Foram utilizados como critérios diagnósticos da SOP os critérios de Rotterdam. Todas as pacientes foram submetidas à avaliação médica seguida da aferição e registro dos dados antropométricos e a realização dos seguintes exames laboratoriais: hormônio estimulante da tireoide (TSH), hormônio folículo estimulante (FSH), prolactina (PRL), Testosterona total, globulina ligadora dos hormônios sexuais (SHBG), 17-α- hidroxiprogesterona, (fase folicular), perfil lipídico, teste oral de tolerância à glicose, glico-hemoglobina a1C, insulina basal. Outras dosagens laboratoriais foram determinadas à critério clínico. O LAP e o HOMA-IR (homeostatic model assessment) foram calculados com os dados obtidos. As pacientes foram divididas em dois grupos: grupo das portadoras de SOP com LAP normal (LAp < 34,5) e grupo das portadoras de SOP com LAP alterado (LAP >34,5) para as comparações do hirsutismo. Para a análise estatística, foram utilizados os programas SPSS Statistics for Windows(r) e Microsoft Excel(r), sendo feitas análises descritivas (frequências, percentuais, médias, desviospadrão) e comparativas (t-Student e qui-quadrado). Foram consideradas relações significativas quando p-valor foi menor ou igual a 0,05. Resultados O LAP foi elevado na maioria das pacientes (n = 177; 67,3%) e o índice de Ferriman-Gallwey (IF) demonstrou que 58,5% das pacientes (n = 154) eram hirsutas. A análise por quartis de LAP, demonstrou correlação positiva (p = 0,04) entre pacientes comIF elevado e LAP no quartil superior (>79,5) quando comparadas àquelas com LAP menor que 29,0 (quartil inferior). Conclusão O estudo demonstrou associação do LAP elevado e hirsutismo. O escore de Ferriman-Gallwey poderia representar uma ferramenta simples e de baixo custo para inferir risco cardiovascular aumentado em portadoras da síndrome.

Produto de acumulação lipídica: acurácia para identificação de portadores da síndrome metabólica em adultos / Product of lipid accumulation: accuracy for identification of patients with metabolic syndrome in adults

A Síndrome Metabólica (SM) tem se tornado um importante problema de saúde pública nos últimos anos tanto pela sua alta magnitude quanto pela sua forte relação com as doenças cardiovasculares (DCV) e o diabetes mellitus do tipo II (DM 2), duas das principais causas de mortalidade em todo o mundo. Portanto, se faz necessária a identificação precoce e precisa de indivíduos em alto risco de desenvolver SM de maneira simples e ágil. Nesse sentido, o Lipid Accumulation Product {LAP) e um novo biomarcador de acúmulo de lipídeos central relacionado ao risco de síndrome metabólica (SM), diabetes e doença cardiovascular. Assim,o objetivo deste estudo foi analisar a capacidade do LAP para identificar indivíduos com SM.Trata-se de um estudo epidemiológico transversal conduzido com 211 funcionários do campus saúde de uma universidade publica de Belo Horizonte - MG. Foi aplicado questionário sobre características demográficas, socioeconômicas, antropométricas e do estilo de vida. A SM foi definida de acordo com os critérios propostos pela NCEP-ATP IIJ atualizada, IDF, AHAJNHBLI e NCEP-ATP 111/IDF harmonizado. A Receiver Operator Characteristic curve (curva ROC) foi utilizada para encontrar o ponto de corte do LAP que melhor identificasse indivíduos com SM diagnosticados segundo diferentes definições. A prevalência da SM foi de: 27,0% (IC 95%: 21,1-33,5) NCEP-ATP III atualizada; 33,2% (IC95%: 26,9-40,0) IDF; 28,4% (IC 95%: 22,5-35,0) AHAJNHBLI e 38,4% (IC 95%: 32,0-45,2)NCEP-ATP 111/IDF harmonizada. As análises das curvas ROC mostraram que o LAP foi discriminador significativo para a SM em todas as definições diagnósticas. Os melhores pontos de corte para identificar a SM foram: 41,10 NCEP-ATP III atualizada (86% sensibilidade, 82,5% especificidade); 37,85 IDF (81,4% sensibilidade, 80,9% sensibilidade);39,39 AHAJNHBLI (88,3% sensibilidade, 81,5% ...

Metabolic syndrome (MS) has become a major public health problem in recent years both forits high magnitude and for its strong relationship with cardiovascular disease (CVD) and diabetes mellitus type II (DM2), two of the main causes of mortality world wide. Therefore, itis necessary an early and accurate identification of individuals at high risk of developing MSin a simple and agile way. Accordingly, the Lipid Accumulation Product (LAP) is a novel biomarker of central lipid accumulation related to risk of metabolic syndrome (MS), diabetes and cardiovascular disease. The objective of this study was to analyze the LAP's ability toidentify individuals with MS. This was a cross-sectional epidemiological study conducted with 211 employees of health campus at a public university of Belo Horizonte city - Minas Gerais State - Brazil. Questionnaire was applied to assess demographic, socioeconomic, anthropometric and lifestyle characteristics. MS was defined according to criteria proposed by NCEP-ATP ill updated, IDF, AHNNHBLI and harmonized NCEP-ATP 111/IDF. TheReceiver Operator Characteristic curve (ROC) was used to find the LAP cutoff that best identified individuals with MS diagnosed according to different definitions. The prevalence ofMS was: 27.0% (95% CI: 21.1to33.5) NCEP-ATP III updated; 33.2% (95% CI: 26.9 to 40.0)IDF; 28.4% (95% CI: 22.5 to 35.0) AHNNHBLI and 38.4% (95% CI: 32.0 to 45.2) harmonized NCEP-A TP 111/IDF. The analysis of ROC curves showed that the LAP was significant discriminator for MS in all diagnostic criteria. The best point cutoffs to identify the MS were 41.10 NCEP-ATP III updated (86% sensitivity, 82.5% specificity); 37.85 IDF(81.4% sensitivity, 80.9% sensitivity); 39.39 AHNNHBLI (88.3% sensitivity, 81.5% specificity) and 33.18 harmonized NCEP-ATP III/IDF (sensitivity 84% and specificity80.8% ). It is concluded that the LAP was associated with MS and had strong and reliable diagnostic accuracy for identifying individuals with MS.

Helicobacter pylori Stool Antigen Levels and Serological Biomarkers of Gastric Inflammation are Associated with Cardio-Metabolic Risk Factors in Type 2 Diabetic Patients

BACKGROUND: Helicobacter pylori infection and subsequent gastric inflammation have been proposed as risk factors for the development of insulin resistance and cardiovascular disease. In this study we assessed the possible association of H. pylori bacterial load, and serum biomarker of gastric inflammation with cardiometabolic risk factors in diabetic patients. METHODS: In this cross-sectional study, 84 H. pylori-infected type 2 diabetic patients were assessed for anthropometrics, biochemical and clinical measurements. Pearson correlation test, linear, and logarithmic regression curve estimation models were used to assess the association of H. pylori stool antigen (HpSAg) levels, and pepsinogen I (PGI) to pepsinogen II (PGII) ratio with fasting serum glucose, insulin, serum lipid and lipoprotein parameters, malondialdehyde, high-sensitive C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body weight, waist circumference and lipid accumulation product (LAP) index. RESULTS: The mean age of participants was 54+/-10 years, and 44% were men. Mean HpSAg levels and PGI/PGII ratio were 0.24+/-0.23 microg/mL and 9.9+/-9.0, respectively. Higher HpSAg as well as lower PGI/PGII was correlated with higher anthropometric measures and LAP. A significant negative correlation between PGI/PGII ratio and blood pressure (r=-0.21 and r=-0.22, systolic and diastolic, respectively, P<0.05), serum insulin (r=-0.17, P=0.05), and hs-CRP (r=-0.17, P=0.05) was observed. A significant linear association between PGI/PGII ratio with serum triglycerides (beta=-0.24, P<0.05), serum high density lipoprotein cholesterol (HDL-C; beta=0.43, P<0.01), and triglycerides/HDL-C ratio (beta=-0.28, P<0.05) were observed. CONCLUSION: Higher H. pylori bacterial load and lower PGI/PGII ratio was associated with higher levels of cardiometabolic risk factors in H. pylori infected type 2 diabetic patients.

Producto de acumulación lipídica está asociado con glucemia en estudiantes universitarias / Lipid accumulation product is associated with blood glucose in female university students

The use of anthropometric indexes, to follow up cardiovascular and metabolic risk factors, has been the focus of several studies during the last years. The Lipid Accumulation Product (LAP) innovates in combining waist circumference (WC), an anthropometric parameter, with fasting triglycerides, a biochemical parameter: the. The LAP was proposed in 2005 by Kahn as a better index than the Body Mass Index (BMI) to predict cardiovascular risk. The few studies published do not present LAP in young female population. For this reason, our study analyzed the association between LAP and fasting glycemia in female university students. A significant positive correlation was found, confirming previous studies with different populations.

La utilización de índices antropométricos para rastrear factores de riesgo cardiovascular y metabólico, ha sido de interés en varios estudios durante los últimos años. El Producto de Acumulación Lipídica (PAL) innova al combinar la circunferencia de cintura (CC), el cual es un parámetro antropométrico, con un parámetro bioquímico: los triglicéridos en ayunas. Kahn propuso el PAL el año 2005 como un índice mejor que el Indice de Masa Corporal (IMC) para predecir riesgo cardiovascular. Algunos estudios publicados no muestran el PAL en una población de mujeres jóvenes. Por esta razón, el objetivo del presente estudio fue analizar la asociación entre PAL y la glucemia en ayunas en estudiantes universitarias. Se detectó una correlación significativamente positiva, confirmando estudios previos en diferentes poblaciones.

Clinical and Biochemical Profiles according to Homeostasis Model Assessment-insulin Resistance (HOMA-IR) in Korean Women with Polycystic Ovary Syndrome

OBJECTIVES: The aim of this study was to investigate the clinical and biochemical profiles according to homeostasis model assessment of insulin resistance (HOMA-IR) in Korean polycystic ovary syndrome (PCOS) patients. METHODS: In 458 PCOS patients diagnosed by the Rotterdam European Society for Human Reproduction and Embryology (ESHRE) criteria, measurements of somatometry, blood test of hormones, glucose metabolic and lipid profiles, and transvaginal or transrectal ultrasonogram were carried out. HOMA-IR was then calculated and compared with the clinical and biochemical profiles related to PCOS. The patients were divided into 4 groups by quartiles of HOMA-IR. RESULTS: The mean level of HOMA-IR was 2.18 +/- 1.73. Among the four groups separated according to HOMA-IR, body weight, body mass index (BMI), waist-to-hip ratio (WHR), triglyceride (TG), total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, lipid accumulation product (LAP) index, high-sensitivity C-reactive protein (hs-CRP), Apoprotein B, free testosterone, and sex hormone binding globulin (SHBG) were found to be significantly different. TG, LAP index, glucose metabolic profiles, and hs-CRP were positively correlated with HOMA-IR after adjustment for BMI. CONCLUSION: Our results suggest that the clinical and biochemical profiles which are applicable as cardiovascular risk factors are highly correlated with HOMA-IR in Korean women with PCOS.

Lipid Accumulation Product Is Associated with Insulin Resistance, Lipid Peroxidation, and Systemic Inflammation in Type 2 Diabetic Patients

BACKGROUND: Lipid accumulation product (LAP) is a novel biomarker of central lipid accumulation related to risk of diabetes and cardiovascular disease. In this study, we assessed the association of LAP with glucose homeostasis, lipid and lipid peroxidation, and subclinical systemic inflammation in diabetic patients. METHODS: Thirty-nine male and 47 female type 2 diabetic patients were assessed for anthropometrics and biochemical measurements. LAP was calculated as [waist circumference (cm)-65]x[triglycerides (mmol/L)] in men, and [waist circumference (cm)-58]x[triglycerides (mmol/L)] in women. Associations of LAP with fasting glucose, insulin, insulin resistance index, lipid and lipoprotein levels, malondialdehyde, and high-sensitive C-reactive protein (hs-CRP) were assessed. RESULTS: Mean age and LAP index were 53.6+/-9.6 and 51.9+/-31.2 years, respectively. After adjustments for age, sex and body mass index status, a significant positive correlation was observed between LAP index and fasting glucose (r=0.39, P<0.001), and homeostasis model assessment of insulin resistance (r=0.31, P<0.05). After additional adjustment for fasting glucose levels, antidiabetic and antilipidemic drugs, the LAP index was also correlated to total cholesterol (r=0.45, P<0.001), high density lipoprotein cholesterol (HDL-C) levels (r=-0.29, P<0.05), triglycerides to HDL-C ratio (r=0.89, P<0.001), malondialdehyde (r=0.65, P<0.001), and hs-CRP levels (r=0.27, P<0.05). CONCLUSION: Higher central lipid accumulation in diabetic patients was related to higher insulin resistance, oxidative stress and systemic inflammation.

Association of both peroxisome proliferator-activated receptor, gene-gene interactions and the lipid accumulation product / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the association of ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptors (PPARα, δ, γ) with lipid accumulation product (LAP) and the additional role of a gene-gene interactions among the 10 SNPs.</p><p><b>METHODS</b>Participants were recruited under the framework of the PMMJS (Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu province) cohort populations survey in the urban community of Jiangsu province of China. A total of 820 subjects were randomly selected and no individual was related. Ten SNPs (rs135539, rs4253778, rs1800206, rs2016520, rs9794, rs10865710, rs1805192, rs709158, rs3856806 and rs4684847) were selected from the HapMap database, which covered PPARα, PPARδ and PPARγ. A linear regression model was used to analyze the relations between ten SNPs in the PPARs and LAP. Mean difference (Difference) and 95% confident interval (95%CI)were calculated. Interactions were explored by using the method of Generalized Multifactor Dimensionality Reduction (GMDR).</p><p><b>RESULTS</b>After adjusting the factors as age, gender, smoking status, occupational physical activity, educational level, high-fat diet as well as low-fiber diet, both rs1800206, s1805192 and rs3856806 were significantly associated with the increased level of LAP. Difference (95% CI) values were 32.47 (22.62-42.31), 12.97 (4.61-21.33) and 12.49 (4.24-20.75). Whereas rs2016520 was significantly associated with the decreased level of LAP. Difference (95%CI) values was -14.67 ( -22.97--6.55). GMDR analysis showed a significant gene-gene interaction among rs135539, rs1800206 of PPARα, rs2016520 of PPARδ and rs10865710, rs3856806, rs709158, rs1805192, rs4684847 of PPARγ for eight-dimension models (P < 0.05), in which prediction accuracy was 0.5902 and cross-validation consistency was 10/10.</p><p><b>CONCLUSION</b>The rs1800206 of PPARα and rs1805192, rs3856806 of PPARγ were significantly associated with the increased level of LAP; rs2016520 of PPARδ was associated with the decreased level of LAP. There was a gene-gene interaction between multiple SNPs.</p>