Impact of plasmatic lipids in glycemic control and its influence in the cardiometabolic risk in morbidly obese subjects.

OBJECTIVES: To evaluate whether biochemical parameters are associated with a good glycemic control and to identify the occurrence of cardiometabolic risk variables. MATERIAL AND METHODS: One hundred forty Brazilians were evaluated. The subjects were characterized with regard to glycemic control as good, fair and poor and were divided into tertiles by TG and HbA(1c). We use the ROC curve to determine which variables were predicted of poor glycemic control and the factor analyses to identify the domains that segregated among the risk variables. RESULTS: Fasting glucose and insulin levels, TG level, VLDL-C and HOMA-IR increased significantly across HbA(1c) tertiles. The best marker for identification of poor glycemic control was triglycerides. The presence of cardiometabolic abnormalities did not alter the glycemic control, but HOMA-IR was significantly higher in subjects with abnormalities. CONCLUSION: The use of TG levels offers a reasonable degree of clinical utility. In morbidly obese subjects insulin resistance is associated with individual cardiometabolic factors.

Impact of plasmatic lipids in glycemic control and its influence in the cardiometabolic risk in morbidly obese subjects / Impacto dos lipídios plasmáticos no controle glicêmico e sua influência no risco cardiometabólico em pacientes obesos mórbidos

OBJECTIVES: To evaluate whether biochemical parameters are associated with a good glycemic control and to identify the occurrence of cardiometabolic risk variables. MATERIAL AND METHODS: One hundred forty Brazilians were evaluated. The subjects were characterized with regard to glycemic control as good, fair and poor and were divided into tertiles by TG and HbA1c. We use the ROC curve to determine which variables were predicted of poor glycemic control and the factor analyses to identify the domains that segregated among the risk variables. RESULTS: Fasting glucose and insulin levels, TG level, VLDL-C and HOMA-IR increased significantly across HbA1c tertiles. The best marker for identification of poor glycemic control was triglycerides. The presence of cardiometabolic abnormalities did not alter the glycemic control, but HOMA-IR was significantly higher in subjects with abnormalities. CONCLUSION: The use of TG levels offers a reasonable degree of clinical utility. In morbidly obese subjects insulin resistance is associated with individual cardiometabolic factors.

OBJETIVOS: Avaliar o quanto os lipídios plasmáticos, o IMC e a glicemia de jejum estão associados com um bom controle glicêmico e identificar a ocorrência de variáveis do risco cardiometabólico. MÉTODO: Cento e quarenta brasileiros foram avaliados. Os pacientes foram caracterizados, de acordo com o controle glicêmico, como tendo bom controle, moderado controle e controle ruim e foram divididos em tercis de TG e HbA1c. Utilizou-se a curva ROC para determinar quais variáveis predizem um controle glicêmico inadequado e a análise fatorial para identificar os domínios que segregam as diferentes variáveis. RESULTADOS: A glicemia de jejum e os níveis de insulina, os níveis de TG, VLDL-C e HOMA-IR aumentaram significativamente de acordo com os tercis de HbA1c. O melhor marcador para identificação de indivíduos com um controle glicêmico ruim foi o triglicérides. A presença de anormalidades cardiometabólicas não alterou significativamente o controle glicêmico, mas o HOMA-IR foi significativamente maior nestes indivíduos. CONCLUSÃO: O uso dos níveis de TG oferece uma boa utilidade clínica. Em pacientes obesos mórbidos, a resistência à insulina esta associada com fatores de risco cardiometabólico.

Fatores ambientais, comportamentais e neuroendocrinológicos envolvidos na gênese da epidemia da obesidade: [revisão] / Environmental, comportamental and neuroendocrinological factors involved in obesity epidemic genesis: [review]

A obesidade constitui hoje um preocupante problema de saúde mundial, pois, além de prejudicar o bem estar físico de seu portador, traz consigo comorbidades associadas que aumentam as taxa de morbi-mortalidade. Entre elas incluem-se hipertensão arterial, diabetes mellitus, síndrome da apnéia obstrutiva do sono, osteoartrose, síndrome metabólica e outras. Os recentes avanços alcançados por importantes pesquisas na área molecular conseguiram elucidar grande parte dos mecanismos de controle central do peso corporal, expondo mais um possível sítio para a ação de drogas antiobesidade. A despeito dessas atualidades, o ambiente em que vivemos e determinados comportamentos que seguimos também apresentam forte influência sobre nosso balanço energético e peso corporal, tornando impossível tratar a obesidade por apenas uma frente de ataque. A atividade física e as mudanças no estilo de vida continuam sendo as medidas iniciais da terapêutica e, após estabelecerem-se estas condutas, as recentes descobertas na terapêutica medicamentosa passam a ter valia na tentativa de conter esta epidemia.

Presently the obesity is a serious health problem in the world because, in addition to the damage to the patients, cause co morbidities like hypertension, diabetes mellitus, osteoartrosis, metabolic syndrome, sleep obstructive apnéia syndrome and others increasing the morbid-mortality taxes. The recent findings achieve by important studies in the molecular area obtained succeed in expose a big part of neural control mechanism of body weight, showing another possible place for antiobesity drugs. In the spite of this, some behaviors that we have and the environment where we live also have a big importance in our energy balance and body weight, making impossible to treat the obesity only by one focus. The physical activity and changes in life style are the first step in the therapeutic and, after this, the recent findings in drugs therapeutic start to have value in the tentative of stopping the epidemic of obesity.