The HOMA-Adiponectin (HOMA-AD) Closely Mirrors the HOMA-IR Index in the Screening of Insulin Resistance in the Brazilian Metabolic Syndrome Study (BRAMS).

BACKGROUND: The major adverse consequences of obesity are associated with the development of insulin resistance (IR) and adiposopathy. The Homeostasis Model Assessment-Adiponectin (HOMA-AD) was proposed as a modified version of the HOMA1-IR, which incorporates adiponectin in the denominator of the index. OBJECTIVES: To evaluate the performance of the HOMA-AD index compared with the HOMA1-IR index as a surrogate marker of IR in women, and to establish the cutoff value of the HOMA-AD. SUBJECTS/METHODS: The Brazilian Metabolic Syndrome Study (BRAMS) is a cross-sectional multicenter survey. The data from 1,061 subjects met the desired criteria: 18-65 years old, BMI: 18.5-49.9 Kg/m² and without diabetes. The IR was assessed by the indexes HOMA1-IR and HOMA-AD (total sample) and by the hyperglycemic clamp (n = 49). Metabolic syndrome was defined using the IDF criteria. RESULTS: For the IR assessed by the clamp, the HOMA-AD demonstrated a stronger coefficient of correlation (r = -0.64) compared with the HOMA1-IR (r = -0.56); p < 0.0001. In the ROC analysis, compared with the HOMA1-IR, the HOMA-AD showed higher values of the AUC for the identification of IR based on the clamp test (AUC: 0.844 vs. AUC: 0.804) and on the metabolic syndrome (AUC: 0.703 vs. AUC: 0.689), respectively; p < 0.001 for all. However, the pairwise comparison did not show evidence of superiority for the HOMA-AD in comparison with the HOMA1-IR in the diagnosis of IR and metabolic syndrome (p > 0.05). The optimal cutoff identified for the HOMA-AD for the diagnosis of IR was 0.95. CONCLUSIONS: The HOMA-AD index was demonstrated to be a useful surrogate marker for detecting IR among adult women and presented a similar performance compared with the HOMA1-IR index. These results may assist physicians and researchers in determining which method to use to evaluate IR in light of the available facilities.

Association of Sleep Deprivation With Reduction in Insulin Sensitivity as Assessed by the Hyperglycemic Clamp Technique in Adolescents.

IMPORTANCE: The association between short sleep duration and decreased insulin sensitivity in adolescents has been described. However, to our knowledge, no studies have investigated this association measuring insulin sensitivity by the hyperglycemic clamp technique. OBJECTIVES: To compare the distributions of parameters of insulin resistance in adolescents with sleep deprivation vs adequate sleep, and to investigate the association between sleep deprivation and insulin sensitivity. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional multicenter study using data from the Brazilian Metabolic Syndrome Study conducted from June 29, 2011, to December 3, 2014, at an obesity outpatient clinic at the University of Campinas and public schools, with a convenience sample of 615 adolescents aged 10 to 19.9 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for age and sex at the fifth percentile or higher. A subsample of 81 adolescents underwent the hyperglycemic clamp technique. MAIN OUTCOMES AND MEASURES: The self-reported sleep duration was used to classify the population into 2 groups: adolescents with sleep deprivation (<8 hours/night) and adolescents with adequate sleep (≥8 hours/night). Insulin sensitivity was assessed using the hyperglycemic clamp technique. RESULTS: Among the 615 adolescents (56.3% female; median age, 15.9 years [interquartile range, 12.9-17.8 years]) included in the sample, the mean (SD) sleep duration was 7.9 (1.7) hours/night. The adolescents with sleep deprivation (n = 257) compared with those with adequate sleep (n = 358) had a higher median (interquartile range) age (17.0 [15.4-18.3] vs 14.1 [11.8-16.9] years), BMI (25.0 [21.2-29.3] vs 23.1 [19.5-27.6]), waist circumference (83.0 [73.5-95.4] vs 79.0 [68.5-91.0] cm), sagittal abdominal diameter (17.9 [15.8-20.8] vs 17.0 [15.0-19.8] cm), neck circumference (35.2 [33.0-38.0] vs 33.0 [30.0-35.5] cm), uric acid level (4.9 [4.0-5.8] vs 4.5 [3.7-5.5] mg/dL), and white blood cell count (7000 [5900-8200] vs 6600 [5600-7800] cells/µL) (all P < .05). Moreover, the adolescents with sleep deprivation had a lower median (interquartile range) insulin sensitivity index compared with those with adequate sleep (0.10 [0.05-0.21] vs 0.21 [0.09-0.33] mg · kgfat-free mass-1 · min-1 · mU/L × 100, respectively; difference, -0.01; 95% CI, -0.01 to -0.00; P = .02). After controlling for age and sex in the multivariate regression model, sleep deprivation remained an independent predictor for those variables. In the sleep deprivation group, BMI and central distribution of fat were higher in all categories of adiposity. CONCLUSIONS AND RELEVANCE: Sleep deprivation (<8 hours of sleep per night) is associated with centripetal distribution of fat and decreased insulin sensitivity in adolescents. Therefore, investigations of sleep duration and sleep quality in adolescents should be included in clinical practice to promote, through health education, the eradication of the health risks associated with sleep restriction.

Impact of weight loss diet associated with flaxseed on inflammatory markers in men with cardiovascular risk factors: a clinical study.

BACKGROUND: Flaxseed has received attention for its anti-inflammatory and antioxidant role. The present study hypothesizes if flaxseed added to a weight loss diet could improve the lipid and metabolic profiles and decrease risk factors related to cardiovascular disease. METHODS: In a prospective, single blinded 42 days protocol, subjects were allocated into two groups with low carbohydrates intake: GriceLC (35% of carbohydrate and 60g of raw rice powder per day) and GflaxLC (32% of carbohydrate and 60g of flaxseed powder per day). Blood pressure, anthropometric measures and serum levels of isoprostane, C-reactive protein, Tumor Necrosis Factor-alpha, glucose, lipidic profile, uric acid, adiponectin, leptin and insulin were measured at baseline and at the end of interventions. Serum and urinary enterodiol and enterolactione were also measured. RESULTS: A total of 27 men with cardiovascular risk factors were evaluated, with mean age of 33 ± 10 years to GriceLC and 40 ± 9 years to GflaxLC. Both groups experienced weight loss and systolic blood pressure reduction. A decrease in inflammatory markers (CRP and TNF-α) was observed after flaxseed intake (mean decrease of 25% and 46% for GflaxLC respectively). All groups also showed improvement in levels of total cholesterol, LDL-c, uric acid and adiponectin. Only GflaxLC group showed a decrease in triglyceride levels. CONCLUSION: This study suggests that flaxseed added to a weight loss diet could be an important nutritional strategy to reduce inflammation markers such as CRP and TNF-α. TRIAL REGISTRATION: ClinicalTrials.gov NCT02132728.

Health significance of fat quality in the diet.

This paper summarizes three presentations on the global and Latin American perspectives on the health significance of fat quality in the diet given at the 16th Congress of the Society of Latin American Nutrition in Havana, Cuba, November 11-16, 2012. Dietary fat quality contributes to the risk of the leading chronic diseases and is more important than fat quantity in reducing the risk of chronic disease mortality, especially from cardiovascular disease (CVD). In many countries, the consumption of saturated fats exceeds the recommended limit of 10% energy (%E) and intakes of polyunsaturated fats (PUFAs) are often below the recommended range of 6-11%E. Consumption of long-chain ω-3 PUFAs is especially low. In many Latin American countries, high consumption of carbohydrates, especially sugars, contributes to obesity, diabetes, hypertension and CVD, while intakes of total fat and PUFAs may be low. Thus, dietary fat recommendations must consider the dietary fat patterns of each country. Nutrition counseling can be effective in teaching individuals and families to modify their food intake patterns and control the major risk factors for chronic disease.

O que é uma dieta saudável para prevenção da doença cardiovascular: o papel dos nutrientes sobre lípides, sobrepeso, hipertensão arterial e inflamação subclínica / What healthy diet is for the prevention of cardiovascular disease: Tte role nutrients on lipids, overweight, arterial hypertension and subclinical inflamation

A prevenção e promoção da saúde cardiovascular é, atualmente, uma das principais metas para a saúde pública do país. O comportamento dietético adotado é uma das principais medidas de prevenção e controle ao risco cardiometabólico. Um dos aspectos iniciais da promoção da saúde cardiovascular se refere à inflamação subclínica, bem como aos demais fatores de risco cardiovasculares, normalmente subsequentes a este processo inflamatório. Estes fatores de risco incluem o sobrepeso e obesidade, as dislipidemias , e as alterações no metabolismo da glicose e hipertensão arterial. Um mix dietético que apresente refeições com calorias distribuídas adequadamente ao longo do dia, nas quais a importância da qualidade das fontes alimentares sejam mais significativas do que as diárias totais, são características essenciais para que a dieta apresente um perfil anti-inflamatório. Desta forma, a dieta com gorduras monoinsaturadas e poliinsaturadas, que apresente uma relação equilibrada entre w-3 e w-6, redução de gorduras saturadas e trans e, preferencialmente, a escolha por proteínas magras de alto valor biológico, carboidratos menos refinados, alimentos ricos em polifenois, vitaminas e minerais podem ser estratégicas interessantes na diminuição da atividade inflamatória.

The prevention and promotion of cardiovascular health is nowadays one of main goals for public health in our country. The adopted dietetic dietetic behavior is one of the main ways of prevention and control of cardiometabolic risk. One of the initial aspects in the promotion of cardiovasculat health refers to subclinical inflammation, and to the other cardiovascular risk factors as well, which are normally subsequent to this inflammatory process. Within this risk factors are the overweight and obesity, the dyslipidemias, the alterations in the glucose metabolism and the arterial hypertension. One dietetic mix, which contains meals with calories suitably distributed all day long, whose importance of quality in food sources are more significant than the total daily calories are essential characteristics for the diet to have an antiinflammatory profile. Therefore, the diet with monounsaturated and polyunsaturated fats, which countains a balanced relationship between w-3 e w-6, saturated and trans fat reduction, and especially the choise for slim proteins and of high biological value, less refined carbohydrates, rich foods in polyphenols, citamins and minerals can be interesting strategies for the decrease in the inflammatory activity. This food pattern seems to be favorable to the prevention and promotion of global cardiovascular heatlh.

Prevalence of cardiovascular risk factors in a population of Brazilian industry workers.

BACKGROUND: Determining the cardiovascular risk factors is essential for the primary and secondary prevention of circulatory system diseases. OBJECTIVE: To obtain the prevalence of cardiovascular risk factors in a population of industry workers in Brazil. METHODS: Transversal cohort study, with a sociodemographic interview to identify cardiovascular risk factors, anthropometric and blood pressure measurements and capillary blood collection for blood glucose, cholesterol and triglyceride measurement in food industry workers of both sexes. RESULTS: A total of 1,047 workers were assessed, with 913 (87%) of them being males, with a mean age of 36 +/- 8 years. The frequency of a sedentary lifestyle was 83% and of overweight, 63%. Systemic arterial hypertension was identified in 28% of the individuals and 45% were in the pre-hypertension range. Alterations in the blood glucose levels were identified in 49% of the participants, as well as high levels of cholesterol and triglycerides in 7% and 11% of the population, respectively. The body mass index (BMI) levels were not associated to income, but there was an inverse association with the level of schooling. CONCLUSION: Overweight and a sedentary lifestyle are the main cardiovascular risk factors in a population of industry workers.

Prevalência de fatores de risco cardiovascular em trabalhadores de uma indústria brasileira / Prevalencia de factores de riesgo cardiovascular en trabajadores de una industria brasileña / Prevalence of cardiovascular risk factors in a population of Brazilian industry workers

FUNDAMENTO: Determinar os fatores de risco cardiovascular é essencial para a prevenção primária e secundária das doenças do aparelho circulatório. OBJETIVO: Obter a prevalência de fatores de risco cardiovascular em uma população de industriários no Brasil. MÉTODOS: Estudo transversal em uma coorte com entrevista sociodemográfica para identificação de fatores de risco cardiovascular, medidas antropométricas e de pressão arterial e coleta de sangue capilar para dosagem de glicose, colesterol e triglicérides em funcionários de ambos os sexos de indústria alimentícia. RESULTADOS: Avaliaram-se 1.047 funcionários, sendo 913 (87 por cento) do sexo masculino, com idade média de 36 ± 8 anos. A freqüência de sedentarismo foi de 83 por cento e de sobrepeso de 63 por cento. Hipertensão arterial foi identificada em 28 por cento dos indivíduos e 45 por cento estavam na faixa de pré-hipertensão. Alteração de glicose capilar foi detectada em 49 por cento dos participantes, colesterol elevado em 7 por cento e triglicérides em 11 por cento da população. Os valores de índice de massa corpórea não se associaram à renda, mas houve relação inversa com nível de escolaridade. CONCLUSÃO: Sobrepeso e sedentarismo são os principais fatores de risco cardiovascular em população de industriários.

BACKGROUND: Determining the cardiovascular risk factors is essential for the primary and secondary prevention of circulatory system diseases. OBJECTIVE: To obtain the prevalence of cardiovascular risk factors in a population of industry workers in Brazil. METHODS: Transversal cohort study, with a sociodemographic interview to identify cardiovascular risk factors, anthropometric and blood pressure measurements and capillary blood collection for blood glucose, cholesterol and triglyceride measurement in food industry workers of both sexes. RESULTS: A total of 1,047 workers were assessed, with 913 (87 percent) of them being males, with a mean age of 36 ± 8 years. The frequency of a sedentary lifestyle was 83 percent and of overweight, 63 percent. Systemic arterial hypertension was identified in 28 percent of the individuals and 45 percent were in the pre-hypertension range. Alterations in the blood glucose levels were identified in 49 percent of the participants, as well as high levels of cholesterol and triglycerides in 7 percent and 11 percent of the population, respectively. The body mass index (BMI) levels were not associated to income, but there was an inverse association with the level of schooling. CONCLUSION: Overweight and a sedentary lifestyle are the main cardiovascular risk factors in a population of industry workers.

FUNDAMENTO: Determinar los factores de riesgo cardiovascular es esencial para la prevención primaria y secundaria de las enfermedades del aparato circulatorio. OBJETIVO: Obtener la prevalencia de factores de riesgo cardiovascular en una población del sector industrial en Brasil. MÉTODOS: Estudio transversal en una cohorte con entrevista sociodemográfica para identificación de factores de riesgo cardiovascular, medidas antropométricas y de presión arterial y colecta de sangre capilar para dosificación de glucosa, colesterol y triglicéridos en funcionarios de ambos sexos de una industria alimenticia. RESULTADOS: Se evaluaron a 1.047 funcionarios, 913 (87 por ciento) del sexo masculino, con edad promedio de 36 ± 8 años. La frecuencia de sedentarismo fue del 83 por ciento mientras que la de sobrepeso resultó en el 63 por ciento. Se identificó hipertensión arterial en el 28 por ciento de los individuos y el 45 por ciento estaban en la franja de prehipertensión. Se detectaron alteración de glucosa capilar en el 49 por ciento de los participantes, colesterol elevado en el 7 por ciento y triglicéridos en el 11 por ciento de la población. Los valores de índice de masa corpórea no se asociaron a la renta, pero hubo relación invertida con nivel de escolaridad. CONCLUSIÓN: Sobrepeso y sedentarismo son los principales factores de riesgo cardiovascular en población de trabajadores del sector industrial.