Breastfeeding and maternal weight changes during 24 months post-partum: a cohort study.

The relationship between breastfeeding and the loss of weight gained during pregnancy remains unclear. This study aimed to investigate the association between breastfeeding and maternal weight changes during 24 months post-partum. We studied a dynamic cohort comprising 315 women living in two cities in the state of Bahia, Brazil. The outcome variable was change in the post-partum weight; the exposure variable was the duration and intensity of breastfeeding. Demographic, socio-economic, environmental, reproductive and lifestyle factors were integrated in the analysis as covariates. The data were analysed using multiple linear regression and linear mixed-effects models. The average cumulative weight loss at 6 months post-partum was 2.561 kg (SD 4.585), increasing at 12 months (3.066 kg; SD 5.098) and decreasing at 18 months (1.993 kg; SD 5.340), being 1.353 kg (SD, 5.574) at 24 months post-partum. After adjustment, the data indicated that for every 1-point increase in breastfeeding score, the estimated average post-partum weight loss observed was 0.191 kg at 6 months (P = 0.03), 0.090 kg at 12 months (P = 0.043), 0.123 kg at 18 months (P < 0.001) and 0.077 kg at 24 months (P = 0.001). Based on these results, we concluded that despite the low expressiveness, the intensity and duration of breastfeeding was associated with post-partum weight loss at all stages of the study during the 24-month follow-up.

Magnesium replacement does not improve insulin resistance in patients with metabolic syndrome: a 12-week randomized double-blind study.

BACKGROUND: To evaluate the effect of magnesium (Mg) replacement on insulin resistance and cardiovascular risk factors in women with metabolic syndrome (MS) without diabetes. METHODS: This 12-week clinical randomized double-blind study compared the effects of 400 mg/day of Mg with those of a placebo (n = 72) on fasting glucose, insulin, HOMA-IR, lipid profile and CRP. Mg was measured in serum (SMg) and in mononuclear cells (MMg). RESULTS: Hypomagnesemia (SMg < 1.7 mg/dL) was seen in 23.2% of patients and intracellular depletion in 36.1% of patients. The MMg means were lower in patients with obesity (0.94 ± 0.54 µg/mg vs. 1.19 ± 0.6 µg/mg, P = 0.04), and insulin resistance (0.84 ± 0.33 µg/mg vs. 1.14 ± 0.69 µg/mg, P < 0.05). Mg replacement did not alter SMg (1.82 ± 0.14 mg/dL vs. 1.81 ± 0.16 mg/dL, P = 0.877) and tended to increment MMg (0.90 ± 0.40 µg/mg vs. 1.21 ± 0.73 µg/mg, P = 0.089). HOMA-IR did not alter in interventions nor in placebo group (3.2 ± 2.0 to 2.8 ± 1.9, P = 0.368; 3.6 ± 1.9 to 3.2 ± 1.8, respectively), neither did other metabolic parameters. CONCLUSION: Serum and intracellular Mg depletion is common in patients with MS; however, Mg replacement in recommended dosage did not increase significantly Mg levels, neither reduced insulin resistance or metabolic control.

Thyroglobulin in the washout fluid of lymph-node biopsy: what is its role in the follow-up of differentiated thyroid carcinoma?

BACKGROUND: The clinical evaluation of enlarged local lymph nodes (LNs) is difficult at the beginning and throughout the follow-up of differentiated thyroid carcinoma (DTC). Although the examination of samples collected from LNs by fine-needle aspiration biopsy cytology (FNAB-C) is extremely specific for the diagnosis of metastases, its sensitivity is low, especially in paucicellular samples. SUMMARY: The measurement of thyroglobulin (Tg) in the fine-needle aspiration biopsy (FNAB) washout fluid (FNAB-Tg) increases the diagnostic performance of cytology to up to 100% sensitivity and specificity. However, the application of FNAB-Tg is currently hindered by the absence of methodological standardization, a lack of definite cutoff points, and the ongoing debate regarding its accuracy in nonthyroidectomized patients, those with elevated serum Tg, and those with circulating anti-Tg antibodies. CONCLUSION: FNAB-Tg improves the diagnostic performance of FNAB-C in LN metastases, even when the latter is unable to diagnose the metastases. For that reason, FNAB-Tg should be included in the monitoring of DTC.

Determinants of postpartum weight variation in a cohort of adult women; a hierarchical approach.

INTRODUCTION: Retention of the weight gained during pregnancy or the weight gain postpartum has been associated with increased prevalence of obesity in women of childbearing age. OBJECTIVE: To identify determinants of weight variation at 24 months postpartum in women from 2 towns in Bahia, Brazil. METHODS: Dynamic cohort data of 325 adult women were collected for 24 months postpartum. Weight variation at 24 months postpartum was considered a response variable. Socioeconomic, demographic, reproductive, related with childbirth variables and lifestyle conditions were considered exposure variables. A linear mixed-effects regression model with a hierarchical approach was used for data analysis. RESULTS: Suitable sanitary conditions in the household (2.175 kg; p = 0.001) and participation social programs for income transfer (1.300 kg; p = 0.018) contributed to weight gain in distal level of determinants, while at intermediate level, pre gestational overweight and surgical delivery had effects on postpartum weight, causing an average increase of 3.380 kg (p < 0.001) and loss of 2.451 kg (p < 0.001), respectively. At proximal level, a score point increase for breastfeeding yielded an average postpartum loss of 70 g (p = 0.002). CONCLUSION: Our results indicate the need to promote weight control during and after pregnancy, encourage extended breastfeeding, and improve living conditions through intersectoral interventions.

Introducción: La retención del aumento de peso durante el embarazo y el aumento de peso después del parto se ha asociado a una mayor prevalencia de la obesidad en las mujeres en edad fértil. Objetivo: Identificar los factores determinantes de la variación del peso en los 24 meses posparto, en mujeres adultas en dos municipios de Bahía/Brasil. Métodos: En una cohorte dinámica se incluyeron 325 mujeres, acompañadas durante 24 meses. La variación del peso a los 24 meses después del parto se consideró variable de respuesta y los factores socioeconómicos, demográficos, reproductivos, de la estilo de vida y factores relacionados con el niño, son las variables de exposición. En el análisis de datos se construyeron modelos de regresión lineal de efectos mixtos con un enfoque jerárquico para identificar los determinantes de la variación del peso posparto. Resultados: Han contribuido al aumento de peso en el nivel distal, inadecuadas condiciones sanitarias de la vivienda (2,175 kg, p = 0,001) y la participación en los programas sociales de transferencia de ingresos (1.300 kg; p = 0,018). En el nivel intermedio, el exceso de peso antes del embarazo aumentó el peso después del parto en una media de 3,380 kg (p < 0,001), mientras que el parto por cesárea contribuyó a la pérdida de 2,451 kg (p < 0,001). A nivel proximal, el aumento de un punto en la puntuación de la lactancia materna contribuyo con la pérdida de 70 g (p = 0,002) en la media del peso posparto. Conclusiones: Estos resultados indican a la necesidad de las acciones de salud dirigidas a controlar el peso durante el embarazo y después del parto incluyendo la promoción de la lactancia materna durante largos períodos y la mejora de las condiciones de vida, que implica acciones intersectoriales.

Determinants of postpartum weight variation in a cohort of adult women: a hierarchical approach / Determinantes de la variación del peso postparto en una cohorte de mujeres adultas; un enfoque jerárquico

INTRODUCTION: Retention of the weight gained during pregnancy or the weight gain postpartum has been associated with increased prevalence of obesity in women of childbearing age. OBJECTIVE: To identify determinants of weight variation at 24 months postpartum in women from 2 towns in Bahia, Brazil. METHODS :Dynamic cohort data of 325 adult women were collected for 24 months postpartum. Weight variation at 24 months postpartum was considered a response variable. Socioeconomic, demographic, reproductive, related with childbirth variables and lifestyle conditions were considered exposure variables. A linear mixed-effects regression model with a hierarchical approach was used for data analysis. RESULTS: Suitable sanitary conditions in the household (2.175 kg; p = 0.001) and participation social programs for income transfer (1.300 kg; p = 0.018) contributed to weight gain in distal level of determinants, while at intermediate level, pre gestational overweight and surgical delivery had effects on postpartum weight, causing an average increase of 3.380 kg (p < 0.001) and loss of 2.451 kg (p < 0.001), respectively. At proximal level, a score point increase for breastfeeding yielded an average postpartum loss of 70 g (p = 0.002). Conclusion: Our results indicate the need to promote weight control during and after pregnancy, encourage extended breastfeeding, and improve living conditions through intersectoral interventions (AU)

Introducción: La retención del aumento de peso durante el embarazo y el aumento de peso después del parto se ha asociado a una mayor prevalencia de la obesidad en las mujeres en edad fértil. Objetivo: Identificar los factores determinantes de la variación del peso en los 24 meses posparto, en mujeres adultas en dos municipios de Bahía/Brasil. Métodos: En una cohorte dinámica se incluyeron 325 mujeres, acompañadas durante 24 meses. La variación del peso a los 24 meses después del parto se consideró variable de respuesta y los factores socioeconómicos, demográficos, reproductivos, de la estilo de vida y factores relacionados con el niño, son las variables de exposición. En el análisis de datos se construyeron modelos de regresión lineal de efectos mixtos con un enfoque jerárquico para identificar los determinantes de la variación del peso posparto. Resultados: Han contribuido al aumento de peso en el nivel distal, inadecuadas condiciones sanitarias de la vivienda (2,175 kg, p = 0,001) y la participación en los programas sociales de transferencia de ingresos (1.300 kg; p = 0,018). En el nivel intermedio, el exceso de peso antes del embarazo aumentó el peso después del parto en una media de 3,380 kg (p < 0,001), mientras que el parto por cesárea contribuyó a la pérdida de 2,451 kg (p < 0,001). A nivel proximal, el aumento de un punto en la puntuación de la lactancia materna contribuyo con la pérdida de 70 g (p = 0,002) en la media del peso posparto. Conclusiones: Estos resultados indican a la necesidad de las acciones de salud dirigidas a controlar el peso durante el embarazo y después del parto incluyendo la promoción de la lactancia materna durante largos períodos y la mejora de las condiciones de vida, que implica acciones intersectoriales (AU)

Serum and intracellular magnesium deficiency in patients with metabolic syndrome--evidences for its relation to insulin resistance.

This cross sectional study evaluated serum (SMg) and intramononuclear (MMg) magnesium in patients with metabolic syndrome without diabetes and correlated them with cardiovascular risk factors. 72 patients and 57 controls (blood donors) were studied. Hypomagnesemia (SMg<1.7 mg/dL) was seen in 23.2% and intracellular depletion in 36.1% of the patients. SMg and MMg means were significantly lower in patients than in controls: 1.80+/-0.18 mg/dL vs. 2.43+/-0.43 mg/dL and 0.98+/-0.55 microg/mg vs. 1.67+/-0.64 microg/mg of protein (P<0.001). Inverse correlation was observed between, SMg and MMg with BMI; SMg with systolic blood pressure and waist circumference in women. Patients with acanthosis nigricans had lower SMg (1.75+/-0.18 mg/dL vs. 1.85+/- 0.18 mg/dL, P<0.05). Non-white people had lower SMg (1.78+/-0.16 mg/dL vs. 1.92+/-0.24 mg/dL, P=0.007) and MMg (0.95+/-0.59 microg/mg vs. 1.13+/-0.42 microg/mg, P=0.03). Patients with IR showed lower MgM means (0.84+/-0.33 microg/mg vs. 1.14+/-0.69 microg/mg, P<0.05). The same occurred in patients with low HDL-c levels (0.92+/-0.46 microg/mg vs. 1.20+/-0.70 microg/mg, P=0.03), and those with moderate and severe hepatic steatosis (0.77+/-0.29 microg/mg vs. 1.21+/-0.80 microg/mg, P<0.05). In conclusion, magnesium depletion in serum and mononuclear cells is common in obese people with metabolic syndrome, and it is more evident in non-white people with insulin resistance. This depletion may contribute to a post-receptor insulin resistance.

Effect of oral contraceptives on vascular endothelial growth factor, Cox-2 and aromatase expression in the endometrium of uteri affected by myomas and associated pathologies.

BACKGROUND: The study was conducted to evaluate vascular endothelial growth factor (VEGF), Cox-2 and aromatase expression in the endometrium of uteri with myomas and other associated pathologies. STUDY DESIGN: Hysteroscopy was performed in 118 women of reproductive age with myomas and menorrhagia, 40 of whom were using a pill containing 75 mcg gestodene+30 mcg ethinylestradiol. Aromatase p450, VEGF and Cox-2 expression was detected using immunohistochemistry. Fisher's Exact Test and the Mann-Whitney test were used in the statistical analysis, with significance established at p<.05. RESULTS: In patients with myomas and menorrhagia, associated pathologies such as adenomyosis, endometrial polyps and endometriosis were found in 32%, 12% and 17% of cases, respectively. Aromatase, Cox-2 and VEGF expression was greater during the proliferative phase compared to the luteal phase of the cycle or following oral contraceptive use. CONCLUSION: Endogenous progesterone or combined oral contraceptives are potent inhibitors of VEGF, aromatase and Cox-2 expression in the endometrium of patients with myomas and menorrhagia.

The interface of oxytocin-labeled cells and serotonin transporter-containing fibers in the primate hypothalamus: a substrate for SSRIs therapeutic effects?

Oxytocin (OT) is a neuropeptide synthesized in the paraventricular (PVN) and supraoptic nuclei (SON) in the hypothalamus. Although OT is more commonly known for its role in the milk-ejection reflex, in recent years research has indicated that OT participates in the expression of social behavior, memory processing, modulation of fear, and stress responses. The demonstration that OT influences affiliative behaviors, such as parental care and reproduction, and decreases anxiety has lead to speculations that it may have a role in mood disorders. Evidence from pharmacologic studies, pointing out the modulation of the OT system by serotonin, has argued in favor of OT as a mediator of serotonin reuptake inhibitors (SSRIs) antidepressant properties. In the present study, we investigated the distribution and overlap of OT-labeled cells and serotonin transporter (5-HTT) immunoreactive (IR) fibers in the Macaque hypothalamus, utilizing immunocytochemical and double-immunofluorescent techniques. Consistent with previous reports, the distribution of OT-labeled cells in the hypothalamus is confined to the PVN and SON. In these nuclei, we demonstrate that the distribution of 5-HTT-labeled fibers follows the distribution of OT-labeled cells. Overlap of OT-labeled neurons and 5-HTT-IR fibers occurs in the parvicellular, magnocellular, dorsal, and posterior subdivisions of the PVN. In the SON, 5-HTT-labeled fibers and OT-labeled cells overlap in the ventromedial subdivision and in the 'capsular' part of the dorsolateral SON. These findings provide neuroanatomic support for the idea that SSRIs' therapeutic effects on social affiliation and anxiety may be mediated in part through components of the OT system.

Quantificação da ecogenicidade hepática para a classificação ultra-sonográfica da doença hepática gordurosa não alcoólica / Quantification of liver echogenicity for ultrasonographic classification of nonalcoholic fatty liver disease

A utilização da ultra-sonografia na identificação da doença hepática gordurosa não alcoólica (DHGNA) apresenta sensibilidade de até 94% e especificidade de até 100%; entretanto, o método apresenta como desvantagem a subjetividade do examinador. Os cri»térios ecográficos para o diagnóstico de DHGNA con»sistem em: aumento de fundo da ecogenicidade em relação à ecogenicidade renal adjacente, atenuação do feixe acústico, áreas focais de maior ecogenicida»de e apagamento das veias supra-hepáticas. Objeti»vo: Quantificar a ecogenicidade hepática para classi»ficar em graus a DHGNA. Método: Utilizou-se a análise de histograma de escala de cinzas para quantificar a ecogenicidade, com a finalidade de análise mais acu»rada das características do tecido hepático. A utiliza»ção do software Adobe Photoshop 7.0@ com o aplicati»vo Wide Histogram@ permite a análise de histogramas de imagens, pois consegue identificar 32.768 tons de cinza. Inicialmente, foi calculado o intervalo represen»tativo da ecogenicidade hepática e do rim subjacente (média:!: 2 desvios-padrão, que corresponde aos 97,5% mais representativos do tecido). Posteriormen»te, foi determinado o percentual de sobreposição da ecogenicidade do fígado com o rim analisado. Resul»tados: Consideraram-se como normal quando o per»centual de sobreposição de ecogenicidade estava em até 25%; esteatose grau I para percentual entre 25 e 50%; esteatose grau 11 para percentual entre 50 e 75%; esteatose grau 111 para percentual acima de 75%. Con»clusão: Os autores concluem que, com quantificação de ecogenicidade, a classificação de DHGNA torna-se objetiva, portanto, não examinador-dependente.

Peripheral insulin resistance during treatment of chronic hepatitis C with peguilated interferon plus ribavirin.

UNLABELLED: Patients with hepatitis C virus (HCV) infection present higher risk of developing type-2 diabetes mellitus (DM). However, the mechanism of this association and the role of antiviral treatment are still unclear. The objective of this study was to investigate the relationship between the use of peguilated interferon and the development of insulin resistance (IR) in these patients. METHODS: HOMA index was evaluated in 30 HCV-infected patients just before and during the first 6 months of treatment with peguilated interferon plus ribavirin. Anthropometrical parameters and glucose/cholesterol profile were also monitored. RESULTS: No changes in HOMA after 6 months of treatment were observed. Glucose levels decreased but not significantly (P = 0.059). Patients with higher HOMA index after 6 months of treatment also presented higher aminotransferase levels (P = 0.03), higher fat index on computed tomography (P = 0.011), longer time of exposure to the virus (P = 0.021), and a positive smoking history when compared to non-insulin resistant patients (P = 0.045). There was no influence of fibrosis stage on liver biopsy in the insulin-resistance development. CONCLUSIONS: No changes in the IR were observed after 6 months of treatment. Insulin resistance is related to the abdominal fat and anthropometrical parameters rather than to the antiviral treatment.

The metabolic syndrome in Spanish migrants to Brazil: unexpected results.

A cross-sectional study was performed involving epidemiological and clinical features of the metabolic syndrome (MS) in Spanish migrants to Brazil and their descendants. This included 479 subjects: Group A (Spanish migrants): n=215; Group B (descendants born in Brazil of Spanish parents): n=126, Group C (mixed descendants born in Brazil with either father or mother born in Spain): n=138. MS was defined according to the original NCEP/ATP III criteria and by the revised NCEP/ATP definition (glucose>or=100mg/dl). Overall prevalence of MS according to NCEP/ATP III criteria was 26.3%. Age/sex-adjusted prevalence was 27.4%. When the revised NCEP criteria were considered, overall prevalence was 30.1% (age/sex-adjusted 31.3%). The differences between the two criteria were 3.8% and 3.9% (CI -1.9-9.4%). When stratified by groups the MS was more prevalent in Group A (37.2%) and Group B (20.6%) than in Group C (10.9%). Environmental factors may have influenced the development of MS. Reason for the apparently protective role of genetic features due to admixture between populations in the mixed descendants needs to be explored.

[Idiopathic central precocious puberty in girls in Bahia, Brazil]. / Puberdade precoce central idiopática em meninas no estado da Bahia.

INTRODUCTION: Although the therapeutic effects of GnRH analogues (GnRHa) in central precocious puberty (CPP) have been established, clinical aspects may vary according to racial groups. OBJECTIVE AND METHODS: To describe the profile of 175 girls from Bahia, Brazil, treated with GnRHa for idiopathic CPP. RESULTS: The mulatto racial group predominated in the sample. The chronological age at puberty was 6.3 +/- 0.1 years. At diagnosis, height was 2.2 +/- 0.1 SD and body mass index (BMI) was 1.5 +/- 0.1 SD (> 2 SD in 32%), this one, inversely associated with age at onset of puberty (R = -0.20, p = 0.008). At treatment, chronological and bone ages were 8.4 +/- 0.1 years and 10.3 +/- 0.1 years, respectively. At the end of treatment (n = 52) age, BMI and height were 10.6 +/- 0.1 years, 1.6 +/- 0.2 SD and 1.9 +/- 0.2 SD, respectively. CONCLUSION: Clinical presentation and evolution were similar to other studies, independently of racial characteristics. In this sample, treatment with GnRHa was not associated to significant weight gain.

Detecção do hipotireoidismo subclínico em gestantes com diferentes idades gestacionais / Detection of subclinical hypothyroidism in pregnant women with different gestational ages

OBJETIVO: Detectar hipotireoidismo subclínico em gestantes. MATERIAL E MÉTODO: Foram estudadas 75 gestantes, voluntárias, residentes na cidade de Itabuna, Bahia. O protocolo constou de: critérios de inclusão: gestante com faixa etária < 40 anos, sem história prévia de doença tireoidiana ou auto-imunes e diabetes mellitus em qualquer idade gestacional; avaliação clínica com entrevista sob a forma de questionário; avaliação laboratorial com dosagem de T4 livre, TSH, anticorpos anti-TPO, perfil lipídico (colesterol total, HDL-colesterol e triglicérides); avaliação ultra-sonográfica da tireóide. RESULTADOS: A idade média foi de 21,6 ± 5,1 anos (14-40); a idade gestacional média foi de 24,2 ± 8,2 semanas (5-39); foi encontrado TSH elevado com T4 livre normal em 3 gestantes (4,0 por cento). A positividade de anticorpos anti-TPO foi de 8,0 por cento. Foram encontradas 5,4 por cento de alterações ultra-sonográficas tireoidianas. CONCLUSÃO: Encontramos uma prevalência de 4,0 por cento de hipotireoidismo subclínico na amostra, e com base neste resultado os autores consideram de grande importância a inclusão da avaliação tireoidiana na rotina do exame pré-natal. Estudos ulteriores se fazem necessários para estabelecer em que momento a avaliação tireoidiana de mulheres grávidas deve ser iniciada e com que freqüência deve ser repetida durante o curso da gestação.

Deficiência de magnésio e resistência à insulina em pacientes com diabetes mellitus tipo 2 / Magnesium deficiency and insulin resistance in patients with type 2 diabetes mellitus

O magnésio é um íon predominantemente intra-celular, que participa como co-fator de mais de 300 reações enzimáticas, dentre elas na atividade da tirosino-cinase. Sua deficiência pode aumentar a resistência periférica à insulina, especialmente em pacientes com síndrome metabólica e diabetes mellitus tipo 2 (DM2). Este trabalho avaliou, em 27 pacientes com DM2 descompensado, o conteúdo intra-celular de magnésio, correlacionando-o com índices laboratoriais de resistência insulínica e controle glicêmico. Hipomagnesemia foi encontrada em 75 por cento dos pacientes e déficit intra-celular em 30,8 por cento. Houve correlação negativa do Mg intra-celular (Mg IC) com HbA1 e com IMC. 59,2 por cento dos pacientes apresentaram HOMA IR > 3,5, e tendência para correlação negativa com o Mg IC, porém sem significância estatística. Apesar do número pequeno de pacientes, ressalta-se que uma vez que deficiência de magnésio é comum em pacientes com diabetes, sua relação com resistência insulínica deve ser mais estudada.

Puberdade precoce central idiopática em meninas no estado da Bahia / Idiopathic central precocious puberty in girls from Bahia, Brazil

INTRODUÇÃO: Embora os efeitos benéficos do tratamento com análogos de GnRH (GnRHa) na puberdade precoce central (PPC) estejam estabelecidos, aspectos clínicos podem variar em função do grupo racial. OBJETIVO E MÉTODOS: Descrever o perfil de 175 meninas com PPC idiopática tratadas com GnRHa na Bahia, Brasil. RESULTADOS: Houve predomínio do grupo racial mulato (73,6 por cento). A puberdade iniciou-se aos 6,3 ± 0,1 anos. Ao diagnóstico, as crianças apresentavam estatura de 2,2 ± 0,1 DP e índice de massa corpórea (IMC) de 1,5 ± 0,1 DP (> 2 DP em 32 por cento), estando este, inversamente associado (R= -0,20, p= 0,008) à idade no início da puberdade. As idades cronológica e óssea foram de 8,4 ± 0,1 anos e 10,3 ± 0,1 anos, respectivamente, ao início do tratamento. No seu término (n= 52), idade, IMC e estatura (n= 52) foram 10,6 ± 0,1 anos, 1,6 ± 0,2 DP e 1,9 ± 0,2 DP, respectivamente. CONCLUSÃO: Apresentação clínica e evolução puberal foram similares a outros estudos, independente do grupo racial. O tratamento com GnRHa não resultou em ganho de peso significativo na amostra estudada.

[Detection of subclinical hypothyroidism in pregnant women with different gestational ages]. / Detecção do hipotireoidismo subclínico em gestantes com diferentes idades gestacionais.

AIM: To detect subclinical hypothyroidism in pregnant women. SUBJECTS AND METHODS: Seventy-five pregnant women who resided in the town of Itabuna, state of Bahia, were voluntarily studied. Inclusion criteria were age < 40 years, no history of previous thyroid disease, autoimmunopathy or diabetes mellitus, and any gestational age; a clinical evaluation (an interview obeying to a questionnaire); laboratory evaluation (free T4, TSH, anti-TPO antibody, total and HDL cholesterol, triglyceride determinations); thyroid ultrasonography. RESULTS: Average age was 21.6 +/- 5.1 (14-40 years); gestation age was 24.2 +/- 8.2 (5-39 weeks); an elevated TSH with normal free T4 was found in 3 cases (4.0%). Anti-TPO antibodies were positive in 8.0% on the pregnant women. In 5.4% of them, thyroid ultrasonographic changes were documented. CONCLUSION: Based on finding of a 4% prevalence of elevated TSH during pregnancy, the authors consider important the inclusion of thyroid function laboratory evaluation in the routine prenatal examination. Further studies appear necessary to establish at what gestational age thyroid function evaluation should be started in pregnant women and how frequently it should be repeated during the course of gestation.

[Magnesium deficiency and insulin resistance in patients with type 2 diabetes mellitus]. / Deficiência de magnésio e resistência à insulina em pacientes com diabetes mellitus tipo 2.

Magnesium is a predominantly intracellular ion, and it is a cofactor in more than 300 enzymatic reactions, like tyrosinokinase activity. Its deficiency may increase insulin resistance, especially in patients with metabolic syndrome or type 2 diabetes. This study evaluated in 27 patients with poorly controlled type 2 diabetes if there was correlation between intracellular magnesium levels, laboratorial indexes of insulin resistance and glycemic control. Decreased serum and intracellular magnesium depletion were found in 75% and 30.8% of patients, respectively. A negative correlation between intracellular magnesium levels (ICMg) and BMI and HbA1 was found. The homeostasis model assessment for insulin resistance (HOMA-IR) was higher than 3.0 in 59.2% of patients and there was a tendency to negative correlation with ICMg levels, although without statistical significance. Despite the small number of patients, this study shows that magnesium deficiency is frequent in patients with diabetes and its correlation with insulin resistance should be more studied.

Avaliação do estado nutricional de adultos e idosos e situação nutricional da população brasileira / Nutritional assessment of adults and elderly and the nutritional status of the Brazilian population

As alterações do estado nutricional (desnutrição e obesidade) são relacionadas com sérios agravos para a saúde. O presente trabalho de revisão da literatura tem por objetivo descrever os principais métodos de avaliação do estado nutricional, com finalidade de facilitar o diagnóstico dos problemas nutricionais e acompanhar intervenções dietoterápicas. Descreve o método clínico, detalha aspectos da antropometria e os exames laboratoriais utilizados em avaliação do estado nutricional. Relaciona alguns dos principais índices múltiplos, utilizados tanto com fins diagnósticos e prognósticos. Informa a respeito da impedância bioelétrica, completando abordagem sobre os métodos convencionais, além de descrever as principais vantagens e desvantagens dos métodos não-convencionais. Finaliza com revisão sobre a situação nutricional da população brasileira, através da análise de dados obtidos em três inquéritos populacionais (1974, 1989, 1997).

Cintilografia de perfusão miocárdica em pacientes diabeticos tipo 2 com dor torácica atípica / Myocardial perfusion scintigraphy in type 2 diabetic patients with atypical chest pain

Foram avaliados através de cintilografia miocárdica de perfusão, 67 pacientes com diabetes tipo 2 (DM2) com dor torácica atípica e com eletrocardiograma de repouso normal ou com alterações inespecíficas da repolarização ventricular, com o objetivo de se verificar a prevalência de alterações miocárdicas isquêmicas. A idade média ± DP dos pacientes foi de 63,5 ± 9 anos. Vinte e um (31,3 por cento) homens e 46 (68,7 por cento) mulheres. Grande parte da amostra (62,7 por cento) apresentou exame normal, enquanto em 37,3 por cento a cintilografia apresentou-se positiva para isquemia. O teste ergométrico foi realizado em 91 por cento (n = 61) e em 31,1 por cento foi positivo para isquemia. A concordância entre a cintilografia miocárdica e o teste ergométrico mostrou baixa correlação entre os dois testes (Kappa = 0,49; P = 0,0001). Concluímos que a cintilografia de perfusão miocárdica comprovou-se de elevado valor clínico na avaliação e diagnóstico da doença coronariana em pacientes com DM2 com dor precordial atípica.

[Nutritional assessment of adults and elderly and the nutritional status of the Brazilian population]. / Avaliação do estado nutricional de adultos e idosos e situação nutricional da população brasileira.

Nutritional disorders (undernutrition and obesity) are associated to increases in morbidity and mortality. This paper consists on a review of literature with the purpose of describing the main methods of nutritional assessment, in order to facilitate the diagnosis of nutritional disorders and the follow-up of dietetics interventions. It describes the clinical method, details procedures of anthropometry and laboratory evaluation and enrolls some of the multiple indices used for diagnosis and prognosis. Information about bioelectric impedance is given. Some aspects of non-conventional methods are reminded. Nutritional status of the Brazilian population is discussed, using the analysis of data collected from three populational surveys (1974, 1989, and 1997).