The effects of macronutrients composition on hormones and substrates during a meal tolerance test in drug-naive and sitagliptin-treated individuals with type 2 diabetes: a randomized crossover study

ABSTRACT Objectives: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Materials and methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543

The effects of macronutrients composition on hormones and substrates during a meal tolerance test in drugnaive and sitagliptin-treated individuals with type 2 diabetes: a randomized crossover study.

Objective: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543.

Screening for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus.

Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol Metab. 2016;60(2):143-51.

Screening for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus

ABSTRACT Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol Metab. 2016;60(2):143-51.

O tratamento do diabetes e doenças cardiovasculares: benefícios e riscos do tratamento farmacológico / Diabetes treatment and cardiovascular diseases: benefits and risks of pharmacologic treatment

O diabetes tipo 2 (DM2) é uma doença de característica evolutiva e silenciosa muito frequente e a sua prevalência vem aumentando em proporções epidêmicas, cujo maior impacto como problema importante de saúde se relaciona à associação do diabetes com o desenvolvimento da doença cardiovascular, que apresenta fatores etiopatogênicos comuns com o processo aterosclerótico, e é a principal causa de mortalidade e morbidade do paciente diabético. Estudos clínicos randomizados delonga duração têm demonstrado que a hiperglicemia crônica e presença de fatores de risco cardiovasculares associados à síndrome metabólica frequentemente observada na maioria dos pacientes com diabetes se relacionam com o desenvolvimento das complicações macro e microvasculares da doença e manutenção continuada do controle glicêmico e o tratamento dos fatores de risco podem prevenir ou retardar as complicações crônicas do diabetes, especialmente as doenças microvasculares. Nas duas últimas décadas, novos fármacos com diferentes mecanismos de ação têm sido utilizados como ferramentas valiosas para a manutenção do controle glicêmico adequado, retardando o desenvolvimento ou prevenindo a presença de complicações do diabetes, entretanto, a prevenção das complicações cardiovasculares do diabetes depende do diagnóstico e da introdução terapêutica precoce em fases iniciais da história natural da doença e o tratamento deverá ser individualizado, considerando os efeitos colaterais dos medicamentos utilizados em pacientes fragilizados ecoronariopatas.

Type 2 diabetes mellitus (DM2) is a progressive and very frequent disease and its prevalence is increasing in epidemic proportions which have a great impact as a public health problem. Cardiovascular artery diseases (CAD) are the main cause of mortality, morbidity, physical incapacity and worsening in quality of life among individuals with diabetes. Recently, long term randomized clinical studies demonstrated that the development of macro and microvascular complications of diabetes are related to chronic hyperglycemic state and to the presence of cardiovascular risk factors associated to the metabolic syndrome frequently presented in patients with DM2 as well as the therapeutic maintenance of an adequate glycemic control and the correction of cardiovascular risk factors could prevent or reduce the development of diabetes complications. Diabetes pathophysiology knowledge presented an impressive improvement during the last two decades and several new pharmacologic agents were developed for clinical care of diabetic patients reducing or preventing chronic complications, especially microvascular diabetes and neuropathic complications. However, the prevention of macrovascular complications efectivity showed to benot only dependent on strict and continuous intensive glycemic controlbut also on the concomitant treatment of cardiovascular risk factors, the precocity of treatment introduction and in avoiding hypoglycemic events that are related to increased mortality in patients with CAD. The glycemic treatment goals in elder and frail individuals and in patients with important comorbidities or cardiovascular disease should beindividualized to achieve the best global cost benefit.

Associação entre adiponectina e resistência insulínica em idosos com Diabetes Mellitus e intolerância à glicose / Association between adiponectin and insulin resistance in older adults with diabetes mellitus and glucose intolerance

A adiponectina é um marcador metabólico, inversamente associada à RI, baixos níveis séricos têm importância como preditor de risco de desenvolvimento de DM2 e níveis elevados de adiponectina estão associados com diminuição do risco de DM2 em idosos (AU)

Comparação entre variáveis metabólicas e quartis de resistência insulínica em idosos / Comparison between metabolic variables and quartiles of insulin resistance in elderly

Entre as variáveis analisadas, a cintura abdominal, IMC, hemoglobina glicada e adiponectina se associaram a maior grau de resistência insulínica

Associação entre adiponectina e resistência insulínica em idosos com Diabetes Mellitus e intolerância à glicose

A adiponectina é um marcador metabólico, inversamente associada à RI, baixos níveis séricos têm importância como preditor de risco de desenvolvimento de DM2 e níveis elevados de adiponectina estão associados com diminuição do risco de DM2 em idosos

Comparação entre variáveis metabólicas e quartis de resistência insulínica em idosos

Entre as variáveis analisadas, a cintura abdominal, IMC, hemoglobina glicada e adiponectina se associaram a maior grau de resistência insulínica

Glycemia and cardiovascular disease in type 1 diabetes mellitus.

OBJECTIVE: To evaluate the role of glycemic control in the development of cardiovascular disease (CVD) in type 1 diabetes mellitus (DM). METHODS: We review the literature regarding coronary atherosclerosis, coronary artery calcification, and the epidemiologic studies related to the role of glycemia and the classic risk factors for coronary artery disease (CAD) in type 1 DM. RESULTS: Four prospective studies (Wisconsin Epidemiologic Study of Diabetic Retinopathy, EURODIAB, Steno Diabetes Center Study of Adults With Type 1 DM, and Pittsburgh Epidemiology of Diabetes Complications study) do not show that glycemic control predicts CAD occurrence. Findings from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study show that compared with conventional insulin therapy, intensive insulin therapy reduces CVD among patients with type 1 DM and is associated with lower prevalence of coronary artery calcification. The discrepancies between the findings from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study and the Pittsburgh Epidemiology of Diabetes Complication study are likely due to differences between the study populations and the lower prevalence of renal disease in the former study. Besides duration of DM and albuminuria/overt nephropathy, insulin resistance is a major determinant of CAD associated with type 1 DM. CONCLUSIONS: Discrepant study results regarding the relationship between glycemia and CAD/coronary artery calcification may be related to the prevalence of renal disease and the presence of the metabolic syndrome. Published data suggest that addressing traditional risk factors including albuminuria, the metabolic syndrome, and inflammatory markers is better for preventing and treating CAD than focusing exclusively on glycemic control, which is still necessary for preventing microvascular complications. Furthermore, there is a synergistic effect of glycemic control and albuminuria on the development of CVD.

[The prevalence of diabetes and stress hyperglycemia in the acute myocardial infarction patients]. / Avaliação da prevalência do diabetes e da hiperglicemia de estresse no infarto agudo do miocárdio.

OBJECTIVES: To evaluate in our population the real prevalence of diabetes (DM) and stress hyperglycemia (HE) in patients with myocardial infarction (IAM) admitted in a cardiologic emergency unit. METHODS: A retrospective analysis of 2262 patients with AMI evaluating the prevalence of DM (referred and diagnosed) and stress hyperglycemia. RESULTS: Besides 12.1% of subjects were previously referred to be diabetic (men: 10.7% and women: 15.8%), diabetes was effectively diagnosed in 24.8% (M: 22.9%, W: 29.7%) and stress hyperglycemia in 13.6% HE of the patients (M: 14.3%, W: 11,7%) indicating that glycemic alterations were effectively observed in 37.2.% of the patients with IAM (M: 37.2%, W: 41.4%). In DM subjects IAM events occurred earlier, total intra-hospital mortality was higher (DM: 20.7%, ND: 13.8%, HE: 13.4%) and less surgical procedures were performed (ND 33.8%, DM: 21.7%, HE: 18.0%). CONCLUSION: The elevated DM and stress hyperglycemia prevalence observed in our study indicates that glycemic alterations is one of the most important risk factors for IAM.

[Cardiovascular disease in type 1 diabetes mellitus]. / Doença cardiovascular no diabetes melito tipo 1.

The association between type 1 diabetes and coronary heart disease has become very clear since the late 1970. It has been demonstrated that there is an important increased risk in morbidity and mortality caused by coronary artery disease in young adults with type 1 diabetes compared with the non diabetic population. The underlying pathogeneses is still poorly understood. While the role of glycemic control in the development of microvascular disease complication is well established its role in CVD in patients with DM1 remains unclear with epidemiologic studies reporting conflicting data. Recent findings from the DCCT/EDIC showed that prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced level of HbA1c during the DCCT. The improvement of glycemic control itself appeared to be particularly effective in younger patients with shorter duration of the disease. Other analyses suggested the glycemia may have a stronger effect on CAD in patients without than in those with albuminúria. Other major determinants of coronary artery disease are the components of metabolic syndrome and the surrogate measure of insulin resistence: eGDR. It is proposed that patients with DM1 should have aggressive medical therapy, risk factor modification and careful monitoring not only of his blood sugar but also of the other processes involved in the atherosclerotic process, mostly the ones with family history of type 2 diabetes.

Avaliação da prevalência do diabetes e da hiperglicemia de estresse no infarto agudo do miocárdio / The prevalence of diabetes and stress hyperglycemia in the acute myocardial infarction patients

OBJETIVOS: Determinar a prevalência do diabetes melito (DM) e da hiperglicemia de estresse (HE) em pacientes com infarto agudo do miocárdio (IAM) admitidos em unidade de emergência cardiológica. MÉTODOS: Análise retrospectiva de 2.262 pacientes com IAM, avaliando, além da prevalência de diabetes referido, o diagnosticado e a hiperglicemia de estresse. RESULTADOS: Apesar de referido em 12,1 por cento dos pacientes (H: 10,7 por cento, M: 15,8 por cento), o DM ocorria efetivamente em 24,8 por cento (H: 22,9 por cento, M: 29,7 por cento) e a HE em 13,6 por cento (H: 14,3 por cento, M: 11,7 por cento) dos indivíduos dessa população. Portanto, alterações glicêmicas ocorreram em 37,4 por cento dos indivíduos com IAM (H: 37,2 por cento, M: 41,4 por cento). Nos pacientes com DM, observou-se maior precocidade etária do IAM, maior prevalência de óbitos (DM: 20,7 por cento, ND:13,8 por cento, HE: 13,4 por cento) e de procedimentos cirúrgicos (ND: 33,8 por cento, HE: 18,0 por cento, DM: 21,7 por cento). CONCLUSÃO: A elevada prevalência de DM e hiperglicemia de estresse observada em nosso estudo indica que as alterações glicêmicas constituem um dos mais importantes fatores de risco para o IAM.

OBJECTIVES: To evaluate in our population the real prevalence of diabetes (DM) and stress hyperglycemia (HE) in patients with myocardial infarction (IAM) admitted in a cardiologic emergency unit. METHODS: A retrospective analysis of 2262 patients with AMI evaluating the prevalence of DM (referred and diagnosed) and stress hyperglycemia. RESULTS: Besides 12,1 percent of subjects were previously referred to be diabetic (men: 10.7 percent and women: 15.8 percent), diabetes was effectively diagnosed in 24,8 percent (M: 22,9 percent, W: 29,7 percent) and stress hyperglycemia in 13,6 percent HE of the patients (M: 14,3 percent, W: 11,7 percent) indicating that glycemic alterations were effectively observed in 37.2. percent of the patients with IAM (M: 37,2 percent, W: 41,4 percent). In DM subjects IAM events occurred earlier, total intra-hospital mortality was higher (DM: 20.7 percent, ND: 13,8 percent, HE: 13,4 percent) and less surgical procedures were performed (ND 33.8 percent, DM: 21.7 percent, HE: 18.0 percent). CONCLUSION: The elevated DM and stress hyperglycemia prevalence observed in our study indicates that glycemic alterations is one of the most important risk factors for IAM.

Doença cardiovascular no diabetes melito tipo 1: [revisão] / Cardiovascular disease in type 1 diabetes mellitus: [review]

O risco de doença arterial coronariana (DAC) nos pacientes com diabetes melito tipo 1 (DM1) é conhecido desde o final dos anos 1970, sendo atualmente a principal causa de mortalidade na população adulta com diabetes tipo 1 de longa duração. A patogênese do processo aterosclerótico nesta doença ainda é obscura, acreditando-se que a hiperglicemia desenvolva aí um papel importante, entretanto vários estudos epidemiológicos mostraram que a associação entre doença coronariana e glicemia, em pacientes com DM1 seja fraca. Dados recentes do estudo DCCT/EDIC mostram que o grupo que recebeu tratamento insulínico intensificado durante o DCCT desenvolveu graus menores de aterosclerose, relacionado aos valores reduzidos de HbA1c durante a fase ativa do estudo, com melhor proteção nos pacientes mais jovens e com menor duração da doença. Há também evidências de que os benefícios são maiores nos pacientes sem nefropatia quando comparados aos com doença renal. Outros fatores de risco importante para o desenvolvimento de DAC em pacientes com DM1 são os mesmos descritos para DM2, incluindo os componentes da síndrome metabólica e marcadores de resistência insulínica. Sugere-se que pacientes com DM1 devam ter o melhor controle glicêmico possível, desde o início da sua doença acrescido de vigilância e tratamento rígido dos fatores de riscos clássicos para DAC, principalmente naqueles com história familiar de DM2.

The association between type 1 diabetes and coronary heart disease has become very clear since the late 1970. It has been demonstrated that there is an important increased risk in morbidity and mortality caused by coronary artery disease in young adults with type 1 diabetes compared with the non diabetic population. The underlying pathogeneses is still poorly understood. While the role of glycemic control in the development of microvascular disease complication is well established its role in CVD in patients with DM1 remains unclear with epidemiologic studies reporting conflicting data. Recent findings from the DCCT/EDIC showed that prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced level of HbA1c during the DCCT. The improvement of glycemic control itself appeared to be particularly effective in younger patients with shorter duration of the disease. Other analyses suggested the glycemia may have a stronger effect on CAD in patients without than in those with albuminúria. Other major determinants of coronary artery disease are the components of metabolic syndrome and the surrogate measure of insulin resistence: eGDR. It is proposed that patients with DM1 should have aggressive medical therapy, risk factor modification and careful monitoring not only of his blood sugar but also of the other processes involved in the atherosclerotic process, mostly the ones with family history of type 2 diabetes.

Diabetes mellitus do tipo 2, síndrome metabólica e modificação no estilo de vida: [revisão] / Type 2 diabetes mellitus, metabolic syndrome and change in lifestyle: [review]

O Diabetes Mellitus do Tipo 2 favorece o aumento da morbidade e da mortalidade por doenças cardiovasculares. Essas doenças apresentam mesmo componente genético e mesmos antecedentes ambientais, sendo a resistência insulínica considerada um dos principais possíveis antecedentes. A síndrome metabólica é um transtorno complexo, representado por um conjunto de fatores de risco cardiovascular, usualmente relacionados à deposição central de gordura e à resistência à insulina. A modificação do comportamento alimentar inadequado e a perda ponderal, associadas à prática de atividade física regular, são consideradas terapias de primeira escolha para o tratamento da síndrome metabólica, por favorecer a redução da circunferência abdominal e da gordura visceral, melhorar a sensibilidade à insulina e diminuir as concentrações plasmáticas de glicose e triglicérides, aumentar os valores de HDL colesterol e, conseqüentemente, reduzir os fatores de risco para o desenvolvimento de Diabetes Mellitus do Tipo 2 e doenças cardiovasculares. Dessa forma, o presente artigo objetivou descrever e analisar alguns dos principais estudos publicados nas últimas décadas, os quais mostraram que a adoção de um estilo de vida adequado possibilita a prevenção primária do Diabetes Mellitus do Tipo 2. As mudanças no estilo de vida impróprio podem ser estimuladas por meio de uma intervenção educacional, dando ênfase ao aspecto nutricional e à atividade física, visando à redução dos fatores de risco relacionados à síndrome metabólica e às doenças cardiovasculares, em diferentes populações.

Type 2 diabetes mellitus promotes increased morbidity and mortality from cardiovascular diseases. These diseases have the same genetic components and environmental antecedents and insulin resistance is considered one of the main possible antecedents. The metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors that are commonly associated with central adiposity and insulin resistance. Changing inadequate feeding habits, losing weight and exercising regularly are considered first-choice therapies in treating the metabolic syndrome since they reduce waist circumference, visceral fat and plasma concentrations of glucose and triglycerides; they improve insulin sensitivity and increase HDL cholesterol; consequently, they reduce the risk factors for type 2 diabetes mellitus and cardiovascular diseases. Thus, the objective of this article was to describe and analyze some of the main studies published in the last decades which showed that adopting a healthy lifestyle promotes the primary prevention of type 2 diabetes mellitus. An educational intervention that focuses on proper nutrition and exercise and, therefore, reduces the risk factors associated with metabolic syndrome and cardiovascular diseases, can help change inadequate lifestyles.

Insulinoterapia em pacientes com doença arterial coronariana e diabetes do tipo 2 / Insulin therapy in patients with coronary artery disease and type 2 diabetes mellitus

O diabetes melito do tipo 2 vem ganhando crescente importância entre os fatores de risco para desenvolvimento e piores desfechos das doenças cardiovasculares. Apesar de ter sido demonstrada, por diversos estudos epidemiológicos, a relação da doença arterial coronariana com a hiperglicemia, o controle glicêmico adequado persistente nem sempre é mantido nos portadores de diabetes melito do tipo 2. Para esses pacientes, a introdução de insulinoterapia é imperativa. Considerando a possível persistência de reserva de insulina pancreática e a comum resistência dos pacientes em aceitar o uso de medicaçõe injetáveis, costuma-se iniciar a insulinoterapia com a introdução de injeção de insulina de ação ao deitar, em complementação ao uso diurno de antidiabéticos orais. Caso seja obtido controle glicêmico adequado, é indicada a substituição dos antidiabéticos orais pela insulinização intensiva basal...

A síndrome metabólica e sua relação com a resistência à insulina, disfunção endotelial e aterogênese / Metabolic syndrome and its relationship with insulin resistance, endothelial dysfunction and atherogenesis

A Síndrome Metabólica (SM) constitui uma combinação particular de fatores de risco cardiovasculares usualmente relacionados à deposição central de gordura e à resistência à insulina (RI). O tecido adiposo apresenta capacidade secretora de substâncias com efeitos biológicos importantes que teriam relação direta com a resistência à insulina. Estas substâncias são, na maioria, polipeptídios entre os quais se incluem: a leptina, a resistina, o peptídio inibidor do ativador de plasminogênio (PAI-1), o fator de necrose tumoral (TNF-?), a interleucina-6 (IL-6), o peptídio estimulador da acilação (ASP), a grelina e a adiponectina. As condições próinflamatórias constituem um elo entre a RI e disfunção endotelial, que é o estágio que precede o desenvolvimento da aterosclerose e tem sido relatado em pacientes com Diabetes Mellitus (DM) tipo 2 e em obesos não diabéticos. Nos últimos anos, tem havido um progresso considerável na compreensão dos mecanismos de ação da insulina e os defeitos moleculares que desencadeiam sua resistência. No entanto, é preciso ainda elucidar muitos mecanismos fisiológicos envolvidos na resistência à insulina e determinar a susceptibilidade genética desta resistência, bem como as interações entre os genes e o estilo de vida.

Mecanismos ambientais implicados no ganho de peso e as oportunidades para prevenção da obesidade / Environmental mechanisms involved in weight gain and opportunities to prevent obesity

As sociedades modernas, especialmente aquelas que se encontram em transição para um estilo de vida ocidental, vem apresentando um aumento significativo da prevalência da obesidade, que em muitos locais apresentam características epidêmicas. Apesar de ser amplamentereconhecido o papel de fatores genéticos, a explosão da obesidadeobservada nos últimos cem anos não pode ser explicada por alterações gênicas que tenham ocorrido neste curto espaço de tempo, mas sim, pelas mudanças ocorridas no meio ambiente conseqüentes ao intenso processo de industrialização e aos avanços tecnológicos que ocorreram no mundo contemporâneo. As determinantesque levaram ao aumento ponderal corporal se relacionam basicamenteàs mudanças ambientais a que indivíduos geneticamente suscetíveis ao ganho de peso se expuseram, aumentando a ingestão calórica e de gorduras, reduzindo a atividade física frente ao estilo de vida característico da vida moderna. Baseado na maior disponibilidade e menor custo dos alimentos, na excessiva mecanização e automatização que tornam o indivíduo mais sedentário e na maior pressãopsicológica de natureza profissional e social, o homem moderno vem sofrendo uma significativa alteração de seu comportamento de natureza obesogênica, que será discutido no presente trabalho. Considerandoque a obesidade é universalmente reconhecida como um importante fator de risco para as doenças cardiovasculares e o diabetes, é necessária maior atenção do ponto de vista de saúde publica em não somente tratar, mas principalmente prevenir a obesidade modificando o ambiente “tóxico” com base em estratégias que promovam mudanças comportamentais ou que obtenham novas tecnologias alimentares.