Association between Pre-Pregnancy BMI and Inflammatory Profile Trajectories during Pregnancy and Postpartum in Brazilian Women with Periodontitis: The IMPROVE Trial.

This study aimed to explore the association between pre-pregnancy BMI and longitudinal changes in inflammatory markers from the second trimester of pregnancy to 6-8 weeks postpartum in women with periodontitis. This is a secondary exploratory analysis of 68 women who took part in a feasibility clinical trial in Rio de Janeiro, Brazil. Inflammatory markers included C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and matrix metalloproteinase-9 (MMP-9) blood concentrations at 11-22 (T0) and 30-36 gestational weeks (T1), and 6-8 weeks postpartum (T3). Longitudinal generalised linear mixed-effects models were used to identify possible associations between pre-pregnancy BMI and changes in concentrations of inflammatory markers. Pre-pregnancy excess weight (ß = 4.39; 95% CI, 2.12-6.65) was significantly associated with increased CRP levels from pregnancy to postpartum. There were no significant associations between pre-pregnancy BMI and longitudinal changes in IL-6, IL-10 and MMP-9. Our findings provide evidence that a higher pre-pregnancy BMI may lead to increases in CRP levels during pregnancy in women with periodontitis, irrespective of the severity of clinical periodontal parameters. Further studies need to investigate if predictors of changes in inflammatory markers can be used as prognostic factors for gestational outcomes.

Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile.

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.

Correction to: Calcium and vitamin D supplementation and/or periodontal therapy in the treatment of periodontitis among Brazilian pregnant women: protocol of a feasibility randomised controlled trial (the IMPROVE trial).

An amendment to this paper has been published and can be accessed via the original article.

Vitamin D and Calcium Milk Fortification in Pregnant Women with Periodontitis: A Feasibility Trial.

This study aims to assess the acceptability, adherence, and retention of a feasibility trial on milk fortification with calcium and vitamin D (Ca+VitD) and periodontal therapy (PT) among low income Brazilian pregnant women with periodontitis (IMPROVE trial). This 2 × 2 factorial feasibility trial used a mixed-methods evaluation. In total, 69 pregnant women were randomly allocated to four groups: 1. fortified sachet with Ca+VitD and milk plus early PT (throughout gestation); 2. placebo and milk plus early PT; 3. fortified sachet with Ca+VitD and milk plus late PT after childbirth; 4. placebo and milk plus late PT. Data were collected via questionnaires, field notes, participant flow logs, treatment diary, and focal group discussions. Quantitative and qualitative data were analysed using appropriate descriptive statistics and content analysis, respectively. Eligibility rate (12%) was below the target of 15%, but participation (76.1%) and recruitment rate (2 women/week) exceeded the targets. Retention rate (78.6%) was slightly below the target (80%). Adherence to the PT was significantly higher in the early treatment groups (98.8%) compared to the late treatment groups (29%). All women accepted the random allocation, and baseline groups were balanced. There was no report of adverse events. This multi-component intervention is acceptable, well-tolerated, and feasible among low-risk pregnant women in Brazil.

Recruitment of low-income pregnant women into a dietary and dental care intervention: lessons from a feasibility trial.

BACKGROUND: There are difficulties in carrying out research in low-income urban communities, but the methodological challenges and suggestions on how to deal with them are often undocumented. The aims of this study are to describe the challenges of recruiting and enrolling low-income pregnant women with periodontitis to a clinical trial on vitamin D/calcium milk fortification and periodontal therapy and also to describe the patient-, study protocol- and setting-related factors related to women's ineligibility and refusal to participate in the study. METHODS: A mixed-method sequential exploratory design was applied. Qualitative and quantitative data on recruitment to a 2 × 2 factorial feasibility clinical trial were used. Eighteen women attending the health centre in a low-income area in Duque de Caxias (Rio de Janeiro, Brazil) took part in focus group discussions, and the data were thematically analysed. Quantitative data were analysed using appropriate descriptive statistics, including absolute and relative frequencies. RESULTS: Of all referrals (767), 548 (78.5%) did not meet the initial eligibility criteria. The main reason for exclusion (58%) was advanced gestational age (> 20 weeks) at first prenatal appointment. In the periodontal examination (dental screen), the main reason for exclusion was the presence of extensive caries (64 out of 127 exclusions). Non-participation of those eligible after the periodontal examination was approximately 24% (22 out 92 eligible women) and predominantly associated with patient-related barriers (e.g. transportation barriers, family obligations, patients being unresponsive to phone calls and disconnected telephones). The study recruited 70 women with periodontitis in 53 weeks and did not reach the benchmark of 120 women in 36 weeks (58.3% of the original target). Recruitment was severely hindered by health centre closures due to general strikes. The recruitment yields were 9.1% (70/767) of all women contacted at first prenatal visit and 76.1% (70/92) of those screened eligible and enrolled in the trial. Women did not report concerns regarding random allocation and considered fortified milk as a healthful and safe food for pregnant women. Some women reported that financial constraints (e.g. transportation costs) could hinder participation in the study. CONCLUSION: Engagement between the research team and health centre staff (e.g. nurses) facilitated referral and recruitment, yet some pregnant women failed to participate in the study largely due to significant patient-related sociodemographic barriers and setting-related factors. Our data illustrate the complexity of overcoming recruitment and enrolment challenges for clinical trials in resource-limited settings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03148483. Registered on 11 May 2017.

Prepregnancy Dietary Patterns and Their Association with Perinatal Outcomes: A Prospective Cohort Study.

BACKGROUND: Dietary intake may be associated with neonatal outcomes, yet little is known about the influence of prepregnancy dietary pattern (DP). OBJECTIVES: To evaluate the association between prepregnancy DPs and perinatal outcomes. DESIGN: Prospective cohort study during pregnancy (baseline between 5 and 13 gestational week and three follow-up visits: 20 to 26 gestational weeks, 30 to 36 gestational weeks, and 30 to 40 days postpartum, respectively). Diet was assessed in the first trimester using a food frequency questionnaire and having prepregnancy as the time frame. PARTICIPANTS/SETTING: Two hundred fifty-three pregnant women met the following eligibility criteria (20 to 40 years of age, 5 to 13 weeks of gestation at baseline, free of chronic [except obesity] or infectious diseases, and with a singleton pregnancy). The final sample was composed of 193 pregnant women attending a public health care center in Rio de Janeiro, Brazil, from 2009 to 2012. MAIN OUTCOME MEASURES: Type of delivery, large for gestational age (LGA), birth length (BL)>90th percentile, Apgar score<7 at 1 minute, and preterm birth. STATISTICAL ANALYSES: Reduced rank regression was used to identify prepregnancy DPs that explain the following response variables: fiber density (daily dietary fiber intake in grams, divided by total daily energy intake in kilocalories), dietary energy density, and percent energy from saturated fat. Statistical analyses included multiple logistic regression models. The following covariates were defined as confounders based on a unique Direct Acyclic Graph for each outcome: maternal age, current smoker, alcohol consumption, years of education, and first-trimester leisure physical activity. RESULTS: The prevalence of normal delivery was 56.7%. LGA occurred in 16%, BL>90th percentile in 24.3%, Apgar score<7 at 1 minute in 14.2%, and preterm birth in 9.5% of the study population. Three DPs were identified: "fast food and candies" was associated with higher odds of LGA (odds ratio [OR]=4.38, 95% CI: 1.32 to 14.48) and BL>90th percentile (OR=4.81, 95% CI: 1.77 to 13.07); "beans, bread, and fat" was inversely associated with Apgar score<7 at 1 minute (OR=0.14, 95% CI: 0.03 to 0.70); and "vegetables and dairy" was inversely associated with preterm birth (OR=0.24, 95% CI: 0.06 to 0.97). There was no association between adherence to DPs and type of delivery. CONCLUSIONS: Higher adherence to fast food and candies prepregnancy DP increased the odds of LGA birth, while a higher adherence to vegetables and dairy DP decreased the odds of preterm birth.

Calcium and vitamin D supplementation and/or periodontal therapy in the treatment of periodontitis among Brazilian pregnant women: protocol of a feasibility randomised controlled trial (the IMPROVE trial).

BACKGROUND: Periodontitis is a common oral inflammation, which is a risk factor for adverse pregnancy outcomes. Intakes of vitamin D and calcium are inversely associated with occurrence and progression of periodontitis. This study aims to assess the feasibility of a multi-component intervention, including provision of milk powder supplemented with calcium and vitamin D and periodontal therapy (PT), for improving maternal periodontal health and metabolic and inflammatory profiles of low-income Brazilian pregnant women with periodontitis. METHODS: The IMPROVE trial is a feasibility randomised controlled trial (RCT) with a 2 × 2 factorial design with a parallel process evaluation. Pregnant women with periodontitis, aged 18-40 years and with < 20 gestational weeks (n = 120) were recruited and randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus PT during pregnancy, (2) placebo sachet and powdered milk plus PT during pregnancy, (3) fortified sachet (vitamin D and calcium) and powdered milk plus PT after delivery and (4) placebo sachet and powdered milk plus PT after delivery. Dentists and participants are blinded to fortification. Acceptability of study design, recruitment strategy, random allocation, data collection procedures, recruitment rate, adherence and attrition rate will be evaluated. Data on serum levels of vitamin D, calcium and inflammatory biomarkers; clinical periodontal measurements; anthropometric measurements; and socio-demographic questionnaires are collected at baseline, third trimester and 6-8 weeks postpartum. Qualitative data are collected using focus group, for analysis of favourable factors and barriers related to study adherence. DISCUSSION: Oral health and mineral/vitamin supplementation are much overlooked in the public prenatal assistance in Brazil and of scarcity of clinical trials addressing these issues in low and middle-income countries,. To fill this gap the present study was designed to assess the feasibility of a RCT on acceptability of a multi-component intervention combining conventional periodontal treatment and consumption of milk fortified with calcium-vitamin D for improving periodontal conditions and maternal metabolic and inflammation status, among Brazilian low-income pregnant women with periodontitis. Thus, we hope that this relatively low-cost and safe multicomponent intervention can help reduce inflammation, improve maternal periodontal health and metabolic profile and consequently prevent negative gestational outcomes. TRIAL REGISTRATION: NCT, NCT03148483. Registered on May 11, 2017.

Longitudinal association of 25-hydroxyvitamin D with adipokines and markers of glucose metabolism among Brazilian pregnant women.

This study aimed to evaluate the longitudinal association of vitamin D status with glycaemia, insulin, homoeostatic model assessment of insulin resistance, adiponectin and leptin. A prospective cohort with 181 healthy, pregnant Brazilian women was followed at the 5th-13th, 20th-26th and 30th-36th gestational weeks. In this cohort, 25-hydroxyvitamin D (25(OH)D) plasma concentrations were analysed using liquid chromatography-tandem MS. Vitamin D status was categorised as sufficient or insufficient using the Endocrine Society Practice Guidelines (≥75/<75 nmol/l) and the Institute of Medicine (≥50/<50 nmol/l) thresholds. Linear mixed-effect regression models were employed to evaluate the association between vitamin D status and each outcome, considering interaction terms between vitamin D status and gestational age (P<0·1). At baseline, 70·7 % of pregnant women had 25(OH)D levels <75 nmol/l and 16 % had levels <50 nmol/l. Women with sufficient vitamin D status at baseline, using both thresholds, presented lower glycaemia than those with insufficient 25(OH)D. Pregnant women with 25(OH)D concentrations <75 nmol/l showed lower insulin (ß=-0·12; 95 % CI -0·251, 0·009; P=0·069) and adiponectin (ß=-0·070; 95 % CI -0·150, 0·010; P=0·085) concentrations throughout pregnancy than those with 25(OH)D levels ≥75 nmol/l. Pregnant women with 25(OH)D <50 nmol/l at baseline presented significantly higher leptin concentrations than those with 25(OH)D levels ≥50 nmol/l (ß=-0·253; 95 % CI -0·044, 0·550; P=0·095). The baseline status of vitamin D influences the biomarkers involved in glucose metabolism. Vitamin D-sufficient women at baseline had higher increases in insulin and adiponectin changes throughout gestation than those who were insufficient.

Dietary patterns and their association with adiponectin and leptin concentrations throughout pregnancy: a prospective cohort.

The aim of this study was to evaluate the association of dietary patterns (DP) with maternal adiposity indicators, leptin, adiponectin and insulin concentrations during pregnancy. A prospective cohort of pregnant women followed up at the 5th-13th, 20th -26th and 30th-36th gestational weeks and 30-40 d postpartum was conducted in Rio de Janeiro. A FFQ was administered in the third trimester (30th-36th gestational weeks). The reduced rank regression procedure was used to identify DP that explain response variables (dietary fibre and total fat) related to indicators of maternal adiposity (postpartum weight retention and gestational weight gain (GWG) adequacy), and plasma leptin, adiponectin and insulin concentrations. The associations between tertiles of DP and the outcomes were determined using logistic regression or longitudinal linear mixed-effect regression models. The mean daily energy intake during pregnancy was 10 104 (sd 3234) kJ (2415 (sd 773) kcal), and GWG was 11·9 (sd 4·2) kg. In all, 40 % of women presented pre-gestational overweight/obesity. Excessive GWG occurred in 34·7 % of pregnant women and 56·6 % were overweight/obese at postpartum. The 'common-Brazilian' DP (characterised by higher intake of beans, rice and lower intake of fast food/snacks, candies/table sugar and processed meats/bacon) was positively associated with adiponectin (ß=1·07; 95 % CI 0·17, 1·98). The 'Western' DP (characterised by higher intake of fast food/snacks and processed meat/bacon and lower intake of noodles/pasta/roots/tubers and sodas) was negatively associated with adiponectin (ß=-1·11; 95 % CI -2·00, -0·22) and positively associated with leptin concentrations (ß=64·9; 95 % CI 22·8, 107·0) throughout pregnancy. It may be suggested that the 'common-Brazilian' is a healthy DP and beneficial for serum concentrations of adiponectin and leptin.

Changes in plasma concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D during pregnancy: a Brazilian cohort.

PURPOSE: To characterize the physiological changes in 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] throughout pregnancy. METHODS: Prospective cohort of 229 apparently healthy pregnant women followed at 5th-13th, 20th-26th, and 30th-36th gestational weeks. 25(OH)D and 1,25(OH)2D concentrations were measured by LC-MS/MS. Statistical analyses included longitudinal linear mixed-effects models adjusted for parity, season, education, self-reported skin color, and pre-pregnancy BMI. Vitamin D status was defined based on 25(OH)D concentrations according to the Endocrine Society Practice Guideline and Institute of Medicine (IOM) for adults. RESULTS: The prevalence of 25(OH)D <75 nmol/L was 70.4, 41.0, and 33.9%; the prevalence of 25(OH)D <50 nmol/L was 16.1, 11.2, and 10.2%; and the prevalence of 25(OH)D <30 nmol/L was 2, 0, and 0.6%, at the first, second, and third trimesters, respectively. Unadjusted analysis showed an increase in 25(OH)D (ß = 0.869; 95% CI 0.723-1.014; P < 0.001) and 1,25(OH)2D (ß = 3.878; 95% CI 3.136-4.620; P < 0.001) throughout pregnancy. Multiple adjusted analyses showed that women who started the study in winter (P < 0.001), spring (P < 0.001), or autumn (P = 0.028) presented a longitudinal increase in 25(OH)D concentrations, while women that started during summer did not. Increase of 1,25(OH)2D concentrations over time in women with insufficient vitamin D (50-75 nmol/L) at baseline was higher compared to women with sufficient vitamin D (≥75 nmol/L) (P = 0.006). CONCLUSIONS: The prevalence of vitamin D inadequacy varied significantly according to the adopted criteria. There was a seasonal variation of 25(OH)D during pregnancy. The women with insufficient vitamin D status present greater longitudinal increases in the concentrations of 1,25(OH)2D in comparison to women with sufficiency.

Dietary intake variations from pre-conception to gestational period according to the degree of industrial processing: A Brazilian cohort.

OBJECTIVE: To estimate food intake changes from pre-conception to gestational period according to the degree of food processing. METHODS: Prospective cohort conducted in a public health care center in Rio de Janeiro with Brazilian pregnant women (n = 189). A food frequency questionnaire was applied at the first (5(th)-13(th)) and third (30(th)-36(th)) gestational trimesters. The food items were classified according to characteristics of food processing in four groups: unprocessed/minimally processed foods; sugar/fat; processed foods and ultra-processed foods. The variation of food intake according to the degree of processing between the pre-conception and gestational period was compared using paired Student's t-test. Linear regression models were performed to estimate the association of mother's characteristics on the variation of food group contribution to the total energy intake between periods. RESULTS: Total energy intake was 2415 (SD = 813) in the pre-conception and 2379 (750) kcal in the gestational period. We excluded women who had implausible total energy intake (<600 and >6000 kcal/day). The contribution of unprocessed/minimally processed food group to total energy intake during pregnancy when compared to the pre-conception period was higher [50.5 (14.1) vs. 48.8 (12.4), p-value = 0.048], while the caloric share of ultra-processed food group was lower [41.3 (14.6) vs. 43.1 (12.5), p-value = 0.032]. We observed a negative association of age (p-value = 0.009) and a positive association of pre-pregnancy BMI (p-value = 0.060) with the variation of ultra-processed food intake. CONCLUSIONS: Ultra-processed food intake decreased, while minimally/unprocessed food intake slightly increased from the pre-conception to gestational period. These results indicate potential for a larger improvement in the women's diet quality and that nutritional counseling interventions in pregnant women are still needed.

Accuracy of plasma interleukin-18 and adiponectin concentrations in predicting metabolic syndrome and cardiometabolic disease risk in middle-age Brazilian men.

The aims of this cross-sectional study were to explore the ability of serum interleukin 18 (IL-18) and adiponectin to identify metabolic syndrome (MetS), and to verify their association with an index of central lipid overaccumulation (lipid accumulation product (LAP)) and cardiometabolic risk factors in a population of middle-aged Brazilian men. A group of 218 apparently healthy middle-aged Brazilian men (age, 50.3 ± 4.97 years) underwent anthropometric, clinical, sociodemographic, and standard serum biochemical assessments. LAP was calculated and the study participants were categorized into 3 groups according to serum IL-18 and adiponectin cut-points tertiles to verify the association of these biomarkers with cardiometabolic risk factors. The MetS group had more less active (p = 0.03) and obese (p < 0.01) individuals who exhibited higher IL-18 (p < 0.01) and lower adiponectin (p < 0.01) than did those in the group with no MetS. After adjustments (age, smoking, alcohol consumption, physical activity level, and total body fat), serum IL-18 ≥ 336.4 pg/mL was an independent factor for MetS occurrence and it was directly associated with LAP (≥51.28), central obesity, hypertriglyceridemia, and hypertension (p < 0.05), but not with high-density lipoprotein cholesterol (HDL-C). Serum adiponectin ≥ 7.02 µg/mL was negatively associated with MetS occurrence, LAP, hypertriglyceridemia, and low HDL-C (p < 0.05), but not with central obesity and hypertension. In conclusion, both IL-18 and adiponectin demonstrated the ability to identify MetS in this population, with IL-18 being more accurate. The association of these biomamarkers with LAP and cardiometabolic risk factors highlights its relevance as a diagnostic tool.

Red but not white meat consumption is associated with metabolic syndrome, insulin resistance and lipid peroxidation in Brazilian middle-aged men.

BACKGROUND: The influence of diet on metabolic syndrome and oxidative stress are not completely known. DESIGN: This cross-sectional study assessed the association of red meat and white meat consumption with metabolic syndrome, insulin resistance and lipid peroxidation in Brazilian middle-aged men. METHODS: A total of 296 subjects (age: 50.5 ± 5.0 years, body mass index: 25.8 ± 3.5 kg/m(2)) were evaluated. Anthropometry, lifestyle features, blood biochemical parameters, diagnosis of metabolic syndrome, homeostatic model assessment for insulin resistance, a lipid peroxidation marker (oxidized low-density lipoprotein) and triglycerides:high-density lipoprotein cholesterol ratio were assessed. Dietary intake was estimated by a food frequency questionnaire. RESULTS: The subjects included in the highest tertile red meat (≥81.5 g/d) and saturated fatty acid from red meat consumption (≥4.3 g/d) had higher occurrence of central obesity (nearly 60%, p < 0.01), hypertriglyceridaemia (nearly 43%, p < 0.01) and metabolic syndrome (35%, p < 0.01). They also had higher values of homeostatic model assessment for insulin resistance, oxidized low-density lipoprotein, and triglycerides:high-density lipoprotein cholesterol ratio, regardless of interfering factors. There were no associations of highest white meat tertile (≥39.4 g/d) and saturated fatty acid from white meat (≥1.0 g/d) consumption with the assessed parameters (p > 0.05). CONCLUSIONS: Red meat consumption was cross-sectionally associated with the occurrence of central obesity, hypertriglyceridaemia, and metabolic syndrome as well as with higher homeostatic model assessment for insulin resistance, oxidized low-density lipoprotein concentrations and triglycerides:high-density lipoprotein cholesterol ratio. The content of saturated fatty acid from red meat consumption may be a factor that contributed to this relationship, while white meat consumption was not associated with metabolic syndrome and the assessed biomarkers.

Efeito da soja e sorgo no índice glicêmico, na ingestão alimentar e na palatabilidade do suco de melancia em adultos saudáveis / Effect of soy flour and sorghum in the glycemic index, food intake and palatability of watermelon juice in healthy adults

O objetivo do trabalho foi avaliar o efeito da adição de farinhas de soja e sorgo no índice glicêmico (IG) e na palatabilidade do suco de melancia e determinar seu impacto sobre a ingestão calórica, em adultos saudáveis. Foi um estudo em crossover e randomizado, envolvendo a participação de 25 adultos saudáveis, de ambos os gêneros. Após jejum noturno de 10-12h, os participantes compareceram ao laboratório e fizeram a ingestão de uma das seguintes bebidas: suco de melancia puro, suco de melancia com farinha de soja e suco de melancia com farinha de sorgo. Cada bebida testada continha 25g de carboidrato disponível. Do total de voluntários, 10 participaram dos testes de determinação do IG das bebidas testadas. A palatabilidade das bebidas foi avaliada, utilizando uma escala hedônica de nove pontos. A ingestão calórica habitual e aquela nos dias de testes foram avaliadas por meio de registro alimentar. O suco de melancia adicionado de soja apresentou IG significativamente menor (IG = 13 ± 4) do que os valores de IG apresentados pelos sucos de melancia puro (IG = 32 ± 4) e de melancia adicionado de farinha de sorgo (IG = 49 ± 8). Entretanto, o suco de melancia adicionado de soja foi considerado menos palatável que os demais. A ingestão calórica não foi afetada pelas bebidas testadas. Concluiu-se que a adição de soja em outras preparações de consumo habitual pode contribuir para a redução do IG das mesmas.

The impact of serum uric acid on the diagnostic of metabolic syndrome in apparently healthy brazilian middle-aged men.

BACKGROUND: Hyperuricemia is related to Metabolic Syndrome (MetS) and cardiovascular diseases, but the use of serum uric acid (UA) to diagnose MetS is currently ignored in clinical practices. OBJECTIVES: To examine the impact of serum UA on the diagnostic of MetS and the relationship of serum UA with cardiometabolic risk factors in apparently healthy Brazilian middle-aged men residents in a city of Minas Gerais. METHODS: In a cross-sectional analysis, 289 apparently healthy middle-aged men underwent anthropometric, clinical, sociodemographic and blood serum biochemical evaluation. By using receive operating curve the internal cutoff of serum UA was determined (5.25 mg/dL). RESULTS: Subjects with two or more components of MetS exhibited higher serum UA as compared to those with one or none component. The inclusion of serum UA ≥ 5.25mg/dL as an additional component of MetS increased the occurrence of this syndrome by 13%. Subjects with UA ≥ 5.25mg/dL showed high prevalence for MetS and association with its components (central obesity, hypertriglyceridemia, dyslipidemia and hypertension) as well as atherogenic risk. CONCLUSIONS: Serum UA has an important impact on the diagnostic of MetS and is related to cardiometabolic risk factors in apparently healthy Brazilian middle-aged men. Its use in clinical practices could aggregate accuracy to diagnose MetS.

Introducción: La hiperuricemia viene sido asociada con el sindrome metabolico (SM) y las enfermedades cardiovasculares, pero el uso del acido urico (AU) en el diagnostico del SM es comunmente ignorado en la practica clinica. Objetivos: Investigar el impacto de las concentraciones de AU en el diagnostico del SM y la asociacion del AU serico con los factores de riesgo cardiometabolico en brasilenos de mediana edad aparentemente saludables residentes en una ciudad de Minas Gerais. Métodos: Por medio de un analisis transversal, 289 hombres de mediana edad aparentemente saludables fueron sometidos a evaluaciones para determinaciones de variables antropometricas, clinicas, sociodemograficos y bioquimicas. Para determinar el mejor punto de corte para la concentracion del AU serico con respecto al diagnostico del SM (5.25 mg/dL) fue utilizada la curva ROC. Resultados: Sujetos con dos o mas componentes del SM han demostrado mayores concentraciones sericas de AU cuando comparados con individuos con uno o ninguno componente. Ademas, la inclusion del AU > 5.25 mg/dL como un componente adicional en el diagnostico del SM aumento la ocurrencia de este sindrome en un 13%. Finalmente, los hombres con AU ≥ 5.25mg/dL presentaron una asociacion positiva con componentes del SM (obesidad central, hipertrigliceridemia, dislipemia e hipertension arterial), asi como un mayor riesgo aterogenico. Conclusión: AU serico tiene un relevante impacto en la ocurrencia del SM, asi como es asociado a reconocidos factores de riesgo cardiometabolico en brasilenos de mediana edad aparentemente saludables y, su uso en la practica clinica podria anadir en la exactitud del diagnostico del SM.

Waist circumference measures: cutoff analyses to detect obesity and cardiometabolic risk factors in a Southeast Brazilian middle-aged men population--a cross-sectional study.

BACKGROUND: Low-cost practical and reliable tools to evaluated obesity-related cardiometabolic diseases are of clinical practice and public heath relevance worldwide. The aims of this cross-sectional study were to determine the anatomical point of waist circumference that best identify overweight, obesity and central obesity in Southeast Brazilian middle-aged men and to test the relationships of its cutoff points with metabolic syndrome (MetS), insulin resistance (IR) and cardiometabolic risk factors. METHODS: Three hundred men [age: 51 (47-54)] underwent anthropometric, body composition, clinical, sociodemographic and blood plasma biochemical evaluations. RESULTS: The umbilical line circumference (WCUL) was the best predictor for overweight (total body fat ≥ 20%; cutoff point: 88.8 cm), obesity (total body fat ≥ 25%; cutoff point: 93.4 cm) and central obesity (abdominal area fat ≥ 34.6%; cutoff point: 95.6 cm) as measured by dual beam X-ray absorptiometry. Subjects with WCUL ≥ 88.8 cm or ≥ 93.4 cm showed significantly higher values for MetS, IR and cardiometabolic risk factors (i.e. glucose and lipid profiles, blood pressure). The occurrence of WCUL ≥ 88.8 cm was positively associated (p <0.01) with the prevalence of MetS and cardiometabolic risk factors and increased the central obesity prevalence by 19.3% while that of WCUL ≥ 93.4 cm was associated with the prevalence of MetS, IR and cardiometabolic risk factors. CONCLUSIONS: WCUL measure seems to be the best predictor for overweight, obesity and central obesity in urban residents Southeast Brazilian middle-aged men; and the WCUL cutoff point (88.8 cm) is significantly associated with MetS, IR and cardiometabolic risk factors in the studied population.

The impact of serum uric acid on the diagnostic of metabolic syndrome in apparently healthy Brazilian middle-aged men / El impacto del ácido úrico sérico en el diagnóstico del síndrome metabólico en brasileños de mediana edad aparentemente saludables

Background: Hyperuricemia is related to Metabolic Syndrome (MetS) and cardiovascular diseases, but the use of serum uric acid (UA) to diagnose MetS is currently ignored in clinical practices. Objectives: To examine the impact of serum UA on the diagnostic of MetS and the relationship of serum UA with cardiometabolic risk factors in apparently healthy Brazilian middle-aged men residents in a city of Minas Gerais. Methods: In a cross-sectional analysis, 289 apparently healthy middle-aged men underwent anthropometric, clinical, sociodemographic and blood serum biochemical evaluation. By using receive operating curve the internal cutoff of serum UA was determined (5.25 mg/dL). Results: Subjects with two or more components of MetS exhibited higher serum UA as compared to those with one or none component. The inclusion of serum UA ≥ 5.25mg/dL as an additional component of MetS increased the occurrence of this syndrome by 13%. Subjects with UA ≥ 5.25mg/dL showed high prevalence for MetS and association with its components (central obesity, hypertriglyceridemia, dyslipidemia and hypertension) as well as atherogenic risk. Conclusions: Serum UA has an important impact on the diagnostic of MetS and is related to cardiometabolic risk factors in apparently healthy Brazilian middle-aged men. Its use in clinical practices could aggregate accuracy to diagnose MetS (AU)

Introducción: La hiperuricemia viene sido asociada con el síndrome metabólico (SM) y las enfermedades cardiovasculares, pero el uso del ácido úrico (AU) en el diagnóstico del SM es comúnmente ignorado en la práctica clínica. Objetivos: Investigar el impacto de las concentraciones de AU en el diagnóstico del SM y la asociación del AU sérico con los factores de riesgo cardiometabólico en brasileños de mediana edad aparentemente saludables residentes en una ciudad de Minas Gerais. Métodos: Por medio de un análisis transversal, 289 hombres de mediana edad aparentemente saludables fueron sometidos a evaluaciones para determinaciones de variables antropométricas, clínicas, sociodemograficos y bioquímicas. Para determinar el mejor punto de corte para la concentración del AU sérico con respecto al diagnóstico del SM (5.25 mg/dL) fue utilizada la curva ROC. Resultados: Sujetos con dos o más componentes del SM han demostrado mayores concentraciones séricas de AU cuando comparados con individuos con uno o ninguno componente. Además, la inclusión del AU > 5.25 mg/dL como un componente adicional en el diagnóstico del SM aumentó la ocurrencia de este síndrome en un 13%. Finalmente, los hombres con AU ≥ 5.25mg/dL presentaron una asociación positiva con componentes del SM (obesidad central, hipertrigliceridemia, dislipemia e hipertensión arterial), así como un mayor riesgo aterogénico. Conclusión: AU serico tiene un relevante impacto en la ocurrencia del SM, así como es asociado a reconocidos factores de riesgo cardiometabólico en brasileños de mediana edad aparentemente saludables y, su uso en la práctica clínica podría añadir en la exactitud del diagnóstico del SM (AU)

Fruit and vegetable intake and related nutrients are associated with oxidative stress markers in middle-aged men.

OBJECTIVE: The aim of this cross-sectional study was to assess the potential relationships between fruit and vegetable (FV) intake and oxidative stress markers in middle-aged men, with an emphasis on vitamin C, fiber, and magnesium content. METHODS: The study was conducted with 296 healthy men, age 50.5 ± 5.0 y, and body mass index (BMI) of 25.8 ± 3.5 kg/m(2). Dietary intake, anthropometry, blood pressure, lifestyle features, and blood and urine biochemical data were assessed with validated procedures. The oxidative stress markers selected were plasma oxidized low-density lipoprotein (ox-LDL), urinary 8-iso-prostaglandin F2 α (8-iso-PGF2 α) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). RESULTS: The men included in the highest tertile of FV intake (≥341.1 g/d) displayed lower concentrations of ox-LDL, 8-iso-PGF2 α and 8-OHdG (P for trend < 0.05), regardless of confounding factors. Concentrations of ox-LDL were negatively associated with fiber from the FV intake (P for trend < 0.05) regardless of confounding factors. ox-LDL and 8-OHdG concentrations tended to be lower in the higher tertile of magnesium (P for trend = 0.06) and vitamin C from FV intake (P for trend = 0.05), respectively. Additionally, concentrations of 8-iso-PGF2 α were lower in men in the highest tertile of fiber (≥6.5 g/d; P for trend = 0.034), vitamin C (≥98.0 mg/d; P for trend = 0.007), and magnesium (≥48.9 mg/d; P for trend = 0.018) from the FV-group intake. CONCLUSIONS: Greater FV intake was independently associated with reduced ox-LDL, 8-OHdG, and 8-iso-PGF2 α in middle-aged men. Fiber, vitamin C, and magnesium from FV seem to contribute to this beneficial relationship.

Usual dietary glycemic load is associated with cardiometabolic risk factors in physically active Brazilian middle-aged men.

INTRODUCTION: The effects of dietary glycemic load (GL) on cardiometabolic risk factors in physically active subjects are not completely known. OBJECTIVE: This cross-sectional study assessed the association of habitual dietary GL with cardiometabolic risk factors in physically active Brazilian middle-aged men. METHODS: One-hundred seventy-six subjects (Age: 50.6 ± 5.0 years, BMI: 25.5 ± 3.6 kg/m2) were evaluated. Anthropometry, lifestyle features, insulin resistance, oxidative stress biomarkers (8-iso-prostaglandin F2α; 8-iso-PGF2α and 8- hydroxydeoxyguanosine; 8-OHdG) and lipid profile were assessed. Dietary intake was estimated through a quantitative food frequency questionnaire. RESULTS: The dietary GL was positively associated with free fatty acid concentrations (ß= 0.311, r2 = 0.13, P-value = 0.034) and triglycerides/HDL cholesterol ratio (ß = 0.598, r2 = 0.19, P-value = 0.028) regardless of confounding factors (central obesity, red meat consumption, age and energy intake). The oxidative stress biomarker, 8-OHdG, was associated with habitual dietary GL (ß = 0.432, r2 = 0.11, P-value = 0.004), regardless of previous confounding factors plus excessive alcohol consumption, iron intake and current smoking status. CONCLUSIONS: The dietary GL was positively associated with lipid profile (free fatty acid concentrations and triglyce rides/HDL cholesterol ratio) and oxidative stress biomarker (8-OHdG). These results indicate potential harmfulness of diet with higher GL to cardiometabolic risk factors in middle-aged men, even in physically active individuals.

Introducción: Los efectos de la carga glucémica (CG) de la dieta sobre los factores de riesgo cardiometabólico en sujetos físicamente activos no están establecidos por completo. Objetivo: Este estudio transversal evaluó la asociación entre la CG de la dieta habitual y los factores de riesgo cardiometabólico en hombres brasileños de mediana edad físicamente activos. Métodos: Ciento setenta y seis sujetos (índice de masa corporal: 25,5 ± 3,6 kg/m2; edad: 50,6 ± 5,0 años) fueron evaluados. Antropometría, características del estilo de vida, la resistencia a la insulina, biomarcadores del estrés oxidativo (8-iso-prostaglandina F2, 8-iso-PGF2y 8 hidroxideoxiguanosina, 8-OHdG) y el perfil lipídico fueron evaluados. La ingesta dietética se estimó por medio de un cuestionario cuantitativo de frecuencia de consumo. Resultados: La CG de la dieta se asoció positivamente con las concentraciones de ácidos grasos libres (= 0,311, r2 = 0,13, P = 0,034) y la razón triglicéridos/colesterol HDL (= 0,598, r2 = 0,19, P = 0,028), independientemente de los factores de confusión (obesidad central, consumo de carne roja, edad e ingesta calórica). El biomarcador del estrés oxidativo, 8-OHdG, también se asoció con CG de la dieta habitual (= 0,432, r2 = 0,11, P = 0,004), independientemente de los factores de confusión anteriores más el consumo excesivo de alcohol, la ingesta de hierro y tabaquismo actual. Conclusiones: La CG de la dieta se asoció positivamente con el perfil lipídico (concentraciones de ácidos grasos libres y razón triglicéridos/HDL colesterol) y el biomarcador de estrés oxidativo 8-OHdG. Estos resultados indican el potencial de nocividad de una dieta con mayor CG respecto a los factores de riesgo cardiometabólico en hombres de mediana edad, incluso en aquellos físicamente activos.

Benefits and relationship of steps walked per day to cardiometabolic risk factor in Brazilian middle-aged men.

OBJECTIVES: We evaluated the benefits and relationship of the number of steps per day to the cardiometabolic risk factors: adiposity indicators; insulin resistance; and metabolic syndrome (MetS) in apparently healthy Brazilian middle-aged men. DESIGN: Cross-sectional. METHODS: Apparently healthy men (age: 50 ± 5 years; n=299) were studied. The number of steps per day was measured by pedometer. The adiposity indicators (waist circumference, total body fat, android and gynoid body fat), serum insulin, glucose and triglycerides, triglycerides/high-density lipoprotein cholesterol (HDL-c) ratio, homeostasis model assessment of insulin resistance (HOMA-IR) and MetS were assessed. Subjects were placed in groups to reflect different levels of steps per day (average of 7 consecutive days): Group 1<10,000 and Group 2 ≥ 10,000. Relationships among variables were measured by multiple linear regressions and the Spearman correlation coefficient as appropriate (p<0.05). RESULTS: The cardiometabolic risk factors were lower (p<0.05) in Group 2 than in Group 1. The number of steps per day was a negative predictive factor for total body fat, android and gynoid body fat and HOMA-IR independent of age, working position, android fat, overweight/obesity prevalence, and triglycerides/HDL-c ratio. Moreover, there was a negative correlation between the number of steps and total body fat, android and gynoid body fat, HOMA-IR and MetS. CONCLUSIONS: Brazilian middle-aged men performing more than 10,000 steps per day have better cardiometabolic conditions than those walking fewer than 10,000 steps. The number of steps per day is inversely related to the indicators of total and regional adiposity, insulin resistance and MetS.