Low bone mass and vitamin D in Brazilian people living with HIV under antiretroviral therapy.

We performed a cross-sectional study in 212 PLHIV under antiretroviral therapy. Bone mass was compromised in 36.5% of relatively young sample and associated with hypogonadism, older age, higher PTH levels, and metabolic syndrome. Hypovitaminosis D was present in 85%, especially those on NNRTI. PURPOSE: Previous studies have reported an increased prevalence of bone demineralization among people living with the human immunodeficiency virus (PLHIV). We aimed to assess bone mineral density (BMD), vitamin D levels, and associated risk factors in Brazilian PLHIV. METHODS: Cross-sectional study with 212 patients in a specialized assistance service. Clinical and demographic information were registered. Laboratory tests were performed, and BMD was measured at the lumbar spine, total hip/femoral neck, and forearm by dual-energy X-ray absorptiometry. Participants were classified into "with low bone mass (wLBM)" and "without low bone mass (woLBM)." Those wLBM encompasses osteoporosis, osteopenia, and below the expected range for age as recommended by the World Health Organization. RESULTS: One hundred and eighty-seven patients were included. Median age was 46.3 years (interquartile range (IQR) 40-52) and duration of HAART exposure was 11.2 years (IQR 7-15). Plasma viral load was undetectable in 79%. Hypovitaminosis D (< 30 ng/mL) was present in 85% and LBM in 36.5%. Men wLBM were more likely to have testosterone deficiency and had higher PTH levels than those woLBM. LBM in women was associated with older age, menopause, and metabolic syndrome. CONCLUSION: This study showed a high frequency of LBM in a relatively young sample, and suggests a detrimental effect of hypogonadism, older age, higher PTH levels, and metabolic syndrome. Hypovitaminosis D was frequent, especially those on non-nucleoside reverse transcriptase inhibitor, higher body mass index, and abdominal circumference.

Phase angle measured by electrical bioimpedance and global cardiovascular risk in older adults.

AIM: Population aging is a worldwide phenomenon associated with physiological and metabolic changes that contribute to the increased prevalence of risk factors for cardiovascular disease. The phase angle (PA) is a variable calculated by bioelectrical impedance analysis, interpreted as a direct measure of cell stability. The objective of the present study was to investigate the correlation of PA with the anthropometric measures, metabolic profile and the cardiovascular risk estimated by the Global Cardiovascular Risk Score in the elderly population. METHODS: A cross-sectional study was carried out with 402 patients aged >60 years (70.4 ± 6.9 years, 74% female) treated in primary care. Patients were evaluated by blood pressure, anthropometric measurements and body composition. The score of the risk and the stratification of the cardiovascular risk were calculated using the criteria from the Framingham Heart Study. RESULTS: Age, systolic blood pressure, neck circumference and fat-free mass correlated with PA in female patients. In men, age and systolic blood pressure were the variables that correlated with the PA in the bivariate analysis. In the multiple linear regression, for the female group the risk score presented an independent variation with PA (P = 0.051) and age (P < 0.0001). The same correlation was observed for the male group both for PA (P = 0.042) and age (P < 0.0001). CONCLUSIONS: The present data show an independent association of PA with overall cardiovascular risk in the elderly population. Geriatr Gerontol Int 2018; 18: 732-737.

Racial differences in HbA1c: a cross-sectional analysis of a Brazilian public primary care population.

BACKGROUND: Blacks show higher levels of HbA1c in studies with different populations and are disproportionately affected by most diabetes-related complications. AIMS: The study aims to investigate if the prevalence of altered glycated hemoglobin (HbA1c) varies with skin color and if there is a familial aggregation of either skin color and HbA1c. METHODS: The study used the CAMELIA study (Cardio-Metabolic-Renal familiar) population, conducted between June 2006 and December 2007 (cross sectional). Families were recruited from 13 Family Doctor Program Unities of Niteroi, Brazil, a highly miscegenated population. The visits included questionnaire, medical consultation, anthropometric and nutritional assessment. Blood pressure, blood/urine samples were collected. The dosage of HbA1c was performed by immunoturbidimetry in Labmax 240 equipment. RESULTS: We compare data of 241 (25.5%) Blacks, versus 422 (44.7%) Mulattos or 272 (28.8%) Whites. The groups did not differ significantly with regard to most measures. Blacks had the lowest levels of income/education, higher frequency of diabetes and hypertension (p<0.20) as higher levels of HbA1c (p<0.05) that persisted after adjusting for possible confounders. Among blacks, the correlations between siblings of HbA1c were higher than among white/mulatto, reaching 86% versus 50%, respectively. CONCLUSION: Those results indicate that Brazilian Blacks patients must have more attention, focusing on diabetes preventive care. Longitudinal studies are needed to address the question if the altered level of HbA1c has a real clinical impact.

Resistance training improves muscle function and body composition in patients with hyperthyroidism.

OBJECTIVE: To evaluate the effect of resistance training on skeletal muscle performance and body composition in patients with medically treated hyperthyroidism. DESIGN: Nonrandomized controlled trial. SETTING: Large public tertiary hospital. PARTICIPANTS: Sixteen sedentary patients with recent clinical diagnosis and laboratory confirmation of hyperthyroidism (7 men, 9 women; age, 38+/-11 y; weight, 58.4+/-2.6 kg; height, 1.6+/-0.3m) were assigned to the control group (medical therapy; n=9) or training group (medical therapy associated with resistance training; n=7). An age- and sex-matched healthy group served as controls (3 men, 5 women; age, 40+/-3 y; weight, 68.4+/-4.3 kg; height, 1.6+/-0.3m). INTERVENTION: Resistance training twice a week for 16 weeks. MAIN OUTCOME MEASURES: Peak muscular strength (by dynamometry and 1 repetition maximum method) and endurance (30% of peak force) for 7 movements and anthropometric measurements. RESULTS: The hyperthyroid patients as a group had lower baseline overall strength values when compared with healthy subjects (200.3+/-16.0 kg vs 274.9+/-21.8 kg, respectively; P=.006). Overall absolute increases in strength (49 kg vs 91 kg, P<.05) and endurance (78.5x10(2)kg/s vs 176.9x10(2)kg/s, P<.05) were higher in the training group compared with the control group. Body weight increased in both groups, but the sum of muscular circumference increased only in the training group (training group, 92.6+/-3.3 cm vs 97.1+/-3.8 cm; control group, 94.6+/-2.2 cm vs 94.4+/-2.1cm; P<.05), with no change in the sum of skinfolds. CONCLUSIONS: Resistance training accelerates the recovery of skeletal muscle function and promotes weight gain based on muscle mass improvement in patients with medically treated hyperthyroidism.

Disfunção muscular esquelética e composição corporal no hipertireoidismo / Skeletal muscle dysfunction and body composition in hyperthyroidism

O objetivo deste artigo é revisar os aspectos da disfunção muscular esquelética e composição corporal no hipertireoidismo. O hipertireoidismo está associado a uma fraqueza muscular generalizada que é parte da manifestação clínica inicial de cerca de 80 por cento dos pacientes, comprometendo a realização de tarefas cotidianas e a qualidade de vida. Um fator que contribui para a redução da força é a atrofia muscular, que tende a afetar mais comumente os grupos musculares proximais. Além disso, o hipertireoidismo é acompanhado de perda ponderal associada à depleção de massa muscular e tecido adiposo. Estudos demonstram que o tratamento medicamentoso é capaz de recuperar a força e mais lentamente a resistência, definida como a capacidade de sustentar cargas submáximas por períodos prolongados, e que o treinamento contra resistência associado ao tratamento medicamentoso, é capaz de promover um maior ganho de força e de resistência muscular nestes pacientes. Embora não tenha sido estabelecido um padrão de composição corporal na recuperação do peso após o tratamento da doença, sabe-se que pacientes submetidos ao treinamento de força apresentam recuperação de peso acompanhado principalmente de ganho de massa muscular.

O papel da glicemia capilar de jejum no diagnóstico precoce do diabetes mellitus: correlação com fatores de risco cardiovascular / The role of fasting capillary glycemia in the early diagnosis of diabetes mellitus: correlation with cardiovascular risk factors

O diabetes mellitus (DM) tem alta prevalência na população mundial. Para avaliar o papel da glicemia capilar dejejum (GCJ) no seu diagnóstico, 277 indivíduos (202F/75M) foram estudados. Os voluntários aparentavam ser saudáveis, tinham mais de 30 anos, e foram recrutados num posto de saúde quando estavam acompanhando pacientes ou se preparavam para fazer um exame de sangue de rotina. Gestação e conhecimento prévio de DM serviram de critérios de exclusão. Após avaliação antropométrica, a GCJ era medida. Os casos com GCJ >96mg/dl eram reavaliados com dosagens de glicemia plasmática em jejum e 2 horas após 75g de dextrosol. Cento e oitenta e sete (67,5 por cento) tiveram GCJ s96mg/dl e 90 (32,5 por cento) GCJ >96mg/dl. Quando os parâmetros idade, peso, índice de massa corporal, cintura abdominal e quadril dos 2 grupos foram comparados entre si, os valores foram sempre estatisticamente maiores (p< 0,01) no grupo com GCJ >96mg/dl. A incidência de DM foi de 7,2 por cneto e de intolerância à glicose, 4,3 por cento. Em conclusão, a GCJ se mostrou um instrumento valioso no diagnóstico precoce do DM.

Avaliaçäo fenotípica dos infiltrados celulares e da expressäo de HLA-DR em tireóides de pacientes com doença de Graves tratados com propiltiouracil / Phenotype evaluation of the cell infiltrated and of the HLA-DR expression in the thyroid of patients with Graves' disease treated with propylthiouracil

É sabido que as tireóides de pacientes com doença de Graves apresentam uma infiltraçao por mononucleares, principalmente linfócitos. Com a intençao de se avaliar estes infiltrados linfocitários, células T e a associaçao entre estes e o HLA-DR, caso os tireócitos estejam positivos para este antígeno de classe II, oito amostras de tecido tireoideano, obtidas cirurgicamente de oito pacientes com a doença de Graves e tratados com propiltiouracil (PTU), foram estudadas em secçoes criostáticas utilizando-se anticorpos monoclonais específicos (UCHT1: CD3, 16H5: CD4, OKT8: CD8, OKM1: CD14 e MID3: HLA-DR) através de imuno-histoquímica (APAAP). Em sete dos oito pacientes foi identificada a presença de células T, com predominância de células CD4+ sobre as CD8+ em quase todos. A expressao anormal de HLA-DR nos tireócitos foi observada em todos os tecidos estudados, sendo que aqueles com maior densidade de infiltraçao linfocitária foram os que apresentaram a maior positividade para o HLA-DR. Nao houve significância estatística quando testadas as combinaçoes HLA-DR e a infiltraçao linfocitária total, as subpopulaçoes linfocitárias entre si (CD4+ e CD8+) e cada uma destas isoladamente com as células T total (CD3+). Uma provável influência do PTU nos infiltrados celulares intraglandulares, como na expressao anormal de HLA-DR nos tireócitos, nao foi possível de ser avaliada, pois todos os tecidos estudados foram expostos a esta droga antitireoideana.