Pro12Ala Polymorphism on the PPARγ2 Gene and Weight Loss After Aerobic Training: A Randomized Controlled Trial.

The objective of this study was to verify the influence of the Pro12Ala polymorphism of the PPARγ2 gene in response of a training program on the body composition. Sixty-nine previously inactive men and women (32.8 ± 8.2 years) were genotyped and underwent a 12-week aerobic (running/walking) training program (3-5 sessions, 40 - 60 min per session, and intensity between the aerobic and anaerobic threshold) (experimental group n = 53) or were part of the control group (n = 16). They were tested for aerobic capacity (ergospirometry), body composition (DXA), abdomen, waist and hip circumferences and nutritional assessment before and 48 h after the experimental protocol. Two-way repeated measures ANOVA test was used to verify possible differences in variables between the experimental vs. control groups or Pro/Pro vs. Pro/Ala groups, and the Chi-squared test was used to verify the distribution of responders and non-responders according to genotype (p < 0.05). Frequencies of 75.5% Pro/Pro (n = 40) and 24.5% Pro/Ala (n = 13) were found, without any occurrence of the recessive homozygote. Body fat reduction was initially confirmed compared to a control group which did not exercise (n = 16; 29.1 ± 8.8 years), so that the exercise group obtained a reduction of -1.3 kg vs. -0.3 kg in the control group (p = 0.03). When they were divided by genotype, there were significant changes in fat mass (-1.3 ± 2.1 kg; p = 0.00), lean mass (0.6 ± 1.5 kg; p = 0.02), fat percentage (-1.3 ± 1.6; p = 0.00), waist circumference (-2.2 ± 2.9 cm; p = 0.00), abdomen circumference (-3.3 ± 3.6 cm; p = 0.00) and hip circumference (-2.7 ± 2.7 cm; p = 0.00) for Pro/Pro genotypes; and fat mass (-1.1 ± 1.7 kg; p = 0.04), fat percentage (-0.9 ± 1.5; p = 0.04), abdomen circumference (-3.9 ± 3.5 cm; p = 0.00) and hip circumference (-1.8 ± 1.8 cm; p = 0.00) for Pro/Ala genotypes, without any group interaction differences. The Chi squared test revealed no differences in the distribution of responders or non-responders according to genotype. It is concluded that an aerobic training program promotes weight loss, but the Pro12Ala polymorphism in the PPARγ2 gene does not influence the variability of aerobic-induced exercise weight loss.

Relationship Between Skeletal Muscle Mass Indexes and Muscular Function, Metabolic Profile and Bone Mineral Density in Women with Recommendation for Bariatric Surgery.

BACKGROUND AND AIM: We evaluated low skeletal muscle mass (LMM) in women prior to bariatric surgery (BS) through different skeletal muscle mass indexes (MMIs) regarding body fat percentage (BFP), handgrip strength (HS), six-minute walk test (6MWT), metabolic profile and bone mineral density (BMD). METHODS: Women (n=62) were allocated into two groups according to LMM: obesity with low muscle mass (OLMM) or obesity with normal muscle mass (ONMM). LMM was defined by the appendicular skeletal muscle mass (ASM) adjusted for weight (ASM/wt × 100) and ASM adjusted for body mass index (ASM/BMI), considering the lowest quintile of the indexes studied. RESULTS: OLMM was found in 30.5% by ASM/wt × 100 and 20.3% by ASM/BMI. Using the ASM/wt × 100, OLMM group had a high BFP, low HS and BMD in L1-L4, femoral neck (FN) and total femur (TF) when compared with ONMM (p < 0.05). Using ASM/BMI, OLMM group had increased BFP, reduced HS and 6MWT in comparison to ONMM (p < 0.05). Metabolic profile was similar between OLMM and ONMM groups by the two MMIs. MMIs were negatively correlated with BFP (p < 0.05) and positively correlated with HS (p < 0.05), and none of them with 6MWT (p > 0.05). ASM/wt × 100 was positively correlated with all BMD sites assessed (p < 0.05). There was positive correlation between ASM/wt × 100 and ASM/BMI. CONCLUSION: OLMM identified by the ASM/wt × 100 and ASM/BMI had higher adiposity and lower HS. Using ASM/BMI, we found that OLMN had a poor physical performance, while the ASM/wt × 100 identified a lower BMD at all sites.

The MTHFR promoter hypermethylation pattern associated with the A1298C polymorphism influences lipid parameters and glycemic control in diabetic patients.

BACKGROUND: Polymorphisms in the gene encoding methylenetetrahydrofolate reductase (MTHFR) have been investigated as risk factors for microvascular complications of diabetes; however, simultaneous analysis of these polymorphisms and the methylation pattern of the gene has never been conducted. The objective of the present study was to evaluate the simultaneous relationship between MTHFR methylation and MTHFR C6TT7 and A1298C polymorphisms with metabolic, inflammatory and oxidative stress parameters related to microvascular complications, diabetic retinopathy (DR) and diabetic nephropathy (DN) in diabetic patients. METHODS: A total of 107 patients who were diagnosed in the previous 5 to 10 years were recruited and divided into groups with complications (DR and/or DN) or without complications. Methylation analysis of the gene promoter was conducted using the MSP technique, and analysis of the A1298C and C677T polymorphisms was conducted using the restriction fragment length polymorphism (RFLP) assay. Microalbuminuria was determined using urine samples, and other analytes of interest were determined in blood samples using commercial kits. The Mann-Whitney and Chi square statistical tests were used with significance considered at p < 0.05. RESULTS: Subjects with a hypermethylated profile and the 1298AA genotype showed the highest levels of blood glucose (p = 0.03), total cholesterol (p = 0.0001) and LDL cholesterol (p = 0.0006). The same profile was associated with higher levels of HbA1c (p = 0.025), glycemia (p = 0.04) and total cholesterol (0.004) in the control group and total cholesterol (p = 0.005) and LDL cholesterol (p = 0.002) in the complications group. Serum creatinine was higher in subjects in the hypermethylated group with the genotype 677CC only in the control group (p = 0.0020). The methylated profile in presence of 677CC + 1298AA and the 677CT/TT +1298AA haplotypes showed higher levels of total cholesterol (p = 0.0024; 0.0031) and LDL cholesterol (p = 0.0060; 0.0125) than 1298AC/CC carriers. The fasting glycemia was higher in hypermethylated profile in the presence of 677CC/1298AA haplotype (p = 0.0077). CONCLUSION: The hypermethylated methylation profile associated with the 1298AA genotype appeared to be connected to higher values of glycemia, total cholesterol and LDL cholesterol.

Influence of basal energy expenditure and body composition on bone mineral density in postmenopausal women.

BACKGROUND: The aim of this study was to investigate the influence of body mass index, body weight, lean mass, fat mass, and basal energy expenditure on bone mineral density in postmenopausal women. METHODS: This was a cross-sectional, descriptive study of a sample of 50 women, with minimum time since menopause between 1 and 10 years. Bone mineral density was assessed at the lumbar spine (L2-L4), femoral neck, Ward's triangle, and trochanter using dual-energy X-ray absorptiometry. Body mass index, lean mass, fat mass, and basal energy expenditure were measured by bioimpedance. RESULTS: The mean age of the women was 51.49 ± 3.86 years and time since menopause was 3.50 ± 2.59 years. Significant negative correlations were found between chronological age and lumbar spine, femoral neck, Ward's triangle, and trochanteric bone mineral density. In regard to time since menopause, we also observed significant negative correlations with bone mineral density at the lumbar spine and Ward's triangle. The following significant positive correlations were recorded: body mass index with bone mineral density at the femoral neck and trochanter; fat mass with bone mineral density at the femoral neck and trochanter; lean mass with bone mineral density at the lumbar spine, femoral neck, and trochanter; and basal energy expenditure with bone mineral density at all sites assessed. On the other hand, the multiple linear regression model showed that: 20.2% of bone mineral density variability at the lumbar spine is related to lean mass and time since menopause; 22.3% of bone mineral density variability at the femoral neck is related to body weight and age; 18.9% of bone mineral density variability at Ward's triangle is related to age and basal energy expenditure; and 39% of bone mineral density variability at the trochanter is related to body mass index, age, and menarche. CONCLUSION: Changes in bone mineral density, specific for each skeletal site, are influenced by age, time since menopause, body weight, body mass index, lean mass, and basal energy expenditure. Lean mass and basal energy expenditure positively influenced bone mineral density at the lumbar spine and Ward's triangle, with a predominance of trabecular bone.

Estimating cardiovascular risk in patients with type 2 diabetes: a national multicenter study in Brazil.

UNLABELLED: According to Brazilian National Data Survey diabetes is the fifth cause for hospitalization and is one of the ten major causes of mortality in this country. AIMS: to stratify the estimated cardiovascular risk (eCVR) in a population of type 2 diabetics (T2DM) according to the Framingham prediction equations as well as to determine the association between eCVR with metabolic and clinical control of the disease. METHODS: From 2000 to 2001 a cross-sectional multicenter study was conducted in 13 public out-patients diabetes/endocrinology clinics from 8 Brazilian cities. The 10-year risk of developing coronary heart disease (CHD) was estimated by the prediction equations described by Wilson et al (Circulation 1998). LDL equations were preferably used; when patients missed LDL data we used total cholesterol equations instead. RESULTS: Data from 1382 patients (59.0% female) were analyzed. Median and inter-quartile range (IQ) of age and duration of diabetes were 57.4 (51-65) and 8.8 (3-13) years, respectively without differences according to the gender. Forty-two percent of these patients were overweight and 35.4% were obese (the prevalence of higher BMI and obesity in this T2DM group was significantly higher in women than in men; p < 0.001). The overall estimated eCVR in T2DM patients was 21.4 (13.5-31.3). The eCVR was high (> 20%) in 738 (53.4%), intermediate in 202 (14.6%) and low in 442 (32%) patients. Men [25.1(15.4-37.3)] showed a higher eCVR than women [18.8 (12.4-27.9) p < 0.001]. The most common risk factor was high LDL-cholesterol (80.8%), most frequently found in women than in men (p = 0.01). The median of risk factors present was three (2-4) without gender differences. Overall we observed that 60 (4.3%) of our patients had none, 154(11.1%) one, 310 (22.4%) two, 385 (27.9%) three, 300 (21.7%) four, 149 (10.5%) five and six, (2%) six risk factors. A higher eCVR was noted in overweight or obese patients (p = 0.01 for both groups). No association was found between eCVR with age or a specific type of diabetes treatment. A correlation was found between eCVR and duration of diabetes (p < 0.001), BMI (p < 0.001), creatinine (p < 0.001) and triglycerides levels (p < 0.001) but it was not found with HbA1c, fasting blood glucose and post-prandial glucose. A higher eCVR was observed in patients with retinopathy (p < 0.001) and a tendency in patients with microalbuminuria (p = 0.06). CONCLUSION: our study showed that in this group of Brazilian T2DM the eCVR was correlated with the lipid profile and it was higher in patients with microvascular chronic complications. No correlation was found with glycemic control parameters. These data could explain the failure of intensive glycemic control programs aiming to reduce cardiovascular events observed in some studies.

Ensaios clínicos com as folhas de Cissus sicyoides I. (vitaceae) em pacientes intolerantes à glicose e em diabéticas tipo 2 / Clinical trials with the leaves of Cissus sicyoides I. (vitaceae) in glucose-intolerant and in type 2

A Cissus sicyoides é popularmente empregada para o tratamento do diabetes e é conhecida como insulina vegetal. Realizaram-se ensaios clínicos de fase II com o infuso das folhas da referida planta, para investigar a eficácia terapêutica, desse vegetal, em voluntárias intolerantes à glicose (GIG n=14) e diabéticas tipo 2 (GD n=12). Preparou-se o chá com 1g do pó das folhas secas, diluído em 150 mL de água quente por 10 minutos (uso popular), dose única. A atividade foi avaliada nos tempos basal, 30° e 60° dias. Aplicou-se questionário para reações adversas e realizaram-se exames clínicos e laboratoriais no Hospital Universitário Lauro Wanderley/UFPB. Os dados foram analisados estatisticamente e o nível de significância foi de 5,0 %. Observou-se que: as voluntárias não exerciam atividade física, possuíam parentes com diabetes, eram hipertensas e obesas; o IMC do GD reduziu significativamente com 60 dias, entre os grupos. Concluiu-se que, nesse estudo, não foi evidenciado efeito hipoglicemiante significativo, nas voluntárias, e que nas doses utilizadas a Cissus sicyoides não causou alterações clínicas e laboratoriais confirmando a segurança da utilização da mesma, como alimento, pela população.

Avaliação do efeito hipoglicemiante de Cissus sicyoides em estudos clínicos fase II / Evaluation of the hypoglycemic effect of Cissus sicyoides in phase II clinical trials

O estudo objetivou realizar ensaios clínicos de fase II com o infuso das folhas de Cissus sicyoides L (Vitaceae) para investigar a eficácia terapêutica desse vegetal em voluntárias intolerantes à glicose (GIG n = 14) e diabéticas (GD n = 12) entre 30 e 59 anos de idade no Hospital Universitário Lauro Wanderley/UFPB. O chá foi preparado com 1g do pó das folhas secas, diluído em 150 mL de água quente por 10 minutos (uso popular), dose única, por um período de 7 dias (fase aguda). No GIG verificou-se a interação entre a glicemia e a insulina através do Teste Oral de Tolerância à Glicose, sem e com a ingestão do infuso. A glicemia e insulinemia foram determinadas nos tempos 0, 1, 2 e 3 h. Para o GD avaliou-se a variação espontânea da glicemia (em jejum e em repouso nos tempos 0, 1, 2 e 3 h) e o perfil glicêmico (antes e 2 h após as refeições) na ausência e na presença do chá. No GIG, o chá das folhas teve atividade hipoglicemiante significativa aos 120 minutos, porém, não houve aumento da insulinemia, além da fisiológica, sugerindo que esse efeito não ocorreu por liberação ou secreção da mesma. No GD o infuso não apresentou efeito hipoglicemiante significativo.

This study aimed to perform Phase II clinical trials with the infusion of the leaves of Cissus sicyoides L to investigate its therapeutic effectiveness in glucose-intolerant (GIG n = 14) and in type 2 diabetic (GD n = 12) volunteers, 30 to 59 years old, at Hospital Universitário Lauro Wanderley/UFPB. The tea was prepared with 1g of dust falling leaves diluted in 150 mL of hot water for 10 minutes (popular usage), in single doses, for 7 days (acute phase). In the GIG, the interaction between the glicemy and the insulin was verified through two oral tests of glucose tolerance, with and without infusion's ingestion. The glicemy and the insulinemy were determined at 0, 1, 2, and 3 hours. For GD, the spontaneous variation of glicemy (during fasting and resting periods, at 0, 1, 2, and 3 hours), and the glicemic profile (before and 2 hours after meals) were evaluated in the absence and in the presence of the tea. For GIG, the tea of the leaves revealed considerable hypoglycemic activity at 120 minutes; however there was no insulinemy increase, beyond the physiological, suggesting that this effect did not happen because of insulinemy's liberation or secretion. For GD, the tea did not demonstrate considerable hypoglycemic activity.

Efeito do uso da farinha desengordurada do Sesamum indicum L nos níveis glicêmicos em diabéticas tipo 2 / Effect of defatted sesame (Sesamum indicum L) flour on the blood glucose level in type 2 diabetic women

Existe um incremento nas pesquisas de plantas e grãos com atividades hipoglicemiantes para prevenção e terapêutica do Diabetes Mellitus, que aumenta em grandes proporções mundialmente. Este estudo avalia o efeito do uso da farinha desengordurada do Sesamum indicum L. nos níveis glicêmicos de diabéticas tipo II submetidas a tratamento dietoterápico. Ensaio clínico controlado e aberto, em dois grupos, experimental (GE) e controle (GC) com avaliação na linha de base (AB), aos 30 (A-30) e 60 dias (A-60). As características gerais não apresentaram diferenças estatísticas entre os grupos. Observou-se diferença estatística significativa na glicemia de jejum (GJ) (p = 0,004) na AB, na GJ (p = 0,002) e peso (p = 0,020) na A30, e apenas no peso (p = 0,011) na A60. Nas glicemias pós-prandiais (GP) e hemoglobinas glicosiladas não houve diferença estatística em nenhuma das avaliações entre os grupos. Evidenciou-se diferença estatística entre a AB - A30 em relação ao peso nos dois grupos, e na AB - A60 na GP (p = 0,04) e peso (p = 0,01) no GE, mas apenas no peso (p = 0,03) no GC. A farinha de gergelim contribuiu no controle glicêmico e no peso em pacientes diabéticas, de forma econômica, saborosa e saudável.

There is an increment in the researches on plants and whole grains with hypoglycemic activity in order to prevent and treat Diabetes Mellitus which has increased rapidly on serious proportions all over the world. This study aimed at evaluating the effect of defatted Sesamum indicum L. flour on blood glucose level in type 2 diabetic women on diet therapy. A controlled and open-label clinical trial, with two groups, experimental group (GE) and control group (GC) were evaluated at the basal line (AB), at thirty day (A-30) and sixty day (A-60). The general characteristics in both groups were similar. There was a significant difference at fasting glucose level (GJ) (p = 0.004) on AB, GJ (p = 0.002) and weight (p = 0.020) on A-30, and only weight (p = 0.011) on A-60. There was no significant difference at postprandial glucose level (GP) and glycosylated hemoglobin level at all the evaluation between the groups. There was a significant difference between AB - A-30 of weight in two groups, and AB - A-60 of GP (p = 0.04) and weight (p = 0.01) on GE, but only of weight (p = 0.03) on GC. The defatted sesame contributed to the glycemic control and weight in diabetic women in a cheap, tasty and healthy manner.

Estudo toxicológico pré-clínico agudo com o extrato hidroalcoólico das folhas de Cissus sicyoides L. (Vitaceae) / Acute pre-clinical toxicological study with the hydroalcoholic extract of the leaves of Cissus sicyoides L. (Vitaceae)

O estudo objetivou realizar ensaio toxicológico pré-clínico inicial para investigar a toxicidade da planta. Na investigação da DL50 foram utilizados grupos de camundongos Swiss machos (n = 10) submetidos a doses de 5,0 g/kg, via oral, e dose de 2,0 g/kg por via intraperitoneal, da fração aquosa das folhas (FAF) de Cissus sicyoides L. Foi retirado sangue através do plexo braquial após sete dias, para análise laboratorial de parâmetros hematológicos e bioquímicos. No estudo anatomopatológico, os animais foram examinados macro e microscopicamente, com ressecção de pulmão, coração, fígado e rins. Para análise dos dados foram utilizadas técnicas de estatística descritiva e inferencial. Na avaliação dos parâmetros hematológicos e bioquímicos dos camundongos Swiss, foram detectadas alterações nas transaminases AST e ALT e na fosfatase alcalina (FAL), caracterizando as alterações hepáticas demonstradas no estudo histopatológico. Na avaliação histológica do fígado de camundongos, evidenciou-se hepatite reacional com portite linfocitária crônica e lobular multifocal, hiperplasia kupferiana, colapsos focais da trama reticular, ausência de fibrose portal e lobular. O estudo toxicológico pré-clínico agudo demonstrou em camundongos alterações hepáticas.

The aim of the study was to carry through pre-clinical toxicological assay to analyze the toxicity of the plant. In the inquiry of the LD50 groups of male Swiss rats (n = 10) were given orally 5.0 g/kg, and 2.0 g/kg intraperitoneally, of the water fraction of the leaves (WFL) of Cissus sicyoides L. Blood was removed through brachial plexus after seven days, for laboratory analysis of hematological and biochemical parameters. In the anatomopathological study, the animals had been examined macro and microscopically, with dissection of lung, heart, liver and kidneys. For analysis of the data techniques of descriptive and inferencial statistics had been used. In the evaluation of the hematological and biochemical parameters of the Swiss rats, alterations in aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (FAL) had been detected, characterizing the demonstrated hepatic alterations in the histopathological study. In the histological evaluation of the rats's liver, submitted to the poisoning, reactionary hepatitis with chronic linfocity portite was proven and to lobular multifocal, hiperplasia kupferiana, focal collapses of the reticular tram, absence of fibrosis, absences of cellular atipias and reactionary subcapsulite. The acute pre-clinical toxicological study demonstrated hepatic alterations in rats.

Use of cabbage leaves (Brassica oleracea var. acephala) in the stabilization of bone mass after menopause / Uso do suco das folhas da couve (Brassica oleracea var acephala), na estabilização da massa óssea pós-menopausa

This work evaluates the use of cabbage leaves, Brassica oleracea var acephala (Cruciferae family) to stabilize bone mass in 13 menopausal women. The mature leaves were used after removal of the midrib and petiole and taken as a juice and given to the patient once a day for 24 months. Densitometric exams were performed every six months. The measurement points were the Trocanter and Ward's triangle. According to the results found, the use of cabbage leaf juice results in bone mass stabilization at the points studied, with perspectives for its use as an important option in disease prevention.

Neste trabalho foi avaliado a utilização da folha da couve Brassica oleracea variedade acephala, pertencente à família Cruciferae, para estabilizar a massa óssea em 13 mulheres após a menopausa. As folhas da couve foram usadas após retirar a nervura principal e o peciolo, na forma de suco de uma folha ao dia, durante 24 meses. Foi realizado a cada seis meses o exame de densitometria óssea para avaliar os resultados. Os locais de medição foram o trocanter e o triângulo de Ward. De acordo com os resultados encontrados, podemos concluir que o uso da folha da couve foi capaz de estabilizar a massa óssea nos sítios estudados, com perspectivas do seu uso também como opção importante para prevenção da doença.

[Nationwide multicenter study on the prevalence of overweight and obesity in type 2 diabetes mellitus in the Brazilian population]. / Prevalência de sobrepeso e obesidade em pacientes com diabetes mellitus do tipo 2 no Brasil: estudo multicêntrico nacional.

AIM: To evaluate the prevalence of overweight and obesity in type 2 diabetic (DM2) outpatients from different regions of Brazil. PATIENTS AND METHODS: We studied 2,519 randomly selected patients, from 11 hospitals, 2 endocrine and one general public care clinics from 10 cities. Overweight was defined as body-mass index (BMI) > 25 and obesity as BMI > 30 kg/m2. Glycemic control (GC) was evaluated by GC index (GCI = patient's HbA1 or HbA1c/upper limit of normal for the method x 100). RESULTS: 39% of the population studied was male, the mean age was 58.8 +/- 11.6 y, the duration from clinical diagnosis of DM2 was 9.0 +/- 7.3y, and BMI was 28.3 +/- 5.2 kg/m2. No measurements of BMI were recorded from 265 patients (10.5%). Patients from the Northeast presented lower BMI as compared with those from the Midwest, Southeast and South areas, respectively (26.4 +/- 4.7 vs. 27.9 +/- 4.8 vs. 29.2 +/- 5.1 vs. 29.4 +/- 5.4 kg/m2; p < 0.001). A greater prevalence of obesity was observed in the Southeast and South areas as compared to the Northeast (p < 0.001), as well as in the female group, respectively (69% vs. 31%; p < 0.001). Normal weight patients presented lower GCI. Patients being treated with two or more oral drugs and an association of insulin plus oral drug presented greater BMI values than those being treated with diet, oral hypoglycemic agents and insulin p < 0.001. The BMI of patients treated by a specialist did not differ from those treated by a generalist. CONCLUSIONS: 75% of our sample was out of adequate BMI and 30% was obese. The percentage of patients with overweight and obesity was comparable to those found in similar European studies but still lower than those found in the USA. The prevalence of obesity in diabetic patients was three times higher than in the overall Brazilian population according to data from the Brazilian Institute of Geography and Statistics (IBGE).

Prevalência de sobrepeso e obesidade em pacientes com diabetes mellitus do tipo 2 no Brasil: estudo multicêntrico nacional / Nationwide multicenter study on the prevalence of overweight and obesity in type 2 diabetes mellitus in the Brazilian population

OBJETIVO: Avaliar a prevalência de sobrepeso e obesidade em pacientes ambulatoriais com diabetes mellitus tipo 2 (DM2) em diferentes regiões do Brasil. PACIENTES E MÉTODOS: Avaliamos aleatoriamente 2.519 pacientes em 11 hospitais, 2 ambulatórios especializados e um posto de saúde em 10 cidades brasileiras. Consideramos sobrepeso um índice de massa corporal (IMC) > 25 e obesidade um IMC > 30 kg/m². O controle glicêmico (CG) foi avaliado pelo índice de CG [ICG= HbA1 e ou HbA1c do paciente/limite superior de normalidade do método x 100]. RESULTADOS: Os pacientes tinham idade de 58,8 ± 11,6 anos, tempo de diagnóstico clínico de DM de 9,0 ± 7,3 anos, IMC de 28,3 ± 5,2 kg/m², e 39 por cento eram do sexo masculino. Do total da amostra, 265 pacientes (10,5 por cento) não apresentavam avaliação do IMC. Os pacientes da região Nordeste apresentaram menor IMC em comparação com os das regiões Centro-Oeste, Sudeste e Sul, respectivamente (26,4 ± 4,7 vs. 27,9 ± 4,8 vs. 29,2 ± 5,1 vs. 29,4 ± 5,4 kg/m²; p< 0,001). Houve maior prevalência de obesidade na região Sudeste e Sul em comparação à região Nordeste (p< 0,001) e nos pacientes do sexo feminino, respectivamente (69 vs. 31 por cento; p< 0,001). Os pacientes com peso normal apresentaram menor ICG. Aqueles em tratamento com associação de duas ou mais drogas orais e associação de insulina + droga oral apresentaram maior IMC do que aqueles em tratamento com dieta, hipoglicemiante oral e insulina; p< 0,001. O IMC não diferiu entre os pacientes assistidos ou não por especialistas. CONCLUSÕES: Da população estudada, 75 por cento não estava na faixa de peso ideal, sendo que um terço tinha obesidade. Nossos dados indicam que o sobrepeso e a obesidade já atingem um percentual de pacientes com DM2 no Brasil semelhante ao relatado em estudos europeus, mas ainda menor do que o observado nos EUA. A prevalência de obesidade nos pacientes diabéticos foi três vezes maior do que a observada na população brasileira em geral de acordo com os dados do IBGE.

Prevalence of Type 2 diabetic patients within the targets of care guidelines in daily clinical practice: a multi-center study in Brazil.

Major clinical studies have shown that the targets for blood glucose, lipid profile and blood pressure in type 2 diabetic patients are difficult to maintain in clinical practice. However, there are few data concerning South American populations. Using guidelines represented by the Brazilian Diabetes Society, we evaluated cardiovascular (CV) risk factors, glycemic control and the availability of screening for diabetes complications in 2233 (60% females) outpatients with type 2 diabetes aged 59.2 +/- 11.3 yr and with a known duration of diabetes of 9.2 +/- 7.2 yr, collected from 8 Brazilian cities. The outcome showed that less intensive clinical care available for diabetic patients in Brazil compared to western industrialized countries leads to widespread poor metabolic control and health status. Less than 30% of the patients reached the target for systolic (28.5%, < 130 mmHg) and diastolic (19.3%, < 80 mmHg) blood pressure, BMI (24.6%, < 25 kg/m2), LDL cholesterol (20.6%, < 2.6 mmol/l) and only 46% reached the goal for HbA1c (one % point above the upper limits of normality for the method used). Only 0.2% of patients reached all the targets. A lower number of women reached the targets for HbA1c, LDL and HDL cholesterol than men (p < 0.001). Women were less likely than men to have funduscopy examinations and urine albumin testing (p < 0.001). We conclude that the national goals for glycemic control, blood pressure and lipid levels are rarely achieved in clinical practice, and that the availability for diabetic complication screening is low. The quality of diabetes care, in particular for women, is poor and should be further reviewed in developing countries.

Plants and their active constituents from South, Central, and North America with hypoglycemic activity

There has been marked interest in recent years in the use of plants for the treatment of diabetes. Plants have been found in many countries which have been indicated as having hypoglycemic activity. The present work is an up-to-date review with 178 references of crude plant extracts and chemically defined molecules with hypoglycemic activity from South, Central and North America. The review refers to 224 plants with their families, parts used and type of extract, organism tested and activity. It also includes 40 compounds isolated from those plants. Some aspects of recent research with natural products from plants directed to the treatment of diabetes are discussed.

Sistematização da assistência de enfermagem ao diabético jovem embasada no autocuidado / The nursing assistance under a sistematic way to care young diabetic focusing on the self-care

A sistematização da assistência de enfermagem ao diabético insulino-dependente utilizando a Teoria do Autocuidado de OREM, foi desenvolvida neste trabalho utilizando uma metodologia qualitativa, tendo como técnica metodológica o estudo de caso, aplicado a entrevista semi-estruturada...

Avaliaçäo da composiçäo corpórea após histerectomia com conservaçäo dos ovários / Body composition evaluation after hysterectomy with ovarian conservation

Os autores avaliam a composição corpórea e o padrão de distribuição de gordura em uma amostra de pacientes climatéricas histerectomizadas durante o menacme, bem como a correlação destes índices com os níveis séricos de hormônios sexuais. Foram estudadas mulheres no climatério, com idades entre 46 e 60 anos, divididas em dois grupos: grupo I (17 pacientes submetidas a histerectomia com preservação ovariana bilateral) e grupo II (23 mulheres não submetidas à cirurgia). Foram determinados índice de massa corpórea (IMC), circunferências periféricas e análise de impedência bioelétrica (BIA) para avaliação indireta da composição corpórea, bem como dosagem das concentrações séricas de hormônios sexuais. Observaram-se valores de IMC elevados na maioria das mulheres (77,5 por cento), encontrando-se estado nutricional normal em apenas 22,5 por cento. A correlação entre índice cintura-quadril e concentrações séricas de estradiol foi estatisticamente significante (p < 0,05) nos dois grupos. Em relação à variável distribuição regional de gordura, observou-se que no grupo I 82,4 por cento das mulheres apresentaram distribuição centralizada e apenas 17,6 por cento apresentaram o padrão ginecóide, encontrando-se valores semelhantes no grupo II. Massa gorda aumentada por BIA (acima de 30 por cento) foi observada em 75 por cento das pacientes, encontrando-se médias de 34,88 (ñ 5,6) no grupo I e de 32,98 (ñ 4,92) no grupo II. As concentrações séricas de hormônios sexuais foram eqüivalentes nos dois grupos, com exceção dos níveis de testosterona total, maiores no grupo II. A gordura corporal está aumentada nesta amostra de mulheres climatéricas e a distribuição regional se faz mais centralizada, não se observando diferenças entre mulheres histerectomizadas com conservação bilateral dos ovários e mulheres do grupo-controle. Observou-se que o padrão centralizado de gordura apresentou correlação com níveis séricos de estradiol. A informação antropométrica sugere a necessidade de aprofundamento dessa avaliação para fundamentar possíveis programas educativos, voltados ao esclarecimento sobre os riscos da obesidade no climatério

Tratamento da osteoporose / Osteoporosis treatment

A osteroporose é uma das doenças mais estudadas atualmente. Muito se tem investido em busca de drogas que atuem nao só evitando a perda óssea relacionada à menopausa e à idade, bem como que aumentem a massa ósea em pessoas com enfermidade já estabelecida. Contudo, as drogas até agora utilizadas nao sao capazes de restabelecer o tecido ósseo perdido com a doença. Os autores fazem uma breve revisao acerca das principais substâncias utilizadas para o tratamento da osteoporose.

Efeito da ooforectomia e histerectomia sobre a densidade mineral óssea / Effect of oophorectomy and hysterectomy on bone mineral density

A realizaçao de histerectomia com ou sem preservaçao ovariana tem sido relacionada a uma menor densidade óssea e a um maior risco de osteoporose. O objetivo deste estudo foi avaliar os efeitos da ooforectomia bilateral e da histerectomia com preservaçao de um ou ambos os ovários sobre a massa óssea. A densidade óssea foi medida por densitometria óssea de dois fótons em coluna lombar e fêmur proximal e a análise de variância foi utilizada para análise estatística. Os resultados demonstraram que as pacientes ooforectomizadas tinham menor densidade óssea que as demais e que tanto a ooforectomia unilateral quanto a preservaçao ovariana bilateral nao geraram uma reduçao significativa da massa óssea, quando comparadas a mulheres normais de mesma faixa etária. Os autores concluem que a ooforectomia bilateral relaciona-se a uma baixa massa óssea e que a histerectomia com preservaçao ovariana uni ou bilateral nao parece ocasionar reduçao adicional da densidade óssea.

Efeito da menopausa precoce sobre os valores da densidade mineral óssea em coluna lombar e fêmur proximal / Effect of the premature menopause on the bone mineral density values in lumbar spine and proximal femur

Com o objetivo de avaliar os efeitos da falência ovariana prematura sobre a densidade mineral óssea os autores estudaram três grupos de mulheres: Grupo I composto por 45 mulheres que se submeteram à histerectomia e ooforectomia bilateral antes dos 40 anos; Grupo II por 22 pacientes que tiveram menopausa precoce antes dos 40 anos de idade; e Grupo III por 29 mulheres que foram submetidas à histerectomia com ovários preservados antes dos 40 anos. A densidade mineral óssea foi calculada utilizando-se um aparelho de densitometria óssea Lunar DPX-L duo-energético com áreas de interesse em coluna lombar (L2-L4) e fêmur proximal (colo femoral, triângulo de Ward e trocanter). Os resultados mostraram que os grupos I e II tiveram valores de densidade óssea semelhantes entre si e menores quando comparados ao grupo III. Os autores concluíram que a menopausa precoce está associada a uma menor densidade mineral óssea e que o deficit total de massa óssea é semelhante nas pacientes que tiveram menopausa prematura cirúrgica (ooforectomia bilateral), bem como nas que sofreram menopausa precoce natural.