Bárbara Limberger Nedel

Major components of metabolic syndrome and adiponectin levels: a cross-sectional study

BackgroundAdiponectin is a major regulator of glucose and lipid homeostasis by its insulin sensitizer properties. Since decreased insulin sensitivity is linked to metabolic syndrome (MS), decreased adiponectin levels may be related to its development. The purpose of the study was to investigate the relationship between adiponectin levels and MS.MethodsFirstly, we cross-sectionally examined subjects with or without MS submitted to an oral glucose tolerance test at Hospital de Clínicas de Porto Alegre (n = 172). A replication analysis was performed in subjects (n = 422) undergoing cardiac angiography at Hospital São Paulo. Subchronic inflammation (US-CRP), coagulation marker (fibrinogen), insulin sensitivity and resistance (Matsuda ISI and HOMA-IR) were estimated. Plasma total and high molecular weight (HMW) adiponectin were measured.ResultsTotal and HMW adiponectin levels were lower in MS subjects (P < 0.05). Total adiponectin levels were lower in the presence of high waist circumference, low HDL-cholesterol and elevated triglyceride criteria in both samples and by elevated blood pressure and glucose criteria in Porto Alegre. HMW adiponectin levels were lower in the presence of low HDL-cholesterol, elevated triglycerides, and glucose criteria. Total adiponectin levels were positively related with HDL-cholesterol and ISI Matsuda, negatively related with waist circumference, glucose, triglycerides, HOMA-IR, and US-CRP and not related with blood pressure. While adjusting for sex and age, increased adiponectin levels remained associated with a reduced prevalence ratio for MS in both cohorts (P = 0.001).ConclusionsAdiponectin levels decreased with increasing number of MS criteria, and it is in part determined by its relationship with HDL, triglycerides and abdominal adiposity.

24-hour blood pressure homeostasis and renal function in subjects with and without metabolic syndrome

Materials and methods We designed a cross-sectional study of consecutive individuals (n=108; females 74%; 52.8±12.7 yrs.; mean±SD) from the Diabetes Clinic of a university hospital. MS was defined by the International Diabetes Federation criteria. BP was measured at office and its circadian variation was determined by 24-h ambulatory BP monitoring, after withdrawal from anti-hypertensive medications. Patients were classified according to their BP behavior: normotension (NT; n=29), white-coat hypertension (WCH; n=19) and ambulatory hypertension (AHT; n=57). Fasting and 2h-plasma glucose levels, lipid profile, creatinine and 24-h urinary albumin excretion (UAER) were measured. Glomerular filtration rate (GFR) was estimated by the CKD-EPI equation. A two-sided P value <0.05 was considered significant. Results Estimated GFR (EGFR) was lower in subjects with MS than in those without MS (Mean±SD; 90±20 vs 98.8±16.5; P=0.047). EGFR was related to age (r=-0.666; P<0.001), fasting glucose (r=0.223; P=0.021), and 24-h systolic BP (r=-0.196; P=0.044), but not to diastolic BP. EGFR was inversely related to sleep-time BP (r=-0.224; P=0.021), morning systolic BP (r=-0.224; P=0.030) and pulse pressure (r=-0.233; P=0.170). Subjects with WCH and AHT compared to those with NT had lower EGFR (Mean±SD; 89.3±18 vs 89.6±26.3 vs 100.2±14.8; P=0.036) and higher UAER (Median [P25-75]; 1 [0-5.3] vs 6.1 [1-19] vs 6.3 [1-16.8]; P=0.031).

Accuracy of insulin resistance indices for metabolic syndrome in a population with different degrees of glucose tolerance

Background Insulin resistance has been associated with the development of metabolic syndrome (MS), which is an interrelated cluster of risk factors for cardiovascular disease and type 2 diabetes (T2D). Several equations derived from the oral glucose tolerance test (OGTT) have been developed as surrogates for the euglycemic hyperinsulinemic clamp technique to estimate insulin resistance and insulin sensitivity.

Waist-to-height ratio as a predictor of metabolic syndrome in a population with different degrees of glucose tolerance

Waist-to-height ratio as a predictor of metabolic syndrome in a population with different degrees of glucose tolerance Tassia Cividanes Pazinato, Barbara Limberger Nedel, Anize Delfino von Frankenberg, Vanessa Piccoli, Luciana Pavan Antoniolli, Mayara Abichequer Beer, Leticia Maria Tedesco Silva, Rodrigo Soares de Souza Marques, Leonardo de Andrade Mesquita, Monique de Moura Machado, Andre Fernandes Reis, Fernando Gerchman

Association of pulse pressure with fasting and 2-h plasma glucose in subjects with different degrees of glucose tolerance

Materials and methods In a cross-sectional study, 128 subjects (53.1±12.3 y, females 72%) were submitted to a 75-g OGTT (measurement of glucose and insulin) and divided according to glucose tolerance status (normal glucose tolerance [NGT; n=38], prediabetes [PDM; n=53] and diabetes [DM; n=37]). 24-h ABPM was performed. Mean 24h PP was calculated as the difference between mean systolic and diastolic blood pressure (BP), obtained through 24-h ABPM. Fasting C-peptide and A1c were collected. Body size (BMI) and central obesity (waist circumference) were assessed. Insulin sensitivity index (ISI Stumvoll), insulin resistance (HOMA-IR) and b-cell function (insulinogenic index; ΔIns30′-0′/ΔGli30′-0′) were estimated. A two-sided P value < 0.05 was considered significant. Results By ABPM, 24-hour PP progressively increased from NGT to DM (mean±SD; NGT 45.9±8.5 vs PDM 51.9±10.4 vs DM 57.8±11.1 mmHg; P<0.001). 24-hour PP was positively related to age (r=0.316; P<0.001), waist circumference (r=0.263; P=0.003), BMI (r=0.35; P<0.001), A1C (r=0.438; P<0.001), 2-h glucose level (r=0.424; P<0.001), C-peptide (r=0.286; P=0.001), HOMA-IR (r=0.155; P=0.085) and it was inversely related to ISI Stumvoll (r=-0.474; P <0.001) and to insulinogenic index (r=-0.184; P=0.048). While adjusting for age and waist circumference, pulse pressure was independently associated with 2 hour plasma glucose (R=0.287; P=0.002) and A1c (R=0.241; P=0.010).