Carlos Alberto Mourão-Júnior

Body mass index, waist circumference, body adiposity index, and risk for type 2 diabetes in two populations in Brazil: general and Amerindian.

Objective The use of the anthropometric indices of adiposity, especially body mass index and waist circumference in the prediction of diabetes mellitus has been widely explored. Recently, a new body composition index, the body adiposity index was proposed. The aim of this study was to compare the effectiveness of body mass index, waist circumference, and body adiposity index in the risk assessment for type 2 diabetes mellitus. Design and methods A total of 1,572 individuals from the general population of Vitoria City, Brazil and 620 Amerindians from the Aracruz Indian Reserve, Brazil were randomly selected. BMI, waist circumference, and BAI were determined according to a standard protocol. Type 2 diabetes mellitus was diagnosed by the presence of fasting glucose ≥126 mg/dL or by the use of antidiabetic drugs. Results The area under the curve was similar for all anthropometric indices tested in the Amerindian population, but with very different sensitivities or specificities. In women from the general population, the area under the curve of waist circumference was significantly higher than that of the body adiposity index. Regarding risk assessment for type 2 diabetes mellitus, the body adiposity index was a better risk predictor than body mass index and waist circumference in the Amerindian population and was the index with highest odds ratio for type 2 diabetes mellitus in men from the general population, while in women from the general population waist circumference was the best risk predictor. Conclusion Body adiposity index was the best risk predictor for type 2 diabetes mellitus in the Amerindian population and men from the general population. Our data suggest that the body adiposity index is a useful tool for the risk assessment of type 2 diabetes mellitus in admixture populations.

The role of uric acid in the insulin resistance in children and adolescents with obesity

Objective: To investigate the association between serum uric acid levels and insulin resistance in children and adolescents with obesity. Methods: Cross-sectional study with 245 children and adolescents (134 obese and 111 controls), aged 8-18 years. The anthropometric variables (weight, height and waist circumference), blood pressure and biochemical parameters were collected. The clinical characteristics of the groups were analyzed by t-test or chi-square test. To evaluate the association between uric acid levels and insulin resistance the Pearsons test and logistic regression were applied. Results: The prevalence of insulin resistance was 26.9%. The anthropometric variables, systolic and diastolic blood pressure and biochemical variables were significantly higher in the obese group (p<0.001), except for the high-density-lipoprotein cholesterol. There was a positive and significant correlation between anthropometric variables and uric acid with HOMA-IR in the obese and in the control groups, which was higher in the obese group and in the total sample. The logistic regression model that included age, gender and obesity, showed an odds ratio of uric acid as a variable associated with insulin resistance of 1.91 (95%CI 1.40-2.62; p<−0.001). Conclusions: The increase in serum uric acid showed a positive statistical correlation with insulin resistance and it is associated with and increased risk of insulin resistance in obese children and adolescents.

Non-HDL cholesterol is a good predictor of the risk of increased arterial stiffness in postmenopausal women in an urban Brazilian population

OBJECTIVES: Increased arterial stiffness is an important determinant of the risk of cardiovascular disease. Lipid profile impairment, especially hypercholesterolemia, is associated with stiffer blood vessels. Thus, the aim of this study was to determine which of the five circulating lipid components (high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL), total cholesterol (TC) and triglycerides) is the best predictor of increased arterial stiffness in an urban Brazilian population. METHODS: A random sample of 1,662 individuals from the general population of Vitoria, Brazil (25-64 years), was selected, and lipid components were measured using standard methods. Pulse wave velocity was measured using a non-invasive automatic device, and increased arterial stiffness was defined as a pulse wave velocity ≥10 m/s. RESULTS: In men, only total cholesterol (OR=1.59; CI=1.02 to 2.48, p=0.04) was associated with the risk of increased arterial stiffness. In women, HDL-C (OR=1.99; CI=1.18 to 3.35, p=0.01) and non-HDL-C (OR=1.61; CI=1.01 to 2.56, p=0.04) were good predictors of the risk of increased arterial stiffness. However, these associations were only found in postmenopausal women (OR=2.06; CI=1.00 to 4.26, p=0.05 for HDL-C and OR=1.83; CI=1.01 to 3.33, p=0.04 for non-HDL-C). CONCLUSION: Our findings indicate that both HDL-C and non-HDL-C are good predictors of the risk of increased arterial stiffness in postmenopausal women in an urban Brazilian population and may be useful tools for assessing the risk of arterial stiffness.

Estimating DSM accuracy for Attention Deficit Hyperactivity Disorder Based on Neurophysiological, Psychological, and Behavioral Correlates

Objective: To find objective evidence of accuracy of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), by comparing classifications of subjects based on behavioral (Attentional Network Test - ANT), psychological (Wechsler Intelligence Scale for Children - WISC-III), and neurophysiological (ANT-related potentials) data. Methods: Twenty typically developing (TD) boys and 19 boys diagnosed with ADHD according to DSM-IV-TR, aged 10-13 years, were examined using the ANT with simultaneous recording of the respective event-related potentials (ERPs). They also performed the Block Design, Digit Spam, Vocabulary and Arithmetic subtests of the WISC-III. A total of 815 variables of interest (VOI) obtained from the ANT, WISC-III scores, and ERP parameters were grouped by hierarchical clustering and integrated in 2 to 6 resultant vectors (RVs), from clusters at hierarchical levels 1 to 5. These RVs were used for the reclassification of subjects using the k-means method. Results: Regarding DSM-IV-TR diagnostics, the RVs from behavioral and psychological data and ERPs from the mid-frontal, mid-parietal plus right frontal, right central, and right temporal channels showed accuracy rates from 0.64 to 0.82 using the k-means reclassification. Among reclassifications with higher agreement (0.82), six subjects were reclassified (4 from the TD group, and 2 from the ADHD group). Assuming the reclassification of these six subjects, the estimated agreement between DSM and biological data was 84.61% with kappa index of 0.69. Conclusion: Results suggest biological validity and efficiency of DSM as a tool for ADHD diagnostics.Background. Psychiatric nosology lacks objective biological foundation, as well as typical biomarkers for diagnoses, which raises questions about its validity. The problem is particularly evident concerning Attention Deficit/Hyperactivity Disorder (ADHD). The objective of this study is to estimate whether the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) is biologically valid for ADHD diagnosis using a multivariate analysis for small samples from a large dataset concerning neurophysiological, behavioral, and psychological variables. Methods: Twenty typically developing boys and 19 boys diagnosed with ADHD, aged 10-13 years, were examined using the Attentional Network Test (ANT) with records of event-related potentials (ERPs). From 815 variables, a reduced number of latent variables (LVs) were extracted with a clustering method, for further reclassification of subjects using the k-means method. This approach allowed multivariate analysis to be applied to a significantly larger number of variables than the number of cases (E. Wigneau et al., 2003, 2015) Results: From datasets including ERPs from the mid-frontal, mid-parietal, right frontal, and central channels, only seven subjects were miss-reclassified by the LVs. An estimated specificity of 75.00% and sensitivity of 89.47% for DSM were found in the reclassification. The kappa index between DSM and behavioral/psychological/neurophysiological data was 0.75, which is regarded as a “substantial level of agreement”. Discussion: Results showed that CLV is a useful method for diagnostic classification using a large dataset of small samples, suggesting the biological validity of DSM for ADHD diagnosis, in accordance to alterations in fronto-striatal networks previously related to ADHD.

Original articleThe role of uric acid in the insulin resistance in children and adolescents with obesityO papel do ácido úrico na resistência insulínica em crianças e adolescentes com obesidade

Objective To investigate the association between serum uric acid levels and insulin resistance in children and adolescents with obesity.