Daniella Fernandes Camilo

Obesidade e asma: associação ou coincidência?

OBJECTIVE: Asthma and obesity are among the major causes of morbidity in childhood and adolescence. Early obesity increases the chances of chronic degenerative diseases in adults. Although the concomitance or both clinical situations are being demonstrated in various studies, the intrinsic mechanisms of this association are still very little known. Therefore, the objective of this article was to review the main studies on the association of obesity and asthma and check if there is a cause-effect relation between them. SOURCES: Systematic review based on indexed data bases MEDLINE (PubMed) and SciELO. Original articles (cross-sectional, case-control, and prospective studies) and meta-analysis published in the period that ranges from January 1998 to January 2008 were reviewed. Studies published in English, Spanish, and Portuguese were researched. SUMMARY OF THE FINDINGS: Although there are various studies on growing prevalence of asthma and obesity, few of them establish cause-effect relations between them. Physiopathological mechanisms and factors involved in this process are still little known. CONCLUSION: Methodological rigor in future studies must seek for answers to better understand if there is association between asthma and obesity or if the relationship between both diseases is a coincidence.

Association of Sleep Deprivation With Reduction in Insulin Sensitivity as Assessed by the Hyperglycemic Clamp Technique in Adolescents

IMPORTANCE The association between short sleep duration and decreased insulin sensitivity in adolescents has been described. However, to our knowledge, no studies have investigated this association measuring insulin sensitivity by the hyperglycemic clamp technique. OBJECTIVES To compare the distributions of parameters of insulin resistance in adolescents with sleep deprivation vs adequate sleep, and to investigate the association between sleep deprivation and insulin sensitivity. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional multicenter study using data from the Brazilian Metabolic Syndrome Study conducted from June 29, 2011, to December 3, 2014, at an obesity outpatient clinic at the University of Campinas and public schools, with a convenience sample of 615 adolescents aged 10 to 19.9 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for age and sex at the fifth percentile or higher. A subsample of 81 adolescents underwent the hyperglycemic clamp technique. MAIN OUTCOMES AND MEASURES The self-reported sleep duration was used to classify the population into 2 groups: adolescents with sleep deprivation (<8 hours/night) and adolescents with adequate sleep (≥8 hours/night). Insulin sensitivity was assessed using the hyperglycemic clamp technique. RESULTS Among the 615 adolescents (56.3% female; median age, 15.9 years [interquartile range, 12.9-17.8 years]) included in the sample, the mean (SD) sleep duration was 7.9 (1.7) hours/night. The adolescents with sleep deprivation (n = 257) compared with those with adequate sleep (n = 358) had a higher median (interquartile range) age (17.0 [15.4-18.3] vs 14.1 [11.8-16.9] years), BMI (25.0 [21.2-29.3] vs 23.1 [19.5-27.6]), waist circumference (83.0 [73.5-95.4] vs 79.0 [68.5-91.0] cm), sagittal abdominal diameter (17.9 [15.8-20.8] vs 17.0 [15.0-19.8] cm), neck circumference (35.2 [33.0-38.0] vs 33.0 [30.0-35.5] cm), uric acid level (4.9 [4.0-5.8] vs 4.5 [3.7-5.5] mg/dL), and white blood cell count (7000 [5900-8200] vs 6600 [5600-7800] cells/μL) (all P < .05). Moreover, the adolescents with sleep deprivation had a lower median (interquartile range) insulin sensitivity index compared with those with adequate sleep (0.10 [0.05-0.21] vs 0.21 [0.09-0.33] mg · kgfat-free mass-1 · min-1 · mU/L × 100, respectively; difference, -0.01; 95% CI, -0.01 to -0.00; P = .02). After controlling for age and sex in the multivariate regression model, sleep deprivation remained an independent predictor for those variables. In the sleep deprivation group, BMI and central distribution of fat were higher in all categories of adiposity. CONCLUSIONS AND RELEVANCE Sleep deprivation (<8 hours of sleep per night) is associated with centripetal distribution of fat and decreased insulin sensitivity in adolescents. Therefore, investigations of sleep duration and sleep quality in adolescents should be included in clinical practice to promote, through health education, the eradication of the health risks associated with sleep restriction.

Obesity and asthma: association or coincidence?

OBJECTIVE Asthma and obesity are among the major causes of morbidity in childhood and adolescence. Early obesity increases the chances of chronic degenerative diseases in adults. Although the concomitance or both clinical situations are being demonstrated in various studies, the intrinsic mechanisms of this association are still very little known. Therefore, the objective of this article was to review the main studies on the association of obesity and asthma and check if there is a cause-effect relation between them. SOURCES Systematic review based on indexed data bases MEDLINE (PubMed) and SciELO. Original articles (cross-sectional, case-control, and prospective studies) and meta-analysis published in the period that ranges from January 1998 to January 2008 were reviewed. Studies published in English, Spanish, and Portuguese were researched. SUMMARY OF THE FINDINGS Although there are various studies on growing prevalence of asthma and obesity, few of them establish cause-effect relations between them. Physiopathological mechanisms and factors involved in this process are still little known. CONCLUSION Methodological rigor in future studies must seek for answers to better understand if there is association between asthma and obesity or if the relationship between both diseases is a coincidence.

Neck circumference as a new anthropometric indicator for prediction of insulin resistance and components of metabolic syndrome in adolescents: Brazilian Metabolic Syndrome Study

OBJECTIVE: To evaluate the correlation between neck circumference and insulin resistance and components of metabolic syndrome in adolescents with different adiposity levels and pubertal stages, as well as to determine the usefulness of neck circumference to predict insulin resistance in adolescents. METHODS: Cross-sectional study with 388 adolescents of both genders from ten to 19 years old. The adolescents underwent anthropometric and body composition assessment, including neck and waist circumferences, and biochemical evaluation. The pubertal stage was obtained by self-assessment, and the blood pressure, by auscultation. Insulin resistance was evaluated by the Homeostasis Model Assessment-Insulin Resistance. The correlation between two variables was evaluated by partial correlation coefficient adjusted for the percentage of body fat and pubertal stage. The performance of neck circumference to identify insulin resistance was tested by Receiver Operating Characteristic Curve. RESULTS: After the adjustment for percentage body fat and pubertal stage, neck circumference correlated with waist circumference, blood pressure, triglycerides and markers of insulin resistance in both genders. CONCLUSIONS: The results showed that the neck circumference is a useful tool for the detection of insulin resistance and changes in the indicators of metabolic syndrome in adolescents. The easiness of application and low cost of this measure may allow its use in Public Health services.OBJETIVO: Avaliar a correlacao da circunferencia do pescoco com resistencia a insulina e com os componentes da sindrome metabolica em adolescentes com diferentes niveis de adiposidade e estadios puberais, bem como determinar a utilidade da circunferencia do pescoco como um parâmetro na predicao de resistencia a insulina em adolescentes.METODOS:Estudo transversal no qual se avaliaram 388 adolescentes de ambos os sexos, de dez a 19 anos. Os adolescentes foram submetidos a avaliacao antropometrica e de composicao corporal, incluindo circunferencias do pescoco e da cintura, e a avaliacao bioquimica. O estadio puberal foi obtido por meio de autoavaliacao e a pressao arterial, pelo metodo auscultatorio. Analisou-se a resistencia a insulina pelo Homeostasis Model Assessment-Insulin Resistance. A correlacao entre duas variaveis foi verificada com o coeficiente de correlacao parcial ajustado para o percentual de gordura corporal e o estadio puberal. O desempenho da circunferencia do pescoco para identificar resistencia a insulina foi testado pela Receiver Operating Characteristic Curve.RESULTADOS: Apos ajuste para o percentual de gordura corporal e estadio puberal, a circunferencia do pescoco correlacionou-se com circunferencia da cintura, pressao arterial, triglicerides e marcadores de resistencia a insulina em ambos os sexos.CONCLUSOES:Os resultados demonstraram que a circunferencia do pescoco e uma ferramenta util para detectar a resistencia a insulina e a alteracao nos indicadores de sindrome metabolica em adolescentes. A facilidade de aplicacao e o baixo custo podem viabilizar sua utilizacao em servicos de Saude Publica.

Sagittal abdominal diameter resembles waist circumference as a surrogate marker of insulin resistance in adolescents-Brazilian Metabolic Syndrome Study

To evaluate the association of the sagittal abdominal diameter (SAD) with insulin resistance (IR) and metabolic syndrome (MetS) components, and to compare SAD with waist circumference (WC).

Adiposity and family history of type 2 diabetes in an admixed population of adolescents: Associations with insulin sensitivity, beta-cell function, and hepatic insulin extraction in BRAMS study

AIMS Insulin resistance and beta-cell dysfunction manifest differently across racial/ethnic groups, and there is a lack of knowledge regarding the pathophysiology of type 2 diabetes mellitus (T2DM) for ethnically admixed adolescents. This study aimed to investigate the influence of adiposity and family history (FH) of T2DM on aspects of insulin sensitivity, beta-cell function, and hepatic insulin extraction in Brazilian adolescents. METHODS A total of 82 normoglycemic adolescents were assessed. The positive FH of T2DM was defined as the presence of at least one known family member with T2DM. The hyperglycemic clamp test consisted of a 120-min protocol. Insulin secretion and beta-cell function were obtained from C-peptide deconvolution. Analysis of covariance considered pubertal stage as a covariate. RESULTS Both lean and overweight/obese adolescents had similar glycemic profiles and disposition indexes. Overweight/obese adolescents had about 1/3 the insulin sensitivity of lean adolescents (1.1 ± 0.2 vs. 3.4 ± 0.3 mg·kg·min·pmol ∗ 1000), which was compensated by an increase around 2.5 times in basal (130 ± 7 vs. 52 ± 10 pmol·l·min) and total insulin secretion (130,091 ± 12,230 vs. 59,010 ± 17,522 pmol·l·min), and in the first and second phases of insulin secretion; respectively (p < 0.001). This increase was accompanied by a mean reduction in hepatic insulin extraction of 35%, and a 2.7-time increase in beta-cell glucose sensitivity (p < 0.05). The positive FH of T2DM was not associated with derangements in insulin sensitivity, beta-cell function, and hepatic insulin extraction. CONCLUSIONS In an admixed sample of adolescents, the hyperglycemic clamp test demonstrated that adiposity had a strong influence, and FH of T2DM had no direct influence, in different aspects of glucose metabolism.

Hypertriglyceridemic waist phenotype indicates insulin resistance in adolescents: validation study front hyperglycemic clamp-Brazilian Metabolic Syndrome Study (BRAMS)

Francieli Barreiro Ribeiro, Cleliani de Cássia da Silva, Ana Carolina Junqueira Vasques, Mariana Porto Zambon, Ana Maria De Bernardi Rodrigues, Daniella Fernandes Camilo, Maria Ângela Reis de Góes Monteiro Antonio, Bruno Geloneze Neto, Francieli Barreiro Ribeiro, Cleliani de Cássia da Silva, Ana Carolina Junqueira Vasques, Mariana Porto Zambon, Ana Maria De Bernardi Rodrigues, Daniella Fernandes Camilo, Maria Ângela Reis de Góes Monteiro Antonio, Bruno Geloneze Neto

Circunferencia del cuello como un nuevo indicador antropométrico para predicción de resistencia a la insulina y componentes del síndrome metabólico en adolescentes: Brazilian Metabolic Syndrome Study - BRAMS

OBJECTIVE: To evaluate the correlation between neck circumference and insulin resistance and components of metabolic syndrome in adolescents with different adiposity levels and pubertal stages, as well as to determine the usefulness of neck circumference to predict insulin resistance in adolescents. METHODS: Cross-sectional study with 388 adolescents of both genders from ten to 19 years old. The adolescents underwent anthropometric and body composition assessment, including neck and waist circumferences, and biochemical evaluation. The pubertal stage was obtained by self-assessment, and the blood pressure, by auscultation. Insulin resistance was evaluated by the Homeostasis Model Assessment-Insulin Resistance. The correlation between two variables was evaluated by partial correlation coefficient adjusted for the percentage of body fat and pubertal stage. The performance of neck circumference to identify insulin resistance was tested by Receiver Operating Characteristic Curve. RESULTS: After the adjustment for percentage body fat and pubertal stage, neck circumference correlated with waist circumference, blood pressure, triglycerides and markers of insulin resistance in both genders. CONCLUSIONS: The results showed that the neck circumference is a useful tool for the detection of insulin resistance and changes in the indicators of metabolic syndrome in adolescents. The easiness of application and low cost of this measure may allow its use in Public Health services.OBJETIVO: Avaliar a correlacao da circunferencia do pescoco com resistencia a insulina e com os componentes da sindrome metabolica em adolescentes com diferentes niveis de adiposidade e estadios puberais, bem como determinar a utilidade da circunferencia do pescoco como um parâmetro na predicao de resistencia a insulina em adolescentes.METODOS:Estudo transversal no qual se avaliaram 388 adolescentes de ambos os sexos, de dez a 19 anos. Os adolescentes foram submetidos a avaliacao antropometrica e de composicao corporal, incluindo circunferencias do pescoco e da cintura, e a avaliacao bioquimica. O estadio puberal foi obtido por meio de autoavaliacao e a pressao arterial, pelo metodo auscultatorio. Analisou-se a resistencia a insulina pelo Homeostasis Model Assessment-Insulin Resistance. A correlacao entre duas variaveis foi verificada com o coeficiente de correlacao parcial ajustado para o percentual de gordura corporal e o estadio puberal. O desempenho da circunferencia do pescoco para identificar resistencia a insulina foi testado pela Receiver Operating Characteristic Curve.RESULTADOS: Apos ajuste para o percentual de gordura corporal e estadio puberal, a circunferencia do pescoco correlacionou-se com circunferencia da cintura, pressao arterial, triglicerides e marcadores de resistencia a insulina em ambos os sexos.CONCLUSOES:Os resultados demonstraram que a circunferencia do pescoco e uma ferramenta util para detectar a resistencia a insulina e a alteracao nos indicadores de sindrome metabolica em adolescentes. A facilidade de aplicacao e o baixo custo podem viabilizar sua utilizacao em servicos de Saude Publica.

Circunferência do pescoço como um novo indicador antropométrico para predição de resistência à insulina e componentes da síndrome metabólica em adolescentes: Brazilian Metabolic Syndrome Study

OBJECTIVE: To evaluate the correlation between neck circumference and insulin resistance and components of metabolic syndrome in adolescents with different adiposity levels and pubertal stages, as well as to determine the usefulness of neck circumference to predict insulin resistance in adolescents. METHODS: Cross-sectional study with 388 adolescents of both genders from ten to 19 years old. The adolescents underwent anthropometric and body composition assessment, including neck and waist circumferences, and biochemical evaluation. The pubertal stage was obtained by self-assessment, and the blood pressure, by auscultation. Insulin resistance was evaluated by the Homeostasis Model Assessment-Insulin Resistance. The correlation between two variables was evaluated by partial correlation coefficient adjusted for the percentage of body fat and pubertal stage. The performance of neck circumference to identify insulin resistance was tested by Receiver Operating Characteristic Curve. RESULTS: After the adjustment for percentage body fat and pubertal stage, neck circumference correlated with waist circumference, blood pressure, triglycerides and markers of insulin resistance in both genders. CONCLUSIONS: The results showed that the neck circumference is a useful tool for the detection of insulin resistance and changes in the indicators of metabolic syndrome in adolescents. The easiness of application and low cost of this measure may allow its use in Public Health services.OBJETIVO: Avaliar a correlacao da circunferencia do pescoco com resistencia a insulina e com os componentes da sindrome metabolica em adolescentes com diferentes niveis de adiposidade e estadios puberais, bem como determinar a utilidade da circunferencia do pescoco como um parâmetro na predicao de resistencia a insulina em adolescentes.METODOS:Estudo transversal no qual se avaliaram 388 adolescentes de ambos os sexos, de dez a 19 anos. Os adolescentes foram submetidos a avaliacao antropometrica e de composicao corporal, incluindo circunferencias do pescoco e da cintura, e a avaliacao bioquimica. O estadio puberal foi obtido por meio de autoavaliacao e a pressao arterial, pelo metodo auscultatorio. Analisou-se a resistencia a insulina pelo Homeostasis Model Assessment-Insulin Resistance. A correlacao entre duas variaveis foi verificada com o coeficiente de correlacao parcial ajustado para o percentual de gordura corporal e o estadio puberal. O desempenho da circunferencia do pescoco para identificar resistencia a insulina foi testado pela Receiver Operating Characteristic Curve.RESULTADOS: Apos ajuste para o percentual de gordura corporal e estadio puberal, a circunferencia do pescoco correlacionou-se com circunferencia da cintura, pressao arterial, triglicerides e marcadores de resistencia a insulina em ambos os sexos.CONCLUSOES:Os resultados demonstraram que a circunferencia do pescoco e uma ferramenta util para detectar a resistencia a insulina e a alteracao nos indicadores de sindrome metabolica em adolescentes. A facilidade de aplicacao e o baixo custo podem viabilizar sua utilizacao em servicos de Saude Publica.