Fabíola Isabel Suano-Souza

Body mass index, adipokines and insulin resistance in asthmatic children and adolescents

Abstract Objective: This study aimed to describe the body mass index, insulin resistance, levels of adipokines and inflammatory markers in Brazilian asthmatic children and adolescents and to investigate their possible association with the severity and control of asthma. Methods: Cross-sectional study (n = 92; age: 3–18 years). Assessed data: Body weight and height, used to calculate the body mass index (BMIZ) and height-for-age (HAZ). Laboratory measurements: Lipid profile; glycemia and insulin for homeostasis model assessment (HOMA); adipokines; tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1); total immunoglobulin E (IgE) and specific IgE against aeroallergens. Results: The median age was 9.6 years (3.0–16.6); most participants were male (n = 52, 56.5%), pre-pubertal (n = 54, 58.6%) and had atopic asthma (n = 85, 92.4%). Overweight/obesity (38%) showed an inverse correlation with age (adjusted odds ratio [OR] = 0.781; 95% confidence interval [CI] 0.66–0.92) and a direct correlation with the leptin concentration (adjusted OR = 1.13; 95% CI 1.04–1.22). Insulin concentration was independently associated with moderated persistent asthma (adjusted OR = 1.31; 95% CI 1.09–1.52). HOMA showed a direct correlation with the leptin (β = 0.475; 95% CI 0.117–0.268) and total IgE (β = 0.197; 95% CI 0.002–0.096) levels and an inverse correlation with the TNF-α levels (β = −0.255; 95% CI;−0.366–0.055). Conclusions: Asthma was associated with insulin resistance and a systemic inflammatory response possibly mediated by adipokines, with leptin levels standing out among the participants with excess weight.

Risk of Atherosclerosis in Patients with Ataxia Telangiectasia

Background and Aims: Evaluate the nutritional status, plasma concentration of vitamin E and markers of cardiovascular risk in ataxia telangiectasia (AT) patients. Methods: Cross-sectional study with 13 patients with AT and 22 healthy controls, evaluating the following factors: nutritional status, food intake, lipid profile, plasma concentration of vitamin E, malondialdehyde and high sensitivity C-reactive protein, linking them with atherosclerosis risk in AT patients. Results: Average age was 14.6 in the AT group, 30.8% were malnourished and 23.1% had stunting. A greater impairment of lean body mass was found in these patients. Concentrations of triglycerides (TG), total cholesterol (CT), LDL-c, non-HDL cholesterol (NHDL-c) were significantly higher in patients and HDL-c, lower. Vitamin E/total lipids and vitamin E/TG ratios were lower in the AT group, and significant inverse correlation between these ratios and NHDL-c, CT/HDL-c, and LDL-c/HDL-c, log TG/HDL-c was observed in the AT group. Alanine aminotransferase correlated directly and significantly with NHDL-c, CT/HDL-c and LDL-c/HDL-c, in patients. Conclusion: The alterations of lipid metabolism biomarkers suggestive of atherosclerotic risk of male AT patients coupled with lower vitamin E/total lipids ratio and low lean body mass may complicate the clinical course of the disease and emphasizes the importance of multidisciplinary care, routine monitoring of cardiovascular biomarkers and appropriate nutritional guidance.

The effect of nutritional intervention on the lipid profile and dietary intake of adolescents with juvenile systemic lupus erythematosus: a randomized, controlled trial:

Objective This study sought to evaluate the effects of a nutritional intervention on the lipid metabolism biomarkers associated with cardiovascular risk, and their variation over time, in juvenile systemic lupus erythematosus (JSLE) patients. This study also investigated the relationships between these biomarkers and dietary intake, nutritional status, disease variables, and medication used. Methods A total of 31 10- to 19-year-old female adolescents with JSLE for at least six months were analyzed. The participants were randomly allocated to two groups: nutritional intervention or control. The intervention group received verbal and printed nutritional instructions once per month over nine months. Before and after the intervention, the participants underwent assessments of anthropometry; dietary intake; physical activity; socioeconomic status; total cholesterol and fractions; triglycerides; apolipoprotein A (Apo A-I); apolipoprotein B (Apo B); paraoxonase (PON) activity (a) and amount (q); myeloperoxidase (MPO); and small, dense LDL-c (sdLDL) particles. Results After nine months, we found significant reductions in the calorie, carbohydrate, total fat, saturated fat, and trans fat intakes in the intervention compared with the control group over time. The PONa/HDL-c ratio increased by 3.18 U/ml/mg/dl in the intervention group and by 0.63 U/ml/mg/dl in the control group (p = 0.037). Unlike the intervention group, the sdLDL levels of the control group worsened over time (p = 0.018). Conclusion The present study detected a reduction in calorie and fat intake, which indicates an improvement of HDL-c function and possible protection against cardiovascular risk for the intervention group.

Body Mass Index and Cardiovascular Risk Factors in Children and Adolescents with High Birth Weight

Background/Aims: This study aimed to identify a possible association among high birth weight with overweight/obesity, high arterial blood pressure, dyslipidemia, and insulin resistance in children and adolescents. Methods: This is a cross-sectional study with 719 children and adolescents (6–12 years) stratified according to birth weight (low birth weight [LBW] <2,500 g, adequate birth weight [ABW] 2,500–3,999 g, and high birth weight [HBW] ≥4,000 g). Data collected were anthropometric data, arterial blood pressure levels, lipid profile, and insulin resistance (fasting glucose and insulin, used to calculate homeostatic model assessment-IR). Results: The mean age of schoolchildren was 9.5 ± 2.0 years and 371 (51.6%) were male. LBW and HBW were observed in 79 of 719 (10.9%) and 40 of 719 (55.6%) children/adolescents, respectively. There was no increased risk of overweight (OR 0.9; 95% CI 0.4–2.1; p = 0.964) and obesity (OR 1.4; 95% CI 0.6–3.5; p = 0.588) in HBW group compared to LBW and ABW groups. HBW was not associated with high blood pressure, dyslipidemia, and insulin resistance. The LBW group was independently associated with higher values of systolic (OR 1.07; 95% CI 1.05–1.10; p < 0.01) and diastolic blood pressure (OR 1.04; 95% CI 1.00–1.07; p = 0.044). Conclusion: There was no association between HBW with overweight/obesity and classic cardiovascular risk factors in this group of children/adolescents. Only LBW was related to higher blood pressure levels.

Growth velocity and weight gain in prepubertal asthmatic children

Objective: To evaluate the stature growth rate (GR) and the weight gain of prepubertal asthmatic children. Method: A retrospective cohort study evaluating medical records of 85 children diagnosed with asthma, aged less than 9 years, of both sexes, with at least one year of follow-up in the allergy outpatient clinic. The data on the disease, weights and heights were collected through a standardized questionnaire on two occasions, with an interval of one year. The curves proposed by Tanner were applied for the analysis of the GR, and the Z-score of the GR (ZGR) was calculated. Results: Excess weight (risk for overweight, overweight and obesity) was observed in 31.8% (27/85) of the patients, but there was no association with the severity of asthma. Low GR (ZGR < -2) was found in 13.9% (11/79) of patients, most frequently among children with moderate/severe persistent asthma compared to persistent mild and intermittent forms (7/11 - 63.6% vs. 21/68 - 30.2%, respectively, p=0.047). Use of steroids (dose, type and time of use) was not associated with GR. Conclusion: GR was most affected in children with moderate/severe asthma.

Vitamin D Postpartum Concentrations: Relationship with Nutritional Condition and Morbidities during Pregnancy

Objective To evaluate postpartum vitamin D deficiency/insufficiency and to relate it to pregestational BMI, gestational weight gain, and sociodemographic variables. Methods This is a cross-sectional study with 225 full-term pregnant women. Data collected are as follows: maternal health, socioeconomic status, pregestational body mass index (BMI), and gestational weight gain. Laboratory evaluation included vitamin D [25(OH)D], calcium, phosphorus, magnesium, and alkaline phosphatase. Results The mean age of women was 25.6±6.6 years. Dark skin color, low education, and work in the urban region were predominant. Regular sun exposure, photoprotection, and vitamin D supplementation were reported by 144 (64.0%), 44 (19.6%), and 5 (2.2%) women, respectively. The mean plasma concentrations of 25(OH)D were 26.0±6.8 ng/mL. Levels compatible with deficiency (<20 ng/mL) and insufficiency (20-30 ng/mL) were observed in 43 (19.1%) and 124 (55.1%) women, respectively. The increase of 1 ng/mL in 25(OH)D concentrations was associated with an increase of 0.16 mg/dL (95%CI 0.19 to 2.02; p=0.018) for calcium. There were no associations with 25(OH)D concentrations with pregestational BMI and with gestational weight gain. Conclusions The high frequency of postpartum vitamin D deficiency/insufficiency in women with a full-term pregnancy in a region with a large and permanent sun exposure reminds us of the need for intervention policies aimed at preventing vitamin D deficiency during pregnancy.

Is There Association between Vitamin D Concentrations and Body Mass Index Variation in Women Submitted to Y-Roux Surgery?

Objective To evaluate vitamin D deficiency and body composition of women submitted to bariatric surgery and relate their body mass index variation after surgery to 25(OH)D concentrations. Method A cross-sectional and controlled study was performed including 49 obese adult volunteer women, submitted to Roux-en-Y gastric bypass (RYGB group). Collected Data Body mass index (BMI), self-declared ethnicity, economic condition, physical activity level, serum concentrations of 25-hydroxycholecalciferol (25(OH)D; radioimmunoassay), parathormone, and body composition by dual-energy X-ray absorptiometry (Hologic DXA-QDR-1000) were collected. Results 25(OH)D deficiency was found in 27 (55.1%) and 8 (21.1%) in the RYGB and control groups (p=0.002). Secondary hyperparathyroidism was more frequent in the RYGB group compared to the control group (15 (30.6%) versus 1 (2.6%); p=0.001). There was no relation of the studied variables and body composition with 25(OH)D deficiency. 25(OH)D concentrations were correlated (r=−0.531; p < 0.001) with BMI reduction, regardless of vitamin D supplementation. Conclusion Women submitted to bariatric surgery (RYGB) around three years ago had higher BMI and vitamin D deficiency, along with hyperparathyroidism, compared to the control group. There was no association between variables related to body composition and 25(OH)D concentrations. On the other hand, vitamin concentrations correlated negatively to BMI variation after undergoing surgery.