Josivan Gomes de Lima

Influence of magnesium status and magnesium intake on the blood glucose control in patients with type 2 diabetes

BACKGROUND & AIMS This study was undertaken to assess magnesium intake and magnesium status in patients with type 2 diabetes, and to identify the parameters that best predict alterations in fasting glucose and plasma magnesium. METHODS A cross-sectional study was carried out in patients with type 2 diabetes (n = 51; 53.6 ± 10.5 y) selected within the inclusion factors, at the University Hospital Onofre Lopes. Magnesium intake was assessed by three 24-h recalls. Urine, plasma and erythrocytes magnesium, fasting and 2-h postprandial glucose, HbA1, microalbuminuria, proteinuria, and serum and urine creatinine were measured. RESULTS Mean magnesium intake (9.37 ± 1.76 mmol/d), urine magnesium (2.80 ± 1.51 mmol/d), plasma magnesium (0.71 ± 0.08 mmol/L) and erythrocyte magnesium (1.92 ± 0.23 mmol/L) levels were low. Seventy-seven percent of participants presented one or more magnesium status parameters below the cut-off points of 3.00 mmol/L for urine, 0.75 mmol/L for plasma and 1.65 mmol/L for erythrocytes. Subjects presented poor blood glucose control with fasting glucose of 8.1 ± 3.7 mmol/L, 2-h postprandial glucose of 11.1 ± 5.1 mmol/L, and HbA1 of 11.4 ± 3.0%. The parameters that influenced fasting glucose were urine, plasma and dietary magnesium, while plasma magnesium was influenced by creatinine clearance. CONCLUSIONS Magnesium status was influenced by kidney depuration and was altered in patients with type 2 diabetes, and magnesium showed to play an important role in blood glucose control.

Beneficial effects of oral chromium picolinate supplementation on glycemic control in patients with type 2 diabetes: A randomized clinical study.

BACKGROUND Chromium is an essential mineral that contributes to normal glucose function and lipid metabolism. This study evaluated the effect of chromium picolinate (CrPic) supplementation in patients with type 2 diabetes mellitus (T2DM). METHODS A four month controlled, single blind, randomized trial was performed with 71 patients with poorly controlled (hemoglobin A1c [HbA1c]>7%) T2DM divided into 2 groups: Control (n=39, using placebo), and supplemented (n=32, using 600μg/day CrPic). All patients received nutritional guidance according to the American Diabetes Association (ADA), and kept using prescribed medications. Fasting and postprandial glucose, HbA1c, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides and serum ferritin were evaluated. RESULTS CrPic supplementation significantly reduced the fasting glucose concentration (-31.0mg/dL supplemented group; -14.0mg/dL control group; p<0.05, post- vs. pre-treatment, in each group) and postprandial glucose concentration (-37.0mg/dL in the supplemented group; -11.5 mg/dL in the control group; p<0.05). HbA1c values were also significantly reduced in both groups (p<0.001, comparing post- vs. pre-treatment groups). Post-treatment HbA1c values in supplemented patients were significantly lower than those of control patients. HbA1c lowering in the supplemented group (-1.90), and in the control group (-1.00), was also significant, comparing pre- and post-treatment values, for each group (p<0.001 and p<0.05, respectively). CrPic increased serum chromium concentrations (p<0.001), when comparing the supplemented group before and after supplementation. No significant difference in lipid profile was observed in the supplemented group; however, total cholesterol, HDL-c and LDL-c were significantly lowered, comparing pre- and post-treatment period, in the control group (p<0.05). CONCLUSIONS CrPic supplementation had a beneficial effect on glycemic control in patients with poorly controlled T2DM, without affecting the lipid profile. Additional studies are necessary to investigate the effect of long-term CrPic supplementation.

Body Adiposity Index Indicates Only Total Adiposity, Not Risk

95.1 ± 16.1 94 ± 13.6 99.7 ± 13.3 106.5 ± 13.9 <0.0001 0.2786* 0.2919* 0.3737* 0.3613* Waist-hip ratio 0.865 ± 0.09 0.876 ± 0.08 0.909 ± 0.08 0.948 ± 0.08 <0.0001 0.2669* 0.3525* 0.3133* 0.2643* Waist-to-height ratio 0.587 ± 0.1 0.580 ± 0.08 0.617 ± 0.08 0.665 ± 0.09 <0.0001 0.2938* 0.3229* 0.3732* 0.3575* BMI (kg/m 2 ) 29.72 ± 6.7 29.68 ± 6.5 31.21 ± 6.7 33.85 ± 7.1 <0.0001 0.2471* 0.2451* 0.341* 0.348* BAI (%Fat) 35.21 ± 6.0 34.17 ± 5.8 35.62 ± 6.9 37.64 ± 8.1 0.26 0.1609* 0.1388* 0.2028* 0.2245* Fasting glycemia (mg/dl) 85.0 ± 7.6 105.1 ± 6.2 88.6 ± 7.4 116.9 ± 25.7 <0.0001 — — — —

Predicting malignant involvement in a thyroid nodule: role of ultrasonography.

OBJECTIVE To assess how ultrasonography can contribute during the evaluation of a thyroid nodule and whether this technique can have a role in predicting malignant involvement. METHODS In this retrospective study, data were analyzed on 220 consecutive patients (with 348 thyroid nodules) who underwent thyroidectomy and had previously undergone assessment by high-resolution thyroid ultrasonography. Nodule size, echogenicity, regularity of margins, halo sign, presence or absence of calcifications, and invasion of surrounding tissues were evaluated. The nodules were classified as low, medium, or high risk for malignant involvement on the basis of nodule characteristics found on ultrasonography. All nodules were submitted to cytologic examination by fine-needle aspiration (FNA) before thyroidectomy. Ultrasound, FNA, and pathologic postoperative results were compared. RESULTS Among the 348 thyroid nodules, 56 were ultrasonographically classified as low risk, 268 as medium risk, and 24 as high risk for malignant potential. Fifty of 56 (89.3%) low-risk nodules and 213 of 268 (79.5%) medium-risk nodules were diagnosed as benign at pathologic postoperative examination. In contrast, however, only 6 of 24 (25%) high-risk nodules were diagnosed as benign. Among the 18 high-risk nodules of 1-cm diameter or larger, FNA showed a 20% false-negative result. CONCLUSION High-risk classification of a thyroid nodule on ultrasonography had a positive predictive value for malignant involvement of 75%. Nodule characteristics analyzed by ultrasonography should be considered at the time of surgical intervention.

Dislipidemia pós-prandial como achado precoce em indivíduos com baixo risco cardiovascular

OBJECTIVE: to show a correlation between postprandial hypertriglyceridemia and cardiovascular risk factors to atherogenesis. RESEARCH DESIGN AND METHODS: 47 (30 women and 17 men, 40.5 ± 14.9years, body mass index: 26.1 ± 5.4kg/m2) non diabetic volunteers with normal (<200mg/dl) triglycerides were studied. Triglycerides, HDL-cholesterol and total cholesterol were measured before (basal), 3 and 5 hours after a 70g-lipid standardized test meal. RESULTS: patients with 3 hours postprandial hypertriglycerides higher than the 2nd Quartile (164.8mg/dl), in spite of normal fasting triglycerides, have higher BMI (28.1 ± 5.6 vs. 24.2 ± 4.5kg/m2; p= 0.008), abdominal circumference (95.7 vs. 84.1cm; p= 0.001), waist/hip ratio (0.92 vs. 0.86; p= 0.008) and diastolic pressure (83.1 vs. 77.2mmHg; p= 0.02) and lower HDL (39.1 vs. 48.3mg/dl; p= 0.008). CONCLUSIONS: Postprandial hypertriglyceridemia related well with others risk factors, even in patients with normal fasting triglycerides.

Is nonalcoholic fatty liver disease an endogenous alcoholic fatty liver disease? – A mechanistic hypothesis

Nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD) are so similar that only a detailed history of alcohol intake can distinguish one from the other. Because subjects with NAFLD produce significantly more endogenous ethanol (EE) than controls, some researchers suspected that these similarities are not merely coincidental. For this reason, it was attempted to show that NAFLD is actually an endogenous alcoholic fatty liver disease (EAFLD). However, negligible blood-alcohol concentration (BAC) and the inability of gut microbiota to produce hepatotoxic concentrations of EE rejected this hypothesis. To clarify these conflicting results, we provide a mechanistic framework explaining how NAFLD may be an EAFLD. First of all, the key finding is that ethanol is a prodrug, enabling the idea that AFLD may develop with negligible/absent BAC. Second, extrahepatic acetaldehyde (ACD) alone recapitulates AFLD and is about 330-fold more hepatotoxic than that generated inside the liver. Third, gut microbiota can even produce much larger amounts of EE than those currently considered cirrhotogenic for man. Fourth, an extensive gut-liver axis first-pass metabolism of ethanol prevents the development of significant BAC in NAFLD. Fifth, all genes involved in EE metabolism are upregulated in the livers of patients with nonalcoholic steatohepatitis (NASH). Last, overexpression of the gene encoding alcohol dehydrogenase (ADH) 4 implicates liver exposure to high concentrations of EE. In conclusion, this work provides mechanistic explanation supporting the assumption that NAFLD may indeed be an EAFLD. If validated by further testing, the hypothesis may help develop novel therapeutic and preventive strategies against this ubiquitous condition.

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

PURPOSE: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. METHODS: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. RESULTS: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. CONCLUSION: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies.

Estresse e função reprodutiva feminina

Este artigo discute a relacao do estresse sobre a funcao reprodutiva, considerando que a infertilidade pode ter causas psicologicas (hipotese da psicogenese) ou pode ser a origem do estresse psicologico. A presenca do estresse tem o potencial de ativar o eixo hipotalamo-hipofise-adrenal, o qual, inibe o eixo hipotalamo-hipofise-ovariano, levando a paralisacao temporaria das menstruacoes. Esse processo pode resultar em infertilidade transitoria para as mulheres. Os autores enfatizam a necessidade de uma abordagem psicologica nos servicos de reproducao, objetivando trabalhar as tensoes e frustracoes advindas da infertilidade e do seu tratamento.

Zinc Status Biomarkers and Cardiometabolic Risk Factors in Metabolic Syndrome: A Case Control Study

Metabolic syndrome (MS) involves pathophysiological alterations that might compromise zinc status. The aim of this study was to evaluate zinc status biomarkers and their associations with cardiometabolic factors in patients with MS. Our case control study included 88 patients with MS and 37 controls. We performed clinical and anthropometric assessments and obtained lipid, glycemic, and inflammatory profiles. We also evaluated zinc intake, plasma zinc, erythrocyte zinc, and 24-h urinary zinc excretion. The average zinc intake was significantly lower in the MS group (p < 0.001). Regression models indicated no significant differences in plasma zinc concentration (all p > 0.05) between the two groups. We found significantly higher erythrocyte zinc concentration in the MS group (p < 0.001) independent from co-variable adjustments. Twenty-four hour urinary zinc excretion was significantly higher in the MS group (p = 0.008), and adjustments for age and sex explained 21% of the difference (R2 = 0.21, p < 0.001). There were significant associations between zincuria and fasting blood glucose concentration (r = 0.479), waist circumference (r = 0.253), triglyceride concentration (r = 0.360), glycated hemoglobin concentration (r = 0.250), homeostatic model assessment—insulin resistance (r = 0.223), and high-sensitivity C-reactive protein concentration (r = 0.427) (all p < 0.05) in the MS group. Patients with MS had alterations in zinc metabolism mainly characterized by an increase in erythrocyte zinc and higher zincuria.

Influência da função tireoidiana nos níveis séricos de CPK

OBJECTIVE: To determine serum CPK variation based on TSH e free T4 (FT4), and to assess serum CPK in pathological states of the thyroid (hyperthyroidism and hypothyroidism), in relation to the euthyroidism. MATERIAL AND METHODS: We evaluated retrospectively 6,230 laboratory results of TSH and CPK from 2007 to 2011. From these, 3,369 had free T4 results. We evaluated the correlation between CPK and TSH and the pathological states of the thyroid. RESULTS: The correlation between TSH and CPK was positive (r = 0.065), while that between CPK and FT4 was negative (r = -0.091, p < 0.05). From the total of results analyzed, 586 (9.4%) were measures of hyperthyroidism, with a median (range) of CPK of 98 U/L (27 to 1,113), and 556 (8.9%) were of hypothyroidism, with CPK of 114 U/L (25-4,182). CONCLUSION: A positive correlation was found between serum CPK and TSH, and a negative correlation between CPK and FT4. CPK was lower in the group with hyperthyroidism, and greater in that with hypothyroidism.