Leila Maria Batista Araújo

Prevalência de Obesidade em Escolares de Salvador, Bahia

A obesidade em criancas e preocupante devido ao risco aumentado de sua persistencia na idade adulta, e pelos riscos de doencas a ela relacionadas. Neste trabalho descrevemos a prevalencia de obesidade em uma amostra representativa de alunos de escolas publicas e particulares de Salvador, Bahia. Foram estudados 387 alunos, com idade entre 5 e 10 anos, sendo 55% do sexo masculino, e 66% alunos de escolas publicas, selecionados atraves de amostragem por conglomerados. A obesidade foi definida a partir do indice de massa corporal (IMC) igual ou maior que o percentil 95 para idade e sexo de acordo com a recomendacao de Himes (1994), utilizando as tabelas de Anjos (1998). Para analise estatistica, aplicou-se o teste de igualdade de proporcoes. Nas escolas particulares, observou-se uma maior prevalencia de obesidade (30%) em relacao as escolas publicas (8%) (p< 0,001). As frequencias de obesidade em relacao ao sexo e grupo racial entre escolas publicas e particulares foram semelhantes. Observou-se maior percentual de obesos na faixa de idade entre 7 e 9 anos nas escolas particulares e entre 9 e 10 anos nas escolas publicas. Para a populacao estudada, a analise das proporcoes aponta na direcao de uma associacao direta entre obesidade e nivel socio-economico.

Perfil do obeso classe III do ambulatório de obesidade de um hospital universitário de Salvador, Bahia

Foram avaliados retrospectivamente 316 obesos classe III (91% mulheres), consecutivamente atendidos num ambulatorio de obesidade de um hospital universitario em Salvador, Bahia, durante oito anos. A idade media±DP dos pacientes foi de 37±10 anos e o indice de massa corporea (IMC) de 47±6kg/m2. Metade deles apresentava obesidade desde a infância ou puberdade e 82% tinha historia familiar de obesidade. Hipertensao arterial foi constatada em 66%, diabetes mellitus em 13,9%, intolerância a glicose em 16,8%, aumento dos niveis de colesterol total e triglicerides (³ 200mg/dl) em 33,5% e 8%, respectivamente, HDL-colesterol baixo (<40mg/dl) em 39,9% e LDL-colesterol elevado (³ 100mg/dl) em 66,7%. Apos tratamento com dieta hipocalorica e aumento da atividade fisica, observou-se perda de peso maior ou igual a 5 e10% em relacao ao peso inicial, em 60 (26,6%) e 28 (12,4%) dos 225 pacientes que retornaram a consulta, num periodo medio de 20±17 meses. Concluindo, a obesidade classe III e uma doenca de dificil tratamento e de elevada frequencia de fatores de risco cardiovascular mesmo em pacientes jovens.

Tratamento do diabetes mellitus do tipo 2: novas opções

O diabetes mellitus do tipo 2 (DM2) resulta de defeitos na secrecao e acao da insulina. Ele esta frequentemente associado a resistencia a insulina, obesidade androide, dislipidemia e hipertensao arterial, constituindo a sindrome metabolica. O tratamento atual visa diminuir a resistencia a insulina e melhorar a funcao da celula beta pancreatica com dieta, exercicios, hipoglicemiantes orais, anti-hiperglicemiantes e/ou drogas anti-obesidade. Novas drogas no tratamento do DM estao surgindo, tornando possiveis multiplas opcoes terapeuticas. Este artigo apresenta uma revisao sobre o assunto.

Síndrome da apnéia e hipopnéia obstrutiva do sono: associação com obesidade, gênero e idade

Obstructive sleep apnea and hypopnea syndrome (OSAHS) has been the focus of extensive research because of its association with neurocognitive and cardiovascular complications. The aim of this study was to evaluate the frequency and association between OSAHS and the class of obesity, gender and age in outpatients referred to a sleep laboratory. We selected 1,595 patients, 71.7% male. Mean ± SD age was 46.7 ± 11.7 years, BMI was 28.1 ± 5.1 kg/m2 and AIH was 13.9 ± 15.5 events/ hour of sleep. The patients were considered apneic when the apnea-hypopnea index (AHI) was > 5 events/hour of sleep; OSAHS was present in: (1) 71.1% of men and 50.3% of women (p 55 years old (p< 0.001). We concluded that OSAHS was directly and strongly associated to the male gender, obesity class and to aging.

Association of acanthosis nigricans with race and metabolic disturbances in obese women

Acanthosis nigricans (AN) has been recognized as a marker of insulin resistance and diabetes mellitus. We have compared frequency of race and metabolic disturbances in obese women with several degrees of AN (AN group, N = 190) to a group without AN (non-AN group, N = 61) from a mixed racial population. The groups were similar regarding age and body mass index. All patients (except the diabetic patients) underwent an oral glucose tolerance test (75 g). The racial distribution of this population was 35.1% white, 37.8% mulatto and 27.1% black and the frequency of AN was 62.5, 82.1 and 83.8%, respectively, higher in black versus white (P = 0.003) and mulatto versus white (P = 0.002) women. The frequencies of diabetes mellitus and impaired glucose tolerance were 5.8 and 12.6% in the AN group and 1.6 and 8.2% in the non-AN group, respectively (P>0.05). Fasting glucose, beta cell function determined by the homeostasis model of assessment (HOMA), fasting insulin and insulin area under the curve were similar for the AN and non-AN groups. A higher HOMA insulin resistance was observed in the AN group compared to the non-AN group (P = 0.02) and in the subgroup of highest degree of AN compared to those with other degrees. The mean lipid levels and the frequency of dyslipidemia were similar for the two groups. AN was strongly associated with the black or mulatto rather than the white race, even after taking into account the effect of age, body mass index and HOMA insulin resistance.

Acanthosis nigricans em mulheres obesas de uma população miscigenada: um marcador de distúrbios metabólicos

< 0,01), mais obesas (41 ± 6 versus 39 ± 6 kg/m 2 , p<0.01), tinham maior circunferencia de cintura, maior frequencia de obesidade androide, de diabetes tipo 2 (11,1% versus 4,3%, p=0,05), maiores niveis de insulina de jejum e de resistencia insulina (Homa IR) do que aquelas sem AN. As frequencias de hipertensao diastolica e alteracoes do colesterol total e fracoes e de triglicerides entre os grupos foram similares. C ONCLUSAO - Em mulheres obesas de uma populacao miscigenada, AN foi mais frequente nas de raca negra e parda e foi observada maior frequencia de co-morbidades da sindrome metabolica em comparacao a populacao sem AN. As mulheres obesas com AN devem ser investigadas para disturbios metabolicos, mesmo sendo jovens. Palavras-chaves: Acantose nigricans; diabetes mellitus nao insulino-dependente; metabolismo; obesidade; racas; resistencia a insulina. Summary: BACKGROUND - Acanthosis nigricans (AN) has been associated with various metabolic and endocrine disturbances. O BJECTIVE: The objective of this study is to evaluate the frequency of metabolic syndrome clusters in a group of obese mixed-race women with

Efeito da injeção percutânea de etanol na redução de nódulos tireoideanos

Para verificar a eficacia da injecao percutânea de etanol (IPE) no tratamento de nodulos tireoideanos (NT) comparou-se o volume de 86 nodulos (77 pacientes), antes e apos uma ou duas sessoes de alcoolizacao. As medianas do volume inicial e final foram respectivamente: 3,5 mL (0,3 a 82,7) e 1,8 mL (0 a 29,4). Sete por cento dos nodulos desapareceram e a media de reducao volumetrica foi de 52,6% ± 31,1 (p< 0,0001). Os diferentes padroes ultra-sonograficos responderam distintamente ao tratamento, com as seguintes medianas de reducao: 37,3% (variando de -39,0 a 82,6) nos NT solidos; 53,5% (14,6 a 88,0) nos predominantemente solidos; 58,0% (21,0 a 64,5) nos mistos; 71,0% (18,8 a 100,0) nos predominantemente cisticos e 90,9% (45,9 a 100,0) nos cisticos. Adicionalmente, buscou-se comparar a variacao do maior diâmetro dos NT, inicialmente sem tratamento, e apos a alcoolizacao, cuja diferenca foi estatisticamente significante (p< 0,00001). A complicacao mais frequente foi dor moderada, em 27,6% dos casos. Concluimos que a IPE mostrou ser uma forma de tratamento segura e eficaz no tratamento de NT benignos.

Hormonal therapy with estradiol and testosterone implants: bone protection?

Objective. To assess bone mineral density (BMD) in postmenopausal women using estradiol and testosterone hormonal implants comparing to that of patients without hormonal therapy. Design of the study. Sixty-one patients were followed in prospective cohort study separated in Group 1, 34 women using implants and Group 2, 27 women without implants and BMD assessment through Dual energy X-ray absorptiometry was conducted in the beginning of follow-up and after 1 year. Results. The average lumbar spine BMD in Group 1 was 1.123 ± 0.16 kg/m2 and 1.144 ± 0.18 kg/m2 after 1 year, p = 0.39 and femur BMD was 0.922 ± 0.16 kg/m2 and 0.957 ± 0.12 kg/m2 after 1 year of treatment, p = 0.076. In Group 2, the initial lumbar spine BMD average was 1.064 ± 0.2 kg/m2 and after 1 year, 1.001 ± 0.23 kg/m2, p = 0.112 and femur BMD changed from 0.928 ± 0.14 kg/m2 to 0.881 ± 0.15 kg/m2 after 1 year, p = 0.046. Conclusion. BMD variance between the groups in the period of 1 year showed that the combination of estradiol and testosterone promoted bone protection in post menopausal women.

Associação da gama-glutamil transferase e a síndrome metabólica em mulheres obesas

OBJETIVE: To evaluate the correlation of gamma-glutamyl transferase (GGT) activity to the presence and number of abnormalities of the metabolic syndrome (MS). SUBJECT AND METHODS: We have studied 353 women consecutively admitted into the obesity outpatient unit, aged 39.0 ± 11.4 years and body mass index 41.3 ± 7.3kg/m2. All patients were asymptomatic, had no history of alcohol abuse or liver disease. National Cholesterol Education Program - Adult Treatment Panel III criteria for diagnosing MS were applied. RESULTS: The frequency of the MS was 50.7% in the patients. The frequency of elevated GGT activity was higher in patients with MS than without it (32% versus 20%, p= 0.05). The average GGT concentration in patients with the MS was significantly higher than in non SM patients (52.8 ± 42.3U/L; Md: 40.0 versus 40.1 ± 28.8U/L; Md: 33.0, p= 0.0001). It was also higher in patients with each one abnormality of the MS, when compared to those without it. In patients with association of three abnormalities of the MS, the mean GGT activity was 51.0 ± 39.2U/L (Md: 36.0); in those with four, 50.8 ± 50.4U/L (Md: 40.5); and five, 64.8 ± 32.3U/L (Md: 61.0). There were positive correlations between GGT and glucose, triglycerides or blood pressure (systolic and diastolic). CONCLUSION: GGT activity was associated to the presence and the number of abnormalities of the MS, as well as to each one abnormality of the MS in obese women.

Is there any association between Hashimoto’s thyroiditis and thyroid cancer? A retrospective data analysis

Objective To evaluate the association between Hashimotos thyroiditis (HT) and papillary thyroid carcinoma (PTC). Materials and Methods The patients were evaluated by ultrasonography-guided fine needle aspiration cytology. Typical cytopathological aspects and/or classical histopathological findings were taken into consideration in the diagnosis of HT, and only histopathological results were considered in the diagnosis of PTC. Results Among 1,049 patients with multi- or uninodular goiter (903 women and 146 men), 173 (16.5%) had cytopathological features of thyroiditis. Thirty-three (67.4%) out of the 49 operated patients had PTC, 9 (27.3%) of them with histopathological features of HT. Five (31.3%) out of the 16 patients with non-malignant disease also had HT. In the groups with HT, PTC, and PCT+HT, the female prevalence rate was 100%, 91.6%, and 77.8%, respectively. Mean age was 41.5, 43.3, and 48.5 years, respectively. No association was observed between the two diseases in the present study where HT occurred in 31.1% of the benign cases and in 27.3% of malignant cases (p = 0.8). Conclusion In spite of the absence of association between HT and PCT, the possibility of malignancy in HT should always be considered because of the coexistence of the two diseases already reported in the literature.