Milene Moehlecke

Blood pressure means rather than nocturnal dipping pattern are related to complications in Type 2 diabetic patients

Aim  To determine whether systolic and diastolic blood pressure (BP) means, during ambulatory BP monitoring (ABPM), are more strongly correlated with microvascular complications and echocardiographic structural alterations than night‐time/daytime (N/D) BP ratio.

Determinants of body weight regulation in humans

Body weight is regulated by the ability of hypothalamic neurons to orchestrate behavioral, endocrine and autonomic responses via afferent and efferent pathways to the brainstem and the periphery. Weight maintenance requires a balance between energy intake and energy expenditure. Although several components that participate in energy homeostasis have been identified, there is a need to know in more detail their actions as well as their interactions with environmental and psychosocial factors in the development of human obesity. In this review, we examine the role of systemic mediators such as leptin, ghrelin and insulin, which act in the central nervous system by activating or inhibiting neuropeptide Y, Agouti-related peptide protein, melanocortin, transcript related to cocaine and amphetamine, and others. As a result, modifications in energy homeostasis occur through regulation of appetite and energy expenditure. We also examine compensatory changes in the circulating levels of several peripheral hormones after diet-induced weight loss.

Effect of metabolic syndrome and of its individual components on renal function of patients with type 2 diabetes mellitus

The objective of this study was to evaluate the effect of metabolic syndrome (MetS) and its individual components on the renal function of patients with type 2 diabetes mellitus (DM). A cross-sectional study was performed in 842 type 2 DM patients. A clinical and laboratory evaluation, including estimated glomerular filtration rate (eGFR) calculated by the modification of diet in renal disease formula, was performed. MetS was defined according to National Cholesterol Education Program - Adult Treatment Panel III criteria. Mean patient age was 57.9 +/- 10.1 years and 313 (37.2%) patients were males. MetS was detected in 662 (78.6%) patients. A progressive reduction in eGFR was observed as the number of individual MetS components increased (one: 98.2 +/- 30.8; two: 92.9 +/- 28.1; three: 84.0 +/- 25.1; four: 83.8 +/- 28.5, and five: 79.0 +/- 23.0; P < 0.001). MetS increased the risk for low eGFR (<60 mL x min(-1) x 1.73 (m2)(-1)) 2.82-fold (95%CI = 1.55-5.12, P < 0.001). Hypertension (OR = 2.2, 95%CI = 1.39-3.49, P = 0.001) and hypertriglyceridemia (OR = 1.62, 95%CI = 1.19-2.20, P = 0.002) were the individual components with the strongest associations with low eGFR. In conclusion, there is an association between MetS and the reduction of eGFR in patients with type 2 DM, with hypertension and hypertriglyceridemia being the most important contributors in this sample. Interventional studies should be conducted to determine if treatment of MetS can prevent renal failure in type 2 DM patients.

ENPP1 K121Q polymorphism and ischemic heart disease in diabetic patients

FUNDAMENTO: O gene ecto-nucleotideo pirofosfatase/fosfodiesterase 1 (ENPP1) e um gene candidato a resistencia insulinica. A resistencia a insulina e um componente importante da sindrome metabolica e tem sido implicada no desenvolvimento de doenca cardiaca isquemica (DCI). OBJETIVO: Avaliar a associacao entre o polimorfismo K121Q do gene ENPP1 e a presenca da DCI em pacientes caucasianos com diabete melito (DM) tipo 2. METODOS: Estudo transversal foi realizado em pacientes com DM tipo 2 (n=573; 50,6% homens; idade 59,5±10,4 anos). DCI foi definida pela presenca de angina ou infarto agudo do miocardio pelo questionario cardiovascular da Organizacao Mundial da Saude e/ou alteracoes compativeis no ECG (codigo Minnesota) ou cintilografia miocardica. O polimorfismo K121Q foi genotipado atraves da tecnica de PCR e digestao enzimatica. RESULTADOS: DCI esteve presente em 209 (36,5%) pacientes. A frequencia dos genotipos KK, KQ e QQ entre os pacientes com DCI foi 60,8%, 34,4% e 4,8%, semelhante a distribuicao dos genotipos entre os pacientes sem DCI (64,0%, 32,7% e 3,3%, P = 0,574). Nao se observou diferenca nas caracteristicas clinicas ou laboratoriais entre os tres genotipos, nem em relacao a presenca de sindrome metabolica. CONCLUSAO: Nenhuma associacao foi encontrada entre o polimorfismo K121A do gene ENPP1 e a presenca de DCI ou caracteristicas fenotipicas de resistencia insulinica.BACKGROUND The ecto-nucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) gene is a candidate gene for insulin resistance. Insulin resistance is a major component of metabolic syndrome (MetS) and has been implicated in ischemic heart disease (IHD). OBJECTIVE To evaluate the association between the K121Q polymorphism of the ENPP1 gene and IHD in white patients with type 2 diabetes mellitus (DM). METHODS A cross-sectional study was performed in type 2 DM patients (n = 573, 50.6% males, age 59.5+/-10.4 years). IHD was defined by the presence of angina or myocardial infarction according to the Worth Health Organization cardiovascular questionnaire and/or compatible electrocardiographic (Minnesota Code), or perfusional abnormalities in myocardial scintigraphy. The K121Q polymorphism of ENPP1 gene was genotyped using PCR-based methods and restriction enzyme digestion. RESULTS IHD was present in 209 (36.5%) patients. The distribution of KK, KQ and QQ genotypes among patients with IHD was 60.8%, 34.4% and 4.8%, not different from the genotype distribution in the group without IHD (64%, 32.7% and 3.3%, P=0.574). No difference was found in the clinical and laboratory characteristics between the three genotypes, neither regarding the prevalence of Metabolic Syndrome. CONCLUSION No association was found between polymorphism K121A of ENPP1 gene and the presence of IHD.

Early reduction of resting energy expenditure and successful weight loss after Roux-en-Y gastric bypass

BACKGROUND Weight loss and body composition changes after Roux-en-Y gastric bypass (RYGB) may influence resting energy expenditure (REE). The effect of lower REE after the procedure on long-term weight remains to be elucidated. OBJECTIVE To evaluate the effects of RYGB on REE and body composition 6 months after RYGB and to find out whether postsurgery REE affects weight at 12 and 18 months SETTING: Tertiary referral hospital, southern Brazil METHOD: A prospective study involving 30 RYGB patients aged>18 years was performed. Body composition was evaluated by X-ray absorptiometry and REE by indirect calorimetry. All patients were assessed before RYGB and 6 months postoperatively. Further analysis of weight was carried out at 12 and 18 months. RESULTS Baseline body mass index was 49±9 kg/m² and mean weight was 128±19 kg, half of which comprised fat mass (50±5%). Baseline mean REE was 2297±182 kcal/d. The percent total weight loss was 26±7%, 32±9%, and 34±9% at 6, 12, and 18 months, respectively. The percent excess weight loss gradually increased from 54 ± 12% at 6 months, to 67 ± 18% at 12 months, and 71 ± 19% at 18 months. REE was significantly lower at follow-up (-405±108 kcal/d; P<.001). Furthermore, an inverse correlation between REE at 6 months and percent excess weight loss at 18 months (r =-.612; P = .035) was observed in the subgroup of patients whose REE decreased>405 kcal/d at 6 months. CONCLUSION Patients undergoing RYGB who had a substantial drop in REE at 6 months may exhibit less long-term weight loss.

Energy expenditure changes after Roux-en-Y Gastric Bypass

Background Weight loss usually decreases energy expenditure (EE) because of changes in body composition (BC). The reduction in EE may contribute, in part, to long-term weight regain. Patients undergoing bariatric surgery might experience a decrease in EE, mainly due to reduced resting metabolic rate (RMR), explained by a decreased lean body mass (LBM), similarly to what occurs to patients after diet-induced weight loss.

Performance of resting metabolic rate estimation equations in obese patients

Background Weight gain may be associated with an imbalance between energy intake and energy expenditure. The resting metabolic rate (RMR) is the main component of total energy expenditure, and is related mainly to lean mass (LM), as well as to other factors such as fat mass (FM), age, sex and genetic factors. A RMR lower than expected may be a risk factor for weight gain. RMR is estimated by equations that use patients weight, sex, age and height to calculate energy needs. Several studies have shown that these equations have a poor agreement with RMR measured by indirect calorimetry (IC) in obese patients once their excess fat-free mass (FFM) is usually not taken into account.

Evaluation of NLRP3 inflamassome expression and its endogen inhibitor CGI-58 in subjects with different obesity degrees

Background Obesity is associated with a state of low-grade chronic inflammation, commonly causing insulin resistance (IR) and type 2 diabetes mellitus (T2D). The NLRP3 inflamassome is a key mediator of metabolic inflammation, and it has been shown to be activated in macrophages of newly diagnosed insulin resistant-T2D patients. In humans, reduction in NLRP3 expression in adipose tissue is linked to decreased inflammation and improved insulin sensitivity in obese T2D patients. Recently, it was demonstrated that the lipolytic factor CGI-58 is an endogenous suppressor of NLRP3 activity in animal models. Therefore, the aim of this study was to evaluate CGI-58 and NLRP3 gene expressions in adipose tissue from individuals with different obesity degrees and their association with metabolic variables.

Low Gestational Weight Gain in Obese Women and Pregnancy Outcomes

Obesity during pregnancy and excessive weight gain during this period are associated with several maternal–fetal and neonatal complications. Moreover, a significant percentage of women have weight retention in the postpartum period, especially those with excessive weight gain during pregnancy. The recommendations of the 2009 Institute of Medicine were based on observational studies that have consistently shown that women with weight gain within the recommended range had better outcomes during pregnancy. In patients with obesity, however, there is no recommendation for weight gain, according to the class of obesity. This review, therefore, aims to evaluate the evidence on key maternal and fetal complications related to low weight gain during pregnancy in obese and overweight patients.

Polimorfismo K121Q do gene ENPP1 e cardiopatia isquêmica em pacientes com diabete melito

FUNDAMENTO: O gene ecto-nucleotideo pirofosfatase/fosfodiesterase 1 (ENPP1) e um gene candidato a resistencia insulinica. A resistencia a insulina e um componente importante da sindrome metabolica e tem sido implicada no desenvolvimento de doenca cardiaca isquemica (DCI). OBJETIVO: Avaliar a associacao entre o polimorfismo K121Q do gene ENPP1 e a presenca da DCI em pacientes caucasianos com diabete melito (DM) tipo 2. METODOS: Estudo transversal foi realizado em pacientes com DM tipo 2 (n=573; 50,6% homens; idade 59,5±10,4 anos). DCI foi definida pela presenca de angina ou infarto agudo do miocardio pelo questionario cardiovascular da Organizacao Mundial da Saude e/ou alteracoes compativeis no ECG (codigo Minnesota) ou cintilografia miocardica. O polimorfismo K121Q foi genotipado atraves da tecnica de PCR e digestao enzimatica. RESULTADOS: DCI esteve presente em 209 (36,5%) pacientes. A frequencia dos genotipos KK, KQ e QQ entre os pacientes com DCI foi 60,8%, 34,4% e 4,8%, semelhante a distribuicao dos genotipos entre os pacientes sem DCI (64,0%, 32,7% e 3,3%, P = 0,574). Nao se observou diferenca nas caracteristicas clinicas ou laboratoriais entre os tres genotipos, nem em relacao a presenca de sindrome metabolica. CONCLUSAO: Nenhuma associacao foi encontrada entre o polimorfismo K121A do gene ENPP1 e a presenca de DCI ou caracteristicas fenotipicas de resistencia insulinica.BACKGROUND The ecto-nucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) gene is a candidate gene for insulin resistance. Insulin resistance is a major component of metabolic syndrome (MetS) and has been implicated in ischemic heart disease (IHD). OBJECTIVE To evaluate the association between the K121Q polymorphism of the ENPP1 gene and IHD in white patients with type 2 diabetes mellitus (DM). METHODS A cross-sectional study was performed in type 2 DM patients (n = 573, 50.6% males, age 59.5+/-10.4 years). IHD was defined by the presence of angina or myocardial infarction according to the Worth Health Organization cardiovascular questionnaire and/or compatible electrocardiographic (Minnesota Code), or perfusional abnormalities in myocardial scintigraphy. The K121Q polymorphism of ENPP1 gene was genotyped using PCR-based methods and restriction enzyme digestion. RESULTS IHD was present in 209 (36.5%) patients. The distribution of KK, KQ and QQ genotypes among patients with IHD was 60.8%, 34.4% and 4.8%, not different from the genotype distribution in the group without IHD (64%, 32.7% and 3.3%, P=0.574). No difference was found in the clinical and laboratory characteristics between the three genotypes, neither regarding the prevalence of Metabolic Syndrome. CONCLUSION No association was found between polymorphism K121A of ENPP1 gene and the presence of IHD.