Odilon Iannetta

Down syndrome and precocious menopause

Purpose: To determine whether women who had children with Down syndrome (DS) had precocious menopause.Methods: We selected 104 mothers of children with DS and 121 normal women who had children with no genetic problems. We conducted an interview and compared their mean age at menopause.Results: We did not detect a statistically significant difference in mean age at menopause. When we stratified into women who had conceived when younger or older than 35 years of age, we found a statistically significant difference only for women who had conceived at the age of 35 years or older. We observed three cases of previous unilateral ovarian surgery in the study group and one case in the control group.Conclusions: We cannot conclude that mothers of children with DS will have precocious menopause. Nevertheless, our findings do not exclude the theory of reduced ovarian reserve as a primordial factor in the genesis of DS.

What is the best equation to estimate the basal energy expenditure of climacteric women

Objectives The methods currently available for the measurement of energy expenditure in patients, such as indirect calorimetry and double-labelled water, are expensive and are limited in Brazil to research projects. Thus, equations for the prediction of resting metabolic rate appear to be a viable alternative for clinical practice. However, there are no specific equations for the Brazilian population and few studies have been conducted on Brazilian women in the climacteric period using existing and commonly applied equations. On this basis, the objective of the present study was to investigate the concordance between the predictive equations most frequently used and indirect calorimetry for the measurement of resting metabolic rate. Methods We calculated the St. Laurent concordance correlation coefficient between the equations and resting metabolic rate calculated by indirect calorimetry in 46 climacteric women. Results The equation showing the best concordance was that of the FAO//WHO//UNU formula ((0.63)), which proved to be better than the Harris & Benedict equation ((0.55)) for the sample studied. Conclusions On the basis of the results of the present study, we conclude that the FAO//WHO//UNU formula can be used to predict better the resting metabolic rate of climacteric women. Further studies using more homogeneous and larger samples are needed to permit the use of the FAO//WHO//UNU formula for this population group with greater accuracy.

Analysis of bone microarchitecture related to anthropometry in climateric women.

BACKGROUND Osteoporosis is one of the most important public health problems involving a high percentage of costs in the medical care system. Reliable diagnostic techniques for an early detection of bone deterioration and studies of factors that influence its development in menopausal women are crucial. The aim of the study was to determine the relationship between bone microarchitecture and anthropometry in climacteric women. METHODS Women were recruited at the Menopause Clinic, University Hospital of FMRP/USP, and submitted to anthropometry and to the evaluation of bone quality (Ultrasound Bone Profile Index, UBPI) and quantity (Amplitudedependent Speed of Sound, AD-SoS-) by phalangeal quantitative osteosonography (DBM Sonic BP). Descriptive analysis of the data was reported and a multiple linear regression was performed using the software SAS® 9.0. RESULTS 71 patients aged 58 ± 7 y were studied: 28% had BMI 18.5-24.9 kg/m(2), 35% BMI 24.9-29.9 and 37% BMI > 30. Mean AD-SoS was 2059 ± 79 m/s and mean UBPI was 0.67 ± 0.13. Considering AD-SoS the dependent variable, there was no statistically significant relationship between age (p = 0.20), BMI (p = 0.76), fat mass by bioelectrical impedance (p = 0.42) and by anthropometry (p = 0.95). The variables had very low effect on the UBPI when it was considered the dependent variable. CONCLUSIONS The relation between bone microarchitecture and the anthropometry of the women studied shows that, the greater the bone quantity, the better the anthropometric parameters, without statistically significance. This work was a cross-sectional study on a small sample that needs to be validated in a prospective design.

Effects of Short-Term Calcium Supplementation in Children and Adolescents with Phenylketonuria

Reduction of bone mineral density and the risk of osteopenia have been reported to occur in phenylketonuria (PKU) patients. This study aimed to evaluate the short-term effects of calcium supplementation in phenylketonuric children and adolescents. The study included 18 patients with PKU aged 5-18 yr (61% male) under clinical and nutritional treatment. Evaluation of food intake, anthropometry, and biochemical and phalangeal quantitative ultrasound were performed before (phase 1) and after (phase 2) calcium supplementation (1000 mg/d) for 34 d. Statistical analysis was performed using t test for paired samples, Wilcoxons test, and McNemars test (p <0.05). There was an inadequate intake of phosphorus and vitamin D, the same occurring with serum concentrations of these nutrients. About 50% of the patients had an accumulation of adipose tissue measures, with a negative correlation between Z-score, body mass index, and phalangeal quantitative ultrasound (amplitude-dependent speed of sound [AD-SoS]). There was a significant difference in urinary phosphorus excretion with higher values before supplementation. Comparison of the two phases revealed significantly higher AD-SoS values after the supplementation (p = 0.017). The reduction in phosphorus excretion associated with increased AD-SoS between the two phases suggested increased bone formation, and showed no negative effects in relation to short-term calcium supplementation in children and in adolescents with PKU.

Use of a Gonadotropin-releasing Hormone Analog to Treat Idiopathic Central Precocious Puberty Is Not Associated with Changes in Bone Structure in Postmenarchal Adolescents

STUDY OBJECTIVES To evaluate bone quantity and quality in postmenarchal adolescents treated for idiopathic central precocious puberty (CPP) in childhood with a gonadotropin-releasing hormone analog (GnRHa) and to determine the serum concentrations of bone remodeling markers. DESIGN AND PARTICIPANTS This cross-sectional study included 53 postmenarchal adolescent girls who were divided into 2 groups: 27 adolescents who were treated with GnRHa in childhood for idiopathic CPP (the CPP group) and 26 women who presented with physiological development of secondary sex traits (the control group). INTERVENTIONS None. MAIN OUTCOME MEASURES Weight, height, body mass index, age at menarche, time since menarche, body composition, bone mineral density (BMD), bone quality, and serum insulin, glucose, osteocalcin, and carboxyl-terminal telopeptide of type I collagen concentrations were compared in the 2 groups. BMD data were analyzed by using both dual-energy x-ray absorptiometry (DXA) and osteosonography, and body composition was measure with the use of DXA and electrical bioimpedance. RESULTS BMD and bone quality did not differ significantly between the CPP and control groups when analyzed by using DXA or osteosonography. Serum osteocalcin concentration was significantly lower (P = .02) in the CPP than in the control group. Insulin was higher in the CPP group, and hyperinsulinemia was an independent predictor of bone quantity and quality assessed by using osteosonography. Body mass index and percent fat were determined by using DXA, and the duration of use of GnRHa treatment and the time since GnRHa discontinuation were not independent predictors of bone quantity and quality. CONCLUSION Postmenarchal adolescents treated with GnRHa for CPP in childhood did not show a reduction in bone quantity or quality.

Quantitative ultrasound at the hand phalanges in patients with bisphosphonate-related osteonecrosis of the jaws

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

Considerações sobre custo-benefício nas políticas de saúde: tratamento curativo versus o preventivo da osteoporose

Abstract From the 1990 decade, several paradigms of daily medical practice have been modified, favoring new, more efficient and effective medical approaches. The knowledge about osteoporosis underwent chan -ges; it previously correlated the reduction of bone mass to an increased risk of fracture and directed the diagnosis only at elderly individuals. A later a model favors, since an early age, the simultaneous observation of the two bone matrices, the protein or real one and the inorganic or secondary one. The two models basically differ in terms of approach: one takes a curative approach, that diagnoses the signs and symptoms already installed of osteoporosis and adopts practices that follow the disease; the other, a preventive approach aiming at avoiding the ins-tallation of the disease. Thus, in order to evaluate the costs and benefits of curative against preven-tive approaches of osteoporosis in public health policies, a comparative study of patients treated in 2007-2009 on HCFMRP – USP was carried out. Data obtained were analyzed as for the costs incurred versus the benefits gained. The results of the study show that the preventive approach to osteoporosis, by means of bone micro-architecture screening, is economically viable. In this respect, in addition to providing economic evidence, the study analyzed the importance of applying a new paradigm regarding osteoporosis on the part of public healthcare policy in order to achieve better living conditions and well --being for the population.Keywords: Public Healthcare Policies; Osteoporosis; Prevention.

Failure of a single nutrition counseling session for climateric women

An adequate food intake is fundamental for eutrophy, prevention and treatment of obesity. Particularly among women, the climacteric phase leads to changes in body composition, characterized by reduced lean mass and energy metabolism resulting in increased fat accumulation associated with inadequate eating habits. On this basis, these women must be counseled about a proper nutrient intake, the maintenance of a healthy weight and the performance of physical activity. Thus, we evaluated a group of climacteric women from a nutritional viewpoint, before and after a single qualitative nutritional intervention and its effectiveness. We also compared two methods of body composition analysis with a gold standard one. Anthropometric, dietary and physical activity data were collected from the volunteers. DXA and bioelectrical impedance (BIA) analysis were performed. The population was counseled during a single interview section about healthy diet with the use of explanatory leaflets (Food Guide Pyramid and The Ten Steps for a Healthy Diet). They were also counseled about the regular practice of physical activities, i. e., 30 min of any physical activity for, at least, 3 times a week. Two years later, the same women were reevaluated using the same criteria of the first evaluation. The data analysis were statistically compared by pair samples Wilcoxon test. St. Laurent test was applied to determine body composition methods concordance. All calculations were made using the SAS/STAT software, version 9. Ten climacteric women were studied. Their mean age, at the beginning, was 54 ± 8 years. The dietary history showed high energy intake and calcium, vitamins, zinc and fiber deficiencies, even after the nutritional counseling. The anthropometry and other body composition measures showed an excess of body weight, high waist circumference and trunk fat accumulation. These data remained constant within the study period and the method closest to the gold standard (DXA) was anthropometry (coefficient 0.57). Despite the nutritional counseling, inadequate dietary habits and inappropriate body composition did not change in the studied climacteric women. This findings show that a single nutritional explanatory interview is not enough to treat, or even prevent nutritional disorders. We emphasize here the importance of a continuous nutritional monitoring that could be provided by continuous educational dietary program with help of multidisciplinary team.