Patrícia Feliciano Pereira

Does breastfeeding influence the risk of developing diabetes mellitus in children? A review of current evidence

OBJECTIVE The aim of this study was to perform a review to investigate the influence of breastfeeding as a protective agent against the onset of diabetes in children. SOURCES non-systematic review of SciELO, LILACS, MEDLINE, Scopus, and VHL databases, and selection of the 52 most relevant studies. A total of 21 articles, specifically on the topic, were analyzed (nine related to type 1 diabetes and 12 to type 2 diabetes). DATA SYNTHESIS The duration and exclusivity of breastfeeding, as well as the early use of cows milk, have been shown to be important risk factors for developing diabetes. It is believed that human milk contains substances that promote the maturation of the immune system, which protect against the onset of type 1 diabetes. Moreover, human milk has bioactive substances that promote satiety and energy balance, preventing excess weight gain during childhood, thus protecting against the development of type 2 diabetes. Although the above mentioned benefits have not been observed by some researchers, inaccuracies on dietary habit reports during childhood and the presence of interfering factors have been considered responsible for the lack of identification of beneficial effects. CONCLUSION Given the scientific evidence indicated in most published studies, it is believed that the lack of breastfeeding can be a modifiable risk factor for both type 1 and type 2 diabetes. Strategies aiming at the promotion and support of breastfeeding should be used by trained healthcare professionals in order to prevent the onset of diabetes.

Circunferência da cintura e relação cintura/estatura: úteis para identificar risco metabólico em adolescentes do sexo feminino?

OBJECTIVE: To evaluate if the waist circumference and the waist-to-height ratio (WHTR) are predictors of cardiovascular risk factors in female adolescents. METHODS: 113 adolescents aged 14 to 19 years old were assessed according to anthropometric data (weight, height, waist circumference), biochemical and clinical parameters (total cholesterol, LDL-C, HDL-C, triglyceride, fasting glucose, insulin, homeostasis model to assess insulin resistance - HOMA-IR), leptin, homocysteine and blood pressure. The cut points used for identification of abdominal fat were waist and WHTR values >90th percentile. RESULTS: Teenagers with abdominal obesity presented greater values of triglycerides (except for WHTR), insulin, HOMA-IR, leptin and systolic and diastolic blood pressure, while the HDL-C was reduced in the group with waist circumference >90th percentile, however without statistical significance (p=0.052). CONCLUSIONS: The present study showed that waist and WHTR are useful measures to identify female adolescents with a high cardiovascular risk, however the waist circumference presented a better performance.

Body fat location and cardiovascular disease risk factors in overweight female adolescents and eutrophic female adolescents with a high percentage of body fat

BACKGROUND Excessive body fat, mainly abdominal fat, is associated with higher cardiovascular risk. However, a fat localisation measurement that would be more indicative of risk in adolescents has not yet been established. OBJECTIVE This study was conducted in order to evaluate the correlation between body fat location measurements and cardiovascular disease risk factors in female adolescents. MATERIALS AND METHODS A total of 113 girls - 38 eutrophic according to their body mass index but with a high percentage of body fat, 40 eutrophic with adequate body fat, and 35 with excessive weight - were evaluated using 15 anthropometrical measurements and 10 cardiovascular risk factors. RESULTS The central skinfold was the best measurement for predicting variables such as glycaemia and high-density lipoprotein; waist circumference for insulin and homeostasis model assessment; coronal diameter for total cholesterol and low-density lipoprotein; sagittal abdominal diameter for triglycerides and leptin; hip circumference for blood pressure; and the central/peripheral skinfold ratio for homocysteine. The correlation between the measurements and the number of risk factors showed that waist circumference and the waist/stature ratio produced the best results. CONCLUSIONS The results suggest that the body fat distribution in adolescents is relevant in the development of cardiovascular risk factors. Simple measurements such as waist circumference and the waist/stature ratio were the best predictors of a risk of disease and they should therefore be associated with the body mass index in clinical practice in order to identify those adolescents at higher risk.

Composição corpórea, alterações bioquímicas e clínicas de adolescentes com excesso de adiposidade

BACKGROUND adolescents with excess body fat and eutrophic had the same metabolic changes expected in obese individuals. OBJECTIVE to evaluate body composition, anthropometric changes, biochemical and clinical characteristics of female adolescents. METHODS a total of 113 adolescents from public schools in Viçosa, MG, divided into three groups: group 1 - consisting of eutrophic adolescents with excess body fat; group 2 - eutrophic with body fat within normal limits; and group 3 - with excess weight and body fat. Weight, height, waist and hip circumference, blood pressure were measured. The body mass index (BMI) and waist-hip ratio were calculated. The percentage of body fat was obtained by bioelectrical impedance horizontally, following its own protocol for this evaluation. The assessment of the percentage of body fat and biochemistry was performed after 12 hours of fasting, and analyzed the lipid profile, blood glucose and insulin, homocysteine, leptin and C-reactive protein. Insulin resistance was calculated by HOMA index. RESULTS the group of eutrophic adolescents, with higher adiposity, behaved in relation to blood pressure, HDL and glucose levels, similarly to adolescents who are overweight. It can be seen that the HOMA index, insulin and leptin increased with increasing body fat. More than half of adolescents had total cholesterol and CRP levels above recommended levels. The most obvious metabolic disorder related to the lipid profile for both groups studied. CONCLUSION excess adiposity in normal weight adolescents may be related to clinical and biochemical changes similar to those found in adolescents who are overweight.FUNDAMENTO: Adolescentes con exceso de adiposidad y eutroficas presentan las mismas alteraciones metabolicas esperadas en individuos obesos. OBJETIVO: Evaluar la composicion corporal, alteraciones antropometricas, bioquimicas y clinicas de adolescentes del sexo femenino. METODOS: Fueron evaluadas 113 adolescentes de escuelas publicas de Vicosa, MG, divididas en tres grupos: grupo 1 - constituido por adolescentes eutroficas con exceso de grasa corporal; grupo 2 - eutroficas con grasa corporal dentro de los limites de normalidad; y grupo 3 - con exceso de peso y de grasa corporal. Peso, estatura, circunferencia de la cintura y cadera, presion arterial fueron medidos. El indice de masa corporal (IMC) y la relacion cintura-cadera fueron calculados. El porcentaje de grasa corporal fue obtenido por la impedancia bioelectrica horizontal, siguiendo protocolo propio para la referida evaluacion. La evaluacion del porcentaje de grasa corporal y bioquimica fue realizada despues de 12 horas de ayuno, siendo analizados perfil lipidico, glucemia y insulina, homocisteina, leptina y Proteina C Reactiva. La resistencia a la insulina fue calculada por el indice HOMA. RESULTADOS: El grupo de las adolescentes eutroficas, con elevada adiposidad, se comporto, en relacion a la presion arterial, fraccion HDL y glucemia, de modo semejante a las adolescentes con exceso de peso. Se pudo notar que el indice HOMA, la insulina y la leptina aumentaron de acuerdo con el aumento de la grasa corporal. Mas de la mitad de las adolescentes presentaba valores de colesterol total y PCR encima de los niveles recomendados. La alteracion metabolica mas evidente se relaciono al perfil lipidico para los grupos estudiados. CONCLUSION: El exceso de adiposidad en adolescentes eutroficas puede estar relacionado a alteraciones bioquimicas y clinicas semejantes a aquellas encontradas en adolescentes con exceso de peso.

Peripheral expression of inflammatory markers in overweight female adolescents and eutrophic female adolescents with a high percentage of body fat

The objective of this study was to evaluate the peripheral expression of inflammatory markers in adolescents with different nutritional status and its correlation with parameters of the metabolic syndrome. Seventy-two female postpubescent adolescents were divided into 3 groups: eutrophic (Co), eutrophic with a high body fat percentage (HBF), and overweight (OW). Data related to the parameters of the metabolic syndrome and the peripheral expression of tumour necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 were evaluated. Higher values of glycemia and insulin resistance were found in the HBF group than in the Co group. No differences related to the peripheral expression of the cytokines were found among the groups. In the HBF group, a positive correlation was observed between TNF-α and IL-6, IL-10 and the proinflammatory cytokines, and IL-6 and glycemia. In the OW group, a positive correlation was found between IL-6 and triglycerides. Adolescents with normal weight but body fat excess present a metabolic profile and body composition similar to those of overweight adolescents. This suggests that these adolescents have a risk of developing cardiovascular diseases similar to that of overweight adolescents. The positive correlation between IL-10 and TNF-α and IL-6 suggests an attempt to inhibit the production of these cytokines by IL-10.

Circunferência da cintura como indicador de gordura corporal e alterações metabólicas em adolescentes: comparação entre quatro referências

OBJETIVO: Avaliar a validade diagnostica de quatro tabelas de referencia para circunferencia da cintura em adolescentes do sexo feminino para deteccao de alteracoes lipidicas, hiperinsulinemia, homeostasis model assessment (HOMA) elevado, hiperleptinemia e elevada adiposidade corporal. METODOS: Avaliadas 113 adolescentes com idade entre 14 e 19 anos, provenientes de escolas publicas de Vicosa (MG). Em amostras de sangue foram dosados colesterol total, LDL, HDL, triglicerideos, insulina e leptina. Determinado percentual de gordura corporal atraves de bioimpedância eletrica tetrapolar. Pela medida de menor diâmetro abdominal foi determinada a circunferencia da cintura do abdomen e calculados valores de sensibilidade, especificidade, valor preditivo positivo e negativo. Foram elaboradas tabelas de contingencia de classificacao de circunferencia da cintura em adolescentes para quatro criterios: Freedman et al., 1999; Taylor et al., 2000; McCarthy et al., 2001; e Moreno et al., 2007. RESULTADOS: Valores de sensibilidade em geral foram baixos para as referencias avaliadas, sendo os maiores obtidos para a de McCarthy et al. Ao contrario, as especificidades foram altas, principalmente para a tabela de Freedman et al. Os valores preditivos positivos foram mais relevantes para colesterol total e percentual de gordura corporal. CONCLUSAO: Os pontos de corte para circunferencia da cintura de McCarthy et al. demonstraram-se os mais adequados para avaliacoes populacionais. A proposta de Freedman et al. por apresentar maior especificidade, e util para uso clinico e pode substituir a realizacao de exames de custo elevado que em muitos locais nao se encontram ao alcance dos profissionais de saude, como leptina e insulina.

Influência do excesso de peso corporal e da adiposidade central na glicemia e no perfil lipídico de pacientes portadores de diabetes mellitus tipo 2

Influence of Body Weight Excess and Central Adiposity in Glycemic and Lipid Profile in Patients with Type 2 Diabetes Mellitus. The purpose of the present study was to evaluate, in diabetic type 2 patients, the influence of body weight excess assessed by BMI and the central adiposity assessed by the waist circumference in the lipid and glycemic profile. One hundred and forty five individuals assisted in a unit of health, aged ≥ 20 years old, were appraised. The female frequency was 61.4%. Among men, the weight excess was correlated with HDL (r = -0.34, p < 0.05), with the total cholesterol (r = 0.35, p < 0.01), and with the triglycerides (r = 49, p < 0.0001), and among women there was correlation just with the triglycerides (r = 0.24, p < 0,05). Waist circumference was correlated with the fast glycemia women’s group (r = 0.3, p < 0.01), with the total cholesterol among men (r = 0.33, p < 0.05) and with triglycerides in both genders (F: r = 0.22, p < 0.05; M: r = 0.49, p < 0.001). Highest glycemic and triglycerides levels were present in patients with excess body weight and central adiposity and lower HDL levels were present in patients with body weight excess. In conclusion, there is association between inadequate metabolic profile and the excess of body weight and/or central obesity, evidencing the need for a nutritional and clinical intervention in the diabetic type 2 patients, in order to reduce the risk of future chronic complications. (Arq Bras Endocrinol Metab 2007;51/9:1516-1521)

Glycemic index role on visceral obesity, subclinical inflammation and associated chronic diseases

BACKGROUND It is believed that the glycemic index (GI) may be used as a strategy to prevent and control noncommunicable diseases (NCD). Obesity is a multifactorial condition, a risk factor for development of other NCDs. Among the different types, abdominal obesity is highlighted, which is essential for the diagnosis of metabolic syndrome, and it is related to insulin resistance, dyslipidemia, hypertension and changes in levels of inflammatory markers. Such indicators are closely related to the development of Type 2 Diabetes and cardiovascular disease. OBJETIVES Discuss the role of GI as a strategy for the prevention and/or treatment of visceral obesity, subclinical inflammation and chronic diseases. RESULTS AND DISCUSSION The intake of low GI diets is associated with glycemic decreases, and lower and more consistent postprandial insulin release, avoiding the occurrence of hypoglycemia. Moreover, consumption of a low GI diet has been indicated as beneficial for reducing body weight, total body fat and visceral fat, levels of proinflammatory markers and the occurrence of dyslipidemia and hypertension. The intake of low GI foods should be encouraged in order to prevent and control non-communicable diseases.

Body composition, biochemical and clinical changes of adolescents with excessive adiposity

BACKGROUND adolescents with excess body fat and eutrophic had the same metabolic changes expected in obese individuals. OBJECTIVE to evaluate body composition, anthropometric changes, biochemical and clinical characteristics of female adolescents. METHODS a total of 113 adolescents from public schools in Viçosa, MG, divided into three groups: group 1 - consisting of eutrophic adolescents with excess body fat; group 2 - eutrophic with body fat within normal limits; and group 3 - with excess weight and body fat. Weight, height, waist and hip circumference, blood pressure were measured. The body mass index (BMI) and waist-hip ratio were calculated. The percentage of body fat was obtained by bioelectrical impedance horizontally, following its own protocol for this evaluation. The assessment of the percentage of body fat and biochemistry was performed after 12 hours of fasting, and analyzed the lipid profile, blood glucose and insulin, homocysteine, leptin and C-reactive protein. Insulin resistance was calculated by HOMA index. RESULTS the group of eutrophic adolescents, with higher adiposity, behaved in relation to blood pressure, HDL and glucose levels, similarly to adolescents who are overweight. It can be seen that the HOMA index, insulin and leptin increased with increasing body fat. More than half of adolescents had total cholesterol and CRP levels above recommended levels. The most obvious metabolic disorder related to the lipid profile for both groups studied. CONCLUSION excess adiposity in normal weight adolescents may be related to clinical and biochemical changes similar to those found in adolescents who are overweight.FUNDAMENTO: Adolescentes con exceso de adiposidad y eutroficas presentan las mismas alteraciones metabolicas esperadas en individuos obesos. OBJETIVO: Evaluar la composicion corporal, alteraciones antropometricas, bioquimicas y clinicas de adolescentes del sexo femenino. METODOS: Fueron evaluadas 113 adolescentes de escuelas publicas de Vicosa, MG, divididas en tres grupos: grupo 1 - constituido por adolescentes eutroficas con exceso de grasa corporal; grupo 2 - eutroficas con grasa corporal dentro de los limites de normalidad; y grupo 3 - con exceso de peso y de grasa corporal. Peso, estatura, circunferencia de la cintura y cadera, presion arterial fueron medidos. El indice de masa corporal (IMC) y la relacion cintura-cadera fueron calculados. El porcentaje de grasa corporal fue obtenido por la impedancia bioelectrica horizontal, siguiendo protocolo propio para la referida evaluacion. La evaluacion del porcentaje de grasa corporal y bioquimica fue realizada despues de 12 horas de ayuno, siendo analizados perfil lipidico, glucemia y insulina, homocisteina, leptina y Proteina C Reactiva. La resistencia a la insulina fue calculada por el indice HOMA. RESULTADOS: El grupo de las adolescentes eutroficas, con elevada adiposidad, se comporto, en relacion a la presion arterial, fraccion HDL y glucemia, de modo semejante a las adolescentes con exceso de peso. Se pudo notar que el indice HOMA, la insulina y la leptina aumentaron de acuerdo con el aumento de la grasa corporal. Mas de la mitad de las adolescentes presentaba valores de colesterol total y PCR encima de los niveles recomendados. La alteracion metabolica mas evidente se relaciono al perfil lipidico para los grupos estudiados. CONCLUSION: El exceso de adiposidad en adolescentes eutroficas puede estar relacionado a alteraciones bioquimicas y clinicas semejantes a aquellas encontradas en adolescentes con exceso de peso.

Aldosterone: a cardiometabolic risk hormone?

INTRODUCTION A aldosterone is a component of the renin-angiotensin-aldosterone system, classically known for its role in sodium and water retention. Besides its effects, has been shown that the aldosterone is associated with the pathogenesis and progression of metabolic syndrome components. A better understanding of this system and interfering factors could help develop pharmacotherapeutic alternatives for several disorders. OBJECTIVES Investigate the relationship between diet and aldosterone, and its influence on cardiometabolic risk factors. RESULTS AND DISCUSSION Diet can affect plasma aldosterone levels; high fructose and fat intake can lead to increased aldosterone levels, whereas the effect of sodium intake remains controversial. Adipose tissue, particularly visceral tissue, appears to produce a lipid-soluble factor that increases aldosterone production. Patients with metabolic syndrome have higher aldosterone levels; moreover, an increased cardiometabolic risk associated with insulin resistance could be partially mediated by the action of aldosterone via mineralocorticoid receptors. Even a subtle activation of this hormonal system may have deleterious effects on the glucose and lipid metabolism related to metabolic syndrome. Nevertheless, additional studies are required to better understand the interactions among adipose tissue, aldosterone, and cardiovascular risk as well as the possible role of diet.