Patricia Moreira Gomes

Supplementation of α-linolenic acid improves serum adiponectin levels and insulin sensitivity in patients with type 2 diabetes

OBJECTIVE ω-3 Polyunsaturated α-linolenic acid (ALA) supplementation has not been studied in the setting of adiponectin levels and insulin sensitivity (IS) improvements in patients with type 2 diabetes mellitus (T2DM) by hyperinsulinemic-euglycemic clamp (HEC). The aim of this study was to examine the influence of ω-3 ALA on IS and adiponectin. METHODS We conducted a randomized study in patients with T2DM and assessed IS using HEC. Twenty patients with T2DM were included and randomly assigned to receive 3 g/d of ALA or placebo for 60 d, in a double-blind design. The assessment of IS by HEC was performed at baseline and after 60 d in all patients; blood samples were taken for the measurement of serum lipids, glucose, insulin, adiponectin, and cytokines. The primary outcome variables were an increase of both glucose infusion rate (GIR) in steady state and glucose metabolization (M) by HEC. The secondary outcomes were an increase in adiponectin levels and a decrease in fasting plasma glucose, glycated hemoglobin, homeostasis model assessment-estimated insulin resistance (HOMA-IR) index, lipids and cytokines. The study was conducted at an academic medical center. RESULTS The ALA group improved IS corrected for fat-free mass (M/FFM; P = 0.04). Both groups showed increased adiponectin after 60 d (P = 0.01), however, the increase for the ALA group was greater (P = 0.04). In the ALA group, adiponectin was positively correlated with GIR (r = 0.76; P = 0.01) and M/FFM (r = 0.62; P = 0.06), and negatively correlated with HOMA-IR (r = -0.61; P = 0.03). CONCLUSION ω-3 ALA supplementation improved glucose homeostasis and was associated with an increase in adiponectin. Improvement in the overall metabolic profile with ω-3 ALA suggests a potential clinical utility for this agent and requires further investigation.

Cardiovascular risk in Japanese-Brazilian subjects

OBJECTIVE To evaluate the prevalence of risk factors for cardiovascular disease in Japanese-Brazilian subjects. SUBJECTS AND METHODS One hundred thirty-one residents of the Mombuca community were studied. Statistical analysis was based on the X² test, Fishers Exact test, Students t test, and ANOVA, at a 5% significance level. RESULTS The average age was 56.7 years-old; 76.3% had dyslipidemia, 24.4% pre-diabetes (PDM), 10.7% type 2 diabetes mellitus (T2DM), 46.6% hypertension, 52.7% abdominal obesity, and 35.8% metabolic syndrome (MS). There were significant correlations between HOMA-IR and MS diagnosis and obesity, while HOMA-β levels were decreased in T2DM and PDM. The ankle-brachial index was positive for peripheral artery disease in 22.3% of the individuals. Electrocardiograms did not show increased evidence of myocardial ischemia. CONCLUSION Subjects of this community are exposed to major cardiovascular risk factors, namely high prevalence of MS diagnoses and increased HOMA-IR.

A Giant Primary Hemangioma of the Thyroid Gland

An 80-yr-old woman was referred with a 40-yr history of a slowly enlarging anterior neck mass. She had no compressivesymptoms,historyoftrauma,previousfine-needle aspiration biopsy, or other neck procedures. There was no family history of thyroid diseases. Physical examination showedagiant (circumference,50cm)painlessgoiter (Fig.1, A and B). Serum TSH (1.97 mIU/liter; normal range, 0.4– 4.0) and free T4 (18.0 pmol/liter; normal range, 10.3–24.5) levels were normal, and no antithyroid antibodies were detected.Computedtomography(Fig.1C)showedalargesolid mass (16 16 17 cm) with multiple peripheral calcifications in the left lobe of the thyroid, with deviation of the tracheaandcervical structures to theright side.Noabnormal findings in the right lobe of the thyroid were found, and surrounding lymph nodes were not detected. Cytological examination obtained by aspiration was inconclusive because only blood could be aspirated. A left-side hemithyroidectomy was performed, and a 22 21 17-cm encapsulated mass weighing 2800 g was removed (Fig. 1D). A cavernous hemangiomawasdiagnosedbyhistologicalanalysis.Thepatient had no complications after surgery and 3 yr later remains asymptomatic. Hemangiomas are an extremely rare category of thyroid nodules that often escape preoperative diagnosis. In most cases, a hemangioma of the thyroid gland is secondary to trauma or fine-needle aspiration biopsy, and they may be considered as a development of vascular proliferation that follows the organization of a hematoma (1). Primary thyroid hemangiomas are infrequent, and they are a development anomaly resulting from the inability of the angioblastic mesenchyma to form canals (2). The hemangioma presents as a hypoechoic area within the thyroid gland, without specific, distinct characteristics. Even experienced radiologists may find this lesion difficult to diagnose. Coarse calcifications, when present, are suggested as a reliable sign of the presence of a hemangioma. More specific studies such as magnetic resonance imaging, single photon angiography, and red blood cellscansmayimprovediagnosticability.Atpresent,mostofthe reported cases had the diagnosis confirmed only after pathological examination of a surgical specimen. There are only nine casesofprimarythyroidhemangiomareportedintheliterature. These cases have had male predominance with variable age at diagnosis and clinical features (Table 1). The present case appears to represent the largest size hemangioma.

Prevalence of the metabolic syndrome using two proposed definitions in a Japanese-Brazilians community

Metabolic Syndrome (MetS) is associated with increased risk of morbi-mortality, thus the characterization of the population magnitude of this syndrome is critical for allocating health care. However, prevalence estimates of MetS in the same population could differ depending on the definition used. Therefore, we compared the prevalence of the MetS using definitions proposed by: National Cholesterol Education Panel Revised (NCEP) and International Diabetes Federation (IDF) 2009 in a Japanese-Brazilians community (131 individuals, age 57 ± 16 years, 1st and 2nd generation). All individuals went through a clinical and laboratorial evaluation for assessment of weigh, height, waist circumference, blood pressure, triglycerides, HDL-cholesterol and fasting plasma glucose. The prevalence of MetS was 26.7% (n = 35) and 37.4% (n = 49) under the NCEP and IDF definitions, respectively. Despite higher blood pressure measurements, waist circumference and serum triglyceride levels and lower HDL cholesterol levels (p < 0.01), individuals identified with MetS did not show increased blood glucose levels. IDF definition classified 14 individuals (10.7%) with MetS that were not classified under the NCEP and 35 individuals were identified with MetS by both criteria. We observed, in this group, more severe lipid disorders, compared to individuals identified only under the IDF definition, and the BMI and waist circumference (p = 0.01; p = 0.006, respectively) were lower. In conclusion, the IDF revised criteria, probably because of the ethnic specific values of waist circumference, was able to identify a larger number of individuals with MetS. However, our data suggesting that additional studies are necessary to define best MetS diagnostic criteria in this population.

Response to the letter: Is there a higher cardiovascular disease risk in Japanese-Brazilians?

eral population ranged from 0.35 to 0.73, with a mean of 0.54 and median of 0.52. Regarding the women group, WHtR values were similar to the general population (0.35 to 0.73), while for men the index varied from 0.43 to 0.67. Therefore, 51.4% of women and 52.8% of men showed the index between 0.5 and 0.59, and 25.7% of women and 14.5% of men showed a rate higher than 0.6. As the optimal cutoff points for WHtR were close to 0.5 in East Asians, and 0.6 in some ethnic groups, WHtR of 0.5 for action level one for cardiovascular risk, and 0.6 for action level two, as sug gested by Ashwell and Hsieh, could be adopted. The meta-analysis (3) involved Asians living in their countries of origin, and did not provide enough data on subject living in the Western world. In our study, people were either born in Japan or were of Japanese descent. Comparing our study with others conducted in Japan, our data showed increased rates for the components of Metabolic Syndrome in the Japanese-Brazilian population of Mumbuca. We appreciate the suggestions of Kurt and cols., which will be remembered in a reassessment of the prevalence risk factors for cardiovascular disease in the JapaneseBrazilian population of Mombuca. Surely, BAI and waist/hip index assessment may contribute to better evaluation of cardiovascular risk in this population, and increase the discussion on which tools may be useful in clinical practice.