Paulo Adriano Schwingel

Anabolic-androgenic steroids: a possible new risk factor of toxicant-associated fatty liver disease.

Background: Industrial toxin and drugs have been associated with non‐alcoholic fatty liver disease (NAFLD); in these cases, the disease has been termed toxicant‐associated steatohepatitis (TASH).

Efeitos do exercício aeróbico e anaeróbico em variáveis de risco cardíaco em adultos com sobrepeso

BACKGROUND Aerobic exercise is an important ally in the fight against cardiovascular risk factors. However, the effects of high-intensity exercise on these factors are still poorly known. OBJECTIVE To compare the effects of aerobic and anaerobic exercise protocols on cardiac risk factors. METHODS 22 individuals with mean age of 40+/-8 years were distributed into the following groups: control (CO), endurance training (ET) and interval training (IT). The protocols lasted 12 weeks, three times a week, with intensities of 10% below and 20% above the anaerobic threshold (AnT). The following measurements were taken: total body mass (TBM), body mass index (BMI), waist circumference (WC), hip circumference (HC), and body composition, in addition to plasma concentrations of glucose (GLU), total cholesterol (CHO), and triglycerides (TG). Waist-hip ratio (WHR) and conicity index (C index) were also calculated. RESULTS The TBM, BMI, WC, GLU, and body composition variables showed significant changes in the ET and IT groups. CHO and HC values were significantly reduced in the ET group, whereas WHR showed a significant reduction in the IT group. AnT and C index in the IT group were significantly different in relation to ET. CONCLUSION In view of the differences found in the results of the variables studied in relation to the training performed, we conclude that an exercise program that includes both high and low-intensity activities is more efficient to ensure the reduction of a greater number of cardiac risk variables.

Association between nonalcoholic fatty liver disease and coronary artery disease

OBJECTIVE Although some investigations have shown a relationship between nonalcoholic fatty liver disease (NAFLD) and cardiovascular diseases, there are few studies analyzing the relationship between NAFLD and coronary artery disease (CAD). The aim of this article was to review the relationship between NAFLD and CAD and the methods of diagnosis used to assess such relationship. METHODS A review was performed using search engines of indexed scientific material, including MEDLINE (by PubMed), Web of Science, IBECS, and LILACS, to identify articles published in Portuguese, English, and Spanish until August, 2012. The studies were eligible if they included the following data: place and year of publication, prevalence and methods used to diagnose NAFLD (ultrasound, computed tomography, nuclear magnetic resonance, or biopsy) and CAD (coronary angiography, or computed tomography), and the exclusion of patients due to alcohol consumption greater than 20g/day. RESULTS Ten articles were selected, most of which were cross-sectional studies. The studies mostly observed the association between NAFLD and the presence and severity of CAD. CONCLUSION The analysis of the review showed that evaluating the existence of NAFLD in patients with CAD from its subclinical form up to the symptomatic clinical form is important due to the higher risk of acute myocardial infarction and consequent increase of mortality.

Increased liver steatosis in anabolic-androgenic steroid users: more evidence towards toxicant-associated fatty liver disease development

hepatitis after patients took numerous Herbalife products which were later found to be contaminated with Bacillus subtilis and/or Bacillus cereus. Cellular suspensions thereof proved to be hepatotoxic in a basic but widely used toxicity assay (2). Causality was assessed by validated scores and was found to be ‘probable’. In other series, causality was considered ‘certain’ after liver abnormalities relapsed following rechallenge to the products. Altogether, published material describe 34 cases of liver injury, mostly of hepatocellular or mixed type, following the consumption of various Herbalife products, often in combination and over long periods of time. In a recent summary on liver injury precipitated by dietary supplements, we review published reports of Herbalife-associated liver injury (and that from many other dietary supplements) and summarize main data in an overview table, but emphasize that the underlying mechanisms of liver injury remain unclear to date (3). However, we provide some thoughts on what these could be based on histology imaging and in vitro assaying, but did not exaggerate, overemphasise or add speculations unsupported by data from publications. We appreciate the Letter to the Editor by Appelhans and Goldstein (4) commenting on our review, and adding some important information. For example, we are delighted to learn that some of the ingredients contained in Herbalife products are no longer marketed – maybe as a reaction to the published reports on their potential hazards? We have so far not observed any further cases in Switzerland indicating that the products distributed here may now be safer than they used to be. If so, this would be just what the spontaneous reports on adverse reactions related to certain health products attempted to achieve: increase the awareness of consumers and manufacturers, and prompt appropriate responses. Appelhans and Goldstein allude that regulatory requirements for dietary supplements are in place to ensure consumers’ safety, however, this may differ if products are produced in different countries. Interestingly, none of the reported cases came from the USA, but from different European countries and Israel suggesting that locally produced, spoiled batches could have been the cause of liver injury. Ample data describe contamination of herbal medicines, foodstuff, dietary supplements and synthetic drugs with pesticides, heavy metals such as lead and mercury, softeners and others. However, we clearly repudiate that we are making generalizations on the contamination of dietary supplements as a rule, but mention openly those in which this seemingly occurred. In contrast to Herbalife Inc., we have no financial interest to disclose, but as physicians, we are responsible for the well-being of our patients and shall advise them to refrain from potentially harmful products for which scientifically proven benefits have not been shown. Clearly, our critical standpoint is not restricted to Herbalife products, but applies to synthetic drugs, herbal and complementary medicine, and to all other dietary supplements as well.

Recreational Anabolic-Androgenic Steroid Use Associated With Liver Injuries Among Brazilian Young Men

Background: The recreational use of anabolic-androgenic steroids (AAS) has reached alarming levels among healthy people. However, several complications have been related to consumption of these drugs, including liver disorders. Objective: To evaluate the prevalence of liver injuries in young Brazilian recreational AAS users. Methods: Between February/2007 and May/2012 asymptomatic bodybuilders who were ≥18 years old and reported AAS use for ≥6 months were enrolled. All had clinical evaluations, abdominal ultrasound (AUS), and blood tests. Results: 182 individuals were included in the study. The median age (interquartile range) was 26.0 years (22.0–30.0) and all were male. Elevated liver enzyme levels were observed in 38.5% (n = 70) of AAS users, and creatine phosphokinase was normal in 27.1% (n = 19) of them. Hepatic steatosis was observed by AUS in 12.1% of the sample. One individual had focal nodular hyperplasia and another had hepatocellular adenoma. One case each of hepatitis B and C virus infection was found. A diagnosis of toxic liver injury was suggested in 23 (12.6%) AAS users without a history of alcohol or other medications/drugs consumption, or evidence of other liver diseases. Conclusions/Importance: Young Brazilian recreational AAS users presented a wide spectrum of liver injuries that included hepatotoxicity, fatty liver, and liver neoplasm. They also presented risk factors for liver diseases such as alcohol consumption and hepatitis B and C virus infection. The results suggest that the risk of AAS use for the liver may be greater than the esthetic benefits, and demonstrate the importance of screening AAS users for liver injuries.

Influence of upper airway abnormalities on the control of severe asthma: a cross-sectional study

A better understanding of severe uncontrolled asthma (UA) in the upper airways is needed. The aims of this study were to assess the prevalence of upper airway abnormalities and their associations with UA.

NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH CORONARY DISEASE FROM A BRAZIL NORTHEAST AREA

Background Nonalcoholic fatty liver disease (NAFLD) is the most frequent chronic liver injury around the world. It is associated with metabolic syndrome and cardiovascular diseases. Objective To evaluate the frequency and relevance of NAFLD in patients with coronary artery disease (CAD). Methods Patients from a Brazil Northeast area, who underwent elective coronary angiography (CAG) from 2009 to 2010 were included. All of them had suspicion of CAD. Criteria to CAD: presence of obstructive lesions in the epicardial coronary arteries, or in their major branches. NAFLD criteria: presence of hepatic steatosis on ultrasound; exclusion of other liver diseases; ethanol intake ≤ 20g/day. Statistics analysis included Independent t-test, Mann-Whitney and Pearsons chi-squared test. Multivariate regression analysis measured the relationship between the risk factors and the concomitant presence of CAD and NAFLD. Results A total of 244 patients were evaluated: 63.5% had CAD and 42.2% had NAFLD. NAFLD was observed in 43.9% of the CAD patients. The regression analysis showed that the relationship between CAD and NAFLD was positively correlated with HOMA-IR ≥3.0 or insulin resistance and overweight/obesity. Conclusion NAFLD was frequent among CAD patients; insulin resistance and overweight/obesity were the most relevant risk factors related to the association NAFLD and CAD. The results suggest that patients with CAD should be evaluated for NAFLD.

Predicting One Repetition Maximum Equations Accuracy in Paralympic Rowers with Motor Disabilities

Schwingel, PA, Porto, YC, Dias, MCM, Moreira, MM, and Zoppi, CC. Predicting one repetition maximum equations accuracy in paralympic rowers with motor disabilities. J Strength Cond Res 23(3): 1045-1050, 2009-Resistance training intensity is prescribed using percentiles of the maximum strength, defined as the maximum tension generated for a muscle or muscular group. This value is found through the application of the one maximal repetition (1RM) test. One maximal repetition test demands time and still is not appropriate for some populations because of the risk it offers. In recent years, the prediction of maximal strength, through predicting equations, has been used to prevent the inconveniences of the 1RM test. The purpose of this study was to verify the accuracy of 12 1RM predicting equations for disabled rowers. Nine male paralympic rowers (7 one-leg amputated rowers and 2 cerebral paralyzed rowers; age, 30 ± 7.9 years; height, 175.1 ± 5.9 cm; weight, 69 ± 13.6 kg) performed 1RM test for lying T-bar row and flat barbell bench press exercises to determine upper-body strength and leg press exercise to determine lower-body strength. One maximal repetition test was performed, and based on submaximal repetitions loads, several linear and exponential equations models were tested with regard of their accuracy. We did not find statistical differences for lying T-bar row and bench press exercises between measured and predicted 1RM values (p = 0.84 and 0.23 for lying T-bar row and flat barbell bench press, respectively); however, leg press exercise reached a high significant difference between measured and predicted values (p < 0.01). In conclusion, rowers with motor disabilities tolerate 1RM testing procedures, and predicting 1RM equations are accurate for bench press and lying T-bar row, but not for leg press, in this kind of athlete.

Revisiting the Heterogeneous IFN-γ Response of Bacille of Calmette-Guérin (BCG)-Revaccinated Healthy Volunteers in a Randomized Controlled Trial: Effect of the Body Mass Index and of the IFNG+874 A/T Polymorphism

In trials evaluating the immune responses to Bacille of Calmette-Guérin (BCG), the genetic background and the nutritional status are host-related factors that could affect the heterogeneity in these parameters. The IFNG+874 A/T (rs 62559044) polymorphism has been reported to influence the IFN-γ production by BCG-vaccinated individuals challenged in vitro with mycobacterial antigens. The body mass index (BMI) is a proxy for the nutritional status and has been associated both with the susceptibility to tuberculosis and with the IFN-γ response. We show that although the IFNG+874 A/T polymorphism was not associated with the heterogeneity of IFN-γ production in a randomized controlled trial that evaluated long-term immune responses to BCG revaccination previously conducted in Salvador, Bahia, Brazil, the effect of this polymorphism on the observed increase in IFN-γ production among revaccinated subjects was adjusted in individuals with a low BMI.

The influence of concomitant use of alcohol, tobacco, cocaine, and anabolic steroids on lipid profiles of Brazilian recreational bodybuilders.

Anabolic-androgenic steroids (AAS) are used to enhance physical performance and/or appearance. The aim of this study was to evaluate the influence of the concomitant use of alcohol, tobacco, cocaine, and AAS on blood lipid profiles of 145 asymptomatic male bodybuilders from the Northeast region of Brazil. Interviews, clinical exams, and serological evaluations were performed on all participants between 2007 and 2009. All subjects’ self-reported use of testosterone or its derivatives, 118 individuals reported alcohol intake, 27-reported cigarette smoking, and 33 confirmed cocaine use. Four subjects were users of all drugs at the same time. Higher levels of total cholesterol and LDL-cholesterol were observed among concomitant users of alcohol, tobacco, cocaine, and AAS. The studys limitations are noted.