Rebeca Antunes Beraldo

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.

Proposed ratios and cutoffs for the assessment of lipodystrophy in HIV-seropositive individuals

Objectives:To propose objective ratios using anthropometry and dual-energy X-ray absorptiometry (DXA) and to suggest cutoff points for them in order to classify lipodystrophy in male patients.Methods:It is a cross-sectional study. DXA was applied and anthropometric measurements were performed in 100 men on highly active antiretroviral therapy. Receiver operating characteristic curves were used to propose cutoffs. Individuals were divided in without (lipo−) or with (lipo+) lipodystrophy and their metabolic parameters were compared.Results:The following ratios were proposed: fat mass ratio by DXA (FMR), waist thigh ratio (WTR), waist calf ratio (WCR), and arm to trunk ratio (ATR). The best cutoffs observed for FMR, WTR and ATR were 1.26, 1.74 and 2.08, respectively. Using the proposed cutoff for FMR, we observed worse metabolic profile, with increased tryglicerides, fasting serum glucose and more hypercholesterolemia in the lipo+ group. WTR and ATR showed a significant correlation with FMR.Conclusions:Anthropometric ratios (WTR/ATR) and FMR can be used to aid the diagnosis of lipodystrophy in order to contribute to a more accurate and earlier diagnosis permitting intervention and even preventing metabolic disturbances.

Comparing the Ability of Anthropometric Indicators in Identifying Metabolic Syndrome in HIV Patients

Background Highly active antiretroviral therapy (HAART) can cause side effects in HIV patients, as the metabolic syndrome. Early identification of risk for development of cardiovascular diseases using available reliable and practical methods is fundamental. On this basis, the aim of this study was to compare the effectiveness of anthropometric indicators to identify metabolic syndrome in HIV patients on HAART. Methods It is a cross-sectional study. A number of 280 stable HIV patients were studied. It measured weight, height, waist circumference (WC), hip circumference (HP), thigh circumference (TC) and calculated body mass index (BMI), body adiposity index (BAI), waist to hip ratio (WHR) and waist to thigh ratio (WTR). There was also a performance of biochemical tests of lipid profile and fasting glucose. Systemic blood pressure was measured. The criteria proposed by the National Cholesterol Education Program III (NCEP-ATP III) to metabolic syndrome classification was used. Individuals were divided in groups with or without metabolic alterations and their anthropometric indicators were compared. Receiver operating characteristic (ROC) curves were designed for each anthropometric indicator using the metabolic syndrome classification to identify sensitivity and specificity. Results WC was a good tool to identify each metabolic disorder separately: total cholesterol (only females, p<0.05), triglycerides (only males, p<0.001), HDL cholesterol (p<0.05), LDL cholesterol (p<005) and fasting glycemic (p<005). WC also showed the best performance to identify metabolic syndrome in both genders (areas under the curve (AUCs): 0.79 and 0.76 for male and female, respectively), while BAI proved to be an inadequate indicator (AUCs: 0.63 and 0.67 for males and females), respectively, in this population. Conclusions The central adiposity measure (WC) had the best performance to identify metabolic syndrome, and it is a convenient, cheap and reliable tool that can be used in clinical practice routinely to prevent cardiovascular complications in HIV patients.

ANTHROPOMETRY AND BIOELECTRICAL IMPEDANCE ANALYSIS COMPARED TO DUAL-PHOTON ABSORPTIOMETRY FOR THE ASSESSMENT OF BODY COMPOSITION OF HIV-SEROPOSITIVE PATIENTS

Introduccion: Se ha descrito cambios en la composicion corporal de pacientes infectados por VIH, tales como la lipoatrofia en ciertas regiones del cuerpo y lipohipertrofia en otros, en representacion de las caracteristicas del sindrome de lipodistrofia. Es importante controlar la cantidad de grasa corporal por segmento utilizando metodos practicos y de bajo costo con el fin de optimizar el tratamiento de este grupo. Objetivos: correlacionar la composicion corporal por segmento corporal obtenidos por las mediciones antropometricas y por impedancia bioelectrica com DXA segmentaria en pacientes seropositivos al VIH en tratamiento antir-retroviral. Metodos: Se midieron las circunferencias de brazo, cintura, cadera, muslo y pantorrilla y los pliegues cutaneos: biceps, triceps, subescapular, suprailiaco) y se realizaron impedancia bioelectrica segmentaria (BIA) el analisis y DXA. La prueba de Pearson se utilizo para determinar las correlaciones y la prueba de San Lorenzo se utilizo para evaluar la concordancia entre las variables. Resultados: Se evaluaron 26 pacientes, 35% de los cuales tenian sobrepeso. El pliegue del triceps (PT), circunferencia de la cintura (CC) y la circunferencia del muslo (CM) se correlacionaron significativamente con la medida obtenida por el patron de oro (p <0.01). No hubo concordancia entre los valores obtenidos por BIA y DXA segmentaria. Conclusiones: Las mediciones antropometricas como PT, CC y CM son importantes para el seguimiento de los cambios en la composicion corporal de los pacientes infectados por VIH que reciben tratamiento antirretroviral. La BIA segmental no demostro ser adecuado para la evaluacion de la composicion corporal en pacientes infectados por VIH.

Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS

INTRODUCTION The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). OBJECTIVE To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. METHODS For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. RESULTS The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). CONCLUSION The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.RESUMO: Introducao: A sindrome da lipodistrofia do HIV e caracterizada por alteracoes no metabolismo e na composicao corporal, que aumentam o risco cardiovascular de pessoas vivendo com HIV/AIDS (PVHA) em uso da terapia antirretroviral de alta potencia (TARV). Objetivo: Avaliar a prevalencia de lipodistrofia e de alteracoes do metabolismo de lipidios e glicose em PVHA em uso da TARV. Metodos: Para avaliacao antropometrica foram aferidos peso, estatura e circunferencia abdominal (CA). Para avaliacao da lipodistrofia foi realizado o exame fisico (subjetivo) e o exame (objetivo) de absortometria com raios X de dupla energia (DEXA) por meio da razao de massa gorda (RMG). Foram tambem realizados exames de lipidograma e glicemia de jejum e utilizados os criterios sugeridos pelo The National Cholesterol Education Program III para classificacao de alteracoes metabolicas. Resultados: A amostra final consistiu em 262 pacientes com idade media de 44,3 ± 10,2 anos. A lipodistrofia, de acordo com o exame fisico, esteve presente em 47,7% (IC95% 41,7 - 53,8) dos pacientes, enquanto pela RMG (DEXA) sua prevalencia foi de 40,8% (IC95% 33,1 - 48,5). A maioria (53,0%; IC95% 47,0 - 59,1) dos pacientes apresentou aumento de adiposidade abdominal segundo a CA. As alteracoes metabolicas mais presentes foram o HDL reduzido (67,6%; IC95% 61,9 - 73,2) e a hipertrigliceridemia (55,7%; IC95% 49,7 - 61,7). Conclusoes: A alta prevalencia de lipodistrofia e alteracoes do metabolismo de lipidios e glicose evidenciam a importância da intervencao precoce nesse grupo de pacientes para prevenir complicacoes cardiovasculares.

Development of predictive equations for total and segmental body fat in HIV-seropositive patients

OBJECTIVES The central point of the HIV lipodystrophy syndrome is changes in body composition that mainly involve the loss of fat in the limbs and face (lipoatrophy) and/or fat gain in the abdominal region and back neck (lipohypertrophy). Currently, the determination of fat per body segment in this group can be obtained by imaging methods such as dual-energy X-ray absorptiometry (DXA) but not by methods that would be more feasible in the practical clinics. The aim of this study was to develop equations to estimate total body fat and fat in each segment using anthropometric and bioelectrical impedance analysis (BIA) variables in HIV-seropositive patients. METHODS We measured circumferences (arm, waist, hip, thigh, calf), skinfolds (biceps, triceps, subscapular, suprailiac) and conducted examinations of BIA, segmental BIA, and DXA in 100 HIV-seropositive men on highly active antiretroviral therapy. Equations were developed by linear regression from these variables to estimate total and segmental fat (arm, leg, and trunk). RESULTS We developed a model for estimation of total body fat with BIA variables and a model based on anthropometric variables. To estimate segmental fat, we developed one model for each segment using anthropometric variables. The coefficients of determination for models of total fat-free mass (BIA and anthopometry), arm fat, trunk fat, and leg fat were 0.87, 0.84, 0.66, 0.76, and 0.5, respectively. CONCLUSIONS The equations proposed in this study allow the assessment of total body fat and fat per body segment with data obtained from accessible, accurate, and reliable methods used in clinical practice.

Prevalence of overweight, obesity and metabolic syndrome in HIV-infected patients

Materials and methods We measured the weight and height and calculated body mass index (BMI). We also performed biochemical tests of lipid profile and fasting glucose. Systemic blood pressure was measured on the right side using a digital sphygmomanometer. Waist circumference was measured from the midpoint between the last rib and the iliac crest. The criteria proposed by the National Cholesterol Education Program III (NCEP-ATP III) to metabolic syndrome classification were used.

INGESTÃO ALIMENTAR, PERFIL BIOQUÍMICO E ESTADO NUTRICIONAL ENTRE VEGETARIANOS E NÃO VEGETARIANOS

Introduction: Vegetarian diets are associated with great health benefits. Objective: The aim of the present study is to compare food intake, lipid profile, blood glucose, blood pressure and anthropometry among vegetarians and non vegetarians. Patients and Methods: It was selected 20 vegetarians and 22 omnivorous. Food intake was evaluated by 24 hours recall. Lipid profile and glycemia were analyzed, also blood pressure and anthropometry (arm and waist circumferences, triceps skinfold thickness, height and weight) were measured. Results: From the vegetarian group, 75% were lacto-ovo-vegetarians; 15% were lacto-vegetarians, and 10% were vegans. Lipid profile, glycemia and blood pressure were not significantly different between groups. The vegetarian group showed a lower body mass index (23 ± 4 kg/m2) than the omnivorous group (27 ± 5 kg/m2). The vegetarian group had a higher intake of fiber and polyunsaturated fat, and lower intake of zinc, phosphorus, niacin, riboflavin than omnivorous individuals. For both groups, it was not achieved recommendations from various nutrients. Conclusion: Vegetarian had a higher intake of fiber and polyunsaturated fat and did not present lipid profile, glycemia or blood pressure alterations. However, only meat exclusion, does not necessarily reflect upon a healthy eating pattern. It depends on other factors.