Telma Maria Araújo Moura Lemos

Influence of magnesium status and magnesium intake on the blood glucose control in patients with type 2 diabetes

BACKGROUND & AIMS This study was undertaken to assess magnesium intake and magnesium status in patients with type 2 diabetes, and to identify the parameters that best predict alterations in fasting glucose and plasma magnesium. METHODS A cross-sectional study was carried out in patients with type 2 diabetes (n = 51; 53.6 ± 10.5 y) selected within the inclusion factors, at the University Hospital Onofre Lopes. Magnesium intake was assessed by three 24-h recalls. Urine, plasma and erythrocytes magnesium, fasting and 2-h postprandial glucose, HbA1, microalbuminuria, proteinuria, and serum and urine creatinine were measured. RESULTS Mean magnesium intake (9.37 ± 1.76 mmol/d), urine magnesium (2.80 ± 1.51 mmol/d), plasma magnesium (0.71 ± 0.08 mmol/L) and erythrocyte magnesium (1.92 ± 0.23 mmol/L) levels were low. Seventy-seven percent of participants presented one or more magnesium status parameters below the cut-off points of 3.00 mmol/L for urine, 0.75 mmol/L for plasma and 1.65 mmol/L for erythrocytes. Subjects presented poor blood glucose control with fasting glucose of 8.1 ± 3.7 mmol/L, 2-h postprandial glucose of 11.1 ± 5.1 mmol/L, and HbA1 of 11.4 ± 3.0%. The parameters that influenced fasting glucose were urine, plasma and dietary magnesium, while plasma magnesium was influenced by creatinine clearance. CONCLUSIONS Magnesium status was influenced by kidney depuration and was altered in patients with type 2 diabetes, and magnesium showed to play an important role in blood glucose control.

Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos

FUNDAMENTO: A obesidade abdominal apresenta elevada prevalencia em mulheres com sindrome dos ovarios policisticos (SOP) e esta associada a um aumento do risco cardiovascular. OBJETIVO: Verificar a acuracia da circunferencia da cintura (CC), da relacao cintura-quadril (RCQ), da relacao cintura-estatura (RCEST) e do indice de conicidade (indice C), no que se refere a deteccao de fatores de risco cardiovascular (FRCV) em mulheres com SOP. METODOS: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnostico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerideos (TG), o LDL-colesterol (LDL-C), o HDL-colesterol (HDL-C), a glicemia de jejum, a glicemia apos teste oral de tolerância a glicose (TOTG) e a pressao arterial (PA) foram avaliados em todas as pacientes, alem das variaveis antropometricas. RESULTADOS: A relacao cintura-estatura foi o marcador que apresentou correlacoes positivas significativas com o maior numero de FRCV (PA, TG e glicemia apos TOTG), destacando-se ainda a correlacao negativa com HDL-C. Todos os marcadores antropometricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlacao positiva tambem com TG. No tocante a acuracia para deteccao de FRCV, os indicadores antropometricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. CONCLUSAO: A RCEST demonstrou ser o indicador antropometrico com a melhor acuracia para a predicao de FRCV. Nesse sentido, propoe-se a inclusao desse parâmetro de facil mensuracao na avaliacao clinica para o rastreamento de mulheres com SOP e FRCV.BACKGROUND Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. OBJECTIVE To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. METHODS The present transversal study allocated 102 women (26.5 +/- 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. RESULTS The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. CONCLUSION The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF.

Evaluation of acute and subchronic toxicity of a non-anticoagulant, but antithrombotic algal heterofucan from the Spatoglossum schröederi in Wistar rats

Fucan is a term used to denominate a family of sulfated polysaccharides rich in L-fucose. The brown alga Spatoglossum schroederi, Dictyotaceae, synthesizes three heterofucans named A, B, and C. Fucan A is a non-anticoagulant heterofucan which possesses potent antithrombotic (in vivo) and antiproliferative (in vitro) activities. However, its toxicity in vivo has not been determined. The present study examined the acute and subchronic toxicity of the fucan A in Wistar rats after subcutaneous administration. After that, the animals were killed and examined. The results showed in the acute study that fucan A did not cause general adverse effects and mortality in the concentrations 0, 20, 100, 1000, and 2000 µg/g body weight per rat for seven days. Regarding the subchronic study, the data showed that the fucan A did not cause any change in hematological and biochemistry parameters, as well as in the morphology, and in the size of the rats organs analyzed at a concentration of 20 µg/g body weight per rat during a 62-day period. In conclusion, this study indicates this heterofucan is a compound with potential pharmacological value that has no toxicity in vivo.

Analysis of heart rate variability in polycystic ovary syndrome

Objective. To compare the modulation of heart rate in a group of volunteers with polycystic ovary syndrome (PCOS) to that of a group of healthy ovulatory women on the basis of R-R interval variability and analyze the relationships between heart rate variability (HRV) and other cardiovascular risk factors. Methods. In a cross-sectional study, HRV and anthropometric, biochemical and hormonal parameters were measured in 23 women with PCOS and 23 age-matched controls. Mean outcomes measures: HRV indexes in the time (SDNN and rMSSD) and frequency domain (low frequency–LF and high frequency–HF). Differences between groups and correlation analysis were performed. Results. Intergroup analysis showed significant differences (p < 0.05) between groups, with lower SDNN, rMSSD, LF and HF indexes in PCOS women when compared to the control group. There was significant negative correlation between BMI and SDNN, LF and HF, indicating a decrease in the autonomic modulation of heart rate with increasing weight. A negative correlation was also found between the high-sensitivity C-reactive protein level and the rMSSD index. Conclusion. Our results show that PCOS is associated with alterations in the autonomic modulation of heart rate, possibly due to the influence of weight gain.

Influence of cortisol and DHEA-S on pain and other symptoms in post menopausal women with fibromyalgia

OBJECTIVE This study aims to assess cortisol and dehydroepiandrosterone sulfate (DHEA-S) levels in post-menopausal women with FMS and correlate it with pain threshold and tolerance, depression and quality of life. METHODS We conducted a cross sectional observational study of 17 women with FMS (FMS group), and 19 healthy volunteers (CT group). Algometry, the Beck Depression Index (BDI) and Fibromyalgia Impact Questionnaire (FIQ) were used. Blood samples were collected in the morning (8:00-9:30 am) to determine cortisol and DHEA-S plasmatic levels by chemiluminescence. RESULTS Significant differences between groups were recorded for pain threshold and tolerance (p< 0.0001), BDI (p< 0.0001) and all FIQ parameters (p< 0.0001). No significant differences in cortisol levels were found between the two groups (p=0.325). In the FMS group, a tangential effect was observed for DHEA-S (p=0.094) and positive correlations were found between DHEA-S, pain threshold (p=0.017) and pain tolerance (p=0.044). No correlation was observed between cortisol and DHEA-S levels and the variables of depression and quality of life for either group. CONCLUSIONS There seems to be an influence of the decreased levels of DHEA-S and increased pain sensitivity in post-menopausal women with FMS.

Evaluation of cardiovascular risk by the LAP index in non-obese patients with polycystic ovary syndrome

OBJECTIVE To analyze the cardiovascular risk of non-obese women with polycystic ovary syndrome (PCOS) by the LAP index (lipid accumulation product). SUBJECTS AND METHODS 283 patients (18-34 years) assigned at the University Hospital of the Federal University of Rio Grande do Norte, Natal-RN, were divided into four groups: 1) lean PCOS (n = 35); 2) healthy lean (n = 162); 3) overweight PCOS (n = 28); 4) healthy overweight (n = 58). RESULTS Patients with PCOS showed higher values of the LAP index than healthy controls: lean (22.26 vs. 15.87 cm.mmol/L; p = 0.007); overweight (40.83 vs. 26.32 cm.mmol/L; p = 0.001). The percentage of women above the 75th percentile of the LAP index was also higher in the subgroups with PCOS: lean (17.1 vs. 6.8%; p = 0.04); overweight (37.5 vs. 13.8%; p = 0.01). CONCLUSIONS In our sample, patients with PCOS showed higher cardiovascular risk assessed by the LAP index in relation to healthy women, even in the absence of obesity.

The impact of body mass on inflammatory markers and insulin resistance in polycystic ovary syndrome

Abstract Objective: To evaluate inflammatory markers and insulin resistance (IR) in women with and without polycystic ovary syndrome (PCOS), with different body mass index (BMI). Methods: Tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were assessed in serum samples from 40 women in reproductive age. Patients were divided into four groups: I (non-eutrophic with PCOS, n = 12), II (non-eutrophic without PCOS, n = 10), III (eutrophic with PCOS, n = 8) and IV (eutrophic without PCOS, n = 10) being non-eutrophic, the overweight and obese women with BMI > 25 kg/m2 and eutrophic women with BMI < 24.9 kg/m2. Homeostatic model assessment (HOMA-IR) was calculated for evaluation of IR. Results: PCOS patients showed increased levels of CRP (p < 0.01) and HOMA-IR (p < 0.01). When divided by BMI, both non-eutrophic and eutrophic PCOS showed increased CRP levels (p < 0.01) and HOMA-IR (p < 0.01). There were no differences in TNF-α and IL-6 levels between groups. Conclusion: In the PCOS group, the levels of CRP and IR were elevated, compared to their counterparts, regardless of body mass.

Anthropometric indices of central obesity how discriminators of metabolic syndrome in Brazilian women with polycystic ovary syndrome

Background: Central obesity is highly prevalent in women with polycystic ovary syndrome (PCOS) and is strongly associated with metabolic syndrome (MetS). Objectives: To define cut-off points of waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and conicity index (C-Index) to discriminate metabolic syndrome (MetS) in Brazilian women with PCOS. Methods: In a cross-sectional study, anthropometric, biochemical and clinical parameters were measured in 113 Brazilian PCOS women (27.2 ± 4.5 years). Receiver operating characteristic (ROC) analysis was used to find out the cut-off points of anthropometric indices to predict MetS according with National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. Results: Considering the ROC curve analysis the WC and WHtR had a similar performance in predicting MetS and these parameters were better than WHR and C-Index. The optimal cut-off values of the anthropometric indices for discriminate MetS were: WC = 95 cm; WHtR = 0.59; WHR = 0.88; and C-Index = 1.25. By using these cut-off points the sensitivity and specificity rates of WC and WHtR were higher than those observed for WHR and C-Index.Conclusion: Our results indicated that WC and WHtR are more accurate than WHR and C-Index to predict MetS in Brazilian PCOS women.

Correlação entre as queixas de incontinência urinária de esforço e o pad test de uma hora em mulheres na pós-menopausa

OBJECTIVE: to correlate complaints of stress urinary incontinence and the results of a one-hour pad test in pre- and postmenopausal women. METHODS: cross-sectional study conducted on 60 postmenopausal volunteers divided into two groups: one consisting of 34 women with involuntary loss of urine due to stress incontinence and the other consisting of 26 women without involuntary loss of urine. A control group of 15 premenopausal women with normal menstrual cycles and no urinary complaints was also used. All women underwent clinical and laboratory analysis as well as the one-hour pad test. Patients were considered to be incontinent when sanitary pad weight post-test was more than 1 g. Data were submitted to descriptive statistics, parametric ANOVA, post-hoc Tukey test and Pearsons correlation. RESULTS: all postmenopausal women presented with stress urinary incontinence during the pad test, both those with urinary loss (4 g) and with no previous loss (3.5 g). A strong correlation was observed between urinary loss and time since menopause (r=0.8; p<0.01) and body mass index (r=0.7; p=0.01). Premenopausal women were continent during the pad test (0.4 g). CONCLUSIONS: the results of the one-hour pad test showed that all postmenopausal women exhibited stress urinary incontinence, including those without urine loss on effort. Urine loss was correlated with time since menopause and body mass index.

Prevalence of α-thalassemia 3.7 kb deletion in the adult population of Rio Grande do Norte, Brazil

α-Thalassemia, arising from a defect in α-globin chain synthesis, is often caused by deletions involving one or both of the α-genes on the same allele. With the aim of investigating the prevalence of α-thalassemia 3.7 kb deletion in the adult population of Rio Grande do Norte, 713 unrelated individuals, between 18 and 59 years-of-age, were analyzed. Red blood cell indices were electronically determined, and A2 and F hemoglobins evaluated by HPLC. PCR was applied to the molecular investigation of α-thalassemia 3.7 kb deletion. Eighty (11.2%) of the 713 individuals investigated presented α-thalassemia, of which 79 (11.1%) were heterozygous (-α3.7/αα) deletions and 1 (0.1%) homozygous (-α3.7/-α3.7). Ethnically, heterozygous deletions were higher (24.8%) in Afro-Brazilians. Comparison of hematological parameters between individuals with normal genotype and those with heterozygous α+-thalassemia showed a statistically significant difference in the number of erythrocytes (p < 0.001), MCV (p < 0.001), MCH (p < 0.001) and Hb A2 (p = 0.007). This study is one of the first dedicated to investigating α-thalassemia 3.7 kb deletion in the population of the State Rio Grande do Norte state. Results obtained demonstrate the importance of investigating this condition in order to elucidate the causes of microcytosis and hypochromia.