Thomaz Cruz

The Effect of Magnesium Supplementation in Increasing Doses on the Control of Type 2 Diabetes

OBJECTIVE Hypomagnesemia occurs in 25–38% of patients with type 2 diabetes. Several studies have suggested an association between magnesium (Mg) depletion and insulin resistance and/or reduction of insulin secretion in these cases. Our purpose was to evaluate if Mg supplementation (as magnesium oxide [MgO]) would improve metabolic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We studied 128 patients with type 2 diabetes (32 men, 96 women, aged 30–69 years), treated by diet or diet plus oral antidiabetic drugs, in the Bahia Federal University Hospital, Brazil. Patients at risk for hypomagnesemia or with reduced renal function were excluded. This study was a clinical randomized double-blind placebo-controlled trial. Patients received either placebo, 20.7 mmol MgO, or 41.4 mmol MgO daily(elementary Mg) for 30 days. Mg concentrations were measured in plasma, in mononuclear cells, and in 24-h urine samples. Fasting blood glucose, HbA1, and fructosamine were used as parameters of metabolic control. RESULTS Of the patients, 47.7% had low plasma Mg, and 31.1% had low intramononuclear Mg levels. Intracellular Mg in patients with diabetes was significantly lower than in the normal population (62 blood donors; 1.4 ± 0.6 vs. 1.7 ± 0.6 μg/mg of total proteins). No correlation was found between plasma and intracellular Mg concentrations (r = −0.179; P = 0.15) or between Mg concentrations and glycemic control (r = −0.165; P = 0.12). Intracellular Mg levels were lower in patients with peripheral neuropathy than in those without (1.2 ± 0.5 vs. 1.5 ± 0.6 μg/mg). Similar findings were observed in patients with coronary disease (1.0 ± 0.5 vs. 1.5 ± 0.6 μg/mg). In the placebo and in the 20.7 mmol Mg groups, neither a change in plasma and intracellular levels nor an improvement in glycemic control were observed. Replacement with 41.4 mmol Mg tended to increase plasma, cellular, and urine Mg and caused a significant fall (4.1 ± 0.8 to 3.8 ± 0.7 mmol/1) in fructosamine (normal, 1.87–2.87 mmol/1). CONCLUSIONS Mg depletion is common in poorly controlled patientswith type 2 diabetes, especially in those with neuropathy or coronary disease. More prolonged use of Mg in doses that are higher than usual is needed toestablish its routine or selective administration in patients with type 2 diabetes to improve control or prevent chronic complications.

Avaliação do estado nutricional de adultos e idosos e situação nutricional da população brasileira

Nutritional disorders (undernutrition and obesity) are associated to increases in morbidity and mortality. This paper consists on a review of literature with the purpose of describing the main methods of nutritional assessment, in order to facilitate the diagnosis of nutritional disorders and the follow-up of dietetics interventions. It describes the clinical method, details procedures of anthropometry and laboratory evaluation and enrolls some of the multiple indices used for diagnosis and prognosis. Information about bioelectric impedance is given. Some aspects of non-conventional methods are reminded. Nutritional status of the Brazilian population is discussed, using the analysis of data collected from three populational surveys (1974, 1989, and 1997).

Serum and intracellular magnesium deficiency in patients with metabolic syndrome—Evidences for its relation to insulin resistance

This cross sectional study evaluated serum (SMg) and intramononuclear (MMg) magnesium in patients with metabolic syndrome without diabetes and correlated them with cardiovascular risk factors. 72 patients and 57 controls (blood donors) were studied. Hypomagnesemia (SMg<1.7 mg/dL) was seen in 23.2% and intracellular depletion in 36.1% of the patients. SMg and MMg means were significantly lower in patients than in controls: 1.80+/-0.18 mg/dL vs. 2.43+/-0.43 mg/dL and 0.98+/-0.55 microg/mg vs. 1.67+/-0.64 microg/mg of protein (P<0.001). Inverse correlation was observed between, SMg and MMg with BMI; SMg with systolic blood pressure and waist circumference in women. Patients with acanthosis nigricans had lower SMg (1.75+/-0.18 mg/dL vs. 1.85+/- 0.18 mg/dL, P<0.05). Non-white people had lower SMg (1.78+/-0.16 mg/dL vs. 1.92+/-0.24 mg/dL, P=0.007) and MMg (0.95+/-0.59 microg/mg vs. 1.13+/-0.42 microg/mg, P=0.03). Patients with IR showed lower MgM means (0.84+/-0.33 microg/mg vs. 1.14+/-0.69 microg/mg, P<0.05). The same occurred in patients with low HDL-c levels (0.92+/-0.46 microg/mg vs. 1.20+/-0.70 microg/mg, P=0.03), and those with moderate and severe hepatic steatosis (0.77+/-0.29 microg/mg vs. 1.21+/-0.80 microg/mg, P<0.05). In conclusion, magnesium depletion in serum and mononuclear cells is common in obese people with metabolic syndrome, and it is more evident in non-white people with insulin resistance. This depletion may contribute to a post-receptor insulin resistance.

Tratamento do diabetes mellitus do tipo 2: novas opções

O diabetes mellitus do tipo 2 (DM2) resulta de defeitos na secrecao e acao da insulina. Ele esta frequentemente associado a resistencia a insulina, obesidade androide, dislipidemia e hipertensao arterial, constituindo a sindrome metabolica. O tratamento atual visa diminuir a resistencia a insulina e melhorar a funcao da celula beta pancreatica com dieta, exercicios, hipoglicemiantes orais, anti-hiperglicemiantes e/ou drogas anti-obesidade. Novas drogas no tratamento do DM estao surgindo, tornando possiveis multiplas opcoes terapeuticas. Este artigo apresenta uma revisao sobre o assunto.

Deficiência de magnésio e resistência à insulina em pacientes com diabetes mellitus tipo 2

Magnesium is a predominantly intracellular ion, and it is a cofactor in more than 300 enzymatic reactions, like tyrosinokinase activity. Its deficiency may increase insulin resistance, especially in patients with metabolic syndrome or type 2 diabetes. This study evaluated in 27 patients with poorly controlled type 2 diabetes if there was correlation between intracellular magnesium levels, laboratorial indexes of insulin resistance and glycemic control. Decreased serum and intracellular magnesium depletion were found in 75% and 30.8% of patients, respectively. A negative correlation between intracellular magnesium levels (ICMg) and BMI and HbA1 was found. The homeostasis model assessment for insulin resistance (HOMA-IR) was higher than 3.0 in 59.2% of patients and there was a tendency to negative correlation with ICMg levels, although without statistical significance. Despite the small number of patients, this study shows that magnesium deficiency is frequent in patients with diabetes and its correlation with insulin resistance should be more studied.

Magnesium Replacement Does Not Improve Insulin Resistance in Patients With Metabolic Syndrome: A 12-Week Randomized Double-Blind Study

Background To evaluate the effect of magnesium (Mg) replacement on insulin resistance and cardiovascular risk factors in women with metabolic syndrome (MS) without diabetes. Methods This 12-week clinical randomized double-blind study compared the effects of 400 mg/day of Mg with those of a placebo (n = 72) on fasting glucose, insulin, HOMA-IR, lipid profile and CRP. Mg was measured in serum (SMg) and in mononuclear cells (MMg). Results Hypomagnesemia (SMg < 1.7 mg/dL) was seen in 23.2% of patients and intracellular depletion in 36.1% of patients. The MMg means were lower in patients with obesity (0.94 ± 0.54 μg/mg vs. 1.19 ± 0.6 μg/mg, P = 0.04), and insulin resistance (0.84 ± 0.33 μg/mg vs. 1.14 ± 0.69 µg/mg, P < 0.05). Mg replacement did not alter SMg (1.82 ± 0.14 mg/dL vs. 1.81 ± 0.16 mg/dL, P = 0.877) and tended to increment MMg (0.90 ± 0.40 μg/mg vs. 1.21 ± 0.73 μg/mg, P = 0.089). HOMA-IR did not alter in interventions nor in placebo group (3.2 ± 2.0 to 2.8 ± 1.9, P = 0.368; 3.6 ± 1.9 to 3.2 ± 1.8, respectively), neither did other metabolic parameters. Conclusion Serum and intracellular Mg depletion is common in patients with MS; however, Mg replacement in recommended dosage did not increase significantly Mg levels, neither reduced insulin resistance or metabolic control.

Effect of oral contraceptives on vascular endothelial growth factor Cox-2 and aromatase expression in the endometrium of uteri affected by myomas and associated pathologies.

BACKGROUND The study was conducted to evaluate vascular endothelial growth factor (VEGF), Cox-2 and aromatase expression in the endometrium of uteri with myomas and other associated pathologies. STUDY DESIGN Hysteroscopy was performed in 118 women of reproductive age with myomas and menorrhagia, 40 of whom were using a pill containing 75 mcg gestodene+30 mcg ethinylestradiol. Aromatase p450, VEGF and Cox-2 expression was detected using immunohistochemistry. Fishers Exact Test and the Mann-Whitney test were used in the statistical analysis, with significance established at p<.05. RESULTS In patients with myomas and menorrhagia, associated pathologies such as adenomyosis, endometrial polyps and endometriosis were found in 32%, 12% and 17% of cases, respectively. Aromatase, Cox-2 and VEGF expression was greater during the proliferative phase compared to the luteal phase of the cycle or following oral contraceptive use. CONCLUSION Endogenous progesterone or combined oral contraceptives are potent inhibitors of VEGF, aromatase and Cox-2 expression in the endometrium of patients with myomas and menorrhagia.

Breastfeeding and maternal weight changes during 24 months post-partum: a cohort study

The relationship between breastfeeding and the loss of weight gained during pregnancy remains unclear. This study aimed to investigate the association between breastfeeding and maternal weight changes during 24 months post-partum. We studied a dynamic cohort comprising 315 women living in two cities in the state of Bahia, Brazil. The outcome variable was change in the post-partum weight; the exposure variable was the duration and intensity of breastfeeding. Demographic, socio-economic, environmental, reproductive and lifestyle factors were integrated in the analysis as covariates. The data were analysed using multiple linear regression and linear mixed-effects models. The average cumulative weight loss at 6 months post-partum was 2.561 kg (SD 4.585), increasing at 12 months (3.066 kg; SD 5.098) and decreasing at 18 months (1.993 kg; SD 5.340), being 1.353 kg (SD, 5.574) at 24 months post-partum. After adjustment, the data indicated that for every 1-point increase in breastfeeding score, the estimated average post-partum weight loss observed was 0.191 kg at 6 months (P = 0.03), 0.090 kg at 12 months (P = 0.043), 0.123 kg at 18 months (P < 0.001) and 0.077 kg at 24 months (P = 0.001). Based on these results, we concluded that despite the low expressiveness, the intensity and duration of breastfeeding was associated with post-partum weight loss at all stages of the study during the 24-month follow-up.

Prevalência de doença tireoideana em pacientes com diabetes tipo 1

INTRODUCTION: Type 1 diabetes (DM1) is frequently associated with other immune diseases, especially autoimmune thyroid disease (ATD). OBJECTIVE: To determine the prevalence of ATD in subjects with DM1 and to investigate possible association with other factors. METHODS: TSH, free T4, antiperoxydase antibody, and hemoglobin A1c were measured in 126 DM1 patients. RESULTS: ATD was found in 26 (20.6%) patients being 11 (8.7%) with overt hypothyroidism, 6 (4.8%) with subclinical hypothyroidism and 9 (7.1%) with thyroiditis without thyroid dysfunction. In one patient (0.8%), ATD (hyperthyroidism) preceded DM1. ATD was associated with current age and age at diagnosis of DM1. No associations of ATD with sex, race, duration of DM1, parity, and home place were observed. CONCLUSIONS: The prevalence of ATD in DM1 patients is high enough to justify screening and is related to current age and to the age at the diagnosis of DM1.

Determinants of postpartum weight variation in a cohort of adult women: a hierarchical approach

INTRODUCTION Retention of the weight gained during pregnancy or the weight gain postpartum has been associated with increased prevalence of obesity in women of childbearing age. OBJECTIVE To identify determinants of weight variation at 24 months postpartum in women from 2 towns in Bahia, Brazil. METHODS Dynamic cohort data of 325 adult women were collected for 24 months postpartum. Weight variation at 24 months postpartum was considered a response variable. Socioeconomic, demographic, reproductive, related with childbirth variables and lifestyle conditions were considered exposure variables. A linear mixed-effects regression model with a hierarchical approach was used for data analysis. RESULTS Suitable sanitary conditions in the household (2.175 kg; p = 0.001) and participation social programs for income transfer (1.300 kg; p = 0.018) contributed to weight gain in distal level of determinants, while at intermediate level, pre gestational overweight and surgical delivery had effects on postpartum weight, causing an average increase of 3.380 kg (p < 0.001) and loss of 2.451 kg (p < 0.001), respectively. At proximal level, a score point increase for breastfeeding yielded an average postpartum loss of 70 g (p = 0.002). CONCLUSION Our results indicate the need to promote weight control during and after pregnancy, encourage extended breastfeeding, and improve living conditions through intersectoral interventions.