Association Between Prehypertension, Metabolic And Inflammatory Markers, Decreased Adiponectin And Enhanced Insulinemia In Obese Subjects.

Obesity is associated with development of the cardiorenal metabolic syndrome, which is a constellation of risk factors, such as insulin resistance, inflammatory response, dyslipidemia, and high blood pressure that predispose affected individuals to well-characterized medical conditions such as diabetes, cardiovascular and kidney chronic disease. The study was designed to establish relationship between metabolic and inflammatory disorder, renal sodium retention and enhanced blood pressure in a group of obese subjects compared with age-matched, lean volunteers. The study was performed after 14 h overnight fast after and before OGTT in 13 lean (BMI 22.92 ± 2.03 kg/m(2)) and, 27 obese (BMI 36.15 ± 3.84 kg/m(2)) volunteers. Assessment of HOMA-IR and QUICKI index were calculated and circulating concentrations of TNF-α, IL-6 and C-reactive protein, measured by immunoassay. THE STUDY SHOWS THAT A HYPERINSULINEMIC (HI: 10.85 ± 4.09 μg/ml) subgroup of well-characterized metabolic syndrome bearers-obese subjects show higher glycemic and elevated blood pressure levels when compared to lean and normoinsulinemic (NI: 5.51 ± 1.18 μg/ml, P < 0.027) subjects. Here, the combination of hyperinsulinemia, higher HOMA-IR (HI: 2.19 ± 0.70 (n = 12) vs. LS: 0.83 ± 0.23 (n = 12) and NI: 0.98 ± 0.22 (n = 15), P < 0.0001) associated with lower QUICKI in HI obese when compared with LS and NI volunteers (P < 0.0001), suggests the occurrence of insulin resistance and a defect in insulin-stimulated peripheral action. Otherwise, the adiponectin measured in basal period was significantly enhanced in NI subjects when compared to HI groups (P < 0.04). The report also showed a similar insulin-mediated reduction of post-proximal urinary sodium excretion in lean (LS: 9.41 ± 0.68% vs. 6.38 ± 0.92%, P = 0.086), and normoinsulinemic (NI: 8.41 ± 0.72% vs. 5.66 ± 0.53%, P = 0.0025) and hyperinsulinemic obese subjects (HI: 8.82 ± 0.98% vs. 6.32 ± 0.67%, P = 0.0264), after oral glucose load, despite elevated insulinemic levels in hyperinsulinemic obeses. In conclusion, this study highlights the importance of adiponectin levels and dysfunctional inflammatory modulation associated with hyperinsulinemia and peripheral insulin resistance, high blood pressure, and renal dysfunction in a particular subgroup of obeses.112

Insulin sensitivity is not decreased in adult patients with hypopituitarism without growth hormone replacement

Decreased insulin sensitivity in patients with hypopituitarism without GH replacement (pHP-WGHR) remains conflicting in literature. It is known that these patients present a decrease in free fat mass and an increase in fat mass. Typically, these kinds of alterations in body composition are associated with a decrease in insulin sensitivity; however, there is no consensus if this association is found in pHP-WGHR. Thus, we investigated pHP-WGHR regarding insulin sensitivity by euglycemic hyperinsulinemic clamp, the gold standard method, and body composition. In a cross-sectional study, we evaluated 15 pHP-WGHR followed up in a Service of Neuroendocrinology and 15 individuals with normal pituitary function as a control group with similar age, gender and body mass index. Insulin sensitivity was evaluated by euglycemic hyperinsulinemic clamp and homeostatic model assessment insulin resistance (HOMA-IR). Kappa coefficient evaluated the agreement between these two methods. Percentage of fat mass, percentage of free fat mass, fat mass weight and free fat mass weight were assessed by electrical bioimpedance. The pHP-WGHR presented similar insulin sensitivity to control group by euglycemic hyperinsulinemic clamp, both by the M-value, (p = 0.0913) and by the area under the glucose infusion rate curve, (p = 0.0628). These patients showed lower levels of fasting glycemia (p = 0.0128), insulin (p = 0.0007), HOMA-IR (p = 0.009). HOMA-IR shows poor concordance with euglycemic hyperinsulinemic clamp (Kappa = 0.16) in pHP-WGHR, while in the control group the agreement was good (Kappa = 0.53). The pHP-WGHR presented higher values of percentage of fat mass (p = 0.0381) and lower values of percentage of free fat mass (p = 0.0464) and free fat mass weight (0.0421) than the control group. This study demonstrated that the insulin sensitivity evaluated by euglycemic hyperinsulinemic clamp in pHP-WGHR was similar to individuals with normal pituitary function, despite the pHP-WGHR presenting higher fatmass percentage. HOMA-IR was not a good method for assessing insulin sensitivity in pHP-WGHR10CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQSem informaçã

Estudo da dinamica insulinica e da secreção de cortisol em pacientes com deficiencia de glicose-6-fosfato desidrogenase

Orientador: Mario Jose Abdalla SaadTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A deficiência de G-6-PD é um erro inato do metabolismo de carboidratos em que a atividade ou estabilidade da glicose-6-fosfato desidrogenase (enzima que cataliza a reação inicial da via das pentoses-fosfato) está reduzida. Uma variedade de alterações é esperada, pois a referida enzima está presente em diferentes células e tecidos, incluindo pâncreas e o córtex da adrenal. Em nosso estudo anterior demonstramos que os portadores dessa deficiência enzimática apresentavam redução na fase rápida de secreção de insulina. No presente trabalho de pesquisa, tivemos como objetivo avaliar de forma mais precisa a secreção de insulina através da quantificação do peptídeo C plasmático após estimulo glicidico, assim como, após a L-arginina, outro estimulante da secreção de insulina, além da sensibilidade periférica à insulina. Constou dos objetivos avaliar a secreção de cortisol após estímulo com ACTH. Para tanto, foram estudados 11 individuos com deficiência de G-6-PD e 11 indivíduos controle que formaram o grupo I e foram submetidos aos testes par avaliar a função secretória da célula ß pancreática (Teste Endovenoso de Tolerância à Glicose - TETG e Teste da Arginina) e a sensibilidade periférica à insulina (Teste de Tolerdncia à Insulina - TTl). E, o grupo II composto com 12 indivíduos com deficiência de G-6-PD e 16 individuos controle que foram submetidos à estimulação das adrenais com ACTH (Teste do Cortisol). Para os dois grupos de estudo os procedimentos experimentais foram realizados após jejum de 12 -14 h. As amostras de sangue para as determinações séricos de glicose, insulina e peptideo C foram coletadas nos tempos: 0 (jejum}, 1, 3, 5, 7, 10, 30 e 60min. após a infusão de 0,5g de glicose/ Kg de peso corporal para o TETG e, 2, 3, 4, 5, 7 e 10 min. após o término da infusão de 50ml de L-arginina a 10% para o teste da arginina. A sensibilidade à insulina foi calculada pelo decaimento dos niveis séricos de glicose nos primeiros 15 min. após a infusão de 0,1 U de insulina regular humana / Kg de Peso corporal. A secreção de cortisol foi avaliada através de amostras basais de cortisol e, 30, 60 e 120 min. após infusão de 0,25mg de ACTH. Os resultados demonstram que pacientes com deficiência de G-6-PD e individuos controle apresentaram valores semelhantes de glicose plasmática durante o TETG. Os niveis séricos de insulina nos primeiros 10 min. do TETG, bem como os índices de avaliação da fase rápida de insulina foram significativamente menores nos pacientes com deficiência de G-6-PD. A quantificação do peptideo C está em concordância com esses resultados, pois os pacientes com deficiência enzimática apresentaram valores de peptideo C significativamente menores nos tempos: 1 min. (C: 3,2 ± 0,5 ng/ml X G-6-PD: 1,2 ± 0,5 ng/ml, p < 0,01); 3 min. (C: 4,5 ± 0,9 ng/ml X G-6-PD: 1,9 ± 0,4 ng/ml, p < 0,02); 5 min. (C: 4,8 ± 0,9 ng/ml X G-6-PD: 1,8 ± 0,3 ng/ml, p < 0,01); 7 min. (C: 4,1 ± 0,7 ng/ml X G-6-PD: 1,4 ± 0,3 ng/ml, p < 0,01); aos 10min. (C: 4,7 ± 1,0 ng/ml X G-6-PD: 1,5 ± 0,4 ng/ml, p < 0,01) e aos 30 min. (C: 4,3 ± 0,5 ng/ml X G-6-PD: 1,9 ± 0,5 ng/ml, p < 0,01) do T. E. T.G. Também a determinação das áreas sob as curvas de peptideo C, nos 60 min. do teste, bem como os índices de avaliação da fase rápida de secreção de insulina demonstram valores menores, estatisticamente significativos para o grupo de pacientes com deficiência de G-6-PD. A extração hepática de insulina,. após estimulo com glicose endovenosa, foi estatisticamente menor para os pacientes com deficiência de G-6-PD (C: 58,4 ± 4,1% X G-6-PD: 38,6 ± 8,8%, p < 0,05). O índice utilizado para avaliar a secreção de insulina no teste da arginna, a média dos três maiores valores nos primeiros 5 min., foi semelhante para os dois grupos quanto aos niveis de insulina, mas significativamente menor no grupo de individuos com deficiência de G-6-PD em relação ao peptideo C. A extração hepática de insulina, durante o teste da arginina, foi menor para o grupo, de portadores de deficiência de G-6-PD, embora esse resultado não tenha sido significativo. A sensibilidade periférica à insulina avaliada pela velocidade de decaimento da glicose foi semelhante nos dois grupos (C: 6,6 ± 1,0%/min. X G-6-PD: 5,56 ± 0.5%/min.). Para o grupo II, onde a secreção de cortisol foi avaliada durante a estimulação com ACTH, os niveis de cortisol plasmático foram significativamente menores nos pacientes com deficiência de G-6-PD aos 30 min. (C: 26 ± 1,2 µg/dl X G-6-PD: 21,1 ± 1,8 µg/dl, p < 0.05). No periodo restante do teste essa diferença desapareceu. A análise das áreas sob as curvas de cortisol foi semelhante nos dois grupos. Esses resultados demonstram que pacientes com deficiência de G-6-PD apresentam diminuição na secreção de insulina (fase rápida) após estimulo com glicose e L-arginina, sensibilidade periférica à insulina semelhante a de indivíduos controle e secreção de cortisol diminuida durante a primeira hora após estimulação com ACTH.Abstract: Glucose - 6 - phosphate dehydrogenase deficiency ( G-6-PD ) is an inborn error of carbohydrate metabolism in which the activity and/or stability of G-6-PD ( enzyme that catalyses the initial reaction of the pentose phosphate pathway) is decreased. Recognition that deficiency of G-6-PD also occurs in other cells, tissues and biologic fluids raises the question that some specific functional alterations might happens in the affected persons. We demonstrated in our previous study that the patients with G-6-PD deficiency showed. Decreased first phase insulin release after glucose stimulation. The aim of the present study was to investigate the insulin secretory activity of pancreatic ß-cells through the determination of the C-peptide concentration after the intravenous glucose and L-arginine stimulation, and to evaluate the insulin sensitivity. It was also a purpose of this study to investigate the cortisol levels in response to stimulation with ACTH in those patients. The study included 11 male controls and 11 patients with G-6-PD deficiency ( group I ) that were studied with intravenous infusion of glucose, L-arginine and regular human insulin (0,1 UI/Kg B.W) to evaluate the secretion and action of insulin. The group II with 16 normal subjects and 12 G-6-PD deficient patients were submited to stimulation with ACTH ( 0,25 mg corticotropin). All the tests were performed in the morning after a 12-14h overnight fast. Blood samples for glucose, insulin, and C-peptide determination were collected before and 1,3,5,7,10,30 and 60 min. after intravenous glucose infusion (0,5 g/Kg body weight) (IVTT), before and 2,3,4,5,7 and 10 min. after L-arginine infusion ( 5g as a 10% solution ). The insulin sensitivity was calculated by the glucose disappearance rate during the first 15 min. after intravenous injusion of 0,1U of human insulin/Kg B.W. The cortisol secretion was evaluated before and at 30,60 and 120 min. after 0,25 mg of ACTH infusion. In the intravenous glucose tolerance test no significant differences were demonstrated between the mean plasma glucose levels of the G-6-PD deficient patients and those of the control group. The serum insulin levels during IVGTT from G-6-PD deficient patients were significantly lower when compared to insulin levels in the normal men in the first 10 min. as the index of first phase insulin release. The serum C - peptide levels were significantly lower in the G-6-PD deficient patients than the control group at: 1,3,5,7,10 and 30 min., and as the area under the curve of C - peptide levels in IVGTI. The hepatic extraction of insulin during IVGTT were significantly lower in the patients than in the control group. The index used to evaluate insulin secretory response after arginine infusion, mean of the highest values during the first 5 min. were similar between patients and controls for insulin levels, but signiflcantly lower in G-6-PD deficient patients when we analysed C-peptide, after arginine infusion. Patients and controls showed similar hepatic extraction of insulin in the arginine test. In the group II, after stimulation with ACTH, the cortisol levels were significantly lower in the G-6-PD deficient patients than the normal men at 30 min., but this differences between the groups decreased gradually and were no statistically significant, after the first hour. The areas under the cortisol levels for the two groups were similar. These results demonstrate that the G-6-PD deficient patients showed decresead insulin secretion ( first phase ) after glucose and L-arginine stimulation, decreased hepatic insulin extraction during IVGTI, no alteration in insulin peripheral sensitivity and decreased cortisol production in the first 30 min. after corticotropin stimulation.DoutoradoDoutor em Medicin

Estudo da secreção de insulina em pacientes com deficiencia de glicose-6-fosfatodesidrogenose

Orientador: Mario Jose Abdalla SaadDissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias MedicasResumo: A deficiência de Glicose 6 Fosfato Desidrogenase (G - 6 - PD) é um erro inato do metabolismo de carboidratos em que a atividade e/ou estabilidade da G -6 PD (enzima que cataliza a reação inicial da via das pentoses -fosfato) está reduzida. Uma variedade de alterações é esperada pois a referida enzima está presente em diferentes células e tecidos incluindo o pâncreas.Objetivando investigar o papel da via das pentoses na secreção de insulinar foram estudados 12 indivíduos com deficiência de G - 6 - PD e 11 indivíduos normais (grupo controle) que após jejum de 12 - 14 horas foram submetidos aos testes oral e venoso de tolerância à glicose ¿Observação: O resumo, na íntegra poderá ser visualizado no texto completo da tese digital.Abstract: Glucose - 6 - Phosphate Dehydrogenase Deficiency (G - 6 - PD) is an inborn error of carbohydrate metabolism in which the ativity and/or stability of G- 6 - PD (enzyme that catalyses the initial reation of the pentose phosphate pathway) is decresead. Recognition that deficiency of G - 6 - PD also occurs in other cells tissues and biologic fluids of affected persons raises the question of whether and under what circunstances impairment of glucose induce insulin secretion might occur in such persons. It was the aim of the present study to investigate insulin responses during intravenous tolerance test and oral glucose tolerance test in patients with G- 6 - PD deficiency ...Note: The complete abstract is available with the full electronic digital thesis or dissertations.MestradoMestre em Medicin

Body composition, resting energy expenditure and inflammatory markers: impact in users of depot medroxyprogesterone acetate after 12 months follow-up

ABSTRACT Objective: The aim of this study was to evaluate for 12 months the changes of body weight using Depot Medroxyprogesterone Acetate (DMPA) and if these changes are related to inflammatory markers. Subjects and methods: Twenty women of childbearing age who chose the DMPA, without previous use of this method, BMI &lt; 30 kg/m², and 17 women using IUD TCu 380A, participated in the study. At the baseline and after one year, changes in weight gain, body composition by the bioimpedance electric method, resting energy expenditure (REE) by the indirect calorimetry method, inflammatory markers and HOMA-IR were assessed. Results: After 12 months of evaluation, we could observe a significant increase in the DMPA group in weight (3,01 kg) and BMI, while the IUD group&apos;s only significant increase was observed in the BMI. Relative to REE there was an increase of basal metabolic rate (BMR) in both groups after one year. The sub-group DMPA that gained &lt; 3 kg had increased significant weight, BMI and body surface (BS) with respiratory quotient (RQ) reduction, while the sub-group that gained ≥ 3 kg had a significant increase in weight, BMI, BS, fat-free mass, fat mass, BMR, Leptin, HOMA-IR and waist circumference, with RQ significantly reduced. Conclusion: Our study found significant changes in weight, body composition and metabolic profile of the population studied in the first 12 months of contraceptive use. These changes mainly increased body weight, leptin levels and HOMA-IR which can contribute to the development of some chronic complications, including obesity, insulin resistance and diabetes mellitus. Arch Endocrinol Metab. 2017;61(1):70-

Cadernos de Saúde Pública

p.7-13O aumento do uso de Medicinas Alternativas e Complementares(MAC) motivou o crescimento do número de estudos qualitativos sobre o tema, justificando a realização de sínteses sobre esse material. Este artigo apresenta uma revisão sistemática de pesquisas qualitativas sobre MAC publicadas em periódicos internacionais. Esta revisão se orientou pela metodologia dos metaestudos. Foi realizada busca em revistas do Portal Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e foram selecionados 32 artigos para análise. Os estudos revisados apresentam questões que têm como foco: o paciente, suas experiências terapêuticas e seus contextos sociais e culturais; o profissional, as relações profissionais e o processo de profissionalização das MAC; a MAC e sua relação com a biomedicina. Conclui-se que as pesquisas qualitativas sobre as MAC ensejam um olhar exploratório sobre o tema, procurando identificar as experiências de pacientes e profissionais com essas terapêuticas, assim como buscam discutir as conseqüências desse uso para a Medicina Convencional ou biomedicina.Rio de Janeir

Evidence produced by qualitative investigations on type 2 diabetes: a review of the literature

Type 2 diabetes has a major impact on patients lives and the healthcare network. Given the growth in qualitative information on diabetes, it becomes important to systematize this knowledge. A meta-study on diabetes was conducted through analysis on 42 articles that were made in journals at the periodicals portal of the Coordination Office for Advancement of Higher-level Personnel (Capes). We found that the studies reviewed had a good theoretical basis, which included: care management, health-disease concepts, professional-patient relationships, professional practices and treatment compliance. The articles clearly described the methodological procedures used. The use of interviews and focal groups for data gathering predominated, and it was sought to explore different views of the individuals investigated. It was reaffirmed that it was important for health professionals and managers to implement healthcare policies, programs and models that are appropriate for the specific features of chronic illness, guided by comprehensive care and co-responsibility

High Prevalence Of Insulin Resistance Assessed By The Glucose Clamp Technique In Hormonal And Non-hormonal Contraceptive Users.

Objective To assess the prevalence of insulin resistance (IR) and associated factors in contraceptive users. Methods A total of 47 women 18 to 40 years of age with a body mass index (kg/m(2)) 1 year of contraceptive use and higher triglyceride levels. IR was more frequent among combined oral contraceptive users, however no association was observed after regression analysis. Conclusions The prevalence of IR was high among healthy women attending a family planning clinic independent of the contraceptive method used with possible long-term negative consequences regarding their metabolic and cardiovascular health. Although an association between hormonal contraception and IR could not be found this needs further research. Family planning professionals should be proactive counselling healthy women about the importance of healthy habits.20110-