Is age a risk factor for liver disease and metabolic alterations in ataxia Telangiectasia patients?

Background: Ataxia telangiectasia (A-T) is a neurodegenerative disease that leads to mitochondrial dysfunction and oxidative stress. Insulin resistance (IR), type 2 diabetes and the risk for development of cardiovascular disease was recently associated as an extended phenotype of the disease. We aimed to assess IRliver involvementcarotid intima-media thickness (cIMT) and metabolic alterations associated to cardiovascular risk in A-T patients, and relate them with age. Results: Glucose metabolism alterations were found in 54.6% of the patients. Hepatic steatosis was diagnosed in 11/17 (64.7%) A-T patients. AST/ALT ratio > 1 was observed in 10/17 (58.8%). A strong positive correlation was observed between insulin sum concentrations with ALT (r = 0.782, p < 0.004) and age (r = 0.818, p = 0.002). Dyslipidemia was observed in 55.5% of the patients. The apolipoprotein (Apo-B)/ApoA-I ratio (r = 0.619p < 0.01), LDL/HDL-c (r = 0.490p < 0.05) and the Apo-B levels (r = 0.545p < 0.05) were positively correlated to cIMT. Conclusions: Metabolic disorders implicated in cardiovascular and liver diseases are frequently observed in adolescent A-T patients and those tend to get worse as they become older. Therefore, nutritional intervention and the use of drugs may be necessary.CAPES Foundation, Ministry of Education of Brazil, Brasilia DF, BrazilFed Univ São Paulo UNIFESP, Escola Paulista Med, Dept Pediat, Rua Otonis 725, BR-04025002 São Paulo, SP, BrazilABC Fdn FMABC, Fac Med ABC, Dept Morphol & Physiol, Santo Andre, SP, BrazilFed Univ São Paulo UNIFESP, Escola Paulista Med, Dept Diagnost Imaging, São Paulo, SP, BrazilSanta Casa São Paulo Sch Med Sci FCMSCSP, São Paulo, SP, BrazilFed Univ Alfenas UNIFAL, Sch Nutr, Alfenas, MG, BrazilFed Univ São Paulo UNIFESP, Escola Paulista Med, Dept Pediat, Rua Otonis 725, BR-04025002 São Paulo, SP, BrazilFed Univ São Paulo UNIFESP, Escola Paulista Med, Dept Diagnost Imaging, São Paulo, SP, BrazilWeb of Scienc

ASSESSING THE NUTRITIONAL CONDITION OF PREGNANT WOMEN IN THE CITY OF SANTO ANDRÉ THROUGH ROSSO’S GRAPH

A falta de vigilancia da condição nutricional da gestante durante o exame pré-natal tem dificultado intervenções adequadas no sentido de prevenir a ocorrência do baixo peso ao nascimento (BP). Foram avaliadas, prospectivamente, 95 gestantes de baixo nível sócio-econômico do Município de Santo André, para realização de exame pré-natal, utilizando-se a curva de Rosso para sua classificação nutricional. O percentual de mãe com baixo peso foi de 36,8%. As mães com mais de duas gestações apresentaram maior ocorrência de sobrepeso ou obesidade e as com menos de duas gestações, percentual significativamente maior de baixo peso. A anemia também se associou de maneira significativa às gestantes de baixo peso. O presente trabalho ressalta a importancia da implantação de instrumento na rede básica de saúde para controlar o ganho de peso da gestante, bem como da vigilancia de outros fatores de risco no intuito de reduzir os elevados percentuais de recém-nascidos com BP.The lack of monitoring ofthenutritional condition of pregnamtwomen during theprenatal exammat^lon has made it difficult for interventions aimir g at the prevention of low weight at birth (BP). 45 pregnmt women of low socio-economic levei registered m the posts of the FOUNDATION for ASSISTANCE to INFANCY (FAISA - Santo André, São Paulo) were evaluated, for accomplishment of prenatal exammation, using Rosso’s Graph for its nutritional classification. The achieved percentage of pregnantwomenwi^th low weightwas 36,8%. Mo^therswi^thmore thamtwo ges^tations and wi^th less than two presented greater occurrence of overweight obesi^ty amd low weight, respectively. Higher percentage of amemia in the pregmant women with low weight was verified. Therefore, it is evident that this instrument should be implemented as routine in ^the prenatal examinabon

Inflammatory markers, tbars and vitamin E in class II and III obese patients before undergoing bariatric surgery

Background: Obesity and its comorbidities such as insulin resistance, endothelial dysfunction, hypertension, type 2 diabetes and atherosclerosis have been associated with chronic inflammation and oxidative stress. Weight loss with maintenance is not always possible. Bariatric surgery has been proved to be the only efficient method for weight reduction in patients with clinically severe obesity. It leads to significant weight loss and improvement and/or remission of comorbidities. On the other hand, considering that surgical intervention per se induces oxidative stress and inflammatory response, the objective of the present study was to verify if some inflammatory marker, TBARS and/or Vitamin E could be evaluated before gastric surgery. Methods: a quantitative cross-sectional study was carried out at Clinica Ana Rosa (Santo André, SP, Brazil). 100 obese patients (BMI ≥ 35-40 kg/m2) awaiting bariatric surgery were selected for this study. The control group included 29 individuals, BMI &lt; 35 kg/m2, with or without associated comorbidities. The patients completed a structured interview. Weight, height, waist and hip circumferences were also collected. Blood was collected. Glucose (G), total cholesterol (TC), HDL cholesterol (HDLc), LDL cholesterol (LDLc), VLDL cholesterol (VLDLc), triglycerides (TG), high-sensitivity C-reactive protein (hs-CRP), vitamin E (VIT E), fibrinogen (FIB), IL-6 (human interleukin-6), TNF-alpha and thiobarbituric acid reactive substances (TBARS) were measured. Results: patients have shown increased serum levels of hs-CRP and FIB. In this study, class II and III obese patients awaiting bariatric surgery and the control group had lower than normal VIT E levels and no significant changes in TBARS levels were observed. Conclusions: excess weight and accumulated fat in subjects with severe obesity seem to be related to increased inflammatory response, therefore, our results reinforce the importance of evaluating inflammatory markers and VIT E in obese patients before bariatric surgery.Â

Laboratorial approach in the diagnosis of food allergy

OBJCTIVE: Review the available laboratory tests used to assist in the diagnosis of IgE-mediated and non-IgE-mediated food allergy. DATA SOURCES: Papers in English and Portuguese published in PubMed and Embase, in the last ten years. Terms searched were food allergy, diagnose and laboratory, isolated and/or associated. DATA SYNTHESIS: The diagnostic approach to food allergy reactions includes a good medical history, laboratory studies, elimination diets and blinded food challenges. More recently, the use of a quantitative measurement of food-specific IgE antibodies has been shown to be more predictive of symptomatic IgE-mediated food allergy. Food-specific IgE serum levels exceeding the diagnostic values indicate that the patient is greater than 95% likely to experience an allergic reaction if he/she ingests the specific food. Such decision point values have been defined just for some foods and inconsistent results were obtained when allergy to the same food was studied in different centers. Food challenges, in particular the double-blind placebo-controlled food challenge (DBPCFC), represent the most reliable way to establish or rule out food hypersensitivity. CONCLUSIONS: A number of recent developments are improving the predictive value of some laboratory tests for the diagnosis of food allergies. However, to date, no in-vitro or in-vivo test shows full correlation with clinical food allergy and the DBPCFC remains the gold standard for the definitive diagnosis of specific food allergies. There is an urgent need for new and fundamentally improved diagnostic approaches, which must be validated in patients with food allergy confirmed by a positive DBPCFC.OBJETIVO: Revisar os exames laboratoriais disponíveis utilizados no diagnóstico da alergia alimentar mediada ou não por IgE. FONTES DE DADOS: Artigos publicados em base de dados PubMed e Embase (língua inglesa e portuguesa) nos últimos dez anos. As palavras-chave utilizadas como fonte de busca foram alergia alimentar, diagnóstico e laboratório, isolados e/ou associados. SÍNTESE DOS DADOS: A abordagem diagnóstica das reações alérgicas a alimentos inclui história clínica completa, estudos laboratoriais, dietas de eliminação e desencadeamentos cegos com alimentos. Recentemente, a medida quantitativa de anticorpos IgE específicos a alimentos tem mostrado ser mais preditiva de alergia alimentar sintomática mediada por IgE. Níveis séricos de IgE específica a alimento que excedam os valores diagnósticos indicam que o paciente tem chance maior que 95% de apresentar uma reação alérgica se ingerir o alimento em questão. Estes valores de decisão foram definidos para alguns alimentos e resultados inconsistentes são obtidos ao se estudar diferentes populações. Os desencadeamentos com alimento, especialmente o duplo-cego controlado por placebo (DADCCP), representa a maneira mais confiável de estabelecer ou descartar o diagnóstico de hipersensibilidade alimentar. CONCLUSÕES: Número crescente de aquisições tem melhorado o valor preditivo de alguns testes laboratoriais empregados no diagnóstico de alergias alimentares. Entretanto, até hoje, não há teste in vitro ou in vivo que mostre correlação completa com a clínica da alergia alimentar. O DADCCP continua sendo o padrão-ouro no diagnóstico definitivo de alergia alimentar específica. São necessárias, urgentemente, novas abordagens diagnósticas válidadas em pacientes com alergia alimentar confirmada por DADCCP positivo.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP-EPM Departamento de PediatriaUniversidade de São Paulo Faculdade de Medicina Departamento de PediatriaUniversidade Federal da Bahia Departamento de PediatriaUNIFESP-EPMUniversidade Federal do Paraná Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM Depto. de PediatriaUNIFESP, EPMSciEL

Plasma concentrations of retinol in obese children and adolescents: relationship to metabolic syndrome components

Objective: To evaluate obese children and adolescents' retinol plasma levels and to correlate them with metabolic syndrome components. Methods: Cross-sectional study with 61 obese children and adolescents (body mass index Z score - ZBMI>+2). Pubertal development, arterial blood pressure, body weight and height for nutritional classification and waist circumference were obtained. A 15mL blood sample was collected (after a 12-hour fasting in a low luminosity room) for retinol determination (cut-off inadequate if <30µg/dL), lipid profile (HDL-c, LDL-c, and triglycerides), oral glucose tolerance test (fasting and 120 minutes) and for high sensitivity C-reactive protein. Spearman correlation and multiple linear regression were used in the statistical analysis. Results: Mean age was 10.7±2.7 years. There was a predominance of male gender 38/61 (62%) and pre-pubertal 35/61 (57%) subjects. The average plasmatic retinol was 48.5±18.6ug/dL. Retinol deficiency and severe obesity were observed in 6/61 (10%) and 36/61 (59%), respectively. Glucose level at 120 minutes was the independent and predictive variable of plasma retinol levels [β=-0.286 (95%CI -0.013 - -0.001)]. Conclusions: An independent and inverse association between plasma retinol levels and glucose tolerance was observed, suggesting an important contribution of this vitamin in the morbidities associated to obesity in children and adolescents