Diabetes and covid-19: more than the sum of two morbidities

The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has caused great concern in countries with high prevalence of this morbidity, such as Brazil. This text shows the picture of diabetes in Brazil, followed by epidemiological data and explanatory hypothesis for the association between diabetes and covid-19. We emphasized how the burden of these two morbidities in a middleincome country has aggravated this pandemic scenario. The comprehension of this association and biological plausibility may help face this pandemic and future challenges

Cognitive deficit: another complication of diabetes mellitus?

As the population getting older, the chronic diseases will be more prevalent as diabetes mellitus (DM) and diseases characterized by cognitive deficits, as dementia. Studies have already shown an association between DM and cardiovascular risk factors associated with cognitive impairment. Besides the vascular complications of DM, studies have proposed the role of hyperglycemia and advanced glycosilation end products (AGEP) causing oxidative stress and β-amiloid protein brain deposition. Other factors have also been investigated, such as the role of insulinemia, genetic and IGF-1 (insulin-like growth factor-1). Some studies showed that good glucose control and intake of poli-unsaturated fat, Ômega-3 or anti-oxidative food can play a protector role against cognitive deficits. Improving knowledge about the association between DM and cognition and its physiopathology, can be essential for the prevention and treatment of cognitive impairment, leading to a beneficial impact on the quality of life of elderly patients with DM.Com o envelhecimento da população, as doenças crônicas serão mais prevalentes, como o diabetes melito (DM) e aquelas caracterizadas por disfunções cognitivas, como as demências. Alguns estudos mostraram associação do DM e outros fatores de risco cardiovascular associados a distúrbios cognitivos. Além das complicações vasculares, estudos sugerem ação da hiperglicemia e dos produtos avançados finais de glicação (PAFG) em estresse oxidativo e acúmulo de substância β-amilóide intracerebral. Outros fatores também vêm sendo investigados, como o papel da insulinemia, da genética e do IGF-1 (insulin-like growth factor-1). Estudos mostraram que o bom controle glicêmico e a ingestão de dieta rica em gordura poliinsaturada, ômega-3 ou alimentos antioxidantes podem ter papel protetor contra os déficits cognitivos. Esclarecimentos sobre a associação entre DM e cognição e sua fisiopatologia podem ser essenciais para a prevenção e o tratamento de déficits cognitivos, levando a impacto positivo sobre a qualidade de vida dos pacientes idosos com DM.Universidade Federal de São Paulo (UNIFESP) EPMUniversidade Federal de São Paulo (UNIFESP) EPM Departamento de Medicina PreventivaUNIFESP, EPM, Depto. de Medicina PreventivaSciEL

O lado saudável do consumo de bebida alcoólica

This article deals with evidences of the association of alcohol intake with health benefits, depending on the varying contents of beverages. Moderate alcohol consumptionis associated with a reduced risk of cardiovascular and cancer outcomes; and is related to the levels of ethanol and polyphenoliccompounds. Those compounds have been found to have antioxidant and anti--inflammatory properties, to favorably acton the lipoprotein status and to decreasethe expression of adhesion molecules, thusimproving insulin sensitivity and endothelial function. Resveratrol, a polyphenolfound mainly in red wine, lowers the risk ofcertain types of cancer also because of itsanti-mutagenic, anti-metastatic, growth--inhibitory and pro-apoptotic activities. However,there is still no recommendation for alcohol intake in order to reach such effects.Abordam-se evidências da associaçãodo consumo de bebidas alcoólicas com benefícios à saúde, segundo diferenças na sua composição. Efeitos benéficosdo consumo moderado na redução dorisco de doenças cardiovasculares e câncer relacionam-se ao teor de etanol e compostos polifenólicos. Estes têm sido atribuídos a propriedades antioxidantes,anti-inflamatórias, ação sobre as concentraçõesde lipoproteínas e expressão de moléculas de adesão, melhorando a sensibilidade à insulina e a função endotelial.O resveratrol, polifenol presente especialmente no vinho tinto, reduz o riscode certos cânceres também devido a ações antimutagênica, antimetastática, antiproliferativae proapoptótica; porém, aind anão há recomendação para o consumode bebida alcoólica com vistas a tal efeito

Efeitos da intervenção em hábitos alimentares e atividade física de mulheres nipo-brasileiras com elevada prevalência de síndrome metabólica, residentes em Bauru, São Paulo, Brasil

We evaluated the impact of a lifestyle intervention on the cardiometabolic risk profile of women participating in the Study on Diabetes and Associated Diseases in the Japanese-Brazilian Population in Bauru. This was a non-controlled experimental study including clinical and laboratory values at baseline and after a 1-year intervention period. 401 Japanese-Brazilian women were examined (age 60.8±11.7 years), and 365 classified for metabolic syndrome (prevalence = 50.6%). Subjects with metabolic syndrome were older than those without (63.0±10.0 vs. 56.7±11.6 years, p 5% do peso apresentaram melhor perfil que as que mantiveram ou ganharam. Programa de intervenção no estilo de vida em nipo-brasileiras de alto risco cardiometabólico, melhorou o perfil antropométrico e bioquímico, porém, se desconhece se serão duradouros, reduzindo eventos cardiovasculares em longo prazo.Universidade de São Paulo Faculdade de Saúde PúblicaUniversidade Federal de São Paulo (UNIFESP) Departamento de Medicina PreventivaUniversidade Federal de São Paulo (UNIFESP) Disciplina de EndocrinologiaUNIFESP, Depto. de Medicina PreventivaUNIFESP, Disciplina de EndocrinologiaSciEL

Prolactin does not seem to mediate the improvement on insulin resistance markers and blood glucose levels related to breastfeeding

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Strategies to decrease this risk should be strongly encouraged. Lactation has been associated, for the mother, with reduction in future T2DM risk in several studies. The mechanisms behind this phenomenon, however, are poorly understood. The aims of this study were, first, to compare blood glucose levels and markers of insulin resistance (MIR) in early postpartum women with overweight/obesity according to their breastfeeding status and, second, to evaluate whether prolactin (PRL) levels could mediate improvements in these parameters.MethodsThe prospective study followed 95 women older than 18 years from early pregnancy for up to 60 to 180 days postpartum. All participants had a BMI > 25 kg/m2 and a singleton pregnancy. At each visit, questionnaires and clinical and biochemical evaluations were performed. Participants were divided into two groups according to the breastfeeding status as “yes” for exclusive or predominant breastfeeding, and “no” for not breastfeeding.ResultsBreastfeeding women (n = 44) had significantly higher PRL levels [47.8 (29.6–88.2) vs. 20.0 (12.0–33.8), p< 0.001]. They also had significantly lower fasting blood glucose levels [89.0 (8.0) vs. 93.9 (12.6) mg/dl, p = 0.04], triglycerides (TG) [92.2 (37.9) vs. 122.4 (64.4) mg/dl, p = 0.01], TG/HDL ratio [1.8 (0.8) vs. 2.4 (1.6) mg/dl, p = 0.02], TyG index [8.24 (0.4) vs. 8.52 (0.53), p = 0.005], fasting serum insulin [8.9 (6.3–11.6) vs. 11.4 (7.7–17.0), p = 0.048], and HOMA-IR [2.0 (1.3–2.7) vs. 2.6 (1.6–3.9), p = 0.025] in the postpartum period compared to the non-breastfeeding group. Groups were homogeneous in relation to prevalence of GDM, pre-gestational BMI, as well as daily caloric intake, physical activity, and weight loss at postpartum. Linear regression analysis with adjustments for confounders showed a statistically significant association of breastfeeding with fasting blood glucose [−6.37 (−10.91 to −1.83), p = 0.006], HOMA-IR [−0.27 (−0.51 to −0.04), p = 0.024], TyG index [−0.04 (−0.06 to −0.02), p = 0.001], and TG/HDL ratio [−0.25 (−0.48 to −0.01), p = 0.038]. Mediation analysis showed that PRL did not mediate these effects. Sensitivity analyses considering different cutoffs for PRL levels also did not show modification effect in the mediation analyses.ConclusionBreastfeeding was associated with improvement in glucose metabolism and MIR 60 to 180 days after birth in overweight and obese women, even when adjusted for confounders. PRL levels were not found to mediate the association between breastfeeding and improvement in MIR

Intervenção comportamental em nipo-brasileiros com alto risco cardiometabólico

OBJETIVO: Evaluar el efecto de programa de promoción de salud en el perfil de riesgo cardiometabólico de nipón-brasileños. MÉTODOS: Un total de 466 participantes en estudio de prevalencia de diabetes en Bauru, Sudeste de Brasil, en el año 2000 completaron un programa de intervención de un año (2005-2006) basado en consejos sobre dieta saludable y práctica de actividad física. Alteraciones en presión arterial y parámetros metabólicos entre 2005 y 2006 se compararon con alteraciones anuales en esas mismas variables entre 2000 y 2005. RESULTADOS: Durante la intervención, se observaron mayores reducciones anuales promedio (dp) en la circunferencia de la cintura [-0,5(3,8) vs. 1,2(1,2) cm/año, pOBJECTIVE: To assess the effect of a health promotion program on cardiometabolic risk profile in Japanese-Brazilians. METHODS: A total of 466 subjects from a study on diabetes prevalence conducted in the city of Bauru, southeastern Brazil, in 2000 completed a 1-year intervention program (2005-2006) based on healthy diet counseling and physical activity. Changes in blood pressure and metabolic parameters in the 2005-2006 period were compared with annual changes in these same variables in the 2000-2005 period. RESULTS: During the intervention, there were greater annual reductions in mean (SD) waist circumference [-0.5(3.8) vs. 1.2(1.2) cm per year, pOBJETIVO: Avaliar o efeito do programa de promoção de saúde no perfil de risco cardiometabólico de nipobrasileiros. MÉTODOS: Um total de 466 participantes de estudo de prevalência de diabetes em Bauru, SP, no ano de 2000 completou um programa de intervenção de um ano (2005-2006) baseado em aconselhamento sobre dieta saudável e prática de atividade física. Alterações em pressão arterial e parâmetros metabólicos entre 2005 e 2006 foram comparados com alterações anuais nessas mesmas variáveis entre 2000 e 2005. RESULTADOS: Durante a intervenção, foram observadas maiores reduções anuais médias (dp) na circunferência da cintura [-0,5(3,8) vs. 1,2(1,2) cm/ano, p < 0,001], pressão arterial sistólica [-4,6(17,9) vs. 1,8(4,3) mmHg/ano, p < 0,001], glicemia 2h pós-sobrecarga de glicose [-1,2(2,1) vs. -0,2(0,6) mmol/L/ano, p < 0,001], LDL-c [-0,3(0,9) vs. -0,1(0,2) mmol/L/ano, p < 0,001] e escore de Framingham [-0,25(3,03) vs. 0,11(0,66)/por ano, p = 0,02], mas não em triglicérides [0,2(1,6) vs. 0,1(0,42) mmol/L/ano, p < 0,001] e insulinemia de jejum [1,2(5,8) vs. -0,7(2,2) UI/mL/ano, p < 0,001], comparado com o período pré-intervenção. Ocorreram reduções significativas na prevalência de glicemia de jejum alterada e tolerância à glicose diminuída após um ano de intervenção (de 58,4% para 35,4%, p < 0,001; e de 30,1% para 21,7%, p = 0,004, respectivamente). CONCLUSÕES: O programa de intervenção de um ano em hábitos de vida traz benefícios ao perfil de risco cardiometabólico em indivíduos nipobrasileiros de alto risco

The association of diabetes, subclinical hypothyroidism and carotid intima-media thickness: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil)

Introduction: The association of diabetes with subclinical thyroid diseases may increase the risk of cardiovascular diseases. We analyzed the association of subclinical hypothyroidism, diabetes, and both diseases with carotid Intima-Media Thickness (cIMT) as a surrogate maker for early cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: Cross-sectional analysis with data from the 3rd visit (2017‒2019). Linear regression models were used to evaluate the association of subclinical hypothyroidism, diabetes and of both diseases with a cIMT presented as Beta (95% Confidence Interval ‒ 95% CI) without adjustment, with adjustment for sociodemographic variables (Model 1) and multivariable adjustment (Model 1 more cardiovascular risk factors). We also used logistic regression models to analyze the Odds Ratio (OR) and 95% CI for the association of both diseases using cIMT &gt; P75%. Results: After the exclusion of patients with previous cardiovascular disease, 5,077 participants with no diseases, 1578 with diabetes, 662 with subclinical hypothyroidism, and 234 with both diseases were included in the analysis. Linear regression models showed an association of cIMT with only diabetes (β&nbsp;=&nbsp;0.019; 95% CI 0.012 to 0.027; p &lt; 0.0001) and subclinical hypothyroidism more diabetes (β&nbsp;=&nbsp;0.03; 95% CI 0.010‒0.047, p &lt; 0.0001). The logistic regression model reported an association between diabetes and CIMT higher than P75% (OR&nbsp;=&nbsp;1.49, 95% CI 1.30‒1.71). No interaction between diabetes and subclinical hypothyroidism was detected using cIMT respectively as a continuous (p&nbsp;=&nbsp;0.29) or as a categorical variable (p&nbsp;=&nbsp;0.92). Discussion: Diabetes was associated with higher cIMT values. However, no additive effect of subclinical hypothyroidism associated with diabetes over cIMT was detected