A systematic review of telemedicine interventions for type 2 diabetes patients

Telemedicine is the use of telecommunications to support health care services and it incorporates a wide range of technology and devices. This systematic review seeks to determine which types of telemedicine technologies have been the most effective at improving the major health factors of subjects with type 2 diabetes. The major health factors identified were blood glucose, systolic and diastolic blood pressure, LDL cholesterol, weight, BMI, triglyceride levels, and waist circumference. A literature search was performed using peer reviewed, scholarly articles focused on the health outcomes of type 2 diabetes patients served by various telemedicine interventions. A total of 15 articles met the search criteria and were then analyzed to determine the significant health outcomes of each telemedicine interventions for type 2 diabetes patients. Results showed that telemedicine interventions using videoconferencing technology resulted in significant improvements in five health factor outcomes (total body weight, BMI, blood glucose, LDL cholesterol, and blood pressure), while telemedicine interventions using web applications and health monitors/modems only produced significant improvements in blood glucose. Future research should focus on examining the costs and benefits of videoconferencing and other telemedicine technologies for type 2 diabetes patients.^

Evaluation of a wellness program at a large private sector petrochemical company in Texas

The study purpose was to analyze the effects Integrated Health Solutions (IHS), an employee wellness program that has been implemented for one year on the corporate campus of a major private sector petrochemical company in Houston, TX, has on employee health. ^ Chronic diseases are the leading causes of morbidity and mortality in the United States and are the most preventable of all health problems. The costs of chronic diseases in the working-age adult population include not only health problems and a decrease in quality of life, but also an increase the cost of health care and costs to businesses and employers, both directly and indirectly. These emerging costs to employers as well as the fact that adults now spend the majority of waking hours at the office have increased the interest in worksite health promotion programs that address many of the behavioral factors that lead to chronic conditions. Therefore, implementing and evaluating programs that are aimed at promoting health and decreasing the prevalence of chronic diseases at worksites is very important. ^ Data came from existing data that were collected by IHS staff during employee biometric screenings at the company in 2010 and 2011. Data from employees who participated in screenings in both 2010 and 2011 were grouped into a cohort by IHS staff. ^ One-tailed t-tests were conducted to determine if there were significant improvements in the biometric measures of body fat percentage, BMI, waist circumference, systolic and diastolic blood pressures, total, HDL, and LDL cholesterol levels, triglycerides, blood glucose levels, and cardiac risk ratios. Sensitivity analysis was conducted to determine if there were differences in program outcomes when stratified by age, gender, job type, and time between screenings. ^ Mean differences for the variables from 2010 to 2011 were small and not always in the desired direction for health improvement indicators. Through conducting t-tests, it was found that there were significant improvements in HDL, cardiac risk ratio, and glucose levels. There were significant increases in cholesterol, LDL, and diastolic blood pressures. For the IHS program, it appears that gender, job type, and time between screenings were possible modifiers of program effectiveness. When program outcome measures were stratified by these factors, results suggest that corporate employees had better outcomes than field employees, males had better outcomes overall than females, and more positive program effects were seen for employees with less time between their two screenings. ^ Recommendations for the program based on the results include ensuring validity of instruments and initial and periodic training of measurement procedures and equipment handling, using normative data or benchmarks to decrease chances for biased estimates of program effectiveness, measuring behaviors as well as biometric and physiologic statuses and changes, and collecting level of engagement data.^

The effects of omega -3 fatty acid -enriched fish on C -reactive protein levels in postmenopausal women

Coronary heart disease (CHD) is the leading cause of death in women and rates markedly increase among women after 65 years of age. C-reactive protein (CRP) is a new clinical indicator of atherosclerotic-related inflammation with a direct pathogenic role. Studies show lifestyle factors can modulate CRP. Omega-3 fatty acids have anti-inflammatory properties and studies suggest that eating fish high in omega-3 fatty acids may lower CHD risk in women. This study sought to assess the possible role of omega-3 fatty acids in the reduction of CHD-related inflammation by investigating the effect of fish consumption on CRP levels. Methods. Twenty-four healthy postmenopausal women were randomly assigned to a fish group (usual diet plus two servings per week of enriched fish) or control group (usual diet with no fatty fish) for eight weeks. Omega-3 fatty acid-enriched fish developed by the West Virginia University Aquaculture Division was used. Serum CRP, serum interleukin-6 (IL-6), and the fatty acid content of red blood cells (RBC) were measured before and after the study. Women also completed food records. RESULTS: Baseline levels of CRP were low (85% of the fish group had normal levels) and few changes in CRP risk category were observed. Mean IL-6 levels were reduced by 27% and 35% in the fish and control groups, respectively (p for between-group difference = 0.60). Changes in RBC fatty acid composition were not statistically significant. Compared to control women, women in the fish group had greater reductions in mean triglycerides (p = 0.08), total cholesterol (P = 0.04), and LDL cholesterol levels (p = 0.06). Baseline dietary intake of total and monounsaturated fatty acids tended to be positively associated with baseline CRP, while vitamin E intake was inversely related. Saturated fat intake tended to have a positive association with IL-6. Conclusions. Findings regarding the effect of two servings of fish on CRP and IL-6 levels are inconclusive due to low baseline levels of CRP and IL-6. However, results indicate two servings of fatty fish have favorable effects on blood lipids. The relationship of dietary components with CRP and IL-6 is complex and further research is needed to determine the varying roles of diet on the inflammatory process. ^

Evolution and treatment of vitamin B12 deficiency as a risk factor for (cognitive and functional) neurodegenerative diseases in institutionalized elderly = Evolución y tratamiento de la deficiencia de vitamina B12 como factor de riesgo de enfermedades neurodegenerativas (cognitivas y funcionales) en las personas mayores institucionalizadas.

Prevalence of vitamin B12 deficiency is very common in elderly people and can reach values as high as 40.5% of the population. It can be the result of the interaction among several factors. Vitamin B12 deficiencies have been associated with neurological, cognitive deterioration, haematological abnormalities and cardiovascular diseases that have an important influence on the health of the elderly and their quality of life. It is necessary to approach the problems arisen from the lack of data relative to them. The main objective of this thesis was to analyse the evolution of vitamin B12 status and related parameters, lipid and haematological profiles and their relationship to health risk factors, and to functional and cognitive status over one year and to determine the effect of an oral supplementation of 500 μg of cyanocobalamin for a short period of 28 days. An additional objective was to analyze the possible effects of medicine intakes on vitamin B status. Three studies were performed: a) a one year longitudinal follow-up with four measure points; b) an intervention study providing an oral liquid supplement of 500 μg of cyanocobalamin for a 28 days period; and c) analysis of the possible effect of medication intake on vitamin B status using the ATC classification of medicines. The participants for these studies were recruited from nursing homes for the elderly in the Region of Madrid. Sixty elders (mean age 84 _ 7y, 19 men and 41 women) were recruited for Study I and 64 elders (mean age 82 _ 7y, 24 men and 40 women) for Study II. For Study III, baseline data from the initially recruited participants of the first two studies were used. An informed consent was obtained from all participants or their mentors. The studies were approved by the Ethical Committee of the University of Granada. Blood samples were obtained at each examination date and were analyzed for serum cobalamin, holoTC, serum and RBC folate and total homocysteine according to laboratory standard procedures. The haematological parameters analyzed were haematocrit, haemoglobin and MCV. For the lipid profile TG, total cholesterol, LDL- and HDLcholesterol were analyzed. Anthropometric measures (BMI, skinfolds [triceps and subscapular], waist girth and waist to hip ratio), functional tests (hand grip, arm and leg strength tests, static balance) and MMSE were obtained or administered by trained personal. The vitamin B12 supplement of Study II was administered with breakfast and the medication intake was taken from the residents’ anamnesis. Data were analyzed by parametric and non-parametric statistics depending on the obtained data. Comparisons were done using the appropriate ANOVAs or non-parametric tests. Pearsons’ partial correlations with the variable “time” as control were used to define the association of the analyzed parameters. XIII The results showed that: A) Over one year, in relationship to vitamin B status, serum cobalamin decreased, serum folate and mean corpuscular volumen increased significantly and total homocysteine concentrations were stable. Regarding blood lipid profile, triglycerides increased and HDL-cholesterol decreased significantly. Regarding selected anthropometric measurements, waist circumference increased significantly. No significant changes were observed for the rest of parameters. B) Prevalence of hyperhomocysteinemia was high in the elderly studied, ranging from 60% to 90 % over the year depending on the cut-off used for the classification. LDL-cholesterol values were high, especially among women, and showed a tendency to increase over the year. Results of the balance test showed a deficiency and a tendency to decrease; this indicates that the population studied is at high risk for falls. Lower extremity muscular function was deficient and showed a tendency to decrease. A highly significant relationship was observed between the skinfold of the triceps and blood lipid profile. C) Low cobalamin concentrations correlated significantly with low MMSE scores in the elderly studied. No correlations were observed between vitamin B12 status and functional parameters. D) Regarding vitamin B12 status, holo-transcobalamin seems to be more sensitive for diagnosis; 5-10% of the elderly had a deficiency using serum cobalamin as a criterion, and 45-52% had a deficiency when using serum holotranscobalamin as a criterion. E) 500 μg of cyanocobalamin administered orally during 28 days significantly improved vitamin B12 status and significantly decreased total homocysteine concentrations in institutionalized elderly. No effect of the intervention was observed on functional and cognitive parameters. F) The relative change (%) of improvement of vitamin B12 status was higher when using serum holo-transcobalamin as a criterion than serum cobalamin. G) Antiaenemic drug intake normalized cobalamin, urologic drugs and corticosteroids serum folate, and psychoanaleptics holo-transcobalamin levels. Drugs treating pulmonary obstruction increased total homocysteine concentration significantly. H) The daily mean drug intake was 5.1. Fiftynine percent of the elderly took medication belonging to 5 or more different ATC groups. The most prevalent were psycholeptic (53%), antiacid (53%) and antithrombotic (47%) drugs.

Associations between macronutrient intake and serum lipid profile depend on body fat in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

The present study aimed to investigate the relationships between macronutrient intake and serum lipid profile in adolescents from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study (2006–7), and to assess the role of body fat-related variables in these associations. Weight, height, waist circumference, skinfold thicknesses, total choles- terol, HDL-cholesterol (HDL-C), LDL-cholesterol, TAG, apoB and apoA1 were measured in 454 adolescents (44 % boys) aged 12·5–17·5 years. Macronutrient intake (g/4180 kJ per d (1000 kcal per d)) was assessed using two non-consecutive 24 h dietary recalls. Associations were evaluated by multi-level analysis and adjusted for sex, age, maternal education, centre, sum of four skinfolds, moderate-to-vigorous.

Phenotypic analysis of mice expressing exclusively apolipoprotein B48 or apolipoprotein B100.

Apolipoprotein (apo)-B is found in two forms in mammals: apo-B100, which is made in the liver and the yolk sac, and apo-B48, a truncated protein made in the intestine. To provide models for understanding the physiologic purpose for the two forms of apo-B, we used targeted mutagenesis of the apo-B gene to generate mice that synthesize exclusively apo-B48 (apo-B48-only mice) and mice that synthesize exclusively apo-B100 (apo-B100-only mice). Both the apo-B48-only mice and apo-B100-only mice developed normally, were healthy, and were fertile. Thus, apo-B48 synthesis was sufficient for normal embryonic development, and the synthesis of apo-B100 in the intestines of adult mice caused no readily apparent adverse effects on intestinal function or nutrition. Compared with wild-type mice fed a chow diet, the levels of low density lipoprotein (LDL)-cholesterol and very low density lipoprotein- and LDL-triacylglycerols were lower in apo-B48-only mice and higher in the apo-B100-only mice. In the setting of apo-E-deficiency, the apo-B100-only mutation lowered cholesterol levels, consistent with the fact that apo-B100-lipoproteins can be cleared from the plasma via the LDL receptor, whereas apo-B48-lipoproteins lacking apo-E cannot. The apo-B48-only and apo-B100-only mice should prove to be valuable models for experiments designed to understand the purpose for the two forms of apo-B in mammalian metabolism.

Estudo do potencial imunomodulador de Dehidroepiandrosterona (DHEA) na inflamação intestinal experimental

As Doenças inflamatórias intestinais (DII) são multifatoriais e sua etiologia envolve susceptibilidade genética, fatores ambientais, disbiose e ativação exacerbada do sistema imunológico no intestino. Essas doenças também tem sido relacionadas a baixos níveis de dehidroepiandrosterona (DHEA), um hormônio precursor de diversos esteroides e relacionado à modulação das respostas imunes. Porém, os mecanismos precisos que relacionam as ações deste hormônio com a proteção ou susceptibilidade à doença de Crohn ou colite ulcerativa ainda não são totalmente conhecidos. Sendo assim, este projeto buscou entender o papel imunomodulador do DHEA exógeno in vitro e in vivo durante a inflamação intestinal experimental induzida por dextran sulfato de sódio (DSS) em camundongos C57BL/6. Inicialmente, in vitro, DHEA inibiu a proliferação de células do baço de forma dose dependente nas concentrações de 5?M, 50?M ou 100?M, com diminuição da produção de IFN-?. Este hormônio não foi tóxico para células de linhagem mieloide, embora tenha causado necrose em leucócitos nas doses mais elevada (50 ?M e 100?M), o que pode ter influenciado a diminuição das citocinas in vitro. Nos ensaios in vivo, os camundongos tratados com DHEA (40 mg/Kg) foram avaliados na fase de indução da doença (dia 6) e durante o reparo tecidual, quando os animais expostos ao DSS e ao DHEA por 9 dias foram mantidos na ausência destas drogas até o dia 15. Houve diminuição do escore pós-morte, melhora no peso e nos sinais clínicos da inflamação intestinal, com redução de monócitos no sangue periférico com 6 dias e aumento de neutrófilos circulantes na fase de reparo tecidual (15 dias). Ainda, a suplementação com DHEA levou à redução da celularidade da lâmina própria (LP) e ao restabelecimento do comprimento normal do intestino. O uso deste hormônio também diminuiu a expressão do RNAm de IL-6 e TGF-?, enquanto aumentou a expressão de IL-13 no colón dos animais durante a fase de indução da doença, o que provavelmente ajudou na atenuação da inflamação intestinal. Além disso, houve acúmulo de linfócitos CD4+ e CD8+ no baço e diminuição apenas de linfócitos CD4+ nos linfonodos mesentéricos (LNM), indicando retenção das células CD4+ no baço após uso do DHEA. O tratamento foi também capaz de aumentar a frequência de células CD4 produtoras de IL-4 e diminuir CD4+IFN-?+ no baço, além de reduzir a frequência de CD4+IL-17+ nos LNM, sugerindo efeito do DHEA no balanço das respostas Th1/Th2/Th17 relacionadas à colite. Em adição, as células de baço dos animais tratados com DHEA e expostos ao DSS se tornaram hiporresponsivas, como visto pela diminuição da proliferação após re-estímulos in vitro. Finalmente, DHEA foi capaz de atuar no metabolismo dos camundongos tratados, levando à diminuição de colesterol total e da fração LDL no soro durante a fase de indução da doença, sem gerar quaisquer disfunções hepáticas. Com isso, podemos concluir que o DHEA atua por meio do balanço das respostas imunes exacerbadas, minimizando os danos locais e sistêmicos causados pela inflamação intestinal induzida por DSS.

Efeito da adição de amido resistente de milho e enzimas sobre as propriedades da massa de pão e as propriedades físicas do pão de forma.

O amido resistente de milho (ARM) não é digerido em humanos fornecendo benefícios para a saúde tais como redução do colesterol, do índice glicêmico e fermentação no cólon. Porém, a substituição parcial de farinha de trigo (FT) por ARM em massa de pão resulta na diluição do glúten prejudicando a qualidade do produto. Massa de pão foi produzida com 12,5 g/100g de ARM e os efeitos das enzimas glicose-oxidase (Gox), tranglutaminase (TG) e xilanase (HE) na massa foram estudados. Massa produzida sem ARM e sem enzimas foi considerada padrão e massa produzida com ARM e sem enzimas foi considerada controle para comparação. Uma metodologia foi desenvolvida para medir o torque durante o amassamento em grande escala, utilizando um reômetro dinâmico adaptado. As propriedades reológicas foram avaliadas nos testes de medidas descritivas de textura, adesividade Chen-Hoseney, extensão uniaxial Kieffer, extensão biaxial e testes oscilatórios em reômetro. Pão produzido de acordo com as formulações padrão, controle e ótima foi avaliado com relação ao volume específico (VEP), firmeza do miolo, cor e análise sensorial para o atributo preferência. As três enzimas testadas influenciaram positivamente o torque máximo atingido durante o amassamento que variou entre (8,36 e 9,38) N m. Gox e TG apresentaram efeito positivo na altura máxima desenvolvida pela massa medida em reofermentógrafo enquanto que o efeito da HE foi negativo. Uma formulação com ARM e enzimas apresentou desempenho de panificação similar a massa padrão (altura máxima ajustada igual a (45,5 ± 3,9) mm), correspondente a adição de (4, 2,5 e 0,5) mg/100g de TG, Gox e HE respectivamente (ótima). A formulação ótima apresentou adesividade, trabalho de adesão, coesividade, dureza, resiliência, resistência à extensão e extensibilidade similares a massa padrão e diferentes da massa controle. As enzimas aumentaram o índice de strain hardening reduzido pela adição de ARM. Para o pão de forma, o VEP variou entre (3,16 e 3,64) cm3/g (diferença não significativa) e o pão produzido com a formulação ótima foi o mais escolhido como preferido. Durante o armazenamento por até 7 dias, o ARM diminuiu a taxa de envelhecimento do pão enquanto que as enzimas apresentaram efeito oposto. Em geral, a substituição parcial de FT por ARM reduziu a elasticidade da massa diminuindo a qualidade do pão enquanto que as enzimas minimizaram esse efeito.

Efeito de fontes de óleos vegetais sobre o desempenho, características de carcaça e qualidade da carne de bovinos Nelore

A inclusão de óleos vegetais na dieta de bovinos tem sido utilizada para aumentar a densidade energética da dieta, melhorar a eficiência alimentar, além de produzir carnes com a composição de ácidos graxos mais favorável à saúde humana. Objetivou-se estudar os efeitos da inclusão de óleos de soja, girassol e linhaça na dieta de bovinos, sobre o desempenho, características quantitativas de carcaça e qualitativas da carne, perfil de ácidos graxos, oxidação lipídica e formação de compostos oxidados do colesterol. Foram confinados 96 bovinos Nelore, castrados, com aproximadamente 380 kg ± 34 kg de peso inicial e idade média de 20 meses. As dietas foram compostas de 79% de concentrado e 21% de volumoso (silagem de milho) e incluídos os óleos de soja, girassol e linhaça. Os animais foram pesados e avaliadas as características de carcaça por ultrassonografia nos dias 0, 28, 56 e 81 de confinamento. Nos dias zero e 81 dias de confinamento foi coletado sangue dos bovinos para avaliação do LDL-colesterol, HDL-colesterol, VLDL-colesterol e triacilgliceróis. Ao final de 81 dias de confinamento, os animais foram abatidos e foi avaliado o pH (uma e 48 horas após o abate) e foram retiradas amostras do músculo longissimus. Foi avaliado a cor, força de cisalhamento (FC) e perdas por cocção (PPC) em carnes não maturadas e maturadas por 14 dias. Duas amostras do longissimus foram expostas por um e três dias em condições semelhantes ao varejo. Nas carnes expostas por um dia foi avaliado a cor e o pH. Nas amostras expostas por três dias foi avaliado além da cor e pH, o perfil de ácidos graxos, TBARS, colesterol e a presença do 7-cetocolesterol. Foi realizada ainda a análise sensorial e determinado a quantidade de lipídios totais das carnes. A estabilidade oxidativa dos óleos utilizados na dieta também foi avaliada. O experimento foi conduzido em delineamento de blocos casualizados, sendo o peso inicial o bloco. O desempenho e as características de carcaça avaliadas por ultrassonografia não foram influenciadas pelas fontes de óleo. Os tratamentos não influenciaram o peso de abate, o peso de carcaça quente, o pH da carcaça uma hora e 48 horas após o abate, o rendimento de carcaça, a cor, as PPC e a FC. O pH foi maior nas carnes maturadas por 14 dias (P=0,01), em relação àquelas sem maturação. As PPC e a FC foram menores (P=0,01) nas carnes maturadas por 14 dias. O óleo de linhaça apresentou menor estabilidade oxidativa seguidos do óleo de girassol e soja. As fontes de óleo não afetaram a concentração dos lipídios do plasma sanguíneo, no entanto, os níveis de VLDL, LDL, HDL, colesterol e triacilgliceróis foram maiores (P<0,01) no final do experimento em relação ao início. Não houve interação entre a espessura de gordura subcutânea (EGS) avaliada no abate e as dietas e efeito das fontes de óleo sobre os valores de TBARS, lipídios e colesterol. Não foi encontrado o 7-cetocolesterol nas carnes. O pH das carnes expostas por um e três dias sob condições de varejo, não foram influenciadas pela dieta nem pela interação da dieta e dos dias de exposição. No entanto, foi observado o efeito de tempo (P<0,01), as carnes expostas por três dias tiveram valores de pH maiores que as carnes expostas por um dia. A cor L*, a* e b* das carnes expostas em gôndola, sob condições de varejo não foi influenciado pela dieta, pelos dias de exposição e nem pela interação dos dias de exposição e dietas. Os ácidos graxos C18:1 n-9, C20:3 n-6 e C20:5 n-3 apresentaram interação entre a EGS e a dieta (P<0,05). O C18:1 cis 6 apresentou maiores concentrações (P<0,05) nas carnes provenientes dos animais alimentados com óleo de linhaça e soja, em comparação com as carnes provenientes da dieta controle. O C18:3 n-3 apresentou maiores concentrações nas carnes de animais alimentados com linhaça (P<0,05), em comparação com os demais tratamentos. O aroma e a textura da carne avaliados em análise sensorial realizada com consumidores não foram alterados pelos tratamentos. A carne dos animais alimentados com óleo de girassol resultou em maiores notas para o sabor (P<0,01), em relação à carne proveniente de animais alimentados com óleo de soja. As dietas controle e girassol resultaram em carnes mais suculentas e com maior aceitabilidade global (P<0,01), em relação ao tratamento soja. Independentemente do tipo de óleo utilizado na dieta dos animais, não houve influência no desempenho e nas características da carcaça. O óleo de linhaça proporcionou carnes com perfil de ácidos graxos mais favorável para a saúde humana, pois apresentou maiores proporções do ácido linolênico e relações ideais de n6:n3 (4,15). O uso de óleos vegetais na dieta, não prejudicou a aparência das carnes e não proporcionaram oxidação lipídica com a formação de compostos de colesterol oxidados nas carnes expostas sob condições de varejo.

Risco cardiovascular em profissionais de saúde

Enquadramento: As doenças cardiovasculares são a principal causa de morte, cuja etiologia surge da conjugação de fatores de risco, causando uma patogenia complexa. Objetivos: identificar quais os fatores de risco, em presença, nos profissionais de saúde do Centro Hospitalar Tondela-Viseu; analisar a relação das variáveis sociodemográficas (sexo e idade) com o risco cardiovascular. Métodos: Estudo quantitativo e não experimental, transversal, descritivo e correlacional. Recorreu-se ao Questionário de Nível de Risco Cardiovascular (QNRC) (Cunha & Macário, 2012). A amostragem é não probabilística por conveniência, constituída por 1000 profissionais de saúde do Centro Hospitalar Tondela-Viseu. Resultados: Amostra maioritariamente feminina (71.3%), na faixa etária dos 36-45 anos (35.8%), a exercerem em serviços médicos (40.1%), destacando-se os enfermeiros (42.7%). Quanto à presença de fatores de risco cardiovascular, 5.2% são hipertensos; 3.5% são obesos; 1.6% sofrem de doença cardíaca; 1.6% sofrem de diabetes mellitus; verificou-se a presença de história familiar de hipertensão arterial (40.6%), obesidade (7.8%), doença cardíaca (15.9%), diabetes mellitus (23.4%); 69.9% apresentavam pressão arterial normal; 37.3% relataram hábitos tabágicos; 80.7% não apresentavam situação sem riso em relação aos triglicerídeos, mas em 19.3% esse estava presente; 61.9% não revelaram risco no parâmetro colesterol total, contudo, 38.1% patenteavam; 88.8% não apresentam risco quanto ao colesterol HDL, porém, 11.2% enquadravam-se no grupo de risco face ao colesterol HDL; 64.0% não apresentam valores de colesterol LDL considerados de risco, todavia, 36.0% revelaram valores de colesterol LDL considerados de risco. Conclusão: Os resultados apontam para a realização de sessões de esclarecimento na promoção da saúde e prevenção das doenças cardiovasculares para profissionais de saúde. Palavras-chave: Fatores de Risco Cardiovascular; Profissionais de Saúde.

The effect of the dietary supplement, Chitosan, on body weight: a randomised controlled trial in 250 overweight and obese adults

CONTEXT: Chitosan, a deacetylated chitin, is a widely available dietary supplement purported to decrease body weight and serum lipids through gastrointestinal fat binding. Although evaluated in a number of trials, its efficacy remains in dispute. OBJECTIVE: To evaluate the efficacy of chitosan for weight loss in overweight and obese adults. DESIGN AND SETTING: A 24-week randomised, double-blind, placebo-controlled trial, conducted at the University of Auckland between November 2001 and December 2002. PARTICIPANTS: A total of 250 participants (82% women; mean (s.d.) body mass index, 35.5 (5.1) kg/m(2); mean age, 48 (12) y). INTERVENTIONS: Participants were randomly assigned to receive 3 g chitosan/day (n = 125) or placebo (n = 125). All participants received standardised dietary and lifestyle advice for weight loss. Adherence was monitored by capsule counts. MAIN OUTCOME MEASURES: The primary outcome measure was change in body weight. Secondary outcomes included changes in body mass index, waist circumference, body fat percentage, blood pressure, serum lipids, plasma glucose, fat-soluble vitamins, faecal fat, and health-related quality of life. RESULTS: In an intention-to-treat analysis with the last observation carried forward, the chitosan group lost more body weight than the placebo group (mean (s.e.), -0.4 (0.2) kg (0.4% loss) vs +0.2 (0.2) kg (0.2% gain), P = 0.03) during the 24-week intervention, but effects were small. Similar small changes occurred in circulating total and LDL cholesterol, and glucose (P < 0.01). There were no significant differences between groups for any of the other measured outcomes. CONCLUSION: In this 24-week trial, chitosan treatment did not result in a clinically significant loss of body weight compared with placebo.

Relationship between homocysteine and cardiorespiratory fitness is sex-dependent

Elevated plasma homocysteine is recognized as an independent risk factor for cardiovascular disease. Recently, there have been conflicting reports of the relationship between physical activity and homocysteine. A more objective measure of physical activity is cardiorespiratory fitness; however, its relationship with homocysteine has yet to be investigated. The aim of this study was to determine the relationship between cardiorespiratory fitness and plasma homocysteine. Cross-sectional associations between cardiorespiratory fitness (VO(2)max) and plasma homocysteine were examined in 49 men and 11 women. A submaximal bicycle test was used to determine VO(2)max and plasma homocysteine was measured using high performance liquid chromatography with fluorescence detection. Dietary analysis determined B vitamin intake. There was a significant inverse relationship between plasma homocysteine concentration and VO(2)max in women (r = -0.81, P = 0.003) but not in men (r = -0.09, P = 0.95). There were no significant relationships between plasma homocysteine and age, BMI, body fat, total cholesterol, and LDL cholesterol. In summary, elevated cardiorespiratory fitness is associated with decreased plasma homocysteine concentrations in women. (C) 2004 Elsevier Inc. All rights reserved.

Carotid artery intimal medial thickness, brachial artery flow-mediated vasodilation and cardiovascular risk factors in diabetic and non-diabetic indigenous Australians

Background: Indigenous Australians are at high risk for cardiovascular disease and type 2 diabetes. Carotid artery intimal medial thickness (CIMT) and brachial artery flow-mediated vasodilation (FMD) are ultrasound imaging based surrogate markers of cardiovascular risk. This study examines the relative contributions of traditional cardiovascular risk factors on CIMT and FMD in adult Indigenous Australians with and without type 2 diabetes mellitus. Method: One hundred and nineteen Indigenous Australians were recruited. Physical and biochemical markers of cardiovascular risk, together with CIMT and FMD were meausred for all subjects. Results: Fifty-three Indigenous Australians subjects (45%) had type 2 diabetes mellitus. There was a significantly greater mean CIMT in diabetic versus non-diabetic subjects (p = 0.049). In the non-diabetic group with non-parametric analyses, there were significant correlations between CIMT and: age (r = 0.64, p < 0.001), systolic blood pressure (r = 0.47, p < 0.001) and non-smokers (r = -0.30, p = 0.018). In the diabetic group, non-parametric analysis showed correlations between CIMT, age (r = 0.36, p = 0.009) and duration of diabetes (r = 0.30, p = 0.035) only. Adjusting forage, sex, smoking and history of cardiovascular disease, Hb(A1c) became the sole significant correlate of CIMT (r = 0.35,p = 0.01) in the diabetic group. In non-parametric analysis, age was the sole significant correlate of FMD (r = -0.31,p = 0.013), and only in non-diabetic subjects. Linear regression analysis showed significant associations between CIMT and age (t = 4.6,p < 0.001), systolic blood pressure (t = 2.6, p = 0.010) and Hb(A1c) (t = 2.6, p = 0.012), smoking (t = 2.1, p = 0.04) and fasting LDL-cholesterol (t = 2.1, p = 0.04). There were no significant associations between FMD and examined cardiovascular risk factors with linear regression analysis Conclusions: CIMT appears to be a useful surrogate marker of cardiovascular risk in this sample of Indigenous Australian subjects, correlating better than FMD with established cardiovascular risk factors. A lifestyle intervention programme may alleviate the burden of cardiovascular disease in Indigenous Australians by reducing central obesity, lowering blood pressure, correcting dyslipidaemia and improving glycaemic control. CIMT may prove to be a useful tool to assess efficacy of such an intervention programme. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

Inhibitors of cholesteryl ester transfer protein - a step forward in the treatment of coronary artery disease?

Although the LDL cholesterol-lowering statins have reduced the mortality and morbidity associated with coronary artery disease (CAD), considerable mortality and morbidity remains. Increasing HDL cholesterol levels is associated with reduced CAD mortality and morbidity. In healthy subjects with mild dyslipidemia, treatment with JTT-705 decreased cholesteryl ester transfer protein (CETP) activity, increased HDL cholesterol and decreased LDL cholesterol. Similarly, another CETP inhibitor, torcetrapib, has recently been shown to increase HDL cholesterol by 46%, decrease LDL cholesterol by 8% and have no effect on triglycerides in subjects with HDL cholesterol levels below 1.0 mmol/l. Increasing HDL cholesterol with inhibitors of CETP represents a new approach to dyslipidemia that requires further investigation, especially in patients with CAD.