Influence of pharmacotherapy complexity on compliance with the therapeutic objectives for HIV+ patients on antiretroviral treatment concomitant with therapy for dyslipidemia: INCOFAR Project

Objectives: To analyze the relationship between pharmacotherapeutical complexity and compliance of therapeutic objectives in HIV+ patients on antiretroviral treatment and concomitant dyslipidemia therapy. Materials and methods: A retrospective observational study including HIV patients on stable antiretroviral treatment during the past 6 months, and dyslipidemia treatment between January and December, 2013. The complexity index was calculated with the tool developed by McDonald et al. Other variables analyzed were: age, gender, risk factor of HIV, smoking, alcoholism and drugs, psychiatric disorders, adherence to antiretroviral treatment and lipid lowering drugs, and clinical parameters (HIV viral load, CD4 count, plasma levels of total cholesterol, LDL, HDL, and triglycerides). In order to determine the predictive factors associated with the compliance of therapeutic objectives, univariate analysis was conducted through logistical regression, followed by a multivariate analysis. Results: The study included 89 patients; 56.8% of them met the therapeutic objectives for dyslipidemia. The complexity index was significantly higher (p = 0.02) in those patients who did not reach the objective values (median 51.8 vs. 38.9). Adherence to lipid lowering treatment was significantly associated with compliance of the therapeutic objectives established for dyslipidemia treatment. A 67.0% of patients met the objectives for their antiretroviral treatment; however, the complexity index was not significantly higher (p = 0.06) in those patients who did not meet said objectives. Conclusions: Pharmacotherapeutical complexity represents a key factor in terms of achieving health objectives in HIV+ patients on treatment for dyslipidemia.

Influence of one selected Tisochrysis lutea strain rich in lipids on Crassostrea gigas larval development and biochemical composition

Effects of a remarkably high overall lipid Tisochrysis lutea strain (T+) upon gross biochemical composition, fatty acid (FA), sterol and lipid class composition of Crassostrea gigas larvae were evaluated and compared with a normal strain of Tisochrysis lutea (T) and the diatom Chaetoceros neogracile (Cg). In a first experiment, the influence of different single diets (T, T+ and Cg) and a bispecific diet (TCg) was studied, whereas, effects of monospecific diets (T and T+) and bispecific diets (TCg and T+Cg) were evaluated in a second experiment. The strain T+ was very rich in triglycerides (TAG: 93–95% of total neutral lipids), saturated FA (45%), monounsaturated FA (31–33%) and total fatty acids (4.0–4.7 pg cell−1). Larval oyster survival and growth rate were positively correlated with 18:1n-7 and 20:1n-7, in storage lipids (SL), and negatively related to 14:0, 18:1n-9, 20:1n-9, 20:4n-6 and trans-22-dehydrocholesterol in membrane lipids (ML). Surprisingly, only the essential fatty acid 20:5n-3 in SL was correlated positively with larval survival. Correlations suggest that physiological disruption by overabundance of TAG, FFA and certain fatty acids in larvae fed T+ was largely responsible for the poor performance of these larvae. ‘High-lipid’ strains of microalgae, without regard to qualitative lipid composition, do not always improve bivalve larval performance.

Adhesion molecules and chemokines: relation to anthropometric, body composition, biochemical and dietary variables

Introduction: Among the inflammatory mediators involved in the pathogenesis of obesity, the cell adhesion molecules P-selectin, E-selectin, VCAM-1, ICAM-1 and the chemokine MCP-1 stand out. They play a crucial role in adherence of cells to endothelial surfaces, in the integrity of the vascular wall and can be modulated by body composition and dietary pattern. Objectives: To describe and discuss the relation of these cell adhesion molecules and chemokines to anthropometric, body composition, dietary and biochemical markers. Methods: Papers were located using scientific databases by topic searches with no restriction on year of publication. Results: All molecules were associated positively with anthropometric markers, but controversial results were found for ICAM-1 and VCAM-1. Not only obesity, but visceral fat is more strongly correlated with E-selectin and MCP-1 levels. Weight loss influences the reduction in the levels of these molecules, except VCAM-1. The distribution of macronutrients, excessive consumption of saturated and trans fat and a Western dietary pattern are associated with increased levels. The opposite could be observed with supplementation of w-3 fatty acid, healthy dietary pattern, high calcium diet and high dairy intake. Regarding the biochemical parameters, they have inverse relation to HDLC and positive relation to total cholesterol, triglycerides, blood glucose, fasting insulin and insulin resistance. Conclusion: Normal anthropometric indicators, body composition, biochemical parameters and eating pattern positively modulate the subclinical inflammation that results from obesity by reducing the cell adhesion molecules and chemokines.

Assessments of body composition and bone parameters of lactating rats treated with diet containing flaxseed meal (Linum usitatissinum) during post-weaning period

Introduction: There are few studies on body composition and the effects of diet on weight postpartum women. The aim was to evaluate the body composition and bone parameters in lactating rats treated with diet containing flaxseed flour during postweaning period. Methods: After weaning, the lactating rat were divided in control (n = 6) and experimental (F, n = 6) group, treated with 25% flaxseed flour diet. After 30 days, body composition by dual-energy X-ray absorptiometry, serum analysis, organs and intra-abdominal fat mass, femur and lumbar vertebra parameters were determined. Results: The groups showed similar food intake, body mass and bone parameters. While F group showed the following: lower body (-5%), gonadal (-17%), mesenteric (-23%) and intra-abdominal (-6%) fat mass. Increase of HDL-cholesterol (+10%) and lower glucose (-15%), triglycerides (P < 0.05, -37%) and cholesterol (P < 0.05, -21%). Conclusions: The findings highlight the effects of flaxseed for control of adiposity and to maintain a healthy biochemical profile during the postnatal period.

Bilirubin is independently associated with oxidized LDL levels in young obese patients

BACKGROUND: Bilirubin can prevent lipid oxidation in vitro, but the association in vivo with oxidized low-density lipoprotein (Ox-LDL) levels has been poorly explored. Our aim is to the association of Ox-LDL with total bilirubin (TB) levels and with variables related with metabolic syndrome and inflammation, in young obese individuals. FINDINGS: 125 obese patients (13.4 years; 53.6% females) were studied. TB, lipid profile including Ox-LDL, markers of glucose metabolism, and levels of C-reactive protein (CRP) and adiponectin were determined. Anthropometric data was also collected. In all patients, Ox-LDL correlated positively with BMI, total cholesterol, LDLc, triglycerides (TG), CRP, glucose, insulin and HOMAIR; while inversely with TB and HDLc/Total cholesterol ratio (P < 0.05 for all). In multiple linear regression analysis, LDLc, TG, HDLc and TB levels were significantly associated with Ox-LDL (standardized Beta: 0.656, 0.293, -0.283, -0.164, respectively; P < 0.01 for all). After removing TG and HDLc from the analysis, HOMAIR was included in the regression model. In this new model, LDLc remained the best predictor of Ox-LDL levels (β = 0.665, P < 0.001), followed by TB (β = -0.202, P = 0.002) and HOMAIR (β = 0.163, P = 0.010). CONCLUSIONS: Lower bilirubin levels may contribute to increased LDL oxidation in obese children and adolescents, predisposing to increased cardiovascular risk.

Lifestyle factors, adiposity and cardiometabolic risk factors in South Asian women living in Scotland

South Asians migrating to the Western world have a 3 to 5-fold higher risk of developing type 2 diabetes and double the risk of cardiovascular disease (CVD) than the background population of White European descent, without exhibiting a proportional higher prevalence of conventional cardiometabolic risk factors. Notably, women of South Asian descent are more likely to be diagnosed with type 2 diabetes as they grow older compared with South Asian men and, in addition, they have lost the cardio-protective effects of being females. Despite South Asian women in Western countries being a high risk group for developing future type 2 diabetes and CVD, they have been largely overlooked. The aims of this thesis were to compare lifestyle factors, body composition and cardiometabolic risk factors in healthy South Asian and European women who reside in Scotland, to examine whether ethnicity modifies the associations between modifiable environmental factors and cardiometabolic risks and to assess whether vascular reactivity is altered by ethnicity or other conventional and novel CVD risks. I conducted a cross-sectional study and recruited 92 women of South Asian and 87 women of White European descent without diagnosed diabetes or CVD. Women on hormone replacement therapy or hormonal contraceptives were excluded too. Age and body mass index (BMI) did not differ between the two ethnic groups. Physical activity was assessed and with self-reported questionnaires and objectively with the use of accelerometers. Cardiorespiratory fitness was quantified with the predicted maximal oxygen uptake (VO2 max) during a submaximal test (Chester step test). Body composition was assessed with skinfolds measured at seven body sites, five body circumferences, measurement of abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) with the use of magnetic resonance imaging (MRI) and liver fat with the use MR spectroscopy. Dietary density was assessed with food frequency questionnaires. Vascular response was assessed by measuring the response to acetylcholine and sodium nitroprusside with the use of Laser Doppler Imaging with Iontophoresis (LDI-ION) and the response to shear stress with the use of Peripheral Arterial Tonometry (EndoPAT). The South Asian women exhibited a metabolic profile consistent with the insulin resistant phenotype, characterised by greater levels of fasting insulin, lower levels of high density lipoprotein (HDL) and higher levels of triglycerides (TG) compared with their European counterparts. In addition, the South Asians had greater levels of glycated haemoglobin (HbA1c) for any given level of fasting glucose. The South Asian women engaged less time weekly with moderate to vigorous physical activity (MVPA) and had lower levels of cardiorespiratory fitness for any given level of physical activity than the women of White descent. In addition, they accumulated more fat centrally for any given BMI. Notably, the South Asians had equivalent SAT with the European women but greater VAT and hepatic fat for any given BMI. Dietary density did not differ among the groups. Increasing central adiposity had the largest effect on insulin resistance in both ethic groups compared with physical inactivity or decreased cardiorespiratory fitness. Interestingly, ethnicity modified the association between central adiposity and insulin resistance index with a similar increase in central adiposity having a substantially larger effect on insulin resistance index in the South Asian women than in the Europeans. I subsequently examined whether ethnic specific thresholds are required for lifestyle modifications and demonstrated that South Asian women need to engage with MVPA for around 195 min.week-1 in order to equate their cardiometabolic risk with that of the Europeans exercising 150 min.week-1. In addition, lower thresholds of abdominal adiposity and BMI should apply for the South Asians compared with the conventional thresholds. Although the South Asians displayed an adverse metabolic profile, vascular reactivity measured with both methods did not differ among the two groups. An additional finding was that menopausal women with hot flushing of both ethnic groups showed a paradoxical vascular profile with enhanced skin perfusion (measured with LDI-ION) but decreased reactive hyperaemia index (measured with EndoPAT) compared with asymptomatic menopausal women. The latter association was independent of conventional CVD risk factors. To conclude, South Asian women without overt disease who live in Scotland display an adverse metabolic profile with steeper associations between lifestyle risk factors and adverse cardiometabolic outcomes compared with their White counterparts. Further work in exploring ethnic specific thresholds in lifestyle interventions or in disease diagnosis is warranted.

Biodiesel a partir de óleos de alta acidez: desenvolvimento de um processo catalítico homogêneo

O presente trabalho visa o desenvolvimento de um processo para a produção de biodiesel partindo de óleos de alta acidez, aplicando um processo em duas etapas de catálise homogênea. A primeira é a reação de esterificação etílica dos ácidos graxos livres, catalisada por H2SO4, ocorrendo no meio de triglicerídeos e a segunda é a transesterificação dos triglicerídeos remanescentes, ocorrendo no meio dos ésteres alquílicos da primeira etapa e catalisada com álcali (NaOH) e álcool etílico ou metílico. A reação de esterificação foi estudada com uma mistura modelo consistindo de óleo de soja neutro acidificado artificialmente com 15%p de ácido oleico PA. Este valor foi adotado, como referência, devido a certas gorduras regionais (óleo de mamona advinda de agricultura familiar, sebos de matadouro e óleo de farelo de arroz, etc.) apresentarem teores entre 10-20%p de ácidos graxos livres. Nas duas etapas o etanol é reagente e também solvente, sendo a razão molar mistura:álcool um dos parâmetros pesquisados nas relações 1:3, 1:6 e 1:9. Outros foram a temperatura 60 e 80ºC e a concentração percentual do catalisador, 0,5, 1,0 e 1,5%p, (em relação à massa de óleo). A combinatória destes parâmetros resultou em 18 reações. Dentre as condições reacionais estudadas, oito atingiram acidez aceitável inferior a 1,5%p possibilitando a definição das condições para aplicação ótima da segunda etapa. A melhor condição nesta etapa ocorreu quando a reação foi conduzida a 60°C com 1%p de H2SO4 e razão molar 1:6. No final da primeira etapa foram realizados tratamentos pertinentes como a retirada do catalisador e estudada sua influência sobre a acidez final, utilizando-se de lavagens com e sem adição de hexano, seguidas de evaporação ou adição de agente secante. Na segunda etapa estudaram-se as razões molares de óleo:álcool de 1:6 e 1:9 com álcool metílico e etílico, com 0,5 e 1%p de NaOH assim como o tratamento da reação (lavagem ou neutralização do catalisador) a 60°C, resultando em 16 experimentos. A melhor condição nesta segunda etapa ocorreu com 0,5%p de NaOH, razão molar óleo:etanol de 1:6 e somente as reações em que se aplicaram lavagens apresentaram índices de acidez adequados (<1,0%p) coerentes com os parâmetros da ANP.

Produção de biodiesel de blendas dos óleos de mamona e arroz em escala piloto

A utilização do óleo de mamona como matéria-prima para produção de biodiesel mostra-se inviável na combustão interna do motor devido sua natureza química incomum que lhe confere especificações acima do permitido nas especificações técnicas da legislação nacional brasileira. Desta forma, a blenda com óleo de arroz refinado (OM:OA) qualifica o biodiesel atendendo a legislação nacional, além de corrigir a elevada acidez do óleo bruto de mamona prejudicial ao processo de transesterificação homogênea básica. No presente estudo realizou-se a produção de biodiesel etílico em escala piloto a partir de blendas de óleo bruto de mamona e óleo refinado de arroz em dois processos: o primeiro processo adotando a mistura direta dos dois óleos e o segundo processo pela esterificação antecipada do óleo bruto de mamona. Ambos os processos foram aplicados visando tanto definir os critérios de processo (acidez inicial) quanto o cumprimento das especificações técnicas (viscosidade e densidade). A produção em escala piloto (200 litros/batelada) foi realizada na Usina Demonstrativa para Produção de Biodiesel – BIOSUL (Edital FINEP, 2005) da Universidade Federal do Rio Grande - FURG utilizando em ambos os processos transesterificação, com hidróxido de sódio, e esterificação com ácido sulfúrico. Os processos apresentaram resultados satisfatórios, sendo o processo de mistura direta (Processo A) o que obteve melhores rendimentos (94,04%, blenda 20:80) enquanto que o processo de pré- esterificação (Processo B) foi aquele que proporcionou a maior fração de óleo de mamona na blenda (80,36%, 33:67). Os resultados para o Processo A de glicerol livre, monoacilgliceróis, diacilgliceróis, triacilgliceróis e de glicerol total foram, respectivamente, de 1,322 %, 6,092 %, 1,000 %, 0,884 e 3,152%. Neste estudo foi comprovada a viabilidade do processamento, em batelada, de blendas dos óleos de mamona e arroz. O óleo de mamona bruto pode ser utilizado em até 30% produzindo biodiesel dentro da legislação, verificando-se assim a viabilidade do uso da mamona na produção de biocombustíveis.

Síntese e caracterização de biodiesel metílico e etílico a partir de blendas dos óleos de tungue e de soja

No presente trabalho foi investigada a transesterificação de blendas dos óleos de soja e de tungue com metanol ou etanol empregando catalisador alcalino (NaOH ou KOH). Foi investigado o tempo reacional, a proporção da blenda, a concentração e o tipo de catalisador, tipo de álcool e razão molar, temperatura e metodologia empregada no tratamento da reação. Nas reações com metanol obtiveram-se melhores conversões com tempo reacional de 1,5h; temperatura de 60°C; proporção blenda dos óleos de soja e de tungue de 90:10 (m/m); concentração de NaOH de 0,5% em relação a massa da blenda e razão molar metanol:blenda de 6:1. O tratamento dos ésteres metílicos produzidos na reação foi realizado por lavagem com água a 60°C após o processo de decantação das fases, metodologia C. O rendimento de ésteres metílicos foi superior a 96% e, o teor de mono-, di- e triacilglicerídeos, glicerol livre e total ficou abaixo dos limites estabelecidos pela ANP, indicando boa conversão (> 96,5%). Nas reações com etanol verificou-se que as melhores condições reacionais foram com uma concentração de catalisador de 0,8% de NaOH em relação a massa da blenda, razão molar etanol:blenda de 9:1, tempo de 1,5h e temperatura de 60°C. O tratamento dos produtos da reação foi realizado por lavagem com água a 60°C após o processo de remoção do etanol e decantação das fases, metodologia D. A concentração do catalisador foi um fator determinante na separação das fases. Uma maior concentração de catalisador favorece a saponificação, dificultando a separação das fases e afetando o rendimento do biodiesel sintetizado, tanto para o metílico quanto o etílico. O índice de acidez, tanto para o biodiesel metílico como o etílico, para qualquer proporção da blenda dos óleos de soja e tungue, ficaram dentro das normas da ANP, com valores abaixo de 0,5 mg.g-1 de KOH.

Determinação simultânea de Glicerol livre e total, MONO-, DI e triglicerídeos em biodiesel etílico de girassol, mamona e da mistura de sebo e soja empregando GC-FID

O biodiesel produzido para ser comercializado no Brasil deve estar de acordo aos padrões de qualidade estabelecidos pela resolução de 4 de fevereiro de 2010 da Agência Nacional do Petróleo, Gás Natural e do Biocombustível (ANP, 04/2010). Neste trabalho, foi estudada a aplicação dos métodos ASTM D 6584 e EN 14105 para o biodiesel de mamona e biodiesel oriundo de rota etílica. Ambos os métodos empregam GC (Cromatografia Gasosa, do inglês Gas Chromatography) com FID (Detecção por Ionização em Chama, do inglês Flame Ionization Detection) e reação de sililação com N-metil-N-(trimetilsilil)trifluoracetamida (MSTFA). Os compostos foram identificados para quantificação pelos tempos de retenção, para os diglicerídeos e triglicerídeos foram utilizadas bandas de tempo de retenção. Os parâmetros de validação considerados foram: curva analítica, linearidade, sensibilidade, robustez, precisão e exatidão. Os métodos ASTM D 6584 e EN 14105 apresentaram sensibilidade semelhante para todos os compostos. Foram escolhidas as condições cromatográficas estabelecidas pelo método ASTM D 6584 por ser mais rápido que o EN14105 e ter sensibilidade semelhante. O método apresentou boa linearidade com todas as curvas analíticas com r maiores que 0,999. A reação de sililação com MSTFA foi otimizada para o biodiesel etílico de mamona em virtude da sua composição química. Um volume de 500 μL de MSTFA foi escolhido para realização dos ensaios de exatidão e precisão. Os valores de exatidão ficaram entre 67 e 145,9% com valores de precisão menores que 11%. Foi avaliada a ocorrência de efeito matriz para biodiesel etílico de mamona, sendo que esse efeito foi considerado baixo para glicerol, monooleína e dioleína e médio para trioleína. Mesmo havendo efeito de matriz o preparo das curvas analíticas em solvente conforme sugerido pelos métodos de referência foi mantido. O método foi robusto frente às variações da composição química da matriz. Na aplicação do método, esse se mostrou adequado para amostras de biodiesel etílico de mamona, de girassol e da mistura de sebo e soja.

Risco metabólico em crianças de 7 a 12 anos

Introdução – A frequência de dislipidemia em crianças e adolescentes tem vindo a aumentar rapidamente nos últimos anos, estando o seu aparecimento associado a fatores genéticos e ambientais. Este indicador, associado a outras doenças como a obesidade, constituem a síndrome metabólica e são considerados fatores de risco para doença cardiovascular e diabetes, que quando presentes na infância podem conduzir precocemente ao aparecimento destas doenças. Objetivos – Avaliar o perfil de indicadores de saúde de crianças no início de um Programa de Educação Contínua; Verificar os efeitos do Programa de Educação Contínua aplicado durante 36 meses (ginástica funcional, brincadeiras de rua e das aulas de natação), sobre os resultados dos exames iniciais de colesterol, triglicerídeos e do IMC. Métodos - Estudo quantitativo, exploratório e descritivo de corte transversal, realizado entre 2012 e 2015 numa amostra não probabilística por conveniência de 165 crianças, 70,0% da população-alvo. As crianças tinham entre 7 a 12 anos de idade, 40,59% entre 11 e 12 anos e 54% eram do sexo feminino. Eram beneficiárias de um plano de saúde que integrava um programa de intervenção (educação contínua e atividade física), designado Crescendo com Saúde e foram selecionadas através de critérios, como: dislipidemia (colesterol total e/ou triglicerídeos elevados), sobrepeso e/ou obesidade, e história familiar de HAS e DM. Os dados clínicos foram obtidos na consulta de enfermagem, utilizando-se a recolha de sangue para dosemanento do perfil lipídico no início do programa e a cada 6 meses e avaliação do IMC na fase inicial do programa e semanalmente. Para classificação do estado nutricional foram utilizados os pontos de corte da OMS (2007). Resultados – no início do programa 69% das crianças apresentavam hipercolesterolémia, 32% aumento do colesterol, 45% tinham excesso de peso (sobrepeso e obesidade) e 12% risco de sobrepeso. Após o programa de intervenção, das 53% crianças que participaram de forma regular, 29% apresentaram redução do colesterol, 16% dos triglicerídeos e o excesso de peso reduziu em 9%, aumentando contudo o risco de sobrepeso para 22%. Das que participaram de forma irregular, apenas 3% reduziram o perfil lipídico e 1% o estado nutricional. Conclusões – O programa de intervenção permitiu uma redução dos fatores de risco de doença metabólica e permitiu melhorar os hábitos das crianças estudadas e suas famílias. Estes resultados comprovam a eficácia a curto e médio prazo dos programas de intervenção na comunidade, e realçam o papel das intervenções preventivas de educação contínua e de atividade física regular, para o processo de redução dos indicadores de risco metabólico desde a infância. Palavra-chave: Crianças; Perfil lipídico; Obesidade; Programa de intervenção .

A influência do exercício físico de moderada intensidade e da suplementação com ácido lipóico sobre a função cardíaca, a bioquímica sanguínea e a angiogênese em miocárdio de Rattus norvegicus

Atualmente o exercício físico vem sendo utilizado com intuito de redução de massa corporal, em especial de massa gorda. Entretanto cresce o número de indivíduos que, associado ao exercício físico, utiliza substâncias com característica lipolítica, como é o caso do ácido lipóico. Tanto o exercício físico, quanto a utilização de suplementação com ácido lipóico são responsáveis por remodelagem vascular (devido à interferência no processo de angiogênese) e modificação de fatores de risco cardiovascular (como hipertensão e lipídeos sanguíneos elevados). Desta forma, o presente estudo buscou analisar a influência do exercício físico de moderada intensidade e da suplementação com ácido lipóico sobre a frequência cardíaca, pressão arterial, bioquímica sanguínea e angiogênese no músculo cardíaco e no músculo esquelético de ratos Wistar. Foram utilizados 80 ratos Wistar, divididos em quatro grupos: controle, ácido lipóico (LA), exercício (E) e associação (ELA). Os animais foram submetidos a um programa de adaptação e treinamento de natação (9 e 17 semanas) com um aumento progressivo no tempo natação (até 1h/dia) e intensidade de carga (até 5% do peso corporal). Os animais receberam ácido lipóico 5 vezes por semana (da 10ª à 17ª semana), 60 mg / Kg / dia. O exercício crônico de intensidade moderada promoveu bradicardia, mas sua associação com a suplementação de ácido lipóico interrompeu este benefício. A suplementação com LA mostrou-se eficaz em melhorar o perfil lipídico, mas associado ao exercício não apresentou redução. A angiogênese foi aumentada no coração e gastrocnêmio dos animais exercitados, a largura da fibra de E, LA e ELA foi reduzida no coração, enquanto no gastrocnêmio apresentaram um aumento na largura das fibras apenas por LA e ELA. A espessura do ventrículo esquerdo diminuiu no grupo E, enquanto que a área da câmara do ventrículo esquerdo, e os níveis de VEGF circulantes, não mostraram nenhuma diferença significativa. Foi observada uma interação negativa entre o exercício físico e a suplementação com ácido lipóico (supressão da bradicardia do exercício de um lado, e a perda da adaptação do perfil lipídico induzido por suplementação de AL por outro lado). Este estudo mostra pela primeira vez, a interação entre o exercício crônico de intensidade moderada e a suplementação com ácido lipóico sobre a remodelação cardíaca e angiogênese, confirmando os benefícios da prática física em melhorar o fornecimento de sangue do músculo, que não foi afetado pelo consumo de ácido lipóico. O ácido lipóico em animais não treinados não foi capaz de estimular a 9 angiogênese cardíaca e ao contrário mostram uma tendência para a redução dos novos vasos.

Exploring the potential role of allostatic load biomarkers in risk assessment of patients presenting with depressive symptoms

Background: Depression is a major health problem worldwide and the majority of patients presenting with depressive symptoms are managed in primary care. Current approaches for assessing depressive symptoms in primary care are not accurate in predicting future clinical outcomes, which may potentially lead to over or under treatment. The Allostatic Load (AL) theory suggests that by measuring multi-system biomarker levels as a proxy of measuring multi-system physiological dysregulation, it is possible to identify individuals at risk of having adverse health outcomes at a prodromal stage. Allostatic Index (AI) score, calculated by applying statistical formulations to different multi-system biomarkers, have been associated with depressive symptoms. Aims and Objectives: To test the hypothesis, that a combination of allostatic load (AL) biomarkers will form a predictive algorithm in defining clinically meaningful outcomes in a population of patients presenting with depressive symptoms. The key objectives were: 1. To explore the relationship between various allostatic load biomarkers and prevalence of depressive symptoms in patients, especially in patients diagnosed with three common cardiometabolic diseases (Coronary Heart Disease (CHD), Diabetes and Stroke). 2 To explore whether allostatic load biomarkers predict clinical outcomes in patients with depressive symptoms, especially in patients with three common cardiometabolic diseases (CHD, Diabetes and Stroke). 3 To develop a predictive tool to identify individuals with depressive symptoms at highest risk of adverse clinical outcomes. Methods: Datasets used: ‘DepChron’ was a dataset of 35,537 patients with existing cardiometabolic disease collected as a part of routine clinical practice. ‘Psobid’ was a research data source containing health related information from 666 participants recruited from the general population. The clinical outcomes for 3 both datasets were studied using electronic data linkage to hospital and mortality health records, undertaken by Information Services Division, Scotland. Cross-sectional associations between allostatic load biomarkers calculated at baseline, with clinical severity of depression assessed by a symptom score, were assessed using logistic and linear regression models in both datasets. Cox’s proportional hazards survival analysis models were used to assess the relationship of allostatic load biomarkers at baseline and the risk of adverse physical health outcomes at follow-up, in patients with depressive symptoms. The possibility of interaction between depressive symptoms and allostatic load biomarkers in risk prediction of adverse clinical outcomes was studied using the analysis of variance (ANOVA) test. Finally, the value of constructing a risk scoring scale using patient demographics and allostatic load biomarkers for predicting adverse outcomes in depressed patients was investigated using clinical risk prediction modelling and Area Under Curve (AUC) statistics. Key Results: Literature Review Findings. The literature review showed that twelve blood based peripheral biomarkers were statistically significant in predicting six different clinical outcomes in participants with depressive symptoms. Outcomes related to both mental health (depressive symptoms) and physical health were statistically associated with pre-treatment levels of peripheral biomarkers; however only two studies investigated outcomes related to physical health. Cross-sectional Analysis Findings: In DepChron, dysregulation of individual allostatic biomarkers (mainly cardiometabolic) were found to have a non-linear association with increased probability of co-morbid depressive symptoms (as assessed by Hospital Anxiety and Depression Score HADS-D≥8). A composite AI score constructed using five biomarkers did not lead to any improvement in the observed strength of the association. In Psobid, BMI was found to have a significant cross-sectional association with the probability of depressive symptoms (assessed by General Health Questionnaire GHQ-28≥5). BMI, triglycerides, highly sensitive C - reactive 4 protein (CRP) and High Density Lipoprotein-HDL cholesterol were found to have a significant cross-sectional relationship with the continuous measure of GHQ-28. A composite AI score constructed using 12 biomarkers did not show a significant association with depressive symptoms among Psobid participants. Longitudinal Analysis Findings: In DepChron, three clinical outcomes were studied over four years: all-cause death, all-cause hospital admissions and composite major adverse cardiovascular outcome-MACE (cardiovascular death or admission due to MI/stroke/HF). Presence of depressive symptoms and composite AI score calculated using mainly peripheral cardiometabolic biomarkers was found to have a significant association with all three clinical outcomes over the following four years in DepChron patients. There was no evidence of an interaction between AI score and presence of depressive symptoms in risk prediction of any of the three clinical outcomes. There was a statistically significant interaction noted between SBP and depressive symptoms in risk prediction of major adverse cardiovascular outcome, and also between HbA1c and depressive symptoms in risk prediction of all-cause mortality for patients with diabetes. In Psobid, depressive symptoms (assessed by GHQ-28≥5) did not have a statistically significant association with any of the four outcomes under study at seven years: all cause death, all cause hospital admission, MACE and incidence of new cancer. A composite AI score at baseline had a significant association with the risk of MACE at seven years, after adjusting for confounders. A continuous measure of IL-6 observed at baseline had a significant association with the risk of three clinical outcomes- all-cause mortality, all-cause hospital admissions and major adverse cardiovascular event. Raised total cholesterol at baseline was associated with lower risk of all-cause death at seven years while raised waist hip ratio- WHR at baseline was associated with higher risk of MACE at seven years among Psobid participants. There was no significant interaction between depressive symptoms and peripheral biomarkers (individual or combined) in risk prediction of any of the four clinical outcomes under consideration. Risk Scoring System Development: In the DepChron cohort, a scoring system was constructed based on eight baseline demographic and clinical variables to predict the risk of MACE over four years. The AUC value for the risk scoring system was modest at 56.7% (95% CI 55.6 to 57.5%). In Psobid, it was not possible to perform this analysis due to the low event rate observed for the clinical outcomes. Conclusion: Individual peripheral biomarkers were found to have a cross-sectional association with depressive symptoms both in patients with cardiometabolic disease and middle-aged participants recruited from the general population. AI score calculated with different statistical formulations was of no greater benefit in predicting concurrent depressive symptoms or clinical outcomes at follow-up, over and above its individual constituent biomarkers, in either patient cohort. SBP had a significant interaction with depressive symptoms in predicting cardiovascular events in patients with cardiometabolic disease; HbA1c had a significant interaction with depressive symptoms in predicting all-cause mortality in patients with diabetes. Peripheral biomarkers may have a role in predicting clinical outcomes in patients with depressive symptoms, especially for those with existing cardiometabolic disease, and this merits further investigation.

A infecção por Leishmania infantum chagasi altera o metabolismo lipídico do hospedeiro

American visceral leishmaniasis (AVL), caused by Leishmania infantum chagasi (L.i.chagasi), stands as a public health problem in Brazil, with human and canine cases related in all states..Lipid metabolism can be modified in several status of infection. For example, experimental studies show that the cholesterol is necessary to internalization and replication of L.i.chagasi in macrophages through caveolar domains. Patients with AVL present low levels of cholesterol and a visible triglycerides increase. This work aimed to evaluate the lipid metabolism in several post-infection status by L.i.chagasi, including individuals with symptomatic infection (AVL), and asymptomatic. The levels of cholesterol, triglycerides, HDL and reactive C protein, were measured. Individuals with AVL were compared with individuals with assymptomatic infection and presented low levels of total cholesterol (128 ± 6.180 mg/dL vs. 158 ±5.733 mg/dL, p=0.0001), HDL (29 ± 1.746 mg/dL vs. 37 ± 1.647 mg/dL, p=0.0001), increased levels of triglycerides (149.5 mg/dL ± 12.72 vs. 78.00 ± 10.43 mg/dL, p=0.0095) and higher levels of reactive C protein (1.750± 0.4939 mg/dL vs. 0.40 ± 0.1707 mg/dL; p=0.0001). The expression of genes related to lipid metabolism, such as LXR-a, LXR-b, PPAR-a, PPAR-d, PPAR-g and APOE was evaluated by real time PCR. A reduction in the expression of those genes was found in the group of AVL patients corroborating the serum levels of the metabolites earlier quantified. Our findings suggest a modulation of metabolism of lipids, in the chronic phase of AVL, this could facilitate the survival of leishmania, due to the known reduction on the ability of macrophages in presenting antigens efficiently to the T cells due to the reduction in the cholesterol available, it results in a subversion of the host immunity.

Biochemical parameters response to weight loss in patients with non-alcoholic steatohepatitis.

Background: Non-alcoholic steatohepatitis (NASH) is a chronic liver disease that is capable of progressing to end-stage liver disease, but generally has a benign course. Non-alcoholic steatohepatitis (NASH) is a growing public health problem with no approved therapy. NASH projected to be the leading cause of liver transplantation in the United States by 2020. Obesity, non-insulin-dependent diabetes mellitus and hyperlipidaemia are the most common associations of the disease. Global prevalence of NASH is 10-24% amongst general population but increases to 25-75% in obese diabetic individuals. Objective: There is an urgent need for efficient therapeutic options as there is still no approved medication. The aim of this study was to detect changes in biochemical parameters including insulin resistance, cytokines, blood lipid profile and liver enzymes following weight loss in patients with non-alcoholic steatohepatitis. Materials and methods: One hundred obese patients with NASH, their age between 35-50 years, body mass index (BMI) from 30 to 35 Kg/m2 were included in the study in two subgroups; the first group (A) received moderate aerobic exercise training in addition to diet regimen , where the second group (B) received no treatment intervention. Results: The mean values of leptin, TNF-α, IL6, IL8, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Homeostasis Model Assessment-Insulin Resistance- index (HOMA-IR), Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDL-c) , Triglycerides (TG) and BMI were significantly decreased in group (A), where the mean value of Adiponectin and High Density Lipoprotein Cholesterol (HDL-c) were significantly increased, while there were no significant changes in group (B). Also, there was a significant difference between both groups at the end of the study. Conclusion: Weight loss modulates insulin resistance, adiponectin, leptin, inflammatory cytokine levels and markers of hepatic function in patients with nonalcoholic steatohepatitis.