Jornal da Síndrome Metabólica

Background: Diabetes is a chronic and irreversible disease that lasts, lifelong, directly concerns any individual of all ages and their relatives, and brings heavy economic burden, affects self-care activities and shortens life expectancy due to the chronic damages it causes, Thus, before considering any possible intervention it was imperative to assess present knowledge, perception, and self-care practices of patients towards the management of diabetes.

Methods: A facility based cross-sectional study supplemented by using both quantitative and qualitative methods was conducted from April – June 2013 in Dilla referral hospital. A total of 310 participants with Diabetes Mellitus were interviewed. Face-to-face interviews were used for quantitative data; and qualitative data were collected by in-depth interview. SPSS version 20 was used to perform descriptive and logistic regression analyses. Statistical significance was set at P-value <0.05 to judge the association.

Result: Two third, 238 (76.8) of them had good practiced on the recommended self-care practices. Among the recommended self-care behaviors, drug adherence 289 (93.2%), dietary intake 154 (49.7%) and regular exercise 138 (44.5%) were the most practiced self-care. Self-blood glucose monitoring was the least practiced which accounted 62 (20%). Approximately 78 % of diabetic patients were developed positive perception towards DM and has a significant effect for patients with diabetes to provide own self-care practice [OR-2.74, 95% CI (1.27, 5.91)]. Majority 79.4% of the respondents were knowledgeable about diabetes, but those diabetic patients who were knowledgeable on DM were less likely performed recommended self-care to manage the disease [OR-0.29, 95% CI (0.10, 0.80)]. On other hand those diabetic patients who were knowledgeable on DM self-care were more likely performed recommended self-care [OR-6.52, 95% CI (2.88, 14.78)]. Education also has a significant effect for patients with diabetes in their own self-care practice. A major point to address therefore is regular access to/contact with diabetic educators which currently is severely substandard.

Conclusions: Management of diabetes may be enhanced by reinforcing patients’ knowledge, developing positive perception and encouraging behavior change whilst taking into consideration patients’ backgrounds. To increase the self-care behavior, the health care team should be utilizing a patient-centered approach in order to deliver diabetes messages on specific issues of management practice.

Metabolic Syndrome, a pathological condition affecting approximately 35% of the USA population, is characterized by obesity, insulin resistance, and hypertension. Metabolic syndrome is considered the single most common condition predisposing to the development of various chronic diseases including diabetes and hypertension. Hypomagnesaemia has been consistently observed in association with metabolic syndrome, but it is unclear whether reduced Mg2+ levels are the consequence or a possible cause for the development of the metabolic syndrome and/or its associated pathologies.

Research performed in our laboratory showed that rats exposed for 2 weeks to a Mg2+ deficient diet presented decreased glucose accumulation into the hepatocytes together with low Mg2+ level in the circulation and within the liver cells. To better investigate the changes in glucose metabolism, HepG2 were used to mimic in vitro Mg2+ deficiency conditions. HepG2 cells cultured in low extracellular Mg2+ presented a 20% decrease in total cellular Mg2+ content, reduced glucose accumulation, and enhanced glucose 6-phosphate (G6P) transport into the endoplasmic reticulum (ER). The increased G6P transport was associated with its enhanced hydrolysis by the glucose 6- phosphatase, but also conversion to 6-phosphogluconolactone by the glucose 6-phosphate dehydrogenase. The latter process resulted in the increased generation of NADPH within the ER and the increased conversion of cortisone to cortisol by the 11-β-hydroxysteroid dehydrogenase type-1 (11-β-OHSD1).

Taken together, our results provide compelling evidence that Mg2+ deficiency precedes and actually promotes some of the hepatic dysmetabolisms typical of the metabolic syndrome. The decrease in intrahepatic Mg2+ content up-regulates G6P entry into the hepatic endoplasmic reticulum and its routing into the pentose shunt pathway for energetic purposes. The associated increased in NADPH production within the ER then stimulates cortisol production, setting the conditions for hepatic insulin resistance and further altering liver metabolism.

Increased erythropoietin (EPO) production is important for erythropoiesis as well as cell viability. The most effective factor for promoting EPO production is hypoxia, which alters the redox state and produces a reducing environment in the cell. In this study, we examined the influence of ethanol on EPO production in HepG2 cells to investigate the effect of increasing the free NADH/NAD+ ratio in the cytosol during normoxia. Ethanol treatment increased the lactate/pyruvate ratio, an index of the cytosolic redox state, in a dose-dependent manner, with maximal promotion of EPO production observed at 300 μM ethanol. These results suggest that altering the cytosolic NADH/NAD+ redox state to the same degree as hypoxia is effective in promoting EPO production. Ethanol (300 μM) increased mRNA expression and protein levels of sirtuin1, which is a transcription factor, related to both hypoxia inducible factor and cytosolic redox state, whereas 2000 μM ethanol did not produce these effects. Although the sirtuin1 inhibitorEX-527 did not affect the lactate/pyruvate ratio, EX-527 inhibited the induction of EPO mRNA expression by 300 μM ethanol. In rat primary hepatocytes and kidney cells, 300 μM ethanol increased sirtuin1 and EPO mRNA expression, as well as EPO concentrations in media. In conclusion, we showed low concentrations of ethanol promote EPO production by increasing sirtuin1 in HepG2 cells, as well as primary liver and kidney cells. The use of ethanol represents a hypoxia-independent method to promote EPO production.

Objective: Evaluation of the incidence of gestational diabetes in PCOS women treated with metformin before and during early pregnancy and to ascertain their family history of diabetes.

Design: Follow-up on all women with PCOS and infertility who received treatment with metformin prior to pregnancy (=index pregnancy) during 10 years. Data on diabetes was retrieved by questionnaire and hospital charts. Main outcome measures: Incidence of gestational diabetes, pregnancy outcome, and fetal size.

Results: In 18 % of the women GDM was diagnosed at some stage. The clinical and obstetrical outcome of the women showed no association with family history of diabetes or GDM. No neonatal anthropometric feature was different with respect to family history of diabetes or GDM and no fetal malformations were found.

Conclusion: GDM and family history of diabetes seem not to be associated with unfavourable pregnancy outcome in PCOS women.

Pituitary adenylate cyclase-activating polypeptide (PACAP) belongs to the secretin/glucagon/vasoactive intestinal peptide (VIP) family and is one of the most highly conserved neuropeptides. The effects of PACAP are mediated through three G-protein coupled receptors: PAC1R, which has specific affinity for PACAP, and VPAC1 and VPAC2 that have equal affinity for both PACAP and VIP. PACAP and PAC1R are widely expressed and distributed throughout the body, including the central nervous system, the gastro-intestinal tract, the endocrine pancreas, the respiratory and cardiovascular systems. With this widespread tissue distribution, PACAP has been shown to be a pleiotropic peptide exerting a range of physiological functions. Within the body, PACAP serves as a neurotransmitter, neuromodulator, neurotrophic factor, neuroprotectant, secretagogue, and neurohormone. In this present review, we provide current insight on the role of PACAP in neuroprotection, its role in energy homeostasis and the impact PACAP may have on respiratory and cardiovascular disease. We conclude with an outlook for the future of PACAP-related research.

Currently sleep disorders are one of the most prevalent problems in children, with an estimated prevalence of 15-20% and a highly variable clinical spectrum. One of the pathologies in which sleep disorders achieve special relevance is in attention-deficit and hyperactivity disorder (ADHD), because the complex association between these two phenomena can largely determine the therapeutic handling and prognosis of these patients. Nowadays, the number of research articles that makes unquestionable the relation between ADHD and sleep disorders is increasing, as well as studies in which actigraphy acquires increasingly validity as a tool to asses sleep in the paediatric population, with a good correlation with polysomnography, considered the "gold standard" in sleep medicine. Our review aims to highlight the positive impact that the use of actigraphy as a screening tool for the detection of sleep problems in ADHD may have on the quality of life of these children and their families. After an exhaustive review of the most recent published literature on this topic, we suggest a set of recommendations which are summarized in that the actigraphy allows us to study longer periods of sleep-wake in an stable way, avoiding the difficulties of polysomnographic studies in children. All this makes it an ideal screening element in the initial assessment of patients with ADHD who report sleep problems.

The metabolic syndrome represents a cluster of closely connected premorbid risk factors or diseases with visceral obesity, prediabetes or type 2 diabetes, hypertension and low dyslipidemia as established traits affecting about 20 % of adults in developed countries. This syndrome develops on a common soil with overnutrition, low physical activity and psychosocial stress as major components. Common comorbidities are fatty liver, sleep apnoe and gout with cardiovascular complications, nephropathy and type 2 diabetes as ‘endstage’ diseases. The term metabolic vascular syndrome was proposed to signal premorbid cardiovascular state and increased cardiovascular morbidity. Thus, a rational diagnostic is needed to elucidate the complex cluster of diseases as basis for an integrated therapy. There is a clear priority for life style intervention however most diseases of the metabolic syndrome need medical treatment. Medical treatment of single traits has to take into account possible pleiotropic or adverse effects on the other traits. Here we present the pros and cons of major medical interventions in type 2 diabetes, hypertension, dyslipidemia and hypercoagulation in the context with the metabolic syndrome.

Objective: The purpose of this study was to examine the prevalence of the metabolic syndrome and its individual components among multiethnic population in a rural area in the Western region of Abu Dhabi in The United Arab Emirates (UAE).

Methods: The analytic sample consisted of 575 adults (males: 309, females: 266), between the age of 22 and 65 years. The National Cholesterol Education Program’s Adult Treatment Panel III (NCEP/ATP III) guidelines (with race specific abdominal circumference cutoff level) were used to identify adults who met their criteria for metabolic syndrome with. Prevalence estimates were calculated for each component of the metabolic syndrome in addition to the overall prevalence of metabolic syndrome. Prevalence estimates were analyzed by sex, ethnicity and working hours.

Results: Approximately 22% of adults met the criteria for metabolic syndrome. The prevalence was 26% in Males and 14% in females, P. Value <0.01. The prevalence was 16% among South East Asians (SEA), 20% among Arabs (ARB) and 26% among South Asians (SA), with P value of 0. 523, 0.075 and <0.05 for ARB versus SEA, ARB versus SA, and SA vs SEA respectively. The prevalence of the metabolic syndrome among night shift workers was 25% in comparison to 19% among daytime workers (P value 0.1). The prevalence of the different components of the metabolic syndrome varied by race and ethnicity

Conclusions: These results demonstrate that metabolic syndrome is less prevalent in rural area than inner city population in UAE which was reported to be around 40% in previous studies possibly because of lifestyle differences. The prevalence varied significantly by race and ethnicity and gender. Night shift work was associated with higher prevalence of the metabolic syndrome in our study but this was not statistically significant.

Glucose and lipid metabolic disorders are two most prevalent complications of obesity. Regarding increasing rates of obesity and its metabolic disorders, more effective approaches are needed for prevention or treatment of related metabolic disorders. Therefore, understanding molecular mechanisms involved in metabolic syndrome would be open new way in maintaining homeostasis in these circumstances. miRNAs are non-coding small RNAs with transcriptional and posttranscriptional regulatory effects on gene expression, however, any disturbance of them could be involved in the pathogenesis of obesity and its related lipid and glucose metabolic disorders. miRNAs are proposed as an ideal non-invasive biological markers for rapid prediction of some obesity related metabolic diseases because of their stability and measurable concentrations in body fluids. Recent evidences reported changes of some important miRNAs profile with regulatory effects on glucose and lipid metabolic pathways even years before the onset and/or diagnosis of these obesity related metabolic disorders. Nutrition and dietary components as significant epigenetic factors have an important role in posttranscriptional regulations of lipid and glucose metabolism genes by modulating of related key miRNAs. Epigenetic suggests the importance of personalized nutrition according to miRNAs profile in prevention, control and treatment of obesity and related metabolic disorders. In this review we summarize evidences regarding the influence of nutrients and food components on some important related circulating miRNAs and their signature as new diagnosis, prognosis and therapeutic agents in obesity related lipid metabolism and diabetes as dietary-derived disorders.

Background: Obesity has become a worldwide concern. Elevated serum leptin has been implicated in obesity in some populations. There is paucity of information on leptin and obesity in Nigeria. This study was designed to evaluate serum leptin, lipids and lipoproteins levels in relationship to anthropometric indices in obese Nigerians.

Methods: Two hundred and seventeen subjects consisting of 154 obese age 44.55 ± 8.81 years and 63 ideal body weight and age matched controls were recruited. The obese group consisted of 120 females and 34 males while the controls were 32 females and 31 males. Anthropometric indices, serum leptin, lipids and lipoproteins were determined using standard procedures.

Results: Results showed significant increases in serum leptin (p<0.001), plasma triglyceride (TG) (p<0.01) and LDLC: HDLC ratio (p<0.05) when compared with the control values. A significant decreased was obtained in plasma HDLC (p<0.01) in the obese siubjects. The obese females had a higher serum leptin than obese males. There were significant increases in the body weight, waist circumference (WC) and hip circumference (HC), BMI and %body fat (%BF) (p<0.001) as well as waist: hip ratio (WHR) (p<0.05) when compared with the control values. Leptin was significantly correlated with WC, HC, BMI, WHR and %BF.

Conclusion: Elevated serum leptin in obese Nigerians with increased plasma TG and decreased HDLC was significantly correlated with anthropometric indices, indications for metabolic syndrome and other chronic diseases.

The objective of this study was to compare the effects of GnRH, prostaglandin F2α (PGF2α) and oxytocin treatments at the time of natural mating on the conception rate (CR) of non lactating pluriparous ewes. All ewes (n=61) were served naturally by fertile rams every 12 hours after the beginning of estrus. After natural mating, ewes were randomly assigned into four treatment groups; G1 received PGF2α (n=14); G2 received GnRH (n=12); G3received oxytocin (n=15) and G4 or control received placebo (n=20). Pregnancy diagnosis was performed 25 days post-insemination by transrectal ultrasonography. Ewes were bled at the day of mating and every 10 days till Day 50 post mating to determine the changes in the total antioxidants during the first third of pregnancy. Pregnancy rate was higher (P<0.05) for all the treatment groups (69.33%) compared with the control group (55.54%). Litter size did not differ between groups except for oxytocin group. Ewe lambs dominate male in this study and the sex ratio unexpectedly preferred them. Total antioxidants did not differ significantly between groups in the present study but they were at their lowest values during estrus in all the studied groups. Gestation length, birth weight, number of services, body weight did not affect the pregnancy rate. It could be concluded that treatments with GnRH and PGF and oxytocin at the time of service could improve conception rate in pluriparous ewes.