Made available in DSpace on 2016-06-02T19:22:02Z (GMT). No. of bitstreams: 1 DoutPD.pdf: 827088 bytes, checksum: 9034d3b4265260b0cd922d5e06b74d93 (MD5) Previous issue date: 2003-09-26 / Prolactin (PRL) has a great number of biologic functions in many species. Beyond the well known effects on reproduction, lactation and maternal behavior, many studies have showed the effects of PRL on the mineral transportation, calcium metabolism and bone. PRL seems to have an effect on the bone, acting direct or indirectly. The aim of this study was to investigate the effects of the PRL on bone mass of female ovariectomized (ovx) Wistar rats, through physical, biomechanical and biochemical analysis of the femur, biochemical of serum and densitometry of the tibia. The rats had 4 months of age in the beginning of the study and were divided in 3 groups: basal group, hiperPRL group (intact, ovx+sham e ovx + 2 grafted anterior pituitary under the kidney capsule) and hipoPRL group (intact+saline, ovx+saline and ovx rats treated with bromocriptina-3 mg/Kg). Statistical analysis of results was performed by a two way analysis of variance (ANOVA) followed by a Student Duncan test. The ovx promoted the figher weight gain and bone growth. It was observed that the ovx+hipófise group showed a significant decreased in maximum force and stiffness when compared with the intact group, and a significant decreased in the densitometry, mineral bone density and percentage of mineral material of the femur when compared with the ovx+sham group. The ovx+ bromocriptine group showed a significant increase in maximum force, stiffness and bone volume of the right femur and the bone mineral content of the tibia when compared with the ovx+saline and basal groups. The lack of the PRL maintains the biomechanical parameters of the ovx rats statistically equal to the intact animals, showing a protective action of the PRL against the osteopenic effect promoted by ovariectomy. / A prolactina (PRL) desempenha uma grande diversidade de ações biológicas em muitas espécies de vertebrados. Além dos bem conhecidos efeitos sobre a reprodução, lactação e comportamento maternal, diversos estudos têm demonstrado os efeitos da PRL sobre o transporte de minerais, e mais recentemente sobre o metabolismo do cálcio e tecido ósseo. A PRL parece exercer um efeito no osso agindo direta ou indiretamente. Sendo assim, o objetivo desse trabalho foi verificar os efeitos da PRL sobre a massa óssea de ratas Wistar ovariectomizadas (ovx), por meio da análise de parâmetros físicos, biomecânicos e bioquímicos do fêmur, bioquímico sérico e da densitometria óssea da tíbia. As ratas tinham 4 meses de idade no início do estudo, e foram divididas em: grupo basal, grupo hiperPRL (intacta, ovx+sham e ovx+implante de 2 hipófises na cápsula renal) e grupo hipoPRL (intacta+salina, ovx+salina e ovx+ 3 mg/Kg de bromocripitina). Os dados foram analisados pela análise de variância (ANOVA) e nos casos significantes, o teste de Duncan para discriminar as diferenças. A ovx promoveu maior ganho de peso corporal e crescimento ósseo associado. Observou-se que o grupo ovx+hipófise apresentou uma diminuição significativa dos valores dos parâmetros força máxima e rigidez, em relação ao grupo intacta, e ainda uma diminuição significativa dos parâmetros densidade óssea, densidade mineral e porcentagem de material mineral do fêmur em relação ao grupo ovx+sham. O grupo ovx+bromocripitina apresentou um aumento significativo em relação à força máxima, rigidez e volume ósseo do fêmur direito e do conteúdo mineral óssea da tíbia quando comparado aos grupos ovx+salina e basal. A diminuição dos níveis de PRL tornou os parâmetros biomecânicos referentes às ratas ovx estatisticamente iguais aos dos animais intactos, indicando uma ação protetora contra o efeito osteopênico promovido pela ovariectomia.

Introdução: Com o aumento da expectativa de vida dos pacientes com Fibrose Cística (FC), a saúde óssea têm sido objeto de estudo a fim de otimizar a qualidade de vida desses pacientes. A prevalência de massa óssea baixa e os fatores de risco associados são altamente variáveis dependendo da população estudada. Objetivos: Determinar a prevalência de massa óssea baixa em pacientes adolescentes e adultos com FC e estudar os fatores potencialmente associados. Métodos: Densidade mineral óssea foi determinada por DXA na coluna lombar em todos os pacientes e no fêmur em pacientes ≥20 anos. Avaliações nutricionais, bioquímicas e pulmonares foram realizadas. Dados referentes ao tratamento farmacológico foram coletados. Resultados: 58 pacientes foram incluídos no estudo (25 homens/ 33 mulheres), média de idade de 23,9 anos (16-53). Massa óssea baixa foi verificada em 20,7% dos pacientes. Não houve histórico de fratura. Z-score da coluna lombar associou-se positivamente com IMC (r= 0,3; p= 0,022), VEF1% (r=0,415; p=0,001). A média do Z-score da coluna foi mais alta nas mulheres que nos homens (p=0,001), em pacientes que não possuíam insuficiência pancreática (p=0,02) e em pacientes que não haviam sido hospitalizados no período de três meses (p=0,032). Os fatores encontrados como preditores independentes de Z-score da coluna lombar foram sexo masculino e IMC. Conclusão: Massa óssea baixa é frequente em pacientes com FC e está associada ao IMC, o qual provavelmente reflete a severidade da doença, e ao sexo masculino. Esforços devem ser empreendidos com o objetivo de manter esses pacientes com perfil nutricional adequado. / Background: Survival of cystic fibrosis (CF) patients has increased, so bone health could be important for the quality of life of affected patients. Several studies described lower bone mass density (BMD) in patients with CF, which increased fracture risk. Objective: The aim of this study was to evaluate the prevalence of low BMD as well as to evaluate the factors associated with bone mass in these patients. Methods: BMD was measured by DXA in lumpar spine (L1-L4), in patients ≤19years-old, or lumbar spine and femur (total and neck) in patients ≥20years-old. Evaluations of nutritional status, biochemical parameters and lung function were performed. Medications were obtained from medical records Results: Fifty-eight patients were included in the study (25 males/33females), mean age 23.9 years (16-53). The prevalence of bone mass below the expected range for age at any site was 20.7%. None of the subjects had history of fracture. Lumbar spine Z-score in FC patients correlated positively with BMI (r= 0.3, p=0.001), and with FEV1 (%predicted) (r=0.415, p=0.022). Mean lumbar spine Z-score were higher in women (p=0.001), in patients with no pancreatic insufficiency (p=0.032), and in patients with no hospitalization in the last 3 months (p=0.02). BMI (p= 0.001) and sex (p=0.001) were independently associated with the Z-score in the lumbar spine. Conclusion: Low bone mass is a frequent problem in patients with CF, being associated with BMI, which could reflect disease intensity, and male sex. A larger effort should be made to keep these patients well-nourished.

Introdução: Com o aumento da expectativa de vida dos pacientes com Fibrose Cística (FC), a saúde óssea têm sido objeto de estudo a fim de otimizar a qualidade de vida desses pacientes. A prevalência de massa óssea baixa e os fatores de risco associados são altamente variáveis dependendo da população estudada. Objetivos: Determinar a prevalência de massa óssea baixa em pacientes adolescentes e adultos com FC e estudar os fatores potencialmente associados. Métodos: Densidade mineral óssea foi determinada por DXA na coluna lombar em todos os pacientes e no fêmur em pacientes ≥20 anos. Avaliações nutricionais, bioquímicas e pulmonares foram realizadas. Dados referentes ao tratamento farmacológico foram coletados. Resultados: 58 pacientes foram incluídos no estudo (25 homens/ 33 mulheres), média de idade de 23,9 anos (16-53). Massa óssea baixa foi verificada em 20,7% dos pacientes. Não houve histórico de fratura. Z-score da coluna lombar associou-se positivamente com IMC (r= 0,3; p= 0,022), VEF1% (r=0,415; p=0,001). A média do Z-score da coluna foi mais alta nas mulheres que nos homens (p=0,001), em pacientes que não possuíam insuficiência pancreática (p=0,02) e em pacientes que não haviam sido hospitalizados no período de três meses (p=0,032). Os fatores encontrados como preditores independentes de Z-score da coluna lombar foram sexo masculino e IMC. Conclusão: Massa óssea baixa é frequente em pacientes com FC e está associada ao IMC, o qual provavelmente reflete a severidade da doença, e ao sexo masculino. Esforços devem ser empreendidos com o objetivo de manter esses pacientes com perfil nutricional adequado. / Background: Survival of cystic fibrosis (CF) patients has increased, so bone health could be important for the quality of life of affected patients. Several studies described lower bone mass density (BMD) in patients with CF, which increased fracture risk. Objective: The aim of this study was to evaluate the prevalence of low BMD as well as to evaluate the factors associated with bone mass in these patients. Methods: BMD was measured by DXA in lumpar spine (L1-L4), in patients ≤19years-old, or lumbar spine and femur (total and neck) in patients ≥20years-old. Evaluations of nutritional status, biochemical parameters and lung function were performed. Medications were obtained from medical records Results: Fifty-eight patients were included in the study (25 males/33females), mean age 23.9 years (16-53). The prevalence of bone mass below the expected range for age at any site was 20.7%. None of the subjects had history of fracture. Lumbar spine Z-score in FC patients correlated positively with BMI (r= 0.3, p=0.001), and with FEV1 (%predicted) (r=0.415, p=0.022). Mean lumbar spine Z-score were higher in women (p=0.001), in patients with no pancreatic insufficiency (p=0.032), and in patients with no hospitalization in the last 3 months (p=0.02). BMI (p= 0.001) and sex (p=0.001) were independently associated with the Z-score in the lumbar spine. Conclusion: Low bone mass is a frequent problem in patients with CF, being associated with BMI, which could reflect disease intensity, and male sex. A larger effort should be made to keep these patients well-nourished.

Introdução - Nos últimos anos diversas hipóteses foram investigadas sobre a relação entre gordura corporal e a massa óssea. Objetivo - O presente estudo visa avaliar a associação de índices de gordura corporal e massa óssea em adultos e idosos. Metodologia - O estudo foi desenvolvido com os dados obtidos do estudo transversal de base populacional intitulado Inquérito Domiciliar de Saúde no Município de São Paulo (ISA Capital 2015), realizada de janeiro de 2015 a maio de 2016. A amostra foi composta por 296 indivíduos, sendo 129 adultos (18 a 59 anos) e 167 idosos (60 anos ou mais), de ambos os sexos. Utilizando os dados antropométricos, foram calculados os índices: Índice de Massa Corpórea (IMC), Índice de Conicidade (IC), Índice de Circularidade Corporal (ICC), Índice de Formato Corporal (IFC), Índice de Adiposidade Corporal (IAC), Índice de Gordura Corporal (IGC) e Índice de Adiposidade Visceral (IAV). Além disso, foram avaliados os dados de gordura corporal (GC) em kg, gordura visceral (GV em gramas), porcentagem de gordura corporal ( por centoGC) e densidade mineral óssea de corpo total (DMO CT), coluna lombar (DMO L1- L4) e do colo do fêmur (DMO femoral), obtidos pelo DXA (modelo Lunar iDXA Advance, GE Healthcare, Madison, WI, USA). Foram calculadas estatísticas descritivas (média, desvio-padrão, percentis); a normalidade foi testada por Anderson- Darling, foi aplicado o teste Mann-Whitney e a correlações de Spearman. A GC (kg) foi ajustada por sexo e idade e a DMO CT, L-L4 e femoral foram ajustadas por gênero, classe etária, atividade física, ingestão de álcool e tabagismo com o uso de Modelos Lineares Generalizados. Uma vez identificado o modelo mais adequado a uma variável resposta, procurou-se reduzir o número de parâmetros com uso do Critério de Informação Akaike (AIC). Para realizar essas análises foi utilizado o software SPSS, 23.0 (SPSS Inc, Chicago IL, USA) e R (Projeto para estatística em sistema computacional) for Windows, versão 3.4.1. O nível de significância adotado foi de 5 por cento. Resultados - No artigo 1 é apresentado uma revisão sobre a relação entre os índices antropométricos e de gordura corporal com Doenças Crônicas Não-Transmissíveis (DCNT) como diabetes mellitus, hipertensão arterial sistêmica, síndrome metabólica entre outras. No artigo 2, foi observado baixa proporção de osteoporose nos participantes. Na relação entre os índices antropométricos com a GC (kg), verificamos que com exceção do IFC e IAV, os demais índices apresentaram correlação positiva e significante com a GC em kg (p<0,001). Entretanto, o modelo que apresentou o melhor ajuste e associação para a GC foi o IGC (89,97 por cento), seguido do IMC (83,93 por cento). Na associação dos índices com a DMO nos 3 sítios (DMO CT, L-L4 e femoral), observamos baixos valores de predição dos modelos avaliados, sendo que o modelo que apresentou melhor associação foi o IMC para DMO femoral. Conclusão O índice antropométrico que mais se aproximou da GC (kg) foi o IMC, como observado na análise de correlação e confirmado na análise inferencial, uma vez que as fórmulas para obtenção de ambos os índices são muito semelhantes. Na relação com a DMO, nenhum índice antropométrico é capaz de predizer a DMO nos 3 sítios avaliados na amostra estudada. / Introduction - In recent years several hypotheses have been investigated on the relationship between body fat and bone mass. Objective - The present study aims to evaluate the association of body composition indexes and bone mass in adults and the elderly. Methods - The study was conducted in a subsample from the populationbased cross-sectional study titled Health Study of São Paulo (ISA-Capital Study- 2015), held from january 2015 to may 2016. This 396 individuals, 129 adults (18 to 59 years) and 167 elderly (60 and over), of both sexes. Data on demographic, anthropometric [weight (kg), height (m), waist circumference and hip (cm)], body composition (body fat distribution) and bone (bone mineral density and composition) analyzed. The ratios was calculated, ranked and analyzed: Body Mass Index (BMI), Body Adiposity Index (BAI), Body Roundness Index (BRI), a Body Shape Index (ABSI) and the Conicity Index (C index) and as a comparison method was the Fat Mass Index (FMI) obtained by DXA. Bone mineral density (BMD) was evaluated in the lumbar spine L1-L4 and femoral neck through energy dual beam absorptiometry technique, issued by an X-ray source - DXA (dual-energy X-ray absorptiometry) Lunar model iDXA Advance (GE Healthcare, Madison, WI, USA). Descriptive statistics (mean, standard deviation, percentiles) were calculated; the normality was tested by Anderson-Darling, thus the Mann-Whitney test and Spearman correlations were applied. The BF (kg) was adjusted by gender and age and the CT, L-L4 and femoral BMD were adjusted for gender, age group, physical activity, alcohol intake e smoking, with the use of Generalized Linear Models. Once the most appropriate model was identified for a response variable, we attempted to reduce the number of parameters using the Akaike Information Criterion (AIC). The SPSS software, 23.0 (SPSS Inc, Chicago IL, USA) and R (Computer statistical system design) for Windows, version 3.4.1 for data analysis were used. The level of significance was set at 5 per cent. Results - In article 1, it presents revision about the relationship between anthropometric and body fat indexes with chronic-degenerative diseases (CDC) such as diabetes mellitus, systemic arterial hypertension, metabolic syndrome, among others. In article 2 a low proportion of osteoporosis was observed in the participants. In the relationship between the anthropometric indices with the BF (kg), we observed that, with the exception of the IFC and VAI, the other indexes presented a positive and significant correlation with the BF in kg (p <0.001). However, the model that presented the best fit and association for BF was FMI (89.97 per cent), followed by BMI (83,93 per cent). In the association of the indexes with BMD in the 3 sites, we observed low values of prediction of the models evaluated, and the model that presented the best association was the BMI for femoral BMD. Conclusion - The anthropometric index that most approached the BF (kg) was BMI, as observed in the correlation analysis and confirmed in the inferential analysis, since the formulas to obtain both indices are very similar. In relation to BMD, no anthropometric index is able to predict BMD at the 3 sites evaluated in the studied sample.

A osteoporose é um distúrbio esquelético caracterizado pela diminuição da força óssea, resultando em um risco aumentado de fratura. A perda óssea ocorre tanto em mulheres como em homens devido ao processo de envelhecimento natural [Drake et al.,2015]. De acordo com o diagnóstico e classificação da Organização Mundial da Saúde (OMS), a osteoporose é definida pela densidade mineral óssea (DMO) na coluna lombar ou quadril inferior a -2,5 do desvio padrão abaixo da média da DMO para uma população de jovens adultos [Cosman et al., 2014]. Tem uma alta prevalência sendo mais freqüente do que a soma de casos de infarto do miocárdio, câncer de mama e acidente vascular cerebral. Essa doença deve ser considerada como um problema de saúde pública, pois afeta o indivíduo em sua função social, física e de trabalho e, portanto, causa impacto socioeconômico [Haddad et al.,2015]. Neste trabalho, desenvolvemos um novo modelo de osteoporose em ratos nude por ooforectomia visando o uso de células humanas para a Medicina Traslacional. Para tanto, foram estabelecidos dois passos e a osteoporose foi analisada por densitometria óssea aos 0, 21, 45 e 60 dias após a cirurgia e por análises histológicas de ossos femorais, i) padronização do modelo animal de osteoporose por ooforectomia, utilizando ratos Sprague-Dawley fêmeas de 12 semanas; ii) na segunda fase do projeto, a osteoporose foi induzida em ratos imunodeficientes nude Rowett fêmeas (NTacFCfiq: NIJ-Whn) de 12 semanas e os mesmos ensaios foram conduzidos para detectar a osteoporose. O soro foi coletado para a medida de estrogênio. As análises da DMO e histológicas mostraram modificação do contéudo mineral e ósseos e da estrutura óssea, respectivamente, aos 60 dias após a cirurgia em ambas as linhagens de ratos fêmeas. Com este trabalho, pretendemos contribuir para a compreensão da biologia da osteoporose utilizando um novo modelo animal, o que pode levar ao desenvolvimento de novos protocolos clínicos e terapêuticos no futuro. / Osteoporosis is a skeletal disorder characterized by decreased bone strength resulting in an increased risk of fracture. Bone loss occurs in both women and men due to the natural aging process [Drake et al.,2015]. According to the World Health Organization (WHO) diagnosis and classification, osteoporosis is defined by the bone mineral density (BMD) in the hip or lumbar spine being less than or equal to -2.5 of the standard deviation below the BMD average for a population of young adults [Cosman et al.,2014]. It has a high prevalence being more frequent than the sum of cases of myocardial infarction, breast cancer and stroke. This disease should be considered as a public health problem, since it affects the individual in his social, physical and work function and, therefore, causes socioeconomic impact [Haddad et al.,2015]. In this work, we developed a new rat model of osteoporosis by oophorectomy aiming the use of human cells for Traslational Medicine. To this end, two steps were established, i) standardization of the animal model of osteoporosis by oophorectomy, using female Sprague-Dawley rats at 12 weeks. The osteoporosis was analyzed by bone densitometry at 0, 21, 45 and 60 days after surgery and by histological analyzes of femoral bones. The serum was collected for measurement of estrogen markers; ii) at second stage of the project, osteoporosis was induced in immunodeficient female nude Rowett (NTacFCfiq: NIJ-Whn) at 12 weeks and the same assays were conducted to detect osteoporosis. Bone mineral density and bone histological analyzes showed changes in the of bone mineral content and bone structure, respectively, at 60 days after surgery in both rat lineages. With this work, we intend to contribute to the understanding of osteoporosis biology using a new animal model, which can lead to the development of new clinical and therapeutic protocols in the future.

Le but cette thèse était d’explorer l’influence du niveau d’activité physique et du niveau de performance physique sur la densité minérale osseuse, la géométrie osseuse de la hanche et le score de l’os trabéculaire chez de jeunes hommes en surpoids et obèses. Trois principales études ont été menées. Une première étude a montré que la pratique d’activités physiques a un effet positif sur le CMO, la DMO et la section transversale du col fémoral chez les hommes en surcharge pondérale. Une deuxième étude a suggéré que le niveau d’activité physique influence positivement les paramètres osseux chez les hommes en surpoids et obèses et que l’optimisation de la masse maigre, de la VO2 max (L/min) et de la force maximale des membres inférieurs peut aider à prévenir l’ostéoporose chez les hommes en surpoids et obèses. Enfin, une dernière étude, a été la première à démontrer une relation positive entre la VO2 max (ml/mn/kg) et les indices de résistance osseuse du col fémoral (le CSI, le BSI et l’ISI) chez les jeunes hommes en surpoids et obèses et a donc suggéré que l’augmentation de la VO2 max chez les hommes en surpoids et obèses pourrait aider à réduire les fractures stéoporotiques. Ces différents résultats suggèrent une adaptation ostéogénique significative des jeunes hommes en surpoids et obèses en réponse à l’entrainement physique. / The aim of this thesis was to explore the influence of physical activity level and physical performance on bone mineral density, hip geometry and trabecular bone score in young overweight and obese men. Three main studies have been conducted. The first study has shown that physical activity practice has a positive effect on BMC, BMD and femoral neck crosssectional area in overweight men. The second study has shown that physical activity level positively affects bone variables in overweight/obese men and that increasing lean mass, VO2 max (L/min) and muscular strength of the lower limbs can help to prevent osteoporosis in overweight and obese men. Finally, the last study, was the first to show positive associations between maximal oxygen consumption (milliliter per minute per kilogram) and composite indices of FN strength (CSI, BSI and ISI) in young overweight and obese men and therefore suggested that enhancing VO2 max in overweight and obese men may help to reduce osteoporotic fractures. These different results suggest a significant osteogenic adaptation in young overweight and obese men in response to physical training.

Não disponível / Background: Visceral adiposity is a risk factor for cardiometabolic diseases and dual-energy x-ray absorptiometry (DXA) represents precise method for measuring visceral adipose tissue (VAT), muscle and bone compartments. The musculoskeletal system deteriorates with aging and may result in osteosarcopenia. Since known risk factors do not fully explain the occurrence of osteosarcopenia, the search for new causal factors, as birth weight (BW) is promising. Objectives: To evaluate whether BW was associated with DXA-determined body composition, bone densitometry and cardiometabolic risk markers in young women from the NutriHS. Paper 1 objective: to propose reference values for DXA-determined VAT, and to test their ability to identify the cardiometabolic risk profile. Paper 2: to examine whether BW was associated with muscle and bone DXA-determined parameters. Paper 3: to investigate whether parameters of muscle and bone compartments were associated and possible predictive factors of these compartments throughout life. Methods: NutriHS is a cohort study conducted in undergraduates and Nutrition graduates and here cross-sectional analyses were performed in 201 healthy women (20-45 years). They answered questionnaires and had anthropometry, muscle strength and performance, DXA-determined body composition and bone densitometry obtained. A random sample of 148 participants had also laboratory tests collected. Multiple regression models, using the directed acyclic graphs-recommended adjustments, were employed. Results: Median age was 23 years and mean BMI was 22.9±2.9 kg/m2. Paper 1: Mean VAT mass and volume were 221.0±306.1 g and 231.8±323.8 cm3, respectively. The third tertiles of VAT were significantly associated with increased frequencies of abnormal anthropometry, HOMA-IR and TyG indexes. Paper 2: Mean BW was 3,199±424 g; BW in quartiles was significantly associated with several muscle and bone parameters. Paper 3: Direct, strong and independent associations between bone and muscle variables were detected. Discussion: Cutoffs for DXA-derived VAT mass (221.0 g) and volume (231.8 cm3) are being suggested for Brazilian young women; these seem able to disclose a mild visceral fat accumulation, prior the deterioration of glucose and lipid metabolism. The role of BW as an early marker for muscle and bone states in young adulthood was shown. In addition, a musculoskeletal profile for a healthy stratus of the Brazilian women was firstly described. Our findings indicated a muscle-bone crosstalk even in young adults and suggested predictive factors (such as BW, physical activity, smoking) of muscle and bone compartments.

Les buts de cette thèse étaient d'explorer les effets de l'obésité et du surpoids sur le contenu minéral osseux (CMO), la densité minérale osseuse (DMO) et la géométrie osseuse de la hanche ches des adolescents et des jeunes adultes libanais. 131 sujets libanais agés de 13 à 30 ans ont acceptés de participer à cette étude (67 de sexe masculin et 64 de sexe féminin) et ont donné leur consentement éclairé. Le poids et la taille ont été mesurés et l'indice de masse corporelle (IMC) a été calculé. La composition corporelle, le CMO du corps entier (CE), la DMO CE, la DMO du rachis lombaire (L2-L4), la DMO de la hanche et la DMO de l'avant-bras ont été mesuréses par la DXA. La géométrie osseuse de la hanche a été évaluée par le logiciel Hip Structure Analysis (HSA). La surface de la section transversale (CSA), le moment d'inertie de la surface transversale (CSMI), le module de section (Z), l'épaisseur corticale (CT) et le buckling ratio (BR) ont été ainsi mesurés par le logiciel HSA. Dans les deux sexes, l'obésité et le surpoids étaient associés à une augmentation des valeurs absolues de CMO, de DMO et d'indicecs géométriques de résistance osseuse (CSA et Z) au niveau de la hanche. Chez les sujets de sexe masculin, le CMO CE, le rapport CMO CE/taille, la DMO CE et la DMO du Radius ultra-distal étaient significativement inférieurs chez le groupe obèse par rapport aux groupes en surpoids et normo-pondérés après ajustement pour le poids (en utilisant une analyse de covariance). Chez les sujets de sexe féminin, après ajustement pour le poids (en utilisant une analyse de covariance), la DMO du rachis lombaire était inférieure chez le groupe obèse par rapport au groupe normo-pondéré alors qu'il n'y avait aucune différence entre les trois groupes (obèse, en surpoids et normo-pondéré) au niveau des indices géométriques de résistance osseuse de la hanche. Cette thèse montre donc que la DMO de certains sites osseux n'est pas correctement adaptée à l'excès de poids chez les jeunes obèses. / The aims of this thesis were to explore the effects of obesity and overweight on bone mineral content (BMC), bone mineral density (BMD) and hip geometry in a group of Lebanese adolescents and young adults. 131 Lebanese subjects (67males and 64 female) whose ages range between 13 and 30 years participated in this study. Informed written consent was obtained from participants. Weight and height were measured, and body mass index (BMI) was calculated. Body composition, whole body bone mineral content (WB BMC), whole body bone mineral density (WB BMD), lumbar spine bone mineral density (L2-L4 BMD), hip BMD and forearm BMD were measured by DXA. To evaluate hip bone strength, DXA scans were analyzed by the hip structure analysis (HSA) program. Cross-sectional area (CSA), section modulus (Z), cross-sectional moment of inertia (CSMI), cortical thickness (CT) and buckling ratio (BR) were measured from hip bone mass profiles using the HSA software. In both sexes, obesity and overweight were associated with higher crude BMC, BMD and geometric indices of hip bone strengh values (CSA and Z). In males, obese group displayed lower WB BMC, WB BMC/height, WB BMD and ultra-distal Radius BMD values in comparison to overweight and normal-weight groups after adjustement for weight (using a one-way analysis of covariance). In females, after adjusting for body weight (using a one-way analysis of covariance), lumbar spine BMD was lower in the obese group compared to the normal-weight group while there were no significant differences among the three groups (obses, overweight and normal-weight) regarding geometric indicesof hip bone strength. This study shows that BMD of some skeletal sites is not well adapted to the increased body weight in young obese.

Este estudo transversal teve por objetivo avaliar e relacionar entre si densidade mineral óssea (DMO), composição corporal e doença periodontal em 22 pacientes do gênero masculino, de 22 a 48 anos, portadores de obesidade, com IMC40kg/m2, candidatos à cirurgia bariátrica, atendidos no Hospital Amaral Carvalho (HAC) pelo Sistema Único de Saúde (SUS). Foram realizadas as avaliações antropométrica, do DXA e da condição periodontal. As variáveis qualitativas e quantitativas foram analisadas por meio da correlação linear pelo índice de correlação de Pearson, considerando o intervalo de confiança de 95% e nível de significância de 5% (p<0,05). O peso médio foi de 148kg (122-198); IMC médio de 48,8 (40,5-62,5); CMO, em média, de 3,31kg (2,7-4,1); DMO de corpo total média de 1,3 g/cm2 (1,1-1,5); e Z-score médio de 1,2 (0,0-2,9). A média de gordura corporal total foi de 43,3% (37,4-52,1), e a porcentagem de massa livre de gordura total foi de 56,6 (47,9-82,3). O IMG (Índice de massa gorda) médio foi de 20,6 (14,4-27,0), relação A/G de 1,2 (1.0-1,6) e o peso de tronco médio, 85,8kg (68,3-116,2). Dos pacientes, 29% apresentaram doença periodontal severa. Na casuística, ocorreu uma diferença a menor de 4,5kg (1,0 a 7,8) no peso de DXA comparado ao peso antropométrico, o que corresponde a uma diferença média de 3,06% (0,05-5,27). Na análise de correlação da avaliação odontológica vs resultado DXA, obteve-se apenas correlação significativa entre o índice de sangramento gengival e o IMG (p=0,031, R= -0,525). Pode-se concluir que o índice de massa corporal esteve inversamente relacionado ao sangramento gengival. Estudos futuros deverão ser conduzidos para esclarecer melhor estes achados. / The present cross-sectional study was aimed at evaluating and establishing the relation between bone mineral density (BMD), body composition and periodontal disease in 22 male patients, aged 22-48 years, with obesity (BMI of 40kg / m2), eligible for bariatric surgery, at Hospital Amaral Carvalho Hospital (HAC) by the Brazilian Unified Health System (SUS). Patients underwent anthropometric evaluations, whole-body DXA and periodontal assessment. Qualitative and quantitative variables were analyzed by means of linear correlation analyzes using the Pearsons correlation coefficient with 95% confidence interval and significance level of 5% (p <0.05). The data analyzes were performed with the aid of the SPSS v.22 program. Mean patients weight was 148kg (122-198); mean BMI, 48.8 (40.5-62.5); mean BMC, 3.31kg (2.7-4.1); mean whole-body BMD, 1.3 g / cm2 (1.1-1.5); and mean Z-score, 1.2 (0.0-2.9). Mean total body fat was 43.3% (37.4-52.1), and the percentage of total lean mass was 56.6 (47.9-82.3). Mean FMI (fat mass index) was 20.6 (14.4- 27.0); A/G ratio 1.2 (1.0-1.6) and mean trunk weight, 85.8 kg (68.3-116, 2). In the present study, 29% of the patients presented with severe periodontal disease. In the sample, there was a shortfall of 4.5 kg (1.0 to 7.8) in the DXA weight compared to anthropometric weight, which corresponds to an average difference of 3.06% (0.05- 5.27). In the correlation analysis between Dentistry assessment and DXA score, only a significant correlation was found between gingival bleeding index and FMI (p = 0.031, R = -0.525). It could be concluded that the body mass index was inversely related to de gingival bleeding. Future studies are needed to better clarify these findings.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-10-13T12:36:09Z No. of bitstreams: 2 Dissertação - Camila Lemos Pinto - 2015.pdf: 3271653 bytes, checksum: 954993469243074fcbf495a6e679acf8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-14T12:23:53Z (GMT) No. of bitstreams: 2 Dissertação - Camila Lemos Pinto - 2015.pdf: 3271653 bytes, checksum: 954993469243074fcbf495a6e679acf8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-14T12:23:53Z (GMT). No. of bitstreams: 2 Dissertação - Camila Lemos Pinto - 2015.pdf: 3271653 bytes, checksum: 954993469243074fcbf495a6e679acf8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-27 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The aim of this study was to examine the efficacy of creatine supplementation associated with resistance training on lean mass, strength and bone mass in the elderly. This was a 12-week, parallel-group, double-blind, randomized, placebocontrolled trial. The individuals were randomly allocated into one of the following groups: placebo plus resistance training (PL + RT) and creatine supplementation plus resistance training (CR + RT). The participants were assessed at baseline and after 12 weeks. The primary outcomes were lean mass and strength, assessed by dual energy X-ray absorptiometry (DXA) and ten-repetition maximal (10RM) tests, respectively. Secondary outcomes included lumbar spine, right and left femoral neck, dual femur and whole body bone mineral density and whole body bone mineral content, assessed by DXA. The CR+RT group had superior gain in lean mass when compared with the PL+RT group (p = 0.02). Changes in 10RM tests in bench press and leg press exercises, body composition, bone mineral density and content of all assessed sites did not significantly differ between the groups (p > 0.05). In conclusion, 12 weeks of creatine supplementation associated with resistance training resulted in increased lean mass. / Este trabalho teve como objetivo avaliar o efeito da suplementação de creatina mono-hidratada associada a um programa de treinamento físico resistido sobre a massa magra, a força e a massa óssea em idosos. Foi realizado ensaio clínico, com grupos paralelos, duplo-cego, randomizado, controlado por placebo com duração de 12 semanas. Os participantes foram alocados em um dos seguintes grupos: placebo e treinamento físico resistido (PL+RT) e suplementação de creatina e treinamento físico resistido (CR+RT). Os participantes foram avaliados antes e após 12 semanas de intervenção. Os desfechos primários foram massa magra e força, avaliados pelo método de absorciometria por dupla emissão de raios-X (DXA) e por testes de 10 repetições máximas (10RM), respectivamente. Os desfechos secundários foram densidade mineral óssea da coluna lombar, dos fêmures direito e esquerdo, do fêmur duplo e de corpo total, bem como o conteúdo mineral ósseo do corpo total, avaliados pelo método DXA. O grupo CR+RT teve ganho superior de massa magra, quando comparado ao grupo PL+RT (p = 0,02). Os valores nos testes de 10RM nos exercícios de supino reto e leg press, a composição corporal, a densidade e o conteúdo mineral ósseos de todos os locais avaliados não diferiram significativamente entre os grupos (p > 0,05). Portanto, 12 semanas de suplementação de creatina associada a um programa de treinamento físico resistido resultaram em aumento de massa magra.