No description available.

Menopause is an important period for bone health in women. Objective: To assess the determinants of bone mineral density (BMD) changes in women transitioning to menopause. Method: A secondary data analysis of the MONET (Montreal-Ottawa New Emerging Team) study. Outcome measures included yearly assessment of menopause status, body composition, BMD, physical activity energy expenditure (PAEE) and dietary calcium and vitamin D intakes. Results: 84 of the original 102 women had complete data for the purpose of the present study. Repeated measures analysis revealed significant decreases in lumbar spine and femoral neck BMD (P< 0.01). Regression analysis revealed that baseline femoral neck BMD, changes in PAEE and trunk fat explained 31% of the variation of BMD changes at the femoral neck, while changes in both PAEE and trunk fat account for 27% of BMD change at lumbar spine. Conclusion: Baseline femoral neck and changes in physical activity energy expenditure and trunk fat are determinants of the reduction of bone mineral density in women transitioning to menopause.

Primary hyperparathyroidism (PHPT) is a common endocrine disease, existing in both genders and in all age groups. Postmenopausal women are at particular risk of developing the disease and estrogen decline after menopause is suggested to affect the progress. Although PHPT is mild in its presentation with subtle or no subjective symptoms, it is associated with an increased risk of associated morbidity and also mortality i.e cardiovascular complications, psychiatric instability, concomitant metabolic abnormalities, obesity and decrease in bone mineral density. The current cure is surgical removal of the diseased gland/s, but other medical alternatives have been investigated. The disease is thoroughly explored in postmenopausal women but less is known about other populations groups. Since progression of the disease generally is slow, the underlying disturbance of the calcium homeostasis can be suspected to have been established a long time prior to diagnose with potential to affect associated morbidity. The general aim of this thesis is to clarify the expression of PHPT in premenopausal women and in elderly men and to explore how frequent the disease in these populations occurs. The women and men were investigated through population-based studies. Baseline data and prevalence of PHPT in premenopausal women age 40-50 years were studied (Paper I), the prevalence was 5.1% in this population and was associated with decreased bone mineral density and associated obesity. In a three years follow up of the female cohort, the effects of menopausal transition and associated morbidity was investigated (Paper II). The prevalence and expression of PHPT in men between 69 and 81 years and impact on bone mineral density, physical performance, fall and fracture prevalence was explored through data from Mr Os Sweden (Papers III and IV). In this population prevalence of PHPT was 0.73% and associated with lower bone mineral density and inferior physical performance.

The Female Athlete Triad, consisting of the interrelated conditions of low energy availability, leading to menstrual disturbances and low bone mineral density, is commonly diagnosed amongst excessively exercising women. The American College of Sports Medicine emphasizes that the underlying factor of the Triad is a discrepancy between dietary energy intake and the energy requirements needed to support high levels of physical activity in addition to other homeostatic and physiological bodily processes. Although low energy availability is largely recognized as a causative factor for amenorrhea and low bone density, no studies to date have examined specific macro- and micro-nutrient intake relating to bone mineral density in the female athlete population. The hypothesis to be tested was that a difference in the intake of specific nutrients between athletes with menstrual disturbances (amenorrheic) and regularly menstruating (eumenorrheic) athletes contributes to low bone mineral density in female athletes exhibiting symptoms of the Triad. Methods: 4-day food records were collected from 118 females, ages 14-23 years, who exhibited weight within the normal range. 68 participants were amenorrheic athletes (AA), 24 participants were eumenorrheic athletes (EUM), and 26 participants were non-exercising females within the same age group (non-athletes: NA). Serum levels of vitamin D, phosphorus, calcium, and estradiol were also collected. Results: In contrast to previous studies, there was no difference in energy availability between the AA, EUM, and NA groups. The groups did differ in their intake of several macro-and micro-nutrients, and many of these nutrients correlated significantly with lumbar spine BMD. In a multivariate model that included vegetable and total proteins, soluble, insoluble and total dietary fiber, pectins, phytic acid, natural folate, calcium intake, vitamin D intake, serum vitamin D levels, and % calories from saturated fatty acids (SFA), only dietary fiber remained negatively associated and % calories from SFA positively associated with lumbar spine BMD. Conclusions: Dietary fiber has a significant inverse association and % calories from SFA a positive association with lumbar spine BMD, even after controlling for other nutrient intake and serum levels and intake of Vitamin D and calcium. Therefore, fiber and saturated fat may exert effects unrelated to vitamin D status and overall energy availability to impact bone density. Nutrition guidelines for female athlete triad patients need to be reassessed.

Submitted by Kyle Robinson Lynch (kyle.lynch.sc@gmail.com) on 2018-07-04T21:31:35Z No. of bitstreams: 1 Dissertation _ Kyle Lynch _ 04.07.18 _ Final.doc: 754176 bytes, checksum: bc069c8ce5a8fc3f6cc9189da04181a0 (MD5) / Rejected by ALESSANDRA KUBA OSHIRO ASSUNÇÃO (alessandra@fct.unesp.br), reason: Solicitamos que realize correções na submissão seguindo as orientações abaixo: - O arquivo deve estar em formato PDF - Acrescentar a ficha catalográfica que deverá ser obtida com a biblioteca através do link abaixo: http://www.fct.unesp.br/#!/biblioteca2340/servicos/elaboracao-de-ficha-catalografica/ - Colocar folha de aprovação contendo as assinaturas dos membros da banca e a data de defesa (caso seja a imagem na pág. iv, colocar novamente, pois ela não apareceu) Agradecemos a compreensão. on 2018-07-05T14:22:19Z (GMT) / Submitted by Kyle Robinson Lynch (kyle.lynch.sc@gmail.com) on 2018-07-10T19:01:42Z No. of bitstreams: 1 Dissertation _ Kyle Lynch _ 10.07.18 _ Final.pdf: 832983 bytes, checksum: 06433c144b0dda4669f10d1027f1f123 (MD5) / Approved for entry into archive by ALESSANDRA KUBA OSHIRO ASSUNÇÃO (alessandra@fct.unesp.br) on 2018-07-11T14:25:27Z (GMT) No. of bitstreams: 1 lynch_kr_me_prud.pdf: 832983 bytes, checksum: 06433c144b0dda4669f10d1027f1f123 (MD5) / Made available in DSpace on 2018-07-11T14:25:27Z (GMT). No. of bitstreams: 1 lynch_kr_me_prud.pdf: 832983 bytes, checksum: 06433c144b0dda4669f10d1027f1f123 (MD5) Previous issue date: 2018-06-21 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: Analisar o risco de fraturas traumáticas de acordo com o engajamento em esportes com diferentes níveis de impacto, assim como identificar o potencial impacto da participação esportiva nos gastos entre adolescentes. Métodos: Estudo longitudinal com 24 meses de seguimento. A amostra foi composta por 285 adolescentes de ambos os sexos (202 meninos e 83 meninas) que foram contatados pelos pesquisadores em escolas (n= 104) e clubes esportivos (n= 181) localizados na região metropolitana de Presidente Prudente, SP, Brasil. Todos os adolescentes foram convidados considerando os seguintes critérios de inclusão: a) idade entre 10-19 anos, 2) assinatura dos pais no termo de consentimento, 3) se contatados em clubes esportivos, pelo menos um ano de treino; se contatados na escola, pelo menos um ano sem prática esportiva ou exercícios. Os grupos foram classificados em: Controle (n= 104), Natação (n= 34), e Esportes de Impacto (n= 147). A ocorrência de fraturas e gastos em saúde foram avaliadas mensalmente durante 12 meses antes da linha de base e 12 meses após linha de base. Sexo, idade, composição corporal, participação esportiva, maturação biológica e proteína CReativa (PCR) foram avaliados durante os 12 meses após a linha de base. Análise estatística foi composta por teste Mann-Whitney, qui-quadrado, Regressão de Cox, Kruskal-Wallis, Analise de Covariância e medidas de tamanho de efeito. A significância estatística foi fixada em p<0.05 e todas as análises foram realizadas no software BioEstat (versão 5,2 [BioEstat, Teffe, Brasil]). Resultados: A incidência de novas fraturas foi de 2,1% (n= 6). A ocorrência de fraturas traumáticas durante o período de 24 meses (12 meses de seguimento + 12 meses prévios) foi de 6,0% ([IC95%: 3,2% a 8,7%]; n= 17). Os gastos totais acumulados durante o período de 12 meses de seguimento foram de U$ 2.991,96. Quando comparados os adolescentes de acordo com a incidência de novas fraturas, não houveram diferenças por sexo, idade, densidade óssea, gordura corporal, esportes, maturação biológica e PCR. Gastos totais também não apresentaram diferença de acordo com a ocorrência de qualquer fratura durante o período de 24 meses. Participação esportiva não mostrou qualquer associação ou risco para a ocorrência de fraturas traumáticas. Quando desmembrados os grupos por esportes, atletismo [US$ 4,13 (27,67)], ginástica [US$ 10,77 (23,90)], judô [US$ 4,24 (6,96)] e natação [US$ 24,67 (46,50)] apresentaram maiores gastos quando comparados ao grupo controle. Caratê, kung-Fu, tênis, basquete e baseball não apresentaram diferenças significativas quando comparados ao grupo controle. Nadadores apresentaram maiores gastos com medicação (p-valor= 0,001), consultas (p-valor= 0,001) e exames (p-valor= 0,005) quando comparados ao grupo controle e esportes de impacto. Mesmo após ajustes por fatores de confusão, nadadores (Média: US$ log10 1,172 [IC95%: 0.925 a 1.420]) tiveram maiores gastos do que o grupo controle (Média: US$ log10 0,280 [IC95%: 0,101 a 0,459]) e esportes de impacto (Média: US$ log10 0,404 [IC95%: 0,290 a 0,519]) (p-valor = 0,001). Participação esportiva explicou 13,2% de toda variância em gastos com saúde, enquanto sexo (2,6% da variância) e fraturas (3,5% da variância) também foram covariáveis relacionadas aos gastos nesse modelo. Conclusão: Os achados desse estudo indicaram que participação esportiva (incluindo esportes de impacto) não aumentou o risco de fraturas entre adolescentes, enquanto fraturas traumáticas foram o principal determinante de gastos com saúde entre adolescentes. Além disso, alguns esportes pareceram estar mais relacionados a maiores gastos com saúde entre adolescentes, independente do impacto econômico de fraturas e sexo. / Objective: To analyze the risk of traumatic fractures according to the engagement in sports with different levels of physical impact, as well as to identify the potential impact of sports participation on health care costs among adolescents. Methods: Longitudinal study with 24 months of follow-up. The sample was composed of 285 adolescents of both sexes (202 boys and 83 girls) who were contacted by the researchers in schools (n= 104) and sports clubs (n= 181) located in the metropolitan region of Presidente Prudente, Sao Paulo, Brazil. All adolescents were invited, considering the inclusion criteria: 1) 10-19 years-old, 2) parents' consent form signed, 3) if contacted in any sports club, at least one year of training experience; if contacted in any school unit, at least one year without regular practice of sport or exercise. The groups were classified as: Control (n= 104), Swimming (n= 34), and Impact Sports (n= 147). The occurrence of fractures and health care costs were assessed monthly during the 12 months before baseline, as well as 12 months after baseline. Sex, age, body composition, sports participation, peak height velocity (PHV) and C-reactive protein (CRP) were assessed during the 12 months of follow-up. Statistical analyses were composed of Mann-Whitney test, chisquare test, Cox Regression, Kruskal-Wallis test, Analysis of Covariance and measures of effect size. Statistical significance was set at p<0.05 and all analyzes were performed using BioEstat software (version 5.2 [BioEstat, Teffe, Brazil]). Results: The incidence of new fractures was 2.1% (n= 6). The occurrence of traumatic fractures during the 24-month period (12-month follow-up plus previous 12 months) was 6.0% ([95%CI: 3.2% to 8.7%]; n= 17). The overall costs accounted during the 12-month follow-up were U$ 2,991.96. When comparing the adolescents according to the incidence of new fractures, there were no differences regarding age, BMD, BF, sports, PHV, and CRP. Overall health care costs were also not different according to subjects with any fracture during the 24-month period. Sports participation did not show any significant association or risk with the occurrence of traumatic fractures. When breaking the groups down by sport, track and field [US$ 4.13 (27.67)], gymnastics [US$ 10.77 (23.90)], judo [US$ 4.24 (6.96)], and swimming [US$ 24.67 (46.50)] presented higher costs when compared to the control group. Karate, kung-Fu, tennis, basketball and baseball did not show significant differences when compared to the control group. Concerning health care costs, swimmers presented higher costs with medicine (p-value= 0.001), appointments (p-value= 0.001), and tests (p-value= 0.005) when compared to control and impact sports groups. Even after adjustment by confounders, swimmers (Mean: US$ log10 1.172 [95%CI: 0.925 to 1.420]) had higher health care costs than control (Mean: US$ log10 0.280 [95%CI: 0.101 to 0.459]) and impact sports (Mean: US$ log10 0.404 [95%CI: 0.290 to 0.519]) (p-value = 0.001). Sports participation explained 13.2% of all variance in health care costs, while sex (2.6% of the variance) and fractures (3.5% of the variance) were also covariates related to health care costs in this model. Conclusion: The findings from this study indicate that sports participation (including impact sports) did not increase the risk of fracture among adolescents, while traumatic fracture was the main determinant of health care costs among these adolescents. Moreover, some sports seem to be related to higher health care costs among adolescents, independently of the significant economic burden of fractures and sex. / 2016/20377-0

Thalassaemia and sickle cell disease (SCD) are the most widely distributed blood genetic disorders that occur at a high frequency in some populations including the Mediterranean region, parts of the Middle East, South East Asia and the Indian subcontinent. It is estimated that thalassaemia major affects 100,000 newborn every year world-wide. The high incidence of these chronic haemolytic diseases in developing countries poses a high load on the national economy because of the expensive treatment protocols and the considerably high morbidity rates of these patients. Repeated blood transfusion to keep haemoglobin above an acceptable level requires well-equipped blood banks with expensive facilities to screen, store and manipulate blood and blood products. Iron chelation therapy is an essential part of treatment to avoid or delay the deleterious effects of iron overload on different organs including the liver, heart, pancreas and endocrine glands. This inquires injecting deferoxamine subcutaneously for 12 hours daily with a special pump. Both deferoxamine and pumps are expensive and therefore not accessible for all patients. In developing countries, the majority of transfusion-dependent patients with chronic haemolytic anaemia (thalassaemia and SCD) suffer from the consequences of sub-optimal treatment. The mortality rate is still high and usually patients die before the age of 30 years. They also suffer from chronic multi-organ damage including cardiac failure, liver cirrhosis, insulin-dependent diabetes mellitus, growth and pubertal failure and many skeletal abnormalities and fractures. In developed countries the introduction of high transfusion regimes and efficient chelation therapy improved survival rates and prevented cardiac and hepatic damage. However, a majority of thalassaemic patients still have significant growth and pubertal abnormalities, bone disease and multiple endocrine disorders. In Egypt the incidence of thalassaemia major ranges between 0.1 - 0.2% which gives very high patient load on the medical services. In our University of Alexandria Children's Hospital, Alexandria, Egypt. The Haematology clinic has an average of 150 thalassaemic children registered. The same problem is encountered by me in the Royal Hospital, Muscat, Oman, with high prevalence of SCD and thalassaemia and suboptimal treatment. Because of the restricted economic resources, both hospitals adopt a low transfusion therapy (to keep haemoglobin above 9 g/dl) with IM chelation 3 times per week. With this form of sub-optimal treatment we observed that a large number of our thalassaemic children have severe growth and pubertal failure/delay, beside other hepatic, cardiac and skeletal abnormalities. In fact they constitute 40% of patients attending our Endocrinology clinic. This stimulated me to perform an extensive study to survey growth and pubertal development in theses patients (study-1) and investigate the different factors that might affect their growth and pubertal development (studies 4 through 10) a \veU as bone mass density (studies &gt; 1,12). The frequent involvement of the liver in these patients led us to study some hepatic functions and the prevalence of transfusion-associated hepatitis B surface antigenaemia and hepatitis-C virus antibody scropositivity in relation to their linear growth (studies 2,3). We studied the nutritional intake of these patients, their intestinal absorption of D-Xylosc and 48-h stool fat content in relation to their body mass index, subcutaneous 'at thickness and mid-arm circumference (studies 4,5,9). Their defective linear growth urged us to investigate their growth hormone (GH) secretion (spontaneous nocturnal as well as after provocation) and insulin-like growth factor-I (IGF-I) and IGK-binding protein-3 (IGKBl'3) concentrations. Our findings demonstrated high prevalence of defective GH secretion in these children that necessitated imaging of their hypothalamic pituitary area. Imaging studies revealed original data about structural abnormalities in the anterior pituitary gland, different degrees of pituitary atrophy and empty sella and infiltration the gland as well as the mid-brain by hacniosidrin in thalassaemic children, the mechanism of these findings was explained (studies 4-6,10). Because of their slow growth, the presence of abnormal GH/IGF-I/BP3 axis, and structural abnormalities of the pituitary gland, the next step dealt with the response of IGF-I to exogenous GH and the clinical response of their linear growth to GH therapy for a year or more (studies 4,9). Based on the fact that these patients have high prevalence of bone pains and osteoporosis during late childhood and have high risk of spontaneous fracture thereafter, we measured their bone mass density to investigate the relation between the former and the degree of iron load, growth parameters, and different anabolic hormone concentrations in these patients (studies 11,12).

An alarming reduction in the numbers of several species of seals in the Baltic Sea was observed during the second half of the 1900s. Organochlorines, particularly PCBs, were found to cause the decline, inducing sterility and severe bone loss. If bone tissue is affected by PCBs, bone could be used as a biomarker for exposure to environmental contaminants. To isolate the effects of PCBs from other factors, experimental studies have been conducted on model species, such as mink. In this study, 58 mink femurs from three different treatment groups and one control group were analysed. Altogether 14 different parameters were measured using peripheral quantitative computed tomography (pQCT). Mink treated with a low dose of PCBs develop increased content, area and thickness of cortical bone. Mink treated with a high dose of PCBs do not show the same effects but have a cortical area similar to that of non-exposed animals. The trabecular density and content is increased in all groups that have been exposed to PCBs. The observed effects may be the result of dioxin-like PCBs binding to the aryl hydrocarbon receptor (AhR). The activation of AhR leads to disruptions in endocrine systems, that in turn impacts bone modelling and remodelling. However, other pathways cannot be ruled out, including the effects of non-dioxin-like PCBs. Further analyses are needed in order to fully understand how PCBs affect bone tissue properties.

Introduction: The topic of this thesis is the Prevention of Osteoporosis in Malabsorption Syndrome. The thesis is divided into two parts; theoretical and practical. The theoretical work in the first part deals with osteoporosis and osteoporosis risk factors with a focus on nutritional factors. Osteoporosis is a systemic metabolic disease of the skeleton characterised by decreased bone mass and changes in the quality of bone tissue. The etiology of osteoporosis is multifactorial. Malabsorption syndrome causes the small intestine, which is essential for absorbing nutrients, to malfunction. In the second part of the theoretical work, attention is paid to malabsorption syndrome and diseases that lead to its development. Objective: The objective of this work is to draw a comparison between the intake of calcium and other important nutrients in relation to bone metabolism for people with lactose intolerance, and compare this with recommended values and a control group of people without lactose intolerance. Methods: Dietary habits were evaluated using a questionnaire method and a detailed analysis of a four-day diet. The Nutriservis Professional programme was used to evaluate diets (determine energy values, amount of essential nutrients, fibre, calcium, plus other minerals and vitamins). Bone mineral...

Menopause transition is usually associated with changes in body composition and a decrease in physical activity energy expenditure. Adipose tissue, especially visceral fat, is an important source of inflammatory markers, which contributes to the development of a pro-inflammatory state. Conversely, high levels of physical activity and exercise have an anti-inflammatory effect. One-hundred and two healthy premenopausal women participated in a 5-year longitudinal observational study (MONET: Montreal Ottawa New Emerging Team). The present secondary analyses were performed on 58 participants between the ages of 47 and 54 years with a full set of data.The aim of study was to investigate the impact of menopause transition and physical activity on inflammatory makers. The major finding of the first of 3 studies was that menopausal transition is accompanied by an increase in inflammatory markers, namely ferritin, IL-8, and sTNFR 1 and 2. The increase in IL-8 and sTNFR2 with menopause could be explained, in part, by changes in fat mass and peripheral fat, respectively. During and after menopause, significant bone loss occurs in women due to reduced estrogen production. Estrogen reduction favors bone resorption by regulating the production and activity of inflammatory markers. Therefore we further investigated the association between inflammatory markers and bone mineral density in premenopausal women transitioning to menopause (paper 2). Our results showed no significant association between change in inflammatory markers and change in bone mineral density in women transitioning to menopause. However, in premenopausal women hs-CRP was negatively associated with total, lumbar spine and femoral neck bone mineral density and along with weight and cardiorespiratory fitness may play a role in bone mineral density variation. Baseline level of hs-CRP, Hp, IL-6 and femoral neck bone mineral density along with percent change in physical activity energy expenditure and menopausal status partly explained the individual variation of bone mineral density losses in women transitioning to menopause. Finally, we investigated time spent in the postmenopausal years and the influence of the duration of the postmenopause status on body composition and cardiometabolic risk factors. We indicated that postmenopausal years and years since menopause is associated with decrease in blood glucose and increase in waist circumference, percent fat mass, total cholesterol, and high density lipoprotein. Inflammatory markers including ApoB, ferritin, adiponectin, sCD14 were higher during years after final menstrual period while sTNFR1 and sTNFR2 were higher during the menopause transition and early postmenopausal years.

Made available in DSpace on 2014-06-11T19:26:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-08-07Bitstream added on 2014-06-13T19:12:52Z : No. of bitstreams: 1 tayar_g_me_sjrp.pdf: 647193 bytes, checksum: c93976b0eb63a8369134ef80302ad964 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / A osteoporose é uma doença metabólica, que se caracteriza por baixa massa e deterioração do tecido ósseo, conduzindo à fragilidade do osso com conseqüente aumento do risco de fraturas. O início da doença é influenciado por uma complexa interação entre fatores genéticos e ambientais, que pode afetar diferentemente os indivíduos. Por essa razão, faz-se necessário o estudo dos polimorfismos dos genes associados ao metabolismo ósseo, como os do Receptor para Vitamina D (VDR) e da Apolipoproteína E (APOE), além dos envolvidos no biometabolismo de agentes ambientais, como as Glutatião-S-Transferases (GSTs). Foram estudados 53 pacientes, homens e mulheres, com osteoporose e ou osteopenia, pareados por sexo e faixa etária com um grupo controle. O DNA foi extraído de leucócitos de sangue periférico e amplificado por Reação em Cadeia da Polimerase (PCR). Os polimorfismos GSTM1 e GSTT1 foram analisados em gel de agarose 2%, enquanto os da APOE e VDR foram submetidos à restrição enzimática com as enzimas Hha I e Fok I, respectivamente, seguido da análise em gel de poliacrilamida 6%, corados com brometo de etídeo e visualizados em luz UV. A análise estatística dos dados foi realizada, utilizando-se o teste t, teste de Fisher, a regressão multivariada e o teste de equilíbrio de Hardy-Weinberg. O genótipo nulo (0/0) de GSTM1 mostrou-se significantemente mais freqüente nos pacientes (64,1%) comparado ao dos controles (37,7%; P= 0,00112). Por outro lado, pacientes e controles não diferiram quanto à presença (+/+) e ausência (0/0) do gene GSTT1 (P=0,5328). A distribuição genotípica do polimorfismo VDR – Fok I revelou freqüência significantemente aumentada do genótipo ff nos pacientes (22,6%; P=0,0078). Para o gene da APOE, o alelo e3 foi significantemente mais freqüente nos controles (0,85; P=0,0431), enquanto... / Osteoporosis is a metabolic disease characterized by low body mass and bone deterioration, leading to bone fragility with the consequent increase of fractures risk. The disease onset is influenced by a complex interaction between genetic, and environment factors that can affect differently the individuals’ response. Therefore, the study of polymorphisms regarding the genes involved in bone metabolism is of upgrade necessity, such as the Vitamin D Receptor gene (VDR), Apolipoprotein E (APOE), besides the genes involved in xenobiotic metabolism, it means, the Glutathion-S-Transferases (GSTs). We have studied 53 patients, men and women, with osteoporosis and/or osteopenia, matched by gender and age with a control group. The DNA was extracted from peripheral blood lymphocytes and amplified through Polimerase Chain Reaction (PCR). GSTM1, and GSTT1 polymorphisms were analyzed in 2% agarose gel, while APOE, and VDR had been submitted to enzymatic restriction with Hha I and Fok I enzymes, respectively, followed by the analysis in 6% polyacrilamide gel, stained with ethidium bromide and visualized under UV light. The statistic analysis was carried on using test t, test of Fisher, the multi-varied regression and the test of Hardy-Weinberg balance. The GSTM1 null genotype (0/0) was significantly more frequent in patients (64.1%) compared to the controls (37.7%; P= 0.00112). On the other hand, patients, and controls did not differ concerning the presence (++) and absence (0/0) of GSTT1 gene (P=0.5328). The genotypic distribution of VDR –Fok I polymorphism showed a significantly increased frequency of the genotype ff in patients (22.6%; P=0.0078). For the APOE, the allele e3 was significantly more frequent in controls (0.85; P=0.0431), while the allele e4 was in patients (0.20; P=0.0075). The genotype...(Complete abstract click electronic access below)