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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
481

Sintomas de insônia e sono diurno associados à ocorrência de hipertensão e diabetes mellitus em idosos / Symptoms of insomnia and daytime sleep associated to occurrence of hypertension and diabetes mellitus in the elderly

Freitas, Denise Cuoghi de Carvalho Veríssimo, 1969- 21 August 2018 (has links)
Orientador: Maria Filomena Ceolim / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T23:18:27Z (GMT). No. of bitstreams: 1 Freitas_DeniseCuoghideCarvalhoVerissimo_D.pdf: 2485963 bytes, checksum: 213465114374498d7288558bab3e51d0 (MD5) Previous issue date: 2013 / Resumo: Distúrbios do sono são prevalentes entre idosos e têm sido associados ao desenvolvimento e agravamento de doenças crônicas, com destaque para a hipertensão e o diabetes mellitus (DM). Estas doenças são responsáveis por elevado percentual de morbidade e mortalidade nessa faixa etária. Este estudo teve por objetivos investigar a associação dos sintomas de insônia e do sono diurno igual ou superior a 90 minutos com a ocorrência de hipertensão e DM em idosos, independente da presença de outros fatores de risco; e identificar fatores preditivos desses distúrbios. Constitui um adendo à pesquisa Fragilidade em Idosos Brasileiros (FIBRA), estudo multicêntrico realizado com idosos residentes na comunidade. Utilizou-se o banco de dados da cidade de Campinas - SP, na qual foi avaliada uma amostra aleatória e representativa de 900 idosos. Destes, 689 foram incluídos neste estudo, atendendo a critérios de seleção previamente definidos. Os dados foram submetidos à análise descritiva e inferencial, por meio do teste Qui-quadrado para verificar a associação entre variáveis e análise de regressão logística univariada e múltipla, para investigar a influência dos sintomas de insônia e do sono diurno igual ou superior a 90 minutos na ocorrência de hipertensão e DM, bem como para identificar os fatores preditivos desses sintomas e do sono diurno de longa duração. Verificou-se predomínio das mulheres, dos idosos mais jovens (65 a 69 anos), casados, aposentados, com um a quatro anos de estudo e residentes com a família. Sintomas de insônia foram relatados por 55,0%, sendo mais prevalentes o despertar precoce, a dificuldade de iniciar o sono e o sono não restaurador. Sono diurno com duração igual ou superior a 90 minutos foi referido por 9,9% dos idosos. Os fatores associados à hipertensão, segundo o modelo de regressão logística múltipla, foram o IMC indicativo de pré-obesidade ou obesidade, os sintomas de insônia e o sedentarismo; para o DM, mostraram-se associados aos não brancos e ao alto risco da relação cintura/quadril. Quanto aos sintomas de insônia, os fatores associados foram à avaliação subjetiva da saúde regular, ruim ou muito ruim, a situação de não estar aposentado e a depressão. A presença de enfisema/bronquite foi o único fator associado ao sono diurno com 90 minutos ou mais de duração. Estes achados alertam os profissionais de saúde para que investiguem sintomas de insônia, mesmo na ausência de queixas dos idosos. As informações coletadas poderão contribuir na prevenção de possíveis agravos à saúde, bem como para subsidiar políticas públicas de prevenção e tratamento. Este projeto está inserido na Linha de Pesquisa "Processo de Cuidar em Saúde e Enfermagem" / Abstract: Sleep disorders are prevalent among the elderly and have been recently associated with the development and worsening of chronic diseases, especially hypertension and diabetes mellitus (DM). These diseases are responsible for high rates of morbidity and mortality in this age group. This study aimed to investigate the association between insomnia symptoms and daytime sleep over 90 minutes with the occurrence of hypertension and DM in the elderly regardless of the presence of other risk factors, and to identify predictive factors of these disorders. It is an addendum to the research Frailty in Brazilian Elderly (FIBRA), multicenter study with elderly community residents. We used the database of Campinas - SP, in which it was, assessed a representative random sample of 900 elderly. Of these, 689 were included in this study, given the selection criteria previously defined. Data were analyzed by descriptive and inferential statistics, using Chi-square test to determine the association between variables, and logistic regression analysis, univariate and multivariate, to investigate the influence of symptoms of insomnia and daytime sleep over 90 minutes in the occurrence of hypertension and DM, as well as to identify factors predictive of insomnia symptoms and long lasting daytime sleep. Results showed a predominance of women, young-old (65 to 69 years), married, retired, with one to four years of formal education, living with relatives. Insomnia symptoms were reported by 55.0%. Mostly frequent insomnia symptoms were early morning awakening, difficulty initiating sleep and non-restorative sleep. Daytime sleep 90 minutes or longer was reported by 9.9% of the elderly. Factors associated with hypertension, according to multiple logistic regression model, were BMI indicative of pre-obesity or obesity, insomnia symptoms and physical inactivity; for DM, associated factors were nonwhite and high risk waist-to-hip relationship. As to insomnia symptoms, risk factors were subjective evaluation of health as fair, poor or very poor, the situation of not being retired and depression. Presence of emphysema/bronchitis was the only factor associated with daytime sleep of 90 minutes or longer. These findings alert health professionals to investigate symptoms of insomnia, even in the absence of complaints from the elderly. They may also help in preventing possible harm to health as well as to support public policies for prevention and treatment. This project is included in the Research Line "Process of Caring in Nursing and Health" / Doutorado / Enfermagem e Trabalho / Doutora em Ciências da Saúde
482

Farelo de aveia e concentrados de ß-glucana nativo e oxidado: efeito sobre parâmetros endócrinos e metabólicos em ratos submetidos a uma dieta hipercolesterolêmica / Oat bran concentrates and ß-glucan native and oxidized: effect on endocrine and metabolic parameters in rats subjected to a hypercholesterolemic diet

Nörnberg, Fabrícia Rehbein 20 March 2014 (has links)
Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2015-03-20T22:12:05Z No. of bitstreams: 2 DISSERTAÇAO FABRICIA REHBEIN NORNBERG.pdf: 1043542 bytes, checksum: 64de5eeba1271d7fb4f60e21b9299bc6 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2015-03-20T23:52:56Z (GMT) No. of bitstreams: 2 DISSERTAÇAO FABRICIA REHBEIN NORNBERG.pdf: 1043542 bytes, checksum: 64de5eeba1271d7fb4f60e21b9299bc6 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2015-03-20T23:53:12Z (GMT) No. of bitstreams: 2 DISSERTAÇAO FABRICIA REHBEIN NORNBERG.pdf: 1043542 bytes, checksum: 64de5eeba1271d7fb4f60e21b9299bc6 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-20T23:53:12Z (GMT). No. of bitstreams: 2 DISSERTAÇAO FABRICIA REHBEIN NORNBERG.pdf: 1043542 bytes, checksum: 64de5eeba1271d7fb4f60e21b9299bc6 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-03-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / A ß-glucana do farelo de aveia tem recebido grande atenção principalmente devido aos efeitos benéficos à saúde, como redução do colesterol sérico e glicemia e controle da saciedade através de regulação hormonal, no entanto seu uso é limitado pois quando adicionado aos alimentos acarreta em características indesejáveis. A oxidação tem sido comumente aplicada a vários polissacarídeos para melhorar suas propriedades tecnológicas, no entanto, existem poucos estudos que avaliem seu impacto na propriedade funcional in vivo. O objetivo desse estudo foi avaliar e comparar os efeitos da ingestão do farelo de aveia e dos concentrados de ß-glucana nativo e oxidado em diferentes concentrações em ratos adultos machos submetidos à dieta hipercolesterolêmica. Para isso, a ß-glucana foi extraída do farelo de aveia e uma parcela oxidada com peróxido de hidrogênio. 42 ratos adultos machos foram divididos em 7 grupos, todos receberam dieta hipercolesterolêmica. O grupo controle não teve alteração na fonte de fibra, os demais grupos receberam modificação, com substituição parcial ou total da fibra da dieta por ß-glucana do farelo de aveia (FA 2,5 e FA 5%), ou através do concentrado nos grupos ß-glucana nativa (BGN 2,5 e BGN 5%) e ß-glucana oxidada (BGO 2,5 e BGO 5%) durante 30 dias. Foi avaliado o consumo alimentar e ganho de peso e após a eutanásia foi feita a dosagem sérica de glicose, lipoproteínas plasmáticas, GLP-1, PYY3-36 e grelina. Foi removida a aorta, gordura epididimal, perirenal e peritoneal, quantificado os lipídeos hepáticos, fecais e ácidos biliares fecais. O concentrado apresentou 42,3% de ß-glucana enquanto que o farelo de aveia 11,9%. O concentrado de ß-glucana nativo apresentou maior potencial de ligação com ácidos biliares in vitro, com 12,1%. In vivo o grupo FA5% apresentou melhores resultados, com menor ganho de peso (71,33 g), menor glicemia (126,47 mg/dL), gordura perirenal (3,74 g), epididimal (3,91 g) e peritoneal (7,65 g) e redução dos níveis de GLP-1 que também foi identificado no grupo que recebeu 2,5% de ß-glucana nativa através de concentrado extraído do farelo de aveia. Todos os grupos de ratos com alteração de fibra nas suas dietas apresentaram maior excreção fecal de gordura, sendo os maiores valores encontrados nos grupos FA5% (15,5 g), BGN5% (15,4 g) e BGO5% (14,4 g), no entanto, somente os grupos FA5% (44,5 g) e BGN2,5% (44,4 g) apresentaram menores valores de gordura hepática, nenhum grupo apresentou redução sérica das lipoproteínas plasmáticas. O nível de grelina foi menor no grupo que consumiu 2,5% de ß-glucana oxidada através de concentrado. O estudo demonstra que o consumo de ß-glucana pode trazer benefícios para a saúde, principalmente quando testada a maior dose na forma de farelo de aveia, uma vez que foi capaz de reduzir os níveis de glicemia, o ganho de peso, os níveis de gordura corporal, além de promover aumento do hormônio da saciedade GLP-1. O processamento da fibra através da extração e da oxidação influência seus efeitos biológicos em ratos. / The ß-glucan from oat bran has received much attention mainly due to beneficial health effects, such as reducing plasma cholesterol and control of satiety through hormonal regulation, however its use is limited because when added to foods leads to undesirable characteristics. The oxidation has been commonly applied to various polysaccharides to improve their technological properties, however, there are few studies that assess their impact on functional property in vivo. The aim of this study was to evaluate and compare the effects of intake of oat bran and of ß-glucan concentrates native and oxidized at different concentrations in adult male rats subjected to a hypercholesterolemic diet. For this, the ß-glucan extracted from oat bran and a portion oxidized with hydrogen peroxide. 42 adult male rats were divided into 7 groups, all received hypercholesterolemic diet. The control group had no change in source of fiber, the other groups were modified, with partial or total substitution of dietary fiber by ß-glucan from oat bran (FA2.5% and FA 5%), or by concentrating on groups native ß-glucan (BGN2.5% and BGN5%) and ß-glucan oxidized (BGO2.5% and BGO5%) for 30 days. Food intake and weight gain has been reported after euthanasia and serum glucose, plasma lipoproteins, GLP- 1, ghrelin and PYY3-36 was taken. The aorta, epididymal, perirenal and peritoneal fat, quantified hepatic lipids, fecal and fecal bile acid was removed. The concentrate showed 42.3% of ß-glucan, while oat bran 11.9%. The concentrated ß-glucan native showed higher binding potential with bile acids in vitro, with 12.1%. In vivo, group FA5% showed better results, with less weight gain (71.33 g), lower blood glucose (126.47 mg/dL), perirenal fat (3.74 g), epididymal (3.91 g) and peritoneal (7.65 g) and reduced levels of GLP-1 that was also identified in the group given 2.5% by native ß glucan concentrate extracted from oat bran. All groups of mice with altered fiber in their diets had higher fecal fat excretion , with the highest values found in groups FA5% (15.5 g), BGN5% (15.4 g) and BGO5% (14.4 g) , however, only groups FA5 % (44.5 g) and BGN2.5 % (44.4 g) had lower levels of liver fat, no group showed reduction of serum lipoproteins. Ghrelin levels were lower in the group that consumed 2.5% of ß-glucan concentrate rusted through. The study shows that consumption of ß-glucan can bring health benefits, especially when the highest dose tested as oat bran, as it was able to lower blood glucose levels, weight gain, levels of body fat, and promote increased satiety hormone GLP-1. The processing of the fiber through the extraction and oxidation influence their biological effects in rats.
483

Ohjausintervention vaikuttavuus elintapoihin ja elintapamuutokseen sitoutumiseen

Ylimäki, E.-L. (Eeva-Leena) 10 March 2015 (has links)
Abstract The purpose of this study was to describe and explain the lifestyle of residents of Lapland who have a risk of cardiovascular diseases. Moreover, the effectiveness of counseling intervention on current lifestyle and adherence to lifestyle change were studied. Participants’ self-assessed and self-reported lifestyles and how these reflect objective measurements were also investigated. The data were collected in three phases in 2007–2009: baseline (n = 53) and follow-ups at 6 months (n = 32) and 12 months (n = 34). Lifestyle intervention was carried out using Skype videocall except for one group. The data was formed of blood test results (fP-Kol, fP-Kol-HDL, fP-Kol-LDL, fP-Gluk), anthropometric (height, weight, BMI, waist circumference) and blood pressure measurements, diabetes risk test, lifestyle questionnaire, adherence to lifestyle change questionnaire and food and exercise diaries. At baseline, serum cholesterol and LDL cholesterol were raised. Participants were at least overweight; they did not exercise enough nor receive enough vegetables or fiber. The self-assessed lifestyle was contradictory to the measurement results. Factors affecting adherence to lifestyle change were the urge to take care of oneself and the responsibility for one’s health. At the 6-month follow-up, improvement in cardiovascular health was detected: the cholesterol level and diabetes risk had decreased. Waist circumference and the number of obese (BMI > 30) decreased. In addition, health-improving changes in lifestyle were detected. The usage of vegetables and berries increased and the usage of salt decreased. However, participants did not exercise enough. At the 12-month follow-up, worsening in dietary habits was detected. However, blood pressure declined and men’s waist circumference remained the same when compared to the previous follow-up. Between baseline and 6-month follow-up some improvements in cardiovascular health could be detected but they did not remain until the 12-month follow-up. Participants assessed their lifestyle to be better than what the objective measurements indicated. Factors affecting adherence to lifestyle change were self-efficacy, adherence to the given advice and guidance and concern over the current lifestyle. Participants benefited from the counseling intervention because small changes were detected towards healthier lifestyle. Lifestyles changed into healthier direction. The results of this study can be utilized when developing counseling intervention further. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää sydän- ja verisuonisairauksien riskiryhmään kuuluvien lappilaisten elintapoja ja ohjausintervention vaikuttavuutta elintapoihin ja elintapamuutokseen sitoutumiseen. Lisäksi kuvattiin tutkittavien itsearvioimia ja raportoimia elintapoja sekä verrattiin niitä objektiivisiin mittaustuloksiin. Ohjausinterventio toteutettiin videopuhelinvälitteisesti Skypellä yhtä ryhmää lukuun ottamatta. Tutkimukseen osallistui 53 työikäistä lappilaista. Tutkimusaineisto kerättiin kolmessa vaiheessa vuosina 2007–2009: nollamittaus (n = 53) sekä seurantamittaukset kuuden (n = 32) ja 12 (n = 34) kuukauden kuluttua. Tutkimusaineisto muodostui verikoetuloksista (fP-Kol, fP-Kol-HDL, fP-Kol-LDL, fP-Gluk), antropometristen mittausten tuloksista (pituus, paino, BMI ja vyötärönympärysmitta), verenpaineesta, diabeteksen riskitestistä, elintapa- ja sitoutumiskyselystä sekä ruoka- ja liikuntapäiväkirjoista. Nollamittauksessa seerumin kolesteroli ja LDL-kolesteroli olivat koholla. Tutkittavat olivat vähintään ylipainoisia, ja liikunta sekä kasvisten ja kuidun saanti oli vähäistä. Oma arvio elintavoista oli ristiriidassa mittaustulosten kanssa. Nollamittauksessa elintapamuutokseen sitouttavia tekijöitä olivat halu huolehtia itsestä ja vastuu omasta terveydestä. Kuuden kuukauden seurantamittauksessa verisuoniterveys oli parantunut kolesterolin ja diabetesriskin osalta. Vyötärönympärysmitta ja lihavien määrä (BMI > 30) väheni. Myös elintavoissa havaittiin muutoksia valtimoterveyttä edistävään suuntaan. Kasvisten ja marjojen käyttö lisääntyi sekä suolan käyttö väheni. Liikuntaa ei kuitenkaan ollut riittävästi. Kahdentoista kuukauden seurantamittauksessa todettiin ”repsahdusta” ruokailutottumuksissa. Edelliseen mittaukseen nähden verenpaine laski ja miesten vyötärönympärysmitta pysyi samana. Nolla- ja kuuden kuukauden mittauksen välillä tapahtui valtimoterveyttä edistäviä muutoksia, joista kaikki eivät ilmentyneet 12 kuukauden seurantamittauksessa. Osallistujat arvioivat elintapojaan paremmaksi kuin mittaustulokset osoittivat. Elintapamuutokseen sitoutumiseen vaikuttavia tekijöitä ovat pystyvyys, sitoutuminen neuvoihin ja ohjeisiin sekä huoli nykyisistä elintavoista. Osallistujat hyötyivät ohjausinterventiosta, sillä elintavoissa tapahtui pieniä muutoksia terveelliseen suuntaan. Tuloksia voidaan hyödyntää kehitettäessä ohjausinterventioita.
484

Effets potentiels et mécanismes d'action antioxydant et anti-inflammatoire d'un apport nutritionnel de spirulines enrichies en silicium / Potential effects and antioxidative/anti-inflammatory action mechanisms of silicon-enriched spirulina.

Vidé, Joris 22 May 2015 (has links)
En raison de ses formes peu biodisponibles retrouvées dans la nature, le silicium n'a reçu que très peu d'intérêt dans le domaine biologique. Or, il est clairement démontré que le silicium peut avoir un rôle important dans la prévention de l'athérosclérose. L'entreprise Phyco-Biotech, productrice de spiruline, s'est intéressée à ce problème. Les propriétés nutritionnelles exceptionnelles de la spiruline, ainsi que ses effets bénéfiques sur certaines pathologies ne sont plus à démontrer. Grâce à un procédé breveté, Phyco-Biotech a réussi à produire une spiruline enrichie en silicium, permettant au silicium d'avoir certainement une meilleure biodisponibilité chez l'homme. L'objectif de ce travail a été d'étudier les effets d'une supplémentation en spiruline enrichie en silicium, en mode préventif, sur un modèle animal d'athérosclérose nutritionnellement induite. Dans une étude de toxicologie chez le rat, constituant la première partie de ce travail, nous avons montré que la spiruline enrichie en silicium n'est pas toxique à la dose utilisée. Dans la seconde partie, nous avons mis en évidence un effet préventif de la spiruline enrichie en silicium sur les multiples composantes de la pathologie athéromateuse et sur les désordres nutritionnels liés à la consommation d'un régime riche en graisses saturées. A la suite de ce travail, nous avons proposé des hypothèses de mécanismes d'action. Ces mécanismes pourraient impliquer une modulation de la voie NF-κB ; ou bien agir sur le remodelage artériel et notamment sur les processus cellulaires impliqués dans les propriétés contractiles de l'artère. La compréhension totale du mécanisme d'action de cette spiruline enrichie en silicium nécessite cependant plus d'investigations. / Due to low bioavailability forms of silicon found in the nature, it has received little interest in the biological field. However, it was clearly demonstrated that silicon may have an important role in prevention of atherosclerosis.The company Phyco-Biotech, spirulina producer, was interested in this problem. The exceptional nutritional properties of spirulina and its beneficial effects on some diseases are well established. Through a patented process, Phyco-Biotech has successfully produced silicon enriched spirulina, allowing the silicon to have a better bioavailability in humans.The objective of this work was to study the effects of a supplementation with silicon enriched spirulina, in an animal model of nutritionally induced atherosclerosis.The first part of this study has shown, using a study in rats, that silicon enriched spirulina was not toxic at the dose used.In the second part, silicon enriched spirulina has shown a preventive effect on risk factors for atherosclerotic disease and disorders related to the consumption of a high fat diet.This work allowed to propose hypothesis of mechanisms of action. Indeed, these mechanisms could involve modulation of the NF-kB pathway, or act on the arterial remodeling or on cellular pathways involved in the contractile properties of the artery. More investigations are needed to determine the complete mechanism of action of this silicon enriched spirulina.
485

Prevalence and factors associated with obesity amongst employees of Open-Cast Diamond Mine in Namibia

Haufiku, Desderius January 2008 (has links)
Magister Public Health - MPH / Background: NAMDEB is a Namibian alluvial diamond mining company, owned in equal shares by the government of republic of Namibia and De Beers. It is mining in the open-cast mines along the southern coast of Namibia, using various methods and equipments such as bowl scrapers, bulldozers, trackdozers and excavators. NAMDEB have got different mining site, where employees are residing in hostels near the mine. One of those mines is the Pocket Beaches mine where this study took place. The study investigated the prevalence and factors associated with obesity amongst employees of Pocket Beaches mine. Obesity rates are increasing at an alarming rate worldwide; 1.2 billion people worldwide are overweight of which 300 million are clinically obese. Of concern is that obesity is a risk factor for many diseases including hypertension, diabetes and other forms of cancers. Although there are several mine workers who on reporting to occupational health services for minor ailment are found to be overweight or obese, we are not certain of the extent of the problem. The health risk associated with obesity could cause a big loss to NAMDEB in terms of care cost, low productivity and absenteeism. Aim: The aim of this study was to investigate the prevalence and determinants of obesity amongst NAMDEB employees working at Pocket Beaches diamond mine Study design: a descriptive, cross-sectional study measured the prevalence of obesity and describes the factors that are associated with obesity and overweight. Study population: NAMDEB employees who were working at Pocket Beaches mine. A simple random sampling technique was used to select participants. 87 employees were selected from 188 total NAMDEB employees working at Pocket Beaches mine. Data collection: Data was collected through interviews. Anthropometric measurements namely weight, height and abdominal circumference were collected using a standard protocol. Analysis: Data was analyzed using Epi Info 2002. Body Mass Index (BMI) was calculated as kg/m2. Overweight was defined as BMI = 25 to 29.9 kg/m2 and obesity as BMI ≥ 30 kg/m2. Waist Circumference ≥80 cm was used to identify central obesity in women and ≥90 cm in men. The frequency of participation in physical activity, barriers to physical activity and food consumption is reported in percent and means. Result: The study found prevalence 42% overweight and 32% obesity among employees of NAMDEB. A significant number of participants 48% never participate in moderate exercise per week. 71% of participants reported lack of motivation to exercise and too tired after work as the major barriers to physical activity. The consumption of fatty foods such as fried chicken and fried meat was common among study subjects. A large number of respondents 79% eat fried chicken regularly while 74% eat fried meat regularly. 79% of participants consumed inadequate fruits and vegetable (1 fruit and vegetable per day). The two most mentioned reasons for low fruits and vegetables consumption were lack of fruits and vegetables in hostel food menu and 14% don’t like fruits. / South Africa
486

Correlates of Vitamin D Status in Healthy Older Adults Living in Miami-Dade and its Association with Non-Skeletal Outcomes: A Cross-Sectional Study

Lopez, Johanna 03 November 2015 (has links)
Examining factors that affect vitamin D status in the fast-growing elderly population of Miami-Dade, Florida, is needed. Vitamin D deficiency in older adults has been linked to correlates of disability, including falls and fractures, and cardiovascular disease. The purpose of this study was to determine the proportion of vitamin D insufficient individuals and their relationship with vitamin D insufficiency in older adults (n=97) living in Miami-Dade. We evaluated the association between vitamin D status and 1) dual task physical performance to understand the link between vitamin D and cognition in the context of mobility; and 2) cardiometabolic risk, measured by galvanic skin response, pulse oximetry, and blood pressure to create a composite score based on autonomic nervous system and endothelial function. Participants completed baseline assessments that included serum levels of vitamin D, anthropometrics, body composition, dual task physical performance and cardiometabolic risk. Surveys to evaluate vitamin D intake, sun exposure, physical activity, and depressive symptoms were completed. Spearman’s correlations, independent t-tests, paired t-tests, repeated measures ANOVAs, and multiple logistic and linear regressions were used to examine the relationship of vitamin D insufficiency (25(OH)D /ml) and sufficiency (25(OH)D ≥30 ng/ml) with determinants of vitamin D status, dual task physical performance variables and cardiometabolic risk scores. Although the proportion of vitamin D insufficient individuals was lower when compared to the prevalance of the general United States elderly population, it was still common in healthy community-dwelling older adults living in Miami-Dade County, especially among Hispanics. Factors that affected skin synthesis (ethnicity, and sun exposure), and bioavailability/metabolism (obesity) were significant predictors of vitamin D status. Vitamin D insufficiency was not significantly correlated with worse dual task physical performance; however, cognitive performance was worse in the vitamin D insufficient group. Our results suggest a relationship of vitamin D insufficiency with executive dysfunction, and support an association with cardiometabolic risk using an innovative electro-sensor complex, possibly by modulating autonomic nervous system activity and vascular function, thus affecting cardiac performance.
487

Carga alimentar em indivíduos com diabetes

Riboldi, Bárbara Pelicioli January 2014 (has links)
Objetivo Avaliar, em indivíduos com diabetes (DM), a resposta de glicose e triglicerídeos duas horas após a ingestão de uma carga alimentar (CA) e sua associação com características clínicas e a presença de doenças crônicas. Metodologia Foram incluídos 915 indivíduos com DM, participantes da linha de base do estudo ELSA-Brasil. Coleta de sangue foi realizada em jejum e duas horas após o consumo da CA, contendo 455 kcal; 14 g de gordura saturada e 47 g de carboidratos. Regressão linear foi utilizada para investigar preditores dos níveis de excursão (diferença entre níveis pós-carga e de jejum) de glicemia e trigliceridemia (variáveis dependentes). Regressão logística foi realizada para descrever a associação da excursão de glicemia e trigliceridemia (variáveis independentes) e a presença de complicações do DM (doença coronariana, infarto, angina, acidente vascular cerebral, ou insuficiência cardíaca). Resultados A mediana da glicemia de jejum foi de 150 (123–198) mg/dL e da excursão de glicose foi 45 (16–79) mg/dL, enquanto que a trigliceridemia de jejum foi de 140 (103–199) mg/dL e a excursão de triglicerídeos foi de 26 (11–45) mg/dL. Maiores excursões de glicemia foram associadas com duração do DM (incremento de 5,7 mg/dL, IC95% 3,7–7,6, a cada 5 anos de doença), uso de insulina (58,5 mg/dL, IC95% 45,43–71,55), outro medicamento para DM (13,6 mg/dL, IC95% 2,5–24,8), idade (4,1 mg/dL, IC95% 0,43–7,69, a cada 10 anos), nível de glicose basal (5,2 mg/dL, IC95% 1,0–4,1, a cada 25 mg/dL); o índice de massa corporal associou-se a menor excursão (-6,8 mg/dL, IC95% -9,7 a -3,85, a cada 5 kg/m²). Maior excursão de trigliceridemia esteve associada com glicemia em jejum (2,5 mg/dL, IC95% 1,64–3,38, a cada 25 mg/dL), e menor excursão associada com triglicerídeos de jejum (-2,97 mg/dL, IC95% -3,24 – -2,69, a cada 25 mg/dL). Conclusão A resposta pós-prandial esteve associada ao tempo de doença, à necessidade de insulina ou outro medicamento para DM, ao índice de massa corporal, além da idade e níveis basais de glicose e triglicerídeos. As excursões de glicose e triglicerídeos estiveram associadas a presença de comorbidades potencialmente tidas como complicações do DM. / Objective We aimed to assess, in individuals with diabetes (DM), the excursions of glucose and triglyceride levels two hours after consumption of a food load (FL) and their association with clinical characteristics and the presence of chronic diseases. Design and Methods We included 915 subjects with DM, participants of in the ELSA-Brazil cohort. Blood sampling was performed at fasting and two hours after consumption of a 455 kcal, 14 g saturated fat and 47 g carbohydrate FL. Linear regression was used to investigate predictors of levels of excursion (difference between post-load and fasting levels) of glucose and triglycerides (dependent variables). Logistic regression was performed to describe the association of glucose excursion and triglycerides excursion (independent variables) and the presence of DM complications (coronary heart disease, myocardial infarction, angina pectoris, stroke, or heart failure). Results The median fasting glucose was 150 (123-198) mg/dL and glucose excursion was 45 (16-79) mg/dL, whereas fasting triglycerides was 140 (103-199) mg/dL and triglycerides excursion was 26 (11-45) mg/dL. Increase of glucose excursion were associated with DM duration (increase of 5.7 mg/dL, 95% CI 3.7 to 7.6, each 5 years of disease), insulin use (58.5 mg/dL, 95% CI 45.43 to 71.55), use of another drug for DM (13.6 mg/dL , 95% CI 2.5 to 24.8), age (4.1 mg/dL, 95% CI 0.43 to 7.69, each 10 years), fasting glucose (5.2 mg/dL, 95% CI 1.0 to 4.1, each 25 mg/dL) and body mass index (-6.8 mg/dL, 95% CI -9.7 to -3.85, each 5 kg/m²). The triglycerides excursion was associated with fasting glucose (2.5 mg/dL, 95% CI 1.64 to 3.38, each 25 mg/dL) and fasting triglycerides (-2.97 mg/dL, 95% CI -3.24 to -2.69, each 25 mg/dL). In logistic regression models adjusting for gender, age, fasting glucose, duration of diabetes, use of insulin and/or other drug for DM, the excursion of glucose was marginally associated with the presence of any complication of diabetes and coronary heart disease. Conclusion Greater glycemic postprandial response was positively associated with indicators of less pancreatic reserve and negatively associated with obesity, while and the size of the response in triglycerides presented only minimal associations. Associations of excursion size with diabetes complications were present.
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Estudos metabolômicos na apneia obstrutiva do sono / Metabolomic profile of obstructive sleep apnea

Adriana Lebkuchen 14 December 2017 (has links)
Introdução: A apneia obstrutiva do sono (AOS) é uma condição clínica comum, embora subdiagnosticada na prática clínica, que está associada de forma independente com um aumento na morbimortalidade cardiovascular. Evidências recentes sugerem que o aumento do risco cardiovascular atribuído à AOS pode ser parcialmente explicado pela desregulação metabólica. No entanto, pouco se sabe sobre o perfil metabólico detalhado destes pacientes e se estes metabólitos podem servir como potenciais biomarcadores para a AOS. Objetivos: O objetivo primário do estudo foi avaliar o perfil metabólico de pacientes com AOS por meio de diferentes estratégias metabolômicas. Como objetivo secundário, avaliamos se o painel de metabólitos selecionados poderia agregar valor diagnóstico ao uso de questionários tradicionalmente empregados para a triagem da AOS. Métodos: Participantes do sexo masculino sem doença cardiovascular prévia ou uso de medicamentos foram submetidos à polissonografia noturna e divididos em 2 grupos pareados por idade e índice de massa corpórea (IMC): sem AOS (índice de apneia e hipopneia [IAH] < 15 eventos/h) e com AOS (IAH >= 15 eventos/h). Além da avaliação clínica, foi aplicado dois questionários para triagem da AOS usados na prática clínica (questionário Berlim e o escore NoSAS). A quantificação de aminoácidos (AA) no plasma foi realizada por cromatografia líquida acoplada à espectrometria de massas sequencial (LC-MS²) previamente desenvolvido e validado no Grupo Fleury. Para as análises metabolômicas e lipidômicas foram utilizados cromatografia gasosa acoplado a espectrometria de massas (GC-MS) e cromatografia líquida (LC) off-line com detecção por ionização/dessorção a laser auxiliada por matriz (MALDI-MS), respectivamente. Para avaliação dos marcadores que estariam associados à AOS foram utilizados teste t de student (p < 0,05) e VIP score > 2 (predição de variável de importância). A sensibilidade e especificidade foram avaliadas por meio da curva receiver operating characteristic (ROC) e modelos de regressão logística em associação com o melhor questionário de triagem para a AOS. Resultados: 53 participantes foram estudados (16 sem AOS e 37 com AOS). Como proposto, a idade média (36 ± 6 vs. 39 ± 7 anos) e o IMC (30,3 ± 3,5 vs. 30,6 ± 3,4 kg/m2) foram semelhantes entres os grupos sem e com AOS, respectivamente. A quantificação dos AA permitiu observar uma diferença significante nos níveis de ácido glutâmico, que foram maiores nos pacientes com AOS (83,5 ± 22,5 ?M) quando comparados ao grupo sem AOS (66,7 ± 24,5 uM), p=0,023. A avaliação do perfil metabolômico resultou em 28 analitos significantes. Seis desses analitos foram provenientes da análise por GC-MS: pacientes com AOS apresentaram maiores níveis de 6-deoxi-D-glicose; 2,6-difenil-1,7-diidrodipirrolo [2,3-b:3\',2\'-e] piridina, ácido 9 (Z)-hexadecenóico e ácido araquidônico e menores níveis de 5,5\'-bifitalato e glutamina quando comparados ao grupo sem AOS (p < 0,05). A análise lipidômica (LC off-line e MALDI-MS) resultou em 22 lipídios significantes subdivididos nas seguintes classes: ceramidas (Cer), fosfatidiletanolamina (PE), lisofosfatidilcolina (LPC), e esfingomielina (SM) com níveis mais elevados em pacientes com AOS em comparação ao grupo sem AOS (p < 0,05). Diacilglicerol (DAG), fosfatidilcolina (PC) e ácido fosfatídico (PA) tiveram níveis significativamente diminuídos nos pacientes com AOS em comparação aos sem AOS. Em relação ao objetivo secundário, o questionário com melhor desempenho para triar a AOS foi o escore NoSAS com uma área sob a curva (AUC) de 0,724. A combinação dos 4 metabólitos (ácido glutâmico, glutamina, 6-deoxi-D-glicose e ácido araquidônico) ou dos 3 lipídios (LPE 35:1, SM d18:1/12:0 e LPC 27:1) selecionados pelo modelo de regressão logística ao escore NoSAS positivo resultou em uma AUC de 0,917 e 0,951, respectivamente, para a detecção da AOS. Conclusão: A aplicação da metabolômica permitiu a identificação de potenciais biomarcadores precoces para a AOS em homens jovens. Estes achados não são explicados por fatores de confusão como a idade, IMC e composição corporal. Este estudo confirma o achado de que os questionários habitualmente usados para a triagem da AOS não apresentam um bom desempenho. A combinação dos metabólitos selecionados aumentou a sensibilidade e especificidade para detecção da AOS em relação ao questionário isolado. Neste contexto, novos estudos são necessários para avaliar se estes biomarcadores poderão ser úteis para a predição do risco cardiovascular e melhora do diagnóstico da AOS / Introduction: Obstructive sleep apnea (OSA) is a common clinical condition, although frequently underdiagnosed in clinical practice. OSA is independently associated with an increased risk of cardiovascular morbidity and mortality. Recent evidence suggests that the cardiovascular risk attributed to OSA may be partially explained by metabolic dysregulation. However, little is known about the detailed metabolic profile of these patients and whether these metabolites may serve as potential biomarkers for OSA. Objectives: The primary objective of the study was to evaluate the metabolic profile of OSA patients through different metabolomics strategies. As a secondary objective, we evaluated whether the panel of selected metabolites could improve diagnostic value to the use of questionnaires traditionally used for OSA screening. Methods: Male participants with no previous cardiovascular diseases and under no medications were submitted to a nocturnal polysomnography and divided into 2 groups matched by age and body mass index (BMI): no OSA (apnea and hypopnea index [AHI] < 15 events/h) an OSA (AHI >= 15 events/h). In addition to the clinical evaluation, was applied two questionnaires to screening OSA in the clinical practice (Berlin questionnaire and the NoSAS score). The quantification of amino acids (AA) in plasma was performed by liquid chromatography coupled to sequential mass spectrometry (LC-MS/MS) previously developed and validated in the Fleury Group. To the metabolomics and lipidomics analysis, we used gas chromatography coupled to mass spectrometry (GC-MS) and off-line liquid chromatography (LC) with matrix-assisted laser ionization/desorption detection (MALDI-MS), respectively. Student\'s t test (p < 0.05) and VIP score >2 (significance variable prediction) were used to evaluate the markers associated with OSA. Sensitivity and specificity were evaluated using the receiver operating characteristic (ROC) curve and logistic regression models in association with the best screening questionnaire for OSA. Results: 53 participants were studied (16 with no OSA and 37 with OSA). As proposed, mean age (36 ± 6 vs. 39 ± 7 years) and BMI (30.3 ± 3.5 vs. 30.6 ± 3.4 kg/m2) were similar between the groups without and with OSA, respectively. The quantification of AA showed a significant difference in the glutamic acid levels, which were higher in patients with OSA (83.5 ± 22.5 ?M) when compared to the group with no OSA (66.7 ± 24.5 ?M), p=0.023. Metabolomics profile analysis resulted in 28 significant analytes. Six of these analytes came from GC-MS analysis: patients with OSA had higher levels of 6-deoxy-D-glucose, 2,6-diphenyl-1,7-dihydrodipyrrolo [2,3-b:3\',2\'-e] pyridine, 9-hexadecenoic acid (Z) and arachidonic acid and lower levels of 5,5\'-biphthalide and glutamine when compared to the no OSA group (p < 0.05). The lipidomics analysis (LC off-line and MALDI-MS) resulted in 22 significant lipids subdivided into the following classes: glycerophosphoethanolamine (PE), lysophosphosphatidylcholine (LPC), and sphingomyelin (SM) with higher levels in patients with OSA when compared to the no OSA group (p < 0.05). Diaglycerol (DAG), glycerophosphocholine (PC) and phosphatidic acid (PA) had significantly decreased levels in patients with OSA compared to those with no OSA. Regarding to the secondary endpoint, the best performing questionnaire for screening OSA was the NoSAS score with an area under the curve (AUC) of 0.724. The combination of the 4 metabolites (glutamic acid, glutamine, 6-deoxy-D-glucose and arachidonic acid) or the 3 lipids (LPE 35:1, SM d18:1/12:0 and LPC 27:1) previously selected by logistic regression model to the NoSAS positive score resulted in an AUC of 0.917 and 0.951, respectively, for the OSA detection. Conclusion: The application of metabolomics strategies allowed the identification of potential early biomarkers for OSA in young male subjects. These findings are not explained by confounding factors such as age, BMI and body composition. This study confirms previous findings that the questionnaires commonly used for screening OSA do not have a good performance. The combination of the selected metabolites increased the sensitivity and specificity to OSA detection in relation to the use of sleep questionnaire only. In this context, further studies are necessary to assess whether these biomarkers may be useful for predicting cardiovascular risk and improving the OSA diagnosis
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Associação entre periodontite crônica, perda dentária e marcador inflamatório de doenças cardiovasculares

Zanella, Silvia Maria January 2017 (has links)
Periodontite crônica e perda dentária tornaram-se ferramentas úteis para estudar a hipótese de que a infecção/inflamação aumenta o risco de doenças cardiovasculares. Tem se demonstrado que a periodontite e suas consequências (perdas dentárias) têm o poder de elevar os marcadores inflamatórios sistêmicos, incluindo a proteína C-reativa, a qual é uma proteína aguda plasmática que é reconhecida como um preditor de infarto e se encontra aumentada em infecções. Com base no entendimento que o processo inflamatório sistêmico é o fator ligante entre as duas condições, o objetivo deste estudo foi analisar a associação entre edentulismo, perda dentária e parâmetros clínicos de periodontite crônica com inflamação sistêmica medida através de níveis de proteína C-reativa. Este estudo transversal controlado faz parte de um macro-projeto do Instituto de Cardiologia do Rio Grande do Sul que num estudo tipo consórcio incluiu 130 pacientes que receberam indicação para realizar cineangiocoronariografia. Os pacientes selecionados foram examinados entre dezembro de 2016 e outubro de 2017 e passaram por exame periodontal completo constando de índice de placa visível (IPV), sangramento à sondagem (SS), perda de inserção (PI), profundidade de sondagem (PS) em todos os dentes presentes nos seis sítios e também coletado o número de dentes perdidos e coleta de exames sanguíneos. A amostra foi dividida em 2 grupos: edêntulos (24,6%) e dentados (75,3%), sendo que maioria era homens (67,7%), com idade média de 63,30(±10,7) brancos (80%), com educação fundamental (70%), sedentários (62%), diabéticos (52%), hipertensos (74%) e com pelo menos um evento cardiovascular anterior (52%). As médias ± desvio-padrão de PS foram de 3,36±1,25; para PIos valores foram de 5,42±1,85; IPV médio de 0,39±0,25; e SS médio de 0,34±0,23, com uma média de 13,44±7,95 dentes. No modelo de regressão logística observou-se o efeito independente da perda dentária após ajustada para fumo e sexo. Conclui-se que a perda dentária está associada a incremento do risco cardíaco medido por inflamação sistêmica. / Chronic periodontitis and tooth loss have become useful tools for studying the hypothesis that infection/inflammation increases the risk of cardiovascular disease. It has been shown that periodontitis and its consequences (tooth loss) have the power to elevate systemic inflammatory markers; one of these markers is C-reactive protein is an acute plasma protein that is recognized as a predictor of myocardial infarction and is increased in infections. Based on the understanding that the systemic inflammatory process is the linking factor between the two conditions the objective of this study was to analyze the association between edentulism, tooth loss and clinical parameters of chronic periodontitis with systemic inflammation measured through C-reactive protein levels. This controlled cross-sectional study is part of a macro-project of the Instituto de Cardiologia do Rio Grande do Sul, which in a consortium-type study included 130 patients who were indicated to perform coronary angiography. The selected patients were examined between December 2016 and October 2017 and underwent complete periodontal examination consisting of visible plaque index (VPI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), in six sites per tooth of all teeth present in addition to blood tests. The sample was divided into 2 groups: edentulous (24,6%) and dentate (75,3%)individuals. The majority were men (67.7%), with mean age of 63.30 (± 10.7) whites (80%), hypertensive (74%) and with at least one previous cardiovascular event (52%). The means and standard deviation of PD were 3.36 ±1.25; for CAL mean values of 5.42 ±1,85; Mean VPI was of 0.39 ± 0.25; and BOP presented 0.34 ± 0.23 as mean, with a mean of 13.44 ± 7.95 teeth present. In logistic regression model, we observed the independent effect of tooth loss after adjustment for smoking and sex. It is concluded that tooth loss is associated with increased cardiac risk as measured by systemic inflammation.
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Contribuições da síndrome metabólica e da atividade física nos custos com saúde de pacientes da rede pública de Presidente Prudente /

Ricardo, Suelen Jane January 2020 (has links)
Orientador: Jamile Sanches Codogno / Resumo: A Síndrome Metabólica (SM) tem sido apontada como importante fator no aumento do risco de doenças cardiovasculares, problema de saúde pública mundial. A doença tem apresentado elevados custos com a utilização de serviços de saúde direcionados aos seus componentes. O estudo objetivou avaliar a presença de SM em adultos, atendidos pelo SUS, assim como a influência da prática de atividade física habitual (AFH) nos custos com serviços de saúde de pacientes com SM. O estudo é de característica transversal, a amostra foi selecionada por meio da sexta coleta de estudo de coorte, realizada na atenção primária de duas Unidade Básicas de Saúde (UBS) da cidade de Presidente Prudente. Participaram deste estudo aqueles que faziam parte da coorte e demonstraram interesse em participar e estiveram presentes em todas as avaliações anteriores. Era necessário ter idade igual ou acima de 50 anos e ter registro ativo na UBS. A SM foi verificada por meio das variáveis bioquímicas, glicose, lipoproteína de alta densidade (HDL) e triglicerídeos (TG) analisadas por meio de exames laboratoriais realizados por laboratórios credenciados. A pressão arterial sistólica e diastólica a circunferência de cintura fora, verificadas por avaliadores. O nível da atividade física habitual (AFH) foi avaliado por questionário e, através de registros em prontuários médicos, foram verificados os custos com serviços de saúde dos pacientes participantes da pesquisa. Esta dissertação foi estruturada em dois capítulos, di... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The study aimed to evaluate the presence of MS in adults, assisted by SUS, as well as the influence of the practice of habitual physical activity (AFH) in the costs of health services for patients with MS. The study is cross-sectional, the sample was selected through the sixth collection of a cohort study, carried out in the primary care of two Basic Health Units (UBS) in the city of Presidente Prudente. Participated in this study those who were part of the cohort who showed interest in participating and were present in all previous evaluations. It was necessary to be 50 years old or over and have active registration at UBS. MS was verified by means of the biochemical variables glucose, high-density lipoprotein (HDL) and triglycerides (TG) were analyzed through laboratory tests performed by accredited laboratories, the systolic and diastolic blood pressure and waist circumference was verified by evaluators. The level of habitual physical activity (AFH) was assessed using a questionnaire, and through medical records, the costs of health services of the patients participating in the research were verified. This dissertation was structured in two chapters, divided as follows: Chapter 1- introduction, objectives and general methodology of the dissertation; Chapter 2- article with the objective of evaluating the prevalence of MS in patients of the Unified Health System (SUS) in Presidente Prudente and analyzing the contribution of its components on the costs of health services in ... (Complete abstract click electronic access below) / Mestre

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