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Motivation - Depression is a mental disorder that has been associated with cardiovascular morbidity and mortality in the Western world. Cardiometablic mechanisms have been implicated as possible intermediating factors in the relationship between depressive symptoms and cardiovascular disease; however this has not yet been determined in black Africans (hereafter referred to as Africans). Aim - The overarching aim of this study was to investigate the relationship between depressive symptoms and cardiometabolic risk. We therefore aimed to assess cardiometabolic function, neuroendocrine responses, inflammatory and haemostatic markers in Africans with depressive symptoms compared to those without symptoms of depression. Methodology - Manuscripts presented in Chapter 2, 3 and 4 utilised data from the cross-sectional, target population multi-disciplinary “Sympathetic activity and Ambulatory Blood Pressure in Africans” (SABPA) study. The participants comprised of 200 African teachers from the Dr Kenneth Kaunda District in North-West province, South Africa. As cardiovascular disease is compromised by a positive HIV status, 19 participants were excluded from further statistical analysis. Stratification was based on the Patient Health Questionnaire 9-item (PHQ-9), which has been validated in a sub-Saharan African setting. PHQ-9 scores > 10 were used to classify participants as having signs of depressive symptoms. Subjects were further stratified by gender (Manuscript 1 and 3) and cortisol responses (Manuscript 2). Cardiometabolic health measures included 24-hour blood pressure, metabolic syndrome markers, neuroendocrine markers [cortisol and 3-methoxy-4-hydroxy-phenylglycol (MHPG)], left ventricular hypertrophy (LVH),inflammatory and haemostatic markers (fibrinogen, C-reactive protein, plasminogen activator inhibitor-1 and D-dimer). Resting 12-lead ECG Cornell Product-Left ventricular hypertrophy (CP-LVH) was measured as a marker of target end-organ damage and cardiovascular dysfunction (Manuscript 1 and 2). Means and prevalence were computed through t-test and Chi-square analysis respectively. Significant differences of mean cardiometabolic measures between depressive symptom status groups were also determined by analysis of covariance (adjusted for traditional cardiovascular risk factors and additional factors as specific per manuscript). Multivariate analysis was used to demonstrate associations between left ventricular hypertrophy (LVH) and cardiometabolic markers in Africans with depressive symptoms (Manuscript 1 and 2) and a logistic regression analysis were performed to examine the association between depressive symptoms and inflammatory/haemostatic factors (Manuscript 3). All subjects who participated gave informed consent, the study was approved by the Ethics Committee of North-West University (NWU-0003607S6), in accordance with the principles outlined by the World Medical Association Declaration of Helsinki of 1975 (revised 2008). Results and conclusions of the individual manuscripts - The aim of the study was to investigate the associations between depressive symptoms and cardiometabolic function including cardiovascular dysfunction. Markers of cardiometabolic function assessed were 24 hour blood pressure measurements, metabolic syndrome markers, neuroendocrine markers [cortisol and 3-methoxy-4-hydroxy-phenylglycol (MHPG)], inflammatory and haemostatic variables (fibrinogen, C-reactive protein, plasminogen activator inhibitor-1 and D-dimer). Manuscript 1, focused on LVH as a marker of cardiovascular dysfunction and metabolic syndrome components as markers of cardiometabolic function. The aim of the study was to assess the associations between LVH and metabolic syndrome (MetS) risk markers in participants with and without depressive symptoms. Results revealed that in African men with depressive symptoms the most significant determinants of LVH were systolic blood pressure (SBP) and the percentage glycosylated haemoglobin (HbA1c). While in African women (with depressive symptoms), this association was determined by low high-density lipoprotein (HDL-cholesterol). The study concluded that in black African men, independent of depressive symptoms, cardiometabolic factors (namely SBP and HbA1c) may be the driving significant factors in the development of cardiovascular diseases. Furthermore, the data showed that depressive symptoms in African women were associated with a measure of target end organ damage, and that this association was driven by a metabolic factor. Manuscript 2, the aim of this manuscript was to examine the relationship between depressive symptoms, neuroendocrine responses [with cortisol and 3-methoxy-phenylglycol (MHPG) as markers] and cardiovascular risk, i.e. LVH. The results revealed that Africans with depressive symptoms demonstrated blunted cortisol and MHPG levels in response to acute mental stress, in comparison to those without symptoms of depression. Additionally, these low cortisol and blunted MHPG responses were associated with LVH in this ethnic group. The conclusion for this manuscript was that, blunted neuroendocrine responses linked depressive symptoms and ECG left ventricular hypertrophy in Africans. When coupled to their hypertensive status, these vasoconstrictive responses (cortisol and MHPG) may underpin the increased long-term depression and vascular disease risk in urban Africans. Manuscript 3, the aim of this manuscript was to investigate the relationship between depressive symptoms and inflammatory/haemostatic markers in a cohort of urban-dwelling black African men and women. Our data demonstrated hypercoagulation vulnerability in African men with depressive symptoms. The African men with signs of depression displayed higher plasminogen activator inhibitor (PAI-1) levels and marginally elevated D-dimer levels. It was concluded that hypercoagulation may partially be the mediating factor between depressive symptoms and cardiovascular risk in African men; a situation that may be exacerbated by hyperkinetic blood pressure. In conclusion, through the assessement of cardiometabolic function and neuroendocrine responses, it seems that Africans withdepressive symptoms are at great risk for cardiovascular related morbidity and mortality, this was particulary evident in the African men (Manuscript 1 and 3). Additionally, it appears that blunted neuroendocrine responses and hypercoagulation could be seen as possible cardiovascular risk markers in Africans with depressive symptoms. / PhD (Physiology), North-West University, Potchefstroom Campus, 2014

Motivation - Depression is a mental disorder that has been associated with cardiovascular morbidity and mortality in the Western world. Cardiometablic mechanisms have been implicated as possible intermediating factors in the relationship between depressive symptoms and cardiovascular disease; however this has not yet been determined in black Africans (hereafter referred to as Africans). Aim - The overarching aim of this study was to investigate the relationship between depressive symptoms and cardiometabolic risk. We therefore aimed to assess cardiometabolic function, neuroendocrine responses, inflammatory and haemostatic markers in Africans with depressive symptoms compared to those without symptoms of depression. Methodology - Manuscripts presented in Chapter 2, 3 and 4 utilised data from the cross-sectional, target population multi-disciplinary “Sympathetic activity and Ambulatory Blood Pressure in Africans” (SABPA) study. The participants comprised of 200 African teachers from the Dr Kenneth Kaunda District in North-West province, South Africa. As cardiovascular disease is compromised by a positive HIV status, 19 participants were excluded from further statistical analysis. Stratification was based on the Patient Health Questionnaire 9-item (PHQ-9), which has been validated in a sub-Saharan African setting. PHQ-9 scores > 10 were used to classify participants as having signs of depressive symptoms. Subjects were further stratified by gender (Manuscript 1 and 3) and cortisol responses (Manuscript 2). Cardiometabolic health measures included 24-hour blood pressure, metabolic syndrome markers, neuroendocrine markers [cortisol and 3-methoxy-4-hydroxy-phenylglycol (MHPG)], left ventricular hypertrophy (LVH),inflammatory and haemostatic markers (fibrinogen, C-reactive protein, plasminogen activator inhibitor-1 and D-dimer). Resting 12-lead ECG Cornell Product-Left ventricular hypertrophy (CP-LVH) was measured as a marker of target end-organ damage and cardiovascular dysfunction (Manuscript 1 and 2). Means and prevalence were computed through t-test and Chi-square analysis respectively. Significant differences of mean cardiometabolic measures between depressive symptom status groups were also determined by analysis of covariance (adjusted for traditional cardiovascular risk factors and additional factors as specific per manuscript). Multivariate analysis was used to demonstrate associations between left ventricular hypertrophy (LVH) and cardiometabolic markers in Africans with depressive symptoms (Manuscript 1 and 2) and a logistic regression analysis were performed to examine the association between depressive symptoms and inflammatory/haemostatic factors (Manuscript 3). All subjects who participated gave informed consent, the study was approved by the Ethics Committee of North-West University (NWU-0003607S6), in accordance with the principles outlined by the World Medical Association Declaration of Helsinki of 1975 (revised 2008). Results and conclusions of the individual manuscripts - The aim of the study was to investigate the associations between depressive symptoms and cardiometabolic function including cardiovascular dysfunction. Markers of cardiometabolic function assessed were 24 hour blood pressure measurements, metabolic syndrome markers, neuroendocrine markers [cortisol and 3-methoxy-4-hydroxy-phenylglycol (MHPG)], inflammatory and haemostatic variables (fibrinogen, C-reactive protein, plasminogen activator inhibitor-1 and D-dimer). Manuscript 1, focused on LVH as a marker of cardiovascular dysfunction and metabolic syndrome components as markers of cardiometabolic function. The aim of the study was to assess the associations between LVH and metabolic syndrome (MetS) risk markers in participants with and without depressive symptoms. Results revealed that in African men with depressive symptoms the most significant determinants of LVH were systolic blood pressure (SBP) and the percentage glycosylated haemoglobin (HbA1c). While in African women (with depressive symptoms), this association was determined by low high-density lipoprotein (HDL-cholesterol). The study concluded that in black African men, independent of depressive symptoms, cardiometabolic factors (namely SBP and HbA1c) may be the driving significant factors in the development of cardiovascular diseases. Furthermore, the data showed that depressive symptoms in African women were associated with a measure of target end organ damage, and that this association was driven by a metabolic factor. Manuscript 2, the aim of this manuscript was to examine the relationship between depressive symptoms, neuroendocrine responses [with cortisol and 3-methoxy-phenylglycol (MHPG) as markers] and cardiovascular risk, i.e. LVH. The results revealed that Africans with depressive symptoms demonstrated blunted cortisol and MHPG levels in response to acute mental stress, in comparison to those without symptoms of depression. Additionally, these low cortisol and blunted MHPG responses were associated with LVH in this ethnic group. The conclusion for this manuscript was that, blunted neuroendocrine responses linked depressive symptoms and ECG left ventricular hypertrophy in Africans. When coupled to their hypertensive status, these vasoconstrictive responses (cortisol and MHPG) may underpin the increased long-term depression and vascular disease risk in urban Africans. Manuscript 3, the aim of this manuscript was to investigate the relationship between depressive symptoms and inflammatory/haemostatic markers in a cohort of urban-dwelling black African men and women. Our data demonstrated hypercoagulation vulnerability in African men with depressive symptoms. The African men with signs of depression displayed higher plasminogen activator inhibitor (PAI-1) levels and marginally elevated D-dimer levels. It was concluded that hypercoagulation may partially be the mediating factor between depressive symptoms and cardiovascular risk in African men; a situation that may be exacerbated by hyperkinetic blood pressure. In conclusion, through the assessement of cardiometabolic function and neuroendocrine responses, it seems that Africans withdepressive symptoms are at great risk for cardiovascular related morbidity and mortality, this was particulary evident in the African men (Manuscript 1 and 3). Additionally, it appears that blunted neuroendocrine responses and hypercoagulation could be seen as possible cardiovascular risk markers in Africans with depressive symptoms. / PhD (Physiology), North-West University, Potchefstroom Campus, 2014

Introdução: O tipo de dieta ingerido pelo indivíduo apresenta relação com a ocorrência de doenças cardiovasculares (DCV), e também com o desempenho cognitivo. As dietas vegetarianas promovem proteção cardiovascular, e parecem estar relacionadas com o desempenho cognitivo. A população de membros da Igreja Adventista do Sétimo Dia (ASD) tem sido estudada por apresentar menor frequência de DCV e de alguns tipos de câncer, e maior longevidade, e um dos hábitos fortemente associados a essas características é a dieta dessa população, que compreende grande número de vegetarianos. No entanto, apesar de as dietas vegetarianas serem frequentes entre os ASD, pouquíssimos estudos têm avaliado o desempenho cognitivo dessa população. O estudo ADVENTO é um estudo longitudinal que buscou avaliar o perfil de saúde de ASD onívoros, ovolactovegetarianos e vegetarianos estritos, utilizando-se de dados sóciodemográficos, cognitivos, psicológicos, dietéticos e cardiometabólicos dessa população. O presente trabalho é um sub-estudo do estudo ADVENTO, e pretende analisar os aspectos cognitivos de sua amostra, associando-os aos marcadores cardiometabólicos e à dieta da mesma. Objetivo: Comparar o desempenho cognitivo dos participantes do estudo ADVENTO praticantes das dietas onívora, ovolactovegetariana e vegetariana estrita, e associá-lo aos marcadores cardiometabólicos e aos tipos e características da dieta da amostra do estudo. Método: Os dados do estudo ADVENTO foram coletados entre março de 2013 e agosto de 2016, no Hospital Universitário da USP, gerando uma amostra composta por 1404 indivíduos ASDs, entre 35 e 74 anos, residentes no estado de São Paulo, divididos em 3 grupos: 542 onívoros, 617 ovolactovegetarianos e 239 vegetarianos estritos. Foram coletados marcadores cardiometabólicos como: índice de massa corporal (IMC), pressão arterial, frequência cardíaca, glicemia de jejum e colesterol total. A avaliação neuropsicológica foi composta por três subtestes da bateria Consortium to Establish a Registry for Alzheimer\'s Disease (CERAD): Lista de Palavras, Fluência Verbal e Teste das Trilhas (Forma B). O padrão dietético foi classificado com base em um questionário de frequência alimentar validado para a dieta brasileira. Quanto à análise estatística, os testes Kruskal-Wallis e Quiquadrado foram utilizados para as análises descritivas e para comparação do desempenho cognitivo entre os grupos, bem como da frequência de ocorrência de baixo desempenho cognitivo, e a análise de regressão logística foi utilizada para verificar a associação entre os marcadores cardiometabólicos e o baixo desempenho cognitivo, e também entre a dieta, bem como o consumo dos grupos de alimentos, e o baixo desempenho cognitivo. Resultados: Quanto ao desempenho nos testes cognitivos, na amostra total, o grupo de onívoros apresentou desempenho independentemente inferior ao do grupo de ovolactovegetarianos na fluência verbal semântica e nas funções executivas. Na amostra de adultos, o grupo de onívoros apresentou desempenho independentemente inferior ao do grupo de ovolactovegetarianos e ao de vegetarianos estritos nas funções executivas, e o grupo de vegetarianos estritos apresentou desempenho independentemente inferior ao de ovolactovegetarianos nas funções executivas. Na amostra de idosos, não foram observadas diferenças. Quanto à prevalência de desempenho baixo, na amostra total, o grupo de onívoros apresentou maior prevalência que o grupo de ovolactovegetarianos de desempenho baixo nas funções executivas e na função global, e o grupo de ovolactovegetarianos apresentou menor prevalência que o grupo de vegetarianos estritos de desempenho baixo na função global. Na amostra de adultos, o grupo de onívoros apresentou maior prevalência que o grupo de ovolactovegetarianos de desempenho baixo nas funções executivas e na função global, e também que o grupo de vegetarianos estritos de desempenho baixo nas funções executivas. Na amostra de idosos, o grupo de vegetarianos estritos apresentou maior prevalência que os grupos de ovolactovegetarianos e de onívoros de desempenho baixo na função global. Quanto à relação entre as variáveis cardiometabólicas e a cognição, na amostra total, o aumento da glicemia de jejum apresentou relação independente com maior ocorrência de desempenho baixo nas funções executivas. Na amostra de adultos, o aumento do IMC apresentou relação independente com maior ocorrência de desempenho baixo na fluência e o aumento da glicemia de jejum apresentou relação independente com maior ocorrência de desempenho baixo nas funções executivas. Na amostra de idosos, o aumento do IMC apresentou relação independente com menor ocorrência de desempenho baixo na função global, o aumento da pressão arterial sistólica apresentou relação independente com menor ocorrência de desempenho baixo na memória e o aumento da pressão arterial diastólica apresentou relação independente com menor ocorrência de desempenho baixo na fluência, mas o aumento do colesterol total apresentou relação independente com maior ocorrência de desempenho baixo na função global. Quanto à relação entre a dieta e a cognição, na amostra total, pertencer ao grupo de ovolactovegetarianos apresentou relação independente com menor ocorrência de desempenho baixo nas funções executivas e na função global, quando comparado ao grupo de onívoros, e pertencer ao grupo que incluía todos os vegetarianos apresentou relação independente com menor ocorrência de desempenho baixo nas funções executivas, quando comparado ao grupo de onívoros. Na amostra de adultos, pertencer ao grupo de ovolactovegetarianos apresentou relação independente com menor ocorrência de desempenho baixo nas funções executivas e na função global, quando comparado ao grupo de onívoros, e pertencer ao grupo que incluía todos os vegetarianos apresentou relação independente com menor ocorrência de desempenho baixo nas funções executivas e na função global, quando comparado ao grupo de onívoros. Na amostra de idosos, pertencer ao grupo de vegetarianos estritos apresentou relação independente com maior ocorrência de desempenho baixo na memória, nas funções executivas e na função global, e o aumento do consumo de frutas apresentou associação independente com maior ocorrência de desempenho baixo na memória. Conclusão: No presente trabalho, tanto na amostra total quanto na amostra de adultos, a dieta onívora apresentou associação independente com pior perfil de desempenho cognitivo, quando comparada à dieta ovolactovegetariana, e também à dieta vegetariana estrita, e esta última apresentou associação independente com pior perfil de desempenho cognitivo, quando comparada à dieta ovolactovegetariana. Na amostra de idosos, a dieta vegetariana estrita apresentou associação independente com pior perfil de desempenho cognitivo, quando comparada à dieta onívora / Introduction: The type of diet consumed by the individual is related to the occurrence of cardiovascular diseases (CVD), and also to cognitive performance. Vegetarian diets promote cardiovascular protection, and seem to be related to cognitive performance. Members of the Seventh-day Adventist Church (SDA) have been studied because they present lower rates of CVD and some types of cancer, and higher rates of longevity, and one of the habits strongly associated with those characteristics is the SDA diet, which comprises large number of vegetarians. Although vegetarian diets are usual among SDAs, very few studies have evaluated the cognitive performance of this population. The ADVENTO study is a longitudinal study designed to evaluate the health profile of omnivorous, lacto-ovo-vegetarian and vegetarian SDAs, through the collection of socio-demographic, cognitive, psychological, dietary and cardiometabolic data. The present work is a sub-study of the ADVENTO study, and intends to analyze the cognitive aspects of its sample, associating them with cardiometabolic markers and dietary aspects. Objective: To compare the cognitive performance of the ADVENTO study participants consuming omnivorous, lacto-ovo-vegetarian and strict vegetarian diets, and to associate it with cardiometabolic markers and dietary patterns, as well as diet characteristics, of the study sample. Method: Data from the ADVENTO study were collected between March 2013 and August 2016 at the University Hospital of the University of São Paulo (USP), Brazil, generating a sample composed of 1404 SDA individuals aged 35-74y, living in São Paulo state, divided into 3 groups: omnivores (n=542), lactoovo-vegetarians (n=617) and strict vegetarians (239). We collected cardiometabolic markers such as: body-mass index (BMI), blood pressure, heart rate, fasting blood glucose and total cholesterol. The neuropsychological evaluation was composed of three subtests from the Consortium to Establish a Registry for Alzheimer\'s Disease (CERAD) battery: Word List Learning, Verbal Fluency and Trail Making Test (Form B). The dietary pattern was classified based on a food frequency questionnaire validated for the Brazilian diet. Regarding the statistical analysis, the Kruskal-Wallis and Chi-square tests were used for the descriptive analyzes and for comparing the cognitive performance between the groups, as well as the frequency in which low cognitive performance occurred, and the logistic regression analysis was used to verify the association between cardiometabolic markers and low cognitive performance, and also between diet, as well as the consumption of food groups, and low cognitive performance. Results: Regarding the performance on the cognitive tests, in the total sample, the omnivore group performed independently lower than the lacto-ovo-vegetarian group on verbal semantic fluency and on the executive functions. In the adult sample, the omnivore group performed independently lower than the lacto-ovo-vegetarian group and than the strict vegetarian group on the executive functions, and the strict vegetarian group performed independently lower than the lacto-ovo-vegetarian group on the executive functions. In the elderly sample, no differences were observed. Regarding the prevalence of low performance, in the total sample, the omnivore group presented a higher prevalence than the lacto-ovo-vegetarian group of low performance on the executive functions and on global function, and the lacto-ovo-vegetarian group presented a lower prevalence than the strict vegetarian group of low performance on global function. In the adult sample, the omnivore group presented a higher prevalence than the lactoovo-vegetarian group of low performance on the executive functions and on global function, and than the strict vegetarian group of low performance on the executive functions. In the elderly sample, the strict vegetarian group presented a higher prevalence than the lacto-ovo-vegetarian group and than the omnivore group of low performance on global function. Regarding the relationship between the cardiometabolic variables and cognition, in the total sample, the increase in fasting blood glucose presented an independent relationship with a higher occurrence of low performance on the executive functions. In the adult sample, the increase in BMI presented an independent relationship with a higher occurrence of low performance on fluency, and the increase in fasting blood glucose presented an independent relationship with a higher occurrence of low performance on the executive functions. In the elderly sample, the increase in BMI presented an independent relationship with a lower occurrence of low performance on global function, the increase in systolic blood pressure presented an independent relationship with a lower occurrence of low performance on memory, and the increase in diastolic blood pressure presented an independent relationship with a lower occurrence of low performance on fluency, but the increase in total cholesterol presented an independent relationship with a higher occurrence of low performance on global function. Regarding the relationship between diet and cognition, in the total sample, belonging to the lacto-ovo-vegetarian group represented an independent relationship with lower occurrence of low performance on the executive functions and on global function, compared to the omnivore group, and belonging to the group which included all vegetarians, represented an independent relationship with a lower occurrence of low performance on the executive functions, compared to the omnivore group. In the adult sample, belonging to the lacto-ovo-vegetarian group represented an independent relationship with lower occurrence of low performance on the executive functions and on global function, compared to the omnivore group, and belonging to the group that included all vegetarians represented an independent relationship with lower occurrence of low performance on the executive functions and on global function, compared to the omnivore group. In the elderly sample, belonging to the strict vegetarian group represented an independent relationship with a higher occurrence of low performance on memory, low performance on the executive functions and low performance on global function, and the increase in fruit consumption presented an independent relatioship with a higher occurrence of low performance on memory. Conclusion: In the present study, the omnivore diet presented an independent association with a worse cognitive performance profile, both in the total sample and in the adult sample, compared to the lacto-ovovegetarian diet, as well as to the strict vegetarian diet, and the latter presented an independent association with a worse cognitive performance profile, compared to the lacto-ovo-vegetarian diet. In the elderly sample, the strict vegetarian diet presented an independent association with a worse cognitive performance profile compared to the omnivore diet

Objetivo: Este estudo teve como objetivo principal analisar o efeito presumido do horário irregular de trabalho, do índice de massa corporal (IMC) e da atividade física nos aspectos cardiometabólicos e de sono em motoristas de caminhão. Métodos: Foi realizado um estudo transversal em uma população de 101 motoristas de caminhão que trabalhavam em uma transportadora de cargas de São Paulo (SP). Após os critérios de exclusão, permaneceram no estudo 57 motoristas (26 do turno diurno e 31 do turno irregular). Os motoristas responderam a um questionário sobre dados sociodemográficos e do trabalho, além do Questionário Internacional de Atividade Física, IPAQ e um questionário para avaliar demanda, controle e apoio social no trabalho. Foram medidas a massa corporal, a estatura, circunferências abdominal e do quadril e o perímetro cervical. Foi realizada uma coleta de sangue em jejum de 12 horas para determinação das concentrações plasmáticas de glicemia, colesterol total e frações triglicérides, leptina, grelina e insulina. Os motoristas também utilizaram por sete dias consecutivos actímetros para estimar os padrões de sono. Para comparação das características sociodemográficas, de trabalho, de saúde e estilo de vida, medidas antropométricas, atividade física, hábitos alimentares, aspectos de sono, parâmetros fisiológicos, bioquímicos e hormonais foram realizados testes de estatística inferencial, após a realização da estatística descritiva. Resultados: Os motoristas obesos apresentaram concentrações de leptina cerca de cinco vezes maior em relação aos eutróficos (p<0,01), sendo que estas foram 40 por cento maiores entre os obesos do turno irregular em relação aos obesos do turno diurno (p<0,01). Por outro lado, os motoristas obesos apresentaram menor concentração de grelina que os motoristas eutróficos (p<0,04). O IMC médio dos motoristas irregulares foi significativamente maior do que dos motoristas diurnos (28,4 ± 3,8 kg/m2 vs 26,4 ± 3,6 kg/m2, p=0,04). A prática de atividade física no tempo de lazer foi baixa em ambos os grupos (<150 min/semana). O teste de Mann-Whitney mostrou que os motoristas do turno irregular eram mais ativos fisicamente do que os motoristas do turno diurno (99 ± 166 min/semana vs 23 ± 76 min/semana, p<0,01). A análise de covariância revelou que os motoristas do turno irregular moderadamente ativos apresentaram maiores pressões arteriais sistólica e diastólica (143,7 e 93,2 mmHg, respectivamente) que os motoristas diurnos moderadamente ativos (116 e 73,3 mmHg, respectivamente) (p<0,05), assim como maior concentração de colesterol total que os motoristas diurnos moderadamente ativos (232,1 e 145 mg/dl, respectivamente) (p=0,01). Independentemente da prática de atividade física, motoristas irregulares apresentaram concentrações mais elevadas de colesterol total e LDL-colesterol (211,8 e 135,7 mg/dl, respectivamente) do que os diurnos (161,9 e 96,7 mg/dl, respectivamente) (Ancova, p<0,05). Considerando-se os motoristas dos dois turnos, observou-se associação entre atividade física e menor latência do sono (Ancova, p=0,04) e melhor eficiência do sono (Ancova, p=0,02). Conclusões: Para a população estudada, a prática de atividade física não foi associada à redução da presença de fatores de risco cardiometabólicos, embora tenha sido associada a uma boa qualidade de sono. A associação observada entre as concentrações dos hormônios reguladores do apetite e o IMC, em conjunto com a associação entre turno e obesidade, sugere a necessidade de realizar estudos sobre o papel do turno de trabalho nas alterações hormonais. Além disso, devido à demanda elevada, longas jornadas e maior tempo de trabalho na profissão, o trabalho dos motoristas de caminhão está associado ao desenvolvimento de fatores de risco cardiometabólicos / Objective: The main aim of this study was to analyse the putative effect of irregular-shift work, body mass index (BMI) and physical activity on cardiometabolic and sleep aspects in truck drivers. Methods: A cross-sectional study was undertaken of 101 truck drivers working for a São Paulo-based transportation company (São Paulo State). A total of 57 drivers (26 day-shift and 31 irregular-shift workers) were included in the study after application of the exclusion criteria. All drivers completed a questionnaire collecting data on sociodemographic data and work characteristics, and also completed the International Physical Activity Questionnaire (IPAQ) along with a questionnaire assessing load, control and social support in the workplace. Measurements of BMI, height, waist/hip circumferences and cervical perimeter were taken. Fasting blood samples (12 hrs.) were collected to determine concentrations of plasma glucose, total cholesterol, triglyceride fractions, leptin, ghrelin and insulin. Drivers also wore actigraphy devices for seven consecutive days to estimate sleep patterns. After descriptive statistical analysis, inferential statistical tests were employed to compare the following data: sociodemographic, work, health and life-style characteristics, anthropometric measurements, physical activity, dietary habits, sleep aspects, as well as physiological, biochemical and hormonal parameters. Results: Obese drivers had five-fold higher concentrations of leptin than normal-weight drivers (p<0.01), with leptin levels 40 per cent greater in irregular-shift than day-shift obese (p<0.01). Obese drivers had lower ghrelin levels than drivers of normal weight (p<0.04). Mean BMI was significantly higher among irregularshift than day-shift workers (28.4 ± 3.8 kg/m2 vs 26.4 ± 3.6 kg/m2, p=0.04). The practice of leisure-time physical activity was generally low in both groups (<150 min/week). Results of the Mann-Whitney test showed that irregular-shift drivers were more physically active than day-shift workers (99 ± 166 min/week vs 23 ± 76 min/week, p<0.01). Analysis of covariance revealed that moderately-active irregular-shift workers had higher systolic and diastolic arterial pressures (143.7 and 93.2 mmHg, respectively) than moderately-active day-shift workers (116 and 73.3 mmHg, respectively) (p<0.05) as well as higher total cholesterol concentrations (232.1 and 145 mg/dl, respectively) (p=0.01). Independently of the practice of physical activity, irregular-shift drivers had higher total cholesterol and LDL-cholesterol concentrations (211.8 and 135.7 mg/dl, respectively) than day-shift workers (161.9 and 96.7 mg/dl, respectively (Ancova, p<0.05). For drivers of both shift types, an association between physical activity and shorter sleep latency (Ancova, p=0.04) and superior sleep efficiency (Ancova, p=0.02) was observed. Conclusions: For the population studied, the practice of physical activity was not associated with reduced presence of the cardiometabolic risk factors, although it has been associated with good quality sleep. The association observed between concentration of appetite-regulating hormones and BMI, and also between shift-type and obesity, points to the need for further studies investigating the role of shift work in hormonal changes. In addition, given the elevated work load, long working hours and time on the job associated with the profession, working as a truck driver is associated with the development of cardiometabolic risk factor

Introdução: Doenças crônicas não transmissíveis representam as principais morbidades da atualidade, dentre estas o diabetes mellitus (DM) tipo 2 e a depressão, as quais encontram-se frequentemente associadas. Ambas contribuem para complicações cardiovasculares e mortalidade. Há evidências de que intervenções comportamentais trazem benefícios cardiometabólicos e psicológicos. Objetivos: Para avaliar intervenção no estilo de vida, este estudo incluiu: 1) revisão sistemática e metanálise destinada a investigar os efeitos de intervenções no estilo de vida na melhora da depressão em indivíduos de risco ou com diabetes mellitus tipo 2; 2) comparação do efeito de duas intervenções no estilo de vida sobre o risco cardiometabólico e na retenção dos indivíduos ao programa; 3) análise do papel da depressão na resposta cardiometabólica às intervenções, mediada pela inflamação e; 4) avaliação do efeito residual 9 meses após término das intervenções quanto às respostas de variáveis clínicas, qualidade de vida (QV) e depressão. Métodos: Para revisão sistemática os principais bancos de dados bibliográficos foram pesquisados, sendo a meta-análise conduzida por modelos de efeito aleatório. O estudo longitudinal incluiu adultos pré-diabéticos, submetidos a 18 meses de intervenção tradicional (TRD) ou interdisciplinar com psicoeducação (INT) para mudanças em hábitos de vida, sendo os dados coletados (antropometria, pressão arterial, perfil bioquímico e marcadores de inflamação PCR, TNF-, adiponectina) no momento basal, 9 e 18 meses, bem como 9 meses após o término do acompanhamento (27 meses). Dieta foi avaliada por recordatórios de 24h, atividade física pelo Questionário Internacional de Atividade Física , depressão pelo Inventário de Beck e a QV pelo Medical Outcome Study Short Form 36 itens. Os momentos e os tipos de intervenção foram comparados por modelos lineares de efeitos mistos. Teste t Student foi aplicado para comparações entre médias, qui-quadrado para avaliar frequências e coeficientes de Pearson ou Spearman para correlações, complementados por análise de regressão múltipla. Resultados: Revisando sistematicamente o efeito na depressão de intervenções, encontrou-se na meta-análise, que em indivíduos com DM, mudanças no 10 estilo de vida reduzem significativamente os escores de depressão (SMD=-0.151; IC: - 0.253, -0.049). Entre os 183 indivíduos que compuseram nossa amostra, 46 por cento tinham sintomas depressivos, e eram predominantemente do sexo feminino, com maior adiposidade e menores escores de QV. Após 18 meses de ambas as intervenções, houve redução nos escores de depressão. Comparada à TRD, a INT provocou maior redução no consumo energético, adiposidade, níveis de pressão arterial, e maior aumento na atividade física e concentrações de adiponectina. Desistentes aos 18 meses apenas da TRD apresentaram pior perfil de saúde e maior escore de depressão, comparados aos que se mantiveram neste subgrupo. Em regressão linear múltipla, a depressão apenas nas mulheres associou-se a não melhora metabólica ao longo de 18 meses e tal associação não foi mediada pela inflamação. Aos 27 meses, apenas a adiposidade diferiu entre as intervenções. A QV e depressão mantiveram-se com melhora aos 27 meses em ambas. Discussão: 1) A metanálise sugere que intervenções no estilo de vida para manejar o DM são efetivas na melhora da depressão. É essencial que este grupo de risco seja rastreado regularmente. 2) Intervenção interdisciplinar com abordagem psicoeducativa mostrou-se útil em atenuar o risco cardiometabólico e na retenção de indivíduos com pior perfil de saúde. 3) Presença de depressão pode predizer menor chance de melhora no perfil cardiometabólico em longo prazo, particularmente entre as mulheres. Maior atenção ao diagnóstico e manejo da depressão deve ser dada a este subgrupo de maior risco. 4) Intervenção interdisciplinar melhorou a QV e reduziu depressão, bem como manteve o peso dos participantes após 9 meses da interrupção do programa, contribuindo para melhora continuada das condições de saúde biopsicossociais. Conclusão: Em geral, intervenção no estilo de vida é eficaz para melhorar o perfil metabólico e depressão, além de ser capaz de manter em tratamento indivíduos com pior estado de saúde. Não se pode comprovar ou afastar que a inflamação media tais benefícios. Esta estratégia é promissora para motivar indivíduos de maior risco na adoção de hábitos saudáveis em longo prazo. Profissionais da saúde e gestores de políticas públicas devem conhecer os efeitos deletérios da depressão no manejo de indivíduos de risco cardiometabólico. Diagnóstico e tratamento da depressão devem contribuir para otimizar o tratamento de distúrbios cardiometabólicos. / Introduction: Nowadays non-communicable chronic diseases, such as diabetes mellitus and depression, are major public health problems worldwide. These conditions are commonly associated and contribute to cardiovascular complications and mortality. Previous studies showed that motivational interviews may improve cardiometabolic and psychological aspects. Objectives: In order to assess lifestyle intervention this study includes: 1) Systematic review and meta-analysis to verify effect of lifestyle interventions on depression; 2) to compare effects of two lifestyle interventions in the cardiometabolic risk and in retention of at-risk individuals; 3) to analyze influence of depression in cardiometabolic response to interventions mediated by inflammation and, 4) to assess residual effect at 9 months after completion of interventions according to clinical variables, quality of life and depression. Methods: In the systematic review major bibliographic databases were searched. Meta-analysis was conducted by random-effects model. The effect of method, duration, and frequency of the interventions were determined via subgroup analyses. Our longitudinal study includes prediabetic adults, submitted to one of two lifestyle interventions (TRD:Traditional or INT:Interdisciplinary). Data were collected (anthropometry, blood pressure, biochemical profile and inflammation markers CRP, TNF-, adiponectin) at baseline, 9th and 18th month, as well as 9 months after completion of interventions (observational phase). Diet was evaluated by 24h recalls and physical activity by IPAQ. Depression was measured by Beck Inventory and quality of life (QOL) by SF-36. Linear mixed-models were applied for longitudinal analysis. Student t-test was used to compare means and chi-square for frequencies. Pearson coefficient was used to select variables for multiple regression analysis. Results: Through systematic review and meta-analysis, we found that lifestyle interventions to manage diabetes reduce depression scores (SMD= -0.151; IC: -0.253, -0.049). Among 183 individuals, 46 per cent had depression, 12 mostly women, with greater adiposity and lower QOL scores. After 18 months of both interventions, depression scores were reduced. Compared to TRD, the INT had greater reductions in energy intake, adiposity, blood pressure levels, likewise higher adiponectin and physical activity levels. Only in the TRD individuals who dropped out showed worse health profile and increased depression scores, compared to those who non dropped out. In multiple regressions, depression in women increased the chances of non-improvement in blood pressure and glucose levels. This association was not mediated by inflammation. In the observational phase, adiposity, but not other parameters, differed between groups over time. QOL and depression were maintained improved with both interventions. Discussion: 1) This meta-analysis suggests that lifestyle interventions intended to manage DM were effective in improving depression. Regular screening for depression is essential for this at-risk subset; 2) The interdisciplinary psychoeducation-based intervention proved to be useful for reducing cardiometabolic risk profile, and improving retention of individuals with worse profile. This approach represents a feasible strategy for motivating at-risk individuals to adopt a long-term healthy lifestyle; 3) Depression predicted a lower chance of improving long-term cardiometabolic risk, particularly in women. We suggest that screening and management of depression as part of lifestyle interventions can potentially improve cardiometabolic responses. 4) Interdisciplinary intervention improved QOL and reduced depression scores, as well as maintained weight loss 9 months after interruption of intervention, which may contributes to the sustained improvement. Conclusion: In general, interdisciplinary intervention was effective to improve cardiometabolic risk and depression, likewise to retain individuals with worse health status. It was not found benefits mediated by inflammation reduction. This strategy may motivate individuals at high risk to adopt healthier life habits. Health professionals must be aware about deleterious effects of depression to manage individuals at risk. Diagnosis and treatment of depression may contribute to optimize treatments of cardiometabolic diseases.

Introdução: Baixo nível de atividade física (AF) associado ao alto consumo energético contribuíram para transição nutricional no Brasil. Estilo de vida saudável reverte em benefícios cardiometabólicos. Considerando que estado inflamatório subclínico media os danos ao sistema cardiovascular, é possível que hábitos de vida saudáveis melhorem os fatores de risco, via atenuação da inflamação. Instrumentos padronizados para medir qualidade da dieta e AF estão disponíveis, mas não estudos locais avaliando a relação destes fatores entre si com base nestes instrumentos, ou examinando suas associações com estado inflamatório e perfil lipídico. Objetivos: Este estudo avaliou a associação entre a versão brasileira do Healthy Eating Index (B-HEI) e nível de AF e destes com marcadores inflamatórios, índice de resistência à insulina e variáveis lipídicas em indivíduos com alto risco cardiometabólico. Métodos: Nesta análise transversal foram incluídos 204 participantes (64,7 por cento mulheres; média de idade de 54,1 anos) de Estudo de Prevenção de Diabetes do CSEscola da FSP-USP, com pré-diabetes ou de síndrome metabólica sem diabetes. Foram realizados questionários e coletas de sangue. Foram utilizados três recordatórios alimentares de 24h para obtenção do B-HEI. O nível de AF foi medido pela versão longa do IPAQ, sendo determinada a AF no lazer, na locomoção, AF total e tempo de TV. Coeficiente de Spearman foi empregado para testar correlações. Para avaliar a relação entre o B-HEI e AF e dos tercis destas variáveis com marcadores inflamatórios e HOMA-IR foi usada ANOVA. Para avaliar associações independentes do B-HEI, tendo como variáveis dependentes parâmetros lipídicos, inflamatórios ou HOMA-IR, usou-se regressão linear múltipla e, para associações independentes da AF como as mesmas variáveis, usou-se regressão logística, sendo obtidos odds ratios (OR) e p de tendência. Resultados: Nos tercis do B-HEI, o nível de AF não diferiu; à medida que melhorava a qualidade da dieta houve tendência à redução do tempo de TV (21,4±11,6; 20,5±11,5; 16,8±10,4 h/sem; p=0,09). Na regressão linear, a circunferência abdominal associou-se inversamente aos escores de B-HEI, mantendo-se marginalmente significante após ajuste para idade e sexo. No mesmo modelo, proteína C reativa associou-se negativamente ao índice (p=0.02). Concentrações de adiponectina apresentaram significância marginal na análise sem ajustes (p=0.06). Estratificando-se indivíduos segundo a duração de AF na locomoção, lazer e total, indivíduos mais ativos (150 min/ sem) apresentaram menores medidas antropométricas, mas apenas para AF no lazer a tendência de redução foi significante. O perfil lipídico melhorou à medida que aumentou o nível de AF. Concentrações de interleucina-6 diminuíram com o aumento das durações de AF no lazer e total (p de tendência = 0,02 e 0,03, respectivamente), enquanto as de adiponectina tenderam a aumentar nos estratos mais ativos apenas para AF no lazer (p de tendência = 0,03). A tendência de hipercolesterolemia aumentou significantemente à medida que reduziu a duração de AF no lazer. Valores elevados da razão Apo B/Apo A foram inversamente associados com AF na locomoção, lazer e total. Foi observado aumento significante da OR de resistência à insulina entre categorias de AF no lazer (p de tendência = 0,04). Não foram observadas associações de qualquer domínio de AF com proteína C-reativa. Conclusões: Nossos dados não apoiam a hipótese de que boa qualidade da dieta e prática de AF estejam associadas. Reforçou-se a esperada associação de perfil cardiometabólico mais favorável com a prática de AF, mas não a da dieta de melhor qualidade medida pelo B-HEI / Background: Low physical activity (PA) level and high energy intake contributed to nutrition transition in Brazil. A healthy lifestyle reverts in cardiometabolic benefits. Considering that subclinical inflammatory status mediates damages to the cardiovascular system, healthy life habits may improve risk factors via attenuation of inflammation. Standardized tools to measure quality of diet and PA are available but not local studies assessing the relationship of these factors based on those tools, or examining their associations with inflammatory status and lipid profile. Objectives: This study evaluated the association between the Brazilian version of the Healthy Eating Index (B-HEI) and total, leisure and transportation PA level, and between those with inflammatory markers, insulin resistance index and lipids in individuals at high cardiometabolic risk. Methods: In this cross-sectional analysis, 204 participants (64.7 per cent women; mean age of 54.1 years) of the Study on Prevention of Diabetes from the FSP-USP School Health Center, with prediabetes or metabolic syndrome without diabetes were included. They were submitted to questionnaires and blood sample collections. 24-h food recalls were used to assess the B-HEI and PA was measured by the long version of the IPAQ. Spearman coefficient was employed to test correlations and ANOVA to analyze the association between the B-HEI and PA, and between the tertiles of these variables with inflammatory markers and HOMA-IR. Multiple linear regression was used to test independent associations of B-HEI, taking lipids, inflammatory markers and HOMA-IR as dependent variables. Logistic regression was used to test independent associations of PA with the same variables, and odds ratios (OR) and p for trend were obtained. Results: Across the B-HEI tertiles PA did not differ. However, as the quality of diet improves TV time decreases (21.4±11.6, 20.5±11.5, 16.8±10.4 h/week p=0.09). In linear regression analysis, abdominal circumference was inversely associated with BHEI, maintaining borderline significance after adjustment for age and sex. Creactive protein was shown to be inversely associated with the index (p=0.02). Adiponectin concentrations had borderline significance with B-HEI in crude analysis but not after adjustments (p=0.06). Stratifying according to the duration of transportation, leisure-time and total PA, the most active subset (150 min/week) showed lower anthropometric measurements, but only for leisure PA the tendency to decreasing values was significant. Lipid profile improved as PA levels increased. Interleukin-6 concentrations decreased as total and leisure PA increased (p for trend = 0.02 and 0.03, respectively), while adiponectin tended to increase in more active subsets only for PA at leisure time (p for trend = 0.03). Tendency for hypercholesterolemia increased significantly as leisure PA duration decreased. High Apo B/Apo A ratio was inversely associated with transportation, leisure and total PA. Significant increase in adjusted OR for insulin resistance from the category of highest to the lowest leisure PA was found (p for trend = 0.04) but statistical significance disappeared when adjusted for BMI. For increased C-reactive protein concentration, no significant association with any PA domain was observed. Conclusion: Our data do not support the hypothesis that good diet quality and PA practice were associated. The expected association of more favorable cardiometabolic profile with PA practice but not with better quality of diet was reinforced

Introdução: O atual estilo de vida traz consequências negativas no que se refere aos padrões dietéticos, nível de atividade física (AF), uso de tabaco e estresse psicossocial, os quais predispõem ao aumento de doenças crônicas não-transmissíveis. Dieta rica em frutas, legumes e verduras (FLV) pode atenuar os efeitos sobre o risco cardiometabólico, havendo evidências consistentes de benefícios na prevenção da obesidade, dislipidemia e diabetes tipo 2. O consumo de FLV, fontes de vitaminas e minerais essenciais para a homeostase corporal está aquém do desejado. Estes alimentos contribuem para um perfil cardiometabólico favorável, atenuando o estresse oxidativo, inflamação e resistência à insulina. Objetivo: Este estudo analisou a associação entre o consumo FLV e de certos micronutrientes com marcadores do estado oxidativo, inflamatório e de resistência à insulina em indivíduos de risco cardiometabólico. Métodos:Nesta análise transversal foram incluídos 205 participantes (65 por cento mulheres; média de idade de 54,1 anos) do Estudo de Prevenção de Diabetes do CS-Escola da FSP-USP, com pré-diabetes ou de síndrome metabólica sem diabetes. Foram submetidos a questionários e coletas de sangue. Entre as dosagens, a superóxido dismutase (SOD) e a LDL oxidada (LDLox) serviram para indicar o estado anti/pró-oxidativo. O nível de AF foi medido pela versão longa do IPAQ. Três recordatórios alimentares de 24h foram empregados para cálculo da ingestão de micronutrientes e de FLV. Três categorias de consumo de FLV consumidas foram criadas considerando-se a recomendação internacional e a ingestão de micronutrientes estratificada segundo tercis de consumo, analisados por ANOVA. Coeficiente de Pearson e regressão linear múltipla foram também empregados. Resultados: Os participantes consumiram uma média de 1800 kcal/dia e 3,7 porções/1000 kcal de FLV. Ao longo das categorias de ingestão de FLV, os valores médios de circunferência da cintura (p=0,06) e pressão arterial diastólica (p=0,05) tenderam a diminuir e adiponectina (p=0,05) a aumentar. Indivíduos no tercil mais alto de ingestão de zinco apresentaram valores mais baixos de massa gorda e HOMA-IR, enquanto as concentrações de PCR foram marginalmente significantes (p=0,06). O HOMA-IR associou-se inversamente com ingestão de zinco e magnésio em todos os modelos. Associações diretas foram encontradas entre as concentrações de SOD com ingestão de FLV, bem como de magnésio em modelos ajustados. A concentração de LDLox se associou inversamente a ingestões de magnésio, vitaminas C e E em modelos ajustados. Resultados similares foram encontrados entre a concentração de LDLox e FLV, mas perdeu a significância após ajustes. Associação direta entre LDLox e ingestão de selênio manteve-se nos modelos ajustados. Conclusão: Nosso estudo sugere que a análise do consumo de FLV e/ou de certas vitaminas e minerais, ainda que estejam abaixo dos níveis recomendados, pode ser útil para identificar estresse oxidativo e resistência à insulina. / Introduction: Current lifestyle has deleterious consequences in dietary habits, physical activity, smoking and psychosocial stress, which have predisposed to non-communicable chronic diseases. A diet rich in fruits and vegetables can attenuate the effects on cardiometabolic risk, and there is consistent evidence of its benefit on the prevention of obesity, dyslipidemia and type 2 diabetes. Worldwide the consumption of fruits and vegetables, sources of vitamins and minerals, which are essential for body homeostasis, is low. These foods contribute to a favorable cardiometabolic profile, attenuating oxidative stress, inflammation and insulin resistance. Objective: Associations between the consumption of certain micronutrients and fruits and vegetables with markers of oxidative status, inflammation and insulin resistance were examined in individuals at cardiometabolic risk. Methods: This cross-sectional analysis included 205 participants (65 per cent women, mean age 54.1 years) with pre-diabetes or with metabolic syndrome without diabetes of the Diabetes Prevention Study of the FSP-USP Health Care Unit. They were submitted to questionaires blood collection. Superoxide dismutase (SOD) and oxidized LDL (oxLDL) were used to indicate the oxidative status. The physical activity level was measured by the long version of IPAQ. Three 24-hour dietary recalls were used to calculate intake of micronutrients and of fruits and vegetables. Three categories of fruits and vegetables consumption were created taking into consideration international recommendations, and micronutrient intake were grouped according tertiles of consumption, these categories analyzed by ANOVA. Pearsons correlation coefficient and multiple linear regression were used. Results: Participants consumed a mean of 1,800 kcal per day and 3.7/1000 kcal servings of fruit and vegetables. Mean values of waist circumference (p=0.06) and diastolic blood pressure (p=0.05) tended to decrease, and adiponectin (p=0.05) to increase across the categories of fruits and vegetables intake. Individuals in the highest tertile of zinc intake showed lower values of fat mass and HOMA-IR, while CRP concentrations were marginally significant (p=0.06). HOMA-IR was inversely associated with zinc and magnesium intakes in all the models. Direct associations were found between SOD concentrations and fruits and vegetables as well as magnesium intakes in adjusted models, while oxLDL concentration was inversely associated with magnesium, vitamin C and E intakes. Similar results were found between oxLDL concentration and fruits and vegetables intake but significance disappeared after adjustments. A direct association between oxLDL and selenium intake was detected after multiple adjustments. Conclusion: Our study suggest that fruits and vegetables and/or selected vitamins and minerals intakes albeit below recommended levels may be useful to identifying oxidative stress and insulin resistance.

Introdução: As doenças cardiovasculares são a principal causa de morbimortalidade mundial, tendo o Brasil um perfil semelhante. Embora diversos fatores de risco sejam associados com os eventos cardiovasculares, esses não conseguem justificar a manifestação de todos os eventos clínicos, indicando que outros componentes estão envolvidos. Diante desse cenário, a dieta ocupa papel de destaque na modulação dos fatores de risco modificáveis e por isso tem sido foco de inúmeros programas de políticas públicas. Objetivo: Avaliar o efeito da suplementação de ômega-3 sobre os fatores de risco cardiometabólicos clássicos e emergentes em indivíduos com diferentes níveis de risco cardiovascular. Métodos: Este estudo foi do tipo clínico baseado em intervenção nutricional, prospectivo, randomizado, duplo cego e placebo controlado. Foram selecionados indivíduos adultos e idosos (n=146), de ambos os sexos, dentre os quais 77 faziam parte do grupo intervenção w-3 e 69 eram do grupo placebo. O risco cardiovascular foi estimado por meio do escore de risco de Framingham (ERF), os grupos foram subdivididos em escore de risco baixo, intermediário e alto. Nos tempos basal e após 4 e 8 semanas de intervenção [3,0 g/dia w-3, contendo 60% de ácido eicosapentaenoico-docosahexaenoico (EPA-DHA) ou placebo] foram coletadas informações socioeconômicas e clínicas, antropométricas, consumo alimentar, nível de atividade física e coleta de sangue após jejum de 12-14h. A partir do plasma foram analisadas as concentrações dos marcadores lipídicos [Colesterol Total, lipoproteínas de baixa densidade (LDL) e alta densidade (HDL), Triacilglicerol (TG), Apolipoproteínas AI e B, ácidos graxos não esterificados (NEFAs) e LDL eletronegativa (-)], ácidos graxos plasmático e aspectos fisicoquímicos de lipopartículas (tamanho e concentração). Os resultados foram analisados por meio do programa SPSS 16.0, sendo adotado o nível de significância de p < 0,05. Resultados: Houve incorporação de 4% do DHA plasmático e consequente redução de 34% do TG em indivíduos com ERF intermediário e de 0,2% da APO AI, 20% de NEFAs e de 0,6% de HDLINTERMEDIÁRIA em indivíduos com alto ERF. Ao longo da intervenção, houve diminuição do CT (p = 0,002), da LDL (p = 0,003), do TG (p < 0,001), do colesterol não HDL (p < 0,001), da HDLPEQUENA (p = 0,011) e da LDL (-) (p < 0,001). Houve aumento da HDL-c (p = 0,003), das partículas de HDLGRANDE (p < 0,001) e HDLINTERMEDIÁRIA (p < 0,001) Conclusão: A suplementação com w-3 promoveu redução dos biomarcadores de risco cardiovascular clássicos e emergentes. Esse conjunto de resultados amplia o papel cardioprotetor do w-3. / Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, with Brazil a similar profile. Although many risk factors are associated with cardiovascular events, these can not justify the manifestation of all clinical events, indicating that other components are involved. Given this scenario, the diet takes prominent role in the modulation of modifiable risk factors and so has been the focus of numerous programs of public policies Objective: To evaluate the effect of supplementation of omega3 (n-3) on cardiometabolic risk factors and emerging classics in individuals with different levels cardiovascular risk. Methods: This study was based on clinical type of nutrition intervention, prospective, randomized, double-blind and placebo controlled. We selected adult and elderly subjects (n=146), both sexes, among which 77 were in the intervention group n - 3 and 69 were in the placebo group. Cardiovascular risk was estimed using the Framingham risk score (FRS), the groups were divided into low-risk score, intermediate and high. At baseline and after 4 and 8 weeks of intervention [3.0 g/ day n-3 containing 60% eicosapentaenoic + docosahexaenoic acid (EPA + DHA) or placebo] socioeconomic and clinical, anthropometric data, dietary intake, physical activity level and blood samples were collected after fasting for 12 -14h. Were analyzed from the plasma concentrations [total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), apolipoprotein (Apo) AI and B, non-esterified fatty acids (NEFAs) and electronegative LDL (-)], plasma fatty acids and physicochemical aspects of lipoparticles (size and concentration). The results were analyzed using the SPSS 16.0 program, adopting the level significance p < 0.05. Results: There was incresed of 4 % of plasma DHA and consequent 34% reduction of TG in individuals with intermediate FRS and 0.2% of the APO AI, 20 % of NEFAs and 0.6 % HDLINTERMEDIATE in subjects with high FRS. During the intervention, CT decreased (p = 0.002), LDL (p = 0.003), TG (p < 0.001), non-HDL cholesterol (p < 0.001) of the HDLSMALL (p = 0.011) and LDL (-) (p < 0.001). There was an increase in HDL-c (p = 0.003), HDLLARGE particles (p < 0.001) and HDLINTERMEDIATE (p < 0.001). Conclusion: Supplementation with n-3 promoted reduction of c1assic and emerging biomarkers on cardiovascular risk. This set of results extends the cardioprotective role of n-3.

Introdução: As doenças cardiovasculares são a principal causa de morbimortalidade mundial, tendo o Brasil um perfil semelhante. Embora diversos fatores de risco sejam associados com os eventos cardiovasculares, esses não conseguem justificar a manifestação de todos os eventos clínicos, indicando que outros componentes estão envolvidos. Diante desse cenário, a dieta ocupa papel de destaque na modulação dos fatores de risco modificáveis e por isso tem sido foco de inúmeros programas de políticas públicas. Objetivo: Avaliar o efeito da suplementação de ômega-3 sobre os fatores de risco cardiometabólicos clássicos e emergentes em indivíduos com diferentes níveis de risco cardiovascular. Métodos: Este estudo foi do tipo clínico baseado em intervenção nutricional, prospectivo, randomizado, duplo cego e placebo controlado. Foram selecionados indivíduos adultos e idosos (n=146), de ambos os sexos, dentre os quais 77 faziam parte do grupo intervenção w-3 e 69 eram do grupo placebo. O risco cardiovascular foi estimado por meio do escore de risco de Framingham (ERF), os grupos foram subdivididos em escore de risco baixo, intermediário e alto. Nos tempos basal e após 4 e 8 semanas de intervenção [3,0 g/dia w-3, contendo 60% de ácido eicosapentaenoico-docosahexaenoico (EPA-DHA) ou placebo] foram coletadas informações socioeconômicas e clínicas, antropométricas, consumo alimentar, nível de atividade física e coleta de sangue após jejum de 12-14h. A partir do plasma foram analisadas as concentrações dos marcadores lipídicos [Colesterol Total, lipoproteínas de baixa densidade (LDL) e alta densidade (HDL), Triacilglicerol (TG), Apolipoproteínas AI e B, ácidos graxos não esterificados (NEFAs) e LDL eletronegativa (-)], ácidos graxos plasmático e aspectos fisicoquímicos de lipopartículas (tamanho e concentração). Os resultados foram analisados por meio do programa SPSS 16.0, sendo adotado o nível de significância de p < 0,05. Resultados: Houve incorporação de 4% do DHA plasmático e consequente redução de 34% do TG em indivíduos com ERF intermediário e de 0,2% da APO AI, 20% de NEFAs e de 0,6% de HDLINTERMEDIÁRIA em indivíduos com alto ERF. Ao longo da intervenção, houve diminuição do CT (p = 0,002), da LDL (p = 0,003), do TG (p < 0,001), do colesterol não HDL (p < 0,001), da HDLPEQUENA (p = 0,011) e da LDL (-) (p < 0,001). Houve aumento da HDL-c (p = 0,003), das partículas de HDLGRANDE (p < 0,001) e HDLINTERMEDIÁRIA (p < 0,001) Conclusão: A suplementação com w-3 promoveu redução dos biomarcadores de risco cardiovascular clássicos e emergentes. Esse conjunto de resultados amplia o papel cardioprotetor do w-3. / Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, with Brazil a similar profile. Although many risk factors are associated with cardiovascular events, these can not justify the manifestation of all clinical events, indicating that other components are involved. Given this scenario, the diet takes prominent role in the modulation of modifiable risk factors and so has been the focus of numerous programs of public policies Objective: To evaluate the effect of supplementation of omega3 (n-3) on cardiometabolic risk factors and emerging classics in individuals with different levels cardiovascular risk. Methods: This study was based on clinical type of nutrition intervention, prospective, randomized, double-blind and placebo controlled. We selected adult and elderly subjects (n=146), both sexes, among which 77 were in the intervention group n - 3 and 69 were in the placebo group. Cardiovascular risk was estimed using the Framingham risk score (FRS), the groups were divided into low-risk score, intermediate and high. At baseline and after 4 and 8 weeks of intervention [3.0 g/ day n-3 containing 60% eicosapentaenoic + docosahexaenoic acid (EPA + DHA) or placebo] socioeconomic and clinical, anthropometric data, dietary intake, physical activity level and blood samples were collected after fasting for 12 -14h. Were analyzed from the plasma concentrations [total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), apolipoprotein (Apo) AI and B, non-esterified fatty acids (NEFAs) and electronegative LDL (-)], plasma fatty acids and physicochemical aspects of lipoparticles (size and concentration). The results were analyzed using the SPSS 16.0 program, adopting the level significance p < 0.05. Results: There was incresed of 4 % of plasma DHA and consequent 34% reduction of TG in individuals with intermediate FRS and 0.2% of the APO AI, 20 % of NEFAs and 0.6 % HDLINTERMEDIATE in subjects with high FRS. During the intervention, CT decreased (p = 0.002), LDL (p = 0.003), TG (p < 0.001), non-HDL cholesterol (p < 0.001) of the HDLSMALL (p = 0.011) and LDL (-) (p < 0.001). There was an increase in HDL-c (p = 0.003), HDLLARGE particles (p < 0.001) and HDLINTERMEDIATE (p < 0.001). Conclusion: Supplementation with n-3 promoted reduction of c1assic and emerging biomarkers on cardiovascular risk. This set of results extends the cardioprotective role of n-3.