Menopause transition is a natural process in a woman’s life associated with altered body fat distribution, increased cardiometabolic risk, and the presentation of vasomotor symptoms including hot flashes and night sweats. A 5-year observational, longitudinal study (MONET: Montreal Ottawa New Emerging Team), was performed to document the effect of menopause transition on body composition and cardiometabolic risk factors. Initially, the study included 102 healthy non-obese premenopausal women between the age of 47 and 55 years. By the end of year 5, 91 women completed the study, 4% were still premenopausal, 29% were perimenopausal and 67% became postmenopausal. The major finding of the first study was that the increases in body fat mass and visceral fat in our cohort of non-obese women followed through the menopause transition were independent of the increase in body weight. Furthermore, these changes in body composition and body fat distribution were not associated with cardiometabolic deteriorations. We further examined whether specific factors such as reporting vasomotor symptoms (hot flashes and/or night sweats), exaggerated exercise systolic blood pressure, physical activity levels and cardiorespiratory fitness, may be associated with adiposity, body fat distribution and cardiometabolic profile. Overall, women that experienced vasomotor symptoms (paper 2) or presented an exaggerated exercise systolic blood pressure (paper 3), did not present any alterations in their body composition, body fat distribution and cardiometabolic profile compared to asymptomatic women and participants with normal blood pressure response to exercise, respectively. Furthermore, exaggerated exercise systolic blood pressure was not predictive of future hypertension after a 5-year follow-up throughout menopause transition. On the other hand, total volume of physical activity was not linked with measures of a cardiometabolic profile, cardiorespiratory fitness appeared to have the greatest cardioprotective effect (paper 4). Therefore, in generally healthy physically active non-obese premenopausal women, the menopause transition does not generally alter cardiometabolic risk factors, and suggests that cardiorespiratory fitness may have greater cardiometabolic protective effects in this cohort.

Introduction: Metabolic syndrome (MetS) is a risk condition describing a clustering of traditional cardiovascular risk factors. A number of risk and protective factors have been associated with MetS, and individuals with MetS are at a higher risk for developing chronic diseases such as diabetes, cancer, and cardiovascular disease. Objective: To contribute to the understanding of MetS in Canada, and to describe how it is a risk state through which material, psychosocial, and behavioural factors associate with chronic diseases. This was examined through three objectives: (i) to describe the prevalence and distribution of MetS; (ii) to examine potential pathways linking income and education with MetS; and (iii) to examine the interplay between non-movement behaviours (NMBs, namely sleep, screen time, and sedentary behaviour) and MetS. Methods: The Canadian Health Measures Survey (2007-2009, 2009-2011, ages 18 and older) was used for all analyses, which include logistic regression, multinomial regression, and calculation of standardized logit coefficients. Results: MetS was prevalent among approximately 20% of Canadian adults. It was significantly associated with chronic diseases, such as diabetes (11.2% vs. 3.4% among those with MetS vs. the general population). A social gradient in MetS was identified, and the behavioural risk factors of alcohol use, smoking, physical inactivity, and screen time were suggested to be partial mediators of this pathway. Findings demonstrated that not adhering to physical activity guidelines (150 minutes or more of moderate-to-vigorous physical activity per week) was associated with increased odds of MetS. A stepwise moderating effect of guideline adherence on screen time and sleep behaviours was demonstrated. Conclusion: MetS is prevalent in Canadian adults, and a high proportion of individuals with MetS have chronic conditions. Addressing the modifiable determinants of physical inactivity, excess screen time, alcohol consumption, and smoking may reduce the social gradient in MetS. Furthermore, adhering to physical activity guidelines may mitigate the associations of NMBs with MetS. The current thesis suggests that healthy behaviours are associated with lower risk for MetS, and therefore, possibly for future chronic disease.

Objectives: This thesis examines the risks among Canadian children and adolescents for developing cardio-metabolic diseases, extending evidence that is well-established for adults to pediatric populations. As well, novel indicators and cut-offs for the measurements of disease risks are proposed and associations between physical activity, weight status, socio-economic status and cardio-metabolic health are examined. Methodology: Secondary data analysis was conducted using data from three cycles of the Canadian Health Measures Survey (CHMS), a nationally representative data set which includes measured anthropometric characteristics. A population health approach was applied throughout, underpinned by the World Health Organization’s Conceptual Framework for Action on the Social Determinants of Health. The thesis was designed such that a series of four manuscripts successively built on the key findings from each previous research paper: 1. Establishing the prevalence of Metabolic Syndrome and its risk factors for 10-18 year olds using the International Diabetes Federation child, adolescent and adult definitions. 2. Estimating pre-obesity epidemic waist circumference reference values for Canadian children 6-10 years using reference data from the 1981 Canada Fitness Survey, the Third National Health and Nutrition Examination Survey (1988-1994), and the CHMS through regression of linear, logarithmic and quadratic functions. This work facilitated an expanded age range for the subsequent projects as age- and sex-specific cut-offs based on a Canadian population prior to the obesity epidemic had not been available. 3. Cardio-metabolic risk by body mass index (BMI), waist circumference (WC), and a combined BMI-WC indicator quantified the associations between a dichotomous cardio-metabolic risk variable, and obesity, using three indicators of obesity including a novel indicator, for ages 6-18 years. 4. Association between cardio-metabolic risk and inflammation quantified the associations between inflammation, using high-sensitivity c-reactive protein (CRP) as a marker, and cardio-metabolic risk to determine if high CRP was a significant predictor of cardiometabolic risk among 6-18 year olds. Results: For Paper 1 (n=1228), only 2.1% were classified as having the Mets though 38% had at least 1 MetS risk factor. For Paper 2, logarithmic regression predicted WC cut-offs with the lowest degree of error. For Paper 3 (n=2678), 35% were classified as having cardio-metabolic risk with significantly higher levels among those classified as obese and/or having a low level of physical activity. All indicators of obesity had significant associations with cardio-metabolic risk. For Paper 4 (n=1831), 43.6% of children and 62.0% of adolescents with high CRP levels were classified as having cardio-metabolic risk, a significant relationship. Participants from households with moderate to high income and/or education had the lowest prevalence of MetS risk factors and abdominal obesity. Conclusions: High CRP is a useful indicator of cardio-metabolic risk for pediatric populations. With further research, novel combinations of BMI and WC may be shown to be more predictive for cardio-metabolic risk than these indicators individually. The substantial prevalence of multiple risk factors which predict premature onset of chronic disease foreshadows potential years of morbidity in adulthood for Canada’s youth population.

Un nombre croissant d’études suggèrent que le rôle des facteurs psychologiques dans le risque cardio-métabolique pourrait différer selon la position socio-économique des individus.Les travaux de cette thèse ont utilisé les données du Centre d'Investigations Préventives et Cliniques, de l'Etude Prospective Parisienne 3 et de la cohorte CONSTANCES pour examiner le rôle modérateur de la profession et catégorie socioprofessionnelle (PCS) sur les relations entre stress ou dépression et différents marqueurs du risque cardio-métabolique.Les résultats montrent que la PCS était un facteur modérateur de l'association du stress perçu avec la PA élevée chez les femmes (étude no 1), le diabète (étude no 2) et l'athérosclérose préclinique (étude no 3), de telle sorte que les individus des PCS les moins favorisées étaient les plus à risque. Cela semblait également être le cas pour l'association entre la dépression et le risque de maladie coronarienne à 10 ans chez les hommes (étude no 4).Ces résultats montrent l'importance de prendre systématiquement en compte le rôle modérateur des inégalités socioprofessionnelles dans la relation entre facteurs psychologiques et risque cardio-métabolique, aussi bien dans les études épidémiologiques pour mieux caractériser ce risque, qu’en santé publique et pratique clinique pour mieux le prévenir. / A growing body of studies suggests that the association between psychological factors and cardiometabolic risk might depend upon individual's socio-economic status.Data of Centre d'Investigations Préventives et Cliniques, Paris Prospective Study 3 and CONSTANCES cohort were used to examine the moderating role of occupational status (OS) on the associations between stress or depression and cardiometabolic risk markers.OS was a moderating factor of the association between perceived stress and high blood pressure among women (study No. 1), diabetes(study No. 2) and subclinical atherosclerosis (study No. 3), with increased risk for the individuals of lower OS. Similar pattern of results were observed for the association between depression and 10-year coronary heart disease risk among men (study No. 4).These results highlight the importance to systematically take into account the moderating effect of occupational inequalities when examining the association between psychological factors and cardiometabolic risk in epidemiological studies to better characterize this risk but also in public health policies and clinical practice for a better prevention.

Introduction: The homeostatic role of the endocannabinoid system (ECS) is mediated through the actions of endocannabinoids. Intake of exogenous cannabinoids found in Cannabis sativa alter the function of the ECS which may then impact other organ systems. Use of cannabis has been inconsistently linked to adverse cardiometabolic outcomes. Rates of cannabis use are high among patients with psychiatric conditions who are already at higher risk of cardiometabolic diseases when compared to the general population. Cannabis use patterns and cardiometabolic risk variables in this population need further study to clarify the links between use and outcomes. Methods: Patients with psychiatric conditions from the St. Joseph’s Healthcare Hamilton Hospital were enrolled into the Cannabis and Physical Health study. Sociodemographic data, medical history, cigarette use, and cannabis use patterns were collected. In addition, cardiometabolic profile data were collected including body mass index, blood pressure, lipids, and HbA1c. Multivariable regression analyses were conducted, and a Bonferroni correction applied. Results: This cross-sectional study enrolled 200 patients (female: n=86, 43.0%), 18 years of age and older. Among 79 cannabis users (female: n=34, 43.0%), the majority (n=53, 67.1%) consumed cannabis daily and had a diagnosis of a moderate cannabis use disorder (CUD; n=57, 72.2%, CUD score = 4.3 ± 3.4). Use of cannabis was initiated on average at 15.2 ± 3.5 years of age and used for an average of 13.5 ± 11.0 years. There was no association between cannabis use and cardiometabolic risk factors when adjusted for age, sex, psychiatric diagnosis, antipsychotic medication use, and cigarette smoking (P>0.006 for all outcomes). Conclusions: Our findings indicate that in this sample of patients with psychiatric diagnoses, patients who use cannabis had a similar cardiometabolic profile to non-users. Patterns of cannabis use highlight the importance of reducing cannabis consumption and preventing or slowing the progression of CUD in this population, as well as limiting adolescent exposure to cannabis. / Thesis / Master of Science (MSc) / The endocannabinoid system regulates several processes in the body via endocannabinoid signaling, and cannabinoids found in cannabis can change endocannabinoid system function. Cardiovascular events and changes in appetite have been noted with cannabis use, and this is especially important in some vulnerable populations at risk of increased cannabis use; one of these groups include patients with psychiatric conditions who tend to use cannabis but also already have an increased cardiometabolic risk. In this thesis, the relationship between cannabis use and cardiometabolic risk was examined in 200 patients, and patterns and determinants of cannabis use explored. Our results demonstrated that of the 79 cannabis users, most consumed cannabis daily, and had a moderate cannabis use disorder. On average, users began cannabis consumption at 15 years of age and for an average duration of 14 years. Moderate cannabis use was not related to cardiometabolic risk in these patients. Our data demonstrate the need to prevent or slow the progression of cannabis use disorder in these patients and the importance of reducing early exposure of adolescents to cannabis.

La déficience partielle en lipoprotéine lipase (LPLD) est associée à une augmentation du risque cardiométabolique chez les hommes et les femmes. L’adiponectine, le syndrome métabolique et la ménopause sont des modulateurs importants de ce risque. L’objectif de cette étude était d’évaluer la contribution de l’adiponectine au profil de risque cardiométabolique de femmes porteuses de variants dans le gène LPL connus pour être associés avec la LPLD. L'échantillon étudié comprenait 568 femmes d'origine canadienne-française, dont 127 avec une LPLD et 441 non LPLD (contrôles). L'influence de l'adiponectine sur le risque associé à la LPLD a été évaluée en utilisant des analyses de régression multiples prenant en compte l’influence du statut ménopausique, des variables anthropométriques, du bilan lipidique, de la glycémie à jeun et du tabagisme. Les résultats montrent que les niveaux d'adiponectine étaient significativement plus faibles dans les groupes LPLD. La contribution des valeurs faibles d’adiponectine au profil de risque cardiométabolique des sujets LPLD était indépendante du statut ménopausique et de toutes les autres covariables étudiées. Cela suggère que l'adiponectine contribue au profil de risque cardiométabolique chez les femmes porteuses d’une mutation connue pour être associée avec la LPLD. / The cardiovascular risk significantly increases after menopause. Lipoprotein lipase (LPL) is a key enzyme in the metabolism of triglyceride (TG)-rich lipoproteins which contributes to cardiometabolic homeostasis. Adiponectin is an adipocytokine which also influences the cardiometabolic status. The objective of this study was to evaluate the contribution of plasma adiponectin to the cardiometabolic status of women carrying loss-of-function LPL gene variants (LPLD). A total of 568 French Canadian women (127 LPLD and 441 controls) were included. The association of plasma adiponectin with LPLD was assessed using multiple regression models. Cardiometabolic covariates included anthropometrics, lipids (TG, HDL-C, LDL-C, apo B), fasting glucose and smoking. Mean plasma adiponectin concentration was significantly lower in women with LPLD. Women carrying loss-of function LPL gene mutations also presented a significantly higher risk of coronary artery disease. In conclusion, these results suggest that low plasma adiponectin significantly contributes to the cardiometabolic risk profile of postmenopausal women carrying loss-of-function LPL gene mutations, independently of anthropometrics, lipids and other covariates.

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

Introdução: Fatores genéticos estão entre os determinantes de obesidade, podendo influenciar a resposta a intervenções em estilo de vida. O impacto de polimorfismos de nucleotídeo único (SNPs) na resposta de biomarcadores a intervenções não é claro. Objetivo: Este estudo examinou as associações de seis SNPs FTO T/A, PPAR Pro12Ala, Apo A1 -75G/A, TNF- -308G/A, IL-6 - 174G/C e AdipoQ 45T/G com mudanças induzidas por uma intervenção em amostra de brasileiros de risco cardiometabólico. Métodos: Em um programa de nove meses de orientações em hábitos alimentares e atividade física, 180 indivíduos com prediabetes ou síndrome metabólica foram genotipados e agrupados segundo a presença do alelo variante de cada SNP e comparados quanto a variáveis antropométricas, metabólicas e inflamatórias. Resultados: A intervenção resultou em redução do consumo calórico, aumento da atividade física, melhora na antropometria e outros biomarcadores. Estratificando pelos SNPs, os principais achados estão contidos em dois artigos. Artigo 1: Houve melhor resposta do perfil glicêmico após a intervenção nos portadores do alelo variante do SNP TNF -308 G/A. Observou-se melhora das variáveis lipídicas nos portadores do alelo variante do SNP IL-6 -174 G/C, enquanto que aqueles com o genótipo referência obtiveram melhora no metabolismo da glicose. Carreadores do SNP AdipoQ 45T/G não obtiveram melhora no perfil lipídico nem no glicêmico.Artigo 2: O alelo variante do FTO T/A associou-se a melhores perfis 9 inflamatório e glicêmico em resposta à intervenção. Portadores do alelo variante do SNP PPAR Pro12Ala obtiveram melhora na pressão arterial, enquanto que indivíduos com o genótipo referência melhoraram o metabolismo lipídico. Carreadores do alelo variante do SNP Apo A1 -75G/A apresentaram melhora no perfil lipídico que, após ajuste para medicação, não se manteve significante. Conclusões: SNPs relacionados à obesidade e comorbidades podem influenciar a resposta de marcadores metabólicos e inflamatórios a intervenções em hábitos de vida em brasileiros. O SNP TNF -308G/A parece favorecer um melhor perfil glicêmico. O SNP IL-6 -174G/C pode conferir efeito benéfico no perfil lipídico, mas não na glicemia. O SNP AdipoQ 45T/G compromete a resposta à intervenção em indivíduos de risco cardiometabólico no nosso meio. O SNP FTO T/A pode favorecer a resposta do metabolismo da glicose e a atenuação da inflamação. O SNP PPAR Pro12Ala pode ter impacto benéfico na pressão arterial, mas não no metabolismo lipídico. Em contraste com a literatura, o SNP Apo A1 -75G/A não parece influenciar resposta dos lípides à intervenção. Mais estudos envolvendo estes SNPs são necessários para possível direcionamento de intervenções a subgrupos específicos de indivíduos de risco. / Introduction: Genetic factors are one of the determinants of obesity and may influence the response to interventions. The impact of single nucleotide polymorphisms (SNPs) in weight loss and inflammatory response to interventions is not clear. Objective: This study examined associations of six polymorphisms FTO T/A, PPAR Pro12Ala, Apo A1 -75G/A, TNF- -308G/A, IL-6 -174G/C and AdipoQ 45T/G with changes induced by lifestyle intervention in Brazilians at cardiometabolic risk. Methods: In a 9-month intervention on diet and physical activity, 180 individuals with prediabetes or metabolic syndrome were genotyped and compared according the presence of variant allele of the SNPs and antrophometric, metabolic and inflammatory variables. Results: The intervention resulted in lower energy intake and greater total physical activity as well as improvement in anthropometry and several biomarkers. Stratified by SNPs, the main findings are covered in two articles. Article 1: Variant allele carriers of TNF -308 G/A SNP decreased plasma glucose after intervention. Lipid profile improved after intervention in variant allele carriers of IL-6 -174 G/C, while individuals with reference genotype had better plasma glucose response. Variant allele carriers of AdipoQ 45T/G did not improve lipid and glycemic profile. Article 2: Only variant allele carriers of FTO T/A decreased fasting plasma glucose and C-reactive protein concentration after intervention. Blood pressure reduced after intervention in variant allele carriers of the PPAR Pro12Ala, while the reference genotype increased Apo A1. Apparent favorable response of lipid profile to intervention in variant allele carriers of Apo A1 -75G/A was not maintained after adjustments for lipid-lowering medication. Conclusions: SNPs associated with obesity and comorbidities may influence the response of metabolic and inflammatory markers after lifestyle intervention. The TNF -308G/A may predispose a better response of glucose metabolism. The IL-6 -174 G/C SNP may confer a beneficial effect on lipid profile but not in glucose metabolism. Our findings reinforce unfavorable effects of the AdipoQ 45T/G SNP in lipid and glucose metabolism after lifestyle intervention in Brazilians at cardiometabolic risk. FTO T/A SNP induces a favorable impact on inflammatory status and glucose metabolism. The reference genotype of PPAR Pro12Ala seems to favor a better lipid profile, while the variant allele to decrease blood pressure. In contrast to literature, our data did not support benefits on lipid profile of the variant allele of Apo A1 -75G/A SNP. Further studies of these SNPs are needed to direct interventions to specific subgroups of at-risk individuals.

INTRODUÇÃO: A exposição materna à frutose durante a gestação e lactação pode contribuir para o desenvolvimento de doenças crônicas na vida adulta da prole. OBJETIVO: Estudar os efeitos da ingestão de frutose durante a gestação e lactação sobre a vida pós-natal no que diz respeito às alterações metabólicas, de expressão gênica e ao comportamento alimentar em ratos machos. METODOLOGIA: Foram utilizados ratos Sprague-Dawley, provenientes de mães alimentadas com ração controle e de mães alimentadas com ração rica em frutose (60%), durante a gestação; a lactação e gestação/lactação. Após o desmame, a prole foi alimentada com ração controle até os 91 dias de vida. Foram analisados os parâmetros: biométricos, dietéticos, metabólicos quanto a glicemia, sensibilidade periférica à insulina, leptina e insulina (séricas e vias de sinalização), neuropeptídios envolvidos no controle do comportamento alimentar, e deposição hepática de gordura. RESULTADOS: Houve redução do índice de Lee no nascimento e hipoleptinemia aos 90 dias de vida, intolerância à glicose na vida pós-natal desde o desmame, concomitante com alterações na sensibilidade à ação da insulina na vida adulta, hiperinsulinemia, dislipidemia, deposição hepática de TAG, estímulo hedônico do comportamento alimentar alterado aos 14 dias de vida pós-natal via núcleo accumbens shell com maior expressão de CART. CONCLUSÃO: As proles possuem possível marca epigenética que pode contribuir para o prejuízo na produção e ação da insulina, ocasionando alterações na homeostase do metabolismo glicídico e lipídico hepáticos, levando a deposição hepática de gordura e alterações no perfil lipídico, com redução da leptinemia na vida adulta, e no controle hedônico central do comportamento alimentar apenas aos 14 dias de vida pós-natal. / INTRODUCTION: Maternal exposure to fructose during gestation and lactation can contribute to the development of chronic diseases in the adult life of offspring. OBJECTIVE: To study the effects of ingestion of fructose during gestation and lactation on postnatal life with respect to metabolic changes, gene expression and feeding behavior in male rats. METHODS: Male Sprague-Dawley rats from mothers fed with control rat chow (AIN-93) and from mothers fed a high fructose diet (60%). Both isocaloric, during gestation; lactation and gestation/lactation. After weaning, the offspring were fed with control rat chow until the 91st days of life. The following parameters were analyzed: biometric, dietary, metabolic for glycaemia, peripheral insulin sensitivity, leptin and insulin (serum and signaling pathways), neuropeptides involved in food behavior control, and hepatic deposition of fat. RESULTS: Reduction in the Lee index at birth and hypoleptinemia at 90 days of age (only in the offspring that the mothers consumed fructose during pregnancy), glucose intolerance in postnatal life since with changes in insulin sensitivity in adult life, hyperinsulinemia, dyslipidemia, hepatic deposition of GAD, hemodialysis of altered eating behavior at 14 days of age). CONCLUSION: The offspring from mothers who consumed fructose rat chow during gestation and lactation have a possible epigenetic mark that may contribute to the impairment in the production and action of insulin, leading to changes in hepatic glucose and lipid metabolism homeostasis, leading to hepatic fat deposition and alterations in the lipid profile, with reduction of leptinemia in adult life, and in the central hedonic control of dietary behavior only at the 14 days postnatal life.

Introdução: Doenças cardiometabólicas são problemas de saúde pública mundial com repercussões sociais e econômicas. Dieta inadequada é apontada como um dos principais fatores de risco modificáveis, de importância central na prevenção destas doenças. Apesar da constatação de que certos nutrientes se associam a doenças, ainda existem dúvidas quanto às relações causais. Objetivos: 1) Revisar a participação dos alimentos e nutrientes na gênese e controle de doenças crônicas não-transmissíveis integrantes da síndrome metabólica (manuscrito 1); 2) Descrever de forma detalhada a estrutura do programa de intervenção interdisciplinar em hábitos de vida, desenvolvido para usuários da rede pública de saúde do município de São Paulo (manuscrito 2); 3) Investigar o efeito de mudanças em fatores dietéticos sobre o metabolismo glicídico, decorrentes de intervenção em hábitos de vida em indivíduos de risco cardiometabólico da rede pública de saúde (manuscrito 3). Métodos: Foram incluídos adultos com diagnóstico de pré-diabetes ou síndrome metabólica sem diabetes em ensaio clínico aleatorizado envolvendo dois tipos de intervenções de 18 meses: tradicional e intensiva. A intervenção tradicional consistiu de consultas trimestrais com endocrinologista; na intensiva, além dos atendimentos médicos, os indivíduos participaram de sessões psicoeducativas em grupo com equipe multiprofissional. As orientações dietéticas visaram à adequação do consumo de gorduras totais (redução de saturadas e trans e elevação de insaturadas) e aumento na ingestão de fibras. As variáveis coletadas nos momentos pré- e pós-intervenção incluíram dados sócio-demográficos, antropométricos, dietéticos e bioquímicos (glicemia de jejum e póssobrecarga, perfil lipídico, insulina, adiponectina, proteína C reativa, IL-6, TNF-, apolipoproteína A1 e B). A dieta foi avaliada por recordatórios de 24 horas, processados pelo Nutrition Data System software. Foram empregados os testes: t de Student, coeficientes de correlações, ANOVA com p de tendência e análises de regressão múltipla para identificar fatores dietéticos associados à melhora do metabolismo glicídico. Resultados: O manuscrito 1 consiste de um capítulo de livro (Nutrição em Saúde Coletiva) abordando aspectos epidemiológicos de doenças do espectro da síndrome metabólica com ênfase em fatores alimentares e estado nutricional. O manuscrito 2 detalha a estrutura, a equipe integrante, as orientações preconizadas e as principais estratégias psicoeducativas utilizadas no programa de intervenção em hábitos de vida desenvolvido (artigo metodológico submetido e website). Análises do manuscrito 3 mostraram que, ao final da intervenção, o aumento na ingestão de ácidos graxos monoinsaturados e fibras solúveis associaramse de forma independente à redução da glicemia de jejum e os primeiros também à melhora da glicemia pós-sobrecarga. Ajustes por medidas antropométricas não alteraram os resultados, o que ocorreu, porém, após inclusão da variável mudança na insulina nos modelos (artigo original). Conclusão: Justifica-se divulgar programas de intervenção como o aqui desenvolvido considerando-se o atual cenário das doenças cardiometabólicas na atualidade. No presente estudo, o aumento na ingestão de ácidos graxos monoinsaturados e de fibras solúveis promoveu benefícios no metabolismo glicídico, independente da adiposidade, ao final da intervenção no estilo de vida. Possíveis mecanismos mediadores destes processos podem incluir principalmente a melhora da sensibilidade à insulina. Dessa forma, nossos achados sugerem fortemente que um aumento factível no consumo destes nutrientes deva ser estimulado como estratégia para a proteção do metabolismo glicídico em indivíduos de risco cardiometabólico / Introduction: Cardiometabolic diseases are global public health problems with social and economic repercussions. Unhealthy diet is seen as one of the main modifiable risk factors, being of central importance for the prevention of these diseases. Despite the evidence that certain nutrients are associated with diseases, causal relationships are still under discussion. Objectives: 1) To review the involvement of foods and nutrients in the genesis and control of non-communicable chronic diseases, that comprise the metabolic syndrome (manuscript 1); 2) To describe in detail the structure of the interdisciplinary intervention program on lifestyle, developed for costumers of public health system of Sao Paulo city (manuscript 2); 3) To investigate the impact of changes in dietary factors on glucose metabolism, induced by a lifestyle intervention in individuals at cardiometabolic risk attended by the public health system (manuscript 3). Methods: Adults with prediabetes or metabolic syndrome without diabetes were included in a randomized clinical trial involving two types of 18-month interventions: a traditional or an intensive one. The traditional intervention consisted of quarterly consultations with an endocrinologist, while in the intensive participants also attended psychoeducational group sessions with a multidisciplinary team, in addition to the medical visits. The dietary recommendations aimed at the adequate intake of fat (reduction of saturated and trans and increase of unsaturated fatty acids) and increase in fiber intake. Socio-demographic, anthropometric, dietary and biochemical (fasting and post-load plasma glucose, lipid profile, insulin, adiponectin, C-reactive protein, IL-6, TNF-, apolipoprotein A1 and B) data were collected at baseline and after 18-month of follow-up. Diet was assessed by 24-h dietary recalls, processed by Nutrition Data System software. Student t test, correlation coefficients, ANOVA with p for trend and multiple linear regressions analyses were employed to identify dietary factors associated with glucose metabolism improvement. Results: Manuscript 1 consists of a book chapter (Nutrition in Public Health) about epidemiological aspects of diseases of the spectrum of metabolic syndrome with emphasis on dietary factors and nutritional status. Manuscript 2 details the structure, professional team, recommendations and the main psychoeducative strategies used in the lifestyle intervention program developed (methodological article submitted and website). Analyses of manuscript 3 showed that the intervention-induced increase in monounsaturated fatty acids and soluble fiber intake were independently associated with reduction on fasting plasma glucose and the former also with 2h-plasma glucose improvement. Adjustment for anthropometric measurements did not change these results but did after including change in insulin in the models (original article). Conclusion: Intervention programs such as the developed herein should be reported taking into consideration the current scenario of cardiometabolic diseases. In the present study, increases in monounsaturated fatty acids and soluble fiber intake promoted benefits in glucose metabolism, independent of adiposity, at the end of the lifestyle intervention. Possible mechanisms mediating these processes may mainly include improvement in insulin sensitivity. Therefore, our findings strongly suggest that a feasible increase in consumption of these nutrients should be encouraged as a strategy for the protection of glucose metabolism in individuals at cardiometabolic risk