The use of cardiovascular risk scores remains the foundation for risk stratification to guide clinical management. Clinicians have access to several cardiovascular risk scores in practice settings. While having several risk scores with different risk factors may provide more information, it does not imply accuracy of the cardiovascular risk score used to calculate individual patient cardiovascular risk. The objective of this study was to compare the Framingham Risk score, Reynolds Risk scores, and the Pooled Cohort Risk Equation (3 commonly used equations) scores with respect to ability to predict cardiovascular events in a diverse ethnic population. Additionally, the potential predictive utility of three novel risk factors (carotid intima media thickness, peripheral arterial tonometry and vasa vasorum) was examined in relation to ability to improve 10-year cardiovascular risk prediction. A secondary analysis of the longitudinal prospective study cohort known as Heart Strategies Concentrating On Risk Evaluation (Heart SCORE) was conducted. The cardiovascular risk scores of study participants who did and did not experience a cardiovascular event composite index consisting of myocardial infarction, death, stroke, acute ischemic stroke, or revascularization were assessed using methods of calibration and discrimination overall and by race and gender. When examining performance of the 3 risk scores, the overall 10-year absolute predicted cardiovascular risk varied substantially (e.g. approximately 2-fold) and this wide variation in predicted 10-year cardiovascular risk was present across race and gender. Nonetheless, despite the wide variation in estimates of absolute risk, the 3 cardiovascular risk score equations were strongly associated with future cardiovascular risk overall and by race and gender. There was some indication that the Reynolds risk score was the most accurate measure of future cardiovascular risk. The 3 novel risk factors examined did not significantly improve 10-year cardiovascular risk prediction above and beyond the standard demographic and clinical variables used in these well-known equations.

A prática regular de exercícios físicos supervisionados tem sido recomendada devido a seus benefícios na saúde. Porém, a supervisão limita o número de praticantes. Uma alternativa para a promoção da saúde pública é o treinamento de caminhada prescrita de forma individualizada e realizada sem supervisão, mas seus efeitos foram pouco estudados em uma situação real. Além disso, a possível influência do nível inicial de atividade física (AF) e de aptidão física (ApF) sobre os efeitos desse treinamento não é conhecida. Assim, este estudo investigou na situação real do Projeto Exercício e Coração: 1) a relação do nível de AF e de ApF com o risco cardiovascular avaliado de forma isolada e global; 2) o efeito do treinamento de caminhada prescrita de forma individualizada e executada sem supervisão sobre esse risco cardiovascular; e 3) a influência do nível inicial de AF e de ApF nas respostas ao treinamento. O risco cardiovascular isolado foi avaliado pela medida do índice de massa corporal (IMC), circunferência da cintura (CC), glicemia, colesterol total e pressão arterial (PA) sistólica e diastólica, enquanto que o risco global foi calculado pelo escore Z (EZ, somatório do escore z de todos os fatores isolados). O nível de AF foi avaliado pelos minutos semanais de AF de lazer e a ApF pelo resultado do teste de marcha estacionária dividido em quartis (Q1 = pior ApF e Q4 = melhor ApF). O IMC e a CC foram menores no grupo muito ativo (MA, +300 min/sem AF) do que no inativo (I, sem nenhuma AF de lazer), enquanto que o EZ foi menor no grupo MA que no I e no ativo (A, 150 a 299 min/sem de AF). Além disso, o IMC e a glicemia foram menores no Q4 que no Q1, a CC foi menor no Q2, Q3 e Q4 que no Q1, e o EZ foi menor no Q3 e Q4 que no Q1 e no Q4 que no Q2. O treinamento de caminhada diminuiu significantemente o IMC, CC, PA sistólica e EZ na amostra total. Além disso, ele reduziu significantemente todos os indicadores de risco específicos em subamostras com valores alterados, com exceção da glicemia. Para finalizar, o efeito do treinamento de caminhada no risco cardiovascular isolado e global foi semelhante nos indivíduos MA e I e nos indivíduos do Q1 e Q4 de ApF. Assim, é possível concluir que: 1) em participantes de uma situação real de promoção de AF para a saúde há associação inversa entre os níveis de AF e de ApF com marcadores de obesidade, glicemia (só ApF) e com o risco cardiovascular global; 2) o treinamento de caminhada prescrita de forma individual e executada sem supervisão em uma situação real reduz alguns fatores de risco isolados, principalmente quando eles estão alterados, e diminui o risco cardiovascular global; e 3) nem o nível inicial de AF nem o de ApF afetam os efeitos de um treinamento de caminhada prescrito de forma individualizada e executado sem supervisão em uma situação real sobre o risco cardiovascular / The regular practice of supervised physical exercise has been recommended due to its benefits on health. However, supervision limits the number of practitioners. An interesting alternative for the promotion of public health is the walking training prescribed individually and executed without supervision, however its effects have been poorly investigated under real situations. In addition, the possible influence of the initial level of physical activity (PA) and physical fitness (PF) on these effects are unknown. Thus, this study investigated under a real situation of the \"Exercise and Heart Project\": 1) the relationship between level of PA and PF with cardiovascular risk evaluated by isolated factors and globally; 2) the effects of walking training prescribed individually and executed without supervision on cardiovascular risk; and 3) the influence of initial level of PA and PF on the responses to walking training. Isolated cardiovascular risk was analyzed by the measurement of body mass index (BMI), waist circumference (WC), blood glucose, total cholesterol, and systolic and diastolic blood pressure (BP), while global risk was calculated by Z score (ZS, sum of Z score of all the factors). PA level was evaluated by weekly minutes of leisure time PA, and PF was evaluated by the results in the 2 minutes step test divided in quartiles (Q1 being the lowest PF and Q4 the highest PF). BMI and WC were significantly lower in the very active (VA, +300 min/week of PA) than in the inactive group (I, no leisure time PA), while ZS was lower in the VA than in the I and active groups (A, between 150 and 299 min/week of PA). In addition, BMI and blood glucose was significantly lower in Q4 than Q1, WC was lower in Q2, Q3 and Q4 than in Q1, and ZS was lower in Q3 and Q4 than Q1 and in Q4 than Q2. Walking training significantly decreased BMI, WC, systolic BP and ZS in the total sample. Also, it decreased all specific risk factors, with exception of blood glucose in subgroups with altered values. Finally, the effects of walking training on isolated risk factors and on ZS were similar in VA and I groups as well as in Q1 and Q4 groups. Thus, it is possible to conclude that: 1) in participants of a real intervention for health promotion, there is an inverse association between the PA and PF levels with the obesity markers, blood glucose (only PF) and global cardiovascular risk; 2) the walking training prescribed individually and executed without supervision in a real situation reduces some isolated cardiovascular risk factors, especially when they are altered, and decreases global cardiovascular risk; and 3) neither the initial level of PA nor the initial levels of PF affects the effects of walking training prescribed individually and executed without supervision in a real situation on cardiovascular risk

Introdução: A obesidade é um importante problema de Saúde Pública e, segundo a Organização Mundial da Saúde, representa uma epidemia global. É considerada uma doença crônica, multifatorial, que depende não só de fatores genéticos e fisiopatológicos, mas também de variáveis culturais, sociais e psicológicas associadas à quantidade e a qualidade da alimentação. Nesse contexto, os adolescentes como foco de mudanças fisiológicas, anatômicas e sociais se tornam um grupo com elevada frequência de fatores de risco associados à obesidade. Objetivo: Avaliar o papel da lipoproteína de baixa densidade eletronegativa [LDL(-)], da proteína transportadora de éster de colesterol (CETP) e da resistência à insulina (RI) no risco cardiometabólico de adolescentes. Métodos: Foram recrutados adolescentes de ambos os sexos, com faixa etária de 10 a 19 anos e, regularmente matriculados em escolas da cidade de São Paulo. Medidas antropométricas, tais como, peso, altura, circunferência da cintura (CC) e composição corporal foram avaliadas, e classificadas considerando sexo e idade. Após jejum (12-15h), foi coletada uma amostra de sangue e a partir do plasma foram realizadas as seguintes análises: glicose, insulina e cálculo do HOMA, perfil lipídico, apolipoproteína A-I e B, atividade da paraoxonase 1 (PON1), ácidos graxos livres (AGL), atividade da CETP e LDL(-). Os resultados obtidos foram analisados por meio dos testes qui-quadrado, Kappa, Kolmogorov-Smirnov, t-student, ANOVA, Mann-Whitney, Kruskal-Wallis, Bonferroni e de tendência linear, com valor de significância de p< 0,05. Resultados: Os adolescentes eutróficos apresentaram menor atividade de CETP e conteúdo de LDL(-) em relação àqueles com excesso de peso. O IMC apresentou associação positiva e linear com o CT/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-) e LDL(-)/CT. Perfil inverso foi observado para HDL-C e ApoA-I. A CC mostrou associação positiva com TG, CT/HDL-C, LDL-C/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-), LDL(-)/CT e CETP. Associação negativa foi observada entre CC e HDL-C e ApoA-I. Após o ajuste pela atividade da CETP, associações entre o HDL-C, LDL-C/HDL-C, CT/HDLC e LDL(-)/LDL-C com o IMC ou CC foram modificadas. Ao ajustarmos pela concentração de LDL(-), nenhuma associação sofreu alteração, o que sugere um mecanismo independente para a regulação dessa partícula durante a obesidade.Ao analisarmos os adolescentes segundo CC, verificamos que os adolescentes com CCALTA apresentaram elevado IMC, por cento de gordura corporal, pressão arterial sistólica, conteúdo de insulina, HOMA, TG, TG/HDL-C, CT/HDL-C, LDL-C/HDL-C, ApoB/ApoA-I, AGL, LDL(-), LDL(-)/CT e atividade da CETP, quando comparados aqueles com CCBAIXA. Perfil inverso foi observado para por cento de massa magra, HDL-C, ApoA-I, HDL/ApoA-I e PON-1. Quando classificados segundo HOMA (resistente à insulina - RI e sensível à insulina - SI), os adolescentes RI mostraram um impacto negativo sobre o IMC, CC, por cento de gordura corporal, pressão arterial, TG e TG/HDL-C, e resultado inverso para por cento de massa magra e PON1. O índice de risco cardiovascular proposto mostrou que o grupo CCALTA-RI = CCALTA-SI > CCBAIXA-RI = CCBAIXASI. Conclusões: Portanto, a concentração de LDL(-) e a atividade da CETP associada à obesidade, principalmente abdominal, alteram o risco cardiometabólico de adolescentes / Introduction: Obesity is a major public health problem and, according to World Health Organization, represents a global epidemic. It is considered a chronic, multifactorial disease, which depends not only of genetic and pathophysiology factors, but also of cultural, social and psychological associated with diet profile variables. In this context, adolescents as the focus of physiological, anatomical and social changes become a group with high frequency of risk factor for obesity. Objective: To evaluate the role of the electronegative low-density lipoprotein [LDL(-)] concentration, cholesteryl ester transfer protein (CETP) activity and insulin resistance on cardiometabolic risk of adolescents. Methods: We recruited adolescents of both sexes, aged 10 to 19 years and enrolled in schools in the city of São Paulo. Anthropometric measurements such as weight, height, waist circumference (WC) and body composition were evaluated and classified according to sex and age. After fasting (12-15h) was analyzed from plasma: glucose, insulin and HOMA, lipid profile, apolipoprotein A-I and B, paraoxonase 1 activity (PON1), non-esterified fatty acids (NEFA), CETP activity and LDL(-). The results were analyzed by chi-square, Kappa, Kolmogorov-Smirnov, t-student, ANOVA, Mann-Whitney, Kruskal-Wallis, Bonferroni and linear tendency test, with p< 0.05. Results: The subjects with normal weight had lower CETP activity and content of LDL(-) than excess weight adolescents. BMI showed positive and linear association with TC/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-) and LDL(-)/TC. Profile opposite was observed for HDL-C and ApoA-I. The WC was positively associated with TG, TC/HDL-C, LDL-C/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-), LDL(-)/CT and CETP. Negative association was observed between WC and HDL-C and ApoA-I. After adjustment for CETP, associations between HDL-C, LDL-C/HDL-C, TC/HDL-C and LDL(-)/LDL-C with BMI or WC were modified. Adjustment for LDL(-) content was not able to change these associations, suggesting an independent mechanism for regulation of the levels of this particle during obesity. Analysis second WC, it was found that adolescents 10 with WCHIGH showed higher BMI, per cent body fat, systolic blood pressure, insulin, HOMA, TG, TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, ApoB/ApoA-I, NEFA, LDL(-), LDL(-)/TC and CETP activity than WCLOW group. Profile opposite was observed for per cent lean body mass, HDL-C, ApoA-I, HDL/ApoA-I and PON-1. When it classified according to HOMA (insulin resistant IR and insulin sensitive IS), IR group showed a negative impact on BMI, WC, per cent body fat, blood pressure, TG and TG/HDL-C, and contrary result for per cent mass lean and PON1. The cardiovascular risk index propose showed that WCHIGH IR = WCHIGH IS > WCLOW IR = WCLOW IS group. Conclusions: Therefore, LDL(-) content and CETP activity associated with obesity, mainly abdominal, alter the cardiometabolic risk of adolescents

A prática regular de exercícios físicos supervisionados tem sido recomendada devido a seus benefícios na saúde. Porém, a supervisão limita o número de praticantes. Uma alternativa para a promoção da saúde pública é o treinamento de caminhada prescrita de forma individualizada e realizada sem supervisão, mas seus efeitos foram pouco estudados em uma situação real. Além disso, a possível influência do nível inicial de atividade física (AF) e de aptidão física (ApF) sobre os efeitos desse treinamento não é conhecida. Assim, este estudo investigou na situação real do Projeto Exercício e Coração: 1) a relação do nível de AF e de ApF com o risco cardiovascular avaliado de forma isolada e global; 2) o efeito do treinamento de caminhada prescrita de forma individualizada e executada sem supervisão sobre esse risco cardiovascular; e 3) a influência do nível inicial de AF e de ApF nas respostas ao treinamento. O risco cardiovascular isolado foi avaliado pela medida do índice de massa corporal (IMC), circunferência da cintura (CC), glicemia, colesterol total e pressão arterial (PA) sistólica e diastólica, enquanto que o risco global foi calculado pelo escore Z (EZ, somatório do escore z de todos os fatores isolados). O nível de AF foi avaliado pelos minutos semanais de AF de lazer e a ApF pelo resultado do teste de marcha estacionária dividido em quartis (Q1 = pior ApF e Q4 = melhor ApF). O IMC e a CC foram menores no grupo muito ativo (MA, +300 min/sem AF) do que no inativo (I, sem nenhuma AF de lazer), enquanto que o EZ foi menor no grupo MA que no I e no ativo (A, 150 a 299 min/sem de AF). Além disso, o IMC e a glicemia foram menores no Q4 que no Q1, a CC foi menor no Q2, Q3 e Q4 que no Q1, e o EZ foi menor no Q3 e Q4 que no Q1 e no Q4 que no Q2. O treinamento de caminhada diminuiu significantemente o IMC, CC, PA sistólica e EZ na amostra total. Além disso, ele reduziu significantemente todos os indicadores de risco específicos em subamostras com valores alterados, com exceção da glicemia. Para finalizar, o efeito do treinamento de caminhada no risco cardiovascular isolado e global foi semelhante nos indivíduos MA e I e nos indivíduos do Q1 e Q4 de ApF. Assim, é possível concluir que: 1) em participantes de uma situação real de promoção de AF para a saúde há associação inversa entre os níveis de AF e de ApF com marcadores de obesidade, glicemia (só ApF) e com o risco cardiovascular global; 2) o treinamento de caminhada prescrita de forma individual e executada sem supervisão em uma situação real reduz alguns fatores de risco isolados, principalmente quando eles estão alterados, e diminui o risco cardiovascular global; e 3) nem o nível inicial de AF nem o de ApF afetam os efeitos de um treinamento de caminhada prescrito de forma individualizada e executado sem supervisão em uma situação real sobre o risco cardiovascular / The regular practice of supervised physical exercise has been recommended due to its benefits on health. However, supervision limits the number of practitioners. An interesting alternative for the promotion of public health is the walking training prescribed individually and executed without supervision, however its effects have been poorly investigated under real situations. In addition, the possible influence of the initial level of physical activity (PA) and physical fitness (PF) on these effects are unknown. Thus, this study investigated under a real situation of the \"Exercise and Heart Project\": 1) the relationship between level of PA and PF with cardiovascular risk evaluated by isolated factors and globally; 2) the effects of walking training prescribed individually and executed without supervision on cardiovascular risk; and 3) the influence of initial level of PA and PF on the responses to walking training. Isolated cardiovascular risk was analyzed by the measurement of body mass index (BMI), waist circumference (WC), blood glucose, total cholesterol, and systolic and diastolic blood pressure (BP), while global risk was calculated by Z score (ZS, sum of Z score of all the factors). PA level was evaluated by weekly minutes of leisure time PA, and PF was evaluated by the results in the 2 minutes step test divided in quartiles (Q1 being the lowest PF and Q4 the highest PF). BMI and WC were significantly lower in the very active (VA, +300 min/week of PA) than in the inactive group (I, no leisure time PA), while ZS was lower in the VA than in the I and active groups (A, between 150 and 299 min/week of PA). In addition, BMI and blood glucose was significantly lower in Q4 than Q1, WC was lower in Q2, Q3 and Q4 than in Q1, and ZS was lower in Q3 and Q4 than Q1 and in Q4 than Q2. Walking training significantly decreased BMI, WC, systolic BP and ZS in the total sample. Also, it decreased all specific risk factors, with exception of blood glucose in subgroups with altered values. Finally, the effects of walking training on isolated risk factors and on ZS were similar in VA and I groups as well as in Q1 and Q4 groups. Thus, it is possible to conclude that: 1) in participants of a real intervention for health promotion, there is an inverse association between the PA and PF levels with the obesity markers, blood glucose (only PF) and global cardiovascular risk; 2) the walking training prescribed individually and executed without supervision in a real situation reduces some isolated cardiovascular risk factors, especially when they are altered, and decreases global cardiovascular risk; and 3) neither the initial level of PA nor the initial levels of PF affects the effects of walking training prescribed individually and executed without supervision in a real situation on cardiovascular risk

Introdução: A obesidade é um importante problema de Saúde Pública e, segundo a Organização Mundial da Saúde, representa uma epidemia global. É considerada uma doença crônica, multifatorial, que depende não só de fatores genéticos e fisiopatológicos, mas também de variáveis culturais, sociais e psicológicas associadas à quantidade e a qualidade da alimentação. Nesse contexto, os adolescentes como foco de mudanças fisiológicas, anatômicas e sociais se tornam um grupo com elevada frequência de fatores de risco associados à obesidade. Objetivo: Avaliar o papel da lipoproteína de baixa densidade eletronegativa [LDL(-)], da proteína transportadora de éster de colesterol (CETP) e da resistência à insulina (RI) no risco cardiometabólico de adolescentes. Métodos: Foram recrutados adolescentes de ambos os sexos, com faixa etária de 10 a 19 anos e, regularmente matriculados em escolas da cidade de São Paulo. Medidas antropométricas, tais como, peso, altura, circunferência da cintura (CC) e composição corporal foram avaliadas, e classificadas considerando sexo e idade. Após jejum (12-15h), foi coletada uma amostra de sangue e a partir do plasma foram realizadas as seguintes análises: glicose, insulina e cálculo do HOMA, perfil lipídico, apolipoproteína A-I e B, atividade da paraoxonase 1 (PON1), ácidos graxos livres (AGL), atividade da CETP e LDL(-). Os resultados obtidos foram analisados por meio dos testes qui-quadrado, Kappa, Kolmogorov-Smirnov, t-student, ANOVA, Mann-Whitney, Kruskal-Wallis, Bonferroni e de tendência linear, com valor de significância de p< 0,05. Resultados: Os adolescentes eutróficos apresentaram menor atividade de CETP e conteúdo de LDL(-) em relação àqueles com excesso de peso. O IMC apresentou associação positiva e linear com o CT/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-) e LDL(-)/CT. Perfil inverso foi observado para HDL-C e ApoA-I. A CC mostrou associação positiva com TG, CT/HDL-C, LDL-C/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-), LDL(-)/CT e CETP. Associação negativa foi observada entre CC e HDL-C e ApoA-I. Após o ajuste pela atividade da CETP, associações entre o HDL-C, LDL-C/HDL-C, CT/HDLC e LDL(-)/LDL-C com o IMC ou CC foram modificadas. Ao ajustarmos pela concentração de LDL(-), nenhuma associação sofreu alteração, o que sugere um mecanismo independente para a regulação dessa partícula durante a obesidade.Ao analisarmos os adolescentes segundo CC, verificamos que os adolescentes com CCALTA apresentaram elevado IMC, por cento de gordura corporal, pressão arterial sistólica, conteúdo de insulina, HOMA, TG, TG/HDL-C, CT/HDL-C, LDL-C/HDL-C, ApoB/ApoA-I, AGL, LDL(-), LDL(-)/CT e atividade da CETP, quando comparados aqueles com CCBAIXA. Perfil inverso foi observado para por cento de massa magra, HDL-C, ApoA-I, HDL/ApoA-I e PON-1. Quando classificados segundo HOMA (resistente à insulina - RI e sensível à insulina - SI), os adolescentes RI mostraram um impacto negativo sobre o IMC, CC, por cento de gordura corporal, pressão arterial, TG e TG/HDL-C, e resultado inverso para por cento de massa magra e PON1. O índice de risco cardiovascular proposto mostrou que o grupo CCALTA-RI = CCALTA-SI > CCBAIXA-RI = CCBAIXASI. Conclusões: Portanto, a concentração de LDL(-) e a atividade da CETP associada à obesidade, principalmente abdominal, alteram o risco cardiometabólico de adolescentes / Introduction: Obesity is a major public health problem and, according to World Health Organization, represents a global epidemic. It is considered a chronic, multifactorial disease, which depends not only of genetic and pathophysiology factors, but also of cultural, social and psychological associated with diet profile variables. In this context, adolescents as the focus of physiological, anatomical and social changes become a group with high frequency of risk factor for obesity. Objective: To evaluate the role of the electronegative low-density lipoprotein [LDL(-)] concentration, cholesteryl ester transfer protein (CETP) activity and insulin resistance on cardiometabolic risk of adolescents. Methods: We recruited adolescents of both sexes, aged 10 to 19 years and enrolled in schools in the city of São Paulo. Anthropometric measurements such as weight, height, waist circumference (WC) and body composition were evaluated and classified according to sex and age. After fasting (12-15h) was analyzed from plasma: glucose, insulin and HOMA, lipid profile, apolipoprotein A-I and B, paraoxonase 1 activity (PON1), non-esterified fatty acids (NEFA), CETP activity and LDL(-). The results were analyzed by chi-square, Kappa, Kolmogorov-Smirnov, t-student, ANOVA, Mann-Whitney, Kruskal-Wallis, Bonferroni and linear tendency test, with p< 0.05. Results: The subjects with normal weight had lower CETP activity and content of LDL(-) than excess weight adolescents. BMI showed positive and linear association with TC/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-) and LDL(-)/TC. Profile opposite was observed for HDL-C and ApoA-I. The WC was positively associated with TG, TC/HDL-C, LDL-C/HDL-C, TG/HDL-C, ApoB/ApoA-I, LDL(-), LDL(-)/CT and CETP. Negative association was observed between WC and HDL-C and ApoA-I. After adjustment for CETP, associations between HDL-C, LDL-C/HDL-C, TC/HDL-C and LDL(-)/LDL-C with BMI or WC were modified. Adjustment for LDL(-) content was not able to change these associations, suggesting an independent mechanism for regulation of the levels of this particle during obesity. Analysis second WC, it was found that adolescents 10 with WCHIGH showed higher BMI, per cent body fat, systolic blood pressure, insulin, HOMA, TG, TG/HDL-C, TC/HDL-C, LDL-C/HDL-C, ApoB/ApoA-I, NEFA, LDL(-), LDL(-)/TC and CETP activity than WCLOW group. Profile opposite was observed for per cent lean body mass, HDL-C, ApoA-I, HDL/ApoA-I and PON-1. When it classified according to HOMA (insulin resistant IR and insulin sensitive IS), IR group showed a negative impact on BMI, WC, per cent body fat, blood pressure, TG and TG/HDL-C, and contrary result for per cent mass lean and PON1. The cardiovascular risk index propose showed that WCHIGH IR = WCHIGH IS > WCLOW IR = WCLOW IS group. Conclusions: Therefore, LDL(-) content and CETP activity associated with obesity, mainly abdominal, alter the cardiometabolic risk of adolescents

By the year 2025, it is anticipated that over 300 million individuals world wide will have type 2 diabetes, with a projected increase from 84 to 288 million (170%) in developing countries and from 51 to 72 million (42%) in developed countries. Diabetes leads to a markedly increased risk of heart disease and renal failure and to expensive and debilitating retinopathy and neuropathy. Cognitive decline is also increased. As there is accumulating evidence of the beneficial effects of moderate carbohydrate, low fat dietary patterns compared to high carbohydrate diets, this thesis will focus on the effects of moderate carbohydrate high protein dietary patterns (total carbohydrate: protein: fat ratio of 40%:34%:26%) on glycemic control, risk factors for macrovascular disease and cognitive function. Information on two key areas in type 2 diabetes will be presented, 1. Acute effects of dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels assessed using continuous glucose monitoring systems (CGMS) with verification of these results through a small repeat study. 2. Chronic effects of energy restricted dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels, HbA1c, cognitive function, cardiovascular disease (CVD) risk markers and renal function. In the acute study, we recruited 23 subjects with type 2 diabetes. The participants were randomized to each of 4, 3-day interventions in a cross over design with a 4 day wash out period in which the carbohydrates were distributed differently at each meal; carbohydrates evenly distributed across the day, or carbohydrates loaded at breakfast, lunch or dinner. Glucose levels were continuously measured using CGMS. Outcomes were assessed by postprandial peak glucose (Gmax), time spent above 12 mmol/L (T>12) and total area under the glucose curve (AUC20). The intervention showed that an even distribution of carbohydrates did not optimise blood glucose control, whereas carbohydrates loaded at the lunch time meal provided the most favourable postprandial profile. To verify these results we conducted a repeat study. Six of the previous participants accepted the invitation to return and complete the even distribution arm of the study after a 20 week time lag. The intervention showed that although HbA1c, fasting blood glucose (FBG), AUC, exercise and ambient temperature remained constant there was a significant effect of change in sunlight hours on Gmax, suggesting an effect of sunlight. To assess the chronic effects of energy restricted dietary patterns on the determinants of HbA1c, cognitive function, CVD risk markers and renal function under conditions of weight loss, we recruited 82 participants with type 2 diabetes. These participants were randomised to one of two high protein energy restricted dietary patterns that differed in cholesterol content, for a 12 week period, in a parallel design. A sub group of these participants completed cognitive function testing with (n=34) or without (n=17) CGMS at baseline and at 8 weeks. After 8 weeks of the intervention the determinants of HbA1c under conditions of energy restriction were evaluated. The intervention showed the change in FBG accounted for most of the variance in change in HbA1c, but % energy reduction also contributed independently of FBG. Both energy restricted high protein diets equally improved glycemic control, particularly T>12, AUC, HbA1c and FBG. Fifty one participants completed cognitive testing to evaluate the effect of weight loss and blood glucose control on cognition. Cognitive function was not altered by time, diet, baseline lipid levels. Working memory was predicted by FBG. Short term memory was predicted by FBG, Gmax and AUC24. Sixty five participants completed 12 weeks of the intervention to assess CVD risk markers and renal function. Renal function was maintained and CV markers improved on both dietary patterns, with greatest improvement in HDL-C observed in the group consuming a high protein, energy restricted dietary pattern, high in dietary cholesterol. In conclusion, in the context of a high protein, carbohydrate restricted dietary pattern, cognitive function and renal function did not change, while glycemia and CV risk profiles improved with weight loss over the short term. Under conditions of energy balance diurnal glucose profiles were optimal when the carbohydrates were loaded in the lunch meal. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1342253 / Thesis (Ph.D.) - University of Adelaide, School of Molecular and Biomedical Science, 2008

By the year 2025, it is anticipated that over 300 million individuals world wide will have type 2 diabetes, with a projected increase from 84 to 288 million (170%) in developing countries and from 51 to 72 million (42%) in developed countries. Diabetes leads to a markedly increased risk of heart disease and renal failure and to expensive and debilitating retinopathy and neuropathy. Cognitive decline is also increased. As there is accumulating evidence of the beneficial effects of moderate carbohydrate, low fat dietary patterns compared to high carbohydrate diets, this thesis will focus on the effects of moderate carbohydrate high protein dietary patterns (total carbohydrate: protein: fat ratio of 40%:34%:26%) on glycemic control, risk factors for macrovascular disease and cognitive function. Information on two key areas in type 2 diabetes will be presented, 1. Acute effects of dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels assessed using continuous glucose monitoring systems (CGMS) with verification of these results through a small repeat study. 2. Chronic effects of energy restricted dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels, HbA1c, cognitive function, cardiovascular disease (CVD) risk markers and renal function. In the acute study, we recruited 23 subjects with type 2 diabetes. The participants were randomized to each of 4, 3-day interventions in a cross over design with a 4 day wash out period in which the carbohydrates were distributed differently at each meal; carbohydrates evenly distributed across the day, or carbohydrates loaded at breakfast, lunch or dinner. Glucose levels were continuously measured using CGMS. Outcomes were assessed by postprandial peak glucose (Gmax), time spent above 12 mmol/L (T>12) and total area under the glucose curve (AUC20). The intervention showed that an even distribution of carbohydrates did not optimise blood glucose control, whereas carbohydrates loaded at the lunch time meal provided the most favourable postprandial profile. To verify these results we conducted a repeat study. Six of the previous participants accepted the invitation to return and complete the even distribution arm of the study after a 20 week time lag. The intervention showed that although HbA1c, fasting blood glucose (FBG), AUC, exercise and ambient temperature remained constant there was a significant effect of change in sunlight hours on Gmax, suggesting an effect of sunlight. To assess the chronic effects of energy restricted dietary patterns on the determinants of HbA1c, cognitive function, CVD risk markers and renal function under conditions of weight loss, we recruited 82 participants with type 2 diabetes. These participants were randomised to one of two high protein energy restricted dietary patterns that differed in cholesterol content, for a 12 week period, in a parallel design. A sub group of these participants completed cognitive function testing with (n=34) or without (n=17) CGMS at baseline and at 8 weeks. After 8 weeks of the intervention the determinants of HbA1c under conditions of energy restriction were evaluated. The intervention showed the change in FBG accounted for most of the variance in change in HbA1c, but % energy reduction also contributed independently of FBG. Both energy restricted high protein diets equally improved glycemic control, particularly T>12, AUC, HbA1c and FBG. Fifty one participants completed cognitive testing to evaluate the effect of weight loss and blood glucose control on cognition. Cognitive function was not altered by time, diet, baseline lipid levels. Working memory was predicted by FBG. Short term memory was predicted by FBG, Gmax and AUC24. Sixty five participants completed 12 weeks of the intervention to assess CVD risk markers and renal function. Renal function was maintained and CV markers improved on both dietary patterns, with greatest improvement in HDL-C observed in the group consuming a high protein, energy restricted dietary pattern, high in dietary cholesterol. In conclusion, in the context of a high protein, carbohydrate restricted dietary pattern, cognitive function and renal function did not change, while glycemia and CV risk profiles improved with weight loss over the short term. Under conditions of energy balance diurnal glucose profiles were optimal when the carbohydrates were loaded in the lunch meal. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1342253 / Thesis (Ph.D.) - University of Adelaide, School of Molecular and Biomedical Science, 2008