Orientador: Eliana Aguiar Petri Nahas / Coorientador: Heloísa M. Luca Véspoli / Banca: Gilberto Uemura / Banca: César Cabello dos Santos / Resumo: Avaliar o risco de síndrome metabólica (SM) em mulheres na pós-menopausa tratadas de câncer de mama, comparadas às mulheres na pós-menopausa sem câncer de mama. Realizou-se estudo clínico, analítico e transversal, com 104 mulheres tratadas de câncer de mama comparadas a 208 mulheres na pós-menopausa (controle), atendidas em Hospital Universitário. Foram incluídas no grupo de estudo mulheres com amenorréia >12 meses e idade ≥45 anos, tratadas de câncer de mama e livre de doença há pelo menos cinco anos. O grupo controle foi constituído de mulheres com amenorréia >12 meses e idade ≥45 anos sem câncer de mama, pareadas pela idade, na proporção 1:2. Por meio de entrevista foram coletados dados clínicos e antropométricos. Na análise bioquímica foram solicitadas dosagens de colesterol total (CT), HDL, LDL, triglicerídeos (TG), glicemia e proteína C-reativa (PCR). Foram consideradas com SM as mulheres que apresentaram três ou mais critérios diagnósticos: circunferência da cintura (CC) > 88 cm; TG ≥ 150 mg/dL; HDL colesterol < 50 mg/dL; pressão arterial ≥ 130/85 mmHg; glicemia de jejum ≥ 100 mg/dL. Para análise estatística foram empregados o teste t-student, o teste do Qui-Quadrado e a regressão logística (odds ratio-OR). A média de idade da pacientes tratadas de câncer de mama foi de 60,6 ± 8,6 anos com tempo médio de seguimento de 9,4 ± 4,4 anos. Maior porcentagem de pacientes tratadas de câncer de mama (46,2%) era obesa quando comparadas ao controle (32,7%) (p<0,05). E menor porcentagem de mulheres tratadas de câncer apresentou valores considerados ótimos de LDL, glicemia e PCR quando comparadas ao controle (p<0,05). A SM foi diagnosticada em 50% das mulheres tratadas de câncer de mama e 37,5% no grupo controle (p<0,05). Entre os critérios... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To assess the risk of metabolic syndrome (MetS) in postmenopausal women breast cancer survivors compared to postmenopausal women without breast cancer. In this cross-sectional study, 104 women breast cancer survivors were compared with 208 postmenopausal women (control), seeking healthcare at a University Hospital. Eligibility criteria included women with amenorrhea > 12 months and age ≥ 45 years, treated for breast cancer and no recorrences for at least five years. The control group consisted of women with amenorrhea >12 months and age ≥ 45 years without breast cancer matched by age, in proportion 1:2. Dates on clinical antecedents and anthropometric indicators were collected. The biochemical parameters, including total cholesterol, HDL, LDL, triglycerides, glucose and C-reactive protein (CRP), were measured. MetS was diagnosed as the presence of at least three components among: waist circumference (WC) >88cm, blood pressure ≥130/85mmHg, triglycerides ≥150mg/dl, HDL <50mg/dl and glucose ≥100mg/dl. For statistical analysis were used: Student t-test, Chi-square test, and logistic regression method (odds ratio-OR). The mean age of women breast cancer survivors was 60.6 ± 8.6 years with a mean follow-up of 9.4 ± 4.4 years. A higher percentage of women breast cancer survivors (46.2%) were obese compared to control (32.7%) (p <0.05). And a smaller percentage of women breast cancer survivors had optimal values of LDL, glucose and CRP compared to controls (p <0.05). MetS was diagnosed in 50% of women breast cancer survivors and 37.5% in the control group (p <0.05). The most prevalent diagnostic criteria of MetS was abdominal obesity (WC> 88 cm) affecting 62.5% of women breast cancer survivors and 67.8% of control group. Women breast cancer survivors had a higher risk for metabolic syndrome... (Complete abstract click electronic access below) / Mestre

Orientador: Roberto Carlos Burini / Banca: Luis Cuadrado Martin / Banca: Aparecida Maria Catai / Resumo: A prevalência crescente de hipertensão arterial é perpetuada por fatores comportamentais tais como dieta inadequada e inatividade física. Determinar os fatores associados à hipertensão arterial em adultos clinicamente triados para programa de mudança de estilo de vida. Foram estudados 1041 indivíduos, de ambos os sexos, com idade entre 26 a 88 anos, voluntários de programa de mudança de estilo de vida. A avaliação da pressão arterial foi realizada obedecendo a VI Diretriz Brasileira de Hipertensão Arterial. Colesterol total e frações, triglicerídios, glicemia, uréia, creatinina, ácido úrico e albumina foram analisados pelo método de Química Seca e proteína C reativa por imunoquimioluminescência. A avaliação antropométrica foi composta pelas medidas de circunferência abdominal, massa e estatura, com posterior cálculo do índice de massa corporal, e o percentual de gordura foi obtido por bioimpedância. A ingestão dietética foi realizada pelo recordatório de 24 horas, com posterior cálculo das porções da pirâmide e Índice de Alimentação Saudável adaptado. A avaliação cardiorrespiratória em esteira ergométrica foi feita pelo teste de Balke modificado. Análises estatísticas foram realizadas utilizando o programa SAS versão 9.2 e descritos em média e desvio padrão. Foi realizado o teste de Wilcoxon com normalidade da amostra sendo avaliada pelo teste de Shapiro-Wilk, e regressão linear com intervalo de confiança de 95%. Os resultados foram discutidos com base no nível de significância de p<0,05. O total de hipertensos atingiu 37,7% sendo 20,8% em uso de hipotensores medicamentosos. Não houve influência significativa da renda e da ingestão dietética sobre a prevalência de hipertensão. Por outro lado houve associação da obesidade e da adiposidade (corporal e abdominal) assim como da hiperglicemia e hipercolesterolemia. Na ausência... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The growing prevalence of hypertension is mainly due to happens by behavioral factors, such as inappropriate diet and physical inactivity. These study aims to determine the associated factors of hypertension in clinically screened adults a lifestyle modification program. One thousand and forty one volunteers were studied, both male and female, between 26 and 88 years old. The blood pressure was measured following VI Hypertension Brazilian Guideline. Plasma total cholesterol, triglycerides, glucose, urea, creatinine, uric acid and albumin were analyzed by the dry chemistry method and C-reactive protein by immunechemmiluminescence. The anthropometric evaluation consisted of weight and height measurements, with subsequent body mass index calculation. Fat percentage was obtained by electrical bioimpedance. Dietary intake was evaluated by a 24-hour food recall, with posterior pyramid servings and the adapted health eating index calculation. The cardiorespiratory fitness evaluation on treadmill was done by the modified Balke test. Statistic analyses were done using the 9.2 version SAS program and described in mean and standard deviation. The Wilcoxon test was done with normality sample being evaluated by the Shapiro-Silk test and linear regression with 95% confidence intervals. The results were discussed based on the significance level of p<0.05. The total number of hypertensive individuals was 37.7%, 20% of them taking anti-hypertensive medicine. There wasn't significant influence of income and dietary intake concerning hypertension prevalence. On the other hand, there was an association of obesity and adiposity (corporal and abdominal) as well as of hyperglycemia and hypercholesterolemia. In the absence of medicine the hypertensive individuals showed similar age and body mass index values, higher of abdominal circumference (female) and glucose and lower of VO2max (female)... (Complete abstract click electronic access below) / Mestre

abstract: Among the general US population, cardiovascular disease (CVD) is the main cause of mortality for Mexican-Americans. CVD is less prevalent among Mexican-Americans than non-Hispanic Whites or African Americans. However, there is limited research regarding the factors associated with increased CVD risk among Mexican-Americans. Thus, this cross-sectional study was conducted to evaluate the effects of non-biological factors (income, education, employment, acculturation) and diet on CVD risk factors in 75 Mexican-American adults (26 males, 49 females; age=37.6±9.3 y, BMI=28.9±5.3 kg/m2, systolic BP=117±11 mmHg, diastolic BP=73±9 mmHg, LDL cholesterol=114±32 mg/dL, HDL cholesterol=44±11 mg/dL, triglycerides=115±61 mg/dL, serum glucose=92±7 mg/dL). Aside from collecting anthropometric measurements, blood pressure, and measuring fasting blood lipids, glucose, and insulin, information about participants' socioeconomic status, income, employment, education, and acculturation were gathered using a survey. Diet data was collected using the Southwestern Food Frequency Questionnaire. Weight, BMI, and waist circumference were significantly greater for those with a monthly income of <$3000 than for those earning >$3000 (81±15 kg vs. 71±15 kg; 29.8±4.6 kg/m2 vs. 26.5±5.1 kg/m2; 98±12 cm vs. 89±14 cm; respectively) and with an education level of high school graduate or less than for those with some college (84±16 kg vs. 72±14 kg; 30.6±4.2 kg/m2 vs. 26.9±4.9 kg/m2; 100±11 cm vs. 91±13 cm; respectively). HDL-C was higher for those with a monthly income of >$3000 than those earning <$3000 (49±12 mg/dL vs. 41±10 mg/dL), those with some college education than those with high school or less (47±10 mg/dL vs. 37±9 mg/dL), and for those employed than those not employed (46±10 mg/dL vs. 40±12 mg/dL). There was no association between acculturation and CVD risk factors. Percent of energy consumed from fat was greater and percent of energy from carbohydrates was lower in those earning <$3000 monthly than those earning >$3000 (32±5% vs. 29±3%; 52±8% vs. 56±4%; respectively). Greater acculturation to the Anglo culture was negatively correlated with body fat percentage (r=-0.238, p=0.043) and serum glucose (r=-0.265, p=0.024). Overall, these results suggest that factors related to sociocultural and socioeconomic status may affect cardiometabolic disease risk in Mexican-Americans living in the Phoenix metropolitan area. / Dissertation/Thesis / M.S. Nutrition 2011

Introdução: A síndrome metabólica (SM) apresenta elevada prevalência na população mundial, sendo a hiperferritinemia um achado frequente nestes pacientes. A investigação do aumento da ferritina nesta doença representa um desafio diagnóstico, muitas vezes necessitando exames de alto custo, mas sendo fundamental para identificação dos pacientes que apresentam sobrecarga de ferro. Objetivo: Avaliar os parâmetros bioquímicos e moleculares relacionados ao metabolismo do ferro em pacientes portadores de SM. Métodos: Através de um estudo transversal, foram avaliados 94 pacientes portadores de SM de acordo com os critérios da International Diabetes Federation que estavam em acompanhamento no ambulatório de Medicina Interna do HCPA. Foram avaliados dados antropométricos e de diagnóstico para SM, dosagem de ferro, ferritina, a saturação da transferrina, hepcidina, além das mutações C282Y e H63D do gene HFE da hemocromatose. Resultados: A prevalência de hiperferritinemia na população em estudo foi de 27,7%, sendo maior no sexo masculino (53,8%) que no sexo feminino (14,5%) (p<0,001). A elevação da saturação de transferrina, e não da ferritina, se correlacionou com mutações do gene da hemocromatose. A hiperferritinemia se associou com saturação de transferrina (p<0,001) e a hepcidina (p=0,008), após análise de regressão logística. Conclusão: A hiperferritinemia é um achado frequente na SM, sendo mais comum em homens. A dosagem da saturação de transferrina é um bom parâmetro para screening de pacientes com mutação da hemocromatose, como já demonstrado na literatura. Sugere-se a hepcidina como um novo biomarcador com potencial promissor na investigação da hiperferritinemia associada à SM. / Introduction: Metabolic syndrome (MS) has a high prevalence in the world population, and hyperferritinemia is a frequent finding in these patients. The investigation of the increased ferritin in this syndrome represents a diagnostic challenge, often requiring expensive tests, but is essential for identification of patients with iron overload. Objective: To evaluate biochemical and molecular parameters related to iron metabolism in patients with MS. Methods: In a cross-sectional study, we evaluated 94 patients with MS according to the criteria of the International Diabetes Federation who were accompanied in the outpatient clinics of internal medicine, Hospital de Clínicas de Porto Alegre. We evaluated anthropometric data and diagnostic criteria for MS, iron dosage, ferritin, transferrin saturation, hepcidin, besides the C282Y and H63D mutations in the HFE hemochromatosis gene. Results: The prevalence of hyperferritinemia in the study population was 27.7% and was higher in males (53.8%) than in females (14.5%) (p <0.001). The elevation of transferrin saturation, but not ferritin, did relate with mutations the hemochromatosis gene. Hyperferritinemia related to transferrin saturation (p <0.001) and hepcidin (p = 0.008) after logistic regression analysis. Conclusion: Hyperferritinemia is a frequent finding in metabolic syndrome, most frequently in men. Determination of transferrin saturation is a good parameter for screening of patients with hemochromatosis mutation, as already demonstrated in literature. It is suggested hepcidin as a new biomarker with promising potential in research hyperferritinemia associated with MS.

OBJETIVO Avaliar as evidências quanto à associação entre síndrome metabólica e periodontite através de uma revisão sistemática da literatura e metanálise de estudos observacionais. MATERIAIS E MÉTODOS Os estudos foram acessados através de busca nas bases eletrônicas Medline, EMBASE e Biblioteca Cochrane e de busca manual para identificar estudos, observacionais, originais, realizados com população adulta, que avaliaram a associação entre síndrome metabólica e doença periodontal. Os estudos deveriam mencionar critério de diagnóstico para síndrome metabólica e pelo menos uma medida clínica para o diagnóstico de periodontite e apresentar as medidas de efeito através de razão de chance (OR), risco relativo (RR) ou taxa de prevalência (PR). Os dados foram extraídos por dois investigadores, de maneira independente. A metanálise dos estudos incluídos foi realizada utilizando-se modelos randômicos. RESULTADOS A revisão sistemática incluiu 17 estudos observacionais, que preencheram os critérios de inclusão. Na metanálise foram incluídos 11 estudos, totalizando dados de 38.189 pacientes. Encontrou-se associação entre síndrome metabólica e periodontite com um OR de 1,78 (IC 95% 1,38- 2,30), e heterogeneidade de i2=93%. Para investigar a alta heterogeneidade foram (1) rodadas análises sequenciais, excluindo-se um estudo por vez, (2) metarregressão avaliando-se isoladamente idade, tabagismo, critério de diagnóstico para síndrome metabólica e exame periodontal completo versus parcial, (3) análise de subgrupos analisando-se em separado estudos em população asiática e não asiática e análise de sensibilidade. A heterogeneidade foi reduzida de forma significativa quando subdividiu-se os estudos com origem em população asiática (OR 2,06, IC 95% 1,60– 2,85, i2= 83,1%) e em população não asiática (OR 1,12 IC 95% 1,04- 1,68, i2=65,3%). CONCLUSÃO Os achados deste estudo reportam uma associação significativa entre síndrome metabólica e doença periodontal. A falta de um número suficiente de estudos longitudinais impede que se estabeleça a direção desta associação. Devido a alta heterogeneidade encontrada, estudos de intervenção bem controlados são necessários para que se conheça a magnitude dessa associação. / PURPOSE To investigate the association of metabolic syndrome and periodontitis by means of a systematic review and a meta-analysis of observational studies. RESEARCH DESIGN AND METHODS The electronic databases Medline, EMBASE and The Cochrane Library were searched for observational studies that evaluated the association of Metabolic Syndrome and Periodontitis. Hand search was also done. Data extraction was performed by two reviewers independently. Pooled effect estimates were obtained by using random-effects meta-analysis. RESULTS Systematic review included 17 studies that fulfilled the inclusion criteria. Meta-analysis was done with 11 studies, providing data of 38.189 patients. The results showed that there is an association estimated in an OR of 1,78 (95%IC 1,38- 2,30) between metabolic syndrome and periodontitis. A high heterogeneity was present (i2=93%). To investigate heterogeneity (1) the meta-analysis was re-ran excluding studies one at a time, (2) univariate metaregression was performed analyzing smoke status, metabolic syndrome criteria and parcial versus complete periodontal record, (3) subgroup analysis splitting studies in those performed with Asiatic populations and with non-Asiatic populations and sensitivity analysis. The heterogeneity was reduced significantly when subgroup analysis was done, for Asiatic population an OR of 2,06 (95% IC 1,60-2,85) and i2= 83,1% and for non-Asiatic population an OR of 1,12 (95% IC 1,04- 1,68) and i2=65,3% were found. CONCLUSION This study showed a significant association between metabolic syndrome and periodontitis. The lack of longitudinal studies in this area prevent from setting the direction of this association. Due to the high heterogeneity found, interventional and well controlled studies are encouraged to elucidate the magnitude of this association.

Excessive fructose consumption in Western diets correlates with increases in obesity, insulin resistance, kidney disease, and non-alcoholic fatty liver disease (NAFLD), collectively part of metabolic syndrome (MBS). Liver and kidneys metabolize 50-70% of ingested fructose, but the fate of remaining fructose remains poorly understood. Moreover, the correlation of fructose ingestion with MBS highlights the need for better understanding of whole-body fructose metabolism, in both health and disease. To that end, valid rodent models for fructose metabolism must reflect the same metabolism in humans. A serious autosomal recessive defect in fructose metabolism, called hereditary fructose intolerance (HFI), is caused by mutations in the aldolase B gene (ALDOB, human; Aldo2, mouse). With low levels of fructose exposure, HFI patients develop NAFLD and liver fibrosis, sharing pathologies with MBS. Targeting Aldo2 for deletion in mice (Aldo2-/-) provides a major step in validating that fructose metabolism in mice mimics that in humans. Like HFI patients, Aldo2-/- mice exposed to chronic, low-level dietary fructose show failure to thrive, liver dysfunction, and potential mortality. The fructose-induced symptoms of HFI and MBS result from flux through the ketohexokinase (KHK)-mediated pathway, and the metabolite Fru 1-P. Bioinformatic analysis reveals gene expression for this pathway is highest in liver, as expected; surprisingly, brain is predicted to have expression levels similar to kidney. This predicted gene expression is validated via RNA in situ hybridization, quantification of enzyme activities, presence of transport proteins, and measuring fructose oxidation rates in adult mice brains. Within the brain, regions of the cerebellum, hippocampus, cortex, and olfactory bulb show the highest population of cells expressing Fru-1-P pathway genes. In these regions, enzyme activities for both KHK and aldolase, and rates of fructolytic flux, are many times that seen in liver slices. Additionally, brains of mice on a high fructose diet show a three-fold increase in KHK activity. This suggests that not only are these regions of the brain capable of metabolizing fructose, but that they are also capable of responding to increases in dietary fructose. This work provides a foundation for research of long-term consequences of excessive fructose consumption in multiple organs. / 2017-06-21T00:00:00Z

Orientador: Tamara Beres Lederer Goldberg / Banca: Anaglória Pontes / Banca: Maria Silvia Souza Vitalle / Resumo: Determinar para uma população de adolescentes matriculados na condição de casos novos no Ambulatório de Medicina do Adolescente da Faculdade de Medicina de Botucatu/UNESP de ambos os gêneros, na faixa etária compreendida entre 10 anos completos e 16 anos incompletos, considerados sobrepesos, obesos e superobesos, quais deles apresentavam critérios para a SM e dentre os critérios avaliados quais eram os mais prevalentes. 200 adolescentes de ambos os gêneros, compreendidos na faixa etária entre 10 anos completos e 16 anos incompletos foram submetidos à avaliação antropométrica, sendo obtidos peso, estatura, circunferência abdominal e calculado o Índice de Massa Corporal (IMC), classificado de acordo com a idade e o sexo e os respectivos pontos de corte propostos pelo Centers for Desease Control and Prevention (CDC, 2002) e classificados em eutróficos, sobrepesos, obesos e superobesos. A aferição da pressão arterial foi criteriosamente obtida segundo as recomendações. Aqueles considerados com o IMC igual ou superior ao 85o percentil para o IMC foram submetidos a avaliação laboratorial, com dosagem de Colesterol Total e Frações, Triglicérides, Insulinemia de jejum, Glicemia de jejum, Tiroxinemia livre (T4 livre) e Hormônio Tireoestimulante (TSH), para avaliar a presença dos critérios para SM propostos por Zimmet e col.,2007,ou excluí-los pela presença de alguma outra alteração clínica ou metabólica, que pudesse estar relacionada a outra doença. A Insulinemia de jejum e a Glicemia de jejum foram também utilizadas para determinar a presença de provável resistência à insulina. Calculou-se HOMA-IR, Quicki e Fração Glicemia de jejum/Insulinemia de jejum (FGI). Dos 200 adolescentes avaliados 69 (34,5%), foram considerados sobrepesos, 77(38,5%) obesos e 54 (27%) superobesos; 41(20,5%) apresentaram diagnóstico de SM pelos critérios utilizados e dentre aqueles... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To determine which individuals showed criteria for MS and, among the investigated criteria, which were the most prevalent in a population of adolescents registered in the condition of new cases at the Adolescents' Medicine Outpatient Unit of the Botucatu School of Medicine/UNESP, of both genders, at the age range from 10 years old (complete) to 16 years old (incomplete), considered to be overweight, obese and super-obese, Two hundred adolescents of both genders, at the age range from 10 years old (complete) to 16 years old (incomplete), were submitted to anthropometric evaluation, and the following measurements were taken: weight, height and abdominal circumference. The Body Mass Index (BMI) was estimated and classified according to age and gender and the respective cutoff points proposed by the Centers for Disease Control and Prevention (CDC, 2002). The participants were then classified as eutrophic, overweight, obese and super-obese. Arterial pressure was carefully measured according to recommendations. Those considered to have BMI equal to or higher than the 85o percentile for BMI were submitted to laboratory evaluation by testing for Total Cholesterol and Fractions, Triglycerides, Fasting Insulinemia, Fasting Glycemia, Free Thyroxinemia (free T4) and Thyroid-stimulating Hormone (TSH) in order to evaluate the presence of the criteria for MS proposed by Zimmet et al, 2007 or exclude them by the presence of a clinical or metabolic alteration that could be related to another disease. Fasting insulinemia and fasting glycemia were also used to determine the presence of probable insulin resistance. HOMA-IR, Quicki and fasting Glycemia fraction/fasting insulinemia (FGI) were calculated. Of the 200 adolescents evaluated 69 (34,5%) were considered to be overweight, 77(38.5%) obese and 54 (27%) super-obese; 41(20.5%) were diagnosed with MS by the criteria used and, among those analyzed... (Complete abstract click electronic access below) / Mestre

Introdução: A síndrome metabólica (SM) apresenta elevada prevalência na população mundial, sendo a hiperferritinemia um achado frequente nestes pacientes. A investigação do aumento da ferritina nesta doença representa um desafio diagnóstico, muitas vezes necessitando exames de alto custo, mas sendo fundamental para identificação dos pacientes que apresentam sobrecarga de ferro. Objetivo: Avaliar os parâmetros bioquímicos e moleculares relacionados ao metabolismo do ferro em pacientes portadores de SM. Métodos: Através de um estudo transversal, foram avaliados 94 pacientes portadores de SM de acordo com os critérios da International Diabetes Federation que estavam em acompanhamento no ambulatório de Medicina Interna do HCPA. Foram avaliados dados antropométricos e de diagnóstico para SM, dosagem de ferro, ferritina, a saturação da transferrina, hepcidina, além das mutações C282Y e H63D do gene HFE da hemocromatose. Resultados: A prevalência de hiperferritinemia na população em estudo foi de 27,7%, sendo maior no sexo masculino (53,8%) que no sexo feminino (14,5%) (p<0,001). A elevação da saturação de transferrina, e não da ferritina, se correlacionou com mutações do gene da hemocromatose. A hiperferritinemia se associou com saturação de transferrina (p<0,001) e a hepcidina (p=0,008), após análise de regressão logística. Conclusão: A hiperferritinemia é um achado frequente na SM, sendo mais comum em homens. A dosagem da saturação de transferrina é um bom parâmetro para screening de pacientes com mutação da hemocromatose, como já demonstrado na literatura. Sugere-se a hepcidina como um novo biomarcador com potencial promissor na investigação da hiperferritinemia associada à SM. / Introduction: Metabolic syndrome (MS) has a high prevalence in the world population, and hyperferritinemia is a frequent finding in these patients. The investigation of the increased ferritin in this syndrome represents a diagnostic challenge, often requiring expensive tests, but is essential for identification of patients with iron overload. Objective: To evaluate biochemical and molecular parameters related to iron metabolism in patients with MS. Methods: In a cross-sectional study, we evaluated 94 patients with MS according to the criteria of the International Diabetes Federation who were accompanied in the outpatient clinics of internal medicine, Hospital de Clínicas de Porto Alegre. We evaluated anthropometric data and diagnostic criteria for MS, iron dosage, ferritin, transferrin saturation, hepcidin, besides the C282Y and H63D mutations in the HFE hemochromatosis gene. Results: The prevalence of hyperferritinemia in the study population was 27.7% and was higher in males (53.8%) than in females (14.5%) (p <0.001). The elevation of transferrin saturation, but not ferritin, did relate with mutations the hemochromatosis gene. Hyperferritinemia related to transferrin saturation (p <0.001) and hepcidin (p = 0.008) after logistic regression analysis. Conclusion: Hyperferritinemia is a frequent finding in metabolic syndrome, most frequently in men. Determination of transferrin saturation is a good parameter for screening of patients with hemochromatosis mutation, as already demonstrated in literature. It is suggested hepcidin as a new biomarker with promising potential in research hyperferritinemia associated with MS.

Obesity and metabolic dysfunction are worldwide health epidemics and they have grown to unprecedented levels. Human NAFLD is directly linked to obesity and metabolic dysfunction, so attention was given to elucidating a more complete understanding of the liver's role in mediating the metabolically healthy obese phenotype and to better characterizing the potential contribution of dietary fat and fatty acids as a therapeutic supplement to obesogenic diets. Specifically, flaxseed is high in α-linolenic acid (ALA; 18:3 n-3) and low in linoleic acid (LA; 18:2 n-6), and contains multiple other components such as fiber and lignans, and was investigated for its high potential to modify obesity phenotype and fatty liver disease. Additionally, we explored the temporal effect of initiating high-fat diets in various phases of adulthood. However, work in this field is complicated by an ongoing search for appropriate preclinical animal models of NAFLD as they have not been able to replicate the full spectrum of human NAFLD. As such, this dissertation sought to explore fatty liver disease in popular murine models of overnutrition, as well as a novel hen model. Major findings from this work showed that (1) exposure to a high-fat diet during early adulthood preserves metabolic homeostasis, modifies liver morphology, and protects against obesity-related disease, (2) dietary enrichment with flaxseed is capable of increasing tissue n3PUFA content, but this appeared to be only weakly related to metabolic and histological outcomes, and (3) there are limitations to the laying hen as a model of NAFLD as the pathogenic changes may not adequately match the human condition.

OBJETIVO Avaliar as evidências quanto à associação entre síndrome metabólica e periodontite através de uma revisão sistemática da literatura e metanálise de estudos observacionais. MATERIAIS E MÉTODOS Os estudos foram acessados através de busca nas bases eletrônicas Medline, EMBASE e Biblioteca Cochrane e de busca manual para identificar estudos, observacionais, originais, realizados com população adulta, que avaliaram a associação entre síndrome metabólica e doença periodontal. Os estudos deveriam mencionar critério de diagnóstico para síndrome metabólica e pelo menos uma medida clínica para o diagnóstico de periodontite e apresentar as medidas de efeito através de razão de chance (OR), risco relativo (RR) ou taxa de prevalência (PR). Os dados foram extraídos por dois investigadores, de maneira independente. A metanálise dos estudos incluídos foi realizada utilizando-se modelos randômicos. RESULTADOS A revisão sistemática incluiu 17 estudos observacionais, que preencheram os critérios de inclusão. Na metanálise foram incluídos 11 estudos, totalizando dados de 38.189 pacientes. Encontrou-se associação entre síndrome metabólica e periodontite com um OR de 1,78 (IC 95% 1,38- 2,30), e heterogeneidade de i2=93%. Para investigar a alta heterogeneidade foram (1) rodadas análises sequenciais, excluindo-se um estudo por vez, (2) metarregressão avaliando-se isoladamente idade, tabagismo, critério de diagnóstico para síndrome metabólica e exame periodontal completo versus parcial, (3) análise de subgrupos analisando-se em separado estudos em população asiática e não asiática e análise de sensibilidade. A heterogeneidade foi reduzida de forma significativa quando subdividiu-se os estudos com origem em população asiática (OR 2,06, IC 95% 1,60– 2,85, i2= 83,1%) e em população não asiática (OR 1,12 IC 95% 1,04- 1,68, i2=65,3%). CONCLUSÃO Os achados deste estudo reportam uma associação significativa entre síndrome metabólica e doença periodontal. A falta de um número suficiente de estudos longitudinais impede que se estabeleça a direção desta associação. Devido a alta heterogeneidade encontrada, estudos de intervenção bem controlados são necessários para que se conheça a magnitude dessa associação. / PURPOSE To investigate the association of metabolic syndrome and periodontitis by means of a systematic review and a meta-analysis of observational studies. RESEARCH DESIGN AND METHODS The electronic databases Medline, EMBASE and The Cochrane Library were searched for observational studies that evaluated the association of Metabolic Syndrome and Periodontitis. Hand search was also done. Data extraction was performed by two reviewers independently. Pooled effect estimates were obtained by using random-effects meta-analysis. RESULTS Systematic review included 17 studies that fulfilled the inclusion criteria. Meta-analysis was done with 11 studies, providing data of 38.189 patients. The results showed that there is an association estimated in an OR of 1,78 (95%IC 1,38- 2,30) between metabolic syndrome and periodontitis. A high heterogeneity was present (i2=93%). To investigate heterogeneity (1) the meta-analysis was re-ran excluding studies one at a time, (2) univariate metaregression was performed analyzing smoke status, metabolic syndrome criteria and parcial versus complete periodontal record, (3) subgroup analysis splitting studies in those performed with Asiatic populations and with non-Asiatic populations and sensitivity analysis. The heterogeneity was reduced significantly when subgroup analysis was done, for Asiatic population an OR of 2,06 (95% IC 1,60-2,85) and i2= 83,1% and for non-Asiatic population an OR of 1,12 (95% IC 1,04- 1,68) and i2=65,3% were found. CONCLUSION This study showed a significant association between metabolic syndrome and periodontitis. The lack of longitudinal studies in this area prevent from setting the direction of this association. Due to the high heterogeneity found, interventional and well controlled studies are encouraged to elucidate the magnitude of this association.