Background The optimal exercise load/intensity for exercise programs for individuals with metabolic syndrome (MetS) has not been investigated. One method of determining optimal exercise load is to measure the blood lactate transition threshold (BLTT), referred to as the anaerobic threshold (AT). The first part of this thesis (study 1) investigated the reproducibility of BLTT testing and the consequent determination of AT via the Mader method (Mader et al. 1986) and a modified form of the ADAPT method (Cheng et al. 1992) in patients with MetS. Furthermore, a comparison of the reproducibility of the AT determination using the Mader et al. (1986) method as opposed to the ADAPT method has not been investigated in MetS patients. The effect of specific exercise protocols on the different components of MetS has also not been investigated. Therefore, the second study in the thesis compared the effects on the components of the MetS of an exercise program that uses BLTT (specifically, the AT) to those of a comparable exercise program (not using AT) taken from the literature. The main aim of the study was to design an exercise program that optimized exercise responses and may thus improve metabolic characteristics in individuals with MetS. The third part of the thesis (study 3) focused on the relationship between cardiorespiratory fitness and the components of the metabolic syndrome. This study developed multiple regression models to find the principal variables that associated with peak vi oxygen consumption (VO2 peak) and AT in persons with MetS. Regression models were also developed to investigate whether these variables were associated with the individual metabolic and cardiovascular components of the metabolic syndrome. Methods In study 1, fifteen male patients diagnosed with MetS (age: 43.5 ± 7.52 years) and fifteen healthy, male participants (age: 44.1 ± 6.08 years) each performed a peak oxygen consumption and BLTT test simultaneously using an incremental protocol to exhaustion on a treadmill, at the same daily times, on three different days. Study 2 used three subject groups. One group consisted of ten participants (male, age: 48.3 ± 7.32 years) with MetS that exercised using the walking program of Leon et al. (1979) (MetSL). A second group consisted of ten participants (male, age: 40.8 ± 8.21 years) with MetS that exercised using velocity at AT to set training intensities (MetSV). A third group consisted of ten participants (male, age: 40.2 ± 7.90 years) without MetS that exercised using velocity at AT to set training intensities (Non-MetSV). Training durations and frequency varied from 20 – 90 minutes and 3 -5 days per week respectively. Height, body mass, waist circumference, blood pressure, fasting plasma triglyceride, total cholesterol, HDL-, LDL- cholesterol, insulin levels, VO2 peak and BLTT were measured in all groups before, during and after twenty weeks of exercise. In addition, oral glucose tolerance tests (OGTT) were administered to all participants. 0 min, 30 min and 2 hours plasma glucose and insulin levels were measured during the OGTT. HOMA-IR and insulinogenic indices were also calculated. Nutritional data were recorded at week 0, 8 and 20 of training. vii In study 3, thirty-one males diagnosed with MetS and twenty-four healthy male participants each performed a VO2 peak and a BLTT test. Height, mass, waist circumference, blood pressure, fasting plasma triglyceride, total cholesterol, HDLcholesterol and insulin levels were also measured. In addition, oral glucose tolerance tests (OGTT) were administered to all participants and HOMA indices were calculated. Results There was no significant difference in treadmill velocity at AT determined by the Mader method or the Modified ADAPT method within both groups of study 1 (p > 0.05). The mean treadmill velocity at AT was higher in the healthy compared to the MetS group using both the Mader and the ADAPT method. Regression analysis and ANCOVA in study 1 demonstrated that this difference was largely due to a higher VO2 peak in the healthy group. The study also found an association between VO2 peak and waist circumference. The coefficient of variation of repeat measurements for both the Mader method and the Adapt method was less than 4% indicating good reproducibility. This was confirmed by the typical error method of Hopkins (2000). Study 2 showed that body mass, BMI and waist circumference decreased significantly in all training groups with the training program using AT and the program not using AT showing similar outcomes in these variables among persons with MetS. Velocity at AT also improved in all training groups. While VO2 peak increased (p < 0.05) in both the MetS groups, it did not change significantly in the group without MetS. Similarly, the blood pressure response was favourable in the groups with MetS yet absent in the group viii without MetS. The training group with MetS that used AT was the only group to show significant, positive changes in any of the metabolic parameters (fasting insulin and HOMA). This group also showed the greatest change in the incidence of MetS. In study 3, presence of MetS, waist circumference and AT were found to associate with VO2 peak and VO2 peak was strongly correlated with AT. Age and body mass were found to correlate with fasting glucose, whilst only age correlated with HDL-cholesterol. Age and VO2 peak both correlated with systolic blood pressure but only VO2 peak had a significant association with diastolic blood pressure. Conclusions Study 1 demonstrated that BLTT tests are reproducible in persons with MetS. Study 2 demonstrated that an endurance exercise program using AT to set intensity is effective in eliciting favourable responses in individuals diagnosed with MetS. In addition, the training program using AT elicited the responses with a reduced exercise frequency and intensity. It also improved insulin sensitivity which was not affected by the walking program. The response to the exercise program that used AT was similar in persons with MetS and in persons without MetS, except in the central cardio-vascular adaptations of VO2 peak and in the metabolic parameters of fasting insulin and the HOMA index. Study 3 found that the lower VO2 peak of participants with MetS is associated with their higher waist circumference. The VO2 peak, in turn, was shown to correlate with anaerobic threshold. Therefore, reducing waist circumference in persons with MetS needs to be a focus of intervention programs for such a group. This study also found that both diastolic and systolic blood pressures were associated with cardio-respiratory fitness (VO2 peak). ix This further supports the benefit of increasing cardio-respiratory fitness in persons with MetS. The results of these studies showed that BLTT tests are simple, low-cost, reproducible ways of setting exercise intensity for persons with MetS that can be incorporated in the routine cardio-respiratory fitness assessment of an individual. Furthermore, the determination of AT from such tests can be used to design an individualized exercise program that can “reverse” the effects of MetS.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Nos Ãltimos anos, a sÃndrome metabÃlica tem despertado profundo interesse e debate na comunidade cientÃfica. A ascensÃo epidemiolÃgica deste distÃrbio ocorre nas mais diversas populaÃÃes e faixas etÃrias, somada à sua capacidade de agregar vÃrios fatores de risco para doenÃas cardiovasculares, como aumento das medidas antropomÃtricas, dislipidemias aterogÃnicas, hipertensÃo arterial sistÃmica, alteraÃÃes do metabolismo dos carboidratos, estado prÃ-inflamatÃrio e prÃ-trombÃtico. Mencionada sÃndrome està associada ao maior risco de desenvolver diabetes mellitus tipo 2, doenÃa coronariana precoce e altas taxas de morbimortalidade para complicaÃÃes cardiovasculares. Teve-se como objetivo geral analisar a circunferÃncia do pescoÃo como possÃvel marcador para a sÃndrome metabÃlica em estudantes de uma universidade pÃblica de Fortaleza-CE. Trata-se de um estudo exploratÃrio, quantitativo, transversal e observacional realizado de marÃo de 2010 a junho de 2011 na Universidade Federal do CearÃ, com 702 universitÃrios das seis grandes Ãreas do conhecimento. Participaram do estudo 440 mulheres e 262 homens com idade entre 16 e 58 anos. Percebeu-se associaÃÃo entre a CP e os dados sociodemogrÃficos; 43,9 % dos homens e 7,1% das mulheres apresentaram CP elevada, sendo estatisticamente significante, p < 0,0001 em ambos os sexos. SituaÃÃo semelhante se deu com a idade (p< 0,001), com a situaÃÃo laboral (p<0,031) e com o semestre (p < 0,012). Em relaÃÃo à prÃtica de atividade fÃsica, 22,4% dos sujeitos que praticam algum tipo de atividade fÃsica regular tiveram a CP elevada (p < 0,503). O IMC tambÃm se mostrou estatisticamente significante com p<0,0001. A CP denotou correlaÃÃo positiva com todos os componentes da sÃndrome metabÃlica segundo os critÃrios do NCEP/ATP III. Conforme se concluiu, a CP à um marcador preditor para sÃndrome metabÃlica numa populaÃÃo de universitÃrios. Contudo, ressalta-se a importÃncia de outros estudos sobre essa temÃtica. / In recent years, the metabolic syndrome has aroused profound interest and debate in the scientific community. The epidemiological ascent of this disorder occurs in a wide range of populations and age groups, in addition to its capacity to aggregate various risk factors for cardiovascular illnesses, such as increased anthropometric measures, atherogenic dyslipidemias, systemic arterial hypertension, alterations in carbohydrate metabolism, pro-inflammatory and pro-thrombotic status. This syndrome is associated with a greater risk of developing type 2 diabetes mellitus, early coronary disease and high morbidity and mortality levels for cardiovascular complications. The general aim was analyze neck circumference as a possible marker for the metabolic syndrome in students at a public university in Fortaleza-CE. An exploratory, quantitative, cross-sectional and observational study was developed between March 2010 and June 2011 at University Federal of CearÃ, involving 702 college students from the six large knowledge areas. Study participants were 440 women and 262 men between 16 and 58 years of age. An association was perceived between neck circumference (NC) and sociodemographic data: 43.9% of men and 7.1% of women showed altered NC, with statistical significance at p < 0.0001. A similar situation occurred for age (p< 0.001), occupational situation (p<0.031) and the semester (p < 0.012). Concerning physical exercise, 22.4% of the subjects who exercise regularly displayed altered NC (p < 0.503). The BMI also showed statistical significance with p<0.0001. NC indicated a positive correlation with all metabolic syndrome components according to NCEP/ATP III criteria. In conclusion, NC is a predictive marker of the metabolic syndrome in a population of college students. The importance of further research on this theme is highlighted though.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

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.

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.

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.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A qualidade do sono à um poderoso preditor de saÃde, pois està relacionado com o risco para problemas de saÃde crÃnicos, como diabetes mellitus, hipertensÃo, obesidade e a SM. Esta à uma agregaÃÃo de problemas cardiometabÃlicos que eleva substancialmente a morbi-mortalidade humana independente da causa. O grau da relaÃÃo entre SM e a quantidade/qualidade do sono jà està estabelecido em idosos, pessoas de meia idade, operÃrios e atà crianÃas, mas, em adultos jovens, aparentemente saudÃveis, ainda à desconhecido. Dessa forma, o objetivo geral desta pesquisa foi analisar a relaÃÃo entre SM e indicadores de saÃde com a qualidade do sono de universitÃrios de Fortaleza-CearÃ. Pesquisa observacional, quantitativa, com desenho transversal. Foram avaliados 701 universitÃrios de 24 cursos das seis Ãreas de conhecimento da UFC entre marÃo e junho de 2011 em duas etapas. Na primeira, os alunos preencheram um instrumento sobre indicadores sociodemogrÃficos, de saÃde e uma versÃo validada e adaptada, aos padrÃes brasileiros, do Pittsburgh Sleep Quality Index. Numa data posterior, com os alunos em jejum por doze horas, coletaram-se os seguintes dados bioquÃmicos: glicemia venosa de jejum, triglicerÃdeos, LDL-C, HDL-C e o cortisol. Nessa mesma ocasiÃo, foram mensurados pressÃo arterial, circunferÃncia abdominal, peso corporal e altura. Analisaram-se os componentes da SM consoante o critÃrio da NCEP-ATP III. Os dados sofreram tripla digitaÃÃo e foram analisados no software STATA versÃo 8.0. Parcela substancial dos universitÃrios eram maus dormidores (95,2%) enquanto uma minoria tinha SM (1,6%). Os alunos com menor duraÃÃo do sono foram os da Ãrea de agrÃrias (6,24h DP 1,23h) e tecnologia (6,29h DP 1,24) (p=0,04). Grande maioria dos alunos maus dormidores (39%) tinha uma renda supeior a seis salÃrios mÃnimos (p=0,03). Os universitÃrios que moravam sozinhos (IC-95%- 1,03-1,08) (p<0,001) ou com os pais, (p<0,020), com idade &#8805; 30 anos (IC95%-1,02-1,07) (p<0,001), com mÃdio risco para etilismo (IC95%-1,03-1,07) (p<0,001) e os fumantes diÃrios (IC95%-1,02-1,06) (p<0,001) apresentavam uma chance superior a 1,05, 1,05,1,05, 104 e 1,05, respectivamente, de possuir mà qualidade do sono. Praticamente todos os alunos com cortisol elevado (96,1%) tinham sono com eficiÃncia de 65-74% (p=0,02). Hà um aumento de 5% na probabilidade de universitÃrios maus dormidores apresentarem SM (RP=1,05; IC 95%:1,03-1,07) (p=0,013). Estes alunos tambÃm possuem uma chance superior a 1,05 de apresentar glicemia elevada (RP=1,05; IC95%-1,03-1,07) (p<0,001). NÃo houve correlaÃÃo estatisticamente significante entre os componentes da SM isolados e o PSQI. Portanto, os universitÃrios maus dormidores possuem uma probabilidade maior de apresentar SM comparativamente aos bons dormidores. à importante que os profissionais de saÃde considerem a avaliaÃÃo da qualidade do sono desses jovens na prevenÃÃo e combate à SM, assim como na elaboraÃÃo de estratÃgias individualizadas para a promoÃÃo da saÃde deles. / The quality of sleep is a powerful predictor of health, because it is related with the risk for chronic health problems, such as diabetes, hypertension, obesity and metabolic syndrome. This is an aggregation of cardio-metabolic problems that substantially increases human morbidity and mortality from any cause. The level of relationship between MS and the quantity/quality of sleep is already established in the elderly, middle-aged people, workers and even children, but in young adults, apparently healthy, is still unknown. Thus, the objective of this research was to analyze the relationship between MS and health indicators with the quality of sleep university in Fortaleza-CearÃ. Observational quantitative research using cross-sectional design. We evaluated 701 college students from 24 courses in the six areas of knowledge of the UFC between March and June 2011 in two stages. In the first, students filled an instrument on socio-demographic and health indicators and a validated version adapted to Brazilian standards from the Pittsburgh Sleep Quality Index. In a posterior date with students fasted for twelve hours, we collected the following biochemical data: fasting venous plasma glucose, plasma triglycerides, LDL-C, HDL-C and cortisol. On the same occasion, we measured blood pressure, waist circumference, height and weight. We analyzed the components of MS based on the NCEP-ATP III. Data were triple typed and analyzed in STATA software version 8.0. A substantial amount of the college students were poor sleepers (95.2%) while a minority had MS (1.6%). Students with shorter sleep duration were in the area of land sciences (6.24h SD  1.23 h) and technology (6.29 h SD  1.24) (p=0.04). Most of the poor sleepers students (39%) had an income above six minimum wages (p=0.03). The students who lived alone (95% CI - 1.03-1.08) (p<0.001) or with parents (p<0.020), age &#8805; 30 years (95% CI - 1.02-1.07) (p<0.001), with average risk for alcoholism (95% CI - 1.03-1.07) (p<0.001) and daily smokers (95% CI - 1.02-1.06) (p<0.001) presented a chance of having poor sleep quality more than 1.05, 1.05, 1.05, 1.04 and 1.05, respectively. Virtually all students with elevated cortisol levels (96.1%) had sleep efficiency with 65-74% (p=0.02). There is a 5% increase in the probability of poor sleepers college students develop MS (PR = 1.05, 95% :1,03-1, 07) (p = 0.013). These students also have a chance greater than 1.05 to present high glucose (PR=1.05; 95% CI â 1.03-1.07) (p<0.001). There was no statistically significant correlation between the individual components of MS and the PSQI. Therefore, the college students poor sleepers have a higher relative risk of presenting SM compared to good sleepers. It is important that health professionals consider the assessment of sleep quality of these young people to prevent and combat MS, as well as in developing individualized strategies to promote their health.

Abstract The purpose of this study was to elucidate the background of valproate-related weight gain and hyperinsulinaemia both in men and women by studying markers of insulin resistance and metabolic syndrome. In addition, the role of leptin, a messenger between adipose tissue and the central nervous system was studied. Valproate has a broad spectrum of antiepileptic activity and is widely used for the treatment of epilepsy. It has been the drug of choice for generalised epilepsy, such as juvenile myoclonic epilepsy, and it is also effective for treatment of partial seizures. In addition, valproate is used to treat other diseases, such as bipolar psychiatric disorders and migraine. The results show that valproate-treated patients have higher serum insulin levels in relation to body mass index than control subjects. This indicates that the high serum insulin levels are not a consequence of increased body mass, especially, as the body mass index did not differ between the VPA treated patients and the control groups. Valproate therapy started at a young age may more often result in elevated serum insulin levels and associated other untoward metabolic changes. Furthermore, according to the present data, high serum insulin levels are a consequence of compromised metabolism of insulin in the liver, rather than reflecting reduced insulin sensitivity. However, the valproate-treated patients cluster risk factors for cardiovascular diseases, although the occurrence of metabolic syndrome is not more common in valproate-treated patients than in control subjects. Leptin does not play an independent role in valproate-related weight gain.