Introdução: O consumo de manteigas e margarinas faz parte do hábito alimentar da população e é uma forma eficaz de suplementação de ácidos graxos. No entanto, até o momento se desconhece os efeitos de ácidos graxos saturados, trans, monoinsaturados, poliinsaturados e de fitosteróis no perfil lipídico, inflamatório, de marcadores de disfunção endotelial e no metabolismo da HDL em indivíduos com síndrome metabólica (SM). Objetivo: Examinar os efeitos do consumo diário de manteiga, margarina com ácido graxo trans, margarina com fitosterol e margarina sem ácido graxo trans, em quantidades recomendadas por diretrizes, sobre: 1) o perfil lipídico, apolipoproteínas (Apo), marcadores inflamatórios e de disfunção endotelial e transferência de lipídeos para HDL, em indivíduos com SM, sem alterar seus hábitos usuais de vida, 2) a associação desses parâmetros com a composição nutricional das dietas dos indivíduos estudados. Métodos: Este estudo foi randomizado, cego, onde 100 indivíduos receberam porções diárias isocalóricas de manteiga ou margarina com ácido graxo trans ou margarina com fitosterol ou margarina sem ácido graxo trans em adição às suas dietas usuais, por 5 semanas. Foram determinados: perfil lipídico, Apos, marcadores inflamatórios e de disfunção endotelial, LDL pequenas e densas e transferências de lipídeos para a HDL. Diferenças entre os grupos foram avaliados por ANOVA. Resultados: A amostra final foi composta por 66 indivíduos (63,6% mulheres, idade média 47,6 anos). Houve redução de -10,3% na Apo B (p=0,043) e de -15,2% na razão Apo B/Apo A-I (p=0,034) após consumo de margarina com fitosterol. Não foram verificadas diferenças significativas nos lípides após consumo de manteiga, margarina com trans ou margarina sem trans. Transferências de fosfolípides foram reduzidas no grupo margarina com fitosterol (-4,7% vs. margarina com trans p=0,037); no grupo margarina sem trans foram reduzidas as transferências de: colesterol éster (-27% vs. manteiga e margarina com trans p=0,002), triglicérides (-43,3% vs. outros grupos p<0,001) e colesterol livre (-16,4%, vs. margarina com trans e margarina com fitosterol p=0,006). Não foram verificadas alterações significantes nos marcadores inflamatórios e de disfunção endotelial entre os grupos. Associações foram observadas entre os marcadores inflamatórios e de disfunção endotelial e consumo de lipídeos totais, ácidos graxos saturados, mono e poliinsaturados, colesterol, além de consumo energético e de carboidratos. As transferências de lipídeos para HDL associaram-se inversamente com o consumo de fibra alimentar. Conclusão: Nossos resultados indicam que o consumo de manteiga, margarina com ácido graxo trans e margarina sem ácido graxo trans, nas quantidades estudadas, por indivíduos com síndrome metabólica que não alteraram seus hábitos usuais de vida, não modificam o perfil lipídico ou marcadores inflamatórios e de disfunção endotelial. O consumo de margarina com fitosterol e margarina sem trans nas quantidades recomendadas reduziram respectivamente a concentração de Apo B e a habilidade da HDL de receber lípides. Os marcadores inflamatórios e de disfunção endotelial associaram-se com o consumo de gorduras e carboidratos, sugerindo que dietas ricas em gorduras e calorias podem modular a resposta inflamatória em indivíduos com SM. / Introduction: The consumption of butter and margarines are part of population dietary habits and is an effective form of fatty acid supplementation. However, the effects of saturated, trans, monounsaturated and polyunsaturated fatty acids and of plant sterol supplementation in the lipid profile, inflammation and endothelial dysfunction markers, and in the metabolism of HDL in individuals with the metabolic syndrome (MS) are unknown. Objective: Examine the effects of daily servings of butter, trans fat margarine, no trans fat margarine, and plant sterol margarine, within guideline recommended amounts, on: 1) plasma lipids, apolipoproteins (Apo), biomarkers of inflammation and endothelial dysfunction and on the lipid transfer of radioactive lipids to HDL particles in free-living subjects with the MS, 2) to analyze the association of these parameters with the nutritional composition of the individuals\' diets. Methods: This was a randomized, single-blind study where 100 MS subjects received isocaloric servings of butter, trans fat margarine, no-trans fat margarine or plant sterol margarine in addition to their usual diets for 5 weeks. The main outcome measures were plasma lipids, Apo, inflammatory and endothelial dysfunction markers, small dense LDL cholesterol concentration and in vitro radioactive lipid transfer from cholesterol-rich emulsions to HDL. Difference among groups was evaluated by ANOVA. Results: Sixty-six subjects completed the study (63.6% women, mean age 47.6 years). There was a significant reduction in Apo B (-10.3 %, p=0.043) and in the Apo B/A-1 ratio (-15.2%, p=0.034) with plant sterol margarine. No changes in plasma lipids were noticed with butter, trans fat margarine and no-trans fat margarine. Transfer rates of lipids to HDL were reduced in the plant sterol margarine group: phospholipids -4.7% (p=0.037 vs. trans fat margarine) and in the no-trans fat margarine group: triglycerides -43.3%, (P<0.001 vs. other groups), cholesterol ester -27% (p=0.002 vs. butter and trans fat margarine) and free cholesterol -16.4% (p=0.006 vs. trans fat and plant sterol margarine). No significant effects were noted on inflammatory and endothelial dysfunction markers concentrations among the groups. An association was observed among the inflammatory markers and of endothelial dysfunction and the consumption of total lipids, saturated, monounsaturated and polyunsaturated fatty acids, cholesterol, energy consumption and carbohydrates. The transfer rates of lipids to HDL were inversely associated with the consumption of dietary fiber. Conclusions: In free living subjects with the MS the consumption of butter, trans fat margarine and no-trans fat margarine, within recommended amounts did not modify the lipid profile or markers of inflammation and endothelial dysfunction. The consumption of plant sterol and no-trans fat margarines reduced respectively Apo B concentrations and the ability of HDL to accept lipids. The inflammatory and endothelial dysfunction markers were positively associated with the consumption of fats and carbohydrates suggesting that diets rich in fats and calories can modulate inflammation in subjects with the MS.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-05T11:27:00Z No. of bitstreams: 1 alinespagnolfedoce.pdf: 675452 bytes, checksum: 4344f40e93111c7814a7762ac2f2a71a (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-05T11:33:55Z (GMT) No. of bitstreams: 1 alinespagnolfedoce.pdf: 675452 bytes, checksum: 4344f40e93111c7814a7762ac2f2a71a (MD5) / Made available in DSpace on 2016-10-05T11:33:55Z (GMT). No. of bitstreams: 1 alinespagnolfedoce.pdf: 675452 bytes, checksum: 4344f40e93111c7814a7762ac2f2a71a (MD5) Previous issue date: 2010-07-29 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A síndrome metabólica (SM) é caracterizada por um grupo de distúrbios que predispõe a doenças cardiovasculares e ao diabetes mellitus tipo 2 (DM2). Obesidade abdominal, resistência à insulina, hipertensão, dislipidemia e um estado pró-inflamatório crônico são os principais componentes desta síndrome. Uma correlação bidirecional entre a SM e a periodontite tem sido sugerida, a partir do estado pró-inflamatório crônico. O objetivo deste estudo foi avaliar a influência da hiperglicemia no desenvolvimento da periodontite crônica e nos níveis séricos de interleucina-10, em indivíduos portadores de SM. Foram avaliados 30 indivíduos distribuídos em três grupos: NSM (não portadores de SM; n= 10); SMNG (portadores de SM normoglicêmicos; n= 10) e SMHG (portadores de SM hiperglicêmicos; n=10). A condição periodontal (profundidade de bolsa (PB), perda de inserção clínica (PIC), índice de placa (IP), sangramento a sondagem (SS) e número de dentes perdidos) e a condição metabólica (exames antropométricos e laboratoriais: glicemia em jejum (GJ), teste oral de intolerância a glicose (TOTG), colesterol HDL e triglicérides (TG)) foram avaliados em cada indivíduo. Os resultados demonstram que os indivíduos do grupo SMHG apresentam porcentagem de sítios com PIC ≥ 3 mm, PIC ≥ 5 mm; PB ≥ 3 mm, IP, SS e número de dentes ausentes mais elevados em relação aos indivíduos do grupo SMNG, esta diferença, porém, não foi estatisticamente significativa. No grupo SMHG, os indivíduos portadores de DM (n= 5) apresentaram porcentagem de sítios com PIC ≥ 5 mm estaticamente superior aos indivíduos pré diabéticos (p= 0,016). A porcentagem de sítios com PIC ≥ 5 mm foi correlacionada positivamente com os níveis de glicemia em jejum. Os indivíduos portadores de SM apresentaram níveis séricos de interleucina-10 mais elevados e diferiram estatisticamente dos indivíduos não portadores de SM (p= 0,003). O presente estudo sugere que a hiperglicemia influencia a gravidade da periodontite crônica e que os níveis aumentados de interleucina-10 estão relacionados com a SM, independente da condição glicêmica. / The metabolic syndrome (MS) is caracterized by a group of disorders that predisposes to cardiovascular diseases and to type 2 diabetes mellitus (T2DM). Abdominal obesity, insulin resistance, hypertension, dyslipidemia and a chronic proinflammatory state are the main components of this syndrome. A bidirectional correlation between MS and periodontitis has been suggested, from the chronic proinflammatory state. The aim of this study was to evaluate the influence of hyperglycemia on the development of chronic periodontitis and serum levels of interleukin-10 in individuals with MS. 30 individuals divided into three groups: NSM (non-MS patients, n = 10); SMNG (normoglycemic patients with MS, n = 10) and SMHG (hyperglycemic patients with MS, n = 10). The periodontal status (pocket depth (PD), clinical attachment loss (CAL), plaque index (PI), bleeding on probing (BOP) and number of missing teeth) and metabolic status (anthropometric and laboratory tests: fasting glucose (FG), oral test of impaired glucose tolerance (OGTT), HDL cholesterol and triglycerides (TG)) were evaluated in each individual. The results show that SMHG group subjects present higher percentage of sites with CAL ≥ 3 mm, CAL ≥ 5 mm, PD ≥ 3 mm, IP, SS and missing teeth than subjetcs in SMNG group, this difference however, was not statistically significant. In group SMHG, subjects with T2DM (n = 5) showed greater percentage of sites with CAL ≥ 5 mm than pre-diabetic subjects (p = 0.016). The percentage of sites with CAL ≥ 5 mm was positively correlated with levels of fasting blood glucose. Individuals with MS showed serum levels of interleukin-10 increased and differed significantly from the NMS group (p = 0.003). The present study suggests that hyperglycemia influences the severity of chronic periodontitis and that increased levels of interleukin-10 are related to the SM, independently on the glycemic status.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-29T13:45:50Z No. of bitstreams: 1 reginacoelimachado.pdf: 584182 bytes, checksum: 3aff2dbd317552baf0742fe28f1db537 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-30T11:21:05Z (GMT) No. of bitstreams: 1 reginacoelimachado.pdf: 584182 bytes, checksum: 3aff2dbd317552baf0742fe28f1db537 (MD5) / Made available in DSpace on 2017-03-30T11:21:05Z (GMT). No. of bitstreams: 1 reginacoelimachado.pdf: 584182 bytes, checksum: 3aff2dbd317552baf0742fe28f1db537 (MD5) Previous issue date: 2009-11-11 / Avalia risco cardiovascular na síndrome metabólica. Não existe consenso sobre o escore mais apropriado para detecção do RCV nesta população. O objetivo é avaliar o risco de doença arterial coronariana (DAC) em indivíduos não diabéticos portadores de SM, com base em três diferentes escores. Foram avaliados trinta e nove indivíduos portadores de SM, por meio do Escore de Risco de Framingham (ERF), pelo ERF modificado pela IV Diretriz Brasileira sobre Dislipidemias e Aterosclerose (ERF-mod) e pelo Prospective Cardiovascular Münster Study (PROCAM). Todos os indivíduos foram submetidos a avaliação clínica, eletrocardiograma de repouso, ecocardiograma, monitorização ambulatorial da pressão arterial, índice tibial-braquial (ITB) além de dosagens de glicose, creatinina, colesterol total, colesterol HDL, triglicérides e microalbuminúria. O LDL colesterol foi estimado pela fórmula de Friedwald. A média de idade foi de 4421,0 anos, com predomínio de mulheres (31/39). Seis (15,4%) indivíduos eram tabagistas e 21 (53,8%) eram hipertensos. O perfil lipídico mostrou níveis baixos de colesterol HDL em 35 (89,7%) dos casos e níveis elevados de triglicérides, colesterol total e colesterol LDL em 28 (71,8%), 19 (48,7%) e 15 (38,5%) dos casos, respectivamente. Microalbuminúria foi diagnosticada em 23 (59%) dos indivíduos, hipertrofia do ventrículo esquerdo (HVE) em três (7,7%) e doença vascular periférica em cinco (12,8%) pacientes. O risco estimado de DAC pelo ERF foi baixo (<10%) em 35 (89,7%) indivíduos e médio (10 a 20%) em quatro (10,3%), não sendo detectado alto risco em nenhum caso. Por outro lado, quando foram considerados fatores agravantes sugeridos pela IV Diretriz Brasileira sobre Dislipidemias e Aterosclerose, o ERF-mod detectou cinco casos (12,8%) de baixo risco, 30 (76,9%) casos de médio risco e quatro (10,3%) de alto risco. Quando se aplicou o PROCAM, 29 (74,4%) indivíduos continuaram na faixa de baixo risco (<10%), sete (17,9%) apresentaram médio risco (10-20%) e três (7,7%), alto risco para doença coronariana em 10 anos. A utilização do ERF parece subestimar o RCV em portadores de SM não diabéticos. Por outro lado, a utilização do ERF-mod ou, alternativamente, do PROCAM parecem mais adequados para a estimativa do RCV nessa população. / It evaluates cardiovascular risk (CVR) in metabolic syndrome. There is no agreement about the best score to estimate the CVR in this population. The objective is to assess the coronary heart disease (CHD) risk in non-diabetic patients with MS using three different scores. Thirty nine subjects with MS were evaluated by the Framingham Risk Score (FRS), FRS modified by IV Diretriz Brasileira sobre Dislipidemias e Aterosclerose (mod-FRS) and by Prospective Cardiovascular Münster Study (PROCAM). All the subjects were submitted to clinical evaluation, electrocardiogram, echocardiogram, ambulatorial blood pressure monitorization, ankle brachial index (ABI) and dosages of glucose, creatinine, total cholesterol, HDLcholesterol, triglycerides and microalbuminúria. LDL-cholesterol was estimated by Friedwald’s formula. Mean age was 4421.0 years and most of individuals were female (31/39). Six subjects (15,4%) were smokers and 21 (53,8%) were hypertensive. Low HDL-cholesterol was detected in 35 (89,7%) individuals and high triglycerides, total cholesterol and LDL-cholesterol levels were observed in 28 (71,8%), 19 (48,7%) e 15 (38,5%) individuals, respectively. Microalbuminuria was diagnosed in 23 (59%) subjects, left ventricular hypertrophy in three (7,7%) and peripheral vascular disease in five (12,8%). Based in the FRS the CHD risk in 10 years was considered low in 35 (89,7%) individuals and intermediate in four (10,3%), with no patient in high risk group. On the other hand, the mod-FRS detected five (12,8%) subjects in low risk, 30 (76,9%) in the intermediate and four (10,3%) individuals in the high risk group. According to PROCAM 29 (74,4%) individuals were in low risk, seven (17,9%) in the intermediate and three (7,7%) in high risk group. In non-diabetic subjects with MS the FRS underestimates the CHD risk, whereas the mod-FRS and alternatively, the PROCAM seem to be more accurate in estimating this risk.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-05-18T13:01:03Z No. of bitstreams: 1 marcellamartinsterra.pdf: 995593 bytes, checksum: 171ab025377f3f8cb2ff4470dae8f83b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-05-18T13:40:01Z (GMT) No. of bitstreams: 1 marcellamartinsterra.pdf: 995593 bytes, checksum: 171ab025377f3f8cb2ff4470dae8f83b (MD5) / Made available in DSpace on 2017-05-18T13:40:01Z (GMT). No. of bitstreams: 1 marcellamartinsterra.pdf: 995593 bytes, checksum: 171ab025377f3f8cb2ff4470dae8f83b (MD5) Previous issue date: 2013-08-05 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / A Síndrome Metabólica (SM) caracteriza-se por acúmulo central de gordura, hipertensão arterial e hipertrigliceridemia. Estudos epidemiológicos e clínicos têm confirmado que a SM está relacionada ao aumento da morbidade e mortalidade em virtude de sua associação ao processo inflamatório e a patologias como a doença cardiovascular, diabete mellitus, dislipidemias, doença renal crônica e esteatose hepática. Pela diversidade de fatores causadores ou contribuintes da SM o tratamento farmacológico ideal não está bem definido. A quercetina por apresentar ação antioxidante, antiinflamatória e vasodilatadora, poderia ser uma alternativa no tratamento das comorbidades que compõem a SM. O presente trabalho objetivou avaliar o efeito da quercetina no fígado e rim de ratos Wistar com SM induzida por dieta hiperlipídica. Ratos Wistar machos foram distribuídos, em três grupos (n=10) que receberam respectivamente: C-dieta padrão; SM-ração hiperlipídica e SMQ-ração hiperlipídica + 10mg/kg/ dia de solução de quercetina, via oral, a partir dos dois meses de idade. Receberam água e ração ad libitum. Avaliaram-se, semanalmente, peso corporal e pressão arterial da cauda. Ao final do experimento, aos seis meses, foram realizados teste oral de tolerância a glicose. Os animais foram anestesiados (xilazina: 10mg/kg e quetamina: 90mg/kg, i.p.) para medida direta da PA. Em seguida, foram exsanguinados e eutanasiados por deslocamento cervical, removeram-se e pesaram-se os rins, fígado, gordura retroperitoneal e epididimária esquerda. Foi feita dosagem sérica de Glicose, Triglicérides, Colesterol, AST, ALT e γ-GT ; Creatinina urinaria, Clearence e morfometria da área e volume glomerular por Hematoxilina-Cromotrope. A presença de fibrose renal foi avaliada pela coloração picrosirius sob luz polarizada. Por análises imuno-histoquímica quantificaram-se as células dos tecidos renais que expressavam marcadores de fator pró-fibrótico (TGF-β1) e miofibroblastos (α-SMA). Os procedimentos foram aprovados pelo CEUA-UFJF (Protocolo nº010/2011). A dieta hiperlipídica promoveu a SM, caracterizada por acúmulo central de gordura, hipertensão arterial, hiperglicemia e hipertrigliceridemia. Houve aumento nos níveis de AST, bem como na expressão de TGF-β1 e porcentagem de fibrose por picrosirius. A administração crônica diária da quercetina em modelo experimental de SM induzida por dieta hiperlipídica não reduziu a pressão arterial, não alterou o perfil nutricional, metabólico e histomorfológico renal dos animais, apesar de atenuar a expressão dos marcadores de fibrose. / Metabolic syndrome (MS) is characterized by increased visceral fat, hypertriglyceridemia and hypertension. Epidemiological and clinical studies have confirmed that MS is associated with increased morbidity and mortality due to its association with inflammation and diseases such as cardiovascular disease , diabetes mellitus, dyslipidemia, chronic kidney disease and hepatic steatosis. Based on the diversity of factors causing or contributing to MS the ideal pharmacological treatment is not well defined. Due to quercetin antioxidant, anti-inflammatory and vasodilatory properties, it could be an alternative for treatment of MS comorbidities. This study aimed to evaluate the effect of quercetin in the liver and kidney of rats with MS dietinduced. Male Wistar rats were divided into three groups (n = 10): C-standard diet; MShigh-fat diet and MSQ-high-fat diet + 10mg/kg / day of quercetin solution orally administered in two months old rats. Water and food was received ad libitum. Body weight and tail blood pressure was assessed weekly. At the end of the experiment, at six months, tests were performed to evaluate oral glucose tolerance. The animals were anesthetized (xylazine: ketamine and 10mg/kg: 90mg/kg, ip) for direct measurement of blood pressure. Then, they were exsanguinated and euthanized by cervical dislocation, kidney, liver, epididymal and retroperitoneal fat left were removed and weighed. Serum glucose, triglycerides, cholesterol , AST, ALT and γ-GT; urinary creatinine was measured; Clearance and morphometry of the area and volume glomerular hematoxylin- Cromotrope stain. The presence of renal fibrosis was evaluated by picrosirius stain under polarized light. For immunohistochemical analyzes were quantified the expression of pro-fibrotic factor (TGF-β1) and myofibroblasts (α-SMA) makers in kidney tissue cells. The procedures were approved by CEUA-UFJF (Protocol No.010/2011). We observed that high fat diet promoted MS, characterized by central fat accumulation, hypertension, hyperglycemia and hypertriglyceridemia. In addition an increase in the levels of AST as well as the expression of TGF-β1 and percentage of fibrosis by picrosirius was observed. Chronic daily administration of quercetin in an experimental model of SM induced by high fat diet did not reduce blood pressure, did not affect the nutritional and metabolic and histomorphological profile of the animals, despite of attenuate the expression of markers of fibrosis.

Orientador: Elinton Adami Chaim / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T03:30:35Z (GMT). No. of bitstreams: 1 Cazzo_Everton_M.pdf: 2625294 bytes, checksum: 2f57e795cce0f0c4c5a74d56bad92609 (MD5) Previous issue date: 2013 / Resumo: A Síndrome Metabólica é um conjunto de fatores interconectados que elevam diretamente o risco de doenças cardiovasculares e diabetes mellitus tipo II. Estes fatores são alterações no metabolismo glicídico, elevação da pressão arterial, níveis elevados de triglicerídeos e reduzidos de lipoproteína de alta densidade, associados à obesidade, especialmente sua forma central ou abdominal. Apresenta prevalência crescente nas últimas décadas, levando a importantes consequências socioeconômicas. Sua fisiopatologia é complexa e ainda não foi totalmente esclarecida, porém sabe-se que possui como elemento principal a resistência insulínica. Em decorrência, observa-se a ocorrência de hiperinsulinemia, disfunção endotelial e inflamação. Seu tratamento clínico consiste em mudanças de estilo de vida associadas à terapia farmacológica concomitante de seus fatores individuais. Com a realização cada vez mais frequente de procedimentos cirúrgicos bariátricos, tem-se observado relevantes resultados advindos de tais operações no controle da síndrome. O objetivo deste estudo é avaliar o impacto do bypass gastrojejunal em Y de Roux sobre a síndrome metabólica, seus componentes individuais e as alterações bioquímicas observadas após a cirurgia. Foi realizada uma coorte histórica envolvendo 96 indivíduos com obesidade grau II/III previamente portadores de síndrome metabólica que foram submetidos à cirurgia há pelo menos 12 meses, avaliando os parâmetros clínicos e bioquímicos dos mesmos antes e após a cirurgia. Observaram-se índices relevantes de resolução pós-operatória da síndrome metabólica (88,5%), diabetes mellitus tipo II (90,6%), hipertensão arterial (85,6%) e dislipidemias (54,2%). A resolução da síndrome metabólica esteve estatisticamente associada aos seguintes fatores: controle glicêmico pós-operatório; glicemia, trigliceridemia e hemoglobinemia glicada pós-operatórias; homeostasis model assessment (HOMA) pós-operatório; número de classes anti-hipertensivas pré e pós-operatórias; percentual de perda de peso. O número de medicações anti-hipertensivas reduziu-se inclusive em indivíduos que não obtiveram resolução completa da hipertensão. Houve redução significativa nos níveis séricos de glicose, insulina, hemoglobina glicada, colesterol total, triglicerídeos e lipoproteína de baixa densidade, e elevação da lipoproteína de alta densidade. Observou-se decréscimo importante da resistência insulínica avaliada através do HOMA. Os índices de resolução de síndrome metabólica e comorbidades relacionadas encontradas neste estudo foram consistentes com achados prévios na literatura. A melhora no perfil glicêmico, insulínico e lipídico foi comparável à descrita em outros estudos, assim como a significativa redução da resistência insulínica avaliada pelo HOMA. Dentro do grupo analisado, o bypass gastrojejunal em Y de Roux apresentou resultados benéficos significativos, constituindo, portanto, uma importante ferramenta no tratamento da síndrome metabólica, propiciando elevados índices de resolução da mesma e de seus componentes individuais, bem como melhora geral do perfil bioquímico relativo à patologia / Abstract: Metabolic syndrome is defined as a set of interconnected factors that increase risk for cardiovascular disease and type II diabetes. These factors are changes on glycemic metabolism, high blood pressure, high serum triglyceride levels and low high density lipoprotein serum levels, associated with obesity, specially the central or abdominal type. Its prevalence has raised on later decades leading to important socioeconomical consequences. It has a complex pathophysiology that has not been completely understood yet but it is known that its main element is insulin resistance. As consequence it is observed hyperinsulinemia, endothelial disfunction and inflammation. Clinical management is based on lifestyle changes associated to drug treatment of its individual components. As surgical treatment of obesity has become more frequent lately it has been seen great results on metabolic syndrome control after bariatric procedures. This study aims to determine the impact of Roux-en-Y gastric bypass on metabolic syndrome and its individual components as well as biochemical changes upon glycemic metabolism observed after surgery. A historic cohort was carried out evaluating 96 subjects with grade II/III obesity previously diagnosed with metabolic syndrome who underwent surgery and whose postoperative follow-up was at least 12 months. Clinical and biochemical parameters were analyzed before and after surgery. This study has shown high resolution rates of metabolic syndrome (88,5%), diabetes (90,6%), hypertension (85,6%) and dyslipidemias (54,2%). Metabolic syndrome resolution was statistically linked to these factors: postoperative glycemic control; postoperative glycemia, hemoglobin A1c and triglyceridemia; postoperative homoestasis model assessment (HOMA); pre and postoperative number of anti-hypertensive classes; percent weight loss. Number of anti-hypertensive classes decreased even in subjects who do not achieve complete hypertension resolution. There was significant decrease on serum levels of glucose, insulin, hemoglobin A1c, total cholesterol, triglycerides and low density lipoprotein, and increase on high density lipoprotein. It was observed relevant decrease on insulin resistance assessed through HOMA. Resolution rates for metabolic syndrome and related comorbidities found on this study were comparable to previous findings on medical literature. Improvement on glycemic, insulinic and lipid profiles was also similar to previous findings, as well as significant decrease on insulin resistance as evaluated through HOMA. Within this group of subjects Roux-en-Y gastric bypass has led to significant positive results proving to be an important therapeutical tool on metabolic syndrome management since it can bring high resolution rates of the syndrome and its individual components as well as general improvement on the biochemical profile related to this pathology / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Orientador: Marcos Antonio Tambascia / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T11:51:28Z (GMT). No. of bitstreams: 1 Comucci_EleonoraBeltrame_M.pdf: 3925973 bytes, checksum: d7cf8e386ee2039949574917c2eba506 (MD5) Previous issue date: 2012 / Resumo: Objetivos: avaliar os níveis séricos de RBP4 em pacientes obesas diabéticas em comparação a pacientes não diabéticas na pré-menopausa. Avaliar a correlação da concentração sérica de RBP4 com marcadores bem estabelecidos de RI e SM. Comparar entre os grupos a porcentagem de gordura corporal (%GC) e espessura da camada íntima-média carotídea (EIMC), verificando a influência do DM2 nos grupos. Métodos: foram avaliadas mulheres (n = 139) divididas em três grupos: Grupo 1 (Controles; n = 45); Grupo 2 (Obesas; n = 53); Grupo 3 (Obesas DM2; n = 41), denominados G1, G2 e G3. Foram avaliados parâmetros bioquímicos, antropométricos e de composição corporal. Resultados: houve diferença estatística significante entre os grupos nos parâmetros relativos à caracterização da amostra quanto aos perfis esperados da síndrome metabólica, DM2 e obesidade. Porém, os níveis de RBP4 não se comportaram como esperado se comparado aos primeiros estudos à respeito da proteína carreadora do retinol. Conclusões: A RPB4 não se mostrou um bom marcador de RI e risco cardiovascular, pois entre os grupos sua distribuição não foi uniforme. De acordo com a análise dos dados obtivemos em G1 correlações positivas da RBP4 com IMC (p<0,05), hemoglobina glicada (p<0,05), insulinemia de jejum (p<0,05); em G2 com hemoglobina glicada (p<0,01); G3 com hemoglobina glicada (p<0,05), glicemia de jejum (p<0,01), HOMA-IR (p<0,01) / Abstract: Objectives: to evaluate the levels of serum RBP4 in premenopausal obese diabetic patients compared with nondiabetic patients. To evaluate the correlation between serum RBP4 with well-established markers of IR and MS. Compare between groups the percentage of body fat (% BF) and thickness of carotid intima-media (CIMT), checking the influence of T2DM into groups. Methods: We evaluated 139 women which were divided into 3 groups: Group 1 (Control, n = 45), Group 2 (obese, n = 53) and group 3 (obese T2DM, n = 41), known as G1, G2 and G3. We assessed biochemical, anthropometric and body composition parameters. Results: There was no statistically significant difference between groups in the parameters for sample characterization regarding the expected profiles of metabolic syndrome, type 2 diabetes and obesity. However, RBP4 levels did not behave as expected when compared to the first studies about the retinol-binding protein. Conclusions: The RPB4 is not a good marker of IR and cardiovascular risk, because distribution between the groups was not uniform. According to data analysis, we obtained in G1 positive correlations of RBP4 with BMI (p <0.05), and glycated hemoglobin (p <0.05), fasting insulin (p <0.05); in G2 with glycated hemoglobin (p <0.01); G3 with glycated hemoglobin (p <0.05), fasting glucose (p <0.01), HOMA-IR (p <0.01) / Mestrado / Clinica Medica / Mestre em Clinica Medica

Made available in DSpace on 2014-08-20T13:49:09Z (GMT). No. of bitstreams: 1 Angeliza Xavier Kalinoski.pdf: 1868537 bytes, checksum: 383eee560adb06fc34ad7f46661b2b1f (MD5) Previous issue date: 2013-02-21 / The Down Syndrome (DS) is a genetic accident classified as intellectual deficit. Some people with DS have associated diseases, which together with a non-active lifestyle, leaves them susceptible to develop a number of chronic non-communicable diseases. Some of these diseases are risk factors for Metabolic Syndrome, such as glucose intolerance, insulin resistance or diabetes mellitus, including two or more factors such as hypertension, elevated plasma triglyceride, HDL and central obesity. It is necessary to increase physical activity for this population. The aim of this study was to investigate the effects of a physical activity program with exergaming (Xbox 360 ® kinectTM), during 16 weeks, on the variables of the Metabolic Syndrome. Physical fitness related to performance tests were conducted and the sessions intensity was controlled usingGT3X accelerometers. It is an experimental study and the population consisted of people with Down syndrome, both sexes over 18 years, residents of the city of Pelotas - RS. We identified 44 individuals, 28 have accepted to participate in the study meeting the inclusion criteria. The sample consisted of 28 subjects, divided into two groups (G1 - intervention (N = 14) and G2 - control (N = 14)), randomly selected and matched by sex. The intervention lasted 16 weeks with 3 sessions per week for 50 minutes. Were applied before and after the intervention a life style questionnaire, physical fitness performance tests, verified hemodynamic variables and conducted biochemical analyzes of both groups. For statistical analysis we used the statistical package SPSS 20.0 for Windows. Regarding Metabolic Syndrome variables systolic blood pressure was the only factor that presented significant difference p <0.01 compared to groups in the post test. In motor performance tests the experimental group presented statistically significant difference in strength tests of upper limb, lower limb strength and agility test showing a p <0.01 when compared between groups, upper limbs strength test was statistically significant. Regarding intensities during the session the overall average was 17.3 minutes in light activity, 22.2 minutes in moderate activity and 10.5 minutes in vigorous activities. Therefore we see a need for accessible programs, health promotion strategies and interventions to increase physical activity levels of people with disabilities. An alternative is to use exergaming that besides being motivational activities are activities with intensities that can change significantly variables related to health. / A Síndrome de Down (SD) constitui-se como acidente genético estando classificada no déficit intelectual. Parte das pessoas com SD possui doenças associadas que, juntamente com um estilo de vida não ativo, as deixa suscetíveis a desenvolver uma série de doenças crônicas não-transmissíveis. Algumas dessas doenças são fatores de risco para a Síndrome Metabólica, como a intolerância à glicose, resistência à insulina ou diabetes mellitus, incluindo dois fatores ou mais como a hipertensão, triglicéride plasmático elevado, HDL e obesidade central. Dessa forma, torna-se necessário incrementar a prática de atividade física para essa população. O objetivo do estudo experimental foi verificar o efeito de um programa de atividade física com exergaming (Xbox 360® kinectTM) durante 16 semanas, sobre as variáveis da Síndrome Metabólica. Foram realizados testes físicos relacionados ao desempenho motor e controlada a intensidade das sessões utilizando os acelerômetros GT3X. Para sua realização, a população estudada foi constituída de pessoas com Síndrome de Down de ambos os sexos maiores de 18 anos, residentes da cidade de Pelotas - RS. Foram identificados 44 indivíduos, 28 se propuseram a participar da pesquisa atendendo os critérios de inclusão. A amostra formada por 28 indivíduos, divididos em dois grupos (G1 - intervenção (N=14) e G2 - controle (N=14)), selecionados aleatoriamente pareados por sexo. A intervenção teve duração de 16 semanas com 3 sessões semanais de 50 minutos. Foram aplicados antes e depois da intervenção um questionário de hábitos de vida, testes de desempenho motor, verificadas as variáveis hemodinâmica e realizadas análises bioquímicas de ambos os grupos. Para as análises estatísticas, foi utilizado o pacote estatístico SPSS 20.0 for Windows. Em relação às variáveis de Síndrome Metabólica, a pressão arterial sistólica foi o único fator que obteve diferença significativa p < 0,01 comparando os grupos no pós-testes. Em relação aos testes de desempenho motor constatou que o grupo experimental obteve diferença estatisticamente significativa nos testes de força de membros superiores, força de membros inferiores e teste de agilidade apresentando um p < 0,01; quando comparado entre grupos, o teste de força de membros superiores apresentou resultados estatisticamente significatico. Em relação às intensidades durante a sessão observou-se que a média geral em minutos foi 17,3 minutos em atividades leves, 22,2 minutos em atividades moderadas e 10,5 minutos em atividades vigorosas. Com isso, vemos uma necessidade de programas acessíveis, estratégias de promoção da saúde e intervenções destinadas a aumentar os níveis de atividade física das pessoas com deficiência. Uma alternativa é a utilização de exergaming que além de serem atividades motivacionais, são atividades com intensidades que podem mudar significativamente em variáveis relacionadas à saúde.

Abstract It has been proposed that in addition to oral glucose tolerance test, detected by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), glycosylated hemoglobin (HbA1c 5.7–6.4%) can be used for screening individuals at high risk of developing type 2 diabetes and CVD. The aim of the present study was to assess whether the use of ADA 2010 prediabetes definition, especially the use of HbA1c 5.7–6.4% may detect different individuals with prediabetes as compared to the use of IFG or IGT, and whether the traditional CVD-risk factors differed between these definitions. Furthermore, the aim was to study if the inflammatory mediators associated with cardiovascular disease are increased in prediabetes and to assess the power of HbA1c 5.7–6.4%, 2-h glucose, and fasting glucose predicting type 2 diabetes and CVD. The present study consisted of the Oulu 35 population. This prospective population-based study was conducted in 1990–2008 to assess the prevalence of type 2 diabetes and glucose abnormalities. All inhabitants of the City of Oulu, Finland, born in 1935 and living in Oulu on 1st October 1990 (n=1,008), were invited to participate 1990–1992 (831 enrolled). At the baseline of the present study 1996–1998, 815 were invited and 593 (73%) of them enrolled. Prediabetes was classified as IFG (fasting blood glucose, FBG 5.6–6.0 mmol/L), IGT (2-hour BG &#8805;7.8 and &#60;11.1 mmol/L) and/or HbA1c 5.7–6.4%. Inflammation was measured with IL-1Ra, IL-8 and RANTES. Prevalence of isolated prediabetes in this population was common with limited overlap between the three different definitions. Differences in CVD risk factors were observed between the three hyperglycemia groups. Isolated HbA1c was associated with overweight and more adverse lipid profile. Low-grade inflammation (measured by IL-1Ra, IL-8 and RANTES) was associated with prediabetes with levels comparable to those with diabetes. The association was independent of visceral adiposity. Finally, HbA1c and 2-h glucose, but not fasting glucose, predicted CVD in 10 years follow-up in women, but not in men. In conclusion, this study demonstrates that HbA1c 5.7–6.4% detects partly different individuals with prediabetes as compared to IFG and IGT. Using only fasting glucose and HbA1c for screening, many subjects at high risk for diabetes and CVD would be missed. However, HbA1c 5.7-6.4% diagnose individuals with high traditional cardiovascular risk factors. Prediabetes is associated with inflammation measured with IL-1Ra, IL-8 and RANTES. Finally, 2-h glucose value is important in screening subjects in high risk for diabetes and CVD. / Tiivistelmä Vuonna 2010 Amerikan diabetesyhdistys (ADA) esitti sokerihemoglobiinin HbA1c 5.7-6.4&#160;% -arvoa diabeteksen esiasteeksi kohonneen paastosokerin (IFG) ja heikentyneen sokerinsiedon (IGT) lisäksi. Tämän tutkimuksen tarkoituksena oli selvittää, miten ADA 2010 -määritelmä diabeteksen esiasteista löytää riskihenkilöitä ja mitkä ovat perinteiset sydän- ja verisuonisairauksien riskitekijät eri ryhmillä (IFG, IGT ja HbA1c 5.7–6.4%). Tulehdusmarkkereita ja näiden eroja määritettiin verrattuna diabeetikoihin ja terveisiin henkilöihin. Lisäksi selvitettiin, kuinka nämä eri diabeteksen esiasteet ennustavat sydän- ja verisuonisairauksien syntyä. Tutkimusaineistona oli Oulu 35 aineisto, jota on tutkittu v. 1990–2008 tyypin 2 diabeteksen ja sokerihäiriöiden esiintyvyyden selvittämiseksi. Ensimmäinen seurantatutkimus tässä ikäkohortissa, joka on nykyisen tutkimuksen alkuvaihe, tehtiin 1996–1998. Osallistujia oli tällöin 593. Seuraava seurantatutkimus tehtiin 2007–2008. Diabeteksen esiasteeksi määritettiin IFG (kohonnut paastoverensokeri, FBG 5.6–6.0 mmol/L), IGT (2-tunnin verensokeri BG &#8805;7.8 ja &#60;11.1 mmol/L) ja HbA1c 5.7–6.4%. Diabeteksen esiasteiden esiintyvyys tässä aineistossa oli huomattava ja määritelmät löysivät vain vähän samoja ihmisiä. Perinteisissä sydän- ja verisuonisairauksien riskitekijöissä oli selkeitä eroja: henkilöt, joilla oli HbA1c 5.7–6.4%, olivat selkeästi enemmän ylipainoisia ja vyötärölihavia, sekä heillä oli huonommat rasva-arvot (HDL ja triglyseridit). HbA1c ja IGT ennustivat sydän- ja verisuonitautien ilmaantumista naisilla, mutta eivät miehillä. Kaikki nämä määritelmät ennustivat diabeteksen syntyä, mutta ei-diabeetikoilla vain 2 tunnin sokeri ennusti sydän- ja verisuonitautia. Sen sijaan matala-asteinen tulehdusreaktio mitattuna IL-1Ra, IL-8 and RANTES- tulehdusmarkkereilla liittyi jo diabeteksen esiasteeseen (ADA 2010) yhtä paljon kuin diabeetikoilla, eikä tämä selittynyt vyötärölihavuudella. Tutkimus osoitti, että diabeteksen eri esiasteet diagnosoivat eri ihmisiä. Jos 2- tunnin sokerirasitusta ei käytettäisi, jäisi runsaasti todellisessa sydän- ja verisuonisairauksien riskissä olevia henkilöitä löytymättä. Toisaalta sokerihemoglobiini HbA1c 5.7–6.4% löytää eri ihmisiä, joilla perinteiset riskitekijät sydän- verisuonisairauksille ovat yleisemmät, joten senkin käyttö voi diabeteksen seulonnassa olla parempi kuin paastosokerin, joka löysi selkeästi huonommin riskihenkilöitä. Sokerirasituskoe on edelleen tärkeä riskihenkilöiden seulonnassa.

Abstract About 11% of infants are born preterm (before 37 weeks of gestation) worldwide. Adults born preterm with very low birth weight show enhancement of cardiometabolic risk factors such as elevated blood pressure and impaired glucose regulation compared with their peers born at term. Not all the cardiometabolic risk factors related to preterm birth are known, or whether they apply to those born less preterm, although about 80% of premature infants are born late preterm. The association between preterm birth and cardiometabolic risk factors in adolescence and adulthood was investigated in three cohort studies: The Helsinki Study of Very Low Birth Weight Adults, the Northern Finland Birth Cohort 1986, and the ESTER study. Preterm birth over its whole range has a long-term impact on a child’s health in later life: adults born preterm with very low birth weight had lower resting energy expenditure, but higher resting energy expenditure per unit lean body mass than their peers born at term. Adolescent girls born before 34 weeks of gestation had higher blood pressure and boys have elevated levels of LDL cholesterol and apolipoprotein B. Adults born preterm were more likely to be obese and to have hypertension or metabolic syndrome than their peers born at term. In addition to conventional biomarkers of cardiometabolic disorders, they had alterations in other cardiometabolic biomarkers, such as uric acid and liver transaminases. Adolescents and adults born preterm are at greater risk of developing cardiometabolic disorders than their peers born at term. Most of the cardiometabolic risk factors related to preterm birth are modifiable. Favorable early life circumstances of premature infants, such as optimal nutrition and reduction of stress in neonatal intensive care units, might reduce the risk of later cardiometabolic disorders. In addition, children and adults born preterm might particularly benefit from primary prevention such as screening for additional risk factors and promotion of healthy lifestyles. / Tiivistelmä Noin joka yhdeksäs lapsi maailmassa syntyy ennenaikaisesti, ennen 37. raskausviikkoa. Keskosena syntyneillä aikuisilla on todettu enemmän joitakin sydän- ja verisuonisairauksien riskitekijöitä kuin heidän täysaikaisena syntyneillä ikätovereillaan. Näistä eniten on tutkittu etenkin kohonneen verenpaineen ja heikentyneen sokerin siedon esiintyvyyttä, mutta kaikkia myöhempien sairauksien riskitekijöitä ei tunneta. Suurin osa aiemmista keskostutkimuksista on tehty hyvin tai erittäin ennenaikaisesti syntyneillä, vaikka yli 80% keskosista syntyy lievästi ennenaikaisena. Ei ole juurikaan tutkimuksia siitä, ovatko sydän- ja verisuonitautien riskitekijät lisääntyneet myös tässä suuressa lievemmin ennenaikaisesti syntyneiden joukossa. Eriasteisen ennenaikaisen syntymän vaikutuksia nuoruus- ja aikuisiän sydän- ja verisuonitautien riskitekijöihin tutkittiin kolmessa kohorttitutkimuksessa: Helsingin Pikku-K -tutkimuksessa, Pohjois-Suomen syntymäkohortti 1986 -tutkimuksessa sekä ESTER-tutkimuksessa. Ennenaikaisella syntymällä sinänsä on pitkäaikaiset vaikutuksen syntyneen lapsen terveyteen myös nuoruudessa ja aikuisuudessa: Hyvin pienipainoisena ennenaikaisesti syntyneillä on korkeampi lepoenergian kulutus rasvatonta painoyksikköä kohden kuin täysiaikaisena syntyneillä ikätovereilla. Hyvin ennenaikaisena (ennen 34. raskausviikkoa) syntyneillä tytöillä on 16-vuotiaina korkeampi verenpaine, ja pojilla suuremmat LDL-kolesterolin ja apolipoproteiini B:n pitoisuudet. Keskosena syntyneet puolestaan täyttivät aikuisina todennäköisemmin lihavuuden, verenpainetaudin ja metabolisen oireyhtymän kriteerit. Perinteisten sydän- ja verisuonitautien riskitekijöiden lisäksi heillä oli muutoksia myös monissa muissa sydän- ja verisuonitautien merkkiaineissa, kuten uraatin ja maksa-arvojen pitoisuuksissa. Ennenaikaisesti syntyneillä nuorilla ja aikuisilla on suurentunut riski sairastua sydän- ja verisuonitauteihin myöhemmällä iällä. Näitä riskejä on mahdollista ennaltaehkäistä, minkä vuoksi ennenaikaisesti syntyneet nuoret ja aikuiset voivat hyötyä terveellisistä elämäntavoista erityisen paljon.

Abstract Abdominal obesity in adults is associated with insulin resistance. The purpose of the present study was to examine insulin resistance-associated abnormalities during military service as well as the effect of smoking on these abnormalities. In 1995 we invited all the 1268 servicemen attending military service in the Ostrobothnian Brigade and in 1997 all the 106 servicemen in the First Signal Company for measurements at the beginning of their service. Metabolic syndrome was defined: hyperinsulinemia (fasting insulin ≥ 13.0  mU/l) and dyslipidemia (triglycerides ≥ 1.7 mmol/l and/or total cholesterol/HDL cholesterol > 5) at the same time. Metabolic syndrome was present in 10% of the servicemen who had a body mass index > 27 kg/m2. Metabolic syndrome was present in 1% of all servicemen. None of the servicemen of normal weight had metabolic syndrome. Smoking increased the prevalence of metabolic syndrome sixfold. The mean weight of servicemen in the Ostrobothnian Brigade increased by 4,6 kg during the service. In the First Signal Company, weight did not change during the service. Total cholesterol, HDL and LDL cholesterol increased in both groups. Two out of three servicemen had increased their exercise activity and their consumption of doughnuts/confectionary during the service. Consumption frequence of doughnuts increased by 166%. Apparently, the changes in the diet had a major effect on lipids, and the beneficial effect of increased exercise could not compensate for it. Smokers had lower levels of adiponectin than non-smokers at the beginning of the service. During the service, the levels of adiponectin decreased. The decrease of adiponectin was related to a decrease in QUICKI but not to smoking. Thus, the decreased adioponectin level was due to a decrease of insulin sensitivity caused by diet. Overweighted servicemen should decrease their weight. I suggest that preventive health education should be pointed to overweighted servicemen. The aim should be to decrease obesity and to abandon smoking. By these means we could reduce or prevent arteriosclerosis and diabetes in the future. This is a common challenge for primary health care in Finland and the Finnish military forces. / Tiivistelmä Aikuisten keskivartalolihavuuteen liittyy insuliiniresistenssiä ja metabolista oireyhtymää, jotka ennakoivat tulevaa diabetestä ja valtimonkovetustautia. Nuorten ylipainoisuus on huomattavasti yleistymässä. Useat nuoret tupakoivat. Tässä väitöskirjatyössä tutkittiin insuliiniresistenssiin liittyviä kardiovaskulaarisia riskitekijöitä varusmiespalvelun aikana ja tupakoinnin yhteyttä näihin riskitekijöihin. Tutkimusaineiston muodostivat kaikki 1 268 Pohjan Prikaatissa vuonna 1995 ja kaikki 106 1. Viestikomppaniassa tammikuussa 1997 palvelunsa aloittanutta varusmiestä. Metabolinen oireyhtymä (MBO) määriteltiin siten, että varusmiehellä oli yhtä aikaa hyperinsulinemia (paastoinsuliini ≥ 13,0 mU/l) ja dyslipidemia (triglyseridipitoisuus ≥ 1,7 mmol/l ja/tai kokonaiskolesteroli/HDL-kolesteroli > 5). Näin määritelty MBO löytyi 10 %:lta niistä varusmiehistä, joiden painoindeksi oli yli 27 kg/m2. MBO esiintyi 1 %:lla kaikista varusmiehistä. Kenelläkään normaalipainoisella ei havaittu metabolista oireyhtymää. Painoindeksi yli 27 kg/m2 esiintyi 11 %:lla varusmiehistä. Tupakointi lisäsi MBO:n esiintymisriskiä kuusinkertaisesti. Pohjan Prikaatin varusmiesten paino lisääntyi 4,6 kg, mutta 1. Viestikomppanian varusmiesten paino ei muuttunut varusmiespalvelun aikana. Kuitenkin kokonaiskolesterolin, HDL- ja LDL-kolesterolin pitoisuudet lisääntyivät molemmilla. Ravinto- ja liikuntakyselytutkimus osoitti, että kahdella kolmesta varusmiehestä liikunnan määrä ja munkkien/kahvileipien käyttö lisääntyi varusmiespalvelun aikana. Munkkien käyttökerrat lisääntyivät 166 %. Ilmeisesti ruokavalion muutoksen aiheuttama "rasvarasitus" ja sen haitallinen vaikutus lipideihin oli niin merkittävä, että se mitätöi lisääntyneen liikunnan tuoman hyödyn. Tupakoivien adiponektiinipitoisuudet olivat varusmiespalvelun alussa matalampia kuin tupakoimattomien. Adiponektiinipitoisuudet vähenivät varusmiespalvelun aikana tupakoivilla ja tupakoimattomilla. QUICKI-indeksin pieneneminen oli itsenäinen selittäjä adiponektiinipitoisuuden muutokselle. Siten adiponektiinipitoisuuden vähenemisen syy oli ruokavalion aiheuttama insuliiniherkkyyden heikkeneminen varusmiespalvelun aikana ja se ei riippunut tupakoinnista. Ylipainoiset kutsuntaikäiset nuoret miehet ja varusmiehet tulisi saada laihtumaan. Suosittelen juuri heille suunnattua täsmäehkäisyä, joka tähtää painonpudotukseen ja tupakoimattomuuteen, sillä ylipainolla ja tupakoinnilla on selvä haitallinen vaikutus insuliiniresistenssiin liittyviin kardiovaskulaarisiin riskitekijöihin jo nuoruusvuosien aikana. Puuttumalla ajoissa vaaratekijöihin valtimonkovetustaudin ja diabeteksen kehittymistä voidaan hidastaa tai estää. Tämä on yhteinen haaste suomalaiselle perusterveydenhuollolle ja puolustusvoimille.