L’adaptation de l’organisme à son environnement est essentielle à sa survie. L’homéostasie énergétique permet l’équilibre entre les apports, les dépenses et le stockage d’énergie. Un surplus calorique important dérègle ce processus et mène au développement du syndrome métabolique caractérisé, entre autres, par une obésité, un diabète de type II, des maladies cardiovasculaires et des dyslipidémies. La ghréline participe au maintien de l’équilibre énergétique durant le jeûne en stimulant la production de glucose par le foie et le stockage lipidique dans le tissu adipeux. Le coactivateur transcriptionnel PGC-1alpha, surexprimé en situation de jeûne, est impliqué dans l’induction de la production de glucose par le foie et l’oxydation des acides gras. Notre hypothèse est que ces deux acteurs clés du métabolisme énergétique constituent un axe de régulation commun. Dans cette étude, nous montrons que la ghréline participe à la régulation de PGC-1alpha. Son récepteur GHS-R1a, possédant une forte activité constitutive, est également impliqué de façon indépendante au ligand. GHS-R1a réduit l’activité transcriptionnelle de PGC-1alpha tandis que l’ajout du ligand inverse modérément cette action. L’effet de GHS-R1a corrèle avec l’acétylation de PGC-1alpha qui est fortement augmentée de façon dose-dépendante. La stabilité de PGC-1alpha est également augmentée par le GHS-R1a indépendamment de l’ubiquitine. La ghréline diminue la capacité de PGC-1alpha à lier PPARbeta, un récepteur nucléaire partenaire de PGC-1alpha. De plus, la ghréline réduit, de façon ligand-dépendante, la capacité de coactivation de PGC-1alpha sur PPARbeta dans les hépatocytes. L’ensemble de ces résultats identifie PGC-1alpha comme cible du signal de la ghréline et suggère un axe de régulation ghréline/PGC-1alpha/PPARbeta.Une meilleure compréhension de cet axe de régulation va permettre la mise en évidence de nouvelles cibles thérapeutiques pour faire face aux pathologies associées au syndrome métabolique. / The adaptation of an organism to its environment is essential to its survival. Energy homeostasis is defined as the balance between intakes, expenses and storage of energy. An excess of calories disrupts this process and leads to the development of the metabolic syndrome that is characterized by obesity, type II diabetes, cardiovascular diseases and dyslipidemia. During fasting, ghrelin participates in the maintenance of energy balance by stimulating hepatic production of glucose and lipid storage in adipose tissue. The transcriptional coactivator PGC-1alpha is overexpressed in the liver during fasting and is involves in the induction of the hepatic glucose production and fatty acid oxidation. Our hypothesis is that these two key performers in the energy metabolism constitute a common axis control. In this study, we show that ghrelin plays a role in the regulation of PGC-1alpha. The ghrelin receptor GHS-R1a is also involved because of its strong constitutive activity in absence of ligand. We found that GHS-R1a inhibited PGC-1alpha transcriptional activity whereas adding ghrelin to cells moderated this effect. PGC-1alpha activation by GHS-R1a correlated with a dose-dependent increase of PGC-1alpha acetylation. The stability of PGC-1alpha was also increased by ghrelin receptor in a manner involving the ubiquitin-independent proteasome pathway. Ghrelin decreased the ability of PGC-1alpha to bind to PPARbeta, one of its nuclear receptor partners. Furthermore, ghrelin decreased the ability of PGC-1alpha to coactivate PPARbeta in a ligand-dependent manner in hepatocytes. Together, these results identify PGC-1alpha as a metabolic target of GHSR-1a signaling and defines a new regulatory axis involving ghrelin/PGC-1alpha/PPARbeta in hepatocytes. A better understanding of this regulation axis will provide novel aspects in therapeutic targeting of diseases associated with the metabolic syndrome.

Les abondances relatives naturelles des différents isotopes stables de l'azote (δ15N) varient selon les tissus au sein d'un individu et selon les individus au sein d'une population, et ces différences reflètent à la fois les caractéristiques de structure et de fonctionnement du métabolisme azoté et ses modulations en lien avec des variations des conditions nutritionnelles et physio-pathologiques. Cette thèse vise, à travers une approche couplée d'expérimentation et de modélisation, à mieux caractériser et comprendre les modulations des δ15N des différents pools azotés et à démontrer la capacité des δ15N à fournir des informations sur les flux azotés de l'organisme, leurs valeurs et modulations, qui sont encore mal connus. Nous avons, dans un premier temps, mesuré les δ15N dans plusieurs tissus (intestin, foie, plasma, muscles, rein, peau...) et dans différentes fractions azotées (acides aminés, protéines, urée, NH4) chez le rat, dans différentes conditions nutritionnelles (chez des rats nourris avec des P de qualité différente, les protéines de lait et de soja) ou physiopathologiques (chez des rats présentant ou non un syndrome métabolique, associant insulino-résistance et obésité, après avoir consommé un même régime potentiellement obésogène). Ces données expérimentales nous ont permis (i) de montrer que l'écart de δ15N entre les protéines tissulaires et le régime est plus important lorsque la qualité protéique est moindre, et (ii) de mettre en évidence que, lors de l'initiation précoce d'un syndrome métabolique associant insulino-résistance et obésité, les δ15N de certains pools métaboliques sont modulés et constituent des signatures isotopiques des modulations métaboliques associées. Par ailleurs, grâce à l'analyse par modélisation compartimentale des cinétiques de δ15N mesurées expérimentalement dans les fractions acides aminés et protéines de différents tissus après augmentation du δ15N du régime, nous avons pu estimer les taux de renouvellement protéique tissulaires et explorer la structure et le fonctionnement des échanges entre acides aminés et protéines des différents tissus et comparer leur degré de compartimentation. Enfin, nous avons développé un modèle multi-compartimental reproduisant l'ensemble des flux azotés inter- et intra-organes de l'organisme et rendant compte des variations de δ15N observées. Cette représentation globale du métabolisme azoté fournit une vision novatrice du fonctionnement intégré du métabolisme azoté dont les données éparses de la littérature ne donnaient auparavant qu'une vision parcellaire et fragmentée. Le modèle a permis de reconstituer les mécanismes qui conduisent à l'observation de différences de δ15N entre pools azotés, de mieux comprendre quelles modulations sont les plus susceptibles d'affecter les δ15N, avec quelle amplitude et dans quel sens, et finalement d'expliquer les variations de δ15N mises en évidence expérimentalement en terme de modulation des flux azotés. L'ensemble de nos résultats d'expérimentation et de modélisation démontre la capacité des δ15N à apporter des informations sur les flux métaboliques azotés et souligne l'intérêt prometteur de cette approche nouvelle pour acquérir une compréhension intégrée du système complexe du métabolisme azoté inter- et intra-organes et des processus homéostatiques qui le régulent et de ses dérégulations pré-pathologiques. / Natural abundances of stable nitrogen isotopes vary among tissues within an individual and among individuals within a population, and these differences are linked to the structural and functioning characteristics of the nitrogen metabolism and also to its modulations in response to variations in nutritional and physiological conditions. In this thesis, we developed an approach combining both experimentation and modeling, in order to better characterize and understand the modulations in the δ15N values of various nitrogen metabolic pools, and to show the capacity of the δ15N to provide information regarding the values and modulations of the body nitrogen fluxes, that are still poorly determined. We first measured the δ15N in various tissues (intestine, liver, plasma, muscle, kidney, skin …) and in various nitrogen fractions (amino acids, proteins, urea, NH4) in rats, under different nutritional (i.e. in rats fed with P of distinct quality, that were milk and soy P) or pathophysiological (i.e. in rats that had or not become obese and insulin resistant after being fed a high-fat diet for 10 weeks). From these experimental data, we showed (i) that the tissue nitrogen discrimination (i.e., the difference between tissue and diet δ15N) is higher when the P is of lesser quality, and (ii) that, during the onset of a metabolic syndrome, in the presence of both insulin resistance and obesity, the δ15N differed in some nitrogen pools and thus constitute isotopic signatures of the metabolic impact of such conditions. In this thesis, we also measured the δ15N kinetics in the amino acid and protein fractions of several tissues after a shift in the diet δ15N. The analysis of these kinetics, using a compartimental modeling approach, enabled us to estimate tissue fractional turnover rates and to investigate the structure and the functioning of the protein synthesis and breakdown exchanges in some tissues and their level of compartmentation. Lastly, we developed a multi-compartmental model that describes the various body nitrogen transfers between and within tissues and accounts for the observed δ15N variability. This model of the nitrogen metabolism provides a new and systemic insight of the interactions and modulations of the various nitrogen fluxes, as opposed to the fragmented information available from the literature data. This model enabled us to reconstruct the mechanisms that caused the observed δ15N differences between nitrogen pools, to better understand how they vary, depending on which metabolic modulation and with which amplitude, and finally to hypothesize which nitrogen fluxes alterations are the more likely to be responsible for the δ15N variations that we observed in our experimentations. In conclusion, our experimental and modelling results show that it is feasible to gain information from the δ15N values regarding the metabolic nitrogen fluxes and their modulations, and highlight the interest of this new approach to get an integrated insight into the complex nitrogen metabolic system and a better understanding of the way the various between and within tissues nitrogen fluxes are regulated and altered.

L’objectif de cette thèse est d’évaluer l’impact potentiel de l’activité physique de loisirs en milieu de travail sur la prévention du SM et sur la réduction des coûts médicaux que le système de santé destine au diabète de type 2 et à l’hypertension artérielle. Résultats : La prévalence du SM est de 24,4%. La proportion des individus qui ont un niveau d’activité physique de loisirs insuffisant est de 78,2%. Les hommes et les femmes qui effectuent ≥30 minutes d’activité physique de loisirs par jour montrent respectivement, 28% et 22% de moins de risque de présenter le SM. Par ailleurs, un investissement hypothétique de 25 852 dollars américains par an (≈ 18 096 euros) pour inciter 400 travailleurs d’une université publique à effectuer un niveau d’activité physique de loisirs recommandable pour la santé, pourrait nous apporter une réduction potentielle de 9% des cas de SM, 6,1% des cas de glucose altéré et 7,4% de cas de tension artérielle altérée ; ainsi que 138 880 dollars américains par an (≈ 97 216 euros) économisés sur le budget que la système de santé mexicain destine aux soins de santé du diabète et de l’hypertension artérielle. Ce qui génèrerait un ratio coût-bénéfice de 0,19 ; ce qui signifie, qu’un dollar investi dans l’organisation des activités physiques de loisirs, permettrait de réduire de 5,2 dollars les coûts médicaux liés au diabète et à l’hypertension artérielle. Conclusion : Nos résultats, nous apportent d’une part, plus d’éléments clefs pour fonder les décisions d’allocation des ressources dans le cadre de la prévention des maladies chroniques, et d’autre part, des éléments clefs pour la mise en œuvre de manière plus efficiente des programmes d’incitation à l’activité physique déjà existants au Mexique / Objective: This thesis assesses the potential impact of leisure-time physical activity on metabolic syndrome prevention and Mexican healthcare system expenditures on type 2 diabetes and hypertension treatment, in a sample of urban Mexican health workers. Results: The prevalence of MS was 24,4%. The proportion of participants who did not perform recommended levels of leisure time physical activity was 78,2%. MS risk was reduced at 28% in men and 22% in women who reported ≥30 minutes per day of physical activity during their leisure time. In addition, a hypothetical investment of $25 852 US dollars annually (≈ 18 096 euros) for engaging 400 workers in the recommended levels of physical activity at workplace, could decrease the prevalence of MS by 9%, cases of hyperglycemia by 6,1%, cases of hypertension by 7,4%, and reduce healthcare system expenditures for treatment of type 2 diabetes and hypertension by 138 880 of US dollars per year (≈ 97 216 euros). That would be a cost-benefit ratio of 0,19: one dollar invested might translate into a healthcare cost reduction of 5,2 dollars. Conclusion: Physical activity should be one of the most important strategies for chronic diseases prevention. Our findings may help to improve resource allocation decisions in the context of chronic disease prevention, as well to guide implementation of more efficient physical activity programs for Mexican workers

<p>S obzirom na visoku prevalencu metaboličkog sindroma (10-40% u svetskoj populaciji) i na činjenicu da prisustvo metaboličkog sindroma duplira rizik od nastanka aterosklerotske bolesti kardiovaskularnog sistema jasna je potreba za identifikacijom indivudualnih parametara koji doprinose njenom razvoju. Metabolički sindrom je klaster faktora rizika metaboličkog porekla koji je udružen sa povećanim rizikom za nastanak aterosklerotske bolesti kardiovaskularnog sistema i dijabetes melitusa tipa 2. Insulinska rezistencija, abdominalna gojaznost, aterogena dislipidemija, hipertenzija, proinflamatorno i protrombotično stanje su faktori koji su u osnovi metaboličkog sindroma a često su i praćeni nagomilavanjem masti u jetri. Cilj rada je bio da se utvrdi odnos između markera disfunkcije hepatocita (AST, ALT, GGT), serumskog nivoa inflamatornih biomarkera (broj leukocita, elektroforeza serumskih proteina, CRP, fibrinogen, TNF-&alpha;), biomarkera endotelne disfunkcije (ADMA i homocistein), kao i nivoa serumskih adipokina (leptin i adiponektin) i debljine intima-medija kompleksa (IMT) karotidne arterije kao pokazatelja prisustva aterosklerotskog procesa. Ispitivanje je dizajnirano kao studija preseka. U ispitivanje je uključeno 58 ispitanika oba pola sa karakteristikama metaboličkom sindroma (NCEP:ATP III kriterijumi). Odabir ispitanika je vr&scaron;en u Odeljenju za pravilnu ishranu i zdravstvenu bezbednost hrane, Instituta za javno zdravlje Vojvodine. Kontrolnu grupu su sačinjavale 30 klinički i biohemijski zdravih ispitanika nepu&scaron;ača koji su prema polnoj i dobnoj strukturi odgovarali ispitivanim grupama bolesnika. Iz ispitivanja su isključene osobe koje konzumiraju vi&scaron;e od 20g/dan alkohola, pu&scaron;ači, koji imaju dijagnostikovan virusni hepatitis B ili C ili pozitivan Hbs antigen, anti-Hbs antitela i anti-HCV antitela, osobe koje imaju verifikovana oboljenja kardiovaskularnog sistema, bubrega, CNS-a, infektivna, maligna i autoimuna oboljenja kao i druga oboljenja jetre i žučnih puteva, osobe koje su pod medikamentoznom terapijom koja može uticati na nivo serumskih biomarkera endotelne disfunckije, lipidni i lipoproteinski status, glikoregulaciju kao i menstruacioni ciklus. Sve laboratorijske analize su urađene u Centru za laboratorijsku medicinu, Kliničkog centra Vojvodine. Doppler ultrasonografski pregled karotidnih arterija i ultrazvuk abdomena i jetre je urađen u Centru za radiologiju Kliničkog centra Vojvodine. Signifikantna pozitivna korelacija niskog stepena je utvrđena između IMT zajedničke karotidne arterije i serumskih koncentracija GGT, hsCRP i leptina kao i odnosa neutrofili/limfociti. Prema prvom konstruisanom regresionom modelu u kojem je zavisna varijabla bila IMT preko 0,09 cm statistički značajan uticaj na predviđanje debljine IMT zajedničke karotidne arterije imaju hsCRP (Exp (B) 1,112 i glikemija (Exp (B) 1,973). Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju glikemija, AST i fibrinogen. Prema drugom konstruisanom regresionom modelu gde su zavisne varijable bile IMT zajedničke karotidne arterije preko 0,09 cm i prisutnost hepatične steatoze najveću mogućnost predviđanja imaju leptin Exp (B) 1,1022 i ALT Exp (B) 1,053. Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju ALT, ADMA i leptin.</p> / <p>Given the high prevalence of metabolic syndrome (10-40% in the world population) and the fact that the presence of metabolic syndrome doubles the risk of atherosclerotic disease of the cardiovascular system, there is a clear need to identify individual parameters that contribute to its development. Metabolic syndrome is a cluster of the risk factors of metabolic origin that is associated with an increased risk for the onset of atherosclerotic disease of the cardiovascular system and type 2 diabetes mellitus. Insulin resistance, abdominal obesity, atherogenic dyslipidemia, hypertension, proinflammatory and prothrombotic conditions are the factors at the base of the metabolic syndrome and are often accompanied by fat accumulation in the liver. The aim of this work was to determine the relation between markers of hepatic dysfunction (AST, ALT and GGT), serum levels of inflammatory biomarkers (white blood cell count, electrophoresis of serum proteins, CRP, fibrinogen, TNF-&alpha;), biomarkers of endothelial dysfunction (ADMA and homocysteine) as well as levels of serum adipokines (leptin and adiponectin) and intima-media thickness of carotid artery as indicators of atherosclerotic process in the patients with metabolic syndrome. Study was cross-sectional. It included 58 participants with metabolic syndrome (NCEP:ATP III criteria) as well as 30 clinically and biochemically healthy nonsmokers, age and gender matched controls. Participants were selected in the Department for Nutrition and Food Safety, Center of Hygiene and Human Ecology Institute of Public Health of Vojvodina. Patients that consumed alcohol more than 20g/day were excluded. Participants with positive HBsAg, anti-HBs-antibodies or anti- HCV antibodies were excluded also. Smokers were also excluded. Patients with cardiovascular diseases, renal diseases, infective, hepatic, malignant and autoimmune diseases were excluded from this study. Subjects which used drugs that could affect biomarker levels of endothelial dysfunction, lipid metabolism, glucose metabolism and menstrual cycle were also excluded. All laboratory analyzes were done in Centre for Laboratory Medicine, Clinical Centre of Vojvodina. Doppler ultrasonography of carotid arteries and ultrasound of abdomen and liver were done in Centre for Radiology, Clinical Centre of Vojvodina. Significant positive correlation of low degree was determined between IMT of common carotid artery and serum concentrations between GGT, hsCRP and leptin and relationship neutrophils/lymphocytes. According to the first constructed regression model where dependent variable was IMT of common carotid artery above 0.09 cm statistically significant influence on foreseeing IMT of common carotid artery have hsCRP (Exp (B) 1.112 and glycaemia (Exp (B) 1.973). According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have glycaemia, AST and fibrinogen. According to the second constructed regression model where dependent variable was IMT above 0.09 cm and present hepatic steatosis greatest probability for foreseeing IMT have leptin Exp (B) 1.1022 and ALT Exp (B) 1.053. According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have ALT, ADMA and leptin.</p>

Em estudo com pacientes portadores de síndrome metabólica atendidos em centro de saúde-escola, vinculado ao Sistema Único de Saúde (SUS), avaliou-se a adesão ao tratamento (medicamentoso e não medicamentoso) e a associação/correlação entre o acesso e uso de medicamentos e o nível de conhecimento dos fatores de risco cardiovascular e adesão. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Ciências Farmacêuticas - Universidade de São Paulo (USP) - em 30 de outubro de 2006 (Protocolo No 395) e compreendeu duas etapas: a primeira compreendeu o corte transversal para a avaliação da adesão ao tratamento medicamentoso e a associação/correlação entre as variáveis; a segunda, que compreendeu a coorte prospectiva com acompanhamento de 12 meses, com avaliações trimestrais, teve o objetivo de avaliar o nível de adesão ao tratamento medicamentoso e não medicamentoso. Utilizou-se a Medida de Adesão ao Tratamento (MAT), uma variação do Teste de Morisky-Green, para a avaliação do comportamento do paciente em relação ao uso de medicamentos. Para a avaliação do tratamento não-medicamentoso, utilizaram-se os seguintes parâmetros: redução de 10% do peso corporal total e realização de atividades físicas em sessões de no mínimo 30 minutos de duração e com a freqüência de pelo menos três vezes por semana. Identificou-se 243 pacientes, dos quais 75 (30,9%) foram incluídos no estudo. O índice médio de adesão ao tratamento medicamentoso foi de 5,44 pontos (desvio-padrão = 0,68), em uma escala de 1 a 6. Não houve nenhuma associação/correlação estatisticamente significante entre as variáveis analisadas e adesão ao tratamento medicamentoso. Entre os 75 pacientes incluídos, 59 (78,7%) apresentaram nível de conhecimento sobre os fatores de risco cardiovascular que variou de regular a bom. As questões relacionadas à dieta e dislipidemia apresentaram os menores níveis de acerto, 33% e 38%, respectivamente. Dos 75 pacientes, 45 (60%) compareceram para todas as avaliações trimestrais. Observou-se que houve alteração significativa da adesão média ao tratamento medicamentoso ao longo dos momentos avaliados. O momento inclusão diferiu significativamente dos momentos 6, 9 e 12 meses, apresentando escore de adesão significativamente menor (p < 0,05). Ao final dos 12 meses, 14 (31,1%) pacientes praticavam atividades físicas. Não houve alteração significativa com relação freqüência e duração das atividades (p=0,889 e p=0,419, respectivamente). Os pacientes portadores de síndrome metabólica que participaram deste estudo apresentaram índices elevados de adesão ao tratamento medicamentoso. No entanto, a avaliação dos parâmetros de adesão ao tratamento não medicamentoso foi indicativa de baixa adesão. / In a study including metabolic syndrome patients being treated in a Health-Medical School Center under the Public Brazilian Healthcare System (SUS), patient compliance with non-drug and drug treatment was evaluated as well as association/correlation between access to and use of medicines and the level of knowledge of cardiovascular risk factors. This study was approved by the Research Ethics Committee of the College of Pharmaceutical Sciences - University of São Paulo (USP) - on October 30th, 2006 (Protocol Number 395) and it was performed in two parts: the first one was a cross-sectional study with the objective of evaluating patient compliance with drug treatment and determining association/correlation between analyzed variables; the second one was a prospective study, with a 12-month follow-up and evaluations performed every three months, aimed at evaluating patient compliance with drug and non-drug treatment. The Measure Treatment Adherence (MTA), a variation of the Morisky-Green Test was used to assess patient behavior associated with the use of medicines. Parameters to evaluate compliance with a non-drug treatment were: to achieve a 10% weight reduction in total body weight and to perform a minimum of 30 minutes of activity at least three-times a week. Among 243 identified patients, 75 (30.9%) were included in this study. An average compliance score was 5.44 points (standard-deviation = 0.68), in a 1 to 6 scale. None of the analyzed variables showed association/correlation with compliance with drug treatment. Among the 75 evaluated patients, 59 (78.7%) showed a good or regular level of knowledge about cardiovascular risk factors. The questions related to diet and dyslipidemia showed the lowest proportion of patients who answered them correctly, 33% and 38%, respectively. Among the 75 patients included, 45 (60%) patients attended all scheduled evaluations. There were statistically significant differences between compliance score during a 12-month follow-up. Compliance score at inclusion moment was significantly lower than compliance score at 6, 9 and 12-month follow-up (p < 0.05). At the end of follow-up period, 14 (31.1%) patients practiced physical activities. There were no statistically significant differences with regard to frequency and duration of activities (p=0.889 and p=0.419, respectively). Patients involved in this research exhibited high level of compliance to drug treatment. Therefore the evaluation of parameters related to compliance with non-drug treatment indicated low patient compliance.

A doença hepática gordurosa não-alcoólica (DHGNA) e a esteatohepatite (EHNA) são freqüentes nos obesos. O objetivo foi determinar a prevalência de DHGNA/EHNA e Síndrome Metabólica (SM) nos grandes obesos; definir preditores de EHNA; estabelecer critérios histológicos para o diagnóstico da EHNA. Avaliados 325 pacientes encaminhados à cirurgia bariátrica (IMC = 35 kg/m2), dos quais 146 foram submetidos à análise histológica; as variáveis clínicas e bioquímicas analisadas e correlacionadas com a histologia. A DHGNA ocorreu em 111 (76%) pacientes e a prevalência de EHNA, conforme critério histológico usado, em 25,3% a 55,5%; SM ocorreu em 57,2%. Os preditores da EHNA foram: SM; alterações glicêmicas; hipertrigliceridemia e HAS. Foram preditores de fibrose: idade acima de 30 anos e AST elevada / Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) has been associated with obesity. Determine prevalence of NAFLD/NASH and metabolic syndrome (MS) in severe obesity; define clinical predictor of steatohepatitis; establish histological criteria necessary to diagnose NASH. Evaluation of 325 patients submitted to bariatric surgery (BMI = 35 kg/m2), among which 146 were submitted to histological analysis; variables clinical and biochemical were analyzed and correlated to histological characteristics. NAFLD occurred in 111 (76%) patients and NASH, according to histological criteria used, in 25.3% to 55.5%; MS was present in 57.2%. Predictors of NASH: MS; glycaemic alterations; hypertriglyceridaemia and high blood pressure (HBP). Predictors of fibrosis: age above 30 years and high AST

Introdução: A terapia antirretroviral (ART) mudou o curso da Aids, porém está associada a alterações metabólicas e aumento do risco de doenças cardiovasculares. Objetivo: Avaliar o efeito da suplementação com ácidos graxos ômega-3 de origem marinha no perfil lipídico, na homeostase da glicose, na distribuição de gordura corporal e nos marcadores inflamatórios de adultos com HIV em ART. Métodos: Artigo 1. Trata-se de uma revisão sistemática da literatura com metanálise. Realizou-se busca por ensaios clínicos na base de dados PubMed; 33 artigos foram localizados, seis cumpriram os critérios de inclusão e quatro apresentavam qualidade metodológica adequada. Foi realizada metanálise com efeitos fixos e descrição das diferenças de médias sumárias (DMS (IC95 por cento )). Artigos 2 e 3. Trata-se de um ensaio clínico aleatorizado e controlado. Foram recrutados 120 adultos com idade entre 19 e 64 anos, de ambos os sexos. Os indivíduos alocados no grupo intervenção foram suplementados por 24 semanas com 3g de óleo de peixe/dia (900mg de ácidos graxos ômega-3) e indivíduos alocados no grupo controle receberam placebo (óleo de soja). Resultados: Artigo 1. Após 8-16 semanas de intervenção com 900-3360mg de ácidos graxos ômega-3/dia, observou-se redução de -80,34mg/dL (IC 95 por cento : -129,08 a -31,60) nas concentrações de triglicérides. A análise agregada de estudos com média de concentração de triglicérides > 300mg/dL no baseline e intervenção com 1800-2900mg de ácidos graxos ômega-3/dia resultou em redução de -129,72mg/dL (IC95 por cento : -206,54 a -52,91). Artigos 2 e 3. Foram considerados nas análises dados de 83 sujeitos. Os modelos multinível não revelaram relação estatisticamente significante entre a suplementação com óleo de peixe e as mudanças longitudinais nas concentrações de triglicérides (p=0,335), LDL-C (p= 0,078), HDL-C (p=0,383), colesterol total (p=0,072), apo B (p=0,522), apo A1 (p=0,420), razão LDL-C/apo B (p=0,107), índice homa-2 IR (p=0,387), IMC (p=0,068), circunferência da cintura (p=0,128), relação cintura/quadril (p=0,359), PCR ultra sensível (p=0,918), fibrinogênio (p=0,148), e fator VIII (p=0,073). Conclusões: Artigo 1. Diferentes doses de ácidos graxos ômega-3 reduziram modo significativo as concentrações de triglicérides, confirmando a potencial aplicabilidade desse nutriente no tratamento da hipertrigliceridemia em pessoas que vivem com HIV em ART. Artigos 2 e 3. Uma dose relativamente baixa de óleo de peixe para pessoas que vivem com HIV em ART não alterou o perfil lipídico, a homeostase da glicose, a distribuição de gordura corporal e a concentração de marcadores inflamatórios. Recomenda-se, em estudos subseqüentes, a avaliação do efeito de doses mais elevadas, bem como a determinação de marcadores inflamatórios mais sensíveis / Background: Although the antiretroviral therapy (ART) revolutionized the care of HIV-infected subjects, it has been associated with metabolic abnormalities and increased risk of cardiovascular diseases. Aims: To review the effects of marine omega-3 fatty acids on lipid profile, insulin resistance and inflammatory markers in subjects living with HIV on ART. Methods: Paper 1. Thirty three articles were found in a PubMed search; six met the inclusion criteria; and four of them were considered of adequate quality and included. Meta-analysis with fixed effects was performed and weighted mean differences (WMD (95 per cent CI)) were described. Paper 2 and 3. The study was conducted in an HIV/Aids care centre affiliated to the Medical School, University of Sao Paulo. This was a randomized controlled trial that assessed the effects of 3g fish oil/day (900mg of omega-3 fatty acids) or 3g soy oil/day (placebo). A hundred and twenty subjects aged between 19 and 64 years were recruited. The statistical analyses were performed in Stata 9. Results: Paper 1. Data from 83 subjects were included in the analyses. The overall reduction on triglyceride concentrations after 8-16 weeks of treatment with 900-3360mg of omega-3/day was WMD=-80.34mg/dL (95 per cent CI: -129.08 to -31.60). The pooled result of studies with mean triglyceride > 300 mg/dL at baseline and 1800-2900mg omega-3/day was WMD=-129.72mg (95 per cent CI: -206.54 to -52.91). Paper 2 and 3. Multilevel analyses revealed no statistically significant relationships between fish oil supplementation and the longitudinal changes in triglyceride (p= 0.335), LDL-C (p= 0.078), HDL-C (p= 0.383), total cholesterol (p=0.072), apo B (p= 0.522), apo A1 (p=0.420), LDL-C/apo B ratio (p=0.107), homa-2 IR index (p=0.387), BMI (p=0.068), waist circumference (p=0.128), waist/hip ratio (p=0.359), hs-CRP (p=0.918), fibrinogen (p=0.148), and VIII factor (p=0.073). Conclusions: Paper 1. Different doses of omega-3 fatty acids reduced significantly triglyceride concentrations confirming the potential applicability of this nutrient on the management of hypertriglyceridemia in HIV-infected subjects on ART. Paper 2 and 3. A relatively low dose of fish oil for HIV subjects on ART did not change lipid profile, insulin resistance, body fat distribution, and inflammatory markers. Further investigations should considerer the assessment of higher doses and more sensitivity inflammatory markers

Introdução. A progressão da síndrome metabólica (SMet) para a doença cardiovascular é complexa, multifatorial e pode estar associada, em parte, com a hiperativação simpática e com a diminuição da sensibilidade barorreflexa (SBR), mecanismos fortemente associados à hipertensão arterial (HAS). Adicionalmente, na hipertensão a resposta da pressão arterial (PA) durante o teste de esforço cardiopulmonar máximo (TECP) e na pressão arterial de 24h (MAPA) está prejudicada. Não é conhecido se pacientes com SMet mas sem hipertensão, apresentam estes prejuízos. Hipóteses. Pacientes com SMet com nível normal de PA clínica apresentam:(1) Resposta aumentada da PA pico e da PA de recuperação em resposta ao exercício máximo; (2) Prejuízo na PA de 24 horas Além disso, analisamos se estas alterações se correlacionam com a atividade nervosa simpática muscular (ANSM) e com a SBR. Métodos. Foram selecionados 72 pacientes recém-diagnosticados com SMet (ATP III), alocados em 3 grupos conforme a classificação da PA (segundo as Diretrizes 2013 ESH/ESC):, SMet hipertensos (HT, n=16, 51±9 anos, 33±4 kg/m2), SMet pré-hipertensos (PHT, n=29, 47±10 anos, 31±3 kg/m2) e SMet normotensos (NT, n=27, 46±7 anos, 32±4 kg/m2). Um grupo controle (C, n=19, 48±2 anos, 25±2 kg/m2) pareado por gênero e idade foi envolvido no estudo. Foram avaliados: a ANSM (microneurografia); a SBR (análise das flutuações espontâneas da PA sistólica e FC) para aumentos (SBR+) e diminuições da PA (SBR-); medidas auscultatórias da PA no pré-teste, pico, 1°, 2° e 4° min de recuperação (TECP); e PAS e PAD de 24 horas, vigília, sono e despertar (MAPA de 24h). O estudo foi dividido em duas partes: Parte 1 - todos os grupos com SMet (HT, PHT e NT) e C foram estudados; e Parte 2 - somente o grupo SMet NT foi comparado ao C. Resultados - Parte 1. Os grupos SMet (HT, PHT e NT) foram semelhantes entre si e apresentaram prejuízo quando comparado ao grupo C nas características físicas, na capacidade física e nos fatores de risco da SMet. Na PAS pico atingida no TECP, o grupo SMet HT apresentou valores superiores quando comparado com SMet PHT, NT, e C (217±23 vs. 202±22; 195±17; 177±24 mmHg; respectivamente; P=0,03). Apresentaram resposta da PAS exagerada (PAS >190 mmHg para mulheres e > 210 mmHg para homens) 81% no grupo HT, 55% no PHT, 37% no NT e 21% no C. Na MAPA, SMet HT apresentou maior PA de 24h que os outros 3 grupos. (P < 0,001). A ANSM foi maior nos grupos SMet HT, PHT e NT quando comparados ao C (33±7; 30±7; 29±6; vs. 18±1 disparos/min, respectivamente, P < 0,001). Somente o grupo SMet HT apresentou menor SBR+ quando comparado ao grupo C (6±3; 8±3; 9±3; vs. 11±5 mmHg/ms; P=0,002). Os grupos SMet HT e PHT apresentaram menor SBR-, enquanto SMet NT foi semelhante ao C (7±2; 9±4; 10±3; vs. 12±5 mmHg/ms; P < 0,05). Houve correlação entre a SBR- e a PAS pico (r=-0,32, P=0,04) com todos os sujeitos dos grupos da SMet e C. Resultados Parte 2. Exceto na PAS no 4º min de recuperação, o grupo SMet NT apresentou maior PAS e PAD comparado ao C em todos os momentos do TECP. O comportamento da PAS e PAD pela área sob a curva (ASC) total foi maior no SMet NT comparado ao C. Na MAPA de 24h, SMet NT apresentou menor PAD no sono que C. Além disso, SMet NT apresentou menor SBR+ e SBR- e maior ANSM comparado ao C. Interessantemente, no subgrupo de pacientes com SMet NT (n=10, 37%) que apresentou PAS pico exagerada a SBR- se correlacionou fortemente com a PAS pico (r=-0,70, P=0,02) e com a PAS no 1º min de recuperação (r=-0,73, P=0,04). Conclusão: Pacientes com SMet, mesmo normotensos, já apresentam resposta exacerbada da PAS e da PAD durante o TECP, dos quais 40% com PAS pico exagerada. A disfunção autonômica pode explicar, pelo menos em parte, esta reposta exacerbada / Introduction. The progression of the metabolic syndrome (MetS) to cardiovascular disease is complex, multifactorial and may be associated in part with sympathetic hyperactivation and reduced baroreflex sensitivity (BRS), mechanisms strongly associated with arterial hypertension (AH). Additionally, in hypertension, the BP response during the maximal cardiopulmonary exercise test (CPET) and 24h BP (ABPM) is impaired. It is not known whether patients with MetS but without hypertension present those damages. Hypotheses. Patients with MetS with normal clinical BP level present: (1) Increased response of peak BP and recovery BP in response to maximal exercise; (2) Impaired 24 hour BP. In addition, we analyzed if those changes are associated with muscle sympathetic nerve activity (MSNA) and BRS. Methods. We selected 72 newly diagnosed patients with MetS (ATP III), subdivided in 3 groups according to the BP classification (according to the ESH/ESC Guidelines): hypertensive MetS (HT, n=16, 51±9 years, 33±4 kg/m2), pre-hypertensive MetS (PHT, n=29, 47± 10 years, 31±3 kg/m2) and normotensive MetS (NT, n= 27, 46±7 years, 32±4 kg/m2). A control group (C, n=19, 48±2 years, 25±2 kg/m2) paired by gender and age was involved in the study. The following were evaluated: the MSNA (microneurography); BRS (analysis of spontaneous fluctuations of systolic BP and HR) for increases to BP (SBR+) and for decreases to BP (SBR-); BP auscultatory measurements in the pre-test, peak, 1st, 2nd and 4th min of recovery (CPET); and SBP and DBP of 24 hours, wakefulness, sleep and awakening (24-hour ABPM). The study was divided into two parts: Part 1. All groups with MetS (HT, PHT and NT) were studied; and C group. Part 2. Only the NT MetS group was compared to the C. Results Part 1. The MetS groups (HT, PHT and NT) were similar and were impaired compared to group C in physical characteristics, physical capacity and risk factors of MetS. In the peak SBP reached at CPET, HT MetS group presented higher values when compared to PHT and NT MetS groups and C (217±23 vs. 202±22, 195±17, 177±-24 mmHg, respectively, P=0.03). There was an exaggerated SBP response (SBP > 190 mmHg for women and > 210 mmHg for men) in 81% of the HT group, 55% of the PHT, 37% of the NT and 21% of the C group. In the ABPM, HT MetS had a higher 24-hour BP than the other 3 groups (P < 0.001). The MSNA was higher in HT, PHT and NT MetS groups when compared to C (33±7, 30±7, 29±6, vs. 18±1 burst/min, respectively, P < 0.001). Only the HT MetS group showed lower SBR+ compared to C (6±3, 8±3, 9±3, vs. 11±5 mmHg/ms, P=0.002). The HT and PHT MetS groups presented lower SBR-, while NT MetS was similar to C (7±2; 9 ±4; 10±3, vs. 12±5 mmHg/ms; P < 0.05). There was a correlation between SBR- and peak SBP (r= -0.32, P=0.04) with all subjects from the MetS and C groups. Results Part 2. Except for SBP in the 4th min of recovery, NT MetS presented higher SBP and DBP compared to C at all moments of the CPET. The SBP and DBP responses by AUC analysis were higher in NT MetS compared to C. In 24h ABPM, NT MetS presented lower DBP in the sleep than in C. In addition, NT MetS presented decreased SBR+ and SBR- and increased MSNA compared with C. Interestingly, in the NT MetS subgroup of patients (n=10, 37%) who showed an exaggerated peak SBP, showed a negative correlation between BRS- and peak SBP (r=-.70; P=0.01) and SBP at 1st minute of recovery (r=.73; P=0.04). Conclusion. Patients with MetS, even normotensive, already present an exacerbated SBP and DBP response during CPET, of which 40% with exaggerated peak SBP. Autonomic dysfunction may explain, at least in part, this exacerbated response

Introdução: As doenças cardiovasculares constituem a principal causa demorbimortalidade nacional. Nesse sentido realizou-se estudo com o objetivo de caracterizar o perfil para riscos cardiovasculares em motoristas profissionais de transporte de cargas que trafegam pela Br-116. Casuística e Método: Estudo transversal, descritivo e exploratório com 258 motoristas profissionais de transporte de cargas com obtenção de informações socioeconômicas; avaliações antropométricas: índice de massa corporal (IMC), circunferência abdominal e medida da pressão arterial; realização de exames laboratoriais: triglicérides, colesterol total e frações, proteína C reativa e creatinina. Analisou-se o risco para doenças cardiovasculares pelo Escore de Risco de Framingham, consumo de bebidas alcoólicas pelo Alcohol Use Disorders Identification-AUDIT, distúrbios psiquiátricos comuns pelo Self Report Questionnaire-SRQ-20, Síndrome Metabólica e angina pectoris pelo Teste de Rose. Os dados foram processados no sistema SPSS v.7.5. O nível de significância adotado foi p<0,05, utilizou-se análise univariada e multivariada. Resultados: A caracterização os motoristas estudados mostrou idade 37,5±10,1 anos, 91% de etnia branca, renda mensal 1.431,3±644,4 reais, 19% tabagistas, 55% referiram ingestão de bebidas alcoólicas, 74% não realizavam atividade físicas, 14% relataram uso de medicamentos inibidores do sono, tempo profissão de 14±10 anos e percorriam 782,9±229,6 km/dia, dirigiam 10 horas por dia e repousavam 06 horas diárias. Verificou-se pelos dados antropométricos que 46% tinham sobrepeso, 36% obesidade e 58% circunferência abdominal alterada (_94 cm). Os exames laboratoriais mostraram 33% com nível de colesterol total _ 200mg/dL, 10% LDL-c _ 160 mg/dL; HDL-c < 40 mg/dL 23%, triglicérides acima de 150 mg/dL 38%, glicemia _ 110mg/dL 7% e proteína C reativa > 0,5 mg/dL 19%, creatinina >1,5 mg/dL 1%. A prevalência da hipertensão arterial foi de 37% e da Síndrome metabólica 24%. O Questionnaire Rose foi positivo em 8,0% dos motoristas, Escore de Risco de Framingham médio/alto em 9%, presença de distúrbios psiquiátricos comuns em 33% e AUDIT 16% no escore que sugere intervenção e aconselhamento. A análise de regressão logística indicou associação independente para as seguintes variáveis (OD Odds ratio, IC intervalo de confiança a 95%): 1-Síndrome Metabólica: IMC (OR=1,40 IC 1,192-1,661); hábito de verificar o colesterol total (OR= 0,102 IC 0,017-0,589); e escore de risco de Framingham médio/alto (OR= 26,389 IC 2,520-276,374). 2-Hipertensão arterial: IMC (OR=1,183 IC 1,065-1,314); glicemia (OR=1,039 IC 1,004-1,076); e hábito de ingerir medicamento para inibir o sono (OR= 0,322 IC 0,129-0,801). 3- Colesterol Total (_ 200 mg/dL): LDL-c (OR=1,157 IC 1,100-1,216);triglicérides (OR=1,012 IC 1,004-1,021) 4- Glicemia (_ 110 mg/dL): IMC (OR=1,153 IC 1,024-1,298); maior tempo de profissão (OR=1,154 IC 1,057-1,259) 5-Proteína C reativa (>0,5 mg/dL): escore de risco de Framingham médio/alto (OR=4,692 IC 1,912-11,515). Conclusão: Verificou-se presença expressiva de fatores de risco cardiovasculares, nesse sentido os profissionais de saúde devem implementar estratégias para estimular mudanças de estilos de vida nos motoristas de transporte de cargas, visando a prevenção primária e secundária / Introduction: Cardiovascular diseases are the main cause of morbidity and mortality in Brazil. Therefore, a study aiming at characterizing the cardiovascular risk profile observed in professional truck drivers who work on Highway Br-116 was carried out. Population and Method: An exploring, descriptive and transversal study with 258 professional truck drivers, social economical information, both body mass index (BMI) and waist circumference evaluations, blood pressure measurement, as well as laboratory test performance: triglycerides, total and fraction cholesterol, and C reactive protein. The risk for cardiovascular diseases was assessed by Framingham scores; alcohol intake by Alcohol Use Disorders Identification-AUDIT; common psychiatric disorders by Self Report Questionnaire-SRQ-20; and angine pectoris by Rose´s test Data were processed in the SPSS system v.7.5, considering that the significance level adopted was 0,05, and univaried and multivaried analyses were used. Results: The characterization of the drivers studied revealed age of 37.5±10.1 years, 91% of them were white, monthly income 1.431,3 ± 644,4 reais (Brazilian currency), 19% were smokers, 55% referred alcohol intake, 74% did not make physical exercises, 14% referred using sleeping inhibitor drugs, professional time 14±10 years and used to drive 782,9±229,6 Km/day. It was observed that 46% of them were overweight and 36% were obese and 58% had altered waist circumference (_ 94 cm) by the anthropometric data. The lab tests showed 33% with total cholesterol level _200 mg/dL, 10% LDLc _160 mg/dL, HDL-c <40 mg/dL 23%, triglycerides over 150 mg/dL 38%, glycemy _110mg/dL 7%, and C reactive protein >0.5 mg/dL 19%. The prevalence of hypertension was 37% and of Metabolic Syndrome, 24%. Rose’s test was positive for 8% of the drivers, Medium/High Framingham scores for 9%, presence of common psychiatric disturbs in 33% and 16% with AUDIT score suggesting intervention and advisory. The logistical regression analysis indicated independent association for the following variables: (OR Odds ratio, CI confidence interval at 95%): 1- Metabolic Syndrome: BMI (OR=1,40 CI 1,192-1,661); the habit of checking the total cholesterol (0,102 IC 0,017-0,589); Medium/high Framingham score (OR=26,389 IC 2,520-276,374); 2-Hypertension: BMI (OR=1,183 IC 1,065-1,314); glycemy (OR=1,039 IC 1,004-1,076); the habit of taking sleeping pills (OR=0,322 IC 0,129-0,801). 3- Total Cholesterol (_ 200 mg/dL): LDL-c (OR=1,157 IC 1,100-1,216); triglycerides (OR=1,012 IC 1,004-1,021). 4- Glycemy (_ 110 mg/dL): BMI (OR=1,153 IC 1,024-1,298); professional time (OR=1,154 IC 1,057-1,259). 5- C reactive protein (>0,5 mg/dL): Medium/high Framingham score (OR=4,692 IC 1,912-11,515). Conclusion: It was observed an expressive presence of cardiovascular risk factors. Therefore health professionals should implement strategies to stimulate changes in truck drivers’ lifestyle, aiming at primary and secondary prevention

Os profissionais da área da saúde que atuam no serviço de atendimento pré-hospitalar podem estar sujeitos a fatores de risco cardiovasculares em razão do estilo de vida adotado e das características do trabalho. O objetivo principal do estudo foi avaliar a influência do plantão de 24 horas sobre a pressão arterial e os fatores de risco para afecções cardiovasculares nesses profissionais. Casuística e Método: Estudo transversal com 154 profissionais (90 enfermeiros, 41 médicos, 23 auxiliares de enfermagem) que atuavam no serviço de atendimento pré-hospitalar: Grupo de Atendimento Médico de Urgência (GRAU-193), Serviço Móvel de Urgência (SAMU-192) e Samu-Vale do Ribeira. Realizou-se medida da pressão arterial casual com aparelho automático validado e considerou-se hipertenso pressão 140/90mmHg e/ou uso de anti-hipertensivos. Procedeu-se a Monitorização Ambulatorial da Pressão Arterial (MAPA), durante o plantão no pré-hospitalar e em dia usual de atividade. Foram analisados o índice de massa corpórea (IMC), a circunferência abdominal (CA), a glicemia, o perfil lipídico e a proteína C reativa. O risco cardiovascular foi calculado pelo Escore de Risco de Framingham (ERF) e avaliada a presença da Síndrome Metabólica. Foram utilizados os instrumentos: Índice de Qualidade de Sono de Pittsburg, Self Report Questionnaire, Inventário de Depressão de Beck, Escala de Estresse no Trabalho e Malasch Burnout Inventory. O nível de significância adotado foi p<0,05, utilizou-se análise univariada e regressão logística para as variáveis significativas. Resultados: As características dos participantes foram: idade 40,9±7,8 anos. Sedentarismo 64,9%, CA alterado 70,2% e IMC sobrepeso/obeso de 65,6%. Alteração de glicose em 11%, colesterol elevado em 11%, LDL-c alto 7,8%, HDL-c alto 11% e triglicérides em 16,2%, proteína C reativa 40,3% nos quartis mais altos. A prevalência da hipertensão arterial pela medida casual no pré-hospitalar foi 33,1% e em dia usual de atividade 13,6%. Na MAPA de 24h no pré-hospitalar 29,3%, dia usual de atividade 22,6%; MAPA da vigília no pré-hospitalar 26,6%, dia usual de atividade 18,5%; MAPA no sono pré-hospitalar 63,0%, dia usual de atividade 42,5%. Houve diferenças significativas nos níveis pressóricos pré-hospitalares em relação ao dia usual de atividade para medida casual sistólica e diastólica (124,9±15,1mmHg/79,0±10,8 mmHg vs. 122,1±14,5mmHg/76,7±10,5mmHg) e na MAPA no período de sono, para a pressão diastólica (110,5±11,5mmHg/72,6±9,5mmHg vs. 111,8±10,8mmHg/67,6±7,9 mmHg). Os fatores associados à hipertensão foram a pela medida casual: HDL-c > 40 mg/dL (Odds Ratio (OR) 0,257; intervalo de confiança (IC) 95%: 0,0810,813) e ERF > 10% (OD: 23,159; IC 95%: 2,029264,378). b) pela MAPA: no período de 24 horas: sexo masculino (OR: 2,717; IC 95%: 1,206-6,122); trabalhar cansado raramente/nunca (OR: 0,197; IC 95%: 0,061-0,638) e às vezes (OR: 0,174; IC 95%: 0,050-0,614); glicemia > 100 mg/dL (OR: 9,983; IC 95%: 1,560-63,881). Para MAPA da vigília: sexo masculino (OR: 3,245; IC 95%: 1,385-7,606); trabalhar cansado raramente/nunca (OR: 0,142; IC 95%: 0,042-0,481); e às vezes (OR: 0,163; IC 95%: 0,045-0,590); glicemia > 100 mg/dL (OR:11,1809; IC 95%: 1,632-76,60) e IMC > 25kg/m2 (OR: 1,101; IC 95%: 1,006-1,206). Para MAPA do sono: IMC > 25kg/m2 (OR: 1,119; IC 95%: 1,021-1,226) e presença de sono diurno (OR: 0,140; IC 95%: 0,065-0,300). O Escore de Risco de Framingham foi médio/alto em 10,6%; Síndrome Metabólica presente em 28,6%, má qualidade de sono em 41,6%, transtornos mentais comuns em 16,2%, depressão em 7,8%, média de estresse no trabalho em 50,1% e Burnout em 29%. Conclusão: houve diferenças pressóricas durante o plantão no serviço pré-hospitalar em relação a um dia usual de atividade, e os profissionais estudados estavam expostos a fatores de risco modificáveis, sendo necessárias mudanças no estilo de vida / Professionals that work in pre-hospital assistance might be subject to the cardiovascular risk factors due to their adopted lifestyle and specific characteristics of their occupation. Casuistic and Method: Transversal study with 154 professionals (90 nurses, 41 physicians, 23 nurse auxiliaries) that work in prehospital: Grupo de Atendimento Médico de Urgência [Group of Emergency Medical Assistance] (GRAU-193), Serviço Móvel de Urgência [Emergency Rescue Service] (SAMU-192) and Samu-Vale do Ribeira. Measures were performed regarding casual blood pressure; it was considered arterial hypertensive pressure (HA) 140/90mmHg and/or use of antihypertensives. The Ambulatorial Monitoring of Blood Pressure (ABPM) was performed during the duty on prehospital and also on casual day of activities. The Body Mass Index (IMC), Abdominal Circumference (CA), glucose, lipids profile and C-reactive protein were analyzed. The cardiovascular risk was used Framingham Risk Score (ERF), Metabolic Syndrome were analyzed. The used tools were: Pittsburg Sleep Quality Index, Self Report Questionnaire, Beck Depression Inventory, Job Stress Scale and Malasch Burnout Inventory. Data were processed on SPSS System v.7.5. The level of significance adopted was p <0,05, univariate analysis was used and the logistic regression was performed for remarkable variables. Results: Age of 40,9 ± 7,8 years. Sedentary lifestyle 64,9%, CA altered 70,2% and IMC overweight/obese of 65,6%. Glucose alteration in 11%, elevated cholesterol in 11%, high LDL-c in 7,8%, high HDL-c in 11% and triglycerides in 16,2%, C-reactive protein in 40,3% on higher quartiles. The prevalence of prehospital HA: 33,1% and casual day of activities 13,6%. ABPM: 24h prehospital 29,3%, casual day of activities 22,6%; ABPM: daytime prehospital 26,6%, casual day of activities 18,5%; ABPM: nighttime prehospital 63,0%, casual day of activities 42,5%. There were significant differences on pressoric levels of prehospital in comparison with casual day of activities for casual measure of systolic and diastolic pressures (124,9±15,1 mmHg/79,0±10,8 mmHg vs. 122,1±14,5 mmHg; /76,7±10,5mmHg), and on ABPM of nighttime period for diastolic pressure (110,5 ± 11,5 mmHg/72,6±9,5 mmHg vs. 111,8±10,8 mmHg/67,6±7,9 mmHg). Factors related with casual HA: HDL-c > 40 mg/dL (Odds Ratio (OR) 0,257; confidence interval (IC) 95%: 0,0810,813) and ERF >10% (OD: 23,159; IC 95%: 2,029264,378). The HA measured by ABPM: on 24 hours period: male gender (OR: 2,717; IC 95%: 1,206-6,122); never/occasionally work tired (OR: 0,197; IC 95%: 0,061-0,638) and sometimes (OR: 0,174; IC 95%: 0,050-0,614); glucose > 100mg/dL (OR: 9,983; IC 95%: 1,560-63,881). For daytime: male gender (OR: 3,245; IC 95%: 1,385-7,606); never/occasionally work tired (OR: 0,142; IC 95%: 0,042-0,481); and sometimes (OR: 0,163; IC 95%: 0,045-0,590); glucose > 100mg/dL (OR: 11,1809; IC 95%: 1,632-76,60) and IMC > 25kg/m2 (OR: 1,101; IC 95%: 1,006-1,206). For nighttime period: IMC > 25kg/m2 (OR: 1,119; IC 95%: 1,021-1,226) and presence of somnolence during day (OR: 0,140; IC 95%: 0,065-0,300). Prevalence of Metabolic Syndrome: 28,6%; Framingham Risk Score: medium/high: 10,6%; poor quality of sleeping 41,6%, common mental disorders: 16,2%, depression: 7,8%, average job stress: 50,1% and Burnout 29%. It might be concluded: that there were pressoric differences during duty on prehospital in comparison with a casual day of activities, and that these professionals are exposed to the modifiable risk factor and need changes in their lifestyles.