Made available in DSpace on 2015-04-14T13:36:07Z (GMT). No. of bitstreams: 1 397351.pdf: 433934 bytes, checksum: d047284ad2d160f1ff1f20002cc71a91 (MD5) Previous issue date: 2007-12-11 / A s?ndrome metab?lica (SM) agrega os principais fatores de risco relacionados com a progress?o da aterosclerose ao estresse oxidativo (EO) e a disfun??o auton?mica do sistema cardiovascular. O objetivo desse estudo ? avaliar o efeito agudo do exerc?cio f?sico moderado (Ex) sobre o EO, a variabilidade da freq??ncia card?aca (VFC) e ativa??o simpato/vagal em indiv?duos sedent?rios com SM. Material e M?todos: Participaram do estudo 08 volunt?rios sedent?rios com SM (segundo os crit?rios da ATP III) e 08 volunt?rios sedent?rios saud?veis (GC) entre 30-60 anos pareados por idade e sexo. Em repouso foram avaliados o perfil lip?dico (HDL-c e Triglicer?dios), a glicose de jejum (Gj), prote?na C reativa ultra sens?vel (PRC-us) e press?o arterial (PA). Foram avaliados no plasma, antes e ap?s o exerc?cio, a atividade da xantina oxidase (XO), da super?xido dismutase (SOD), da glutationa peroxidase (GPx) e as concentra??es de Ti?is. A VFC entre os batimentos card?acos (RR) do ECG foi determinada no dom?nio da freq??ncia por modelagem auto-regressiva (AR). Os espectros de baixa freq??ncia (LE = 0.02 0.07 Hz) e o de alta freq??ncia (HF = 0.2 0.4 Hz) foram utilizados para determinar o balan?o simpato/vagal (LF/HE). A ativa??o simp?tica (AS) e a ativa??o vagal (AV) foram induzidas pela posi??o em p? e pela ventila??o controlada respectivamente. O EX foi realizado em uma esteira ergom?trica e a intensidade do esfor?o foi ajusta pela FC (65 a 75% da FC m?x prevista para a idade). Os resultados foram comparados pela ANOVA de duas vias e pelo p?s-teste de Tukey. A correla??o de Pearson foi utilizada para estudar a rela??o entre a distribui??o dos dados. 76,6?3,6 Bpm). Nossos achados mostraram tamb?m, que o aumento da XO se correlacionou com a redu??o da VAR (r=-60 p <0,05).Conclus?o: O EX aumenta a resposta a AS, reduz a resposta a AV e reduz a VAR confirmando o efeito delet?rio da SM sobre a modula??o auton?mica do sistema cardiovascular, lentificando o retorno da Ft aos valores basais. o EX n?o alterou a avalia??o do EQ, mas o aumento da atividade da XO plasm?tica se correlacionou com a redu??o da VAR indicando que a produ??o de esp?cies reativas de oxig?nio pode desempenhar um papel importante no balan?o simpato/vagal dos indiv?duos com SM

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2016-06-22T18:54:20Z No. of bitstreams: 1 TES_ANA_LETICIA_VARGAS_BARCELOS_COMPLETO.pdf: 1508088 bytes, checksum: ebb1a61bcd13d9f1f26191fbf2f2434e (MD5) / Made available in DSpace on 2016-06-22T18:54:21Z (GMT). No. of bitstreams: 1 TES_ANA_LETICIA_VARGAS_BARCELOS_COMPLETO.pdf: 1508088 bytes, checksum: ebb1a61bcd13d9f1f26191fbf2f2434e (MD5) Previous issue date: 2016-03-30 / Metabolic syndrome is a public health problem due to its high prevalence, once it is characterized by a set of risk factors that, when associated, predisposes to the development of atherosclerosis and its complications (acute myocardial infarction and stroke) and diabetes mellitus type 2. These risk factors are interconnected by biochemical, clinical, metabolic and inflammatory reactions. Chronic inflammation is closely related to the adipose tissue, predisposing to an induction of various cytokines which constitutes an important link between insulin resistance and endothelial dysfunction, precursor of atherosclerosis. The aim of this study was to evaluate the profile of cytokines in patients with metabolic syndrome and severe coronary artery disease. This was a controlled cross-sectional study with descriptive-analytic approach in patients treated at the Cardiometabolic Clinic of the Hospital S?o Lucas / PUCRS, Porto Alegre, Brazil. The sample was composed of three independent groups. Group 1 (n = 30) was composed of patients diagnosed with metabolic syndrome without significant coronary artery disease; group 2 (n = 30) was composed of patients with metabolic syndrome but with severe coronary artery disease; and group 3, control group, comprised healthy individuals. The activities of pro and anti-inflammatory cytokines, the oxidative stress, the anthropometric data and the biochemical data were evaluated. Levels of pro-inflammatory interleukins (TNF-?, IL-6, IL-12) were significantly higher in group 1, and so were IL-10 (anti-inflammatory) levels in this group. The main finding of this study showed that high IL-10 levels in patients with metabolic syndrome are associated with lower incidence of severe coronary artery disease, suggesting a protective effect through its anti-inflammatory activity, even in the presence of increased levels of other pro-inflammatory cytokines. Low IL-10 levels are associated with higher incidence of severe coronary artery disease in this population. / A S?ndrome Metab?lica ? um problema de sa?de p?blica devido a sua alta preval?ncia, pois se caracteriza por um conjunto de fatores de risco, que associados predisp?e o desenvolvimento de doen?a ateroscler?tica e suas complica??es (infarto agudo do mioc?rdio e acidente vascular cerebral) e Diabetes mellitus tipo 2. Esses fatores de risco est?o interligados por aspectos bioqu?micos, cl?nicos, metab?licos e por rea??es inflamat?rias. A inflama??o cr?nica apresenta estreita rela??o com o tecido adiposo, predispondo a uma indu??o de diversas citocinas as quais constituem um elo importante entre a resist?ncia ? insulina e a disfun??o endotelial, precursora da aterosclerose. O objetivo do presente estudo ? avaliar o perfil das citocinas em pacientes com s?ndrome metab?lica e doen?a arterial coronariana grave. Foi realizado um estudo observacional do tipo transversal controlado com abordagem descritivo-anal?tica em pacientes atendidos no Ambulat?rio Cardiometab?lico do Hospital S?o Lucas/PUCRS, Porto Alegre, Brasil. A amostra foi composta por tr?s grupos independentes. No grupo 1 (n=30) foram inclu?dos pacientes com diagn?stico de s?ndrome metab?lica sem doen?a arterial coronariana grave; no grupo 2 (n=30) pacientes com s?ndrome metab?lica por?m com doen?a arterial coronariana grave e no grupo 3, grupo controle, foram inclu?dos indiv?duos saud?veis. Foram avaliadas as atividades das citocinas pr? e anti-inflamat?rias, o estresse oxidativo, dados antropom?tricos e dados bioqu?micos. N?veis de interleucinas pr?-inflamat?rias como TNF-?, IL-6, IL-12 apresentaram-se n?veis significativamente mais elevados no grupo 1, bem como a IL-10 (anti-inflamat?ria). O principal achado deste estudo demonstrou que altos n?veis de IL-10 em pacientes com s?ndrome metab?lica est?o associados a menor incid?ncia de doen?a arterial coronariana grave. Isto sugere um efeito protetor atrav?s de sua atividade anti-inflamat?ria, mesmo na presen?a de n?veis aumentados de outras citocinas pr?-inflamat?rias. Baixos n?veis de IL-10 est?o associados a maior ocorr?ncia de doen?a arterial coronariana grave nessa popula??o.

Made available in DSpace on 2015-04-14T13:22:08Z (GMT). No. of bitstreams: 1 445314.pdf: 2487058 bytes, checksum: 8400f31d0724c60e094c2ef206204175 (MD5) Previous issue date: 2012-12-12 / This dissertation deals with lifestyle changes in patients with metabolic syndrome (MS), using the Transtheoretical Model (TTM) as the framework of intervention. Initially, we present a contextualization of the current research from both a theoretical and a practical point of view. From a theoretical point of view we discuss (1) the metabolic syndrome and its prevalence in Brazil; (2) constructs from TTM; (3) some studies that used this model for health problems; and (4) factors that may interfere with the motivation of subjects to change their behavior. We approach the practical side from the four dimensions that this dissertation examines: stages of change, processes of change, markers of change and context of change. To answer the four questions in a more detailed way, this dissertation is composed of four articles: a thematic essay about the importance of techniques and therapeutic alliance in the treatment; an empirical study comparing the efficacy of two treatments based on TTM with a control treatment; an empirical study of predictor factors to weight loss; and one article about the development of an intervention based on TTM for patients with MS, with a focus on the adherence to diet and exercise. The thematic essay discusses the treatments with manual versus treatments without a manual to be followed, debating what the more important factor in the treatment is: the techniques or the working alliance. The discussion is based on different authors with diverse opinions, and do not seek a single truth, but provides a platform for discussion about how psychotherapists are formed as well as about their work. The first empirical study tackles the efficacy of two treatments - individual (IT) and group (GT) - both based on TTM for patients with MS. The article presents how each intervention was applied, and shows which variables had significant effect on each group. The results show that participants from IT had significantly improved upon their weight, body mass index (BMI), abdominal circumference, amount of exercise per week, readiness to exercise 3-5 times per week, and their readiness to increase fibers and to decrease salt. Group treatment has no better results than control treatment for any outcome. The second empirical study evaluates the predictor factors of weight loss in these patients, submitted to the treatments tested in the first article. For the total sample, the predictors of weight loss were self-efficacy to keep diet after treatment and self-efficacy to keep exercising after treatment. Perceived problem severity shows to contribute to a very small weight loss or increase in weight. For individual intervention readiness to exercise 3 to 5 times per week was a predictor of weight loss. For group treatment, the predictor factors were: self-efficacy to keep diet after and self-efficacy to keep exercise after the treatment. Pressure to change, familly support, anxiety/depression and intrusive behavior did not significantly contribute to the prediction of changes. Examining the three treatments as independent variables, Individual Treatment increases in 3 times the chance of losing more than 5% of the initial weight / Esta tese aborda a mudan?a do estilo de vida em pacientes com s?ndrome metab?lica (SM), e utilizou como abordagem de interven??o o Modelo Transte?rico de Mudan?a de Comportamento (MTT). Inicialmente apresenta uma contextualiza??o geral, contemplando o contexto da pesquisa do ponto de vista te?rico e do ponto de vista pr?tico. O primeiro deles aborda a s?ndrome metab?lica e sua preval?ncia no Brasil; conceitos do Modelo Transte?rico de Mudan?a; alguns estudos com o modelo e problemas de sa?de; e fatores que podem interferir na motiva??o para mudan?a. O segundo, aborda de forma geral as quatro quest?es de pesquisa que esta tese buscou responder. Para responder ?s quatro quest?es de forma detalhada, a tese ? composta por 4 artigos: um ensaio tem?tico sobre a import?ncia das t?cnicas e da rela??o terap?utica no tratamento; um estudo emp?rico comparando a efic?cia de duas interven??es baseadas no MTT com uma interven??o padr?o; um estudo emp?rico dos fatores preditivos de redu??o de peso; e um artigo sobre o desenvolvimento de uma interven??o baseada no MTT para pacientes com s?ndrome metab?lica (SM) com objetivo de enfocar a ades?o ? dieta e ao exerc?cio f?sico. O ensaio tem?tico discute os tratamentos manualizados versus os n?o manualizados, enfocando o que ? mais importante no tratamento, as t?cnicas aplicadas ou a rela??o terap?utica. A discuss?o ? fundamentada em diversos autores com posicionamentos distintos, e n?o busca uma verdade ?nica, mas sim uma reflex?o sobre como os psicoterapeutas s?o formados e o sobre o seu trabalho. O artigo emp?rico aborda a efic?cia das interven??es individual (II) e grupal (IG), baseadas no MTT para pacientes com SM. Este artigo apresenta como cada uma das interven??es aconteceu, e mostra quais vari?veis de interesse tiveram mudan?as significativas em cada grupo de tratamento. Os resultados demonstraram que os participantes da II tiveram melhora significativa no peso, ?ndice de massa corporal, circunfer?ncia abdominal, quantidade de exerc?cio por semana, prontid?o para realizar exerc?cio aer?bico de 3-5 vezes por semana, para aumentar consumo de fibras e para reduzir o de sal. A interven??o grupal n?o obteve resultados estatisticamente significativos quando comparados aos da Interven??o Padr?o em nenhuma vari?vel. O segundo artigo emp?rico avaliou os fatores preditivos de redu??o de peso nestes pacientes submetidos aos tratamentos testados no primeiro artigo emp?rico. Para a amostra como um todo, foram preditores de redu??o de peso: a auto-efic?cia para se manter em dieta ap?s o tratamento e a auto-efic?cia para de manter em exerc?cio ap?s o tratamento. A percep??o de gravidade da SM mostrou ter contribu?do apenas para uma pequena redu??o de peso ou at? mesmo para um aumento de peso. Na interven??o individual a prontid?o para realizar exerc?cio aer?bico de 3 a 5 vezes por semana foi preditora de redu??o de peso. Na interven??o grupal os fatores preditores de sucesso foram: auto-efic?cia para se manter em dieta e auto-efic?cia para se manter em exerc?cio ap?s o tratamento, ao passo que a percep??o sobre a gravidade da SM e a prontid?o para realizar exerc?cio f?sico de 3 a 5 vezes por semana contribu?ram para uma perda m?nima de peso ou at? mesmo ganho de peso. Press?o para mudar, apoio familiar, ansiedade/depress?o e comportamento intrusivo n?o predisseram mudan?as. Avaliando-se os 3 grupos de interven??o como vari?veis independentes, fazer parte da Interven??o Individual mostrou maiores chances de perder mais de 5% do peso inicial. A tese buscou contemplar 4 dimens?es do MTT (est?gios de mudan?a, processos de mudan?a, marcadores e contexto)

Made available in DSpace on 2015-04-14T13:22:12Z (GMT). No. of bitstreams: 1 447811.pdf: 146207 bytes, checksum: 610a9cb5a91a87e979f9474d2a351138 (MD5) Previous issue date: 2013-03-19 / The first choice of treatment for patients with Metabolic Syndrome (MS) is the lifestyle changing, which includes the practice of physical exercise and healthy eating, being the Transtheoretical Model of Change (TTM) one of the most used approaches to intervene in relation to these behaviors. However, the literature points out, despite the paucity of studies, that patients have difficulty in adhere to the proposed orientations and keep the changes achieved after the end of treatment. This dissertation sought to address these two subjects and was composed of two sections. The first compared the baseline characteristics between subjects with MS who completed and did not complete a randomized clinical trial, based on TTM, in order to modify the lifestyle and cardiovascular risk (MERC), and identified factors associated with treatment completion. Were assessed, 127 subjects with a mean age of 49.58 years (SD = 7.77) and diagnosis of MS, enrolled at MERC between the years 2010 and 2012. Most of the sample completed the intervention (p <0.01), whereas those individuals older than 50 years (OR: 7.5, 95% CI 1.2 to 46.7, p <0.05 ), who exercise (OR: 1.9, 95% CI: 1.0 - 7.0, p <0.05), have religion (OR: 4.6, 95% CI 1.1 to 13.2; p <0.05), high self-efficacy for regular eating habits (OR: 1.2, 95% CI: 1.0 - 2.3, p <0.05), don t have binge eating (OR: 6.1 95% CI: 2.1 to 23.8, p <0.05) and don t have depression (OR: 4.9, 95% CI: 1.4 to 19.4, p <0.05), are more likely to complete the treatment. The second section conducted the follow-up (T3) of the MERC program participants, on average, one year after the initial assessment (T1). The sample consisted of 55 individuals with MS and an average age of 51.9 years (SD = 6.5), divided into 3 groups: Group Intervention - GI (n = 19); Individual Intervention - II (n = 20); Standard Intervention - SI (n = 16). Time effect was significant (<0.001), with a decrease in weight, body mass index, waist circumference, diastolic and systolic blood pressure (SBP) means. There were differences between groups only regarding weight, wherein just the individuals of GI and II maintained treatment outcomes and still showed a significant reduction when compared T3 and T1, and SBP, with II standing out in relation to others. At T3, most individuals were motivated, but with selfefficacy on average for regulating eating habit and medium/low to perform physical exercise, which reinforces the need for monitoring continuously these patients. The results show that an interdisciplinary program, aimed at lifestyle changing, based on MTT, is effective in the management of patients with MS, not only in relation to adherence promotion, but also in maintenance of treatment outcomes. / A primeira escolha de tratamento para pacientes com S?ndrome Metab?lica ? a mudan?a do estilo de vida, que contempla a pr?tica de exerc?cio f?sico e alimenta??o saud?vel, sendo o Modelo Transte?rico de Mudan?a (MTT) uma das abordagens mais utilizadas para intervir em rela??o a estes comportamentos. No entanto, a literatura aponta, apesar da escassez de estudos, que os pacientes t?m dificuldade de aderir ?s orienta??es propostas e manter as mudan?as alcan?adas ap?s o t?rmino do tratamento. Esta disserta??o buscou contemplar estas duas quest?es e foi composta por duas se??es. A primeira comparou as caracter?sticas da linha de base entre indiv?duos com SM que conclu?ram e n?o conclu?ram um ensaio cl?nico randomizado, visando ? modifica??o do estilo de vida e risco cardiovascular (MERC), baseado no MTT, e identificou os fatores associados ? conclus?o do tratamento. Foram avaliados 127 sujeitos com m?dia de idade de 49,58 anos (DP=7,77) e diagn?stico de SM, que participaram do programa MERC entre os anos de 2010 e 2012. A maior parte da amostra concluiu a interven??o (p<0,01), sendo que, aqueles indiv?duos com idade acima de 50 anos (OR: 7,5; IC95%: 1,2 46,7; p<0,05), que fazem exerc?cio (OR: 1,9; IC95%: 1,0 - 7,0; p<0,05), t?m religi?o (OR: 4,6; IC95%: 1,1-13,2; p<0,05), auto-efic?cia alta para regular h?bito alimentar (OR: 1,2; IC95%: 1,0 2,3; p<0,05), n?o apresentam compuls?o alimentar (OR: 6,1; IC95%: 2,1 23,8; p<0,05) e n?o possuem depress?o (OR: 4,9; IC95%: 1,4 19,4; p<0,05), t?m mais chance de concluir o tratamento. A segunda se??o realizou o seguimento (T3) dos participantes do programa MERC, em m?dia, um ano ap?s a avalia??o inicial (T1). A amostra foi composta por 55 indiv?duos, com SM e idade m?dia de 51,9 anos (DP= 6,5), divididos em 3 grupos: Interven??o Grupal IG (n=19); Interven??o Individual - II (n=20); Interven??o Padr?o - IP (n=16). O efeito do tempo foi significativo (<0,001), com uma diminui??o das m?dias do peso, ?ndice de massa corporal, circunfer?ncia abdominal, press?o arterial sist?lica (PAS) e diast?lica. Houve diferen?a entre os grupos apenas em rela??o ao peso, em que somente os indiv?duos da II e da IG mantiveram os resultados do tratamento e ainda apresentaram uma redu??o significativa quando comparados T3 e T1, e ? PAS, com a II sobressaindo-se em rela??o ?s demais. No T3, grande parte dos indiv?duos ainda estava motivada, mas com auto-efic?cia m?dia para regular h?bito alimentar e m?dia/baixa para realizar exerc?cio f?sico, o que refor?a a necessidade de realizar o acompanhamento cont?nuo destes pacientes. Os resultados apontam que um programa interdisciplinar, visando ? mudan?a de estilo de vida, baseado no MTT, ? efetivo no manejo de pacientes com SM, n?o s? em rela??o ? promo??o da ades?o, como ? manuten??o dos resultados do tratamento.

Made available in DSpace on 2014-12-17T14:13:51Z (GMT). No. of bitstreams: 1 AnaCAAG_TESE.pdf: 1218484 bytes, checksum: 515ab0b05a0c78a389b8ec33b20042ef (MD5) Previous issue date: 2013-11-27 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Preeclampsia is defined as an extremely serious complication of the pregnancy-puerperium cycle with delayed emergence of cardiovascular risk factors, including metabolic syndrome. The research aimed estimate the prevalences of metabolic syndrome and associated factors in women with preeclampsia and normal pregnancy followed five years after childbirth. This is a cross-sectional observational study using a quantitative approach, conducted at a maternity school in the city of Natal in Rio Grande do Norte state. The sample was composed of 70 women with previous preeclampsia and 75 normal selected by simple random probability sampling. Subjects were analyzed for sociodemographic, obstetric, clinical, anthropometric and biochemical parameters. International Diabetes Federation criteria were adopted to diagnose metabol ic syndrome. The Kolmogorov-Smirnov, Mann-Whitney, Student s t, Pearson s chi-squared, and Fisher s exact tests, in addition to simple logistic regression, were used for data analysis, at a 5% significance level (p &#8804; 0.05). Statistical tests demonstrated elevated body mass index (p = 0.001), predominance of family history of diabetes mellitus (p = 0.022) and significantly higher prevalence of metabolic syndrome in the preeclampsia group (37.1%) when compared to normal (22.7%) (p = 0.042). Intergroup comparison showed a high number of metabolic syndrome components in women with previous preeclampsia. Altered systolic and diastolic blood pressure (p < 0.001) was the most prevalent, followed by low concentrations of high-density lipoproteins (p = 0.049), and hyperglycemia (p=0.030). There was a predominance of the metabolic syndrome in women with schooling 0-9 years (42.4%) (p = 0.005), body mass index above 30Kg.m 2 (52.3%) (p < 0.001), uric acid high (62.5%) (p = 0.050 and family history of hypertension (38.5%) (p< 0.001). Multivariate analysis of the data showed that the body mass index above 30 kg.m2, education level less than 10 years of study (p < 0.001) and family history of hypertension (p = 0.002) remained associated with the metabolic syndrome after multivariate analysis of the data. It is considered Women with previous preeclampsia exhibited high prevalence of metabolic syndrome and their individual components in relation to normal, especially, altered systolic and diastolic blood pressure, low concentrations of high-density lipoproteins and hyperglycemia. The factors associated to this ou tcome were obesity, less than 10 years of schooling, and family history of hypertension. Overall, this study identified young women with a history of PE exposed to a higher cardiovascular risk than normal / A pr?-ecl?mpsia ? uma complica??o de extrema gravidade do ciclo grav?dico puerperal e contribui com o surgimento tardio de fatores de risco cardiovascular, dentre os quais a s?ndrome metab?lica. A pesquisa objetivou estimar as preval?ncias da s?ndrome metab?lica e fatores associados em mulheres que apresentaram pr?-ecl?mpsia e gravidez normal, acompanhadas cinco anos ap?s o parto. Trata-se de um estudo observacional transversal de abordagem quantitativa, realizado em uma maternidade escola no munic?pio de Natal, Rio Grande do Norte. A amostra foi constitu?da por 70 mulheres com pr?-ecl?mpsia pr?via e 75 normais selecionadas por meio do m?todo de amostragem probabil?stica aleat?ria simples, do banco de dados do grupo de pesquisa Sa?de da Mulher do Departamento de Tocoginecologia da Universidade Federal do Rio Grande do Norte, das quais foram analisados os par?metros sociodemogr?ficos, obst?tricos, cl?nicos, antropom?tricos e bioqu?micos. Para diagn?stico da s?ndrome metab?lica, adotou-se o crit?rio estabelecido pela International Diabetes Federation. Quanto ? an?lise dos dados, foram aplicados testes estat?sticos de Kolmogorov-Smirnov, Mann-Whitney, t de Student, Qui Quadrado de Pearson, exato de Fisher e modelo de regress?o log?stica simples com n?vel de signific?ncia estat?stica de 5% (p&#8804; 0,05). Ap?s aplica??o dos testes estat?sticos constatou-se um ?ndice de massa corp?rea elevado (p = 0,001), predom?nio de antecedentes familiares de diabetes mellitus (p = 0,022) e preval?ncia significativamente maior da s?ndrome metab?lica no grupo com pr?-ecl?mpsia (37,1%) em rela??o ?s normais (22,7%) (p = 0,042). Comparando os grupos, verificou-se um n?mero elevado de componentes da s?ndrome metab?lica nas mulheres com pr?-ecl?mpsia pr?via. A press?o arterial sist?lica e diast?lica alteradas (p < 0, 001) foi o mais prevalente, seguido da baixa concentra??o de lipoprote?nas de alta densidade (p = 0, 049) hiperglicemia (p = 0,030). Houve o predom?nio da s?ndrome metab?lica nas mulheres com escolaridade de 0 a 9 anos (42,4%) (p = 0,005), ?ndice de massa corp?rea acima de 30Kg.m 2 (52,3%) (p < 0,001), ?cido ?rico elevado (62,5%) (p = 0,050) e hist?rico familiar de hipertens?o arterial (38,5%) (p < 0,001). A an?lise multivariada dos dados apontou que o ?ndice de massa corp?rea acima de 30 kg.m 2 , grau de escolaridade menor que 10 anos de estudo (p < 0,001) e antecedentes familiares de hipertens?o arterial (p = 0,002) permaneceram associados ? s?ndrome metab?lica. Considera-se que as mulheres com PE pr?via apresentavam uma elevada preval?ncia da s?ndrome metab?lica e de seus componentes individuais em rela??o ?s normais, em particular, a press?o arterial sist?lica e diast?lica alteradas, os n?veis baixos da concentra??o de lipoprote?nas de alta densidade e a hiperglicemia. Os fatores independentemente associados a esse desfecho foram: obesidade, grau de escolaridade inferior a 10 anos e hist?rico familiar de hipertens?o arterial. De forma geral, este estudo identificou mulheres jovens com hist?rico de PE expostas a um risco cardiovascular mais elevado do que as normais

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-15T00:07:45Z No. of bitstreams: 1 ErikaPaulaSilvaFreitasDeOliveira_DISSERT.pdf: 1875508 bytes, checksum: 4bfd3ff4fc3e27d660f60ba378499f40 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-16T23:28:34Z (GMT) No. of bitstreams: 1 ErikaPaulaSilvaFreitasDeOliveira_DISSERT.pdf: 1875508 bytes, checksum: 4bfd3ff4fc3e27d660f60ba378499f40 (MD5) / Made available in DSpace on 2017-03-16T23:28:34Z (GMT). No. of bitstreams: 1 ErikaPaulaSilvaFreitasDeOliveira_DISSERT.pdf: 1875508 bytes, checksum: 4bfd3ff4fc3e27d660f60ba378499f40 (MD5) Previous issue date: 2016-12-01 / A s?ndrome metab?lica (SM) ? uma doen?a multifatorial, cujas altera??es fisiopatol?gicas podem comprometer o status de zinco. O objetivo deste estudo foi avaliar os biomarcadores do status de zinco e as associa??es com fatores de risco cardiometab?licos em indiv?duos com SM. Trata-se de um estudo tipo caso-controle, desenvolvido com 88 adultos e idosos com SM, caracterizados segundo os crit?rios do National Cholesterol Education Program - Adult Treatment Panel III (NCEP/ATP-III), e 37 indiv?duos sem SM ou outra condi??o cl?nica com influ?ncia nos par?metros de zinco. Foram realizadas avalia??es cl?nicas, antropom?tricas, perfil lip?dico, glic?mico e inflamat?rio. Verificou-se a ingest?o de zinco, concentra??es de zinco no plasma e eritr?cito, bem como a excre??o de zinco na urina, pelo m?todo de espectrofotometria de absor??o at?mica. Diferen?as entre os grupos foram avaliadas por modelos de regress?o. Correla??es foram identificadas pelo coeficiente de Pearson (r). A idade m?dia dos participantes foi de 50 (11) anos e 44 (11) anos para o grupo de pacientes com SM e controles, respectivamente. A m?dia da ingest?o cal?rica di?ria foi significativamente maior para os pacientes com SM (p = 0,003), e a ingest?o diet?tica de ambos os grupos caracterizou-se como hiperproteica, normoglic?dica e normolip?dica. O consumo m?dio de zinco foi significantemente menor no grupo SM comparado com o controle (6,57(1,64) mg/dia vs 9,37(2,41) mg/dia; p<0,001). N?o foram observadas diferen?as significativas nas concentra??es de zinco no plasma (88,81(18,28) ?g/dL vs 87,82(17,44) ?g/dL; p>0,05). Identificou-se concentra??es significantemente maiores de zinco no eritr?cito no grupo SM (47,47(8,29) ?g/gHb vs 41,43(7,37) ?g/gHb; p<0,001), independente dos ajustes por covari?veis. A excre??o de zinco na urina foi significantemente maior no grupo SM (554,80(291,00-787,60) ?g/24h vs 375,40(197,60-597,50) ?g/24h; p=0,008), e os ajustes por idade e sexo explicaram 21% das diferen?as (R2=0,21; p<0,001). No grupo SM foram constatadas associa??es significativas entre zinc?ria e a glicemia de jejum (r=0,479), circunfer?ncia da cintura (r=0,253), triglicer?deos (r=0,360), hemoglobina glicada (HbA1c) (r=0,250), Homeostasis model assessment ? insulin resistance (HOMA-IR) (r=0,223) e prote?na C reativa ultra-sens?vel (PCR-us) (r=0,427) (todos p<0,05). Na SM observamos inadequa??es na ingest?o de zinco e confirmamos comprometimento no status de zinco, caracterizadas por aumento do zinco no eritr?cito e maior zinc?ria, embora as concentra??es de zinco no plasma estejam dentro dos valores de refer?ncia. Altera??es dos fatores de risco cardiometab?licos influenciam na zinc?ria de pacientes com SM. / Metabolic syndrome (MS) is a multifactorial disease whose pathophysiological alterations might compromise zinc status. The aim of this study was to evaluate zinc status biomarkers and their associations with cardiometabolic risk factors in individuals with MS. This is a study case-control, developed with 88 adults and elderly with SM, according to the National Cholesterol Education Program - Adult Treatment Panel III (NCEP / ATP-III), and 37 individuals without MS or other clinical condition with influence on zinc status. Clinical and anthropometric assessments were performed and lipid, glycemic, and inflammatory profiles were also obtained. It was evaluated zinc intake, plasma zinc, erythrocyte zinc, and urinary zinc excretion levels, by atomic absorption spectrophotometry. Differences between groups were evaluated by regression models. Correlations were identified by Pearson coefficient (r). The average age of participants was 50 (11) years and 44 (11) years for the group of patients with MS and controls, respectively. The average energy intake was significantly higher in patients with MS (p = 0.003) and dietary intake in both groups was characterized as high percentage of protein intake, and a proper percentage of carbohydrate and fat intake. Zinc intake average was significantly lower in MS group compared with control group (6.57 (1.64) mg/day vs 9.37 (2.41) mg/day; p < 0,001). No significant differences were observed in plasma zinc levels (88.81(18.28) ?g/dL vs 87.82(17.44) ?g/dL; p > 0.05). It was found significantly higher erythrocyte zinc levels in the MS group (47.47(8.29) ?g/gHb vs 41.43(7.37) ?g/gHb;p < 0.001) independent from co-variable adjustments. Urinary zinc excretion level was significantly higher in the MS group (554.80(291.00-787.60) ?g/24h vs 375.40(197.60-597.50) ?g/24h; p = 0.008), and adjustments for age and sex explained 21% of the difference, (R2 = 0.21, p < 0.001). SM group were found significant associations between zincuria and fasting blood glucose level (r = 0.479), waist circumference (r = 0.253), triglyceride levels (r = 0.360), glycated hemoglobin (HbA1c) levels (r = 0.250), homeostatic model assessment - insulin resistance (HOMA-IR) (r = 0.223) and high-sensitivity C-reactive protein levels (hs-PCR) (r =0.427) (all p <0.05). In SM we confirmed inadequacies in zinc intake and confirmed impairments in zinc status, characterized by increasing the erythrocytes zinc and higher zincuria, although plasma zinc levels were within the reference values. plasm zinc levels into references values. Alterations in cardiometabolic risk factors influence zincuria in patients with MS.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-21T18:57:51Z No. of bitstreams: 1 SephoraLouyseSilvaDeAquino_DISSERT.pdf: 1193820 bytes, checksum: 6fae5e7a49aca61ea1d816758627555e (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-28T00:43:51Z (GMT) No. of bitstreams: 1 SephoraLouyseSilvaDeAquino_DISSERT.pdf: 1193820 bytes, checksum: 6fae5e7a49aca61ea1d816758627555e (MD5) / Made available in DSpace on 2017-03-28T00:43:51Z (GMT). No. of bitstreams: 1 SephoraLouyseSilvaDeAquino_DISSERT.pdf: 1193820 bytes, checksum: 6fae5e7a49aca61ea1d816758627555e (MD5) Previous issue date: 2016-11-22 / O risco de s?ndrome metab?lica pode ser influenciado pelo status inadequado de vitamina D, sendo a exposi??o ? luz solar a principal fonte externa desta vitamina. O objetivo do estudo foi avaliar a influ?ncia dos fatores ambientais, biol?gicos e nutricionais em fun??o das esta??es do ano no status de 25OHD em pacientes com s?ndrome metab?lica. Estudo transversal desenvolvido com 180 indiv?duos adultos e idosos com idade entre 18-80 anos, ambos os sexos, com diagn?stico de s?ndrome metab?lica, segundo os crit?rios do National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). Foi considerada como vari?vel dependente a concentra??o de 25OHD; e como vari?veis independentes: idade, sexo, cor da pele, uso de filtro solar, fototipo de pele, escore de exposi??o solar, ?ndice de radia??o ultravioleta (IRUV), localiza??o geogr?fica, esta??es do ano, ?ndice de massa corporal (IMC), rela??o cintura-quadril (RCQ), circunfer?ncia da cintura (CC), paratorm?nio (PTH), c?lcio total s?rico, al?m do c?lcio e vitamina D da dieta. Potenciais preditores para a magnitude do status de 25OHD foram investigados por meio de 16 modelos de regress?o linear univariado, e sete modelos de regress?o m?ltipla. Foram estabelecidas medidas de associa??o e correla??o. O n?vel de signific?ncia adotado foi 5%. O status de 25OHD foi significativamente diferente entre inverno e ver?o (P=0,017). A m?dia de 25OHD indicou insufici?ncia no inverno (25,89ng/mL+7,61) e sufici?ncia no ver?o (31,81ng/mL+10,22), com aumento de 5,59ng/mL no ver?o. No modelo de regress?o linear simples, a concentra??o de 25OHD associou-se significativamente com o ver?o (P=0,003), de modo que a vari?vel esta??o do ano explicou 4,2% da variabilidade do status de 25OHD. O escore de exposi??o solar foi significativamente associado com a concentra??o de 25OHD (P=0,008), explicando 3,4% da variabilidade. No modelo de regress?o m?ltipla, sexo (P=0,027), RCQ (P=0,027), escore de exposi??o solar (P=0,006) e inverno vs. ver?o (P=0,004), explicaram 10,4% da varia??o da concentra??o de 25OHD. Os homens tiveram a concentra??o de 25OHD 3,71ng/mL maior do que as mulheres. O aumento de 1,0 unidade no escore de exposi??o solar, resultou no acr?scimo de aproximadamente 0,16ng/mL na concentra??o de 25OHD. A RCQ teve associa??o inversa com a concentra??o de 25OHD. A esta??o do ano ver?o e a exposi??o solar influenciaram no status de 25OHD dos indiv?duos com s?ndrome metab?lica residentes de uma regi?o do Brasil com elevados ?ndices de radia??o ultravioleta. / The risk of metabolic syndrome can be influenced by inadequate vitamin D levels, and exposure to sunlight is the main external source of vitamin D. This study assessed the influence of environmental, biological and nutritional factors as a function of seasons on the 25OHD status among individuals with metabolic syndrome. A cross-sectional study was developed with 180 adult and elderly individuals of both genders, between 18-80 years of age, with metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The 25OHD concentration was considered dependent variable; the independent variables were age, gender, skin color, use of sunscreen, skin type, sun exposure score, ultraviolet index (UVI), geographic location, season, body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), parathyroid hormone (PTH) level, total serum calcium level, and diet levels of calcium and vitamin D. The potential predictors for the 25OHD levels were investigated using 16 univariate linear regression models and seven multiple regression models. Measures of association and correlation were established and statistical significance was assumed for P < 0.05 (5%). The 25OHD status differed significantly between winter and summer (P = 0.017). The average 25OHD level was insufficient during the winter (25.89 ? 7.61 ng/mL) and sufficient during the summer (31.81 ? 10.22 ng/mL), with an increase of 5.59 ng/mL in the summer. In the simple linear regression model, 25OHD concentration was significantly associated with the summer season (P = 0.003); the season variable explained 4.2% of the variability in 25OHD concentration. The sun exposure score was significantly associated with 25OHD concentration (P = 0.008), explaining 3.4% of the variability. In the multiple regression model, gender (P = 0.27), WHR (P = 0.27), sun exposure score (P = 0.006), and winter vs. summer (P = 0.004) explained 10.4% of the variation in 25OHD concentration. Men had a 25OHD concentration 3.71 ng/mL higher than that of women. An increase of 1.0 unit in the sun exposure score resulted in an increase of approximately 0.16 ng/mL on 25OHD concentration. WHR showed an inverse association with the 25OHD concentration. The summer season and sun exposure influenced the 25OHD status in individuals with metabolic syndrome living in a region of Brazil with a high ultraviolet radiation index.

Made available in DSpace on 2015-04-14T13:54:00Z (GMT). No. of bitstreams: 1 447889.pdf: 2289503 bytes, checksum: 1234922077e7ae93bb35fed2dc89d12d (MD5) Previous issue date: 2013-03-11 / INTRODUCTION : Metabolic syndrome (MS) has a high prevalence among the elderly. In its management, are included drug and non-drug measures, such as diet and regular physical exercise. In this context, treatment compliance is essential for successful treatment. The present studi aims at describing the prevalence of adherence to medication and non-medication in elderly patients with metabolic syndrome, followed by the Primary Health Care (PHC) and association with demographic, socio-cultural-economic and clinics. METHODS : Cross-sectional and observational, conducted with 110 elderly individuals, diagnosed with Metabolic Syndrome by NCEP-ATP III criteria, from the "Clinical and Epidemiological Study of Elderly followed by the PHC in the city of Porto Alegre (EMISUS)". To evaluate adherence to medication was used the Measure Treatment Adherence (MTA). To evaluate adherence to diet and exercise, it was used a questionnaire developed by the authors of the study, based on the recommendations of the First Brazilian Guidelines for Metabolic Syndrome. RESULTS : The mean age of the sample was 68.3 ? 6.6 years (61-90 years). Most composed by elderly women (N = 74, 67.3%) and the most frequent age group was 60-69 years old (64.5%). From the 110 patients included, 100 were using daily medications, from which antihypertensives were the most prevalent (87%). The average score of the MAT was 5.5 ? 0.4 and the median 5.5 (used as a cutoff to determine compliance). Fifty six percent of the elderly (95% CI = 25 to 42.7%) were considered adherent to medication. From the statistically significance associations between adherence to therapy with gender and cardiovascular risk (CV), women were significantly more adherent than men, and elderly with low CV risk were more adherent than those at intermediate risk and high. It was not verified a statistically significant association between medication adherence and education, income and polypharmacy. Of the total sample, 82 (74.5%) patients received some nutritional guidance, from which 33.9% (95% CI = 25 to 42.7%) were adhered to the diet. Reducing salt food item was the diet with greater adherence (89.1%), and lower adherence item (59.7%) was related to whole kinds of foods. The most cited reason for non-adherence to diet was lack of persistence (38.9%). Only 23.6% (CI-15 0.7 to 31, 5%) of the elderly adhered to exercise. Physical problems such as arthritis and back pain, both with 26.9%, were the main reasons for non-adherence. There were no statistically significant differences between the non-drug treatment adherence with demographic, socio-cultural-economic and cardiovascular risk. CONCLUSION : We found that in elderly patients with metabolic syndrome followed by Primary Health Care, the prevalence of adherence to drug therapy was 56%, adherence to diet was 33,9% and adherence to exercise was 23.6%, which is statistically significant between medication adherence and cardiovascular risk. / INTRODU??O : A S?ndrome Metab?lica (SM) apresenta uma preval?ncia elevada entre a popula??o idosa. No seu manejo, est?o inclu?das medidas medicamentosas e n?o medicamentosas, como dieta e pr?tica regular de exerc?cio f?sico. Neste contexto, a ades?o ao tratamento ? essencial para o sucesso do tratamento. OBJETIVOS : Descrever a preval?ncia da ades?o ao tratamento medicamentoso (ATM) e n?o medicamentoso em idosos portadores de s?ndrome metab?lica, atendidos na Estrat?gia Sa?de da Fam?lia (ESF) e sua associa??o com vari?veis demogr?ficas, socioculturais, econ?micas e cl?nicas. M?TODOS : Estudo transversal e observacional, realizado com 110 idosos com diagn?stico de SM pelo crit?rio do NCEP-ATP III, participantes do Estudo Epidemiol?gico e Cl?nico dos Idosos Atendidos pela ESF do Munic?pio de Porto Alegre (EMISUS). Para avalia??o da ades?o ao tratamento medicamentoso foi utilizada a Medida de Ades?o ao Tratamento (MAT utilizado, como ponto de corte para determina??o de ades?o/n?o ades?o ao tratamento, a mediana da MAT). Para avalia??o da ades?o ? dieta e ao exerc?cio f?sico, foi utilizado um question?rio desenvolvido pelas autoras, com base nas recomenda??es da I Diretriz Brasileira de S?ndrome Metab?lica. O uso de cinco ou mais medicamentos por dia foi considerado polifarm?cia. RESULTADOS : A m?dia de idade da amostra foi 68,3?6,6 anos (61-90 anos). A maioria dos idosos eram mulheres (N= 74; 67,3%). A faixa et?ria mais frequente foi a de 60-69 anos (64,5%). Dos 110 idosos avaliados, 100 utilizam medica??es diariamente (90,9%), com um n?mero m?dio de 3,65?1,55. Entre o uso de anti-hipertensivos, hipoglicemiantes/insulina e antihipolipemiantes, o grupo dos anti-hipetensivos foi o mais frequentemente utilizados (87%). A pontua??o m?dia da MAT foi 5,5?0,4 e a mediana 5,5. Cinquenta e seis por cento dos idosos (IC 95%= 25-42,7%) foram considerados aderentes ao tratamento medicamentoso. Observou-se diferen?a estatisticamente significativa da ATM com sexo e risco cardiovascular (CV), sendo que as mulheres mostraram-se significativamente mais aderentes do que os homens e os indiv?duos com baixo risco CV foram mais aderentes dos que 12 os de risco intermedi?rio e alto. N?o foi verificada associa??o com escolaridade, renda e polifarm?cia. Receberam alguma orienta??o alimentar 82 idosos (74,5%), sendo considerados aderentes ? dieta 33,9% deles (IC 95%= 25-42,7%). A redu??o do sal foi considerado o item da dieta com maior ades?o (89,1%) e o item de menor ades?o foi o dos alimentos integrais (59,7%). A falta de persist?ncia foi o motivo para n?o ades?o ? dieta, mais frequentemente citado (38,9%). Em rela??o ao exerc?cio f?sico, apenas 23,6% dos idosos (IC-15,7-31,5%) aderiam ? pr?tica. Problemas f?sicos como artrose e lombalgia foram apontados como os principais motivos para a n?o ades?o (26,9%). N?o foi observada diferen?a estat?stica significativa da ades?o ? dieta e ao exerc?cio f?sico com as vari?veis demogr?ficas, socioculturais, econ?micas e risco cardiovascular. CONCLUS?O : Constatou-se que, em idosos portadores de s?ndrome metab?lica, acompanhados pela ESF, a preval?ncia da ades?o ao tratamento medicamentoso foi 56%, ades?o ? dieta 33,9% e ades?o ao exerc?cio f?sico 23,6%. Observou-se associa??o estatisticamente significativa da ades?o ao tratamento medicamentoso com sexo e risco cardiovascular.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-18T22:30:52Z No. of bitstreams: 1 DISSERTA??O TACIANE.pdf: 1332823 bytes, checksum: 16624f495ae47a3674ddd9369197c8bf (MD5) / Made available in DSpace on 2016-10-18T22:30:52Z (GMT). No. of bitstreams: 1 DISSERTA??O TACIANE.pdf: 1332823 bytes, checksum: 16624f495ae47a3674ddd9369197c8bf (MD5) Previous issue date: 2015-03-31 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Metabolic syndrome is a set of changes consisting of dyslipidemia, glucose intolerance, hypertension, obesity and hyperinsulinemia. The study of this syndrome is of great importance to public health, since it can lead to negative outcomes that could increase their risk of cardiovascular disease in the general population. OBJECTIVE: Investigate the occurrence of metabolic syndrome and associated factors in adults treated in public health services in the city of Feira de Santana - BA. METHOD: epidemiological study, cross-sectional and exploratory conducted in 479 adults aged at least 20 years, seen at public health services in the fair city of Santana - BA. Information was obtained through structured questionnaires, anthropometric clinical and oral, and biochemists. The diagnosis of metabolic syndrome took into account the criteria proposed by the National Cholesterol Education Program - Adult Treatment Panel III / (NCEP-ATP III) and the International Diabetes Federation (IDF). Prevalence ratios were estimated (PR) and their respective confidence intervals of 95% (95% CI) and statistical significance level of 5%. Multivariate analysis was constructed using Poisson regression. RESULTS: Presented in the form of a scientific paper: "Metabolic syndrome and its associated factors in adults", to be submitted to the Journal Brazilian Archives of Endocrinology and Metabolism. The occurrence of MS ranged from 57% (NCEP / ATP III) to 62% (IDF). In the bivariate analysis female, advanced age, overweight, and some comorbidities proved to be independently associated with MS. In the hierarchic analysis, only BMI ? 30 kg / m? (NCEP-ATPIII) and no measurement of blood pressure periodically (IDF) remained independently associated with metabolic syndrome. CONCLUSIONS: The metabolic syndrome is a public health problem among individuals in this study. The body mass index ? 30 kg / m2 not regular blood pressure measurements are important predictors of the metabolic syndrome in adults. / A S?ndrome Metab?lica ? um conjunto de altera??es constitu?do por dislipidemia, intoler?ncia ? glicose, hipertens?o arterial, obesidade e a hiperinsulinemia. O estudo desta s?ndrome ? de grande relev?ncia para a sa?de p?blica, uma vez que pode ocasionar desfechos negativos capazes de aumentar o risco de doen?as cardiovasculares na popula??o em geral. OBJETIVO: Investigar a ocorr?ncia de S?ndrome Metab?lica e seus fatores associados em indiv?duos adultos atendidos em servi?os de sa?de p?blica no Munic?pio de Feira de Santana ? BA.M?TODO: Estudo epidemiol?gico, transversal, e de car?ter explorat?rio realizado em 479 adultos com idade m?nima de 20 anos, atendidos em servi?os de sa?de p?blica no munic?pio de Feira de Santana ? BA. As informa??es foram obtidas mediante aplica??o de question?rios estruturados, exames cl?nicos antropom?tricos e bucais, e bioqu?micos. O diagn?stico da s?ndrome metab?lica levou em considera??o os crit?rios propostos pelo National Cholesterol Education Program - Adult Treatment Panel III / (NCEP-ATP III) e pela Internacional Diabetes Federation (IDF). Foram estimadas raz?o de preval?ncia (RP) e seus respectivos intervalos de confian?a de 95% (IC 95%) e n?vel de signific?ncia estat?stica de 5%. A an?lise multivariada foi constru?da usando a regress?o de Poisson. RESULTADOS:Apresentados em forma de artigo cient?fico: ?S?ndrome metab?lica e seus fatores associados em indiv?duos adultos?, a ser submetido ? Revista Arquivos Brasileiros de Endocrinologia e Metabologia. A ocorr?ncia da SM variou entre 57% (NCEP/ATP III) a62% (IDF). Na an?lise bivariada, sexo feminino, faixa et?ria avan?ada, excesso de peso, e algumas comorbidades mostraram-se independentemente associados com SM. Na an?lise hierarquizada, apenas ?ndice de massa corporal ? 30kg/m? (NCEP-ATPIII) e n?o aferi??o da press?o arterial periodicamente (IDF)permaneceram independentemente associados ? s?ndrome metab?lica.CONCLUS?ES: A s?ndrome metab?lica representa um problema de Sa?de P?blica entre os indiv?duos desse estudo. O ?ndice de massa corporal ? 30kg/m2 a n?o aferi??o regular da press?o arterial s?o potenciais preditores da s?ndrome metab?lica em adultos.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2017-11-27T20:53:26Z No. of bitstreams: 1 edilenemqa-tese.pdf: 4986958 bytes, checksum: 98721b3ed915b46fe60ca445665ea3ca (MD5) / Made available in DSpace on 2017-11-27T20:53:26Z (GMT). No. of bitstreams: 1 edilenemqa-tese.pdf: 4986958 bytes, checksum: 98721b3ed915b46fe60ca445665ea3ca (MD5) Previous issue date: 2016-09-26 / Metabolic syndrome (MS) is a complex disorder with a strong genetic basis and multifactorial etiology. Insulin resistance (IR) causes MS and it can be triggered by intestinal inflammation like the use of lactose in patients intolerant of this carbohydrate. It was found that variants in the lactase gene are associated with lactase non persistence LNP and MS in a population sample of Salvador/Bahia; and whether these variants are modifying the response to diet-therapeutic intervention in patients with this syndrome; also compared the biochemical test of lactose tolerance (LTT) with genetic diagnosis; and tested the association of mutations in the lactase gene with cofactors SM (TGL, HDL-C, blood pressure, glucose levels, waist circumference), with anthropometric variables (Arm Circumference, Body Mass Index, Hip Circumference, hip-waist ratio,lean massand fat mass percentages) and other factors associated with MS: insulin, total cholesterol, LDL-C, VLDL-C, C-reactive protein, HOMA-IR, renal function (creatinine, urea, uric acid, microalbuminuria) and vitamin D. There were two studies: a case-control with 257 cases (MS) and 210 controls and other clinical trial study, which was conducted with three types of diet in patients with metabolic syndrome: diet 1 - No lactose; Diet 2 - Lactose and energy restriction; Diet 3 - Only energy restriction. In all groups were also evaluated for nine SNPs in the lactase (LCT) gene. The genotyping of SNPs was carried out by TaqMan assays. Data were analyzed using SPSS, 20.0, and the Hardy-Weinberg Equilibriumhaplotype frequencies were calculated using Arlequin, 2000 program. The results showed that all diets improve several MSaspects after two months of intervention, especially in the diet 1, that also decreased inflammation, insulin resistance and dyslipidemia (LDL-C). In addition,it was the diet that most took out patients of the MS: 2.72 times more likely to get out of MS than diet 3. LNP was high in both cases and controls. There was compatibility between clinical diagnosis for LNP by Lactose Tolerance Test and two of the studied SNPs, they were rs4988253 and rs182549, those that have proved functional studies. Thus, it is suggested the analysis of LCT gene polymorphisms before the nutritional therapeutics for patients with MS, as well as to take out the lactose in their diet. / A S?ndrome Metab?lica (SM) ? uma desordem complexa, de forte base gen?tica e de etiologia multifatorial. Dentre as suas causas, encontra-se a Resist?ncia ? Insulina (RI) que pode ser desencadeada pela inflama??o intestinal, pelo uso de lactose em pacientes intolerantes a este carboidrato. Verificou-se quais variantes no gene da lactase est?o associados ? IL e SM em amostra da popula??o de Salvador/Bahia; e tamb?m se estas variantes s?o modificadoras da resposta ? interven??o dietoter?pica em portadores desta s?ndrome; comparou-se tamb?m o teste bioqu?mico de toler?ncia ? lactose (TTL) com o diagn?stico gen?tico; e testou-se a associa??o das muta??es no gene da lactase com os cofatores da SM (TGL, HDL-c, press?o arterial, glicemia, circunfer?ncia da cintura), com vari?veis antropom?tricas (circunfer?ncia do bra?o, ?ndice de massa corporal, circunfer?ncia do quadril, raz?o cintura quadril, percentual de massa magra e massa gorda) e com outros fatores associados ? SM: insulina, colesterol total, LDL-C, VLDL, Prote?na C reativa, HOMA-IR, fun??o renal (creatinina, ur?ia, ?cido ?rico, microalbumin?ria) e vitamina D. Foram realizados dois estudos: um caso-controle com 257 casos (SM) e 210 controles e outro estudo de tipo ensaio cl?nico, que foi realizado com tr?s tipos de dieta com os pacientes com SM: dieta 1 ? sem lactose; dieta 2 ? sem lactose e com restri??o energ?tica; Dieta 3 ? apenas restri??o energ?tica. Em ambos os grupos tamb?m foram avaliados 9 SNPs no gene da lactase. A genotipagem dos SNPs foi realizada pela tecnologia de ensaios TaqMan. Os dados foram analisados pelo programa SPSS ver 20.0 e a adequa??o das frequ?ncias genot?picas ao Equilibrio de Hardy-Weinberg e c?lculo da frequ?ncia dos hapl?tipos formados pelos polimorfismos foram obtidos atrav?s do programa Arlequin ver 2000. Os resultados mostraram que todas as dietas melhoram o quadro da SM ap?s dois meses de interven??o, com destaque para a dieta 1, que tamb?m diminuiu a inflama??o, resist?ncia ? insulina e a dislipidemia (LDL-C). Al?m disso foi a dieta que mais tirou paciente da SM: apresentou 2,72 vezes mais chances de sair da SM que a dieta 3. A intoler?ncia ? lactose foi alta tanto em casos como em controles. Houve compatibilidade do TTL com os SNPsrs4988253 e rs182549, os ?nicos que possuem estudos funcionais. Assim, sugere-se an?lise de polimorfismos do gene da lactase antes da prescri??o nutricional para pacientes com SM, bem como, a retirada da lactose da dieta.