Background: Fifty percent of medications are not taken as prescribed. This is a major public health issue yet there is very limited evidence on the factors associated with medicines adherence in people with mild to moderate Intellectually Disabilities and diabetes (IDD). This study evaluated the frequency of, and factors associated with, medicines non-adherence in this group compared to people without ID but with diabetes (non-IDD).Methods: A systematic review of the literature informed the theoretical model tested. A two-stage, sequential mixed methods study with 111 people with type 1 and 2 diabetes, (IDD = 33, non-IDD = 78) was then carried out. Stage one (quantitative) compared frequency of medication adherence in the group overall, IDD and non-IDD. Univariate and multiple regression analysis evaluated associations between factors (ID, depression, side effects, self-efficacy and perceived level of social support) and medicines non-adherence. Stage two (qualitative) explored findings of stage one with 12 stage one participants' carers using semi-structured interviews. Results: Data were collected between July 2014 and May 2016. The frequency of medicines adherence was similar in the IDD and non-IDD population (70% vs 62%, p = 0.41). The theoretical model did not predict medicines non-adherence. After controlling for support with medicines and complexity of regime (number of medications and use of insulin), depression was an independent predictor in the non-IDD and group overall (p < 0.001). In the IDD group, perceived side effects was an important, but non-significant, predictor of non-adherence (p = 0.06). Carers' perceptions of adherence and depression were consistent with stage one findings. Conclusions: Optimising adherence to diabetes medicines is equally challenging in IDD and non-IDD populations. Associations between independent factors and adherence differed between the two groups: in the non-IDD population, depressive symptoms were associated with non-adherence whereas in the IDD population perceived level of side effects appeared most dominant. Due to small sample sizes findings were inconclusive therefore, a sufficiently powered study further investigating the relationship between adherence and side effects in people with ID and diabetes is recommended.

Le diabète de type 2 est une pathologie chronique complexe associant une altération de sécrétion de l'insuline par le pancréas et une résistance à l'insuline au niveau des tissus périphériques, notamment au niveau du foie et du muscle squelettique. Son origine est multifactorielle, alliant des anomalies génétiques et environnementales, en particulier nutritionnelles. Un des mécanismes par lesquels les facteurs nutritionnels (comme les glucides et les lipides en excès) contribuent au développement du diabète et à son aggravation est la glucolipotoxicité. En effet, l'élévation de la glycémie et des lipides plasmatiques, ainsi que l'accumulation ectopique de lipides dans les tissus, participent au développement de l'insulinorésistance hépatique et musculaire et aux dysfonctions des cellules bêta, en partie via l'induction d'un stress métabolique, impliquant notamment le stress oxydant, le stress du réticulum endoplasmique (RE) et la perturbation de l'homéostasie calcique. Nous avons étudié les effets de la glucotoxicité et de la lipotoxicité dans les cellules bêta pancréatiques et les mécanismes impliqués. Nous nous sommes aussi intéressés à des traitements potentiellement protecteurs de la fonction bêta-pancréatique. Nous avons fait l'hypothèse que les effets bénéfiques de l'inhibition du système rénine-angiotensine sur l'incidence du diabète de type 2 chez l'homme étaient médiés par une action directe sur les cellules bêta. Nos résultats montrent que le glucose chronique à une dose élevée entraine une réduction de la sécrétion d'insuline des cellules bêta des îlots de Langerhans humains par une action conjointe sur le stress du RE, le stress oxydant et l'homéostasie calcique. L'inhibition du SRA a permis de restaurer cette fonction grâce notamment à une action inhibitrice sur la voie Phospholipase C-IP3-Calcium / This study addressed the hypothesis that inhibiting the soluble epoxide hydrolase (sEH)-mediated degradation of epoxy-fatty acids, notably epoxyeicosatrienoic acids, has an additional impact against cardiovascular damage in type 2 diabetes, beyond its previously demonstrated beneficial effect on glucose homeostasis. The cardiovascular and metabolic effects of the sEH inhibitor t- AUCB (10 mg/l in drinking water) were compared to those of the sulfonylurea glibenclamide (80 mg/l), both administered for 8 weeks in FVB mice subjected to a high-fat diet (HFD, 60% fat) for 16 weeks. Mice on control chow diet (10% fat) and non-treated HFD mice served as controls. Glibenclamide and t-AUCB similarly prevented the increased fasting glycemia in HFD mice but only t-AUCB improved glucose tolerance and decreased gluconeogenesis, without modifying weight gain. Moreover, t-AUCB reduced adipose tissue inflammation, plasma free fatty acids and LDL cholesterol, and prevented hepatic steatosis. Furthermore, only the sEH inhibitor improved endothelium-dependent relaxations to acetylcholine, assessed by myography in isolated coronary arteries. This improvement was related to a restoration of epoxyeicosatrienoic acid and nitric oxide pathways, as shown by the increased inhibitory effects of the NO-synthase and cytochrome P450 epoxygenase inhibitors, L-NA and MSPPOH, on these relaxations. Moreover, t-AUCB decreased cardiac hypertrophy, fibrosis and inflammation, and improved diastolic function, as demonstrated by the increased E/A ratio (echocardiography) and decreased slope of the enddiastolic pressure-volume relation (invasive hemodynamics). These results demonstrate that she inhibition improves coronary endothelial function and prevents cardiac remodeling and diastolic dysfunction in obese type 2 diabetic mice

Le diabète de type 2 (DT2) est associé à un risque athéro-thrombotique élevé, en partie dû à l'hyperactivation plaquettaire et aux dyslipoprotéinémies. Les lipoprotéines de haute densité (HDL) possèdent des propriétés anti-athérogènes et subissent des modifications glycoxydatives lors du DT2. Notre objectif a été de déterminer les effets d'HDL glycoxydées in vitro ou de DT2 sur les plaquettes sanguines humaines et de déterminer leur contenu en lipides oxydés. Les HDL glycoxydées possèdent des proportions moindres d'acides linoléique et arachidonique dans les phospholipides (PL) et esters de cholestérol, des concentrations plus élevées de dialdéhyde malonique et des principaux acides gras hydroxylés (AGOH) dont les 9-HODE, 13- HODE et 15-HETE dans toutes les classes lipidiques, en particulier dans les PL ainsi que des concentrations très faibles de vitamine E comparativement aux HDL contrôles. Les HDL glycoxydées in vitro et de patients DT2 inhibent de façon dose-dépendante l'agrégation plaquettaire induite par le collagène via le récepteur SR-BI. Ces HDL glycoxydées diminuent la phosphorylation des p38 MAPK et cPLA2 plaquettaires. D'autre part, des HDL contrôles enrichies avec le PC(16:0/13-HODE) inhibent fortement l'agrégation comparativement aux HDL contrôles. De plus, les effets des sous-classes d'HDL, HDL 2 & 3, de DT2 et de témoins ont été testés sur l'agrégation plaquettaire. Les HDL2 de DT2 possèdent des concentrations d'AGOH plus élevées que les HDL3 de DT2 et tendent à inhiber plus l'agrégation plaquettaire. En conclusion, nos résultats montrent que les HDL glycoxydées de patients diabétiques ne perdent pas leurs propriétés anti-agrégantes, qui pourraient être médiées par certaines PL oxydés / Type 2 diabetes (T2D) is associated with a high athero-thrombotic risk, partly due to platelet hyperactivation and dyslipoproteinemia. High-density lipoproteins (HDL) possess antiatherogenic properties and undergo glycoxidation changes in T2D. Our objective was to determine the effects of glycoxidized HDL in vitro or from T2D patients on human blood platelets and to identify their oxidized lipid species. Compared to control HDL, glycoxidized HDL have lower proportions of linoleic and arachidonic acids in phospholipids (PL) and cholesteryl esters, higher concentrations of malondialdehyde and main hydroxylated fatty acid (HOFA) including 9-HODE, 13-HODE and 15-HETE in all lipid classes, especially in PL, and very low concentrations of vitamin E. In vitro glycoxidized and T2D HDL dose-dependently inhibit platelet aggregation induced by collagen via the SR-BI receptor. Glycoxidized HDL decrease the phosphorylation of platelet p38 MAPK and cPLA2. On the other hand, control HDL enriched with oxidized phospholipids i.e. PC(16:0/13-HODE) strongly inhibit platelet aggregation compared to controls. Moreover, the effects of HDL subclasses, HDL 2 & 3, from T2D patients and healthy controls were tested on platelet aggregation. T2D HDL2 have higher concentrations of HOFA than T2D HDL3 and tend to inhibit platelet aggregation to a greater extent. In conclusion, our results show that T2D glycoxidized HDL do not lose their anti-aggregatingproperties and are even more effective than control HDL. These anti-aggregatory effects could be partly due to some oxidized PL species

L’obésité est devenue un véritable problème de santé publique. Elle est fréquemment associée à plusieurs anomalies cardiométaboliques telles que l’hypertension artérielle, l’insulinorésistance et les dyslipidémies qui font le lit du diabète de type 2 et des maladies cardiovasculaires. Cependant la fréquence de ces anomalies varie considérablement parmi les sujets obèses faisant de cette maladie chronique une situation clinique très hétérogène. A ce titre un nouveau concept a émergé, impliquant une population de patients sans facteurs de risque apparents, appelé « obèse métaboliquement sain » ou « metabolically healthy obese » (MHO). Des efforts sont en cours pour comprendre les mécanismes sous-jacents à ce phénotype et ses conséquences à long terme. L’objectif principal de cette thèse était d’étudier le lien entre le phénotype MHO et diverses pathologies chroniques connues pour être associées à l’obésité. Les données provenant des cohortes Whitehall II et GAZEL ont été utilisées pour examiner les associations entre le phénotype MHO et la mortalité, les maladies cardiovasculaires, le diabète de type 2 et la dépression. En comparaison aux sujets de poids normal métaboliquement sains, les individus MHO ont un risque accru de mortalité globale et cardiovasculaire, de diabète de type 2 et de maladies cardiovasculaires mais pas de dépression. Comparés aux sujets obèses avec anomalies métaboliques, les individus MHO ont un risque similaire de mortalité et de maladies cardiovasculaires, mais un moindre risque de diabète de type 2 et dépression. Nos résultats suggèrent que l’obésité à profil cardiométabolique normal n’est pas une condition bénigne. Une meilleure compréhension de ce phénotype contribuera à améliorer la décision thérapeutique et aidera peut-être à identifier des cibles thérapeutiques nouvelles. / Obesity has become a major public health concern. It is frequently associated with several cardiometabolic abnormalities such as hypertension, insulin resistance and dyslipidemia leading to type 2 diabetes and cardiovascular disease. However, the frequency of these abnormalities varies widely among obese subjects, making this chronic condition a very heterogeneous clinical situation. As such a new concept has emerged, involving a population of patients without metabolic risk, called "metabolically healthy obese" (MHO). Intense interest surrounds the MHO phenotype with on-going efforts to understand the mechanisms underlying this phenotype and its long-term consequences. The main objective of this thesis was to study the relationship between the MHO phenotype and various chronic diseases known to be associated with obesity. Data from the Whitehall II and GAZEL cohorts were used to examine associations between this phenotype and mortality, cardiovascular diseases, type 2 diabetes, and depression. Compared to metabolically healthy normal weight subjects, MHO individuals have an increased risk of overall and cardiovascular mortality, type 2 diabetes and cardiovascular diseases, but not depression. Compared to metabolically unhealthy obese subjects, MHO individuals have a similar risk of mortality and cardiovascular disease, but a lower risk of type 2 diabetes, and depression. Our results suggest that obesity with normal cardiometabolic profile is not a benign condition. A better understanding of this phenotype will enhance therapeutic decision making and possibly help to identify new therapeutic targets.

Le diabète de type 2 (DT2) est une maladie chronique associée à de graves et coûteuses complications. Dans un contexte de restriction budgétaire, il est nécessaire de pouvoir estimer les ressources à affecter à la prise en charge des maladies chroniques et donc de suivre l’évolution épidémiologique et économique d’une telle maladie. Une base de données a été construite à partir des données médico-administratives de l’assurance maladie luxembourgeoise. Elle comprenait les consommations de soins, associées au diabète et ses complications, des patients diabétiques de type 2 traités entre 2000 et 2006. L’objectif était d’étudier les champs d’utilisation de ces données et leurs applications possibles pour les décisions en santé publique. Cette thèse en donne quelques exemples. En 2006, la prévalence du DT2 au Luxembourg était de 3,79% (N= 17 070). Un algorithme a permis d’identifier trois stades de la néphropathie diabétique (3,77% des cas de DT2 en 2006). L’analyse de l’adhérence aux recommandations européennes de bonnes pratiques médicales a mis en évidence une situation critique associée à certains facteurs (médecin traitant, type de traitement, région de résidence…). Les dépenses moyennes d’un patient en hémodialyse a été estimé à 116 647€/patient en 2006. Enfin, une analyse médico-économique a montré la dominance coût-efficace d’une stratégie d’implémentation de la dialyse péritonéale sur la situation actuelle. Malgré les difficultés à évaluer leur qualité, les données médico-administratives offrent une source d’informations précieuses pour les décideurs publics et les professionnels de la santé, dans le but d’améliorer la prise en charge des patients. / Type 2 diabetes (T2D) is a chronic disease associated with many severe and costly complications. In a context of budgetary constraint, it is necessary to obtain an estimate the amount of resources to allocate to the management of chronic diseases. This includes monitoring the epidemiologic and economic evolutions. A database was built from medico-administrative databases of the national health insurance of Luxembourg. It included the healthcare consumptions associated with diabetes and its complications, of all type 2 diabetic patients treated in Luxembourg between 2000 and 2006. The objectives were to study the fields of use of this database and the possible applications for public health decision-making. This thesis gives some examples. In 2006, T2D prevalence in Luxembourg was 3.79% (N= 17070). An algorithm was built and permitted to identify three stages of diabetic nephropathy (3.77% of T2D cases in 2006). The analysis of the adherence to European follow-up guidelines showed a critical situation associated to several factors (treating physician, type of treatment, living region…). The mean costs associated with patients in dialysis were estimated at 116 647€/patient in 2006. Finally, a health-economic evaluation showed the dominance of a strategy promoting peritoneal dialysis in Luxembourg over the present situation.

Diabetes mellitus tipo 2 (DM2) está associado a um estado de inflamação crônica e ativação do estresse do retículo endoplasmático (ERE). Nesse contexto, são necessários estudos para encontrar alternativas que melhorem o quadro inflamatório, como os ácidos graxos poli-insaturados ômega 3 (n-3 PUFA), um conhecido agente anti-inflamatório. Esse estudo teve por objetivo avaliar o efeito da suplementação do ácido alfa-linolênico (ALA, um n-3 PUFA) no estresse do retículo endoplasmático e no estado inflamatório no tecido adiposo subcutâneo abdominal (TASC) em pacientes com DM2. Foi conduzido um estudo duplo-cego, prospectivo, placebo-controlado. Vinte pacientes com DM2 foram randomizados para suplementação com 3g/dia de ALA ou placebo durante 60 dias. O tecido adiposo foi coletado através de punção aspirativa por agulha fina do abdome antes e após a suplementação e os genes e proteínas foram avaliados através de PCR em tempo real e western blot. Foi encontrada, após suplementação, uma redução da expressão gênica do XBP1 (20%), sXBP1 (70%) e aumento da expressão gênica do GRP78 (150%), confirmado na expressão proteica. Além disso, foi encontrado aumento da expressão gênica da adiponectina (90%) e redução da expressão gênica do IL-6 (80%) e IRS-1 (60%), sem correlação com a expressão proteica, no tempo pós-suplementação com ALA. Portanto, foi demonstrado que o ALA pode modular o ERE através da via da IRE1/XBP, levando ao aumento das chaperonas (BIP/GRP78), além de um efeito adicional na expressão gênica da adiponectina, IL-6 e IRS-1, o que pode demonstrar um potencial terapêutico do ALA em pacientes com DM2. / Type 2 diabetes mellitus (T2DM) is a state of chronic inflammation and activation of endoplasmic reticulum stress (ERS). In this context, studies are necessaries to find new possibilities to improve this inflammation such as the n-3 polyunsaturated fatty acid (n-3 PUFA) acting as an anti-inflammatory agent. In this study, we aimed to evaluate the effect of n-3 PUFA alpha-linolenic acid (ALA, a n-3 PUFA) supplementation in T2DM patients on the molecular expression of ERS genes in abdominal subcutaneous adipose tissue (SAT). We performed a placebo-controlled study, in a double-blind design with 20 T2DM patients, receiving, randomly, 3g/day of ALA or placebo for 60 days. The adipose tissue was collected by fine-needle aspiration in abdomen before and after the supplementation and the genes and proteins were evaluated by real-time PCR and western blot. It was seen, after the supplementation, a reduction in XBP1 (20%), sXBP1 (70%) and an increase in Grp78 (150%) gene expression, likewise same results in protein concentration. Furthermore, it was observed an increase in adiponectina (90%) gene expression and reduction in IL-6 (80%) and IRS-1 (60%) gene expression, with no correlation to protein expression after supplementation of ALA. Therefore, we have provided evidence that ALA may modulate ERS by the IRE1/XBP pathway leading to an increase in chaperones (BIP/GRP78), additionally its effect on adiponectina, IL-6 and IRS-1 gene expression can demonstrate a therapeutic potential in T2DM.

L’insuline et la sérotonine (5-HT) sont deux acteurs majeurs du maintien de l’homéostasie énergétique, fonction placée sous le contrôle de l’hypothalamus. En ciblant cette région, l’insuline remplit de nombreuses fonctions métaboliques via l’activation de la voie PI3K/Akt. La 5-HT exercent des effets biologiques similaires mais les voies de signalisation impliquées dans ces processus étaient jusqu’alors mal connues. De plus, il avait été démontré que la 5-HT est capable d’activer la voie PI3K/Akt/GSK3β dans l’hippocampe, mécanisme sous-tendant potentiellement les effets antidépresseurs du neurotransmetteur. Les principaux objectifs de cette thèse étaient d’étudier 1/ l’activation de la voie PI3K/Akt par la 5-HT dans l’hypothalamus de rats diabétiques (modèle Goto-Kakizaki) et chercher un potentiel dialogue avec l’insuline and 2/ les mécanismes sous-tendant l’induction de la dépression par une alimentation hyperlipidique, par l’analyse de la phosphorylation d’Akt et GSK3β sous l’action de l’insuline, de la leptine et de la 5-HT dans l’hippocampe de rat.Ici on montre que 1/ la 5-HT stimule la voie PI3K/Akt dans l’hypothalamus et que la phosphorylation d’Akt induite par la 5-HT est atténuée dans des conditions d’insulino-résistance, suggérant l’existence d’un dialogue entre les voies de signalisation de l’insuline et de la 5-HT. Par ailleurs, nos résultats indiquent qu’une alimentation hyperlipidique induit un comportement dépressif réversible chez le rat, qui pourrait impliquer la voie PI3K/Akt/GSK3β dans les neurones subgranulaires du gyrus denté. La mise en évidence d’un dialogue entre les voies de signalisation de la 5-HT, de la leptine et de l’insuline au niveau central enrichit nos connaissances sur le rôle de ces facteurs dans la régulation de l’homéostasie énergétique et de l’humeur, et propose un lien moléculaire entre diabète de type 2, obésité et dépression / Insulin and serotonin (5-HT) are two key players in the maintenance of energy homeostasis which is controlled by the hypothalamus. In this brain region, insulin mediates numerous metabolic effects via the activation of the PI3K/Akt signaling pathway. 5-HT exerts similar biological properties by acting in the hypothalamus but the signaling pathways accountable for these effects are still unclear. Moreover, it has been reported that 5-HT induces the activation of the PI3K/Akt pathway in the hippocampus and the inhibition of GSK3β, suggesting this action as a potential mechanism for the antidepressant effects of this neurotransmitter.The main objectives of this thesis were to study 1/ the serotonin-induced activation of the PI3K/Akt in the hypothalamus of wild type and diabetic rats (Goto-Kakizaki model) and search a potential cross-talk with insulin and, 2/ the mechanisms underlying the high-fat diet induced depression by investigating the role of the phosphorylation of Akt and GSK3β by 5-HT, insulin and leptin in the hippocampus of rats.Here, we show that 5-HT triggers the PI3K/Akt signaling pathway in the rat hypothalamus, and that this activation is attenuated in insulin-resistant conditions, suggesting a cross-talk between insulin and 5-HT. Moreover, we reported that high-fat diet feeding induces a reversible depressive-like behavior, which may involve the PI3K/Akt/GSK3β pathway in subgranular neurons of the dentate gyrus. In conclusion, the activation of the PI3K/Akt pathway and its target GSK3β by 5-HT in the hypothalamus and in the dentate gyrus, respectively, can be impaired in insulin-/leptin-resistant states, which may underlie a link between metabolic diseases and depression.

Made available in DSpace on 2014-06-11T19:30:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-25Bitstream added on 2014-06-13T21:01:31Z : No. of bitstreams: 1 fernandes_ra_dr_rcla.pdf: 1297724 bytes, checksum: 896dd66dcf9341e251f414b66fbe846a (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A prevalência da prática regular de atividades físicas na população adulta brasileira ainda é desconhecida, principalmente em cidades do interior dificultando assim a elaboração de campanhas efetivas na promoção de sua prática. Objetivo: Portanto, o objetivo deste trabalho foi analisar, em adultos de ambos os sexos no Estado de São Paulo, a prevalência da prática regular de atividades físicas e suas associações com as doenças cardio-metabólicas. Métodos: Por meio de amostragem aleatória em diferentes estágios, uma amostra de 2720 adultos (idade > 18 anos) foi selecionada em oito cidades do Estado de São Paulo. As entrevistas foram feitas nos domicílios dos entrevistados através de questionários sobre: (i) Atividade física atual no lazer (fisicamente ativo se ≥180min/sem de atividades moderadas ou vigorosas a mais de 4 meses); (ii) Barreiras pessoais; (iii) Atividade física na infância e adolescência; (iv) Doenças e excesso de peso; (v) Informações gerais (sexo, escolaridade e idade). O teste qui-quadrado analisou associações entre os dados categóricos e a regressão logística analisou a magnitude das mesmas. Resultados: No lazer, homens foram mais ativos do que as mulheres (p= 0,001), bem como, grupos com maior escolaridade (p= 0,007) e menor idade (p= 0,002) foram mais ativos. Moradores da capital foram menos ativos do que moradores do litoral e interior do estado (p= 0,001). Tanto na capital, como no interior e litoral, quanto maior o número de barreiras pessoais, menor a prática de atividades no lazer (p= 0,001 para todos). Adultos que praticaram atividades esportivas na infância e adolescência apresentaram 1,6 vezes mais chances de serem ativos no lazer (p= 0,001). Além disso, indivíduos que foram ativos ao longo da vida apresentaram 45% (p= 0,013), 35% (p= 0,010) e 49% (p= 0,011) menos chance de relatar hipertensão arterial... / Background: Physical activity level in Brazilian adults is unknown, mainly in non-capital cities and this absence of data difficult the implementation of effective promotion programs. Objectives: To analyze, in adults of both genders living in Sao Paul State, the physical activity level and its associations with some diseases. Methods: A sample of 2720 adults has been selected in eight cities of the Sao Paulo State through a multistage random process. Questionnaires were applied through home interviews: (i) current physical activity (physically active: ≥180min/wk of either moderate or vigorous activities for at lest 4 months before the interview); (ii) Personal barriers; (iii) Early physical activity; (iv) Diseases and overweight; (v) general information (gender, schooling and age). Chi-square test analyzed associations among categorical data and logistic regression indicated the magnitude of it. Results: In leisure time, men were more physically active than women (p= 0.001), as well as, groups of higher schooling (p= 0.007) and lower age (p= 0.002). People living in Capital reported lower physical activity practice than those one from coast and non-capital cities (p= 0.001). In all cities, higher number of personal barriers was associated with lower leisure time physical activity (p= 0.001 for all). Adults engaged in sport activities during childhood and adolescence had 1.6 more likely to be active in leisure time (p= 0.001). Moreover, persons persistently active through life had 45% (p= 0.013), 35% (p= 0.010) and 49% (p= 0.011) less likely to report arterial hypertension, dyslipidemia and obesity, respectively. Area residents of places with higher number of public parks were more physically actives (p= 0.005), but not in the Capital (p= 0.982). Conclusions: physical activity level is higher in coast and non-capital cities, as well as, in the Capital there were more personal... (Complete abstract click electronic access below)

Orientador: Angelina Zanesco / Banca: Maria Claudia Costa Irigoyen / Banca: Katia de Angelis / Banca: Henrique Luiz Monteiro / Banca: Rodolfo Franco Puttini / Resumo: Introdução: A prevalência da prática regular de atividades físicas na população adulta brasileira ainda é desconhecida, principalmente em cidades do interior dificultando assim a elaboração de campanhas efetivas na promoção de sua prática. Objetivo: Portanto, o objetivo deste trabalho foi analisar, em adultos de ambos os sexos no Estado de São Paulo, a prevalência da prática regular de atividades físicas e suas associações com as doenças cardio-metabólicas. Métodos: Por meio de amostragem aleatória em diferentes estágios, uma amostra de 2720 adultos (idade > 18 anos) foi selecionada em oito cidades do Estado de São Paulo. As entrevistas foram feitas nos domicílios dos entrevistados através de questionários sobre: (i) Atividade física atual no lazer (fisicamente ativo se ≥180min/sem de atividades moderadas ou vigorosas a mais de 4 meses); (ii) Barreiras pessoais; (iii) Atividade física na infância e adolescência; (iv) Doenças e excesso de peso; (v) Informações gerais (sexo, escolaridade e idade). O teste qui-quadrado analisou associações entre os dados categóricos e a regressão logística analisou a magnitude das mesmas. Resultados: No lazer, homens foram mais ativos do que as mulheres (p= 0,001), bem como, grupos com maior escolaridade (p= 0,007) e menor idade (p= 0,002) foram mais ativos. Moradores da capital foram menos ativos do que moradores do litoral e interior do estado (p= 0,001). Tanto na capital, como no interior e litoral, quanto maior o número de barreiras pessoais, menor a prática de atividades no lazer (p= 0,001 para todos). Adultos que praticaram atividades esportivas na infância e adolescência apresentaram 1,6 vezes mais chances de serem ativos no lazer (p= 0,001). Além disso, indivíduos que foram ativos ao longo da vida apresentaram 45% (p= 0,013), 35% (p= 0,010) e 49% (p= 0,011) menos chance de relatar hipertensão arterial... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Physical activity level in Brazilian adults is unknown, mainly in non-capital cities and this absence of data difficult the implementation of effective promotion programs. Objectives: To analyze, in adults of both genders living in Sao Paul State, the physical activity level and its associations with some diseases. Methods: A sample of 2720 adults has been selected in eight cities of the Sao Paulo State through a multistage random process. Questionnaires were applied through home interviews: (i) current physical activity (physically active: ≥180min/wk of either moderate or vigorous activities for at lest 4 months before the interview); (ii) Personal barriers; (iii) Early physical activity; (iv) Diseases and overweight; (v) general information (gender, schooling and age). Chi-square test analyzed associations among categorical data and logistic regression indicated the magnitude of it. Results: In leisure time, men were more physically active than women (p= 0.001), as well as, groups of higher schooling (p= 0.007) and lower age (p= 0.002). People living in Capital reported lower physical activity practice than those one from coast and non-capital cities (p= 0.001). In all cities, higher number of personal barriers was associated with lower leisure time physical activity (p= 0.001 for all). Adults engaged in sport activities during childhood and adolescence had 1.6 more likely to be active in leisure time (p= 0.001). Moreover, persons persistently active through life had 45% (p= 0.013), 35% (p= 0.010) and 49% (p= 0.011) less likely to report arterial hypertension, dyslipidemia and obesity, respectively. Area residents of places with higher number of public parks were more physically actives (p= 0.005), but not in the Capital (p= 0.982). Conclusions: physical activity level is higher in coast and non-capital cities, as well as, in the Capital there were more personal... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-07-29T15:25:18Z (GMT). No. of bitstreams: 1 Tese Ana Clara M e S Carvalho - Patologia Clinica.pdf: 1557137 bytes, checksum: 899de7fc14fbe34def669ae52588c5f8 (MD5) Previous issue date: 2012-02-27 / Introduction: The dietary fiber, particularly soluble, are assigned the physiological effects that are important for the treatment of patients with type 2 diabetes mellitus. Objective: To evaluate the effect of supplementing wheat dextrin in insulin sensitivity, glycemic control and lipid, and nutritional status of patients with type 2 diabetes mellitus. Methodology: This is a trial blind, randomized, lasting 12 weeks.The sample consisted of 27 type 2 diabetic subjects of both sexes with a BMI &#8805; 25.00 kg/m2 and sedentary. These subjects were randomized into two groups, test (n = 14) and placebo (n = 13). The test group was supplemented daily with 200 ml of orange flavor beverage without the addition of sugar and added 10 g of wheat dextrin, 30 minutes before the lunch. The control group received the same drink daily, but without the addition of fiber. Participants were instructed to maintain their lifestyle (diet and physical activity). Fasting plasma glucose, glycated hemoglobin (A1c), insulin sensitivity, lipid profile, the level of physical activity, intestinal function, food intake, and anthropometric indicators were assessed at baseline, 45 and 90 days intervention. Results: The A1c, fasting glucose and lipid profile showed no significant differences within and between groups. There was an increase in the values of HOMA-IR (p = 0.0163) and fasting insulin (p = 0.0406) at 45 days in the placebo group, with significant difference. The increase in HOMA-IR and fasting insulin resulted in decreased insulin sensitivity in the placebo group. In the test group showed no changes in insulin sensitivity. The test group showed improvement in bowel function. The fiber intake was below the recommendation for the diabetic.Food intake, body weight, BMI and waist circumference (WC) also showed no significant change. The percentage of body fat increased in the placebo group at 45 days (p = 0.0342) and decreased in the test group compared to placebo (p = 0.0216 and 0.0285). The basal metabolic rate (BMR) increased in the test group and decreased in placebo (p = 0.0198 and 0.005). Conclusion: Wheat dextrin in 10g/dia dosage did not improve insulin sensitivity, glycemic control and lipid, did not reduce body weight and WC and does not cause changes in the consumption of energy and macronutrients. There was increased consumption of fiber for the minimum of the recommendation, regulate bowel function, reduced body fat and increased the BMR. / Introdução: À fibra dietética, especialmente a fibra solúvel, são atribuídos efeitos fisiológicos que são importantes para o tratamento do paciente com diabetes mellitus tipo 2. Objetivo: Avaliar o efeito da suplementação de dextrina de trigo na sensibilidade à insulina, controle glicêmico e lipídico, e estado nutricional de portadores de diabetes mellitus tipo 2. Metodologia: Trata-se de um ensaio clínico cego, randomizado com duração de 12 semanas. A amostra foi composta por 27 indivíduos diabéticos tipo 2 de ambos os sexos, com IMC &#8805; 25,00 kg/m2 e sedentários. Estes indivíduos foram randomizados em dois grupos, teste (n=14) e placebo (n=13). O grupo teste foi suplementado diariamente com 200 ml de bebida sabor laranja sem adição de açúcar e adicionada de 10 g de dextrina de trigo, 30 minutos antes do almoço. O grupo placebo recebeu diariamente a mesma bebida, mas sem adição de fibra. Os participantes foram orientados a manter seu estilo de vida (hábitos alimentares e de atividade física). A glicemia de jejum, a hemoglobina glicada (A1c), a sensibilidade à insulina, o perfil lipídico, o nível de atividade física, o funcionamento intestinal, o consumo alimentar, e os indicadores antropométricos foram avaliados no início, aos 45 e aos 90 dias de intervenção. Resultados: A A1c, a glicemia de jejum e o perfil lipídico não apresentaram diferenças significativas intra e entre grupos. Houve aumento nos valores de HOMA-IR (p=0,0163) e insulina de jejum (p=0,0406) aos 45 dias no grupo placebo, com diferença significativa. O aumento de HOMA-IR e insulina de jejum resultou em diminuição da sensibilidade à insulina do grupo placebo. No grupo teste não apresentou mudanças na sensibilidade à insulina. O grupo teste apresentou melhora no funcionamento intestinal. O consumo de fibras foi inferior a recomendação para o diabético. O consumo alimentar, o peso corporal, o IMC e a circunferência de cintura (CC) também não apresentaram mudanças significativas. A porcentagem de gordura corporal aumentou no grupo placebo aos 45 dias (p=0,0342) e diminuiu no grupo teste quando comparado ao grupo placebo (p=0,0216 e 0,0285). A Taxa de Metabolismo Basal (TMB) aumentou no grupo teste e diminuiu no placebo (p=0,0198 e 0,005). Conclusão: A dextrina de trigo na dosagem de 10g/dia não promoveu melhora na sensibilidade à insulina, no controle glicêmico e lipídico; não reduziu o peso corporal e CC e, não gerou mudanças no consumo de energia e de macronutrientes. Houve aumentou do consumo de fibra, para o mínimo da recomendação; regularização do funcionamento intestinal, redução da gordura corporal e aumento da TMB.