RESUMO Racional: Atualmente o estilo de vida expõe a população a diversos fatores de risco relacionados a hábitos alimentares e à inatividade física, contribuindo para o surgimento de doenças crônicas. Objetivo: Analisar a associação entre o cortisol salivar e os componentes da síndrome metabólica. Métodos: Estudo transversal com 28 indivíduos, idade entre 30 e 59 anos apresentando três ou mais dos seguintes achados: circunferência abdominal ≥88 cm (mulheres) e ≥102 cm (homens); pressão arterial sistólica >130 mmHg e pressão arterial diastólica >85 mmHg; glicemia >100 mg/dl; triglicerídeo >150 mg/dl; lipoproteína de alta densidade <40 mg/dl (homens) e <50 mg/dl (mulheres). Foram realizadas coletas do cortisol salivar nos seguintes horários 8 h, 12 h e 20 h e analisadas por radioimunoensaio. Resultados: A média de idade foi 51,9±7,5 anos, 64,3% eram mulheres e a média do índice de massa corporal foi 33,6±3,2 kg/m². O nível de cortisol salivar às 8 h teve média de 18,7±4,8 ng/dl. Os indivíduos com glicemia de jejum >110 mg/dl, apresentaram níveis médios de cortisol significativamente menores que os com glicemia de jejum <110 mg/dl (12,8±5,2 vs. 17,3±4,2). As correlações significativas foram HOMA vs. circunferência abdominal (r=0,465; p˂0,005) e triglicerídeos (r=0,473; p˂0,005), circunferência abdominal vs. glicemia de jejum (r=0,446; p˂0,005) e índice de massa corporal (r=0,730; p˂0,0001), triglicerídeos vs. lipoproteína de alta densidade (r=0,441 p˂0,005) e glicemia de jejum (r=0,440; p˂0,005). Conclusão: O cortisol salivar pela manhã, em indivíduos com glicemia cronicamente elevada, pode representar uma contraregulação do eixo hipotálamo-hipófise-adrenal, sendo achado importante e pouco investigado.

ABSTRACT Background: Actually the lifestyle exposes the population to several risk factors related to alimentary habits and less physical activity that contributes to chronic diseases appearance worldwide. Aim: To analyze the association between salivary cortisol and the components of metabolic syndrome. Methods: This is a cross-sectional study. As part of it, 28 individuals aged 30-59 years presenting three or more of the following findings: CA: ≥88 cm for women and ≥102 cm for men; SBP>130 mmHg and DBP>85 mmHg; GL>100 mg/dl; TG>150 mg/dl; HDL<40 mg/dl for men and <50 mg/dl for women. Was performed analysis of salivary cortisol (by radioimmunoassay) from 25 salivary samples collected throughout the day, for evaluating changes in the circadian rhythm of this hormone (8AM, noon and 8PM). Results: 28 evaluated individuals had a mean age of 51.9±7.5 years, mostly women (64.3%) and a mean of BMI 33.6±3.2 kg/m². The cortisol level from the 8AM averaged 18.7±4.8 ng/dlL. Individuals with FPG>110mg/dl, have significantly lower average levels of cortisol than ones with FPG <110 (12.8±5,2 vs. 17.3±4.2). Significant correlations were HOMA vs. WC (r=0,465; p˂0,005) and TG (r=0,473; p˂0,005), WC vs. FG (r=0,446; p˂0,005) and BMI (r=0,730; p˂0.0001); TG vs. HDL (r=0,441 p˂0,005) and FG (r=0,440; p˂0,005). Conclusion: Morning salivary cortisol in subjects with chronically elevated blood glucose can represent a downregulation of the hypothalamic-pituitary adrenal axis. This is an important finding not yet well investigated.

Introduction: hypertriglyceridemic waist phenotype (EWET) has been poorly tested in patients with established cardiovascular disease. Objectives: to evaluate a possible association between EWET, glycidic and lipid profile in patients with newly diagnosed heart attack (HA). Methods: cross-sectional study among 45 inpatients with myocardial infarction. Lipid profile (total cholesterol, HDL-c, LDL-c, serum triglycerides, TC/HDL-c ratio, non-HDL cholesterol) and glycidic profile (fasting glucose, serum insulin, glycated hemoglobin, HOMA-IR, glucose/insulin ratio) were obtained. Weight, height and waist circumferences (WC) were assessed; BMI and EWET were calculated. Analysis of Covariance Models (ANCOVA) was used to assess the objectives. Results: mean age of participants was 58.75 ± 12.41 years and 55.6% (n = 25) were men. After adjustment for age, gender and BMI, EWET was significantly associated with lower HDL-c (p = 0.02), higher TC/HDL-c ratio (p = 0.003) and a trend toward fasting glucose (p = 0.11). Conclusion: EWET phenotype seems to be associated with a worse lipidic profile in patients with newly diagnosed HA.

Introducción: el fenotipo de la cintura hipertrigliceridémica (CHT) ha sido poco estudiado en pacientes con enfermedad cardiovascular establecida. Objetivos: evaluar la posible asociación entre el CHT, el perfil glicídico y los lípidos en pacientes con nuevo diagnóstico de infarto. Métodos: estudio transversal en 45 pacientes con infarto de miocardio. Se obtuvieron los lípidos (colesterol total, HDL-c, LDL-c, triglicéridos séricos, relación CT/ HDL-c, colesterol no-HDL) y el perfil glicídico (glucosa, insulina sérica, hemoglobina glucosilada, HOMA-IR, relación glucosa/insulina). Fueron evaluados peso, talla y circunferencia de la cintura (CC); se calcularon el IMC y el CHT. Se utilizó el análisis de los modelos de covarianza (ANCOVA) para evaluar los objetivos. Resultados: la media de edad de los participantes fue de 58,75 ± 12,41 años, y el 55,6% (n = 25) eran hombres. Tras ajustar por edad, sexo y el IMC, el CHT se asoció significativamente con una menor HDL-c (p = 0,02), mayor relación CT/HDL-c (p = 0,003) y una tendencia hacia la glucosa en ayunas (p = 0,11). Conclusión: el fenotipo CHT parece estar asociado con un peor perfil lipídico en pacientes con diagnóstico reciente de infarto.

Introduction: lipid Accumulation Product (LAP) Index correlates to cardiovascular risk factors in general population but it has not been tested in hospitalized patients. Objectives: we aimed to evaluate associations between LAP Index and metabolic profile in a tertiary hospital. Methods: Cross-sectional study with 90 inpatients. Lipid profile, fasting glucose, systolic and diastolic blood pressure measurements were obtained from electronic medical records. Weight, height and waist circumferences (WC) were assessed; Body Mass Index (BMI) and LAP Index were calculated. Data were expressed as mean ± standard deviation or percentage. Pearson's correlation and Multiple Linear Regression were used to assess the objectives. Results: mean age of participants was 55.03 ± 14.86 years and 47.8% (n = 43) were men. After adjustment for sex, age and physic activity LAP Index (log-transformed) was significantly associated with HDL-cholesterol (p < 0.001), fasting glucose (p = 0.02), systolic blood pressure (p = 0.03) and a trend toward total cholesterol (p = 0.07). Conclusion: There are independent association between LAP Index (log-transformed) and metabolic profile in hospitalized patients.

Introducción: el índice PAL (Producto de Acumulación Lipídica) se correlaciona con factores de riesgo cardiovasculares en la población general, pero no ha sido probado en pacientes hospitalizados. Objetivos: evaluar las asociaciones entre el índice PAL y el perfil metabólico en un hospital de tercer nivel. Métodos: estudio transversal con 90 pacientes hospitalizados. Se obtuvieron de los registros médicos electrónicos el perfil lipídico, la glucosa en ayunas y las mediciones de la presión arterial sistólica y diastólica. Fueron evaluados el peso, la talla y la circunferencia de la cintura (CC); se calcularon el índice de Masa Corporal (IMC) y el índice de PAL. Los datos se expresan como media ± desviación estándar o porcentaje. Para evaluar los objetivos se utilizaron la correlación de Pearson y la regresión lineal múltiple. Resultados: la edad promedio de los participantes fue de 55,03 ± 14,86 años y el 47,8% (n = 43) eran hombres. Después de ajustar por sexo, edad y actividad física, el índice PAL (transformado-log) se asoció significativamente con el HDL-colesterol (p < 0,001), la glucosa en ayunas (p=0,02), la presión arterial sistólica (p = 0,03) y una tendencia hacia el colesterol total (p = 0,07). Conclusión: en los pacientes hospitalizados existe una asociación independiente entre el índice PAL (transformado- log) y el perfil metabólico.

Introduction: The nutritional approach in the treatment of metabolic syndrome is a fundamental factor. It is important to raise awareness to patients about the benefits of following the treatments when you want to promote changes in lifestyle. Objective: The aim of this study was to assess nutritional adequacy in subjects with metabolic syndrome according to the dietary recommendations prescribed. Methods: Quasi-experimental research with 72 subjects with metabolic syndrome, held in southern Brazil. A nutritional orientation was conducted, related or not with physical exercise for three months. A 24-hour recall and two-day food record, were the reference method of dietary intake assessment. Nutritional adequacy was determined by the energy and nutrient intakes as defined by the Brazilian Food Guide Pyramid groups. Results: Volunteers reached on average 80% of the energy consumption recommended. Protein and lipid intake was higher, and carbohydrate consumption was lower than recommended levels. There was a low intake of cereals, vegetables, dairy product and beans (p<0.001) as compared with the recommended servings. A high consumption of meat (p<0.001) and an adequate intake of fruit (p=0.149) were observed. Conclusion: The dietary intake was insufficient to meet the recommendation of energy, although the goal for weight loss was achieved. Still, the results show the need for a balance in food intake and quality of the diet to achieve nutritional adequacy.

Introducción: La terapia nutricional en el tratamiento del síndrome metabólico es un factor clave. Es importante educar los pacientes sobre los beneficios de seguir el tratamiento cuando se quiere promover cambios nel estilo de vida. Objetivo: El objetivo fue evaluar la adecuación nutricional en individuos con síndrome metabólico de acuerdo con las recomendaciones dietéticas prescritas. Métodos: Un ensayo clínico con 72 sujetos con síndrome metabólico, llevados a cabo en el sur de Brasil. Asesoramiento nutricional se llevó a cabo, asociada o no con el ejercicio físico durante tres meses. Un retiro de alimentos de 24 horas, y un registro de alimentos de dos días fueron los métodos de referencia para el consumo de alimentos. La adecuación nutricional se determinó mediante la ingesta de energía y nutrientes, grupos de alimentos definidos por la Pirámide de Alimentos del Brasil. Results: Los voluntarios alcanzado un promedio del 80% del consumo de energía se recomienda. La ingestión de proteínas y lípidos fue mayor de lo esperado, y la ingesta de hidratos de carbono fue inferior a los niveles recomendados. Hubo una baja ingesta de cereales, verduras, productos lácteos y frijoles (p <0,001) en comparación con las porciones recomendadas. Se observaron un alto consumo de carne (p <0,001) y la ingesta de fruta adecuada (p = 0,149). Conclusión: El consumo dietético fue insuficiente para cumplir con las recomendaciones de la energía, aunque se logró la meta de pérdida de peso. Aún así, los resultados muestran la necesidad de un equilibrio de la ingesta de alimentos y calidad de la dieta para lograr la adecuación nutricional.

Fundamento: A síndrome metabólica é um transtorno complexo representado por um conjunto de fatores de risco cardiovascular. A adoção de um estilo de vida saudável está fortemente relacionada à melhora da Qualidade de Vida e interfere de forma positiva no controle dos fatores de risco presentes nessa condição clínica. Objetivo: Avaliar o efeito de um programa de modificação do estilo de vida sobre o Escore de Risco Cardiovascular Global de Framingham em indivíduos com síndrome metabólica. Método: Trata-se de uma subanálise de um ensaio clínico randomizado, controlado, cegado, com duração de três meses. Os participantes foram randomizados em quatro grupos: intervenção nutricional + placebo (INP), intervenção nutricional + suplementação de ácidos graxos ômega 3 (3 g/dia de óleo de peixe) (INS3), intervenção nutricional + atividade física + placebo (INEP) e intervenção nutricional + atividade física + suplementação de ácidos graxos ômega 3 (INES3). O Escore de Risco Cardiovascular Global de Framingham de cada indivíduo foi calculado antes e após a intervenção. Resultados: Participaram do estudo 70 indivíduos. Observou-se uma redução da média do escore após a intervenção de forma geral (p < 0,001). Obteve-se uma redução para risco intermediário em 25,7% dos indivíduos. Após a intervenção, observou-se redução significativa (p < 0,01) da "idade vascular", sendo esta mais expressiva nos grupos INP (5,2%) e INEP (5,3%). Conclusão: Todas as intervenções propostas produziram efeito benéfico para a redução do escore de risco cardiovascular. O presente estudo reforça a importância da modificação do estilo de vida na prevenção e no tratamento das doenças cardiovasculares.

Background: Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. Objective: To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. Methods: A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. Results: The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Conclusion: Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.