ABSTRACT Objective: To describe the clinical characteristics, management, and fetal outcomes of patients diagnosed with gestational diabetes mellitus (GDM) or overt diabetes (OD) during pregnancy who followed up at a public healthcare referral center in Brazil. Materials and methods: A retrospective cohort study based on the medical records of women diagnosed with dysglycemia during pregnancy between January 2015 and July 2017 was conducted. Results: Out of 224 pregnant women evaluated, 70% were overweight/obese. GDM was observed in 78.6% of pregnant women, while 21.4% presented with OD. Approximately 59% of patients could be diagnosed with GDM or OD by fasting plasma glucose (FPG) alterations alone. Exclusive diet therapy was used in 50.9% of patients. The need for insulin therapy was higher in OD patients (60.4%) than in GDM patients (38.1%) (p = 0.006). Women who needed insulin (n = 96) had a mean initial dose of 0.33 IU/kg (±0.27) and a final value of 0.39 IU/kg (±0.34). The cesarean rate was 74.3%. The fetal outcomes evaluated were macrosomia (2.15%), large for gestational age (LGA) fetus (15.83%), intensive care unit (ICU) need (4.32%), Apgar score ≤7 (6.47%), hypoglycemia (14.39%) and jaundice (16.55%). Conclusions: Patients with GDM and OD presented with several similar clinical features. Approximately half of the patients presented with adequate glycemic control only with diet management. Patients with OD presented a higher need for insulin therapy. Although overweight and obesity were frequent within both groups, they could possibly explain many of our findings.

Resumo Dados comparando medidas antropométricas, análise de impedância bioelétrica (BIA) e parâmetros de absorciometria de raios-X de dupla energia (DXA) são de alguma forma limitados e conflitantes. O objetivo deste estudo foi correlacionar parâmetros antropométricos de BIA e de DXA entre adultos obesos brasileiros, com foco na comparação com tecido adiposo visceral (TAV) obtido na DXA e no valor das medidas antropométricas. Cinquenta participantes voluntários foram inscritos. O teste de correlação de Spearman foi utilizado para avaliar a correlação do TAV com medidas antropométricas, da BIA e de outros parâmetros da DXA. O coeficiente de correlação intra-classe (ICC) foi usado para avaliar a concordância entre massa magra (MM), massa gorda (MG), % de gordura corporal (%GC) e % de gordura corporal na parte superior do corpo (%GSC) obtidos por BIA e DXA. A maioria era do sexo feminino (80%) e apresentava índice de massa corporal médio (IMC) de 39,0 (± 6,4) kg / m2. As únicas medidas antropométricas que mostraram uma forte correlação com o TAV foram a circunferência abdominal (CA) e a relação cintura / estatura (RCE), mas apenas no sexo feminino. Houve uma correlação muito boa para MM [ICC = 0,951 (IC = 0,913 - 0,972)], MG [ICC = 0,987 (IC = 0,977 - 0,993)], % GC [ICC = 0,961 (IC = 0,931-0,978)], e % GSC [ICC = 0,873 (IC = 0,776 - 0,928)], entre os dados coletados através de BIA e DXA. Dentre as medidas antropométricas avaliadas, apenas a CA e a RCE parecem estimar pacientes com distribuição de gordura abdominal e maior TAV no sexo feminino. A DXA e a BIA mostraram-se semelhantes para a avaliação de MM, MG,% GC e % GSC, embora a DXA tenha a vantagem de estimar o VAT.

Abstract Data comparing anthropometric measurements, bioelectrical impedance analysis (BIA) and dual-energy X-ray absortiometry (DXA) parameters are somehow limited and conflicting. The objective of this study was to correlate anthropometric, BIA and DXA parameters among obese Brazilian adults with focus on the comparison with visceral adipose tissue (VAT) obtained from DXA and in the value of antropometric measurements. Fifty voluntary participants were enrolled. The Spearman correlation test was used to assess the correlation of VAT with anthropometric measurements, BIA and other DXA parameters. The intra-class correlation coefficient (ICC) was used to evaluate concordance between lean mass (LM), fat mass (FM), %body fat (%BF) and %upper body fat (%UBF) obtained from BIA and DXA. Most were female (80%) and had an average body index mass (BMI) of 39.0 (± 6.4) kg/m2. The only anthropometric measurements showing a strong correlation with VAT were abdominal circumference (AC) and waist-to-height ratio (WHtR), but just in females. There was a very good correlation for LM [ICC = 0.951 (CI = 0.913 - 0.972)], FM [ICC = 0.987 (CI = 0.977 – 0.993)], %BF [ICC = 0.961 (CI = 0.931-0.978)], and %UBF [ICC = 0.873 (CI = 0.776 – 0.928)], between data collected through BIA and DXA. Among the anthropometric measurements assessed, only AC and WHtR seems to estimate patients with abdominal fat distribution and higher VAT in females. DXA and BIA proved similar for the evaluation of LM, FM, %BF and %UBF, although DXA has the advantage of estimating VAT.

OBJETIVO: Avaliar a qualidade de vida e sua associação com a prática de vida diária e controle metabólico em pacientes portadores de acromegalia. SUJEITOS E MÉTODOS: Estudo seccional de série de casos, composto por 42 pacientes recrutados na Unidade de Neuroendocrinologia do Hospital Universitário de Brasília. O nível de atividade física foi estimado pelo Questionário Internacional de Atividade Física (IPAQ-6), que avalia o tempo gasto semanalmente em atividades físicas que variam de intensidade em diferentes contextos de vida. A qualidade de vida foi avaliada pelo questionário SF-36. Os dados obtidos foram comparados aos níveis de hormônio do crescimento (GH) e fator de crescimento semelhante à insulina (IGF-1). Os testes t Students e Fisher foram aplicados e p < 0,05 foram considerados significativos, SPSS 17.0. RESULTADOS: Avaliaram-se 22 mulheres com idades de 51,33 ± 14,33 e 20 homens com idades de 46,2 ±13,18. Artralgia foi relatada em 83% dos pacientes. Em homens, os sítios de dor mais comuns foram os joelhos (73%), coluna vertebral (47% lombar, 53% segmentos torácico e cervical), mãos e quadris (40%). Os maiores escores no SF-36 foram observados em pacientes com níveis intermediário ou alto de atividade física, sobretudo nos domínios social (75 CI 57,3-92,6), saúde geral (75,5 CI 60,4-90,5), saúde mental (70 CI 57,8-82,1). CONCLUSÕES: A presença e a severidade do prejuízo no desempenho físico e dor não se associaram com Gh e IGF-1 no diagnóstico, tempo de exposição prévio à doença. Todavia, pacientes considerados controlados apresentaram melhores escores nos domínios físico e emocional, comparados com pacientes com hipersomatotrofismo persistente. Tais achados sugerem benefícios do controle metabólico na qualidade de vida.

OBJECTIVE: To evaluate the quality of life and its association with daily physical activity and disease control in acromegalic patients. SUBJECTS AND METHODS: A cross-sectional, case series study, composed of 42 patients recruited from the Neuroendocrinology Unit of the University Hospital of Brasilia. Level of physical activity was accessed by the International Physical Activity Questionnaire (IPAQ 6-short-form), which evaluates the weekly time spent on physical activity of moderate to vigorous intensity in different contexts of life. Quality of life was evaluated by The Medical Outcome Study Questionnaire Short Form (SF-36). Data was compared to growth hormone (GH) and insulin-like growth factor (IGF-1) levels. Students' t test and Fisher test were used, p < 0.05, SPSS 17.0. RESULTS: Twenty-two women, aged 51.33 ± 14.33 and 20 men, aged 46.2 ± 13.18 were evaluated. Arthralgia was present in 83% of cases. In men, the most common sites of pain were the knees (73%), spine (47% lumbar, and 53% thoracic and cervical segments), hands and wrists (40%). Higher scores on SF-36 were observed in patients with intermediate or high levels of physical activity, in the domains social functioning (75 CI 57.3-92.6), general health (75.5 CI 60.4-90.5), mental health (70 CI 57.8-82.1). CONCLUSIONS: In this study, the presence and severity of physical disability and pain were not associated with initial GH and IGF-1 levels or time of exposure to GH excess. However, the patients considered controlled, with normal a normal age-adjusted IGF-1, presented higher scores in SF-36, in physical and emotional domains, compared with patients with persistent hypersomatotrophism. These findings suggest benefits of metabolic control in self-reported quality of life.