Επίδραση της εφαρμογής μη επεμβατικού μηχανικού αερισμού στις μεταβολικές διαταραχές ασθενών με χρόνια αναπνευστική ανεπάρκεια τύπου ΙΙ

Model Assessment ◽

Homa Index ◽

Homeostasis Model Assessment

Εισαγωγή: Η εφαρμογή του Μη Επεμβατικού Μηχανικού Αερισμού (Μ.Ε.Μ.Α) έχει αποδειχθεί αποτελεσματική στη βελτίωση των τιμών των αερίων αίματος και της ποιότητας ζωής σε ασθενείς με σταθερή Χ.Α.Π και συνυπάρχουσα χρόνια υπερκαπνική αναπνευστική ανεπάρκεια. Ωστόσο, οι επιπτώσεις του Μ.Ε.Μ.Α στο μεταβολικό προφίλ των ασθενών αυτών, δεν έχουν πλήρως διερευνηθεί. Σκοπός: Ο σκοπός της παρούσας μελέτης ήταν να αξιολογηθούν οι πιθανές επιπτώσεις της μακροχρόνιας (διάρκειας ενός έτους) εφαρμογής Μ.Ε.Μ.Α κατ’ οίκον, στην αντίσταση στην ινσουλίνη και στα επίπεδα λεπτίνης και αδιπονεκτίνης στον ορό, στους προαναφερθέντες ασθενείς. Υλικό και Μέθοδος: Στην παρούσα μελέτη περιελήφθησαν είκοσι πέντε (25) ασθενείς με Χ.Α.Π και χρόνια υπερκαπνική αναπνευστική ανεπάρκεια, σε σταθερή κατάσταση. Προϋπόθεση συμμετοχής στη μελέτη ήταν η απουσία συνοσηρότητας. Οι συμμετέχοντες στη μελέτη αξιολογήθηκαν στο εξωτερικό ιατρείο Μ.Ε.Μ.Α του Νοσοκομείου στον πρώτο, τρίτο, έκτο, ένατο και δωδέκατο μήνα μετά την αρχική αξιολόγηση. Σε κάθε εξέταση γινόταν καταμέτρηση των τιμών των αερίων αίματος σε ηρεμία (pH, pO2, pCO2, HCO3-), σπιρομετρικός έλεγχος (FVC, FEV1, FEV1/FVC%), προσδιορισμός του δείκτη μάζας-σώματος (Body Mass Index - ΒΜΙ), της κλίμακας υποκειμενικής εκτίμησης δύσπνοιας MRC (Medical Research Council) και του ερωτηματολογίου εκτίμησης ημερήσιας υπνηλίας Epworth (Epworth Sleepiness Scale - ESS). Επίσης διενεργούνταν αιμοληψία και προσδιορισμός στον ορό του αίματος των τιμών γλυκόζης νηστείας, ινσουλίνης, λεπτίνης και αδιπονεκτίνης. Εν συνεχεία προσδιοριζόταν η αντίσταση στην ινσουλίνη με τον υπολογισμό του δείκτη Homeostasis Model Assessment (HOMA) index. Πραγματοποιήθηκε περιγραφική και επαγωγική στατιστική ανάλυση. Αποτελέσματα: Διαπιστώθηκε στατιστικά σημαντική βελτίωση στην τιμή του FEV1 από τον πρώτο μήνα της παρακολούθησης (34.1±11.6% vs 37 ± 12.3%, p=0.05). Επίσης βελτιώθηκαν οι τιμές τόσο της μερικής πίεσης του CO2 όσο και της μερικής πίεσης του O2 στο αρτηριακό αίμα. Αμφότερες οι βελτιώσεις στα αέρια αίματος διατηρήθηκαν καθ’ όλη τη διάρκεια της μελέτης. H δύσπνοια (MRC) και η ημερήσια υπνηλία (Epworth Sleepiness Scale) υφέθηκαν από τον πρώτο μήνα. Δεν διαπιστώθηκε καμία σημαντική αλλαγή του ΒΜΙ κατά τη διάρκεια του ενός έτους της μελέτης. Διαπιστώθηκε μια στατιστικά σημαντική ελάττωση της αντίστασης στην ινσουλίνη μετά τον 9ο μήνα χρήσης της συσκευής μη επεμβατικού μηχανικού αερισμού (3,4 ± 2,3 vs 2,2 ± 1,4 , p < 0,0001) η οποία παρέμεινε σημαντική μέχρι και τον δωδέκατο μήνα. Όσον αφορά στα επίπεδα της αδιπονεκτίνης, υπήρξε σημαντική βελτίωση από τον πρώτο μήνα της χρήσης Μ.Ε.Μ.Α (11,4 ± 4,9 ng/ml vs 13,3 ± 5,5 ng/ml , p = 0,003). Η ανάλυση πολλαπλής παλινδρόμησης έδειξε ότι ο αρχικός δείκτης HOMA συσχετίστηκε με την paCO2 (β = 0,07 ± 0,02 , p = 0,001), ενώ τα αρχικά επίπεδα αδιπονεκτίνης συσχετίστηκαν με την FVC ( β = 0,05 ± 0,02 , p = 0,035 ) και την τιμή των HCO3 (β = 0,18 ± 0,06 , p = 0,002). Συμπέρασμα: Η εφαρμογή Μ.Ε.Μ.Α σε ασθενείς με σταθερή Χ.Α.Π και συνυπάρχουσα υπερκαπνική αναπνευστική ανεπάρκεια βελτιώνει την ευαισθησία στην ινσουλίνη, τον μεταβολισμό της γλυκόζης, καθώς και τα επίπεδα αδιπονεκτίνης, παράλληλα με τη βελτίωση της αναπνευστικής ανεπάρκειας.

Dispneia em DPOC: além da escala modified Medical Research Council

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132010000500008 ◽

2010 ◽

Vol 36 (5) ◽

pp. 571-578 ◽

Cited By ~ 24

Author(s):

Lilia Azzi Collet da Rocha Camargo ◽

Carlos Alberto de Castro Pereira

Keyword(s):

Body Mass Index ◽

Medical Research ◽

Airway Obstruction ◽

Exercise Capacity ◽

Body Mass ◽

Research Council ◽

Oxygen Cost ◽

Shortness Of Breath

OBJETIVO: Avaliar as correlações entre diversos instrumentos de avaliação de dispneia, dados espirométricos e de tolerância ao exercício e índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) em pacientes com DPOC. MÉTODOS: Entre março de 2008 e julho de 2009, de 79 pacientes com DPOC recrutados, 50 foram selecionados. Esses pacientes retornaram após um mês de tratamento regular com formoterol e responderam aos seguintes instrumentos: escala modified Medical Research Council (mMRC), Baseline Dyspnea Index (BDI), Oxygen Cost Diagram (OCD) e Shortness Of Breath Questionnaire (SOBQ). Em seguida, realizaram espirometria e teste de caminhada de seis minutos (TC6), com a medição da distância percorrida no TC6 (DTC6), medida de SpO2 inicial e final, e graduação da dispneia pela escala analógica visual (EAV) e escala de Borg. RESULTADOS: As melhores correlações entre os instrumentos foram entre Borg e EAV (r s = 0,79) e BDI e SOBQ (r s = -0,73). Entre as escalas unidimensionais (VAS, mMRC, OCD e de Borg), apenas VAS se correlacionou com os parâmetros de espirometria, ao passo que as escalas multidimensionais BDI e SOBQ apresentaram fraca correlação. Houve boas correlações entre mMRC, BDI e SOBQ com DTC6. Entre os parâmetros espirométricos, a capacidade inspiratória (CI) e CVF tiveram as melhores correlações com DTC6. Na análise multivariada, BDI e CI foram selecionados como os melhores preditores para DTC6. CONCLUSÕES: Escalas multidimensionais de dispneia devem ser aplicadas para avaliar pacientes com DPOC.

O índice BODE correlaciona-se com a qualidade de vida em pacientes com DPOC?

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132010000400009 ◽

2010 ◽

Vol 36 (4) ◽

pp. 447-452 ◽

Cited By ~ 9

Author(s):

Zênia Trindade de Souto Araujo ◽

Gardenia Holanda

Keyword(s):

Body Mass Index ◽

Medical Research ◽

Airway Obstruction ◽

Exercise Capacity ◽

Body Mass ◽

Research Council ◽

Indice Bode

OBJETIVO: Determinar se há uma correlação entre o índice Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE; IMC, obstrução das vias aéreas, dispneia e capacidade de exercício) e a qualidade de vida relacionada à saúde em pacientes com DPOC. MÉTODOS: Foram avaliados 42 pacientes com DPOC quanto a parâmetros de função pulmonar; variáveis antropométricas; capacidade de exercício através da distância máxima percorrida no teste de caminhada de seis minutos; dispneia através da escala modificada Medical Research Council (MRC); índice BODE; e a qualidade de vida através do questionário do Saint George's Respiratory Questionnaire modificado (SGRQm). Os pacientes foram alocados em dois grupos de acordo com a estratificação de gravidade da doença: VEF1 > 50% e VEF1 < 50%. RESULTADOS: Os valores médios do índice BODE para os grupos VEF1 > 50% e VEF1 < 50% foram, respectivamente, 2,58 ± 1,17 e 4,15 ± 1,81. Houve diferença significativa na comparação das variáveis VEF1 e VEF1/CVF entre os grupos. Houve correlações moderadas e significativas entre os escores do índice BODE e todos os domínios do SGRQm no grupo de pacientes com VEF1 < 50%. CONCLUSÕES: Houve correlação entre o escore do índice BODE e os escores de todos os domínios do SGRQm nos pacientes com DPOC com VEF1 < 50%. Portanto, os pacientes DPOC com VEF1 < 50% morrem mais rápido e têm pior qualidade de vida.

RELAÇÃO ENTRE MOBILIDADE DIAFRAGMÁTICA COM VARIÁVEIS CLÍNICAS E FUNCIONAIS EM PACIENTES COM DPOC

Revista Contexto & Saúde ◽

10.21527/2176-7114.2021.42.9628 ◽

2021 ◽

Vol 21 (42) ◽

pp. 63-74

Author(s):

Elizabeth do Canto Brancher ◽

Eduardo Matias dos Santos Steidl ◽

Tamires Daros Dos Santos ◽

Maurício Tatsch Ximenes Carvalho ◽

Paulo Roberto Oliveira de Jesus ◽

...

Keyword(s):

Body Mass Index ◽

Medical Research ◽

Exercise Capacity ◽

Body Mass ◽

Research Council ◽

Airflow Obstruction ◽

Copd Assessment Test ◽

Indice Bode

Avaliar se há relação entre a mobilidade diafragmática com o tempo de trânsito oral e faríngeo, pontuação do índice preditor de mortalidade Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE), dispneia e o estado de saúde em pacientes com doença pulmonar obstrutiva crônica (DPOC). Estudo transversal com avaliação dos seguintes desfechos: mobilidade diafragmática (ultrassonografia), tempo de trânsito oral e faríngeo (videofluoroscopia), preditor de mortalidade (pontuação no índice BODE), dispneia (escala do Medical Research Council modificada - mMRC) e estado de saúde (COPD Assessment Test). Participaram do estudo 19 pacientes com diagnóstico clínico de DPOC estágios II e III da GOLD (65,95±7,9 anos; 11 homens; VEF1 47,76±21,91% predito). Houve correlação negativa e forte entre a mobilidade diafragmática e o índice BODE (r=-0,822; p<0,0001), correlação negativa e moderada com o tempo de trânsito faríngeo na consistência líquida (r=-0,508; p=0,02) e correlação negativa e moderada com a dispneia (r=-0,527; p=0,02). Na análise multivariada, a mobilidade diafragmática foi associada negativamente com o índice BODE (β=-5,21; p<0,001; IC 95% -7,28 a -3,15) e com o tempo de trânsito oral e faríngeo na consistência líquida (β=-13,65; p<0,08; IC 95% -29,16 a 1,86). Não houve correlação entre a mobilidade diafragmática com o tempo de trânsito oral (consistência líquida e pastosa), com o tempo de trânsito faríngeo (consistência pastosa) e com o escore do CAT. Sugere-se que em pacientes com DPOC a mobilidade diafragmática está associada com o índice BODE, tempo de trânsito faríngeo na consistência líquida e dispneia.

Correlation between Body Mass Index and Homa Index in Bariatric Patients

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2019-0004 ◽

2019 ◽

Vol 26 (1) ◽

pp. 31-38

Author(s):

Paula Dejeu ◽

Viorel Dejeu ◽

Dănuț Dejeu ◽

Bembea Marius

Keyword(s):

Insulin Resistance ◽

Bariatric Surgery ◽

Body Mass Index ◽

Body Mass ◽

The Body ◽

Model Assessment ◽

Homa Index ◽

Bariatric Patients ◽

Gastric By Pass

Abstract Background and aims: Overweight and obese individuals are prone to an insulin resistance status assessed in the present study by the HOMA index ("Homeostasis model assessment"). This prospective study assessed the body mass index (BMI) and the insulin resistance status (HOMA index) in obese patients after bariatric surgery (gastric sleeve, gastric by-pass). Material and Methods: The study included 48 patients who were assessed before the bariatric surgery and at 6 months thereafter. The assessment included the body mass index (BMI) and the HOMA index before meal. Results: There was a significant positive correlation between BMI and HOMA index, mostly between weight loss and improvement in insulin resistance status (rho = 0.308, p = 0.0335). Conclusions: BMI decreases significantly after bariatric surgery, which correlates positively with an improvement in insulin resistance status.

Correlation of the Homeostasis Model Assessment Index and Adiponectin, Leptin and Insulin Levels to Body Mass Index-Associated Gene Polymorphisms in Adolescents

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2018.18.03.005 ◽

2018 ◽

Vol 18 (3) ◽

pp. 291

Author(s):

María D. Martínez-Martínez ◽

Hugo Mendieta-Zerón ◽

Luis Celis ◽

Cristian F. Layton-Tovar ◽

Rocío Torres-García ◽

...

Keyword(s):

Body Mass Index ◽

Single Nucleotide Polymorphisms ◽

Body Mass ◽

Peroxisome Proliferator ◽

Model Assessment ◽

Homa Index ◽

Nucleotide Polymorphisms ◽

Peroxisome Proliferator Activated Receptor

Single Nucleotide ◽

Objectives: This study aimed to describe correlations between glucose, insulin and adipokine levels and the homeostasis model assessment (HOMA) index with regards to the presence/absence of fat mass and obesity-associated (FTO) rs9939609 and peroxisome proliferator-activated receptor (PPAR)-y rs1801282 single nucleotide polymorphisms (SNPs) as indicators of body mass index in adolescents. Methods: This cross-sectional study was conducted between September and December 2016 in Toluca, Mexico. A total of 71 students between 14–18 years old were included. Various anthropometric and laboratory measurements were collected, including lipid profile, glucose, insulin and adipokine levels and HOMA index. The degree of association between variables was evaluated with regards to the presence/absence of the SNPs. Results: Leptin levels were significantly higher among female students (P = 0.001), although adiponectin levels did not differ significantly (P = 0.060). There were significant positive correlations between insulin levels and HOMA index with FTO (r = 0.391; P = 0.007 and r = 0.413; P = 0.005, respectively) and PPARγ (r = 0.529; P = 0.007 and r = 0.537; P = 0.007, respectively) SNPs. Leptin showed a significant positive correlation in the presence of PPARγ (r = 0.483; P = 0.007) or in the absence of both SNPs (r = 0.627; P = 0.039). However, adiponectin was significantly negatively correlated in the presence of FTO, either alone (r = −0.333; P = 0.024) or in combination with PPARγ (r = −0.616; P = 0.043). Conclusion: The presence of FTO and/or PPARγ SNPs might be related to a genetic predisposition to metabolic syndrome.Keywords: Obesity; Body Mass Index; Single Nucleotide Polymorphisms; Fat Mass and Obesity Associated Protein, Human; Peroxisome Proliferator-Activated Receptor gamma; Adipokines.

Circulating Irisin in Relation to Insulin Resistance and the Metabolic Syndrome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-2373 ◽

2013 ◽

Vol 98 (12) ◽

pp. 4899-4907 ◽

Cited By ~ 235

Author(s):

Kyung Hee Park ◽

Lesya Zaichenko ◽

Mary Brinkoetter ◽

Bindiya Thakkar ◽

Ayse Sahin-Efe ◽

...

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Body Mass Index ◽

Body Mass ◽

Model Assessment ◽

Cvd Risk ◽

Baseline Serum ◽

The Metabolic Syndrome ◽

Increased Risk

Context: Irisin, a recently identified hormone, has been proposed to regulate energy homeostasis and obesity in mice. Whether irisin levels are associated with risk of the metabolic syndrome (MetS), cardiometabolic variables, and cardiovascular disease (CVD) risk in humans remains unknown. Objective: Our objective was to assess the associations between baseline serum irisin levels and MetS, cardiometabolic variables, and CVD risk. Design, Setting, and Subjects: We conducted a comparative cross-sectional evaluation of baseline circulating levels of the novel hormone irisin and the established adipokine adiponectin with MetS, cardiometabolic variables, and CVD risk in a sample of 151 subjects. Results: Baseline irisin levels were significantly higher in subjects with MetS than in subjects without MetS. Irisin was associated negatively with adiponectin (r = −0.4, P < .001) and positively with body mass index (r = 0.22, P = .008), systolic (r = 0.17, P = .04) and diastolic (r = 0.27, P = .001) blood pressure, fasting glucose (r = 0.25, P = .002), triglycerides (r = 0.25, P = .003), and homeostasis model assessment for insulin resistance (r = 0.33, P < .001). After adjustment for potential confounders, including body mass index, subjects in the highest tertile of irisin levels were more likely to have MetS (odds ratio [OR] = 9.44, 95% confidence interval [CI] = 2.66–33.44), elevated fasting blood glucose (OR = 5.80, 95% CI = 1.72–19.60), high triglycerides (OR = 3.89, 95% CI = 1.16–13.03), and low high-density lipoprotein cholesterol (OR = 3.30, 95% CI = 1.18–9.20). Irisin was independently associated with homeostasis model assessment for insulin resistance and general Framingham risk profile in multiple linear regression analyses after adjustment for confounders. Adiponectin demonstrated the expected associations with outcomes. Conclusions: Irisin is associated with increased risk of MetS, cardiometabolic variables, and CVD in humans, indicating either increased secretion by adipose/muscle tissue and/or a compensatory increase of irisin to overcome an underlying irisin resistance in these subjects.

Associations between body mass index and breast cancer markers

Journal of Oncology Research ◽

10.30564/jor.v2i1.2007 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Ishita Saha ◽

Poonam Singh ◽

Sunit Kumar Medda ◽

Rabindra Nath Das

Keyword(s):

Breast Cancer ◽

Body Mass Index ◽

Body Mass ◽

Cancer Biomarkers ◽

Model Assessment ◽

Monocyte Chemoattractant Protein 1 ◽

Negatively Associated ◽

Monocyte Chemoattractant ◽

Breast Cancer Biomarkers

Body mass index (BMI) and breast cancer biomarkers such as resistin, leptin adiponectin, monocyte chemoattractant protein-1 (MCP-1) and homeostasis model assessment of insulin resistance (HOMA-IR) are highly associated with each other. The report has focused the inter-relationship between BMI and breast cancer biomarkers based on probabilistic modeling. It has been shown that mean BMI is positively associated with leptin (P<0.0001) and MCP-1 (P=0.0002), while it is negatively associated with adiponectin (P=0.0003), HOMA-IR (P<0.0001), and it is higher for healthy women (P=0.0116) than breast cancer women. In addition, variance of BMI is negatively associated with resistin (P=0.1450). On the other hand, mean MCP-1 is positively associated with BMI (P<0.0001). Mean resistin is positively associated with the interaction effect of BMI and leptin (BMI*Leptin) (P=0.0415), while its variance is positively associated with BMI (P=0.0942), and it is negatively associated with BMI*Adiponectin (P=0.1518). Leptin is positively associated with BMI (P<0.0001). Also adiponectin is negatively associated with BMI (P<0.0001), BMI*Leptin (P=0.1729), while it is positively associated with Age*BMI (P=0.0017) and BMI*Resistin (P=0.0615). It can be concluded that BMI and breast cancer biomarkers are strongly associated with each other. Care should be taken on BMI for breast cancer women.

Modulation of Adiponectin and Leptin during Refeeding of Female Anorexia Nervosa Patients

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-1683 ◽

2007 ◽

Vol 92 (5) ◽

pp. 1843-1847 ◽

Cited By ~ 60

Author(s):

Dalit Modan-Moses ◽

Daniel Stein ◽

Clara Pariente ◽

Amit Yaroslavsky ◽

Anka Ram ◽

...

Keyword(s):

Insulin Resistance ◽

Body Mass Index ◽

Anorexia Nervosa ◽

Insulin Sensitivity ◽

Body Mass ◽

Female Adolescent ◽

Model Assessment ◽

Hmw Adiponectin ◽

Total Adiponectin

Abstract Context: Several studies assessed adiponectin levels in anorexia nervosa (AN) patients, however, data regarding the dynamics of changes in adiponectin levels during refeeding of these patients is limited and contradicting. Objective: Our objective was to assess adiponectin levels and the distribution of its different isoforms in AN patients before and after long-term refeeding, and to relate them to alterations in body mass index, leptin, insulin sensitivity, and additional endocrine parameters. Design, Setting, and Participants: We conducted a longitudinal controlled study of 38 female adolescent malnourished AN inpatients, with 13 young, lean, healthy women serving as controls. Blood samples were obtained upon admission and thereafter at 1, 3, and 5 months (at target weight). Main Outcome Measures: Changes in body mass index, leptin, adiponectin, insulin sensitivity, and adiponectin multimeric forms were measured. Results: At admission, leptin levels of AN patients were significantly lower, whereas insulin sensitivity (assessed by homeostasis model assessment-insulin resistance), adiponectin levels, and the ratio of high molecular weight (HMW) adiponectin to total adiponectin were significantly higher compared with controls. During weight recovery, leptin levels and homeostasis model assessment-insulin resistance increased significantly, whereas adiponectin and HMW adiponectin/total adiponectin ratio decreased significantly, to levels similar to controls. An initial increase in adiponectin levels was observed after 1 month of refeeding. There was no correlation between adiponectin and either T4 or cortisol levels. Conclusions: Our study demonstrates hyperadiponectinemia, increased adiponectin HMW isoform, and increased insulin sensitivity in adolescent AN female patients and reversal of these findings with weight rehabilitation. We hypothesize that increased adiponectin levels may have a protective role in maintaining energy homeostasis during extreme malnourishment.