Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce

Detalhes bibliográficos
Ano de defesa: 2016
Autor(a) principal: Furino, Vanessa de Oliveira
Orientador(a): Germano, Carla Maria Ramos lattes
Banca de defesa: Não Informado pela instituição
Tipo de documento: Dissertação
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Universidade Federal de São Carlos
Câmpus São Carlos
Programa de Pós-Graduação: Programa de Pós-Graduação em Enfermagem - PPGEnf
Departamento: Não Informado pela instituição
País: Não Informado pela instituição
Palavras-chave em Português:
Palavras-chave em Inglês:
Área do conhecimento CNPq:
Link de acesso: https://repositorio.ufscar.br/handle/ufscar/7496
Resumo: Introduction: Premature adrenarche (PA) is characterized by the appearance of pubic hair and/or axillary, acne and body odor before age 8 in girls and before 9 in boys and these individuals are at increased risk of developing metabolic syndrome (MetS). Vitamin D and irisin seem to have an active role in the metabolism of carbohydrates and lipids, however, little is known of the role of these hormones in the PA. Objective: To analyze the vitamin D and irisin levels in children diagnosed with PA and the relationship of these substances with body composition of these children. Methodology: a quantitative exploratory cross-sectional study that evaluated 15 children diagnosed with PA and 15 controls (C) matched recruited in the public health of the city of São Carlos, Brazil. Anthropometric data were analyzed: height, weight, waist circumference (WC), triceps skinfold thickness (TSF), systolic blood pressure (SBP) and diastolic blood pressure (DBP). The participants did tests of FSH, LH, testosterone, estradiol, blood glucose, insulin, 17OHP, total cholesterol (TC), LDL, HDL, triglycerides (TG), S-DHEA, 25(OH)D and irisin. Data analysis was performed using the GraphPad Prism 5 program. The paired Wilcoxon test was used to assess the difference between means and the correlation through the Spearman test, with 5% significance level. Results: There was no significant difference between the C and PA groups in anthropometric data. The TG levels (99 ± 14.8 mg/dl in the children C versus 68 ± 9.1 mg/dl in children with PA) (p= 0.0233) and 25(OH)D (26 ± 0.9 ng/ml in the children C versus 30.2 ± 1.6 ng/ml in children with PA) (p= 0.0307) significantly were different between groups. In group C the variable that correlated significantly with irisin was 25(OH)D (r= -0.9358); in the PA group: LDL (r= 0.5620), 17OHP (r= 0.6014), TG (r= 0.6434), insulin (r= 0.5998) and relationship glucose/insulin (r= -0.7033). In group C the variable that was significantly correlated with vitamin D was irisin (r = -0.9358); there was no significant correlation of variables with 25(OH)D in the AP group. Discussion and Conclusion: This study showed higher percentage of individuals with hyperinsulinemia, insulin resistance and CA high in the PA group, important markers of MetS and future cardiovascular disease. An innovative result of this study was the strong negative correlation between irisin and 25(OH)D found in C children, suggesting an interaction of these two hormones in these individuals, which may be related to compensatory modulation of irisin in response to changing metabolism lipid found in this group. In children with PA, the highest correlation of metabolic parameters with irisin may represent a physiological modulation of this hormone by elements related to carbohydrate metabolism (as in control children C) and a specific modulation in PA, due to the same pathophysiological mechanisms that result in unfavorable metabolic profile. Since the PA can lead to an increased risk of cardiovascular disease, these children must have a suitable and long-term clinical follow-up.
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spelling Furino, Vanessa de OliveiraGermano, Carla Maria Ramoshttp://lattes.cnpq.br/1685750854841732http://lattes.cnpq.br/5406611490052377ab838d95-f40c-4f63-a43e-3afc27faefef2016-09-27T19:26:21Z2016-09-27T19:26:21Z2016-03-21FURINO, Vanessa de Oliveira. Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce. 2016. Dissertação (Mestrado em Enfermagem) – Universidade Federal de São Carlos, São Carlos, 2016. Disponível em: https://repositorio.ufscar.br/handle/ufscar/7496.https://repositorio.ufscar.br/handle/ufscar/7496Introduction: Premature adrenarche (PA) is characterized by the appearance of pubic hair and/or axillary, acne and body odor before age 8 in girls and before 9 in boys and these individuals are at increased risk of developing metabolic syndrome (MetS). Vitamin D and irisin seem to have an active role in the metabolism of carbohydrates and lipids, however, little is known of the role of these hormones in the PA. Objective: To analyze the vitamin D and irisin levels in children diagnosed with PA and the relationship of these substances with body composition of these children. Methodology: a quantitative exploratory cross-sectional study that evaluated 15 children diagnosed with PA and 15 controls (C) matched recruited in the public health of the city of São Carlos, Brazil. Anthropometric data were analyzed: height, weight, waist circumference (WC), triceps skinfold thickness (TSF), systolic blood pressure (SBP) and diastolic blood pressure (DBP). The participants did tests of FSH, LH, testosterone, estradiol, blood glucose, insulin, 17OHP, total cholesterol (TC), LDL, HDL, triglycerides (TG), S-DHEA, 25(OH)D and irisin. Data analysis was performed using the GraphPad Prism 5 program. The paired Wilcoxon test was used to assess the difference between means and the correlation through the Spearman test, with 5% significance level. Results: There was no significant difference between the C and PA groups in anthropometric data. The TG levels (99 ± 14.8 mg/dl in the children C versus 68 ± 9.1 mg/dl in children with PA) (p= 0.0233) and 25(OH)D (26 ± 0.9 ng/ml in the children C versus 30.2 ± 1.6 ng/ml in children with PA) (p= 0.0307) significantly were different between groups. In group C the variable that correlated significantly with irisin was 25(OH)D (r= -0.9358); in the PA group: LDL (r= 0.5620), 17OHP (r= 0.6014), TG (r= 0.6434), insulin (r= 0.5998) and relationship glucose/insulin (r= -0.7033). In group C the variable that was significantly correlated with vitamin D was irisin (r = -0.9358); there was no significant correlation of variables with 25(OH)D in the AP group. Discussion and Conclusion: This study showed higher percentage of individuals with hyperinsulinemia, insulin resistance and CA high in the PA group, important markers of MetS and future cardiovascular disease. An innovative result of this study was the strong negative correlation between irisin and 25(OH)D found in C children, suggesting an interaction of these two hormones in these individuals, which may be related to compensatory modulation of irisin in response to changing metabolism lipid found in this group. In children with PA, the highest correlation of metabolic parameters with irisin may represent a physiological modulation of this hormone by elements related to carbohydrate metabolism (as in control children C) and a specific modulation in PA, due to the same pathophysiological mechanisms that result in unfavorable metabolic profile. Since the PA can lead to an increased risk of cardiovascular disease, these children must have a suitable and long-term clinical follow-up.Introdução: A adrenarca precoce (AP) é caracterizada pelo surgimento de pelos pubianos e/ou axilares, acne e odor corporal antes dos 8 anos de idade em meninas e antes dos 9 em meninos e estes indivíduos têm risco aumentado de desenvolver síndrome metabólica (SM). A vitamina D e a irisina parecem ter um papel ativo no metabolismo de carboidratos e lipídeos, no entanto, pouco se sabe do papel desses hormônios na AP. Objetivo: Analisar os valores de vitamina D e irisina em crianças com diagnóstico de AP e a relação dessas substâncias com a composição corporal dessas crianças. Metodologia: Estudo quantitativo transversal exploratório, no qual foram avaliadas 15 crianças com diagnóstico de AP e 15 controles (C) pareados, recrutados na rede pública de saúde da cidade de São Carlos, SP. Foram determinados dados antropométricos: altura, peso, circunferência abdominal (CA), prega cutânea tricipital (PCT), pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD). Os participantes realizaram exames de glicemia, insulina, colesterol total (CT), LDL, HDL, triglicerídeos (TG), DHEA-S, 17OHP, 25(OH)D e irisina. A análise dos dados foi realizada através do programa GraphPad Prism 5. O teste de Wilcoxon pareado foi utilizado para avaliar a diferença entre as médias e sua correlação através do teste de Spearman, com nível de significância de 5%. Resultados: Não houve diferença significativa entre os grupos C e AP quanto aos dados antropométricos. Os valores de TG (99 ± 14,8 mg/dl nos indivíduos C versus 68 ± 9,1 mg/dl nos indivíduos com AP) (p= 0,0233) e de 25(OH)D (26 ± 0,9 ng/ml nos indivíduos C versus 30,2 ± 1,6 ng/ml nos indivíduos com AP) (p= 0,0307) foram significativamente diferentes entre os grupos. No grupo C a variável que se correlacionou significativamente com a irisina foi a 25(OH)D (r= -0,9358); no grupo AP: LDL (r= 0,5620), 17OHP (r= 0,6014), TG (r= 0,6434), insulina (r= 0,5998) e relação glicemia/insulina (r= -0,7033). No grupo C a variável que se correlacionou significativamente com a 25(OH)D foi a irisina (r= - 0,9358), não houve correlação significativa das variáveis com a 25(OH)D no grupo AP. Discussão e conclusão: Este estudo evidenciou maior porcentagem de indivíduos com hiperinsulinemia, resistência insulínica e CA elevada no grupo AP, importantes marcadores de SM e doenças cardiovasculares futuras. Um resultado inovador deste estudo foi a forte correlação negativa entre a irisina e a 25(OH)D encontrada em crianças controle, sugerindo uma interação destes dois hormônios nesses indivíduos, que pode estar relacionada a uma modulação compensatória da irisina em resposta à alteração do metabolismo lipídico encontrada nesse grupo. Em crianças com AP, a maior correlação dos parâmetros metabólicos com a irisina pode representar uma modulação fisiológica desse hormônio por fatores relacionados ao metabolismo de carboidratos (assim como nas crianças controles) e uma modulação específica na AP, decorrente dos mesmos mecanismos fisiopatológicos que resultam num perfil metabólico desfavorável. Como a AP pode levar a um risco aumentado de doença cardiovascular, essas crianças devem ter um acompanhamento clínico adequado e de longo prazo.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)porUniversidade Federal de São CarlosCâmpus São CarlosPrograma de Pós-Graduação em Enfermagem - PPGEnfUFSCarAdrenarca precoceIrisinaVitamina DCriançasPremature adrenarcheIrisinVitamin DChildrenCIENCIAS DA SAUDE::ENFERMAGEMValores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoceLevels of vitamin D and irisin and its correlation with body composition in children with premature adrenarcheinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisOnline600600ded40f8f-56a6-41e1-9160-27ae8d5f4c1finfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFSCARinstname:Universidade Federal de São Carlos (UFSCAR)instacron:UFSCARORIGINALDissVOF.pdfDissVOF.pdfapplication/pdf3835001https://repositorio.ufscar.br/bitstream/ufscar/7496/1/DissVOF.pdf76a7690d0dcbe93db09803bc9ca4b037MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81957https://repositorio.ufscar.br/bitstream/ufscar/7496/2/license.txtae0398b6f8b235e40ad82cba6c50031dMD52TEXTDissVOF.pdf.txtDissVOF.pdf.txtExtracted texttext/plain249385https://repositorio.ufscar.br/bitstream/ufscar/7496/3/DissVOF.pdf.txte37453a40ee939d873958d7d6c8c1f0cMD53THUMBNAILDissVOF.pdf.jpgDissVOF.pdf.jpgIM Thumbnailimage/jpeg6412https://repositorio.ufscar.br/bitstream/ufscar/7496/4/DissVOF.pdf.jpg3a8a19e8478d068393b835b473d866bbMD54ufscar/74962023-09-18 18:30:52.721oai:repositorio.ufscar.br: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Repositório InstitucionalPUBhttps://repositorio.ufscar.br/oai/requestopendoar:43222023-09-18T18:30:52Repositório Institucional da UFSCAR - Universidade Federal de São Carlos (UFSCAR)false
dc.title.por.fl_str_mv Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
dc.title.alternative.eng.fl_str_mv Levels of vitamin D and irisin and its correlation with body composition in children with premature adrenarche
title Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
spellingShingle Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
Furino, Vanessa de Oliveira
Adrenarca precoce
Irisina
Vitamina D
Crianças
Premature adrenarche
Irisin
Vitamin D
Children
CIENCIAS DA SAUDE::ENFERMAGEM
title_short Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
title_full Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
title_fullStr Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
title_full_unstemmed Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
title_sort Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce
author Furino, Vanessa de Oliveira
author_facet Furino, Vanessa de Oliveira
author_role author
dc.contributor.authorlattes.por.fl_str_mv http://lattes.cnpq.br/5406611490052377
dc.contributor.author.fl_str_mv Furino, Vanessa de Oliveira
dc.contributor.advisor1.fl_str_mv Germano, Carla Maria Ramos
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/1685750854841732
dc.contributor.authorID.fl_str_mv ab838d95-f40c-4f63-a43e-3afc27faefef
contributor_str_mv Germano, Carla Maria Ramos
dc.subject.por.fl_str_mv Adrenarca precoce
Irisina
Vitamina D
Crianças
Premature adrenarche
topic Adrenarca precoce
Irisina
Vitamina D
Crianças
Premature adrenarche
Irisin
Vitamin D
Children
CIENCIAS DA SAUDE::ENFERMAGEM
dc.subject.eng.fl_str_mv Irisin
Vitamin D
Children
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::ENFERMAGEM
description Introduction: Premature adrenarche (PA) is characterized by the appearance of pubic hair and/or axillary, acne and body odor before age 8 in girls and before 9 in boys and these individuals are at increased risk of developing metabolic syndrome (MetS). Vitamin D and irisin seem to have an active role in the metabolism of carbohydrates and lipids, however, little is known of the role of these hormones in the PA. Objective: To analyze the vitamin D and irisin levels in children diagnosed with PA and the relationship of these substances with body composition of these children. Methodology: a quantitative exploratory cross-sectional study that evaluated 15 children diagnosed with PA and 15 controls (C) matched recruited in the public health of the city of São Carlos, Brazil. Anthropometric data were analyzed: height, weight, waist circumference (WC), triceps skinfold thickness (TSF), systolic blood pressure (SBP) and diastolic blood pressure (DBP). The participants did tests of FSH, LH, testosterone, estradiol, blood glucose, insulin, 17OHP, total cholesterol (TC), LDL, HDL, triglycerides (TG), S-DHEA, 25(OH)D and irisin. Data analysis was performed using the GraphPad Prism 5 program. The paired Wilcoxon test was used to assess the difference between means and the correlation through the Spearman test, with 5% significance level. Results: There was no significant difference between the C and PA groups in anthropometric data. The TG levels (99 ± 14.8 mg/dl in the children C versus 68 ± 9.1 mg/dl in children with PA) (p= 0.0233) and 25(OH)D (26 ± 0.9 ng/ml in the children C versus 30.2 ± 1.6 ng/ml in children with PA) (p= 0.0307) significantly were different between groups. In group C the variable that correlated significantly with irisin was 25(OH)D (r= -0.9358); in the PA group: LDL (r= 0.5620), 17OHP (r= 0.6014), TG (r= 0.6434), insulin (r= 0.5998) and relationship glucose/insulin (r= -0.7033). In group C the variable that was significantly correlated with vitamin D was irisin (r = -0.9358); there was no significant correlation of variables with 25(OH)D in the AP group. Discussion and Conclusion: This study showed higher percentage of individuals with hyperinsulinemia, insulin resistance and CA high in the PA group, important markers of MetS and future cardiovascular disease. An innovative result of this study was the strong negative correlation between irisin and 25(OH)D found in C children, suggesting an interaction of these two hormones in these individuals, which may be related to compensatory modulation of irisin in response to changing metabolism lipid found in this group. In children with PA, the highest correlation of metabolic parameters with irisin may represent a physiological modulation of this hormone by elements related to carbohydrate metabolism (as in control children C) and a specific modulation in PA, due to the same pathophysiological mechanisms that result in unfavorable metabolic profile. Since the PA can lead to an increased risk of cardiovascular disease, these children must have a suitable and long-term clinical follow-up.
publishDate 2016
dc.date.accessioned.fl_str_mv 2016-09-27T19:26:21Z
dc.date.available.fl_str_mv 2016-09-27T19:26:21Z
dc.date.issued.fl_str_mv 2016-03-21
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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dc.identifier.citation.fl_str_mv FURINO, Vanessa de Oliveira. Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce. 2016. Dissertação (Mestrado em Enfermagem) – Universidade Federal de São Carlos, São Carlos, 2016. Disponível em: https://repositorio.ufscar.br/handle/ufscar/7496.
dc.identifier.uri.fl_str_mv https://repositorio.ufscar.br/handle/ufscar/7496
identifier_str_mv FURINO, Vanessa de Oliveira. Valores de vitamina D e irisina e sua correlação com a composição corporal em crianças com adrenarca precoce. 2016. Dissertação (Mestrado em Enfermagem) – Universidade Federal de São Carlos, São Carlos, 2016. Disponível em: https://repositorio.ufscar.br/handle/ufscar/7496.
url https://repositorio.ufscar.br/handle/ufscar/7496
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language por
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dc.publisher.none.fl_str_mv Universidade Federal de São Carlos
Câmpus São Carlos
dc.publisher.program.fl_str_mv Programa de Pós-Graduação em Enfermagem - PPGEnf
dc.publisher.initials.fl_str_mv UFSCar
publisher.none.fl_str_mv Universidade Federal de São Carlos
Câmpus São Carlos
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reponame_str Repositório Institucional da UFSCAR
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