CONTEXT AND OBJECTIVE: The prevalence of vitamin B12 deficiency varies from 5.8% to 30% among patients undergoing long-term treatment with metformin. Because of the paucity of data on Brazilian patients, this study aimed to determine the frequency of B12 deficiency and related factors among Brazilian patients with type 2 diabetes mellitus (T2DM) using metformin. DESIGN AND SETTING: Cross-sectional study at a public university hospital. METHODS:Patients with T2DM and a control group of non-diabetics were included. Serum B12 levels were measured and biochemical B12 deficiency was defined as serum levels < 180 pg/ml. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) or histamine H2 antagonists were determined. RESULTS: 231 T2DM patients using metformin (T2DM-met) and 231 controls were included. No difference in the frequency of PPI or H2-antagonist use was seen between the groups. B12 deficiency was more frequent in the T2DM-met group (22.5% versus 7.4%) and this difference persisted after excluding PPI/ H2-antagonist users (17.9% versus 5.6%). The factors that interfered with serum B12 levels were PPI/H2-antagonist use and duration of metformin use ≥ 10 years. Use of PPI/H2-antagonists was associated with B12 deficiency, with an odds ratio of 2.60 (95% confidence interval, 1.34-5.04). CONCLUSIONS: Among T2DM patients, treatment with metformin and concomitant use of PPI/H2-antagonists are associated with a higher chance of developing B12 deficiency than among non-diabetics. RESUMO CONTEXTO E OBJETIVO:A prevalência de deficiência de vitamina B12 varia de 5,8% a 30% nos pacientes em tratamento a longo prazo com metformina. Devido à escassez de dados em pacientes brasileiros, este estudo determinou a frequência de deficiência de B12 e fatores relacionados em pacientes brasileiros com diabetes mellitus tipo 2 (DM2) usando metformina. TIPO DE ESTUDO E LOCAL: Estudo transversal em hospital público universitário. MÉTODOS: Pacientes com DM2 e um grupo controle de não diabéticos foram incluídos. Os níveis séricos de vitamina B12 foram dosados e deficiência bioquímica de B12 foi definida como níveis séricos < 180 pg/ml. Foi investigada a associação entre deficiência de B12 e idade, duração do DM2, duração do uso e dose de metformina, uso de inibidores de bomba de prótons (IBP) ou antagonistas dos receptores histamínicos H2 (antagonistas-H2). RESULTADOS: 231 pacientes DM2 usando metformina (DM2-met) e 231 controles foram incluídos. Não houve diferença na frequência de uso de IBP/antagonistas-H2 entre os grupos. Deficiência de B12 foi mais frequente no grupo DM2-met (22,5% versus 7,4%) e essa diferença persistiu após exclusão dos usuári-os de IBP/antagonistas-H2 (17,9% versus 5,6%). Fatores que interferiram nos níveis séricos de B12 foram: uso de IBP/antagonistas-H2 e duração do uso de metformina ≥ 10 anos. O uso de IBP/antagonistas-H2 associou-se com deficiência de B12, com um risco relativo de 2,60 (95% intervalo de confian...

BackgroundMetabolic syndrome (MS) is an aggregation of risk factors that increase the incidence of cardiovascular events and diabetes mellitus (DM). Population aging is accompanied by higher prevalence of MS, which varies depending on the population studied and the diagnostic criteria used. ObjectiveTo determine prevalence of MS in the elderly using four diagnostic criteria and agreement between them. MethodsCross-sectional study on 243 patients older than 60 years (180 women) in Niterói, RJ. They were evaluated by clinical examination, fasting glucose, fasting insulin, lipid profile and anthropometric measurements - weight, height, waist circumference and waist/hip ratio. Prevalence of MS was estimated by World Health Organization (WHO) modified, National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria. ResultsPrevalence was high with the four criteria WHO (51.9%), NCEP-ATPIII (45.2%), IDF (64.1%) and JIS (69.1%), and agreement between criteria by kappa was moderate in almost all comparisons WHO vs. IDF (k = 0.47;95% confidence interval (CI), 0.35 to 0.58); WHO vs. NCEP-ATPIII (k = 0.51; 95% CI, 0.40 to 0.61); WHO vs. JIS (k = 0.45; 95% CI, 0.33 to 0.56); IDF vs. NCEP-ATPIII (k = 0.55; 95% CI, 0.45 to 0.65) and NCEP-ATPIII vs. JIS (k = 0.53; 95% CI, 0.43-0.64), except between IDF vs. JIS (K = 0.89;95% CI, 0.83 to 0.95), which was considered good. ConclusionPrevalence of MS was high with the four diagnostic criteria, mainly by JIS. There was good agreement between JIS and IDF criteria and moderate among the others.

The present data show an independent association of PA with overall cardiovascular risk in the elderly population. Geriatr Gerontol Int 2018; 18: 732-737.

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Since both obesity and osteoporosis are public health problems worldwide, strategies aimed at preventing both conditions should be encouraged during aging.

BackgroundIn most individuals, obesity and insulin resistance coexist. However, some individuals have excessive adipose tissue mass but remain insulin sensitive. Moreover, lean individuals can develop acute inflammation-induced insulin resistance, even without excess adipose tissue mass.ObjectiveOur aim was to compare inflammatory markers in overweight, insulin-sensitive and lean, insulin-resistant healthy subjects.MethodsA cross-sectional study with 1098 participants (CAMELIA project) was conducted in family doctor primary care program at Niteroi, RJ, Brazil. In the present substudy, we have selected non-obese healthy subjects (n = 203). Insulin resistance was defined by a homeostatic model assessment (HOMA-IR) >2.6, and overweight subject BMIs were 25< BMI <30 kg/m2. Associations were estimated through binary logistic regression with generalized estimation equation models.ResultsWe compared overweight, insulin-sensitive healthy individuals (n = 74) with a mean age of 39.2 ± 1.3 and lean, insulin-resistant healthy individuals (n = 18) with a mean age of 31.9 ± 3.6. C-reactive protein levels were positively correlated with body mass index in the lean, insulin-resistant group. In the multiple regression model, a positive association was observed with MCP-1 and IL-6 expression after adjustment for age, waist circumference, glycated hemoglobin, resistin, adiponectin, C-reactive protein and PAI-1 levels.ConclusionOur findings suggest that a lean, insulin-resistant subject may have higher pro-inflammatory marker levels (MCP-1, IL-6 and resistin) than an overweight, insulin-sensitive subject. This suggest an early risk phenotype that should further be investigated for possible prognostic implications.

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A circunferência do pescoço prediz a resistência insulínica no idoso? Um estudo transversal na atenção primária no Brasil ¿La circunferencia del cuello predice la resistencia a la insulina en el anciano? Un estudio transversal en la atención primaria en Brasil