Relação entre o índice de massa corpórea, diabetes mellitus tipo 2, estresse oxidativo e polimorfismos nos genes da enzima conversora de angiotensina (ECA) e metilenotetrahidrofolato redutase (MTHRF)
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2016-12-13
Autores
Pirozzi, Flavio Fontes [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: o aumento da prevalência da obesidade e do diabetes mellitus tipo 2 (DM2) é um grande desafio de saúde pública mundial e, por serem doenças heterogêneas e que elevam a chance do surgimento de doenças cardiovasculares, parâmetros de avaliação de risco são necessário na avaliação destes indivíduos. Objetivos: correlacionar diferentes variáveis como o índice de massa corpórea (IMC), os polimorfismos I/D ECA e C677T MTHFR e provas de estresse oxidativo em uma população de obesos brasileiros, com e sem diabetes, e doenças associadas com a síndrome metabólica. Casuística e métodos: avaliamos 125 indivíduos com obesidade (IMC maior ou igual a 30 Kg/m2) que foram divididos em dois grupos: grupo DM2 (obesos com DM2, n = 47) e grupo controle (obesos sem DM2, n= 78). Os pacientes do grupo DM2 apresentavam maior média de idade (p=0,02) e maior número de indivíduos com dislipidemia (p<0,05). Por meio de uma amostra de sangue periférico foi avaliado os polimorfismos I/D ECA e C677T MTHRF e as provas de estresse oxidativo, o TBARS e o TEAC. Resultados: na comparação entre os grupos com os polimorfismos analisados, não encontramos diferença significativa de chance de ocorrência e proteção para o DM2 em diferentes modelos de herança, na avaliação dos genótipos e no sinergismo entre eles. No polimorfismo I/D ECA, o genótipo mais frequente em ambos os grupos é o DD. Também não encontramos diferença significativa destes polimorfismos e as complicações microvasculares no grupo DM2. Correlacionando o IMC com o estresse oxidativo, encontramos uma correlação diretamente com o TBARS (r =0,7941) e inversamente proporcional com o TEAC (r=-0,6022) de forma significativa (p<0,0001). Entretanto, não houve diferença nos valores médios de TBARS e do TEAC entre os grupos DM2 e controle. O genótipo DD foi o mais frequente em ambos e o mesmo está relacionado com aumento do risco cardiovascular. Na presença do genótipo DD do polimorfismo I/D ECA, notamos um pior estresse oxidativo em relação aos outros genótipos. O mesmo não ocorreu na análise do homozigoto mutante TT no polimorfismo C677T MTHFR. Discussão: em uma população multiétnica, não encontramos relação destes polimorfismos na gênese do DM2 mas a maior frequência do genótipo DD em obesos com e sem diabetes e um pior padrão do estresse oxidativo nesses indivíduos se corelacionam com os dados na literatura e o maior risco do desenvolvimento de doenças cardiovasculares estaria mais relacionado com a obesidade do que a presença do diagnóstico do DM2. Conclusões: pela análise do estresse oxidativo, o IMC e a presença do genótipo DD são importantes ferramentas na avaliação de risco cardiovascular. Ressaltamos que, pela primeira vez, avaliamos o papel desses dois polimorfismos em uma população multiétnica de obesos brasileiros.
Introduction: the increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM) is a major global public health challenge and, because they are heterogeneous diseases that increase the chance of cardiovascular diseases, risk assessment parameters are necessary in the evaluation of these individuals. Aims: to correlate different variables such as body mass index (BMI), ACE I/D and MTHFR C677T polymorphisms, and oxidative stress tests in a population of obese Brazilians, with and without diabetes, and diseases associated with metabolic syndrome. Casuistry and methods: we evaluated 125 individuals with obesity (BMI greater than or equal to 30 kg /m2) who were divided into two groups: T2DM group (obese with T2DM, n = 47) and control group (obese without T2DM, n = 78). Patients in the T2DM group presented higher mean age (p=0.02) and higher number of individuals with dyslipidemia (p<0.05). The ACE I/D and MTHRF C677T polymorphisms and the oxidative stress, TBARS and TEAC tests, were evaluated using a peripheral blood sample. Results: in the comparison between the groups with the analyzed polymorphisms, we do not find a significant difference in the chance of occurrence and protection for T2D in different inheritance models, in the evaluation of genotypes and in the synergism between them. In the ACE I/D polymorphism, the most frequent genotype in both groups is DD. We also do not find a significant difference of these polymorphisms and the microvascular complications in the T2DM group. Relating BMI to oxidative stress, we found a correlation directly with TBARS (r=0.7941) and inversely proportional to the TEAC (r =-0.6022) in a significant way (p <0.0001). However, there was no difference in the mean values of TBARS and TEAC between T2DM and control groups. The DD genotype was the most frequent in both, and the same is related to increased cardiovascular risk. In the presence of the DD genotype of the ACE I/D polymorphism, we noticed a worse oxidative stress in relation to the other genotypes. The same do not occur in the analysis of the mutant homozygote TT in the MTHFR C677T polymorphism. Discussion: in a multiethnic population, we do not find a relation of these polymorphisms in the genesis of T2DM, but the greater frequency of the DD genotype in obese patients with and without diabetes and a worse pattern of oxidative stress in these individuals corelate with the data in the literature and the greater risk of development of cardiovascular diseases would be more related to obesity than the presence of the diagnosis of T2DM. Conclusions: BMI and presence of the DD genotype are important tools for assessing cardiovascular risk by oxidative stress analysis. We emphasize that, for the first time, we evaluated the role of these two polymorphisms in a multiethnic population of obese Brazilians.
Introduction: the increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM) is a major global public health challenge and, because they are heterogeneous diseases that increase the chance of cardiovascular diseases, risk assessment parameters are necessary in the evaluation of these individuals. Aims: to correlate different variables such as body mass index (BMI), ACE I/D and MTHFR C677T polymorphisms, and oxidative stress tests in a population of obese Brazilians, with and without diabetes, and diseases associated with metabolic syndrome. Casuistry and methods: we evaluated 125 individuals with obesity (BMI greater than or equal to 30 kg /m2) who were divided into two groups: T2DM group (obese with T2DM, n = 47) and control group (obese without T2DM, n = 78). Patients in the T2DM group presented higher mean age (p=0.02) and higher number of individuals with dyslipidemia (p<0.05). The ACE I/D and MTHRF C677T polymorphisms and the oxidative stress, TBARS and TEAC tests, were evaluated using a peripheral blood sample. Results: in the comparison between the groups with the analyzed polymorphisms, we do not find a significant difference in the chance of occurrence and protection for T2D in different inheritance models, in the evaluation of genotypes and in the synergism between them. In the ACE I/D polymorphism, the most frequent genotype in both groups is DD. We also do not find a significant difference of these polymorphisms and the microvascular complications in the T2DM group. Relating BMI to oxidative stress, we found a correlation directly with TBARS (r=0.7941) and inversely proportional to the TEAC (r =-0.6022) in a significant way (p <0.0001). However, there was no difference in the mean values of TBARS and TEAC between T2DM and control groups. The DD genotype was the most frequent in both, and the same is related to increased cardiovascular risk. In the presence of the DD genotype of the ACE I/D polymorphism, we noticed a worse oxidative stress in relation to the other genotypes. The same do not occur in the analysis of the mutant homozygote TT in the MTHFR C677T polymorphism. Discussion: in a multiethnic population, we do not find a relation of these polymorphisms in the genesis of T2DM, but the greater frequency of the DD genotype in obese patients with and without diabetes and a worse pattern of oxidative stress in these individuals corelate with the data in the literature and the greater risk of development of cardiovascular diseases would be more related to obesity than the presence of the diagnosis of T2DM. Conclusions: BMI and presence of the DD genotype are important tools for assessing cardiovascular risk by oxidative stress analysis. We emphasize that, for the first time, we evaluated the role of these two polymorphisms in a multiethnic population of obese Brazilians.
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Palavras-chave
Obesidade, Índice de massa corpóreo, Diabetes, Polimorfismo, Estresse oxidativo, Obesity, Body mass index, Polymorphism, Oxidative stress