RESUMO
BACKGROUND: Current pediatric guidelines for heterozygous familial hypercholesterolemia (HeFH) propose pharmacotherapy (PT) with statins from age 8 to 10 years; however, schemes with absorption inhibitors combined with statins, could be started earlier. The aim of the study was to show the 10-year results of a combined treatment protocol. METHODS: Prospective, descriptive and analytical study. Pediatric patients (n=70; mean age at PT initiation 9.3 years [range, 2-17.5]) with HeFH who required PT between 2005 and 2015 were included. All patients ≥10 years, with LDL >190 mg/dL or >160 mg/dL with one cardiovascular risk factor (CVRF) or >130 mg/dL with two or more CVRF; and those patients 5-10 years and with LDL-C >240 mg/dL or a family history of a cardiovascular event before 40 years, were medicated. After a period on a lipid-lowering diet (LLD), all patients were started on ezetimibe. Patients who did not achieve the treatment goal were given statins. The variables were: age, age at PT initiation, duration of PT, initial LDL-C, mean LDL-C during ezetimibe monodrug therapy, mean LDL-C during combined PT, and percentage of LDL decrease. RESULTS: LDL-C levels were: Baseline: 235 mg/dL±55; after 3 months on ezetimibe: 167 mg/dL±47 (decrease: -27.62%). In 18 patients who did not reach the treatment goal atorvastatin was added and their LDL-C decreased -41.5% (p: 0.02). Overall, mean final LDL-C was 155 mg/dL±30.4 (range, 98-257) and treatment goals were reached in 74% of the patients. No severe side effects were reported. CONCLUSIONS: Combined and sequential treatment starting at early ages was shown to be safe and effective over this follow-up period.
Assuntos
Anticolesterolemiantes/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Ezetimiba/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Adolescente , Anticolesterolemiantes/efeitos adversos , Argentina/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Criança , LDL-Colesterol/sangue , Terapia Combinada/efeitos adversos , Dieta com Restrição de Gorduras/efeitos adversos , Monitoramento de Medicamentos , Quimioterapia Combinada/efeitos adversos , Ezetimiba/efeitos adversos , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/dietoterapia , Hiperlipoproteinemia Tipo II/fisiopatologia , Lipoproteínas LDL/sangue , Masculino , Ambulatório Hospitalar , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
The exposure to adverse events early in life may affect brain development. Omega-3 polyunsaturated fatty acid (n-3 PUFA) deficiency has been linked to the development of mood and anxiety disorders. The aim of this study was to examine the interaction between variations in the early environment (handling or maternal separation) and the chronic exposure to a nutritional n-3 PUFA deficiency on locomotor activity, sucrose preference, forced swimming test and on serum and hippocampal brain-derived neurotrophic factor (BDNF) levels. Rats were randomized into Non-handled (NH), Neonatal Handled (H) and Maternal Separated (MS) groups. Pups were removed from their dams (incubator at 32°C on postnatal days (PND) 1-10) during 10 min/day (H) or 3h/day (MS). On PND 35, males were subdivided into diets adequate or deficient in n-3 PUFA for 15 weeks. H and MS gained weight differently, and animals receiving the n-3 PUFA deficient diet gained less weight. MS displayed a higher food consumption and higher consumption of sucrose solution during the second hour of exposure to the sucrose preference test. No differences were observed in the swimming test. H group had increased locomotion and showed a higher response to amfepramone. No significant effect was observed on serum BDNF levels. BDNF protein levels were decreased in animals receiving the n-3 PUFA deficient diet. We observed that early life environment and a mild n-3 PUFA deficiency are able to affect several behavioral aspects (food and sucrose consumption and locomotor response), and lead to a differential hippocampal BDNF metabolism in adult life.
Assuntos
Ácidos Graxos Ômega-3/farmacologia , Privação Materna , Estresse Psicológico/metabolismo , Animais , Animais Recém-Nascidos , Peso Corporal , Fator Neurotrófico Derivado do Encéfalo/sangue , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Dieta com Restrição de Gorduras/efeitos adversos , Dietilpropiona/farmacologia , Ácidos Graxos Ômega-3/metabolismo , Feminino , Preferências Alimentares , Manobra Psicológica , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Resposta de Imobilidade Tônica , Masculino , Atividade Motora/efeitos dos fármacos , Gravidez , Ratos , Estresse Psicológico/sangue , Estresse Psicológico/dietoterapia , Estresse Psicológico/psicologiaRESUMO
A colestase diminui o fluxo da bile para o intestino resultando em má-absorção de gordura, colesterol e vitaminas lipossolúveis quando prolongada causa cirrose biliar. A ligadura do ducto biliar em ratos jovens é usada como modelo de atresia biliar. Há duas possibilidades de tratamento dietoterápico dessa condição: substituição de triacilgliceróis de cadeia longa (TCL) por triacilgliceróis de cadeia média (TCM) ou suprimento de TCL na quantidade suficiente para evitar deficiência de ácidos graxos essenciais (AGE) como única fonte de gordura. Objetivo:comparar os efeitos de uma dieta com baixo teor de gordura com uma dieta com gordura de coco de babaçu sobre o metabolismo lipídico, a função ea lesão hepática em ratos jovens com cirrose biliar secundária (CBS). Métodos: submetemos 40 ratos divididos em 4 grupos de 10 animais, a partir de P21 (21 graus dia pós natal) até p 49, a dois dos seguintes tratamentos: 1) ligadura e resseção do ducto biliar comum (L) ou operação simulada (S) e 2) dieta com baixo teor de gordura ( óleo de milho fornecendo 4,5 por cento da quantidade total de calorias, dieta SG) ou dieta com gordura de coco de babaçu (essa gordura fornecendo 32,7 por cento e óleo de milho fornecendo 1,7 por cento da quantidade total de calorias, dieta GC). Ambas dietas contêm a quantidade mínima de AGE. O valor calórico da dieta SG é 372,8 kcal/100g e da dieta CG é 396,1 kcal/100g. Levando em conta a quantidade de TCL que não é absorvida na ausência de bile, as dietas são isocalóricas No P48 foi realizado o teste do tempo de sono induzido pelo pentobarbital, com injeção intraperitonial na dose de 50mg/kg de peso do animal. No P49 foi colhido sangue por punção cardíaca para as seguintes determinações: atividades séricas de aspartato aminotrasferase (AST) e de alanina aminotransferase (ALT), concentrações séricas de colesterol total (CT) e frações, triacilgliceróis (TG), vitamina A (VA), albulmina e globulina Foram determinados o peso, o conteúdo de...
Assuntos
Animais , Masculino , Ratos , Dieta com Restrição de Gorduras/efeitos adversos , Lipídeos , Cirrose Hepática Biliar , Gorduras Vegetais , Ratos WistarRESUMO
The present study examines the effects of caloric restriction in cardiac tissue evaluation markers of oxidative stress. High-fat dietary restrictions can have a long-term impact on cardiac health. Dietary restriction of control diet increased myocardial superoxide dismutase (SOD) and catalase activities. Dietary restriction of fatty acid-enriched diets increased myocardial lipoperoxide concentrations, while SOD activity was decreased in cardiac tissue of rats with dietary restriction of fatty acid-enriched diets. Dietary restriction of unsaturated fatty acid-enriched diet induced the highest lipoperoxide concentration and the lowest myocardial SOD activity. Dietary restriction of unsaturated fatty acid decreased myocardial glycogen, and increased the lactate dehydrogenase/citrate synthase ratio. Dietary restriction of fatty acid-enriched diets were more deleterious to cardiac tissue than normal ad lib.-fed diet. In conclusion, the effects of caloric restriction on myocardial oxidative stress is dependent on which nutrient is restricted. Dietary restriction of fatty acid-enriched diets is deleterious relative to ad lib.-fed chow diet.