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The transcription factor nuclear factor-kappa-B (NFkappaB) is implicated in inflammatory responses, obesity and the metabolic syndrome, while immune cells appear to play a central role in mediating insulin resistance and can be used as a model to study inflammation and its relationship with insulin resistance. In peripheral blood mononuclear cells of overweight participants with the metabolic syndrome, we evaluated (1) the effect of diet-induced weight loss on the expression of genes involved in NFkappaB activation and (2) their association with insulin sensitivity. The genes studied were: TNF receptors TNFRSF1A and TNFRSF1B, and IL1R1, TLR4, TLR2, ICAM1, CCL5 and IKBKB.We analysed data from 34 overweight participants with abnormal glucose metabolism and the metabolic syndrome, who were randomised to a weight-reduction (n = 24) or control group (n = 10) for 33 weeks. The mRNA expression was measured using real-time PCR. Measures of insulin and glucose homeostasis were assessed by IVGTT and OGTT.In general, the genes studied were downregulated after weight loss intervention. The changes in TLR4, TLR2, CCL5 and TNFRSF1A mRNA expression were associated with an increase in insulin sensitivity index independently of the change in waist circumference (p0.05). The change in IKBKB expression correlated with most of the changes in gene expression in the weight-reduction group.These results suggest that proteins encoded by CCL5, TLR2 and TLR4, and TNFRSF1A might contribute to insulin-resistant states that characterise obesity and the metabolic syndrome.ClinicalTrials.gov NCT 00621205.

OBJECTIVE We investigated the effect of early-phase insulin secretion on the incidence of type 2 diabetes in individuals with impaired glucose tolerance (IGT) participating in the Finnish Diabetes Prevention Study (DPS). We examined how a lifestyle intervention affected early-phase insulin secretion (ratio of total insulin area under the curve [AUC] and total glucose AUC [AIGR] from 0 to 30 min) during a 4-year follow-up intervention trial and whether AIGR0–30 response was modified by insulin sensitivity (IS) and obesity. RESEARCH DESIGN AND METHODS A total of 443 participants with IGT originally randomized to a lifestyle intervention or control group were studied. IS and AIGR0–30 were estimated from an oral tolerance glucose test administered annually during the 4-year follow-up trial and were related to the risk of diabetes onset over a 6-year follow-up. RESULTS Lifestyle intervention resulted in higher IS (P = 0.02) and lower unadjusted AIGR0–30 (P = 0.08) during the 4-year follow-up. A higher IS and a lower BMI during the follow-up were associated with a lower unadjusted AIGR0–30 during the follow-up, independently of study group (P < 0.001). A greater increase in IS on the median cutoff point of a 0.69 increase was associated with higher IS-adjusted AIGR0–30 during the follow-up (P = 0.002). In multivariate models, IS and IS-adjusted AIGR0–30 were both inversely associated with diabetes incidence (P < 0.001). Participants who progressed to type 2 diabetes were more obese and had lower IS and Matsuda IS index-AIGR0–30 than nonprogressors. CONCLUSIONS Our results indicate that the reduction in the risk of developing type 2 diabetes after lifestyle intervention is related to the improvement of IS along with weight loss. Improved IS may also have beneficial effects on preservation of β-cell function.

The common polymorphism rs9939609 of the fat mass and obesity-associated gene (FTO) is strongly associated with obesity, but the biological function is still unknown. We compared the FTO gene expression in subcutaneous adipose tissue and peripheral blood mononuclear cells (PBMCs) between overweight and normal weight individuals. We also investigated if mRNA levels of FTO in adipose tissue correlated with the adiposity or inflammatory markers and mRNA levels of genes involved in the response to hypoxia (HIF-1a) and cell death(HMGB1).The mRNA expression of FTO in adipose tissue was greater in obese than normal weight individuals (p0.001), but there was no difference in FTO expression in PBMCs. FTO mRNA levels did not correlate with adiposity or inflammatory markers and FTO expression was not influenced by the FTO rs9939609 genotype. FTO mRNA level correlated positively with gene expression levels of HIF-1a and HMGB1 in subcutaneous adipose tissue (r = 0.59, p0.001; r = 0.69, p0.001, respectively; adjusted for BMI and adipocyte cell size).Altogether, FTO expression appeared not to have a well-defined impact on clinical or biochemical parameters comprising the metabolic syndrome. The correlations with the genes related to hypoxia and cell death suggest novel biological activities for FTO.

Diabetic nephropathy (DN) is the leading cause of kidney disease in patients starting renal replacement therapy, and affects up to 40% of type 1 and type 2 diabetic patients. Diet seems to play an important role in the development of the disease. There are evidences supporting the concept that not only the amount but also the origin of dietary protein are associated with DN. Few studies analyzed the role of dietary lipids. A low-protein diet slows down the decline of renal function and ameliorates the DN prognosis and death in patients with type 1 diabetes with micro- and macroalbuminuria. Studies in type 2 diabetic patients are scanty but short-term studies suggest that this approach decreases albuminuria. However, the use of low-protein diet for long periods is compromised by poor compliance and its long-term safety is not firmly established. Enthusiastic results come up when comparing the effect of different sources of animal protein on renal function and lipid profile in patients with DN, which may represent an alternative strategy for low-protein diet on medical nutritional therapy in patients with DN and in cardiovascular risk factors and endothelial function.

The purpose of this study is to reflect about the assistance to be given to parents of preterm and low weight babies, born in neonatal units, based on existing literature and the authors' practical experiences. Although mothers right to be close to their babies is assured by law, most of the nurseries still keep strict visit schedules to parents. However, there are some units where mothers' permanency is allowed. The question, in these cases, is if parents effective involvement in the care of the baby should or should not be allowed. For the nursing care unit, the authors suggest some intervention strategies to adapt parents to the new situation, and to strengthen the relationship between them and the baby. The recommendations are as follows: parents free access to the nurseries; motivation of early physical contact between parents and baby; implementation of multi-professional support groups to help parents during the different stages of clinical evolution; incentive for breastfeeding, and direct care of the babies; structuring of formal and informal groups of support for parents during and after hospitalization.

Neonatal care has improved greatly in recent years, focusing its efforts on low weight and premature children. Literature has considered prematurity under several focuses, recommending the following of growth and development in a systematic way. The present study tries to present a review of the literature on nursing care in the follow-up to premature children, in order to promote a reflection about the health care given to this customers. Authors searched in the data bank of the University of São Paulo, international periodicals and recent books. In general, studies focus on nursing role and strategies, such as home visits, in order to provide follow-up for the children and give orientations to mothers, as well as give support to the families. Studies emphasize the importance of multiprofessional teams working with mothers, children and families from neonatal intensive care to the post-neonatal period. The following of children brings out the need of reorganization and integration of health services, as well as the improvement of the relationships between professionals and families. Therefore, it is important to characterize the follow-up of this children, enabling the way for a more effective role in nursing care.

Children morbimortality rates in Brazil provide some indications about the life patterns of certain social groups, considered as risk groups, due to their vulnerability to a number of health impairments, but they do no display a clear picture of their quality of life. The present study aims to describe the steps undertaken by the authors to construct a qualitative research study on maternal living conditions and lifestyle, discussing certain aspects related to the study's design, such as, the definition of the research problem, the theoretical framework and data collection, particularly, the use of oral reports by mothers and the advantages and difficulties of this technique. Such narratives make it possible for researchers to come to know the needs, worries and strategies mothers use to care for their children's health, as well as, expose some wider social determinants of their life patterns. The knowledge thus generated is important to orientate the organization of policies and social practices to be developed by the health sector.

The interpration of the interaction in galaxies is simplified in mixed pairs (E+S) because most or all of the cold gas can be traced to an origin in a single galaxy (S). We used spectroscopy, imaging, far-IR, and stellar population synthesis to study the stellar content and history of star formation in the nuclear region of the early-type galaxy in the mixed pair AM0327-285. We used the procedure for stellar population synthesis developed by Bica (1988) to estimate the star-formation history of the nucleus of the elliptical galaxy. The method uses a library of star clusters, and estimates the chemical evolution in a test population with two parameters: age and metallicity; no assumptions on gravity or details of stellar evolution are necessary, and the IMF is implicit in the cluster spectra. The procedure allows one to both determine the chemical enrichment and date successive generations of star formation. The result indicates that the dominant population is old and metal-rich ([Z/Z]⊙=0.3), while ∼ 10% of the flux at 5870 A arises from a young stellar population (age < 5 × 108 yr), confirming that this early-type galaxy had recent star formation as suggested also by photometry and far-IR data (de Mello et al 1994). This age is close to several estimates of the characteristic timescale of the interaction, suggesting that the mass influx associated with this star formation occurred as a result of an earlier phase of the interaction and not as a result of the present geometry of the pair.