Efeitos da dieta hipocalórica sobre a função endotelial em adultos obesos
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Resumo
A obesidade é uma doença inflamatória crônica caracterizada pelo acúmulo excessivo de gordura no tecido adiposo. Componentes fisiopatológicos decorrentes do excesso de gordura corporal, como alterações no balanço de adipocinas, resistência insulínica e aumento de mediadores inflamatórios, promovem disfunção endotelial, e, consequentemente, maior risco de morbidade e mortalidade de origem cardiovascular. Por outro lado, a adoção de dieta hipocalórica tem sido recomendada como medida não farmacológica para o tratamento da obesidade. Portanto, o objetivo desse artigo foi o de realizar uma revisão de literatura sobre os efeitos da dieta hipocalórica na função endotelial em adultos com obesidade. Foram analisados 26 artigos com os descritores dieta redutora, restrição calórica e perda de peso, combinados com os termos vasodilatação e endotélio, publicados nas bases de dados eletrônicas Medline e Scielo. Foi possível observar que a dieta hipocalórica, quando associada à perda de peso corporal, melhora os parâmetros metabólicos, inflamatórios, hemodinâmicos e neurovasculares, os quais promovem melhora da função endotelial em indivíduos obesos. Entretanto, para que esses benefícios sejam obtidos, a dieta deve ser individualizada, balanceada e com orientação e prescrição de especialistas.
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Referências
Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica. Diretrizes brasileiras de obesidade 2009/2010. 3. ed. Itapevi: AC Farmacêutica; 2009. p. 85.
Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235-41. http://dx.doi.org/10.1001/jama.2009.2014
Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil. Rio de Janeiro: IBGE; 2010.
Coutinho T, Goel K, Corrêa de Sá D, Carter RE, Hodge DO, Kragelund C, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of “normal weight central obesity”. J Am Coll Cardiol. 2013;61(5):553-60. http://dx.doi.org/10.1016/j.jacc.2012.10.035
Shankar SS, Steinberg HO. Weight loss and vascular function: the good and the unknown. Hypertension. 2008;52(1):57-8. http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.112441
Lerman A, Zeiher AM. Endothelial function: cardiac events. Circulation. 2005;111(3):363-8. http://dx.doi.org/10.1161/01.CIR.0000153339.27064.14
Van Guilder GP, Stauffer BL, Greiner JJ, Desouza CA. Impaired endothelium-dependent vasodilation in overweight and obese adult humans is not limited to muscarinic receptor agonists. Am J Physiol Heart Circ Physiol. 2008;294(4):1685-92. http://dx.doi.org/10.1152/ajpheart.01281.2007
Tonacio AC, Trombetta IC, Rondon MU, Batalha LT, Kuniyoshi FH, Laterza MC, et al. Effects of diet and exercise training on neurovascular control during mental stress in obese women. BrazJ Med Biol Res. 2006;39(1):53-62. http://dx.doi.org/10.1590/S0100-879X2006000100006
Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900.000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-96. http://dx.doi.org/10.1016/S0140-6736(09)60318-4
Maeda S, Jesmin S, Iemitsu M, Otsuki T, Matsuo T, Ohkawara K, et al. Weight loss reduces plasma endothelin-1 concentration in obese men. Exp boil Med. 2006; 231(6):1044-47.
Raitakari M, Ilvonen T, Ahotupa M, Lehtimäki T, Harmoinen A, Suominen P, et al. Weight reduction with very-low-caloric diet and endothelial function in overweight adults: role of plasma glucose. Arterioscler Thromb Vasc Biol. 2004;24(1):124-8. http://dx.doi.org/10.1161/01.ATV.0000109749.11042.7c
Morel O, Luca F, Grunebaum L, Jesel L, Meyer N, Desprez D, et al. Short-term very low-calorie diet in obese females improves the haemostatic balance through the reduction of leptin levels, PAI-1 concentrations and a diminished release of platelet and leukocytederived microparticles. Int J Obes (Lond). 2011;35(12):1479-86. http://dx.doi.org/10.1038/ijo.2011.19
Johnstone AM, Lobley GE, Horgan GW, Bremner DM, Fyfe CL, Morrice PC, et al. Effects of a high-protein, low-carbohydrate v. high-protein, moderate-carbohydrate weight-loss diet on antioxidant status, endothelial markers and plasma indices of the cardiometabolic profile. Br J Nutr. 2011;106(2):282-91. http://dx.doi.org/10.1017/S0007114511000092
Capel F, Klimcáková E, Viguerie N, Roussel B, Vítková M , Kováciková M, et al. Macrophages and adipocytes in human obesity: adipose tissue gene expression and insulin sensitivity during calorie restriction and weight stabilization. Diabetes. 2009;58(7):1558-67. http://dx.doi.org/10.2337/db09-0033
Mavri A, Poredoš P, Suran D, Gaborit B, Juhan-Vague I, Poredoš P. Effect of diet-induced weight loss on endothelial dysfunction: early improvement after the first week of dieting. Heart Vessels. 2011;26(1):31-8. http://dx.doi.org/10.1007/s00380-010-0016-1
Pierce GL, Beske SD, Lawson BR, Southall KL, Benay FJ, Donato AJ, et al. Weight loss alone improves conduit and resistance artery endothelial function in young and older overweight/obese adults. Hypertension. 2008;52(1):72-9. http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.111427
Borges RL, Ribeiro-Filho FF, Carvalho KMB, Zanella MT. Impacto da perda de peso nas adipocitocinas, na proteína C-Reativa e na sensibilidade à insulina em mulheres hipertensas com Oobesidade central. Arq Bras Cardiol. 2007;89(6):371-5. http://dx.doi.org/10.1590/S0066-782X2007001800010
Straznicky NE, Grima MT, Eikelis N, Nestel PJ, Dawood T, Schlaich MP, et al. The effects of weight loss versus weight loss maintenance on sympathetic nervous system activity and metabolic syndrome components. J Clin Endocrinol Metab. 2011;96(3):E503-8. http://dx.doi.org/10.1210/jc.2010-2204
Wycherley TP, Brinkworth GD, Noakes M, Buckley JD, Clifton PM. Effect of caloric restriction with and without exercise training on oxidative stress and endothelial function in obese subjects with type 2 diabetes. Diabetes Obes Metab. 2008;10(11):1062-73. http://dx.doi.org/10.1111/j.1463-1326.2008.00863.x
de la Sierra A, Larrousse M. Endothelial dysfunction is associated with increased levels of biomarkers in essential hypertension. J Hum Hypertens. 2010;24(6):373-9. http://dx.doi.org/10.1038/jhh.2009.91
Cabral MD, Teixeira PFS, Leite SP, Vaisman M. Marcadores de função endotelial no hipotireoidismo. Arq Bras Endocrinol Metab. 2009;53(3):303-09. http://dx.doi.org/10.1590/S0004-27302009000300002
Bigornia SJ, Mott MM, Hess DT, Apovian CM, McDonnell ME, Duess MA, et al. Long-term successful weight loss improves vascular endothelial function in severely obese individuals. Obesity. 2010;18(4):754-9. http://dx.doi.org/10.1038/oby.2009.482
Hirata Y, Nagata D, Suzuki E, Nishimatsu H, Suzuki J, Nagai R. Diagnosis and treatment of endothelial dysfunction in cardiovascular disease. Int Heart J. 2010;51(1):1-6. http://dx.doi.org/10.1536/ihj.51.1
Varady KA, Bhutani S, Klempel MC, Phillips SA. Improvements in vascular health by a low-fat diet, but not a high-fat diet, are mediated by changes in adipocyte biology. Nutr J. 2011;10:8. http://dx.doi.org/10.1186/1475-2891-10-8
Russo I, Traversa M, Bonomo K, De Salve A, Mattiello L, Del Mese P, et al. In central obesity, weight loss restores platelet sensitivity to nitric oxide and prostacyclin. Obesity . 2010;18(4):788-97. http://dx.doi.org/10.1038/oby.2009.302
Volek JS, Ballard KD, Silvestre R, Judelson DA, Quann EE, Forsythe CE, et al. Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation. Metabolism. 2009;58(12):1769-77. http://dx.doi.org/10.1016/j.metabol.2009.06.005
Angelico F, Loffredo L, Pignatelli P, Augelletti T, Carnevale R, Pacella A, et al. Weight loss is associated with improved endothelial dysfunction via NOX2-generated oxidative stress down-regulation in patients with the metabolic syndrome. Intern Emerg Med. 2012;7(3):219-27. http://dx.doi.org/10.1007/s11739-011-0591-x
Davis NJ, Crandall JP, Gajavelli S, Berman JW, Tomuta N, Wylie-Rosett J, et al. Differential effects of low-carbohydrate and lowfat diets on inflammation and endothelial function in diabetes. J Diabetes Complications. 2011;25(6):371-6. http://dx.doi.org/10.1016/j.jdiacomp.2011.08.001
Wycherley TP, Brinkworth GD, Keogh JB, Noakes M, Buckley JD, Clifton PM. Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. J Intern Med. 2010;267(5):452-61. http://dx.doi.org/10.1111/j.1365-2796.2009.02174.x
Krysiak R, Handzlik-Orlik G, Okopien B. The role of adipokines in connective tissue diseases. Eur J Nutr. 2012;51(5):513-28. http://dx.doi.org/10.1007/s00394-012-0370-0
Cerqueira FM, Brandizzi LI, Cunha FM, Laurindo FR, Kowaltowski AJ. Serum from calorie-restricted rats activates vascular cell enos through enhanced insulin signaling mediated by adiponectin. PLoS One. 2012;7(2):e31155. http://dx.doi.org/10.1371/journal.pone.0031155
Schulte DM, Müller N, Neumann K, Oberhaüser F, Faust M, Güdelhöfer H, et al. Pro-inflammatory wnt5a and anti-inflammatory sfrp5 are differentially regulated by nutritional factors in obese human subjects. PLoS One. 2012;7(2):e32437. http://dx.doi.org/10.1371/journal.pone.0032437
Brinkworth GD, Noakes M, Buckley JD, Keogh JB, Clifton PM. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr. 2009;90(1):23-32. http://dx.doi.org/10.3945/ajcn.2008.27326
Kopp HP, Krzyzanowska K, Möhlig M, Spranger J, Pfeiffer AFH, Schernthaner G. Effects of marked weight loss on plasma levels of adiponectin, markers of chronic subclinical inflammation and insulin resistance in morbidly obese women. Int J Obes. 2005;29(7):766-71. http://dx.doi.org/10.1038/sj.ijo.0802983
De Keulenaer GW, Alexander RW, Ushio-Fukai M, Ishizaka N, Griendling KK. Tumour necrosis factor alpha activates a p22phoxbased NADH oxidase in vascular smooth muscle. Biochem J. 1998;329(Pt 3):653-7.
Ouchi N, Higuchi A, Ohashi K, Oshima Y, Gokce N, Shibata R, et al. Sfrp5 is an anti-inflammatory adipokine that modulates metabolic dysfunction in obesity. Science. 2010; 329(5990):454-7. http://dx.doi.org/10.1126/science.1188280
McLaughlin T, Carter S, Lamendola C, Abbasi F, Yee G, Schaaf P, et al. Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Am J Clin Nutr. 2006;84(4):813-21.
Keogh JB, Brinkworth GD, Noakes M, Belobrajdic DP, Buckley JD, Clifton PM. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of car diovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr. 2008;87(3):567-76.
Hennig B, Toborek M, McClain CJ. High-energy diets, fatty acids and endothelial cell function: implications for atherosclerosis. J Am Coll Nutr. 2001;20(2 Suppl):97-105. http://dx.doi.org/10.1080/07315724.2001.10719021
National Heart Lung and Blood Institute [internet]. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Disponível em: <http://www.nhlbi.nih.gov/ guidelines/obesity/ob_home.htm>. Acesso em: 08 ago 2013.