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Title: Zinco-alfa2-glicoproteína e sua associação com composição corporal e gasto energético de pacientes em hemodiálise
Keywords: Adipocinas;  Tecido adiposo;  Metabolismo energético;  Diálise renal;  Adipokines;  Adipose tissue;  Energy metabolism;  Renal dialysis;  MEDICINA;  CIÊNCIAS MÉDICAS
Issue Date: 27-Mar-2012
Abstract: Zinc-alpha2-glycoprotein (ZAG) is an adipokine inversely related to adiposity through its involvement in lipid mobilization, increased of energy expenditure and inhibition of lipogenesis. Recently, high ZAG levels were described in patients undergoing hemodialysis (HD), however, its clinical relevance still need investigation. The aim of this study was evaluated ZAG levels and its association with body composition and energy expenditure in HD patients. Forty-nine HD patients (mean age 53.1 ± 12.8 years, 28 men, 67.8 ± 41.1 months on HD, body mass index (BMI) of 23.9 ± 4.3 kg/m2) and 20 subjects not on renal replacement (mean age 49.5 ± 15.2 years, 9 men, BMI of 25.6 ± 4.1 kg/m2) were studied. Blood samples were collected to determine ZAG plasma levels, inflammatory markers (C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-&#945;) and interleukin-6 (IL-6)) and adipokines (leptin and adiponectin). The body composition was evaluated by anthropometric data and the muscle function, by handgrip strength (HGS). HGS values less than the 10th percentile of an age-, gender- and regional specific reference were considered as muscle function loss. The energy expenditure was evaluated by SenseWear Pro2 Armband. The food intake was measured via 24h recall, carried in 3 distinct occasions (HD day, non-HD day, and weekend). Although the most of HD patients (59.2%) was eutrophic according to body mass index, 91.1% presented high percentage of body fat (%BF) and 43.5%, reduced midarm muscle circumference. The HGS mean values were higher in men (28.8 ± 9.7 kg vs 13.9 ± 6.5 kg for women; p < 0.0001) and 55.8% of patients presented muscle function loss. In relation to food intake, the mean of energy intake was 1421.2 ± 531.2 kcal/day. The total energy expenditure of HD patients was 2257.7 ± 639.9 kcal/dia and the resting energy expenditure, 1513.4 ± 322.8 kcal/dia. The CRP, TNF-&#945;, IL-6 and leptin levels were higher in HD patients, while adiponectin levels were comparable between these patients and control group subjects. ZAG plasma levels were higher in HD patients (135.9 ± 40.9 mg/L vs 54.6 ± 23.0 mg/L in control group subjects; p<0.0001). In HD patients, ZAG was negatively correlated with adiposity parameters (sum of skinfolds (r= -0.47; p = 0.001), %BF (r = -0.36; p = 0.01), fat mass (FM) (r= -0.39; p = 0.008) and FM/free fat mass (FFM) ratio (r= -0.35; p = 0.01) and for each 1% reduction in %BF, ZAG increases 2.4 mg/L (p = 0.04). Circulating ZAG was also inversely correlated with TNF-&#945; (r= -0.42; p = 0.01). Energy expenditure, FFM, muscle function and food intake were not associated with ZAG levels. In conclusion, ZAG plasma levels are increased in HD patients and are negatively associated with inflammatory status and body fat mass. Therefore, ZAG seems to contribute to better metabolic profile in HD patients
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