GILIANE BELARMINO DA SILVA

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LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina

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  • conferenceObject
    Reduced Transcobalamin I Gene Expression Following Roux-en-Y Gastric Bypass Surgery Can Contribute to B12 Deficiency
    (2015) SALA, Priscila; MACHADO, Natasha; BELARMINO, Giliane; ISHIDA, Robson; GUARDA, Ismael; GIANNELLA-NETO, Daniel; SANTO, Marco Aurelio; MOURA, Eduardo; SAKAI, Paulo; SILVA, Ismael; YE, Jianping; HEYMSFIELD, Steven; WAITZBERG, Dan
  • bookPart
    Triagem e Avaliação do Estado Nutricional
    (2016) WAITZBERG, Dan Linetzky; DIAS, Maria Carolina Gonçalves; BELARMINO, Giliane; RASLAN, Mariana
  • article 18 Citação(ões) na Scopus
    Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass
    (2017) SALA, Priscila; BELARMINO, Giliane; TORRINHAS, Raquel S.; MACHADO, Natasha M.; FONSECA, Danielle C.; RAVACCI, Graziela R.; ISHIDA, Robson K.; GUARDA, Ismael F. M. S.; MOURA, Eduardo G. de; SAKAI, Paulo; SANTO, Marco A.; SILVA, Ismael D. C. G. da; PEREIRA, Claudia C. A.; LOGULLO, Angela F.; HEYMSFIELD, Steven; GIANNELLA-NETO, Daniel; WAITZBERG, Dan L.
    OBJECTIVES: Vitamin B12 (B12) deficiency after Roux-en-Y gastric bypass (RYGB) is highly prevalent and may contribute to postoperative complications. Decreased production of intrinsic factor owing to gastric fundus removal is thought to have a major role, but other components of B12 metabolism may also be affected. We evaluated changes in the expression levels of multiple B12 pathway-encoding genes in gastrointestinal (GI) tissues to evaluate the potential roles in contributing to post-RYGB B12 deficiency. METHODS: During double-balloon enteroscopy, serial GI biopsies were collected from 20 obese women (age, 46.9 +/- 6.2 years; body mass index, 46.5 +/- 5.3 kg/m(2)) with adult-onset type 2 diabetes (fasting plasma glucose >= 126 mg/dl; hemoglobin A1c >= 6.5%) before and, at the same site, 3 months after RYGB. Gene expression levels were assessed by the Affymetrix Human GeneChip 1.0 ST microarray. Findings were validated by real-time quantitative PCR (RT-qPCR). RESULTS: Gene expression levels with significant changes (P <= 0.05) included: transcobalamin I (TCN1) in remnant (-1.914-fold) and excluded (-1.985-fold) gastric regions; gastric intrinsic factor (GIF) in duodenum (-0.725-fold); and cubilin (CUBN) in duodenum (+0.982-fold), jejunum (+1.311-fold), and ileum (+0.685-fold). Validation by RT-qPCR confirmed (P <= 0.05) observed changes for TCN1 in the remnant gastric region (-0.132-fold) and CUBN in jejunum (+2.833-fold). CONCLUSIONS: RYGB affects multiple pathway-encoding genes that may be associated with postoperative B12 deficiency. Decreased TCN1 levels seem to be the main contributing factor. Increased CUBN levels suggest an adaptive genetic reprogramming of intestinal tissue aiming to compensate for impaired intestinal B12 delivery.
  • article 16 Citação(ões) na Scopus
    Body adiposity index performance in estimating body fat in a sample of severely obese Brazilian patients
    (2015) BELARMINO, Giliane; HORIE, Lilian Mika; SALA, Priscila Campos; TORRINHAS, Raquel S.; HEYMSFIELD, Steven B.; WAITZBERG, Dan L.
    Background/objectives: The body adiposity index (BAI) estimates the amount of body fat (BF) in humans. In Mexican-American and African-American populations, BAI has performed better than body mass index (BMI). The aim of this study was to evaluate the performance of BAI in estimating percentage (BF%) in severely obese Brazilian patients, with air displacement plethysmography (ADP) used as the reference method. Subjects/methods: Estimation of BF% by ADP, anthropometric measurements (height, abdominal and hip circumferences, body weight, and BMI) and BAI calculation were performed in 72 obese subjects (BMI >= 30 kg/m(2)) aged 30-55 years. Results: The mean BF% estimates +/- standard deviation were 52.1 +/- 5.7 % for ADP and 47.7 +/- 7.4 % for BAI, with a positive Pearson correlation (r(p) = 0.66) and a positive Lin's concordance correlation (r(c) = 0.479) observed between these methods. The 95 % limits of individual agreement between BAI and ADP ranged from -5.769 % to 16.036 %, with BAI exhibiting an average positive bias of 5.13 % compared to the reference method. For each studied variable, BAI exhibited a systematic bias, as evidenced by a tendency for low BF% values to be overestimated. Conclusion: For Brazilian patients with severe obesity, BAI does not provide an accurate estimate of BF%.
  • article 40 Citação(ões) na Scopus
    Diagnosing Sarcopenia in Male Patients With Cirrhosis by Dual-Energy X-Ray Absorptiometry Estimates of Appendicular Skeletal Muscle Mass
    (2018) BELARMINO, Giliane; GONZALEZ, Maria Cristina; SALA, Priscila; TORRINHAS, Raquel Susana; ANDRAUS, Wellington; D'ALBUQUERQUE, Luiz Augusto Carneiro; PEREIRA, Rosa Maria R.; CAPARBO, Valeria F.; FERRIOLI, Eduardo; PFRIMER, Karina; DAMIANI, Lucas; HEYMSFIELD, Steven B.; WAITZBERG, Dan L.
    Background: Ascites in cirrhotic patients interfere with accurate assessment of skeletal muscle when diagnosing sarcopenia. We hypothesized measurement of appendicular skeletal muscle index (ASMI) with dual-energy x-ray absorptiometry (DXA) improves the diagnosis of sarcopenia in cirrhotic patients as ASMI does not include the fluid-filled abdominal compartment. Objective: To evaluate if ASMI is influenced by ascites, lower limb edema (LLE) and predicts mortality alone or combined with handgrip strength (HGS) in cirrhotic patients. Design: ASMI, HGS, and 36-month mortality were obtained in 144 men with cirrhosis. ASMI was compared before and after paracentesis in 20 men with ascites and to results from 20 matched controls. The prognostic value of ASMI alone and with HGS was tested in a survival. Survival probabilities were obtained for sarcopenia diagnosed by standard ASMI and HGS European Working Group on Sarcopenia in Older People (EWGSOP) cutoffs and a new cutoff calculated from our ASMI + HGS tertiles. Results: ASMI did not change after paracentesis, was lower in patients than in controls (P < .001), and was not influenced by LLE (D = 0.30 kg/m2, P = .068; R-2 = 2.40%). Mortality was influenced by ASMI and HGS (P-interaction = 0.028). Sarcopenia diagnosed by EWGSOP was also diagnosed by our new cutoff; both predicted mortality with the latter more sensitive for mortality risk prediction (P = .011). Conclusions: DXA-measured ASMI is not influenced by ascites or LLE in cirrhotic patients; can diagnose low skeletal muscle/sarcopenia; and predicts mortality, particularly when combined with HGS.
  • article 3 Citação(ões) na Scopus
    New anthropometric and biochemical models for estimating appendicular skeletal muscle mass in male patients with cirrhosis
    (2021) BELARMINO, Giliane; TORRINHAS, Raquel Susana; V, Natalia Magalhaes; HEYMSFIELD, Steven B.; WAITZBERG, Dan L.
    Objectives: The use of easily accessible methods to estimate skeletal muscle mass (SMM) in patients with cirrhosis is often limited by the presence of edema and ascites, precluding a reliable diagnosis of sarcopenia. The aim of this study was to design predictive models using variables derived from anthropometric and/or biochemical measures to estimate SMM; and to validate their applicability in diagnosing sarcopenia in patients with cirrhosis. Methods: Anthropometric and biochemical data were obtained from 124 male patients (18-76 y of age) with cirrhosis who also underwent dual-energy x-ray absorptiometry (DXA) and handgrip strength (HGS) assessments to identify low SMM and diagnose sarcopenia using reference cutoff values. Univariate analyses for variable selection were applied to generate predictive decision tree models for low SMM. Model accuracy for the prediction of low SMM and sarcopenia (when associated with HGS) was tested by comparison with reference cutoff values (appendicular SMM index, obtained by DXA) and clinical sarcopenia diagnoses. The prognostic value of the models for the prediction of sarcopenia and mortality at 104 wk of follow up was further tested using Kaplan-Meier graphics and Cox models. Results: The models with anthropometric variables, alone and combined with biochemical variables, showed good accuracy (0.89 [0.83; 0.94] and 0.90 [0.84; 0.95], respectively) and sensitivity (0.72 [0.56; 0.85] and 0.74 [0.59; 0.86], respectively) and excellent specificity (0.96 [0.90; 0.99] and 0.97 [0.92; 0.99], respectively) in predicting SMM. Both models showed excellent accuracy (0.94 [0.89; 0.98], good sensitivity (0.68 [0.45; 0.86]), and excellent specificity (1.00 [0.96; 1.00]) in predicting sarcopenia. The models predicted mortality in patients with sarcopenia, with the likelihood of death sixfold greater relative to patients not predicted to have sarcopenia. Conclusions: Our simple and inexpensive models provided a practical and safe approach to diagnosing sarcopenia patients with cirrhosis along with an estimate of their mortality risk when other reference methods are unavailable.
  • conferenceObject
    Measurement of Adipose Tissue by L4 Computed Tomography, Air Displacement Plethysmography and Bioelectrical Impedance in Ascitic Cirrhotic Patients
    (2012) BELARMINO, Giliane; WAITZBERG, Dan L.; D'ALBUQUERQUE, Luiz A. C.; HEYMSFIELD, Steven B.; ANDRAUS, Wellington; PINHEIRO, Rafael
    Introduction: Fat and lean body mass depletion affects about 60% of liver cirrhotic patients being associated with complications and negative prognosis. However, controversy exists regarding the best body composition (BC) assessment method for ascitic cirrhotic (AC) patients. Muscle and adipose tissue surface areas were evaluated with computed tomography (CT) at L4 vertebrae and were significantly related to whole-body muscle and fat mass. But the high cost of CT limits its clinical routine use. Air displacement plethysmography (ADP) has the same limitation. Bioelectrical impedance analysis (BIA) is a widely available BC method that is simple to use in clinical practice and has minimal risk. However BIA in ascitic cirrhotic patients may not accurately evaluate BC due to alterations in hydration. Our aim was to compare, in AC patients, adipose tissue estimated from three methods using L4 CT as the reference. Methods: In 8 AC patients (6M/2F), Child class B, age was (X ± SD) 58 ± 11 years and BMI 22.86 ± 4.08 kg/m2. Adipose tissue was measured through L4 CT, multislice CT (Toshiba Aquilion 64®) and ADP (BOD POD® BC System, Life Measurement Instruments, GerAr MED-Brazil) and BIA Bodystat Quadiscam 4000®. The data collected was statistically analyzed using Spearman’s correlation coef ficient with p<0.05. Results: The absolute value for adipose tissue was for L4 CT 273.1 cm2 ± 100,2, for ADP 34,2% ± 7,8 and for BIA 29,1% ± 5,4. The correlation was r=0.88 between L4 CT and ADP. There were no significant correlations between the other methods. Table 1. Comparison of the correlation coefficient of adipose tissue estimated through of L4 CT, ADP and BIA. L4 CT vs ADP 0.88 0.01 L4 CT vs BIA 0.77 0.07 ADP vs BIA 0.35 0.38 Conclusions: BIA cannot be used for adipose tissue estimation in patients with cirrhosis and ascites.
  • conferenceObject
    CHANGES IN INTESTINAL GENE EXPRESSION AFTER ROUX-EN-Y GASTRIC BYPASS COULD CONTRIBUTE TO ALZHEIMER DISEASE (AD) RISK REDUCTION.
    (2016) SALA, P.; BELARMINO, G.; MACHADO, N. M.; FONSECA, D. C.; ISHIDA, R. K.; TORRINHAS, R. S. M. M.; GIANNELLA-NETO, D.; WAITZBERG, D. L.
  • article 8 Citação(ões) na Scopus
    Intestinal expression of toll-like receptor gene changes early after gastric bypass surgery and association with type 2 diabetes remission
    (2020) SALA, Priscila; TORRINHAS, Raquel Susana Matos de Miranda; FONSECA, Danielle C.; MACHADO, Natasha Mendonca; SINGER, Joelle; SINGER, Pierre; RAVACCI, Graziela Rosa; BELARMINO, Giliane; FERREIRA, Beatriz A. M.; MARQUES, Mariane; ISHIDA, Robson Kiyoshi; GUARDA, Ismael Francisco Mota Siqueira; MOURA, Eduardo Guimaraes Hourneaux de; SAKAI, Paulo; SANTO, Marco Aurelio; SUNAGA, Daniele Yumi; HEYMSFIELD, Steven B.; BEZERRA, Daniele Pereira dos Santos; CORREA-GIANNELLA, Maria Lucia; WAITZBERG, Dan Linetzky
    Objectives: Abnormal activation of toll-like receptors (TLRs) is observed in obese rodents and is correlated with local dysbiosis and increased gut permeability. These purported changes trigger systemic inflammation associated with obesity-related comorbidities, including type 2 diabetes (T2D). Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for severe obesity and known to induce changes in the gut microbiota and decrease systemic inflammation in humans. This study examined the intestinal expression of TLR-encoding genes in obese women (n = 20) treated with RYGB surgery and the relationship of these genes with T2D remission (T2Dr Methods: Intestinal biopsies were performed before and 3 months after RYGB surgery. Partial and complete T2Dr after 1 year was assessed using the American Diabetes Association criteria. Affymetrix Human GeneChip 1.0 ST array (microarray) and TaqMan assay (real-time quantitative polymerase chain reaction) were used to analyze intestinal gene expression, and associations with systemic markers of energy homeostasis were examined. Results: Patients experienced significant weight loss (P < 0.001) and altered gut TLR gene expression 3 months after surgery. The main effects were a reduction in jejunal TLR4 expression in patients with complete and partial T2Dr (P < 0.05). There was a postoperative decrease in jejunal TLR7 expression in patients with complete T2Dr that correlated inversely with high-density lipoprotein cholesterol and positively with triglyceride concentrations, but not with weight loss. Conclusions: RYGB-induced weight loss-independent changes in the expression of intestinal TLR-encoding genes in obese women and complete T2Dr that was correlated with systemic markers of energy homeostasis. The modulation of intestinal TLRs may mediate inflammatory mechanisms linked to T2Dr after RYGB surgery.
  • conferenceObject
    BODY ADIPOSITY INDEX IN ASSOCIATION WITH METS AND CARDIOVASCULAR RISK MARKERS
    (2016) BELARMINO, Giliane; SALA, Priscila; TORRINHAS, Raquel S. M.; WAITZBERG, Dan L.