LILIAM TAKAYAMA GUERRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Abnormal Body Composition in Takayasu Arteritis Patients: Role of Inflammatory Cytokines and Adipokines(2015) SILVA, Thiago Ferreira da; NETO, Mauricio Levy; CAPARBO, Valeria; TAKAYAMA, Liliam; PEREIRA, Rosa M. R.conferenceObject Performance of FRAX® Brazil and NOGG Methodology with and Without Bone Mineral Density upon Predicting Fractures on a Community-Dwelling Elderly Population with High Incidence of Osteoporotic Fractures - The Sao Paulo Ageing and Health (SPAH) Study(2023) FREITAS, Thiago Q.; OLALLA, Leonardo F. Guerron; TAKAYAMA, Liliam; CAPARBO, Valeria F.; FIGUEIREDO, Camille P.; MACHADO, Luana G.; DOMICIANO, Diogo S.; PEREIRA, Rosa M. R.- Low bone mineral density among HIV-infected patients in Brazil(2017) CHABA, Daniela Cardeal da Silva; SOARES, Lismeia R.; PEREIRA, Rosa M. R.; RUTHERFORD, George W.; ASSONE, Tatiane; TAKAYAMA, Liliam; FONSECA, Luiz A. M.; DUARTE, Alberto J. S.; CASSEB, JorgeDecrease in bone mineral density (BMD) has been a complication among people living with HIV/AIDS. To investigate the prevalence of osteopenia/osteoporosis among HIV-infected people living in Sao Paulo city, we studied 108 HIV-infected patients (79 men and 29 women). We extracted data from patients' medical records and BMD was measured by dual-energy X-ray absorptiometry (DXA). Median age of participants was 42 years (interquartile range [IQR] 36-48 years), and the median time since HIV diagnosis was 4.01 years (IQR 2-11 years). Patients had acquired HIV primarily by the sexual route (men who have sex with men 44%, heterosexual 49%). Median age, duration of HIV infection, duration of ART and CD4 nadir were similar for men and women. Plasma viral load was undetectable for 53 patients (49%). Median CD4 T cell count was 399 cells/mu L (IQR 247 - 568). Twenty five patients (23%) had LBMD, and there was no statistically significant difference between men and women (<-1). The associated risk factors for LBMD were older age (>= 50 years old) and smoking with a RR of 3.87 and 2.80, respectively. Thus, despite the lack of statistically significant relationship between the use of ART and LBMD or between duration of ART and LBMD, these factors should be addressed in larger studies.
- A predictive model of vitamin D insufficiency in older community people: From the Sao Paulo Aging & Health Study (SPAH)(2014) LOPES, Jaqueline B.; FERNANDES, Georgea H.; TAKAYAMA, Liliam; FIGUEIREDO, Camille P.; PEREIRA, Rosa M. R.Objective: To evaluate the prevalence of 25-hydroxyvitamin D insufficiency (25OHD < 20 ng/mL) and to develop a predictive model for this status. Methods: This is a cross-sectional study including 908 community-dwelling older subjects, 18% (158) of which were randomly selected to be a ""test"" sample, with the remaining (750) composing a ""development"" sample. A radioimmunoassay technique was used to measure 25OHD levels. Anthropometrical data, information about lifestyle habits and co-morbidities were obtained. Multiple logistic regression models were created. An Index Risk of Vitamin D Insufficiency (IRVDI) was designed and subsequently validated. The performance of this tool was assessed through ROC analysis. Results: The prevalence of 25OHD <20 ng/mL was of 58.0% (CI 95% 51.6-64.6). The clinical independent factors for 25OHD <20 ng/mL were female gender (OR=2.16; 95%CI 1.13-4.13; p=0.020), diabetes (OR=1.84; 95%CI 1.23-2.74; p=0.003) and season (winter/spring) (OR=3.63, 95%CI 2.62-4.88; p < 0.001). After statistical adjustments, the IRVDI was able to identify older people at risk for vitamin D insufficiency with a sensitivity of 55.9%, specificity 72.3% and ROC area of 0.685 (p < 0.001). Conclusions: Our results suggest that vitamin D insufficiency is common among Brazilian community-dwelling elderly. Female gender, diabetes and the season (winter/spring) were the important parameters that predicted this status. The clinical use of these parameters can be help to design and target appropriate public health interventions. The IRVDI is a convenient tool for the selection of older people at risk for vitamin D insufficiency.
- Effects of diuretics furosemide and hydrochlorothiazide on CKD-MBD: A prospective randomized study(2021) VASCO, Raquel F. V.; TAKAYAMA, Liliam; PEREIRA, Rosa M. R.; MOYSES, Rosa M. A.; ELIAS, Rosilene M.Although diuretics are often prescribed to control fluid overload, they can change Chronic kidney disease-mineral and bone disorder (CKD-MBD) parameters. Previous studies have shown an association between diuretic prescription and changes in both calciuria and parathormone levels. However, the causal relationship could not be confirmed. In addition, the effects of diuretics on bone mineral density and turnover markers are yet to be established. To evaluate the effects of diuretics on CKD-MBD, we have performed a prospective randomized trial comparing hydrochlorothiazide with furosemide in a stage 3CKD population followed for 1 year. Furosemide increased bone remodeling and parathormone levels, whereas hydrochlorothiazide attenuated parathyroid hormone rise and decreased bone turnover markers.
- Assessment of Bone Microarchitecture in Patients with Systemic Mastocytosis and its Association with Clinical and Biochemical Parameters of the Disease(2023) FRANCO, Andre S.; MURAI, Igor H.; TAKAYAMA, Liliam; CAPARBO, Valeria F.; MARCHI, Luan L.; VELLOSO, Elvira D. R. P.; PEREIRA, Rosa M. R.Patients with systemic mastocytosis (SM) are at high risk of bone deterioration. However, the evaluation of bone microarchitecture in this disease remains unclear. We aimed to assess bone microarchitecture in patients with SM. This was a cross-sectional study of 21 adult patients with SM conducted in a quaternary referral hospital in Sao Paulo, Brazil. A healthy, age-, weight-, and sex-matched cohort of 63 participants was used to provide reference values for bone microarchitecture, assessed by high resolution peripheral quantitative computed tomography (HR-pQCT). Total volumetric bone mineral density (vBMD), cortical vBMD, and cortical thickness at the radius were significantly lower in the control group compared with the SM group (all P < 0.001). Patients with aggressive SM had significantly lower trabecular number (Tb.N) (P = 0.035) and estimated failure load (F.load) (P = 0.032) at the tibia compared with those with indolent SM. Handgrip strength was significantly higher in patients who had more Tb.N at the radius (rho, 0.46; P = 0.036) and tibia (rho, 0.49; P = 0.002), and lower who had more trabecular separation at the radius (rho, -0.46; P = 0.035) and tibia (rho, -0.52; P = 0.016). Strong and positive associations between F.load (rho, 0.75; P < 0.001) and stiffness (rho, 0.70; P < 0.001) at the radius, and between F.load at the tibia (rho, 0.45; P = 0.038) were observed with handgrip strength. In this cross-sectional study, aggressive SM was more susceptible to bone deterioration compared with indolent SM. In addition, the findings demonstrated that handgrip strength was associated with bone microarchitecture and bone strength.
- Risk Factors for Low Muscle Mass in a Population-based Prospective Cohort of Brazilian Community-dwelling Older Women: The Sao Paulo Ageing & Health (SPAH) Study(2020) MACHADO, Ketty L. L. L.; DOMICIANO, Diogo S.; MACHADO, Luana G.; LOPES, Jaqueline B.; FIGUEIREDO, Camille P.; CAPARBO, Valeria F.; TAKAYAMA, Liliam; MENEZES, Paulo R.; PEREIRA, Rosa M. R.Introduction: Sarcopenia is characterized by progressive loss of skeletal muscle mass, which results in decreased muscle strength, functional impairment, and increased risk of death. Few studies have performed a concomitant evaluation of clinical, laboratory, and body composition variables to accurately determine the contribution of each parameter to low muscle mass (LMM) in older subjects. This study aimed to identify risk factors (clinical, laboratory parameters, BMD, and body composition by DXA including visceral fat) for LMM in a prospective cohort of older Brazilian women. Methods: A total of 408 women aged >= 65 yr from the Sao Paulo Ageing & Health study were evaluated with clinical data, laboratory bone tests, BMD, and body composition by DXA using Hologic QDR 4500A equipment. Risk factors were measured at baseline (2005-2007). After a follow-up of 4.3 +/- 0.8 yr, subjects were classified according to the LMM definition of the Foundation for the National Institutes of Health criteria. LMM was defined when appendicular lean mass divided by body mass index was less than 0.512. Multivariate logistic regression models were used to identify independent risk factors for LMM. Results: At the end of follow-up, 116 women (28.4%) had LMM. Age averages were 73.3 +/- 4.9 yr in the LMM group and 72.5 +/- 4.5 yr in the normal group (p = 0.11). Mean BMI was 30.6 +/- 5.2 kg/m(2) in the LMM group and 28.1 +/- 4.7 kg/m(2) in the normal group (p < 0.001). In multivariate analyses, predictors of LMM were: falls (OR = 1.14, p = 0.016), TSH levels (OR = 1.08, p = 0.018, per 1 mu UI/L-increase), serum creatinine levels (OR =11.11, p < 0.001, per 1 mg/dL-decrease), and visceral adipose tissue (VAT) mass (OR = 1.17, p < 0.001, per 100 g increase). Conclusions: Falls, high TSH, low creatinine, and high VAT were risk factors for LMM in older women. More attention should be paid to these factors, since they are potentially reversible with adequate intervention.
conferenceObject Effects Of Downhill Running On Body Composition In Ovariectomized Rats: A Pilot Study(2013) MURAI, Igor H.; NICASTRO, Humberto; TAKAYAMA, Liliam; PEREIRA, Rosa M. R.; GUALANO, BrunoconferenceObject Association of Moderate/Severe Vertebral Fractures with Reduced Trabecular Volumetric Bone Density in Older Women and Reduced Areal Femoral Neck Bone Density in Older Men from Community: A Cross-Sectional Study (SPAH)(2018) TORRES, Georgea H. F.; GUZMAN, Luis F. S.; ALVARENGA, Jackeline C.; SR., Levi Neto; CAPARBO, Valeria F.; TAKAYAMA, Liliam; DOMICIANO, Diogo S.; SR., Neusa Lopes; PEREIRA, Rosa M. R.- Bone erosions associated with systemic bone loss on HR-pQCT in women with longstanding polyarticular juvenile idiopathic arthritis(2023) RIBEIRO, Surian Clarisse C. R.; SALES, Lucas P.; FERNANDES, Alan L.; PEREZ, Mariana O.; TAKAYAMA, Liliam; CAPARBO, Valeria F.; ASSAD, Ana Paula L.; AIWAKA, Nadia E.; GOLDENSTEIN-SCHAINBERG, Claudia; BORBA, Eduardo F.; DOMICIANO, Diogo S.; FIGUEIREDO, Camille P.; PEREIRA, Rosa M. R.Objectives: To analyze longstanding polyarticular juvenile idiopathic arthritis (pJIA) for possible associations between localized bone damage (erosions), and systemic bone loss. Besides, to compare the systemic bone mass of pJIA with healthy controls. Methods: Thirty-four pJIA women and 99 healthy controls (HC) were included. Radius and tibia of all subjects were scanned by HR-pQCT. Volumetric bone mineral density (vBMD), bone microarchitecture, and -finite element parameters were analyzed. Patients underwent HR-pQCT of 2nd and 3rd metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the dominant hand, for bone erosions quantification. Results: The mean age of patients was 31.5 +/- 7.4yrs with a mean disease duration of 21.7 +/- 9.2yrs. Bone erosions were detectable in 79% of patients. The number of bone erosions was positively correlated with cortical porosity (Ct.Po) at tibia (r = 0.575, p = 0.001), and radius (r = 0.423, p = 0.018); and negatively correlated with cortical vBMD at tibia (r=-0.420, p = 0.015). In a logistic regression analysis, adjusted for anti-CCP, the presence of bone erosions was independently associated with Ct.Po at radius (p = 0.018) and cortical vBMD at tibia (p = 0.020). Moreover, cortical and trabecular vBMD, trabecular number, and mu-finite element parameters were decreased in patients compared to HC (p < 0.05). Conclusion: Bone erosions in longstanding pJIA women were associated with decreased cortical bone parameters, and these patients showed systemic bone impairment at peripheral sites compared with healthy controls.