ANA MARIA PITA LOTTENBERG
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LIM/10 - Laboratório de Lípides, Hospital das Clínicas, Faculdade de Medicina
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- I Brazilian Guidelines On Cardiovascular Prevention(2013) SIMAO, A. F.; PRECOMA, D. B.; ANDRADE, J. P.; CORREA FILHO, H.; SARAIVA, J. F. K.; OLIVEIRA, G. M. M.; MURRO, A. L. B.; CAMPOS, A.; ALESSI, A.; AVEZUM JUNIOR, A.; ACHUTTI, A. C.; MIGUEL, A. C. M. G.; SOUSA, A. C. S.; LOTEMBERG, A. M. P.; LINS, A. P.; FALUD, A. A.; BRANDAO, A. A.; SANJULIANI, A. F.; SBISSA, A. S.; ALENCAR FILHO, A. C.; HERDY, A. H.; POLANCZYK, C. A.; LANTIERI, C. J.; MACHADO, C. A.; SCHERR, C.; STOLL, C.; AMODEO, C.; ARAUJO, C. G. S.; SARAIVA, D.; MORIGUCHI, E. H.; MESQUITA, E. T.; CESENA, F. H. Y.; FONSECA, F. A. H.; CAMPOS, G. P.; SOARES, G. P.; FEITOSA, G. S.; XAVIER, H. T.; CASTRO, I; GIULIANO, I. C. B.; V, I. Rivera; GUIMARAES, I. C. B.; ISSA, J. S.; SOUZA, J. R. M.; FARIA NETO, J. R.; CUNHA, L. B. N.; PELLANDA, L. C.; BORTOLOTTO, L. A.; BERTOLAMI, M. C.; MINAME, M. H.; GOMES, M. A. M.; TAMBASCIA, M.; MALACHIAS, M. V. B.; SILVA, M. A. M.; IZA, M. C. O.; MAGALHAES, M. E. C.; BACELLAR, M. S. C.; MILANI, M.; WAJNGARTEN, M.; GHORAYEB, N.; COELHO, O. R.; VILLELA, P. B.; V, P. C. B. Jardim; SANTOS FILHO, R. D.; STEIN, R.; CASSANI, R. S. L.; D'AVILA, R. L.; FERREIRA, R. M.; BARBOSA, R. B.; POVOA, R. M. S.; KAISER, S. E.; ISMAEL, S. C.; CARVALHO, T.; GIRALDEZ, V. Z. R.; COUTINHO, W.; SOUZA, W. K. S. B.
- Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022)(2023) PEPE, Renata Bressan; LOTTENBERG, Ana Maria; FUJIWARA, Clarissa Tamie Hiwatashi; BEYRUTI, Monica; CINTRA, Dennys Esper; MACHADO, Roberta Marcondes; RODRIGUES, Alessandra; JENSEN, Natalia Sanchez Oliveira; CALDAS, Ana Paula Silva; FERNANDES, Ariana Ester; ROSSONI, Carina; MATTOS, Fernanda; MOTARELLI, Joao Henrique Fabiano; BRESSAN, Josefina; SALDANHA, Juliana; BEDA, Lis Mie Masuzawa; LAVRADOR, Maria Silvia Ferrari; BOSCO, Mariana Del; CRUZ, Patricia; CORREIA, Poliana Espindola; MAXIMINO, Priscila; PEREIRA, Silvia; FARIA, Silvia Leite; PIOVACARI, Silvia Maria FragaObesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.
- Brazilian evidence-based guideline for screening, diagnosis, treatment, and follow-up of metabolic dysfunction-associated steatotic liver disease (MASLD) in adult individuals with overweight or obesity: A joint position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM), Brazilian Society of Hepatology (SBH), and Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso)(2023) MOREIRA, Rodrigo Oliveira; VALERIO, Cynthia Melissa; VILLELA-NOGUEIRA, Cristiane Alves; CERCATO, Cintia; GERCHMAN, Fernando; LOTTENBERG, Ana Maria Pita; GODOY-MATAS, Amelio Fernando; OLIVEIRA, Ricardo de Andrade; MELLO, Carlos Eduardo Brandao; ALVARES-DA-SILVA, Mario Reis; LEITE, Nathalie Carvalho; COTRIM, Helma Pinchemel; PARISI, Edison Roberto; SILVA, Giovanni Faria; MIRANDA, Paulo Augusto Carvalho; HALPERN, Bruno; OLIVEIRA, Claudia PintoIntroduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as Nonalcoholic fatty liver disease (NAFLD), is one of the most common hepatic diseases in individuals with overweight or obesity. In this context, a panel of experts from three medical societies was organized to develop an evidence-based guideline on the screening, diagnosis, treatment, and follow-up of MASLD. Material and methods: A MEDLINE search was performed to identify randomized clinical trials, meta-analyses, cohort studies, observational studies, and other relevant studies on NAFLD. In the absence of studies on a certain topic or when the quality of the study was not adequate, the opinion of experts was adopted. Classes of Recommendation and Levels of Evidence were determined using prespecified criteria. Results: Based on the literature review, 48 specific recommendations were elaborated, including 11 on screening and diagnosis, 9 on follow-up, 14 on nonpharmacologic treatment, and 14 on pharmacologic and surgical treatment. Conclusions: A literature search allowed the development of evidence-based guidelines on the screening, diagnosis, treatment, and follow-up of MASLD in individuals with overweight or obesity.
- Dietary interesterified fat enriched with palmitic acid induces atherosclerosis by impairing macrophage cholesterol efflux and eliciting inflammation(2016) AFONSO, Milessa Silva; LAVRADOR, Maria Silvia Ferrari; KOIKE, Marcia Kiyomi; CINTRA, Dennys Esper; FERREIRA, Fabiana Dias; NUNES, Valeria Sutti; CASTILHO, Gabriela; GIOIELLI, Luiz Antonio; BOMBO, Renata Paula; CATANOZI, Sergio; CALDINI, Elia Garcia; DAMACENO-RODRIGUES, Nilsa Regina; PASSARELLI, Marisa; NAKANDAKARE, Edna Regina; LOTTENBERG, Ana MariaInteresterified fats are currently being used to replace trans fatty acids. However, their impact on biological pathways involved in the atherosclerosis development was not investigated. Weaning male LDLr-KO mice were fed for 16 weeks on a high-fat diet (40% energy as fat) containing polyunsaturated (PUFA), TRANS, palmitic (PALM), palmitic interesterified (PALM INTER), stearic (STEAR) or stearic interesterified (STEAR INTER). Plasma lipids, lipoprotein profile, arterial lesion area, macrophage infiltration, collagen content and inflammatory response modulation were determined. Macrophage cholesterol efflux and the arterial expression of cholesterol uptake and efflux receptors were also performed. The interesterification process did not alter plasma lipid concentrations. Although PALM INTER did not increase plasma cholesterol concentration as much as TRANS, the cholesterol enrichment in the LDL particle was similar in both groups. Moreover, PALM INTER induced the highest IL-1 beta, MCP-1 and IL-6 secretion from peritoneal macrophages as compared to others. This inflammatory response elicited by PALM INTER was confirmed in arterial wall, as compared to PALM. These deleterious effects of PALM INTER culminate in higher atherosclerotic lesion, macrophage infiltration and collagen content than PALM, STEAR, STEAR INTER and PUFA. These events can partially be attributed to a macrophage cholesterol accumulation, promoted by apoAl and HDL2-mediated cholesterol efflux impairment and increased Olr-1 and decreased Abca1 and Nr1h3 expressions in the arterial wall. Interesterified fats containing palmitic acid induce atherosclerosis development by promoting cholesterol accumulation in LDL particles and macrophagic cells, activating the inflammatory process in LDLr-KO mice.
conferenceObject Palmitic Interesterified Fat Induces Atherosclerosis and Inflammatory Cytokine Secretion in LDL Receptor Knockout Mice(2014) AFONSO, Milessa S.; LAVRADOR, Maria Silvia F.; KOIKE, Marcia; BOMBO, Renata P.; NUNES, Valeria S.; CATANOZI, Sergio; CASTILHO, Gabriela; PASSARELLI, Marisa; NAKANDAKARE, Edna R.; LOTTENBERG, Ana Maria- Effect of echium oil combined with phytosterols on biomarkers of atherosclerosis in LDLr-knockout mice: Echium oil is a potential alternative to marine oils for use in functional foods(2015) BOTELHO, Patricia Borges; GUIMARAES, Jessica Pereira; MARIANO, Karina Rocha; AFONSO, Milessa da Silva; KOIKE, Marcia Kiyomi; LOTTENBERG, Ana Maria Pita; CASTRO, Inar AlvesBioactive compounds may be an alternative approach to prevent atherosclerosis. To evaluate this hypothesis, LDLr-knockout mice were supplemented with omega-3 fatty acids from Echium oil (10.24mg/d of oil with 1,14mg/d of SDA and 9.06mg/d of ALA) equivalent to 0.7mg/d of EPA after conversion, combined or not with phytosterols (0.76mg/d), during the first 2 months of life. Subsequently, dyslipidaemia was induced by a high-fat diet for the following 2 months. Echium oil, isolated or combined with phytosterols, improved lipid profile in plasma reducing triacylglycerol (90.37.6mg/dL) and VLDL-c (18.01.5mg/dL) concentrations when compared with Control (115.8 +/- 9.4mg/dL and 23.2 +/- 1.9mg/dL, respectively). Echium oil also increased catalase (5.66 +/- 0.13U/mg protein) while Echium oil combined with phytosterol increased glutathione peroxidase activity (26.27 +/- 0.10U/mg protein) when compared with Control (5.18 +/- 0.10U/mg protein and 25.31 +/- 0.16U/mg protein, respectively). In addition, groups receiving Echium oil have reduced malondialdehyde concentration in liver (p=0.05). However, no difference was observed in fatty streak lesions when compared with Control. Isolated phytosterols did not change cholesterol absorption and increased lesion area compared with control group. This result can be associated with the high dose applied in the first step of supplementation and with the form of supplementation (gavage). Practical applications: One factor that contributes to the number of deaths from cardiovascular disease is that pharmacological interventions usually start too late in life. For this reason, functional foods development is a very important strategy to prevent atherosclerosis, since their inclusion in diet can start much earlier. However, it represents a challenge because many physiological responses from chronic consumption of bioactive compounds are still unknown. In this study, considering the positive results on triglyceridemia and oxidative stress biomarkers, we suggest that Echium oil can be an alternative for development of functional foods. We selected Echium oil due to its higher proportion of stearidonic fatty acids (pro-EPA) and lower sensory limitation than marine oils. Echium oil improves lipid profile and reduces oxidative stress, while phytosterol increases fatty streak.
- The impact of dietary fatty acids on macrophage cholesterol homeostasis(2014) AFONSOA, Milessa da Silva; CASTILHO, Gabriela; LAVRADOR, Maria Silvia Ferrari; PASSARELLI, Marisa; NAKANDAKARE, Edna Regina; LOTTENBERG, Simao Augusto; LOTTENBERG, Ana MariaThe impact of dietary fatty acids in atherosclerosis development may be partially attributed to their effect on macrophage cholesterol homeostasis. This process is the result of interplay between cholesterol uptake and efflux, which are permeated by inflammation and oxidative stress. Although saturated fatty acids (SAFAs) do not influence cholesterol efflux, they trigger endoplasmic reticulum stress, which culminates in increased lectin-like oxidized LDL (oxLDL) receptor (LOX1) expression and, consequently, oxLDL uptake, leading to apoptosis. Unsaturated fatty acids prevent most SAFAs-mediated deleterious effects and are generally associated with reduced cholesterol efflux, although alpha-linolenic acid increases cholesterol export. Trans fatty acids increase macrophage cholesterol content by reducing ABCA-1 expression, leading to strong atherosclerotic plaque formation. As isomers of conjugated linoleic acid (CLAs) are strong PPAR gamma ligands, they induce cluster of differentiation (CD36) expression, increasing intracellular cholesterol content. Considering the multiple effects of fatty acids on intracellular signaling pathways, the purpose of this review is to address the role of dietary fat in several mechanisms that control macrophage lipid content, which can determine the fate of atherosclerotic lesions.
bookPart Influências de dietas sobre a função endotelial(2016) LOTTENBERG, Ana Maria Pita; LAVRADOR, Maria Silvia Ferrari; AFONSO, Milessa da Silva; MACHADO, Roberta Marcondes- Challenges in familial chylomicronemia syndrome diagnosis and management across Latin American countries: An expert panel discussion(2021) SANTOS, Raul D.; LORENZATTI, Alberto; CORRAL, Pablo; NOGUEIRA, Juan Patricio; CAFFERATA, Alberto M.; AIMONE, Daniel; LOURENCO, Charles M.; IZAR, Maria Cristina; LIMA, Josivan G.; LOTTENBERG, Ana Maria; ALONSO, Rodrigo; GARAY, Karla; MORALES, Alvaro Ruiz; VARGAS-URICOECHEA, Hernando; PENA, Christian A. Colon; ROMAN-GONZALEZ, AlejandroFamilial chylomicronemia syndrome (FCS) is a rare genetic disorder characterized by extremely high triglyceride levels due to impaired clearance of chylomicrons from plasma. This paper is the result of a panel discussion with Latin American specialists who raised the main issues on diagnosis and management of FCS in their countries. Overall FCS is diagnosed late on the course of the disease, is characterized by heterogeneity on the occurrence of pancreatitis, and remains a long time in care of different specialists until reaching a lipidologist. Pancreatitis and secondary diabetes are frequently seen, often due to late diagnosis and inadequate care. Molecular diagnosis is unusual; however, loss of func-tion variants on the lipoprotein lipase gene are apparently the most frequent etiology. A founder effect of the glycosylphosphatidylinositol anchored high density lipoprotein binding protein 1 gene has been de-scribed in the northeast of Brazil. Low awareness of the disease amongst health professionals contributes to inadequate care and an inadequate patient journey.
- Omega-6 polyunsaturated fatty acids prevent atherosclerosis development in LDLr-KO mice, in spite of displaying a pro-inflammatory profile similar to trans fatty acids (vol 224, pg 66, 2012)(2013) MACHADO, R. M.; NAKANDAKARE, E. R.; QUINTAO, E. C.; CAZITA, P. M.; KOIKE, M. K.; NUNES, V. S.; FERREIRA, F. D.; AFONSO, M. S.; BOMBO, R. P.; MACHADO-LIMA, A.; SORIANO, F. G.; CATANOZI, S.; LOTTENBERG, A. M.