Título :	Avaliação longitudinal da aquisição da massa óssea de crianças e adolescentes com diabetes mellitus tipo 1 : seguimento de oito anos
Autor :	Martins, Naiara Viudes Garcia
Orientador(es)::	Castro, Luiz Claudio Gonçalves de
Assunto::	Diabetes Diabetes mellitus tipo 1 Massa óssea - aquisição Densitometria óssea Antropometria Pediatria
Fecha de publicación :	23-ago-2024
Data de defesa::	29-ene-2024
Citación :	MARTINS, Naiara Viudes Garcia. Avaliação longitudinal da aquisição da massa óssea de crianças e adolescentes com diabetes mellitus tipo 1: seguimento de oito anos. 2024. 97 f., il. Dissertação (Mestrado em Ciências da Saúde) — Universidade de Brasília, Brasília, 2024.
Abstract:	Introduction: Diabetes mellitus (DM) is one of the most relevant chronic non-communicable diseases worldwide, with a major impact on the individual's physical, mental and social health and generating constant demand on the health system. In the pediatric group, type 1 DM (DM1) is the most prevalent form. Associated with the fact that individuals with diabetes have an increased risk of micro and macrovascular complications throughout their lives, DM1 is also associated with serious negative implications for the patient's bone health. Currently, there are still few studies investigating the outcomes of DM1 on the acquisition of bone mass in children and adolescents. Objective: Study and describe the profile of bone mass accrual, and the clinical variables related to it, in children and adolescents with DM1 over a period of eight years, through the analysis of bone mineral density (BMD) of the lumbar spine and total body image obtained by bone densitometry (DXA). Methods: Longitudinal, retrospective study, with assessment of BMD obtained by DXA of the same group of children and adolescents with DM1, in two moments, separated by a period of 8 years, in 2009 (T1) and 2017 (T2), followed in Secretaria de Saúde do Distrito Federal. The clinical variables weight, height, body mass index (BMI), mean glycated hemoglobin (A1c), intake calcium, practice of physical activity and number of fractures of this group of patients at moments T1 and T2. Participants underwent DXA at T1 and T2. The bone mass of this group was studied in terms of BMD Z-score of the lumbar spine L1-L4 (Z L1-L4) and total body less head (Z CT). At T2, patients were categorized into two groups, according to the duration of DM1: Group A, with less than 10 years of DM1, and group B, with more than 10 years of DM1. The patients' clinical variables were correlated with the duration of DM1, clinical evolution and densitometric findings. L1-L4 BMD and CT data were correlated with the patients' pattern of bone mass acquisition throughout the study period. Results: The cohort consisted of 21 patients (13 female), median age at the first assessment 7.1 years (first quartile Q1: 3.6; third quartile Q3: 9.1) and at the second assessment, 18 .5 years (Q1: 15.8; Q3: 20). The median duration of DM1 at T2 was 10.5 years (Q1: 9.4; Q3 : 13.5). Group A (n = 9, 7 females) had a median age of 16.5 years (Q1: 14.5; Q3: 18.6) at T2, height Z-score (Ze) -0.29 ± 0, 73 standard deviations (SD), BMI Z-score (ZIMC) 0.92 ± 0.54 SD and mean A1c 8.5 ± 1.6%. Group B (n = 12, 6 females) had a median age of 19.25 years at T2 (Q1: 17.25; Q3: 21.3), Ze -0.28 ± 1.28 SD, ZIMC -0 .08 ± 0.77 SD and mean A1c 9.2 ± 1.9%. For the total group, there was a reduction in Ze over the period, in males from 1.07 ± 1.4 to 0.01 ± 1.4 SD (p = 0.011). There was no difference in ZBMI and mean A1c at T1 and T2, for the total group or categorized by sex. There was no difference in the intake of calcium and practice of physical activity between moments T1 and T2 of the studied group. Between the two moments of the study, the variation (delta) of the Z CT of the total group was 0.21 ± 0.89 and that of Z L1-L4 -0.39 ± 0.78 SD with a significant difference when comparing the behavior in these sites (p = 0.0125). There was a strong correlation between Z L1-L4 at moments T1 and T2 (r = 0.75; p = 0.0008), as well as Z CT (r = 0.661, p = 0.0011) for the total group when the group was categorized by sex. Fifteen patients showed a decrease in Z L1-L4 and seven patients in Z CT, between T1 and T2. Patients who decreased more than 1 SD in BMD between T1 and T2 had a relative risk of fractures 4.25 times higher than the other participants. Five patients had highenergy nonvertebral fractures between T1 and T2 (4 males). Patients who suffered fractures presented, at T2, lower Z L1-L4 (p = 0.0447), delta (between T1 and T2) of Z L1-L4 (p = 0.012), Z CT (p = 0.034) and delta of Z CT (p = 0.0005). In the total group, a moderate negative correlation was obtained, at T2, between the mean A1c and Z L1-L4 (r = -0.504; p = 0.023). In relation to groups A and B, there was no difference in the means of Z L1-L4 and Z CT (p = 0.672 and p = 0.924, respectively), as well as in the deltas of Z L1-L4 and Z CT (p = 0.735 and p = 0.80, respectively). No patient presented clinical osteoporosis. Conclusion: In this cohort of adolescent children and young adults with DM1, despite no difference in anthropometric characteristics, a drop in Ze was identified in male patients between T1 and T2. Although no changes were observed in BMD of L1-L4 and CT in the eightyear interval, in the general group, when categorized by sex and evaluated by the duration of DM1, there was a less favorable behavior of acquisition of BMD of L1-L4 in relation to CT BMD between moments T1 and T2. Strongly positive correlation between lumbar spine BMD values at T1 and T2, as well as for total body BMD when categorized by sex. The presence of high-energy non-vertebral fractures in this group of patients was associated with significantly lower BMD values at L1-L4 and CT, as well as a greater drop in the mean BMD value at these sites between T1 and T2, with the relative risk of fractures of 4.25 in relation to other individuals. There was a moderate negative correlation between A1c and lumbar spine BMD for patients in the T2 cohort.
metadata.dc.description.unidade:	Faculdade de Ciências da Saúde (FS)
Descripción :	Dissertação (mestrado) — Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2024.
metadata.dc.description.ppg:	Programa de Pós-Graduação em Ciências da Saúde
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