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  1. Article ; Online: Infeccions as the etiology for obesity.

    Suplicy, Henrique de Lacerda / Bornschein, Andressa

    Arquivos brasileiros de endocrinologia e metabologia

    2009  Volume 53, Issue 2, Page(s) 159–164

    Abstract: The role of infection on obesity development has been questioned since the early 1980's. Several studies on animals have shown that physiopathologic mechanisms through which infections can produce obesity do exist. At least eight types of obesity- ... ...

    Abstract The role of infection on obesity development has been questioned since the early 1980's. Several studies on animals have shown that physiopathologic mechanisms through which infections can produce obesity do exist. At least eight types of obesity-inducing viruses have been identified in animals, especially poultry and mice. Studies on humans are far less convincing; however, two adenoviruses, Ad-36 and SMAM-1, have shown adipogenic properties. In vitro studies with 3T3-L1 cells stated the activation of the enzymatic pathway that leads to fatty tissue accumulation; in vivo studies have also detected higher levels of antibodies against such viruses on obese subjects. Although most known infections nowadays cause obesity through central nervous system lesions, the Ad-36 adenovirus infection affects fatty tissue directly, raising doubts regarding central role component in this case.
    MeSH term(s) 3T3-L1 Cells ; Adenoviridae/classification ; Adenoviridae/physiology ; Adenoviridae Infections/complications ; Adenoviridae Infections/physiopathology ; Adenovirus Infections, Human/complications ; Adenovirus Infections, Human/physiopathology ; Adenoviruses, Human/classification ; Adenoviruses, Human/physiology ; Adipogenesis/physiology ; Adipose Tissue/metabolism ; Animals ; Chickens ; Dogs ; Humans ; Mice ; Obesity/metabolism ; Obesity/virology
    Language English
    Publishing date 2009-04-15
    Publishing country Brazil
    Document type Journal Article ; Review
    ZDB-ID 603919-4
    ISSN 1677-9487 ; 0004-2730
    ISSN (online) 1677-9487
    ISSN 0004-2730
    DOI 10.1590/s0004-27302009000200007
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  2. Article ; Online: Infeccions as the etiology for obesity Infecções na etiologia da obesidade

    Henrique de Lacerda Suplicy / Andressa Bornschein

    Arquivos brasileiros de Endocrinologia e Metabologia, Vol 53, Iss 2, Pp 159-

    2009  Volume 164

    Abstract: ... oito tipos de obesidade induzidas por viroses foram caracterizadas em animais, especialmente em ... L1 demonstraram que ativações enzimáticas levam ao acúmulo de gordura celular. Estudos in vivo ... detectaram níveis elevados de anticorpos contra certas viroses especialmente em indivíduos obesos. A maioria ...

    Abstract The role of infection on obesity development has been questioned since the early 1980's. Several studies on animals have shown that fisiopathologic mechanisms through which infections can produce obesity do exist. At least eight types of obesity-inducing viruses have been identified in animals, especially poultry and mice. Studies on humans are far less convincing; however, two adenoviruses, Ad-36 and SMAM-1, have shown adipogenic properties. In vitro studies with 3T3-L1 cells stated the activation of the enzymatic pathway that leads to fatty tissue accumulation; in vivo studies have also detected higher levels of antibodies against such viruses on obese subjects. Although most known infections nowadays cause obesity through central nervous system lesions, the Ad-36 adenovirus infection affects fatty tissue directly, raising doubts regarding central role component in this case. Desde o início dos anos 1980, o papel das infecções tem sido debatido quanto à etiologia da obesidade. Diversos estudos em modelos animais têm demonstrado que mecanismos fisiopatológicos ativados pelas infecções podem induzir também à obesidade. Pelo menos oito tipos de obesidade induzidas por viroses foram caracterizadas em animais, especialmente em camundongos e galinhas. Estudos em humanos existem, mas são menos convincentes. No entanto, duas adenoviroses (Ad-36 e SMAN-1) apresentam características adipogênicas. Estudos in vitro com a linhagem celular 3T3-L1 demonstraram que ativações enzimáticas levam ao acúmulo de gordura celular. Estudos in vivo detectaram níveis elevados de anticorpos contra certas viroses especialmente em indivíduos obesos. A maioria das infecções potenciais causadoras de obesidade atua produzindo ativações ou lesões no sistema nervoso central. Por outro lado, a infecção por Ad-36 adenovírus afeta diretamente o tecido adiposo, expandindo dessa forma a etiologia viral da obesidade para mecanismos hipotalâmicos e periféricos.
    Keywords Infecções humanas por vírus ; obesidade ; Human virus infections ; obesity ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language Portuguese
    Publishing date 2009-03-01T00:00:00Z
    Publisher Sociedade Brasileira de Endocrinologia e Metabologia
    Document type Article ; Online
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  3. Article ; Online: Personality type, eating behaviour and suicide risk in women in treatment for obesity.

    de Figueiredo, Maria do Desterro / Nasser, Stella Nabuco / Franco, Carina Bertoldi / Dos Santos, Christiane Bischof / Boguszewski, Cesar Luiz / Suplicy, Henrique Lacerda / Rodrigues, Adriane Maria / Radominski, Rosana Bento

    Eating and weight disorders : EWD

    2020  Volume 26, Issue 2, Page(s) 547–554

    Abstract: Objectives: To determine the personality types of women in treatment for obesity and the associations among their personality characteristics, eating behaviour and suicide risk.: Subjects: Sixty women in pharmacological treatment for obesity ( ... ...

    Abstract Objectives: To determine the personality types of women in treatment for obesity and the associations among their personality characteristics, eating behaviour and suicide risk.
    Subjects: Sixty women in pharmacological treatment for obesity (clinical group: CG) and 60 women post-bariatric gastric bypass surgery (surgical group: SG) were evaluated.
    Methods: This was an observational and transversal study conducted in a specialized outpatient unit. Personality types were evaluated through the Myers-Briggs Type Indicator (MBTI) test. A semi-structured questionnaire that investigated sociodemographic and lifestyle characteristics was applied, along with the Binge Eating Scale (BES) and the Columbia-Suicide Severity Rating Scale (C-SSRS).
    Results: Among the 16 possible personality types, the ISFJ (Introversion, Sensing, Feeling, Judging) and ESFJ (Extraversion, Sensing, Feeling, Judging) types were more frequent. In the SG, 32% of the participants presented with the ISFJ type, and 18.3% presented with the ESFJ type. In the CG, 33% presented with the ISFJ type and 25% presented with the ESFJ type. There was a higher prevalence of binge eating behaviour in the CG (Cohen's d: - 0.47; p < 0.0001) and a higher tendency to graze in the SG (p = 0.005). Participants with introverted attitudes showed a higher prevalence of severe binging (13.3% vs 3.3%, p = 0.07), suicidal thoughts throughout life (STTL) (69.5% vs 45.1%, p = 0.007), and recent suicidal thoughts (RSTs) (30.4% vs 11.7%, p = 0.01) in comparison to extraverted participants. BMI was associated with a higher chance of STTL (37.96 ± 6.41 kg/m
    Conclusions: Women who were in pharmacological treatment for obesity or were post-bariatric surgery present specific types of personality. Introversion was associated with a higher BMI and a higher risk of suicidal thoughts.
    Level of evidence: Level V, cross-sectional descriptive study.
    MeSH term(s) Cross-Sectional Studies ; Feeding Behavior ; Female ; Humans ; Obesity ; Personality ; Personality Inventory ; Suicide
    Language English
    Publishing date 2020-03-14
    Publishing country Germany
    Document type Journal Article ; Observational Study
    ZDB-ID 2038625-4
    ISSN 1590-1262 ; 1124-4909
    ISSN (online) 1590-1262
    ISSN 1124-4909
    DOI 10.1007/s40519-020-00877-9
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  4. Article: The cerebrospinal fluid/serum leptin ratio during pharmacological therapy for obesity.

    Rodrigues, Adriane Maria / Radominski, Rosana Bento / Suplicy, Henrique de Lacerda / De Almeida, Sergio Monteiro / Niclewicz, Patricia Artigas / Boguszewski, Cesar Luiz

    The Journal of clinical endocrinology and metabolism

    2002  Volume 87, Issue 4, Page(s) 1621–1626

    Abstract: The aim of the present study was to evaluate the cerebrospinal fluid (CSF)/serum leptin ratio during pharmacological therapy for obesity with centrally and peripherally acting drugs. Thirty-one obese women (mean age, 32.3 +/- 10 yr; body mass index, 38.2 ...

    Abstract The aim of the present study was to evaluate the cerebrospinal fluid (CSF)/serum leptin ratio during pharmacological therapy for obesity with centrally and peripherally acting drugs. Thirty-one obese women (mean age, 32.3 +/- 10 yr; body mass index, 38.2 +/- 5.2 kg/m(2); body fat, 43.3 +/- 5.4%) were studied before and 2 months after a weight loss program consisting of a balanced diet (1200 kcal/d) plus drug therapy. The patients were randomly assigned into three study groups: group I, fenproporex 25 mg/d (n = 10); group II, sibutramine 10 mg/d (n = 10); and group III, orlistat 120 mg tid (n = 11). Body fat, measured by dual-energy x-ray absorptiometry, and serum and CSF concentrations of leptin were examined at baseline and 2 months after therapy. At baseline, clinical and biochemical characteristics of the groups were similar. All of the women lost weight, approximately 7.0% of their initial body weight, and the reduction was not different among the groups. Serum leptin fell significantly after 2 months in all groups, and the decline was proportional to the reduction in body fat, because leptin levels adjusted for body fat did not change after treatment. CSF leptin levels showed a significant decrease after 2 months in all groups, and this decline was higher on group III compared with group I (P = 0.006). After therapy, the CSF/serum leptin ratio did not change in group I (1.57 +/- 0.3 to 1.72 +/- 0.62%) and group II (1.78 +/- 1.01 to 1.69 +/- 1.27%), whereas it declined significantly in group III (1.65 +/- 0.43 to 1.09 +/- 0.47%; P < 0.01), corresponding to a decrease of 33.3 +/- 22.5% for the CSF/serum leptin ratio. The percentage change in group III was significantly different from the positive variation on group I (11.9 +/- 42.1%; P = 0.006) and close to the statistical significance compared with the negative variation seen in group II (-7.6 +/- 27.8%; P = 0.06). Our results showed that the CSF/serum leptin ratio decreased after weight loss in obese women treated during 2 months with orlistat, whereas this ratio did not change in this period of time in obese women treated with fenproporex and sibutramine.
    MeSH term(s) Adolescent ; Adult ; Amphetamines/therapeutic use ; Anti-Obesity Agents/therapeutic use ; Appetite Depressants/therapeutic use ; Cyclobutanes/therapeutic use ; Humans ; Lactones/therapeutic use ; Leptin/blood ; Leptin/cerebrospinal fluid ; Middle Aged ; Obesity/blood ; Obesity/drug therapy ; Obesity/pathology ; Weight Loss
    Chemical Substances Amphetamines ; Anti-Obesity Agents ; Appetite Depressants ; Cyclobutanes ; Lactones ; Leptin ; orlistat (95M8R751W8) ; fenproporex (W0194S5FOA) ; sibutramine (WV5EC51866)
    Language English
    Publishing date 2002-04
    Publishing country United States
    Document type Clinical Trial ; Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 3029-6
    ISSN 1945-7197 ; 0021-972X
    ISSN (online) 1945-7197
    ISSN 0021-972X
    DOI 10.1210/jcem.87.4.8420
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  5. Article ; Online: Estudo ecocardiográfico evolutivo das alterações anátomo-funcionais do coração em obesos submetidos à cirurgia bariátrica Evolutive echocardiographic study of the structural and functional heart alterations in obese individuals after bariatric surgery

    Luciana de Cerjat Bernardes P. Cunha / Cláudio L. Pereira da Cunha / Admar Moraes de Souza / Nelson Chiminacio Neto / Ricardo Soares Pereira / Henrique Lacerda Suplicy

    Arquivos Brasileiros de Cardiologia, Vol 87, Iss 5, Pp 615-

    2006  Volume 622

    Abstract: ... mulheres: 82,6%) com idade média de 37,9 anos. Tinham obesidade classe III ou classe II com co-morbidades ... RESULTADOS: Antes da operação o peso era de 128,7 ± 25,8 kg e a pressão arterial (PA) 142,2 ± 16,2/92,2 ± 10 ... interventricular, com dimensão diastólica do VE normal e padrão geométrico predominante de remodelamento ...

    Abstract OBJETIVO: Avaliar com a Dopplerecocardiografia a reversibilidade das alterações estruturais e funcionais do coração em obesos submetidos à cirurgia bariátrica. MÉTODOS: Foram estudados 23 obesos (19 mulheres: 82,6%) com idade média de 37,9 anos. Tinham obesidade classe III ou classe II com co-morbidades. Realizaram avaliação clínica e ecocardiográfica no pré-operatório, 6 meses e 3 anos após a cirurgia. RESULTADOS: Antes da operação o peso era de 128,7 ± 25,8 kg e a pressão arterial (PA) 142,2 ± 16,2/92,2 ± 10,4 mmHg. No pós-operatório houve redução do peso aos 6 meses (97,6 ± 18,3 Kg) e aos 3 anos (83,6 ± 13,5 Kg), e da PA aos 6 meses (128,5 ± 16,1/80,7 ± 9,9 mmHg) com resultado mantido em 3 anos. Ao ecocardiograma, antes da cirurgia havia hipertrofia da parede posterior do ventrículo esquerdo (VE) e septo interventricular, com dimensão diastólica do VE normal e padrão geométrico predominante de remodelamento concêntrico (74%). Após 6 meses, diminuíram as espessuras do septo e da parede posterior, e aumentou a dimensão diastólica do VE. Em 3 anos o padrão geométrico predominante era o normal (69%), com redução da massa de VE e do índice de massa do VE/altura² . Observou-se também melhora da função diastólica de VE, com aumento da relação E/A em 6 meses, mantendo-se em 3 anos e diminuição do tempo de relaxamento isovolumétrico do VE em 6 meses e em 3 anos. Houve melhora do Índice de Desempenho Miocárdico em 6 meses, mantendo-se em 3 anos, em 13 pacientes estudados retrospectivamente. Notou-se aumento do tempo de ejeção em 6 meses, mantendo-se em 3 anos, e discreto aumento da fração de ejeção em 3 anos, sugerindo melhora da função sistólica de VE. CONCLUSÃO: A redução de peso obtida através da cirurgia para obesidade promove modificações estruturais e funcionais benéficas ao coração. OBJECTIVE: To evaluate with Doppler echocardiography the reversibility of structural and hemodynamic changes in obeses after bariatric surgery. METHODS: Twenty-three patients (19 women = 82.6%) were studied. Mean age was 37.9 years. All subjects had Class III or Class II obesity with comorbidity and were submitted to bariatric surgery. Clinical and echocardiographic evaluation were performed preoperatively, in 6 months and 3 years after surgery. RESULTS: Preoperatively, the mean weight and blood pressure (BP) were respectively 128.7± 25.8 kg and 142.2 ± 16.2 / 92.2 ± 10.4 mmHg. Postoperatively, they showed important body weight reduction in 6 months (97.6 ± 18.3 kg) and 3 years (83.6 ± 13.5 kg), and BP reduction in 6 months (128.5 ± 16.1/80.7 ± 9.9 mmHg) that remain stable in 3rd year. On echocardiogram, preoperatively, there was hypertrophy of the septum and posterior wall associated with normal diastolic dimension; the predominant LV geometric pattern was concentric remodeling (74%). At six months, thinning of the ventricular septum and LV posterior wall, and increase in LV diastolic dimension were demonstrated. At 3rd year, the predominant LV pattern was normal (69%), with reduction of LV mass and LV mass/height² index. We noticed improved diastolic function, with an increased E/A ratio and a decreased LV isovolumic relaxation time. The Myocardial Performance Index was obtained retrospectively in 13 patients and improved in 6 months. There was an increase of the ejection time in 6 months and an elevation of the ejection fraction in 3rd year, suggesting improvement of the LV systolic function. CONCLUSION: The weight loss obtained with bariatric surgery promotes both structural and functional myocardial changes that improve cardiac performance.
    Keywords Obesidade ; cirurgia bariátrica ; ecocardiograma transtorácico ; função ventricular esquerda ; Obesity ; bariatric surgery ; transthoracic echocardiography ; left ventricular function ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language English
    Publishing date 2006-11-01T00:00:00Z
    Publisher Sociedade Brasileira de Cardiologia - SBC
    Document type Article ; Online
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  6. Article ; Online: Evolutive echocardiographic study of the structural and functional heart alterations in obese individuals after bariatric surgery.

    Cunha, Luciana de Cerjat Bernardes P / da Cunha, Cláudio L Pereira / de Souza, Admar Moraes / Chiminacio Neto, Nelson / Pereira, Ricardo Soares / Suplicy, Henrique Lacerda

    Arquivos brasileiros de cardiologia

    2007  Volume 87, Issue 5, Page(s) 615–622

    Abstract: Objective: To evaluate with Doppler echocardiography the reversibility of structural and hemodynamic changes in obeses after bariatric surgery.: Methods: Twenty-three patients (19 women = 82.6%) were studied. Mean age was 37.9 years. All subjects had ...

    Abstract Objective: To evaluate with Doppler echocardiography the reversibility of structural and hemodynamic changes in obeses after bariatric surgery.
    Methods: Twenty-three patients (19 women = 82.6%) were studied. Mean age was 37.9 years. All subjects had Class III or Class II obesity with comorbidity and were submitted to bariatric surgery. Clinical and echocardiographic evaluation were performed preoperatively, in 6 months and 3 years after surgery.
    Results: Preoperatively, the mean weight and blood pressure (BP) were respectively 128.7 +/- 25.8 kg and 142.2 +/- 16.2 / 92.2 +/- 10.4 mmHg. Postoperatively, they showed important body weight reduction in 6 months (97.6 +/- 18.3 kg) and 3 years (83.6 +/- 13.5 kg), and BP reduction in 6 months (128.5 +/- 16.1/80.7 +/- 9.9 mmHg) that remain stable in 3rd year. On echocardiogram, preoperatively, there was hypertrophy of the septum and posterior wall associated with normal diastolic dimension; the predominant LV geometric pattern was concentric remodeling (74%). At six months, thinning of the ventricular septum and LV posterior wall, and increase in LV diastolic dimension were demonstrated. At 3rd year, the predominant LV pattern was normal (69%), with reduction of LV mass and LV mass/height2 index. We noticed improved diastolic function, with an increased E/A ratio and a decreased LV isovolumic relaxation time. The Myocardial Performance Index was obtained retrospectively in 13 patients and improved in 6 months. There was an increase of the ejection time in 6 months and an elevation of the ejection fraction in 3rd year, suggesting improvement of the LV systolic function.
    Conclusion: The weight loss obtained with bariatric surgery promotes both structural and functional myocardial changes that improve cardiac performance.
    MeSH term(s) Adult ; Bariatric Surgery ; Body Mass Index ; Cardiovascular Diseases/prevention & control ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular/physiopathology ; Hypertrophy, Left Ventricular/prevention & control ; Male ; Obesity, Morbid/physiopathology ; Obesity, Morbid/surgery ; Retrospective Studies ; Severity of Illness Index ; Ventricular Function, Left/physiology
    Language Portuguese
    Publishing date 2007-01-15
    Publishing country Brazil
    Document type Journal Article
    ZDB-ID 730261-7
    ISSN 1678-4170 ; 0066-782X
    ISSN (online) 1678-4170
    ISSN 0066-782X
    DOI 10.1590/s0066-782x2006001800011
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  7. Article ; Online: Decrease in leptin production by the adipose tissue in obesity associated with severe metabolic syndrome Diminuição da produção de leptina pelo tecido adiposo na obesidade associada à síndrome metabólica severa

    Gilberto Jorge da Paz-Filho / Alexei Volaco / Henrique Lacerda Suplicy / Rosana Bento Radominski / Cesar Luiz Boguszewski

    Arquivos brasileiros de Endocrinologia e Metabologia, Vol 53, Iss 9, Pp 1088-

    2009  Volume 1095

    Abstract: ... MetS). MÉTODOS: Cinquenta e um adultos obesos (9 homens, 36,7 ± 10,0 anos, índice de massa corpórea ... pacientes foram divididos em três grupos, de acordo com o numero de critérios para MetS: Grupo I, nenhum ou ... inversamente ao peso (r = -0,41; p = 0,027), ao REE (r = -0,34; p = 0,01) e ao número de critérios para MetS (r ...

    Abstract OBJECTIVE: To evaluate the associations between leptinemia and the components of metabolic syndrome (MetS). METHODS: Fifty-one obese adults (9 men; 36.7 ± 10.0 years; body mass index (BMI) 46.2 ± 10.0 kg/m²) were submitted to clinical examination, determinations of body fat mass (BF, bioimpedance) and resting energy expenditure (REE, indirect calorimetry), and to hormonal and biochemical analysis. Patients were categorized into three groups, according to the number of criteria for MetS: Group I: none or 1; Group II: 2; and Group III: 3 or 4 criteria. RESULTS: Absolute leptinemia (LepA; 37.5 ± 16.9 ng/mL) was directly correlated with BMI (r = 0.48; p = 0.0004), waist circumference (r = 0.31; p = 0.028) and BF (r = 0.52; p = 0.0001). Leptinemia adjusted for BF (LepBF) was inversely correlated with weight (r = -0.41; p=0.027), REE (r = -0.34; p = 0.01) and number of MetS criteria (r = -0.32; p = 0.02). There was no difference in LepA among the groups. LepBF in Group III (0.58 ± 0.27 ng/mL/kg) was significantly lower compared to Group I (0.81 ± 0.22 ng/mL/kg; p = 0.03) and Group II (0.79 ± 0.30 ng/mL/kg; p = 0.02). CONCLUSIONS: Leptin production by the adipose tissue is decreased in obese subjects fulfilling three or more criteria of MetS, suggesting a state of relative leptin deficiency in obesity associated with advanced stages of MetS. OBJETIVO: Avaliar as associações entre leptinemia e os componentes da síndrome metabólica (MetS). MÉTODOS: Cinquenta e um adultos obesos (9 homens, 36,7 ± 10,0 anos, índice de massa corpórea, IMC, 46,2 ± 10,0 kg/m²) foram submetidos à avaliação clínica, a determinações da massa adiposa (BF, bioimpedância) e do gasto energético basal (REE, calorimetria indireta) e a análises hormonais e bioquímicas. Os pacientes foram divididos em três grupos, de acordo com o numero de critérios para MetS: Grupo I, nenhum ou 1; Grupo II: 2; e Grupo III: 3 ou 4 critérios. RESULTADOS: A leptinemia absoluta (LepA; 37,5 ± 16,9 ng/mL) se correlacionou diretamente a IMC (r = 0,48; p = 0,0004), circunferência abdominal (r = 0,31; p = 0,028) e BF (r = 0,52; p = 0,0001). A leptinemia ajustada por BF (LepBF) se correlacionou inversamente ao peso (r = -0,41; p = 0,027), ao REE (r = -0,34; p = 0,01) e ao número de critérios para MetS (r = -0,32; p = 0,02). Não houve diferença de LepA entre os grupos. LepBF no Grupo III (0,58 ± 0,27 ng/mL/kg) foi significativamente menor que no Grupo I (0,81 ± 0,22 ng/mL/kg; p = 0,03) e II (0,79 ± 0,30 ng/mL/kg; p = 0,02). CONCLUSÕES: A produção de leptina pelo tecido adiposo está diminuída em pacientes obesos que preenchem três ou mais critérios para MetS, sugerindo um estado de deficiência relativa de leptina na obesidade associada a estágios avançados de MetS.
    Keywords Leptina ; adipocinas ; obesidade ; síndrome metabólica ; leptinemia ; Leptin ; adipokines ; obesity ; metabolic syndrome ; Diseases of the endocrine glands. Clinical endocrinology ; RC648-665 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language Portuguese
    Publishing date 2009-12-01T00:00:00Z
    Publisher Sociedade Brasileira de Endocrinologia e Metabologia
    Document type Article ; Online
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