Έθδνζε Γεθεκβξίνπ Ηαλνπαξίνπ 2011 ΡΔΣΝΠ 46

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1 NEWSLETTER Έθδνζε Γεθεκβξίνπ Ηαλνπαξίνπ 2011 ΡΔΣΝΠ 46 ΞΔΟΗΗΔΣΝΚΔΛΑ Αππφφ ηηννλλ εεθθδδφφηηεε ΡΡαα άάξξζζξξαα ηηννππ κκήήλλαα ΔΔΙΙΑΑΤΤΡΡΟΦΗ Ρα απμεκέλα επίπεδα 25-πδξνμπ-βηηακηλεο D νξνχ κεηά απφ απψιεηα βαξνπο ζε παρχζαξθεο γπλαίθεο ζρεηίδνληαη κε ηελ βειηίσζε ηεο αλζεθηηθφηεηαο ζηελ ηλζνπιίλε ΘΔΚΗΣΟΘΙΖ ΣΕΟΣΕΑ M.D Ph.D. Ελδξνθξηλνιόγνο, Επηκειεηήο Ελδνθξηλνινγίαο Δηαβήηε Μεηαβνιηζκνύ Ννζνθνκείν Παλαγία Θεζζαινλίθεο ΑΑΣΣΚΚΗΣΣΗ Ξφηε αμηνινγείηαη εξγνκεηξηθά κηα νκάδα πνδνζθαίξνπ ΘΑΛΑΖ ΚΟΤΡΣΕΗΑΠΖ Ph.D. Δηδάθησξ Εξγνθπζηνινγίαο Specialist in physical condition of Football Αγαπεηέο νί θίιεο-νη, Έλαο θαηλνχξγηνο ρξφλνο, ην 2011 μεδηπιψλεηαη κπξνζηά καο! Κε ζηφρνπο, επηδηψμεηο, ηδέεο, concept λα παίξλνπλ ζάξθα θαη νζηά ζην δηάβα ηνπ θαηλνχξγηνπ ρξφλνπ θαη κάιηζηα ζε ζχληνκν ρξνληθφ δηάζηεκα (πξηλ απφ ην ηέινο ηνπ δεχηεξνπ ηξηκήλνπ!). Πηελ νηθνλνκηθή θξίζε θαη ζηηο επηπηψζεηο ηηο, νη ζπλεξγάηεο κνπ θαη εγψ απαληάκε κε δεκηνπξγία θαηλνχξγησλ concept, αληηπξνζψπεπζε θαηλνχξγησλ εηαηξεηψλ, κεγαιχηεξε «εζσηεξηθή» θαη «εμσηεξηθή νξγάλσζε» θαη πην δνκεκέλε ιεηηνπξγηθή έθθξαζε ζηελ επηθνηλσλία καο ηφζν κε ηδηψηεο φζν θαη κε ην επαγγεικαηηθφ θνηλφ! Πην 46 ν ειεθηξνληθφ καο πεξηνδηθφ ζαο θαινχκε λα πεξηεγεζείηε θαη λα εληξπθήζεηε ζηηο ζειίδεο ηνπ! Κε επηζηεκνληθά άξζξα θαηαμησκέλσλ επηζηεκφλσλ ζηνπο ρψξνπο ηεο Γηαηξνθήο θαη ηεο Άζθεζεο (βι. παξαθάησ) κε «Λέα», «Γξαζηεξηφηεηεο» θαη ηηο λέεο εμειίμεηο ζηα επηδνηνχκελα πξνγξάκκαηα ζέινπκε λα ζαο πξνζθέξνπκε φηη πην ηειεπηαίν έρεη λα δείμεη ε επηθαηξφηεηα ηφζν ζηελ επηζηήκε φζν θαη ζηελ επηρεηξεκαηηθή πξαθηηθή! Κε ηελ αθιφλεηε πεπνίζεζε φηη ζα ηα θαηαθέξνπκε αθνχ αλαδείμνπκε ηελ θαιχηεξε πιεπξά ηνπ εαπηνχ καο ζαο εχρνκαη έλα δεκηνπξγηθφ έηνο 2011! Κε εθηίκεζε, Γξξααζζ ηηεεξξ ηφφηηεεηηεεοο η Ν γπξνιφγνο ΡΡαα λλέέαα κκααοο ΔΔππη ηδδννηηννχχκκεελλαα ππξξννγγξξάάκκκκααηηαα

2 Ρν άξζξν ηνπ κήλα ΓΔΗΑ ΘΔΚΗΠΡΝΘΙΖΠ ΡΕΝΡΕΑΠ M.D Ph.D. Δλδξνθξηλνιφγνο, Δπηκειεηήο Δλδνθξηλνινγίαο Γηαβήηε Κεηαβνιηζκνχ Λνζνθνκείν Ξαλαγία Θεζζαινλίθεο RISING SERUM 25-HYDROXY-VITAMIN D LEVELS AFTER WEIGHT LOSS IN OBESE WOMEN CORRELATE WITH IMPROVEMENT IN INSULIN RESISTANCE ΡΑ ΑΜΖΚΔΛΑ ΔΞΗΞΔΓΑ 25-ΓΟΝΜ-ΒΗΡΑΚΗΛΖΠ D ΝΟΝ ΚΔΡΑ ΑΞΝ ΑΞΥΙΔΗΑ ΒΑΟΝΠ ΠΔ ΞΑΣΠΑΟΘΔΠ ΓΛΑΗΘΔΠ ΠΣΔΡΗΕΝΛΡΑΗ ΚΔ ΡΖΛ ΒΔΙΡΗΥΠΖ ΡΖΠ ΑΛΘΔΘΡΗΘΝΡΖΡΑΠ ΠΡΖΛ ΗΛΠΝΙΗΛΖ Themistoklis Tzotzas, Fotini G. Papadopoulou, Kostantinos Tziomalos, Spiros Karras, Kostantinos Gastaris, Petros Perros, and Gerasimos E. Krassas Department of Endocrinology, Diabetes, and Metabolism (T.T., F.G.P., K.T., S.K., K.G., G.E.K.), Panagia General Hospital, Thessaloniki, Greece; and Department of Endocrinology (P.P.), Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom κοπός: Σθνπόο ηεο έξεπλαο ήηαλ λα εμεηάζεη ηηο αιιαγέο ζηελ 25-πδξνμπ-βηηακίλε D νξνύ (25OHD) θαη ζηα επίπεδα PTH ζην αίκα 4 θαη 20 εβδνκάδεο κεηά ηελ απώιεηα βάξνπο ιόγσ δίαηηαο ρακειήο ζεξκηδηθήο πξόζιεςεο. Κεθοδολογία: Εμεηάζηεθαλ 44 παρύζαξθεο γπλαίθεο [ειηθίαο 40.6 ± 11.4 yr, Δείθηε Μάδαο Σώκαηνο (BMI) 36.7 ± 4.9 kg/m 2 ] θαη 25 νκάδαο ειέγρνπ (BMI 22.9 ± 1.5 kg/m 2 ). Μεηξήζεθαλ αλζξνπνκεηξηθέο θαη θαξδηνκεηαβνιηθέο παξάκεηξνη θαζώο θαη ηα επίπεδα 25ΟΗD θαη PTH πξνζδηνξίζηεθαλ ζε θαηάζηαζε baseline θαζώο θαη 4 θαη 20 εβδνκάδεο κεηά από δίαηηα ρακειήο ζεξκηδηθήο πξόζιεςεο. Αποηελέζμαηα: Σηελ θαηάζηαζε baseline, ηα επίπεδα 25OΗD levels ήηαλ ρακειόηεξα ζηηο παρύζαξθεο ζε ζρέζε κε ην δείγκα ειέγρνπ (17 ± 6.0 vs ± 8.7 ng/ml, P < 0.001), ελώ δελ βξέζεθαλ δηαθνξέο ζηα επίπεδα ηνπ PTH. Γηα όιεο ηηο γπλαίθεο βξέζεθε αξλεηηθή ζπζρέηηζε αλάκεζα ζηα επίπεδα 25OΗD θαη ην ζσκαηηθό βάξνο (BW) (r=-0.32, P<0.001), BMI (r=-0.37, P<0.001), ηελ πεξηθέξεηα κέζεο (r=-0.26, P<0.05), θαη ην πνζνζηό κάδαο ιίπνπο (r=-0.38, P< 0.001) όπσο απηό κεηξήζεθε κε βηνειεθηξηθή εκπέδεδε. Η 4 εβδνκάδσλ δίαηηα ρακειήο ζεξκηδηθήο πξόζιεςεο (n = 37) κείσζε ην ζσκαηηθό βάξνο θαη νδήγεζε ζε ζεκαληηθέο βειηηώζεηο ζηνλ δείθηε (HOMA) θαη ηα επίπεδα ησλ ιηπηδίσλ. Η 20 εβδνκάδσλ δίαηηα ρακειήο ζεξκηδηθήο πξόζιεςεο (n = 26) είρε σο απνηέιεζκα ηελ κείσζε ηνπ ζσκαηηθνύ βάξνπο θαη ηνπ BMI θαηά 10%,

3 ηνπ δείθηε HOMA (4.7 ± 3.8 vs ± 1.7, P < 0.01), θαη ησλ ιηπηδίσλ (εθηόο ησλ ηεο HDL ρνιεζηεξόιεο) θαη αύμεζε ζηελ 25OHD (15.4 ± 6.0 vs ± 5.1 ng/ml, P < 0.05), ζε ζρέζε κε ηελ θαηάζηαζε baseline. Τα επίπεδα PTH παξέκεηλαλ ακεηάβιεηα. Η αύμεζε ζηα επίπεδα ηεο 25OHD ζρεηίζηεθαλ κε ηελ κείσζε ζηα επίπεδα ηεο ηλζνπιίλεο θαη ηνλ δείθηε HOMA (r =-0.43, P < 0.05). σμπεράζμαηα: Τα επίπεδα 25OHD ζην αίκα ήηαλ ρακειά ζηηο παρύζαξθεο γπλαίθεο θαη ζπζρεηίζηεθαλ αληηζηξόθσο κε ηελ ζνβαξόηεηα ηεο παρπζαξθίαο. Η απώιεηα βάξνπο θαηά 10% κεηά από δίαηηα ρακειήο ζεξκηδηθήο πξόζιεςεο αύμεζε ηα επίπεδα ηεο 25OHD θαη απεηή ε αύμεζε ήηαλ θαηά θύξην ιόγν ζπλδεδεκέλε κε ηελ αλζεθηηθόηεηα ζηελ ηλζνπιίλε. Τν άξζξν δεκνζηεύηεθε ζην πεξηνδηθό Journal of Clinical Endocrinoly and Metabolism 95: , 2010 Introduction Vitamin D and PTH participate actively in bone metabolism and calcium homeostasis. In recent years it has become clear that vitamin D has pleiotropic effects with possible roles in the pathogenesis of cancer, immune system disorders, type 1 and 2 diabetes mellitus, cardiovascular disease, etc.; vitamin D deficiency has been associated with increased risks of these diseases (1). In fact, vitamin D receptors are expressed in a variety of tissues besides those involved in calcium homeostasis and bone development (2). Obesity, a state of body fat expansion and insulin resistance, has been found to be associated with low levels of serum 25-hydroxy-vitamin D(25OHD), the best clinical indicator of vitamin D status, and high levels of serum PTH (3 5). Recent studies in children and adults using anthropometric measurements and body composition analysis techniques confirmed associations between adipose tissue at various sites and these two metabolic parameters (6 9). The inverse correlation between obesity and 25OHD has been attributed mainly to sequestration of this fat soluble vitamin in adipose tissue and less probably to the limited sun exposure in obese subjects due to limited mobility; there is also some evidence that vitamin D inhibits the development of adipocytes (10). In vitro and in vivo studies suggest that PTH may promote fat accumulation and obesity through increases of calcium concentration within adipocytes; this increased intracellular concentration of calcium is also known to inhibit lipolysis (11). It has been reported that patients with primary and secondary hyperparathyroidism have excess body weight (BW) and fat mass (FM) (12, 13). Besides the effects of obesity on bone metabolic markers, insulin sensitivity has been found to correlate positively with levels of vitamin D and negatively with levels of PTH. Vitamin D may improve lean body mass, enhance insulin synthesis and release, increase insulin receptor expression, and suppress inflammation. These actions of vitamin D may be mediated by its active metabolite 1,25-dihydroxyvitamin D or via suppression of PTH (14, 15). Weight loss in obese subjects could influence vitamin D and PTH status. Most studies have tried to address this issue by investigating patients before and after bariatric surgery. Such an intervention, however, induces a malabsorptive state, resulting in profound decreases of vitamin D levels followed by compensated increases of PTH (16, 17). Studies with laparoscopic gastric banding surgery, which does not induce malabsorption but results in substantial weight loss showed either a stabilization or a decrease of vitamin D levels in some patients (18, 19). Reinehr et al. (20) examined obese children after a lifestyle weight loss program and found significant increase in 25OHD levels and decrease in PTH levels. To the best of our knowledge, only one study in obese adults, which was designed primarily to report on changes of osteoprotegerin, has examined changes of PTH and 25OHD at one-time point after diet-induced weight loss (21). The aims of the present pilot interventional study were to determine the short (4 wk) and longer-term (20 wk) effects of weight loss by a low-calorie diet on serum concentrations of 25OHD and PTH in

4 obese nondiabetic women and to examine the relationship between obesity and insulin resistance indices and lipid parameters. Patients and Methods Patients Forty-four obese women aged 40.6 ± 11.4 yr (range yr) with body mass index (BMI) of 36.7 ± 4.9 kg/m 2 and 25 age-matched healthy women aged 41.3 ± 13.3 yr (range yr) with normal BMI (controls), all in good general health, were selected to participate in the present interventional study. Exclusion criteria were primary hyperparathyroidism or other skeletal disease; malabsorptive, hepatic, renal, and other chronic diseases; familial or secondary dyslipidemia other than that due to the state of obesity; endocrine disorders including type 2 diabetes mellitus (defined as fasting blood glucose _7.0 mmol/liter or 126 mg/dl); excess alcohol (ingestion of more than 50 g/d of ethanol); smoking behavior (more than five cigarettes per day); or treatment with hypolipidemic, antiobesity, and hormonal drugs or drugs related to calcium and vitamin D metabolism. Thirty-three obese women (75%) and 19 controls (77%) were of reproductive age. None of the subjects had been on a slimming diet for at least 4 months before the initiation of the study. The ethical committee of the Medical School of Thessaloniki approved the study protocol. All women provided their written informed consent. All obese subjects were carefully monitored at baseline and 4 and 20 wk after the initiation of the weight loss program on an outpatient basis in the Department of Endocrinology, Diabetes, and Metabolism, Panagia General Hospital, Thessaloniki, Greece. Among the 44 obese women, 37 completed the 4-wk and 26 the 20-wk intervention study. Anthropometry All measurements were performed by the same investigator (T.T.) before and 4 and 20 wk after introduction of a weight reduction program. BW was determined to the nearest 0.1 kg with a calibrated beam balance and standing height to the nearest 0.5 cm. BMI was calculated as weight (kilograms) divided by height squared (square meters). Waist circumference (WC) was measured using a cloth tape midway between the lower rib and the iliac crest and hip circumference as the maximum circumference over the buttocks. Body composition was determined by impedance analysis with the use of a single-frequency bioelectrical impedance analysis (BIA), which emitted 50 KHz and 800κA (model BIA-101A; Akern STA, Florence, Italy) (22). Percentage of FM (FM%) was determined by using Bodygram software (version 1.21; Akern Srl, Florence, Italy). This BIA method allows discrimination between fat and fluid overload and the monitoring of changes of FM% in obese subjects undergoing weight reduction, even of minimal degree (22). Dietary intervention All obese women initially followed a 2-wk run-in period during which they were encouraged to follow their nutritional habits and maintain their habitual levels of physical activity. At day 0 of the weight reduction program, initial caloric levels of each subject were estimated using the Harris-Benedict formula for women [ (weight in kilograms) (height in centimeters) (age in years)] (23). Thereafter a lowcalorie diet was individually prescribed on the basis of an average calorie restriction of 1000 kcal/d. Initially the administered diets consisted of a mean of 1385 ± 312 kcal/d (5775 ± 1301 kj/d) and ranged from 1015 to 1880 kcal/d (4232 to 7840 kj/d), depending on the initial BW. The daily distribution of nutrients was 48.5 ± 4.1% (163.8 ± 21.7 g) carbohydrates, 28.5 ± 3.2% (43.9 ± 12.0 g) fat, and 23.0 ± 1.4% (77.7 _ 15.8 g) protein, and daily calculated contents of calcium and vitamin D were 791± 32 mg and 221 ± 37 IU,

5 respectively. The diets were analyzed for nutrient composition using the computerized nutritional system Science Fit Diet 200A (Science Fit, Athens, Greece). After 8 wk of the intervention, all diets were adapted with an additional energy restriction of 20% of the ingested calories and with approximately the same macronutrient composition until the end of the weight loss period (18 20 wk). Thereafter the subjects were stabilized for 2 wk at a steady weight before reassessment was performed at wk. During the period of the protocol, participants were asked not to change their habits of physical activity. All obese women were asked to attend the center weekly during the 20-wk follow-up. Laboratory Measurements Serum and plasma samples (obtained by centrifugation at 4 C) were taken after a 12-h overnight fast before and after the dietary treatment and stored frozen at -70 C until they were assayed. Season of blood draw was determined from the date of the baseline visit. Blood samples taken from December through February were coded as winter, from March through May as spring, from June through August as summer, and from September through November as fall. The electrochemiluminescence immunoassay ECLIA (Roche DiagnosticsGmbA, Mannheim, Germany) was used for25ohd and PTH assays. Measuring range for vitamin D was ng/ml, within-run precision %, and total precision %. Expected values for PTH were pg/ml, functional sensitivity 6.0 pg/ml, within-run precision %, and total precision %. Serum total cholesterol (TC) and triglyceride (TG) levels were measured using enzymatic methods (Bioanalyzer 30R; Wako Chemicals GmbH, Combe, Japan). High-density lipoprotein cholesterol (HDL-C) was measured in the serum supernatant after the precipitation of very low-density lipoproteins and low density lipoprotein cholesterol (LDL-C) with Mg2_/dextran. LDL-C concentrations were estimated using Friedewald s equation (24). Serum apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and lipoprotein (a) [Lp(a)] concentrations were determined by immunonephelometric assays (Boehring Diagnostics GmbH, Marburg, Germany). Glucose serum concentrations were measured using an enzymatic assay and serum insulin levels were determined using an immunoradiometric assay kit (Biosource INS-IRMA kit; Biosource Europe SA, Nivelles, Belgium). The normal range for insulin levels was 2 25 κiu/ml. Insulin sensitivity was also estimated by the homeostasis model assessment (HOMA) index (25). Statistical analyses Data are presented as mean±sd. Differences between groups were assessed with one-way ANOVA and post hoc tests were carried out with the Holm-Sidak method. Changes during the study were assessed with the paired-samples t test. Correlations between variables were assessed using Pearson s coefficient of correlation. In all cases, a two-tailed P < 0.05 was considered significant. All data were analyzed using the statistical package SPSS (version 15.0; SPSS, Chicago, IL). Results Baseline analyses At baseline, obese women demonstrated significantly lower levels of 25OHD compared with controls (patients 17.0 ± 6.0, controls 23.8 ± 8.7 ng/ml, P < 0.001), whereas PTH concentrations were no different between the two groups. Notably, 69.7% of the obese group had 25OHD levels less than 20 ng/ml (deficiency), 93.4% had 25OHD levels less than 30 ng/ml (insufficiency), whereas the corresponding figures for the control group were 56 and 72%, respectively. A seasonal variation of 25OHD levels was seen in obese women: 25OHD levels in the winter group (13.3 ± 3.4 ng/ml) were lower than in the summer (22.4 ± 4.7 ng/ml) and fall groups (24.6 ± 5.9

6 ng/ml, P < for both), and those in the spring group (14.7± 3.7 ng/ml) had lower levels than those in the summer and fall groups (P < and P < 0.001, respectively). No seasonal differences were observed in the control group probably due to the small number of subjects in each of the four categories. Neither 25OHD nor PTH levels varied significantly between pre- and postmenopausal subjects. Most anthropometric and lipid parameters with the exception of levels of HDL-C, ApoA1, Lp(a), and blood glucose were higher in obese women than in controls. All baseline measurements for both groups are presented in Table 1. Pearson correlation analyses for all women (n = 68) showed a negative correlation between 25OHD and the following obesity indices: BW (r = , P < 0.008), BMI (r = , P < 0.002), WC (r = , P< 0.030), and FM% (r = , P < 0.001). A negative correlation between levels of25ohd and PTHwas found only in obese women (r = , P < 0.024). No significant correlations were found between 25OHD and lipid parameters. PTH levels correlated negatively with LDL-C levels in all women(r = , P< 0.046).

7 Analyses during weight loss After 4 wk, the hypocaloric dietary intervention produced a small but significant decrease in BW, BMI, WC, and FM% (P<0.001). Weight loss was associated with a significant reduction in most of the lipoprotein and metabolic parameters measured; PTH and 25OHD did not change significantly during this time period (Table 2). After 20 wk, a decrease of BW, BMI, and FM% of the order of 10% and a decrease of WC at 9% were achieved, which were associated with significant reductions in insulin levels (19.0±12.4 vs. 13.1±7.1_U/ml,P<0.05),HOMA index (4.74±3.8 vs. 3.10±1.7, P<0.05) and serum lipids [except HDL-C, apoa1, and Lp(a)] and significant increases in 25OHD levels by 34% (15.4 ± 6.0 vs ± 5.1 ng/ml, P < 0.05). PTH levels appeared to be unaffected (Table 2). A significant negative correlation was found between changes in 25OHD levels and changes in insulin levels (r =-0.380, P < 0.045) and HOMA index (r=-0.433, P< 0.039) (Fig. 1). A trend for negative correlation was found between changes in 25OHD levels and changes in BW (r =-0.367, P<0.065) and BMI (r=-0.376, P<0.059) (Fig. 2) but no significant correlation between changes in 25OHD levels and changes in FM%.No significant correlations were found between 25OHD and lipid parameters. Discussion The present study examined the effects of a low-calorie diet on 25OHD and PTH levels in nondiabetic obese women at two different time points. At baseline, levels of vitamin D were lower in obese subjects than in controls, whereas levels of PTH were similar between the two groups. The introduction of a 4-wk low-calorie diet did not significantly influence these two metabolic parameters; however, after 20 wk a modest degree of weight loss of 10% was associated with a significant increase of 25OHD levels by 34%, whereas PTH levels remained unaffected. The changes in 25OHD levels at 20 wk were more closely associated with the changes (improvement) in insulin resistance indices than changes in obesity indices.

8 It is now well established that low vitamin D levels are commonly observed in obese children and adults (4 6). This finding was confirmed by the results of the present study, which showed that 25OHD levels were inversely correlated both with indices of total obesity such as BW, BMI, FM%, and indices of abdominal obesity such as WC. Studies performed using sophisticated equipment for assessing body composition also suggest that the low vitamin D levels found in obesity are associated both with total body and regional (sc and visceral) adipose tissue (5, 7, 9). Although the precise mechanism for the lower levels of vitamin D in obesity is not known, the most plausible

9 explanation is that the expanded adipose tissue traps and stores this fat-soluble vitamin (26). In our obese group, the vast majority of women (almost 93%) were identified as either vitamin D deficient (<20 ng/ml) or vitamin D insufficient (<30 ng/ml), whereas in controls the respective rates were 72%. These data in our small population groups are in line with the recent reports that vitamin D deficiency is an epidemic phenomenon showing particular high prevalence in southern European populations (27, 28). We also observed that the welldescribed seasonal variation effect on 25OHD was significant only in obese women; this negative result in controls cannot be explained and is probably attributed to the small sample of these subjects. PTH levels have been reported to be elevated in obese subjects, in keeping with a compensating mechanism to vitamin D insufficiency (5, 29, 30). It has been suggested that the increased PTH per se can promote lipogenesis and obesity via calcium stimulation, which enhances lipogenesis and inhibits lipolysis in adipocytes (11, 31). Although a significant negative correlation was found between 25OHD and PTH levels in the total population studied, PTHlevels in the obese group did not differ compared with controls. The absence of elevated PTH could be attributed to the small number of subjects but could also be due to a relative metabolic resistance to vitamin D despite low levels of 25OHD, which has been reported in some population groups (6, 32). It has been suggested that a low threshold of vitamin D has to be reached for PTH to rise leading to metabolic disturbances. This cutoff point has recently been proposed to be fixed at 15 ng/ml (33). In our study, baseline mean 25OHD concentrations were somehow higher than this threshold, perhaps explaining the nonelevated mean PTH levels. Current proposed molecular mechanisms to explain normal PTH in the face of low 25OHD

10 include nutrient receptor disturbances and intracellular magnesium deficiency (32). The introduction of a low-calorie diet in obese women resulted in changes of metabolic parameters that varied according to the time period after the diet and the amount of weight loss achieved. At 4 wk there was a small but significant reduction of all obesity indices, improvement of insulin resistance, and improvement of most lipid parameters with the exception of Lp(a). Changes in PTH and 25OHD were minimal and did not reach statistical significance. The content of the hypocaloric diet in vitamin D throughout the first phase of the study was estimated at about 200 IU/d, which is lower than recent recommendations for adequate intake for age and gender (34). Our findings showed that this level of dietary intake of vitamin D did not induce any significant effect on its serum levels, measured as 25OHD. After the 20-wk dietary treatment period, obese women achieved a moderate weight loss by 10% of the initial BW and improved significantly indices of insulin resistance and most blood lipids. These changes were accompanied by significant increases of25ohdlevels by 34%, whereas PTH levels remained unchanged. The effects of weight reduction on vitamin D and PTH were evaluated in two recent interventional studies. In the first study, Reinehr et al. (20) examined 133 obese children, aged 12 yr, who followed a 1-yr lifestyle interventional program. A small reduction of excess BW in 35 children by -0.9 U of BMI led to a significant increase of 25OHD levels and significant decrease of PTH levels. In the second study, Holecki et al. (21) assessed the effects of a low-calorie balanced diet weight loss program on changes of PTH and 25OHD for 3 months and found similar changes of their levels as those reported in the previous study in children. The increase of vitamin D in our study did not correlate significantly with the reduction of obesity parameters although a trend for negative correlations was found between changes of 25OHD and changes of BW and BMI. Interestingly, improvement of insulin resistance as indicated by reductions of insulin levels and HOMA index correlated with increases of 25OHD levels. This novel finding suggests that after modest weight reduction, insulin resistance is a more significant determinant of 25OHD levels than body fat. However, our findings may also indicate that increasing 25OHD levels after weight loss may improve insulin resistance. Lifestyle interventions resulting in greater weight and fat loss are necessary to clarify this important issue. The negative association between vitamin D levels and insulin resistance has been observed in many crosssectional and prospective studies (35, 36). Two very recent studies, however, suggested that in obesity both low 25OHD levels and insulin resistance could be explained in large part by the increased adiposity (37, 38). Ηn young women with polycystic ovary syndrome, which often represents a state of insulin resistance, low serum of 25OHD concentrations were also found and were associated with the presence of both obesity and insulin resistance (39, 40). Experimental studies have shown that vitamin D enhances insulin synthesis and release, increases insulin receptor expression, and suppresses inflammation (15). At present, low vitamin D levels are a risk factor for metabolic syndrome and type 2 diabetes mellitus and supplementation studies for preventing or improving these conditions are currently ongoing (41). The importance of the rise in 25OHD levels during weight loss is also highlighted by the recent reports, which have suggested a threshold for the effect of vitamin D deficiency on insulin resistance (33). Our obese subjects displayed 25OHD concentrations fairly similar to the reported threshold, and consequently, we suggest that increasing 25OHD levels through weight reduction could confer beneficial effects on insulin sensitivity. Furthermore, recent evidence suggests that chronic vitamin D deficiency may be a risk factor for atherosclerosis mediated through various mechanisms in the pathophysiology of cardiovascular disease (42). Our study illustrates that a modest amount of weight loss of about 10% of the initial body weight constitutes a relevant intervention to reduce an emerging risk factor for type 2 diabetes mellitus and cardiovascular diseases in addition to other conventional risk factors such as dyslipidemia and hypertension. Limitations of the present study, which has to be considered as a pilot study, include the relatively small number of subjects that finally completed the weight loss program and the relatively small observational period

11 of 20 wk. In conclusion, levels of 25OHD are low in obese patients and are clearly associated with the degree of obesity. Moderate weight reduction of about 10% after a low-calorie diet can increase 25OHD levels, and this increase is mainly associated with an improvement in insulin resistance. Further studies including more subjects, longer periods of weight loss and maintenance, and greater amounts of weight loss are necessary to clarify the interrelationships between adipose tissue, insulin resistance, and vitamin D levels. Acknowledgments Address all correspondence and requests for reprints to: Gerasimos E. Krassas, M.D., Ph.D., F.R.C.P. (Lond), Chairman, Department of Endocrinology, Diabetes, and Metabolism, Panagia General Hospital, Nikolaou Plastira, 22, Nea Krini, Thessaloniki, Greece. krassas@the.forthnet.gr. References 1. Holick MF 2004 Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80(Suppl 6):1678S 1688S 2. Bouillon R, Carmeliet G, Verlinden L, van Etten E, Verstuyf A, Luderer HF, Lieben L, Mathieu C, Demay M 2008 Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev 29: Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S 1985 Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 76: Parikh SJ, EdelmanM,Uwaifo GI, Freedman RJ, Semega-JannehM, Reynolds J, Yanovski JA 2004 The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab 89: Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, Seidell JC, Lips P 2005 Adiposity in relation to vitamindstatus and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90: Alemzadeh R, Kichler J, Babar G, Calhoun M 2008 HypovitaminosisDin obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism 57: Young KA, Engelman CD, Langefeld CD, Hairston KG, Haffner SM, Bryer-Ash M, Norris JM 2009 Association of plasma vitamin D levels with adiposity in Hispanic and African Americans. J Clin Endocrinol Metab 94: Kremer R, Campbell PP, Reinhardt T, Gilsanz V 2009 Vitamin D status and its relationship to body fat, final height, and peak bone mass in young women. J Clin Endocrinol Metab 94: Moschonis G, Tanagra S, Koutsikas K, Nikolaidou A, Androutsos O, Manios Y 2009 Association between serum 25-hydroxyvitamin Dlevels and body composition in postmenopausal women: the postmenopausal Health Study. Menopause 16: Reid IR 2008 Relationships between fat and bone. Osteoporos Int 19: Xue B, Greenberg AG, Kraemer FB, ZemelMB2001 Mechanism of intracellular calcium ([Ca2_]i) inhibition of lipolysis in human adipocytes. FASEB J 15: Bolland MJ, Grey AB, Gamble GD, Reid IR 2005 Association between primary hyperparathyroidism and increased body weight: a meta-analysis. J Clin Endocrinol Metab 90: Rejnmark L, Vestergaard P, Brot C, Mosekilde L 2008 Parathyroid response to vitamin D insufficiency: relations to bone, body composition and to lifestyle characteristics. Clin Endocrinol (Oxf) 69: Tai K, Need AG, Horowitz M, Chapman IM 2008 Vitamin D, glucose, insulin, and insulin sensitivity. Nutrition 24: Teegarden D, Donkin SS 2009 Vitamin D: emerging new roles in insulin sensitivity. Nutr Res Rev 22: Moreiro J, Ruiz O, Perez G, Salinas R, Urgeles JR, RiescoM,García-Sanz M 2007 Parathyroid hormone and bone marker levels in patients with morbid obesity before and after biliopancreatic diversion. Obes Surg 17: Aasheim ET, Bjo rkman S, Søvik TT, Engstro m M, Hanvold SE, Mala T, Olbers T, Bøhmer T 2009 Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr 90: Pugnale N, Giusti V, Suter M, Zysset E, He raïef E, Gaillard RC, Burckhardt P 2003 Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. Int J Obes Relat Metab Disord 27: Nadler EP, Youn HA, Ren CJ, Fielding GA 2008 An update on 73 U.S. obese pediatric patients treated with laparoscopic adjustable gastric banding: comorbidity resolution and compliance data. J Pediatr Surg 43: Reinehr T, de Sousa G, Alexy U, Kersting M, Andler W 2007 Vitamin D status and parathyroid hormone in obese children before and after weight loss. Eur J Endocrinol 157: Holecki M, Zahorska-Markiewicz B, Janowska J, Nieszporek T, Wojaczyn ska-stanek K, Zak- Gołab A, Wiecek A 2007 The influence of weight loss on serum osteoprotegerin concentration in obese perimenopausal women. Obesity (Silver Spring) 15:

12 22. Piccoli A, Brunani A, Savia G, Pillon L, Favaro E, Berselli ME, Cavagnini F 1998 Discriminating between body fat and fluid changes in the obese adult using bioimpedance vector analysis. Int J Obes Relat Metab Disord 22: Owen OE, Kavle E, Owen RS, Polansky M, Caprio S, Mozzoli MA, Kendrick ZV, Bushman MC, BodenG1986Areappraisal of caloric requirements in healthy women. Am J Clin Nutr 44: Friedewald WT, Levy RI, Fredrickson DS 1972 Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18: Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC 1985 Homeostasis model assessment: insulin resistance and _-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28: Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF 2000 Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72: HolickMF2007 VitaminDdeficiency.NEngl J Med 357: Lips P 2007 Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol 103: Lips P, Wiersinga A, van Ginkel FC, Jongen MJ, Netelenbos JC, Hackeng WH, Delmas PD, van der Vijgh WJ 1988 The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects. J Clin Endocrinol Metab 67: Pitroda AP, Harris SS, Dawson-Hughes B 2009 The association of adiposity with parathyroid hormone in healthy older adults. Endocrine 36: Zemel MB 2002 Regulation of adiposity and obesity risk by dietary calcium: mechanisms and implications. JAmColl Nutr 21:146S 151S 32. Lenders CM, Feldman HA, Von Scheven E, Merewood A, Sweeney C, Wilson DM, Lee PD, Abrams SH, Gitelman SE, Wertz MS, Klish WJ, Taylor GA, Chen TC, Holick MF 2009 Elizabeth Glaser Pediatric Research Network Obesity Study Group. Relation of body fat indexes to vitamindstatus and deficiency among obese adolescents. Am J Clin Nutr 90: Ashraf A, Alvarez J, Saenz K, Gower B, McCormick K, Franklin F 2009 Threshold for effects of vitamin D deficiency on glucose metabolism in obese female African-American adolescents. J Clin Endocrinol Metab 94: National Osteoporosis Foundation 2010 Clinician s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation, Liu E, Meigs JB, Pittas AG, McKeown NM, Economos CD, Booth SL, Jacques PF 2009 Plasma 25- hydroxyvitamin d is associated with markers of the insulin resistant phenotype in nondiabetic adults. J Nutr 139: Forouhi NG, Luan J, Cooper A, Boucher BJ, Wareham NJ 2008 Baseline serum 25-hydroxy vitamin d is predictive of future glycemic status and insulin resistance: the Medical Research Council Ely Prospective Study Diabetes 57: Cheng S, Massaro JM, Fox CS, Larson MG, Keyes MJ, McCabe EL, Robins SJ, O Donnell CJ, Hoffmann U, Jacques PF, Booth SL, Vasan RS, Wolf M, Wang TJ 2010 Adiposity, cardiometabolic risk, and vitamin D status: the Framingham Heart Study. Diabetes 59: Muscogiuri G, Sorice GP, Prioletta A, Policola C, Casa SD, Pontecorvi A, Giaccari A Hydroxyvitamin D concentration correlates with insulin-sensitivity and BMI in obesity. Obesity (Silver Spring) doi: /oby Hahn S, Haselhorst U, Tan S, Quadbeck B, Schmidt M, Roesler S, Kimmig R, Mann K, Janssen OE 2006 Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 114: Yildizhan R, Kurdoglu M, Adali E, Kolusari A, Yildizhan B, Sahin HG, Kamaci M 2009 Serum 25- hydroxyvitamin D concentrations in obese and non-obese women with polycystic ovary syndrome. Arch Gynecol Obstet 280: Danescu LG, Levy S, Levy J 2009 Vitamin D and diabetes mellitus. Endocrine 35: Wallis DE, Penckofer S, SizemoreGW2008 The sunshine deficit and cardiovascular disease. Circulation 118:

13 Ρν άξζξν ηνπ κήλα ΑΠΘΖΠΖ ΘΑΛΑΠΖΠ ΚΝΟΡΕΗΑΞΖΠ Ph.D. Γηδάθησξ Δξγνθπζηνινγίαο Specialist in physical condition of Football ΞΝΡΔ ΑΜΗΝΙΝΓΔΗΡΑΗ ΔΟΓΝΚΔΡΟΗΘΑ ΚΗΑ ΝΚΑΓΑ ΞΝΓΝΠΦΑΗΟΝ Νη εξγνκεηξηθέο εμεηάζεηο ζε κία επαγγεικαηηθή νκάδα πνδνζθαίξνπ ζα πξέπεη λα γίλνληαη ζε πέληε (5) θάζεηο σο εμήο: 1. Ξξηλ ηελ έλαξμε ηεο πξνεηνηκαζίαο γίλνληαη νη πξψηεο εξγνκεηξηθέο* εμεηάζεηο γηα λα ζρεδηαζηεί ε πξνπφλεζε ηεο πξνεηνηκαζίαο επηά (7) ή νθηψ (8) εβδνκάδσλ αλάινγα κε ην ζθεπηηθφ ηνπ θάζε πξνπνλεηή, αληίζηνηρα λα δηαπηζησζνχλ ηπρφλ αηνκηθέο ηδηαηηεξφηεηεο (κπτθέο αληζνξξνπίεο πηζαλνί ηξαπκαηηζκνί δηφηη νη παίθηεο έξρνληαη απφ κεηαβαηηθφ ζηάδην) θαη γεληθφηεξα λα δηαπηζηψζνπκε ην επίπεδν ηεο θπζηθήο θαηάζηαζεο ηνπ θάζε παίθηε ζηελ ζπγθεθξηκέλε ρξνληθή πεξίνδν. Θαηφπηλ λα γίλνπλ ηα απαξαίηεηα γθξνππ πξνπφλεζεο ψζηε λα δερηνχλ ηηο αλάινγεο πξνπνλεηηθέο επηβαξχλζεηο ζρεηηθά κε ην αηνκηθφ επίπεδν ηνπ θάζε παίρηε. 2. Κεηά ηελ 10ε εβδνκάδα ζα πξέπεη λα επαλαιεθηνχλ εξγνκεηξηθέο εμεηάζεηο γηα λα δηαπηζηψζνπκε ην επίπεδν ηεο θπζηθήο θαηάζηαζεο ηνπ θάζε πνδνζθαηξηζηή θαη θαη επέθηαζε ηεο νκάδαο, δειαδή αλ νη πξνπνλεηηθέο επηβαξχλζεηο πνπ είραλ ζρεδηαζηεί γηα ηελ πξνεηνηκαζία ήηαλ νη πξνβιεπφκελεο θαη νη θαηάιιειεο. 3. Ρελ 20ε έσο ηελ 22ε εβδνκάδα απφ ηελ έλαξμε ηεο πξνεηνηκαζίαο ζα πξέπεη λα επαλαιεθηνχλ νη εξγνκεηξηθέο εμεηάζεηο ηελ πεξίνδν απηή παξνπζηάδεηαη κηα ζρεηηθή πξνπνλεηηθή θάκςε ζηελ νκάδα, δειαδή έρνπκε κηα κείσζε ζηελ αεξφβηα ηθαλφηεηα ηεο ηάμεσο ηνπ 2%-3% θαη 7%-8% ηεο ηθαλφηεηαο ηεο δχλακεο γηα απηφ ηηο εβδνκάδεο απηέο (νη νπνίεο είλαη ζπλήζσο ζηα κέζα Γεθεκβξίνπ) ζα πξέπεη λα πξνζέμνπκε παξά πνιχ ην επίπεδν ηεο θπζηθήο θαηάζηαζεο ηεο νκάδα καο. 4. Δπφκελεο εξγνκεηξηθέο εμεηάζεηο είλαη ζηηο αξρέο ηνπ δεπηέξνπ γχξνπ (ζηα κέζα Φεβξνπαξίνπ) ζθνπφο απηψλ ησλ εμεηάζεσλ είλαη λα δηαγλψζνπκε θαη λα πξνζπαζήζνπκε λα δηαηεξήζνπκε ην πξνπνλεηηθφ επίπεδν ηελ νκάδα ζην πςειφηεξν ζεκείν ρσξίο επηπιένλ επηβαξχλζεηο κέρξη ηέινο ηνπ πξσηαζιήκαηνο (ζηαζεξνπνίεζε θαη δηαηήξεζε πξνπνλεηηθνχ επίπεδνπ). 5. Ξξηλ ηειεηψζεη ην πξσηάζιεκα γίλνληαη νη ηειεπηαίεο εμεηάζεηο γηα λα ζρεδηαζηεί ην πξνπνλεηηθφ πιάλν ηεο κεηαβαηηθήο πεξίνδνο, ζθνπφ απηψλ ησλ εμεηάζεσλ είλαη λα δηαπηζηψζνπκε αλ ε νκάδα ηειεηψλνληαο ην πξσηάζιεκα είλαη θνπξαζκέλε ή φρη θαη απνθεί θαη έπεηηα λα ζρεδηάδεηαη ην αλάινγν πξνπνλεηηθφ πιάλν ηεο κεηαβαηηθήο πεξηφδνπ πνπ έρεη δηάξθεηα πεξίπνπ ηέζζεξεο (4) εβδνκάδεο (νη

14 ιεγφκελεο δηαθνπέο ησλ πνδνζθαηξηζηψλ). Γηα λα πεηχρνπκε έλα νινθιεξσκέλν ζρέδην πξνπφλεζεο ζε κία αγσληζηηθή πεξίνδν απφ Ηνχιην κέρξη Κάην δελ επαξθνχλ απφ κφλεο ηνπο νη εξγνκεηξηθέο εμεηάζεηο εδψ ππάξρεη θάπνηα βαζηθή πξνυπφζεζε γηα ηελ βειηίσζε ή δηαηήξεζε ηεο επίδνζεο ηεο νκάδαο είλαη ν θαιά πξνγξακκαηηζκέλνο ηξφπνο εθγχκλαζεο πνπ νλνκάδεηαη «ζσζηφο θαηακεξηζκφο ηεο πξνπφλεζεο», δειαδή: Αμηνιφγεζε (Δξγνκεηξηθέο εμεηάζεηο) Νξγάλσζε ηεο πξνπφλεζεο. Δθηέιεζε ηεο πξνπφλεζεο. Έιεγρνο (θαξδηνηειεκεηξία) θαη ξχζκηζε ηεο πξνπφλεζεο (επαλαπξνζδηνξηζκφο πξνπνλεηηθψλ ζηφρσλ). Κε ηνλ φξν «Θαηακεξηζκφ ηεο πξνπφλεζεο» ελλννχκε ηελ ζσζηά πξνγξακκαηηζκέλε, βξαρππξφζεζκε θαη κεζνπξφζεζκε πξνπνλεηηθή επίδξαζε ζηελ νκάδα ζε κηα δεδνκέλε θαηάζηαζε, κε ζηφρν ηελ επίηεπμε ηεο θαιχηεξεο δπλαηήο απφδνζήο ηεο, δειαδή ην εηήζην πξνπνλεηηθφ πιάλν (κεγάθπθινο- κεζφθπθινοκηθξφθπθινο-πξνπνλεηηθή κνλάδα), πνπ ζθνπφο πάληα είλαη ε αγσληζηηθή θφξκα θαη ε εηνηκφηεηα ηνπ αζιεηή ζηελ αγσληζηηθή πεξίνδν, γηα λα απνθχγνπκε θαηλφκελα πνπ ν πνδνζθαηξηζηήο λα πεηάεη ζηελ πξνπφλεζε (π.ρ. Ρξίηε Ρεηάξηε- Ξέκπηε) θαη λα έρεη θαθή αγσληζηηθή απφδνζε (λα ζέξλεηαη αγσληζηηθά) ηελ Θπξηαθή ζηνλ αγψλα. Ρειεηψλνληαο ζα ήζεια λα αλαθέξσ κε φζα δηαβάδνπκε ζηηο αζιεηηθέο εθεκεξίδεο θαη site γηα ηνπο πξνπνλεηέο πνπ δελ θάλνπλ εξγνκεηξηθέο εμεηάζεηο θαη κε ζπλέπεηα ηελ θαθή θπζηθή θαηάζηαζε ηεο νκάδαο ηνπο. Απηφ έρεη σο εμήο, ζε κία πηζαλή αιιαγή πξνπνλεηή (μέλνπ ή έιιελα) απηφ πνπ ζα πξέπεη λα δνζεί βαξχηεηα είλαη, λα ελεκεξσζεί ν πξνπνλεηήο απφ ηνλ εξγνθπζηνιφγν θαη ηνλ γπκλαζηή ηεο νκάδαο γηα ην επίπεδν ηεο νκάδαο θαη ηνλ αηνκηθφ θάθειν ηνπ θάζε πνδνζθαηξηζηή θαη λα δεη ηεο ηειεπηαίεο εξγνκεηξηθέο εμεηάζεηο πνπ ζα πξέπεη λα κελ μεπεξλνχλ ρξνληθά ηηο 10 ηειεπηαίεο εβδνκάδεο, ζε δηαθνξεηηθή πεξίπησζε ζα πξέπεη λα δεηήζεη λα γίλνπλ λέεο εξγνκεηξηθέο εμεηάζεηο, ψζηε λα κπνξεί ν ίδηνο καδί κε ην πξνπνλεηηθφ team λα δηαγλψζεη ην πξνπνλεηηθφ επίπεδν ηεο νκάδαο, γηα λα κπνξέζεη λα επαλαπξνζδηνξίζεη ηνπο πξνπνλεηηθνχο ζηφρνπο ηεο νκάδαο αλάινγα κε ην πξνπνλεηηθφ επίπεδν, θαζψο επίζεο λα κπνξεί λα εθαξκφδεη ηε δηθή ηνπ πξνπνλεηηθή θηινζνθία πνπ ηνλ δηέπεη, ζε δηαθνξεηηθή πεξίπησζε εάλ ν πξνπνλεηήο δελ αθνινπζήζεη ηνλ ζπγθεθξηκέλν δξφκν ζα βξεζεί θάπνηα ζηηγκή ζε πξνπνλεηηθφ θαη αγσληζηηθφ αδηέμνδν. Αλ αλαηξέμνπκε ζηηο Διιεληθέο νκάδεο ηεο Super League θαη έρνπκε ζην κπαιφ καο φια ηα παξαπάλσ ηφηε ζα θαηαιάβνπκε απφ πνχ πξνέξρνληαη φια ηα πξνπνλεηηθά θαη αγσληζηηθά πξνβιήκαηα κηαο νκάδεο (θαθή θπζηθή θαηάζηαζε-ηξαπκαηηζκνί θιπ). *Θαιφλ είλαη κε θάζε εξγνκεηξηθή εμέηαζε παξάιιεια ζε ζπλεξγαζία κε ηνλ γηαηξφ ηεο νκάδαο λα γίλεηαη θαη έλαο πιήξεο θιηληθφο έιεγρνο απφ αηκαηνινγηθέο θαη βηνρεκηθέο εμεηάζεηο γηα λα έρνπκε ηελ πιήξε εηθφλα ηεο νκάδαο. Ξξφζθιεζε ζπγγξαθήο άξζξσλ γηα ην Newsletter Ζ Ππληαθηηθή Δπηηξνπή ηνπ Newsletter, πξνζθαιεί λένπο θαη θαηαμησκέλνπο επηζηήκνλεο απφ φιν ην θάζκα ηεο Άζθεζεο, γείαο, Γηαηξνθήο, Δπεμίαο ζηε ζπγγξαθή άξζξσλ γηα ην ειεθηξνληθφ πεξηνδηθφ καο. Θα ζέιακε επίζεο λα ζαο επραξηζηήζνπκε γηα ηελ κέρξη ηψξα ζπκκεηνρή ζαο, ε νπνία έρεη ζπκβάιιεη ζεκαληηθά ζηελ κεγάιε απνδνρή θαη ζηα ζεηηθά ζρφιηα πνπ έρεη απνζπάζεη ην Newsletter ηεο SCIENCE TECHNOLOGIES

15 Γεληθέο Ξξνδηαγξαθέο Άξζξσλ: Κνξθή.doc Λα ζπλνδεχεηαη απφ δηαγξάκκαηα θαη ζρεηηθέο εηθφλεο αλ είλαη δπλαηφλ (ζα πξέπεη απνζηέιινληαη σο μερσξηζηά αξρεία, θαη φρη ελζσκαησκέλα ζην.doc αξρείν) Λα ππάξρνπλ αλαθνξέο θαη πεγέο ζην ηέινο Πχληνκν βηνγξαθηθφ αξζξνγξάθνπ (θσηνγξαθία -πξναηξεηηθά-, ηξέρνπζα ζέζε, ζεκαληηθέο ζέζεηο, πηπρία θιπ. έσο 7 γξακκέο) Ρν άξζξν ζα πξέπεη λα απνζηαιεί ειεθηξνληθά ζην info@sciencetech.gr Λέα 1 ST INTERNATIONAL ABOUT POOL SALON Τξ 1ξ POOLabout International SALON θα ποαγμαςξπξιηθεί από Φεβοξσαοίξσ 2011 ρςξ Εκθεριακό Κέμςοξ Expo Athens ρςη Λεωτόοξ Αμθξύραπ ρςημ Παλλήμη, (αςςική ξδόπ, ένξδξπ 14). Τυπώστε τημ παραπάμω πρόσκληση για ελέυθερη είσοδο

16 7Ζ ΔΞΗΠΡΖΚΝΛΗΘΖ ΓΗΖΚΔΟΗΓΑ ΞΑΣΠΑΟΘΗΑΠ (ΔΗΔΞ) Φεβξνπαξίνπ 2011 Μελνδνρείν Divani Caravel, Αζήλα Πην πιαίζην ηεο ζπλερνχο θαη εκπεξηζηαησκέλεο ελεκέξσζεο ησλ ηαηξψλ θαη ησλ ινηπψλ επαγγεικαηηψλ πγείαο πάλσ ζε ζέκαηα πνπ αθνξνχλ άκεζα ζηελ παρπζαξθία αιιά θαη ζηηο ζχγρξνλεο εμειίμεηο ζηνλ ηνκέα ησλ κεηαβνιηθψλ θαη κε επηπινθψλ, ε Διιεληθή Ηαηξηθή Δηαηξεία Ξαρπζαξθίαο δηνξγαλψλεη ηελ 7 ε Δπηζηεκνληθή Γηεκεξίδα θαη ην 7ν Θιηληθφ Φξνληηζηήξην, κε ζέκα «Ξαρπζαξθία θαη ζπλνδέο δηαηαξαρέο» απφ 25 έσο 27 Φεβξνπαξίνπ 2011, ζην μελνδνρείν Divani Caravel. Ζ 7ε Δπηζηεκνληθή Γηεκεξίδα θαη ην 7ν Θιηληθφ Φξνληηζηήξην ηεο ΔΗΔΞ πεξηιακβάλνπλ δηαιέμεηο δηαθεθξηκέλσλ Διιήλσλ θαη μέλσλ νκηιεηψλ, ζηξνγγπιά ηξαπέδηα, debates, θιέγνληα ζέκαηα ηεο επηθαηξφηεηαο θαζψο θαη ζπλαληήζεηο κε ηνλ εηδηθφ, πξνζδνθψληαο έηζη λα θαιχςνπλ φζν ην δπλαηφλ πιεξέζηεξα ην ελδηαθέξνλ ζε ζέκαηα εξεπλεηηθά, θιηληθά θαη ζεξαπεπηηθήο αληηκεηψπηζεο ηεο παρπζαξθίαο θαη ησλ επηπινθψλ ηεο. Ξιεξνθνξίεο ζην:

17 Health Care & Φπζηθή δσή Φεβξνπαξίνπ 2011 Expo Athens, Αλζνχζα Πηα πιαίζηα ηεο 6εο Γηεζλνχο Ηαηξηθήο Έθζεζεο Medic Expo '11 δηνξγαλψλεηαη γηα 1 ε ρξνληά δηαθξηηφ ηκήκα έθζεζεο κε ηίηιν: «1 η HEALTH CARE & ΦΤΗΘΖ ΕΩΖ» Πηφρνο ηεο 1 εο HEALTH CARE & ΦΠΗΘΖ ΕΥΖ είλαη ε ελεκέξσζε ηνπ θνηλνχ θαη ηδηαίηεξα ησλ παζρφλησλ απφ επηζηήκνλεο & επαγγεικαηίεο πγείαο ζε ζέκαηα πξφιεςεο θαη βειηίσζεο πγείαο κε θπζηθά πξντφληα θαη ππεξεζίεο. Α. ΔΛΗΑΗΑ ΟΙΗΣΗΘΖ ΗΑΣΡΗΘΖ ΖΚΔΟΗΓΑ ΝΚΝΗΝΞΑΘΖΡΗΘΖΠ ΗΑΡΟΗΘΖΠ ΞΝ ΡΖΛ ΑΗΓΗΓΑ ΡΖΠ ΔΘΛΗΘΖΠ ΔΡΑΗΟΔΗΑΠ ΝΚΝΗΝΞΑΘΖΡΗΘΖΠ ΗΑΡΟΗΘΖΠ ΠΛΔΟΓΑΠΗΑΠ ( Δ.Δ.Ν.Η.Π.) ΚΔ ΘΔΛΡΟΗΘΝ ΘΔΚΑ: «Ζ ΝΚΝΗΝΞΑΘΖΡΗΘΖ ΗΑΡΟΗΘΖ ΠΖΚΔΟΑ» Βαζηθνί Νκηιεηέο : ( Γηαζέζηκνο ρξφλνο 120 ) α. Β. ΕΑΦΔΗΟΗΝ MD Τπρίαηξνο-Νκνηνπαζεηηθφο ( Ξξφεδξνο Δ.Δ.Ν.Η.Π.) β. Γ. ΙΝΘΑΠ MD Τπρίαηξνο-Νκνηνπαζεηηθφο Β. ΔΠΗΣΖΚΟΛΗΘΖ ΖΚΔΡΗΓΑ ΚΔ ΘΔΛΣΡΗΘΟ ΘΔΚΑ: ΡΑ ΠΚΞΙΖΟΥΚΑΡΑ ΓΗΑΡΟΝΦΖΠ ΘΑΗ ΡΟΝΦΗΚΑ ΔΗΓΗΘΖΠ ΓΗΑΡΟΝΦΖΠ ( ΞΝ ΡΖΛ ΑΗΓΗΓΑ ) ΡΝ ΔΙΙΖΛΗΘΝ ΠΛΓΔΠΚΝ ΔΗΠΑΓΥΓΔΥΛ ΘΑΗ ΞΑΟΑΓΥΓΥΛ ΞΟΝΗΝΛΡΥΛ ΦΠΗΘΖΠ ΓΗΑΒΗΥΠΖΠ ΘΑΗ ΡΖΛ ΔΞΝΞΡΔΗΑ ΡΝ ΞΟΝΔΓΟΝ ΡΖΠ ΔΞΗΠΡΖΚΝΛΗΘΖΠ ΔΞΗΡΟΝΞΖΠ Α. ΘΙΝΘΝΕΑ Γξ ΦΑΟΚΑΘΝΙΝΓΗΑΠ Βαζηθνί νκηιεηέο: ( Γηαζέζηκνο ρξφλνο 180 ) α. Α. ΘΙΝΘΝΕΑΠ Γξ Φαξκαθνινγίαο κε ζέκα: «Ρα Ππκπιεξψκαηα Γηαηξνθήο θαη Ρξφθηκα Δηδηθήο Γηαηξνθήο ζήκεξα θαη νη εμειίμεηο ηνπ αχξην». β. Γξ Λ. ΘΑΡΠΑΟΝΠ-Δπηζηεκνληθφο Ππλεξγάηεο ΔΘΔΦΔ Γεκφθξηηνο κε ζέκα: «Κεζνγεηαθή Διιεληθή Γηαηξνθή θαη γεία» γ. Α. ΡΟΗΑΛΑΡΑΦΙΙΝ-ΞΗΡΗΓΖ, Αλ. θαζεγήηξηα Ηαηξηθήο Πρνιήο Αζελψλ κε ζέκα: «Ιηπαξά Νμέα ζε Ηζνξξνπία». Θα ππάξμνπλ θαη άιινη νκηιεηέο. ΔΗΓΗΘΑ ΘΔΚΑΡΑ: Β1. Ηζρπξηζκνί γείαο & Γηαηξνθήο γηα ηα ζπκπιεξψκαηα δηαηξνθήο Β2. Ππκπιεξψκαηα δηαηξνθήο: Απνηειεζκαηηθφηεηα θαη αζθάιεηα B3. Φπηηθά ζπκπιεξψκαηα δηαηξνθήο Ινηπά πξνηεηλφκελα: Σνξεγνί θαη ζπκκεηέρνπζεο εηαηξείεο ζηελ εκεξίδα Θα πξνβιεζνχλ εηαηξείεο κε πξνηάζεηο θαη πξντφληα φπσο: πγηεηλή βηνδηαηξνθή - βφηαλα & ειημήξηα ζπκπιεξψκαηα δηαηξνθήο - θπζηθά πξντφληα θαξκαθείνπ παξαδνζηαθέο κέζνδνη θξνληίδαο ηεο πγείαο θπζηθά test πγείαο - βηνξπζκηζηηθέο ζπρλφηεηεο θέληξα θαη ζρνιέο ζπκπιεξσκαηηθψλ ελαιιαθηηθψλ ζεξαπεηψλ θπζηθά ηακαηηθά θέληξα, εθδφζεηο ππεξεζίεο & πξντφληα θπζηθήο δσήο θ.α. Ξιεξνθνξίεο ζην:

18 34 Ζ COSMOESTETICA Καξηίνπ 2011 HELEXPO PALACE ΑΘΖΛΑ Έθζεζε Κεραλεκάησλ θαη Ξξντφλησλ Αηζζεηηθήο, κε ηαπηφρξνλν Ππκπφζην, πνπ νξγαλψλνληαη γηα ινγαξηαζκφ ηνπ Ξαλειιήληνπ Ππλδέζκνπ Αληηπξνζψπσλ, Δηζαγσγέσλ, Θαηαζθεπαζηψλ Κεραλεκάησλ Αηζζεηηθήο- Φπζηνζεξαπείαο & Ξαξαζθεπαζηψλ Θαιιπληηθψλ (Ξ.Π.Α.Κ.Θ.Α.) θαη έρνπλ ζαλ ζηφρν ηελ φζν ην δπλαηφλ πιεξέζηεξε ελεκέξσζε ησλ Αηζζεηηθψλ, αιιά θαη ησλ κειινληηθψλ επαγγεικαηηψλ ζε φ,ηη λεφηεξν έρεη λα παξνπζηάζεη ν θιάδνο. Γηα δειψζεηο ζπκκεηνρήο επηθνηλσλείζηε κε ηε γξακκαηεία ηνπ ΞΠΑΚΘΑ. Ξιεξνθνξίεο ζην:

19 Hellas PHARM Απξηιίνπ 2011 HELEXPO PALACE Tν θεηηλφ Hellas PHARM, δηνξγαλψλεηαη γηα δσδέθαηε ρξνληά απφ ηνπο Φαξκαθεπηηθνχο Ππιιφγνπο Αηηηθήο θαη Ξεηξαηά θαη είλαη αθηεξσκέλν ζηελ αλάπηπμε ηεο επηρεηξεκαηηθφηεηαο ηνπ θαξκαθείνπ. Απψηεξνο ζηφρνο ηνπ είλαη λα ελεκεξψζεη ηνπο ζπλέδξνπο-θαξκαθνπνηνχο γηα ηελ αλάγθε ελεξγεηψλ πνπ ζα ζπκβάιινπλ θαη ζηελ επηρεηξεκαηηθή θαηαμίσζή ηνπο, θαζψο ε επηζηεκνληθή θαηαμίσζε είλαη αδηαπξαγκάηεπηε. Ξην ζπγθεθξηκέλα, ην πξφγξακκα ηνπ ζπλεδξίνπ, πνπ ζα πξαγκαηνπνηεζεί ζηηο 9 θαη 10 Απξηιίνπ, ζην Helexpo Palace, ζην Καξνχζη, πεξηιακβάλεη: «Ρν θαξκαθείν ηελ επφκελε κέξα: επθαηξίεο θαη πξνθιήζεηο» ζηελ θεληξηθή ζπλεδξηαθή ελφηεηα. 1st Business Forum for Pharmacists κε ζέκα «Αλάπηπμε Δπηρεηξεκαηηθφηεηαο Φαξκαθείνπ». Ρν απφγεπκα ηνπ Παββάηνπ θαη ην πξσί ηεο Θπξηαθήο, κε νινθιεξσκέλν πξφγξακκα management θαη νξγάλσζεο θαξκαθείνπ, εμππεξέηεζεο πειαηψλ, marketing θαη ηερληθψλ πσιήζεσλ OTC s, ζπκπιεξσκάησλ δηαηξνθήο, θαιιπληηθψλ, θ.ά. Ξιεξνθνξίεο ζην: , fax: info@kprovoli.gr /

20 SFENDAMI MOUNTAIN FESTIVAL Απξηιίνπ 2011 Πθελδάκε Ξηεξίαο Διάηε λα κνηξαζηνχκε ηηο εκπεηξίεο καο, ηηο ζθέςεηο καο θαη ηνπο πξνβιεκαηηζκνχο καο. Διάηε λα απνιαχζνπκε ηε ζπληξνθηθφηεηα, ηελ απιφηεηα ηεο δσήο θαη ηελ ειιεληθή θηινμελία. Ρξέμηκν - Ξνδήιαην Δθδειψζεηο θαη δηαγσληζκνί γηα παηδηά απφ ηξηψλ ρξφλσλ θαη άλσ, γηα νηθνγέλεηεο θαη γηα ειηθησκέλνπο κε θέθη γηα δσή Αζιεηηθά ζεκηλάξηα Δπηδείμεηο δεμηνηερλίαο Ρνπηθά πξντφληα θαη έζηκα Δθζέηεο κε δηάθνξα αζιεηηθά πξντφληα Ξαδάξη αζιεηηθψλ εηδψλ απφ αζιεηέο Έλα ελδηαθέξνλ αζιεηηθφ, πνιηηηζηηθφ, ελεκεξσηηθφ θαη ςπραγσγηθφ δηήκεξν πνπ ζα πξαγκαηνπνηεζεί γηα πέκπηε ζπλερή ρξνληά ζηε Πθελδάκε Ξηεξίαο απφ ηηο Απξηιίνπ Ξαξάιιειεο Δθδειψζεηο ην δηήκεξν: Θαηά ηε δηάξθεηα ηνπ δηεκέξνπ νη επηζθέπηεο θαη νη αζιεηέο ζα έρνπλ ηελ δπλαηφηεηα λα ςπραγσγεζνχλ κε ηηο επηδείμεηο δεμηνηερλίαο πνπ ζα πξαγκαηνπνηεζνχλ, λα ελεκεξσζνχλ απφ ηα ζεκηλάξηα, λα ζπκκεηέρνπλ ζε παξάιιειεο δξαζηεξηφηεηεο πνπ ζα γίλνπλ θαηά ηελ δηάξθεηα ησλ αγψλσλ, λα γεπηνχλ παξαδνζηαθέο ιηρνπδηέο θαη λα παξαθνινπζήζνπλ έζηκα ηεο πεξηνρήο, λα κάζνπλ θαη λα δνπλ απφ θνληά ηα λέα πξντφληα θαη ηηο θαηλνηνκίεο ζηα αληίζηνηρα αζιήκαηα κε ηελ έθζεζε ησλ εηαηξεηψλ πνπ ζα ιεηηνπξγεί ην δηήκεξν, λα ζπκκεηέρνπλ ζην παδάξη κε δηθά ηνπο αζιεηηθά είδε πνπ ζα πξαγκαηνπνηεζεί θαηά ηε δηάξθεηα ησλ εθδειψζεσλ θαη άιια πνιιά γεγνλφηα πνπ κέρξη ηελ εκέξα ηνπ αγψλα ζα ζπκπιεξψζνπλ ην κελνχ ηνπ δηεκέξνπ Sfendami Mountain Festival 2011.

21 15 Ν ΞΑΛΔΙΙΖΛΗΝ ΦΑΟΚΑΘΔΡΗΘΝ ΠΛΔΓΟΗΝ Καΐνπ 2011 Μελνδνρείν Royal Olympic, Αζήλα Ζ Ξαλειιήληα Έλσζε Φαξκαθνπνηψλ κε ηδηαίηεξε ραξά ζαο αλαθνηλψλεη ηελ δηνξγάλσζε ηνπ 15νπ Ξαλειιήληνπ Φαξκαθεπηηθνχ Ππλεδξίνπ, πνπ ζα πξαγκαηνπνηεζεί ζηηο Ρν Ξαλειιήλην Φαξκαθεπηηθφ Ππλέδξην, ε κνλαδηθή επηζηεκνληθή έθθξαζε φινπ ηνπ θαξκαθεπηηθνχ θφζκνπ ζηελ Διιάδα, δηνξγαλψλεηαη θάζε δχν ρξφληα θαη απνηειεί πιένλ θαηαμησκέλν ζεζκφ. Πην πξφγξακκα ηνπ 15νπ Ππλεδξίνπ πεξηιακβάλνληαη νκηιίεο απφ δηαθεθξηκέλνπο Έιιελεο θαη μέλνπο επηζηήκνλεο, θαζψο θαη εηδηθνχ ελδηαθέξνληνο ζηξνγγπιέο ηξάπεδεο θαη δνξπθνξηθά ζπκπφζηα. Ρν Ππλέδξην απεπζχλεηαη ζην ζχλνιν ησλ θαξκαθνπνηψλ απφ φινπο ηνπο εξγαζηαθνχο θιάδνπο φπσο, Φαξκαθεία, Λνζνθνκεία, Βηνκεραλίεο, Ξαλεπηζηήκηα, Δξεπλεηηθά Θέληξα, γεηνλνκηθέο πεξεζίεο θαη Αζθαιηζηηθά Ρακεία. Γξαζηεξηφηεηεο

22 ΠΛEΟΓΑΠΗΑ ΚΔ ΡΑ ΘΑΡΑΠΡΖΚΑΡΑ COSMOS Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα, YAMMAX, POLAR θαη ACCUSPLIT ζηα θαηαζηήκαηα COSMOS ζην Ξεξηζηέξη Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα, YAMMAX, POLAR θαη ACCUSPLIT ζηα θαηαζηήκαηα COSMOS ζην Ζξάθιεην ΠΛEΟΓΑΠΗΑ ΚΔ ΡΑ ΘΑΡΑΠΡΖΚΑΡΑ SPORT 2000

23 Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα, YAMMAX, POLAR θαη ACCUSPLIT ζηα Sport 2000 ζηελ Θέξκε Θεζζαινλίθεο Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα, YAMMAX, POLAR θαη ACCUSPLIT ζηα Sport 2000 ζηελ Βάξε Αηηηθήο ΠΛEΟΓΑΠΗΑ ΚΔ ΡΝ ΘΑΡΑΠΡΖΚΑ ΑΙΒΔΛΗΥΡΖΠ SPORT Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα, YAMMAX, POLAR θαη ACCUSPLIT ζην θαηάζηεκα ΑΙΒΔΛΗΥΡΖΠ SPORT ζηελ Ι.Βνπιηαγκέλεο - Αζήλα

24 ΠΛEΟΓΑΠΗΑ ΚΔ ΡΑ ΘΑΡΑΠΡΖΚΑΡΑ INTERSPORT Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα, YAMMAX, POLAR θαη ACCUSPLIT ζηα InterSport ζηελ Σαιθίδα Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα, YAMMAX, POLAR θαη ACCUSPLIT ζηα InterSport ζηελ Ιακία

25 ΠΛEΟΓΑΠΗΑ ΚΔ ΡΖΛ ΔΡΑΗΟΗΑ ΓΗΓΘΑΠ Απφ ηελ επίζθεςε γηα εθπαίδεπζε ζηα πξντφληα ζε Polar, Yamax ζηελ εηαηξία Ηαηξηθψλ Δίδψλ & Κεραλεκάησλ Γίγθαο ΠΛEΟΓΑΠΗΑ ΚΔ ΡΝ ΓΚΛΑΠΡΖΟΗΝ BODYSOUL Απφ ηελ επίδεημε ηνπ νκαδηθνχ ηειεκεηξηθνχ ζπζηήκαηνο POLAR CARDIO GX ζην event ηνπ γπκλαζηεξίνπ BODYSOUL ζηελ Σαιθίδα

26 PERSONAL TRAINING CONGRESS ΠΡΝ ΓΚΛΑΠΡΖΟΗΝ STUDIO ONE Ζ εηαηξία καο ζπκκεηείρε ζην Personal Training Congress πνπ πξγκαηνπνηήζεθε ζην event ηεο ζρνιήο Studio One Vari Sports Club ηνπ Γ. Μεξνχ ζηηο /01/2011 φπνπ θαη έγηλε παξνπζίαζε ηνπ ηνπ νκαδηθνχ ηειεκεηξηθνχ ζπζηήκαηνο POLAR CARDIO GX Ζ SCIENCE TECHNOLOGIES ΠΡΝ FACEBOOK Ζ εηαηξία καο βξίζθεηαη ζην facebook ζηνλ παξαθάησ ζχλδεζκν: Όζνη έρεηε ήδε ινγαξηαζκφ ζην facebook απιά θάληε θιηθ ζηνλ παξαπάλσ ζχλδεζκν ή απιά ζηελ αλαδήηεζε πιεθηξνινγήζηε SCIENCE TECHNOLOGIES θαη γίλεηε fan ψζηε λα ελεκεξψλεζηε γηα φια ηα ηξέρνληα επηζηεκνληθά θαη ζπλεδξηαθά λέα ζηνλ ρψξν ηεο ΓΔΗΑΠ ΑΠΘΖΠΖΠ ΓΗΑΡΟΝΦΖΠ ΔΔΜΗΑΠ. Όζνη δελ έρεηε ινγαξηαζκφ ζην facebook κπνξείηε λα εγγξαθείηε ζην