IJCS | Volume 31, Nº3, May/ June 2018

278 Camargo et al. Manual lymphatic drainage, natriuresis and lipolysis International Journal of Cardiovascular Sciences. 2018;31(3)274-281 Original Article as compared with the nOCPu group. An increase in this parameter was observed on both study days, suggesting that MLD had no effect on this variable (Table 3). Glycerol excretion did not change in nOCPu on both study days, and on control day, values of this variable were greater at 0 for OCPu as compared with nOCPu. Although glycerol excretion increased over time in the OCPu group on control day, it was greater in the OCPu group (Table 4). ANP values in nOCPu at 60 min were higher than in OCPu. MLD increased ANP excretion in OCPu only (Table 5). Discussion One strength of the protocol proposed in this studywas a “control” day, to demonstrate that changes occurring after the MLD were actually caused by the procedure. When control day of both groups was compared, no difference in urinary excretion was found. Graugaard- Jensen et al. 12 investigated 8 healthy, young women with regular menstrual cycle in low and high estrogen phases. The author showed that hormone levels had no effect on urinary excretion. In addition, although urinary excretion did not change between the two time-points, the authors observed a tendency towards sodium retention when estrogen was high. Table 3 - Urinary sodium excretion in young women, users (OCPu) or not (nOCPu) of oral contraceptives on manual lymphatic drainage (MLD) day or control (C) day at 0, 60 and 120 minutes 0 60 120 P** 60 vs 0 P # 120 vs 0 P & 120 vs 60 nOCPu C 140(110.50-184.20) 202.90±113.40 194.70(148.50-244.20)# 0.07 0.04 0.97 MLD 185.40±100.00 200 .00(109.70-329.40 )** 203.00±93.13 0.02 0.26 0.24 OCPu C 113.30(78.05-149.50)* 198.20±87.13** 210 .00(166.90-333.90 ) #& 0.0001 0.0001 0.001 MLD 161.10±87.10 199.80(138.70-313.60)** 237.60(193.70-331.60) # 0.0001 0.0001 0.08 Between- group analysis P* C 0.02 0.86 0.10 P MLD 0.39 0.82 0.06 Within- group analysis nOCPu 0.53 0.21 0.90 OCPu 0.05 0.19 0.91 Normal distribution was tested by the Shapiro-Wilk test. Data without normal distribution were expressed as median and interquartile range (25%-75%), whereas those with normal distribution as mean ± standard error. For normally distributed data, the Mann-Whitney test was used for unpaired data (different “n”) and the Wilcoxon test for paired data (same “n”). The unpaired t-test was used for data that failed to pass the normality test. Significance level was set at 5%. Based on our protocol, nOCPu responded to MLD with increased sodium excretion and nOCPu with increased urinary excretionwhen comparedwith nOCPu, suggesting an acute effect of this technique on natriureis, and hence on urine composition. Camargo et al. 11 showed that one MLD session promoted an increase in urinary excretionwith unaltered sodium excretion or urinary osmolarity in OCP non- users. On the other hand, OCP users were not sensitive to the acute effect of the therapy. These findings suggest an underlying hormonal regulation of thesemechanisms. Increased estrogen and progesterone levels were found in OCP users, even though the exact mechanism of these hormones onwater-electrolyte balance is still unclear. 2,4,13 Stachenfeld & Taylor 4 investigated the effects of gonadotropin-releasing hormone (GnRH) administration, combined or not with 17 beta-estradiol (transdermal patches, 0.1 mg/day) in young, healthy, non-smoking women. The authors found that 17 beta-estradiol caused a reduction in urinary osmolarity by concentration of vasopressin in the plasma at baseline. Stachenfeld & Keefe 3 found that estrogen and progesterone in young, healthy women caused little change inwater and sodium regulation, suggesting that these hormones affect allostasis. These investigators reported a reduction in osmotic threshold and increase in plasma vasopressin, without changes in urinary free water, indicating that