Polycystic Ovary Syndrome among Obese Adolescents.

BACKGROUND AND AIMS: In adolescence and obesity, the pathophysiology of polycystic ovary syndrome (PCOS) is very difficult to distinguish. We aimed to assess the diagnosis of PCOS in the population of obese adolescent. METHODS: Cross-sectional study. SETTING: Pediatric Endocrinology Weight and Management Clinic from Children's Institute, São Paulo, Brazil. PARTICIPANTS: Forty-nine post-menarcheal obese adolescents with mean age of 14.7 years. INTERVENTIONS: Anthropometric assessment and review of medical records were done. Clinical and laboratory hyperandrogenism were quantified using Ferriman-Gallwey index and androgenic dosages, respectively. Ovarian morphology was evaluated through suprapubic ultrasonography. RESULTS: By the 2015 Witchel et al. guideline for PCOS in adolescence, 18.4% were diagnosed as having PCOS. When assessed by Rotterdam, Androgen Excess and PCOS Society, and American National Institute of Health criteria's, 26.4%, 22.4%, and 20.4% had PCOS, respectively. Irregular menstrual cycles were found in 65.3% of patients. Clinical hyperandrogenism was observed in 16.3% of girls and 18.4% had elevated serum androgen values. Suprapubic ultrasonography revealed enlarged ovaries in 18.4% of the adolescents. CONCLUSIONS: PCOS in all-comers obese adolescents from a Weight and Management Clinic in a quaternary hospital is more frequent when compared to adult women showed in the literature.

Puberty in girls with Prader-Willi syndrome: cohort evaluation and clinical recommendations in a Latin American tertiary center.

Introduction: Prader-Willi syndrome (PWS) is a genetic disorder characterized by hypothalamic-pituitary deficiencies including hypogonadism. In girls with PWS, hypogonadism can present early in childhood, leading to genital hypoplasia, delayed puberty, incomplete pubertal development, and infertility. In contrast, girls can present with premature activation of the adrenal axis leading to early pubarche and advanced bone age. We aim to evaluate the progression of puberty and adrenarche signals in girls with PWS. Methodology: A longitudinal retrospective cohort study included girls with PWS followed at a Pediatric Endocrinology Outpatient Clinic in a Tertiary University Hospital in Sao Paulo, Brazil from 2002 to 2022. Data collected via chart review included clinical information on birth history, breast and pubic hair Tanner stages, presence of genital hypoplasia, age at menarche, regularity of menstrual cycles, body mass index (BMI) z-score, final height, age of initiation of estrogen replacement and growth hormone replacement, as well as results for PWS genetic subtype; biochemical investigation (LH, FSH, estradiol, DHEA-S); radiographic bone age and pelvic ultrasound. Results: A total of 69 girls were included in the study and the mean age of puberty onset was 10.2 years in those who started puberty after the age of 8 years. Breast Tanner stage IV was reached by 29.1% girls at a mean age of 14.9 years. Spontaneous menarche was present in 13.8% and only one patient had regular menstrual cycles. Early adrenarche was seen in 40.4% of cases. Conclusion: Our study demonstrated in a large sample that girls with PWS often present with delayed onset of puberty despite frequent premature adrenarche. Based on our results, we suggest an estrogen replacement protocol for girls with PWS to be started at the chronological age or bone age of 12-13 years, taking into consideration the uterus size. Further prospective studies are needed.

Obesity as a Thrombogenic and Cardiovascular Risk Factor in Children.

BACKGROUND/AIMS: Obesity leads to increased risk of thromboembolic events in adults, but few studies have addressed the relationship between obesity and thrombogenic risk during childhood. The aim of this study was to evaluate the prothrombotic state of obese children in comparison with healthy children. METHODS: Thrombin generation, fibrinogen, and D-dimer levels, along with metabolic parameters, were measured in 72 prepubertal children, of which 47 were obese and 25 eutrophic. RESULTS: A significant increase in thrombin generation, fibrinogen, and dyslipidemia was found among obese patients. CONCLUSION: A prothrombotic state develops in childhood obesity during the prepubertal phase.

Prader-Willi syndrome: endocrine manifestations and management.

Prader-Willi syndrome (PWS) is a genetic disorder caused by the absence of gene expression in the 15q11.2-q13 paternal chromosome. Patients with PWS develop hypothalamic dysfunction that can lead to various endocrine changes such as: obesity, growth hormone deficiency, hypogonadism, hypothyroidism, adrenal insufficiency and low bone mineral density. In addition, individuals with PWS have increased risk of developing type 2 diabetes mellitus. This review summarizes and updates the current knowledge about the prevention, diagnosis and treatment of endocrine manifestations associated with Prader Willi syndrome, especially diagnosis of growth hormone deficiency, management and monitoring of adverse effects; diagnosis of central adrenal insufficiency and management in stressful situations; screening for central hypothyroidism; research and treatment of hypogonadism; prevention and treatment of disorders of glucose metabolism. Careful attention to the endocrine aspects of PWS contributes significantly to the health of these individuals. Arch Endocrinol Metab. 2020;64(3):223-34.

Growth hormone treatment in Prader-Willi syndrome patients: systematic review and meta-analysis.

BACKGROUND: Growth hormone (GH) treatment is currently recommended in Prader-Willi syndrome (PWS) patients. OBJECTIVES: To evaluate the impact (efficacy and safety) of the use of recombinant human GH (rhGH) as a treatment for PWS. METHOD: We performed a systematic review and, where possible, meta-analysis for the following outcomes: growth, body mass index, body composition, cognitive function, quality of life, head circumference, motor development/strength, behaviour and adverse effects. We included all PWS patients, with all types of genetic defects and with or without GH deficiency, who participated in rhGH studies performed in infancy, childhood and adolescence, that were either randomised controlled trials (RCTs) (double-blinded or not) or non-randomised controlled trials (NRCTs) (cohort and before and after studies). The databases used were MEDLINE, Embase and Cochrane Central. RESULTS: In 16 RCTs and 20 NRCTs selected, the treated group had an improvement in height (1.67 SD scores (SDS); 1.54 to 1.81); body mass index z-scores (-0.67 SDS; -0.87 to -0.47) and fat mass proportion (-6.5% SDS; -8.46 to -4.54) compared with the control group. Data about cognition could not be aggregated. Conclusion Based on high quality evidence, rhGH treatment favoured an improvement of stature, body composition and body mass index, modifying the disease's natural history; rhGH treatment may also be implicated in improved cognition and motor development in PWS patients at a young age. ETHICS AND DISSEMINATION: The current review was approved by the ethical committee of our institution. The results will be disseminated through conference presentations and publications in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42019140295.

BARIATRIC SURGERY AS A TREATMENT FOR IDIOPATHIC INTRACRANIAL HYPERTENSION IN A MALE ADOLESCENT: CASE REPORT.

OBJECTIVE: To describe a case of a male adolescent with symptomatic idiopathic intracranial hypertension (IIH) associated with obesity treated with bariatric surgery. CASE DESCRIPTION: A 16-year-and-6-month-old severely obese boy [weight: 133.6 kg; height: 1.74 m (Z score: +0.14); BMI: 44.1 kg/m2 (Z score: +4.4)], Tanner pubertal stage 5, presented biparietal, high-intensity, and pulsatile headaches, about five times per week, associated with nocturnal awakenings, and partial improvement with common analgesics, for three months. Ophthalmologic evaluation evidenced bilateral papilledema. Cranial computed tomography revealed no mass or anatomic abnormalities. Lumbar puncture showed increased intracranial pressure of 40 cmH2O (reference value: <28 cmH2O) with a normal content. After being diagnosed with IIH, the patient was started on acetazolamide. However, after three months, he was still symptomatic. He was diagnosed with obesity due to excess energy intake and, as he had failed to lose weight after a conventional clinical treatment, bariatric surgery was indicated. The patient (at 16 years and nine months) underwent an uncomplicated laparoscopic sleeve gastrectomy. Ophthalmologic evaluation, performed five months after surgery, revealed normal visual acuity in both eyes and improvement of bilateral papilledema. Follow-up at 18 months showed a 67.5% loss of excess weight (weight: 94.5 kg and BMI: 31.2 kg/m2) and complete resolution of IIH symptoms. COMMENTS: IIH is characterized by increased intracranial pressure with no evidence of deformity or obstruction of the ventricular system on neuroimaging. It has been associated with obesity. Bariatric surgery may be a valid alternative approach for morbidly obese adolescent patients with refractory symptoms.

Obesity Prevention: Strategies and Challenges in Latin America.

PURPOSE OF REVIEW: The purpose of this study is to present changes of policies and norms aimed to reduce obesity levels that have been adopted in some Latin American countries. RECENT FINDINGS: The global increase of the excess weight within the population has been demanding governmental actions aimed at preventing health impacts generated by obesity. Over recent years, many Latin American countries have established a number of regulations aimed at reducing weight in the population using interventions that could effectively prevent childhood obesity, including the taxation of sugar-sweetened beverages (SSBs), increasing physical activity in open spaces, and, especially, front-of-package labeling. Some strategies are part of the Action Plan for Prevention of Child and Adolescence Obesity signed by all countries in Latin America, which currently have among the highest prevalence of childhood obesity in the world. Among them are the implementation of fiscal policies on energy-dense and nutrient-poor foods and taxes on SSBs; improvements in nutrition labeling, highlighting the front-of-package (FOP) labeling to promote the choice of healthier products at the time of purchase; and promotion of an active lifestyle, such as encouraging the use of bicycle paths or physical activity programs at school. The real impact of these prevention strategies implemented in Latin America on the prevalence of obesity is still unknown.

Programa de Qualidade na Interação Familiar (PQIF) para manejo de comportamentos na síndrome Prader-Willi / Family interaction quality program (PQIF) for behavioral management in prader-willi syndrome / Programa de interacción familiar de calidad (PQIF) para manejo de comportamiento en el síndrome prader-willi

Pais e cuidadores de crianças com a síndrome Prader-Willi (SPW) enfrentam desafios no manejo dos comportamentos característicos do fenótipo comportamental dessa condição, que demandam habilidades parentais que nem sempre fazem parte do seu repertório, o que torna necessário um treino específico. O objetivo do presente estudo foi aplicar e avaliar o Programa de Qualidade na Interação Familiar (PQIF) para pais de crianças com SPW. Sete participantes associados ao ambulatório de SPW do Hospital das Clínicas de São Paulo (ICr-HCFMUSP) participaram do estudo, e medidas foram aplicadas nas fases pré, pós e follow-up. O escore de estilo parental demonstrou aumento no uso de práticas parentais positivas para seis dos sete participantes. Os participantes também apresentaram melhora na auto-observação, ampliação no repertório de análise de comportamentos e de manejo adequado. Limites deste estudo são discutidos, contudo, os dados reforçam a importância de se validar ferramentas que atendam essa população

Parents and relatives of children with Prader-Willi Syndrome (PWS) face challenges in managing behaviors characteristic of the behavioral pheno-type of this condition, which require specific parental skills, that are not always part of their repertoire, and therefore training. The aim of the present study was to apply and evaluate the Family Interaction Quality Program (PQIF) for parents of children with PWS. Seven participants associated to the PWS outpatient clinic of the ICr-HCFMUSP took apart in the study, and measures were applied in the pre, post and follow-up phases. The parenting style score demonstrated an increased use of positive parenting practices for six of the seven participants. Participants also showed improvements in self-observation, expansions in the repertoire of analysis of behaviors and appropriate handling. Limits of this study are discussed; however, the data reinforce the importance of validating tools that attend this population

Los padres y cuidadores de niños con Síndrome de Prader-Willi (SPW) enfrentan desafíos en el manejo de conductas difíciles, propias del fenotipo conductual de esta condición, que demandan habilidades parentales y capacitación específicas. El objetivo del presente estudio fue aplicar y evaluar el Programa de Calidad de Interacción Familiar (PQIF) para madres, padres y relatives de niños con SPW. En el estudio formaron parte siete participantes asociados a la clínica ambulatoria ICW-HCFMUSP SPW y se aplicaron instrumentos en las fases previa, posterior a la prueba y en la fase de seguimiento. El puntaje del estilo parental demostró un aumento en el uso de prácticas parentales positivas para seis de los siete participantes. Los participantes también mostraron una mejora en la autoobservación, una expansión en el análisis de la conducta y un repertorio de manejo apropiado. Se discuten los límites de este estudio, sin embargo, los datos refuerzan la importancia de validar las herramientas para esta población

PRADER-WILLI SYNDROME: WHAT IS THE GENERAL PEDIATRICIAN SUPPOSED TO DO? - A REVIEW. / SÍNDROME DE PRADER WILLI: O QUE O PEDIATRA GERAL DEVE FAZER - UMA REVISÃO.

OBJECTIVE: To carry out a review about Prader-Willi Syndrome based on the most recent data about the subject and to give recommendation for the general pediatricians for early diagnoses and follow-up. DATA SOURCES: Scientific articles in the PubMed and SciELO databases. The research was not limited to a specific time period and included all articles in such databases. DATA SYNTHESIS: The Prader-Willi Syndrome (PWS) is a rare genetic disorder resulting from the loss of imprinted gene expression within the paternal chromosome 15q11-q13. PWS is characterized by endocrine abnormalities, such as growth hormone (GH) deficiency, obesity, central adrenal insufficiency, hypothyroidism, hypogonadism and complex behavioral and intellectual difficulties. PWS individuals also may present other comorbidities, such as sleep disorders, scoliosis, constipation, dental issues and coagulation disorders. The follow-up protocol of the Children's Institute at Universidade de São Paulo is based on four main pillars: diet, exercise, recombinant human growth hormone (rhGH) therapy and behavioral and cognitive issues. The diet must include a caloric restriction of 900 kcal/day, according to the Prader-Willi Eating Pyramid and exercise plan is focused on daily aerobic exercises and postural therapy. The rhGH therapy is highly recommended by the international scientific literature and must be started as soon as the diagnostic is made. The management of behavioral issues is based on strategies to establish routine and rules. CONCLUSIONS: If the general pediatrician becomes more familiar with PWS, the diagnosis and treatment will start earlier, which is essential to improve the quality of life and care for these individuals.

OBJETIVO: Realizar uma revisão sobre a Síndrome de Prader-Willi (SPW) com base nas publicações mais recentes e fornecer recomendações ao pediatra geral para diagnóstico precoce e seguimento. FONTE DE DADOS: Artigos publicados nas bases Pubmed e SciELO. A pesquisa não foi limitada a um período e incluiu todos os artigos das bases de dados. SÍNTESE DOS DADOS: A SPW é uma síndrome genética rara, resultante da perda do imprinting gênico expresso no cromossomo paterno 15q11-q13, sendo caracterizada por alterações endocrinológicas, como deficiência de hormônio de crescimento, obesidade, insuficiência adrenal central, hipotireoidismo, hipogonadismo, além de alterações comportamentais e déficit intelectual. Há outras comorbidades associadas, como distúrbios de sono, escoliose, constipação, problemas dentários e alterações de coagulação. O protocolo de seguimento da SPW do Instituto da Criança da Universidade de São Paulo se baseia em quarto pilares principais: dieta, exercício físico, terapia com hormônio de crescimento humano recombinante (rhGH) e manejo comportamental e cognitivo. A dieta deve ser restrita a 900 kcal/dia, de acordo com a Pirâmide Alimentar do Prader-Willi, e o exercício físico deve ser diário, aeróbico e postural. A terapia com rhGH é fortemente recomendada pela literatura científica internacional e deve ser iniciada assim que for realizado o diagnóstico da síndrome. O manejo do comportamento é realizado com estratégias para estabelecer rotina e regras. CONCLUSÕES: Se a SPW se tornar mais familiar ao pediatra geral, o diagnóstico e o tratamento começarão mais precocemente, o que irá melhorar a qualidade de vida e os cuidados desses pacientes.

Laparoscopic sleeve gastrectomy in severely obese adolescents: effects on metabolic profile.

OBJECTIVE: The objective was to conduct clinical and metabolic evaluations of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG) (up to 24 months). SUBJECTS AND METHODS: This was designed as a retrospective, descriptive series of cases study, conducted in Instituto da Criança, São Paulo, Brazil. Analysis of clinical and laboratory data from 22 obese adolescents between 14 and 19 years old submitted to LSG between 2007 and 2014. Patients had BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Anthropometric, clinical and laboratory assessments were performed: before surgery, 6, 12, 18, and 24 months after surgery. We assessed weight loss and metabolic changes up to 24 months after LSG. RESULTS: The mean preoperative weight and BMI were 128.5 kg (SD = 23.1) and 46.5 kg/m2 (SD = 74), respectively. There was an average weight loss of 34.5 kg in the first 12 months' post LSG, corresponding to a 60% excess weight loss (EWL), as well as an average reduction in BMI of 12.3 kg/m2. However, after 24 months, the average EWL was 45%, corresponding to an average weight regain (WR) of 13.3 kg (15%) within two years. LSG improved dyslipidemia in 67.8% of patients, a significant remission of hepatic steatosis 47% and 37.7% systemic arterial hypertension; type 2 diabetes remission was complete. CONCLUSIONS: LSG proved to be a safe and effective procedure and seems to be the new hope for the obesity epidemic.

Bariatric surgery as a treatment for idiopathic intracranial hypertension in a male adolescent: case report / Cirurgia bariátrica como tratamento de pseudotumor cerebral primário em adolescente do sexo masculino: relato de caso

ABSTRACT Objective: To describe a case of a male adolescent with symptomatic idiopathic intracranial hypertension (IIH) associated with obesity treated with bariatric surgery. Case description: A 16-year-and-6-month-old severely obese boy [weight: 133.6 kg; height: 1.74 m (Z score: +0.14); BMI: 44.1 kg/m2 (Z score: +4.4)], Tanner pubertal stage 5, presented biparietal, high-intensity, and pulsatile headaches, about five times per week, associated with nocturnal awakenings, and partial improvement with common analgesics, for three months. Ophthalmologic evaluation evidenced bilateral papilledema. Cranial computed tomography revealed no mass or anatomic abnormalities. Lumbar puncture showed increased intracranial pressure of 40 cmH2O (reference value: <28 cmH2O) with a normal content. After being diagnosed with IIH, the patient was started on acetazolamide. However, after three months, he was still symptomatic. He was diagnosed with obesity due to excess energy intake and, as he had failed to lose weight after a conventional clinical treatment, bariatric surgery was indicated. The patient (at 16 years and nine months) underwent an uncomplicated laparoscopic sleeve gastrectomy. Ophthalmologic evaluation, performed five months after surgery, revealed normal visual acuity in both eyes and improvement of bilateral papilledema. Follow-up at 18 months showed a 67.5% loss of excess weight (weight: 94.5 kg and BMI: 31.2 kg/m2) and complete resolution of IIH symptoms. Comments: IIH is characterized by increased intracranial pressure with no evidence of deformity or obstruction of the ventricular system on neuroimaging. It has been associated with obesity. Bariatric surgery may be a valid alternative approach for morbidly obese adolescent patients with refractory symptoms.

RESUMO Objetivo: Descrever um caso de cirurgia bariátrica como tratamento de pseudotumor cerebral primário (PTCP) em adolescente do sexo masculino com obesidade. Descrição do caso: Adolescente, sexo masculino, 16 anos e 6 meses, com obesidade exógena [peso:133,6 kg; estatura:1,74 m (escore z: +0,14); IMC: 44,1 kg/m2 (escore z: +4,4)], estadiamento puberal de Tanner 5, apresentando cefaleia bi-parietal, pulsátil e de alta-intensidade, cerca de cinco vezes por semana, associada a despertares noturnos, e com melhora parcial com analgésicos comuns, há três meses. A avaliação oftalmológica evidenciou papiledema bilateral e a tomografia computadorizada de crânio não revelou massas ou alterações anatômicas. A punção lombar mostrou pressão intracraniana elevada de 40 cmH2O (Referência: <28 cmH2O) com conteúdo normal. Feito o diagnóstico, o paciente foi iniciou uso de acetazolamida. No entanto, após 3 meses, o paciente mantinha-se sintomático. Ele foi diagnosticado com obesidade devido ao consumo calórico excessivo e, como não havia obtido sucesso na perda de peso com tratamento clínico convencional, a cirurgia bariátrica foi indicada. Aos 16 anos e 9 meses, o paciente foi submetido a gastrectomia vertical laparoscópica sem complicações. A avaliação oftalmológica, cinco meses após a cirurgia, revelou melhora do papiledema bilateral com acuidade visual normal em ambos os olhos. Apresentou perda de excesso de peso de 67,5% (peso: 94,5 kg e IMC:31,2 kg/m2) e resolução completa dos sintomas de PPTC 18 meses após a cirurgia. Comentários: O PTCP é caracterizado pelo aumento da pressão intracraniana, sem evidência de deformidade ou obstrução do sistema ventricular na neuroimagem. Está associado à obesidade. A cirurgia bariátrica pode ser uma alternativa terapêutica válida para pacientes adolescentes obesos graves com sintomas refratários.

[The effect of sibutramine on weight loss in obese adolescents]. / O efeito da sibutramina na perda de peso de adolescentes obesos.

OBJECTIVE: To evaluate the effect of sibutramine on weight loss in obese adolescents. SUBJECTS AND METHODS: A double-blind controlled study lasting 13 months. The study included 73 obese adolescents of both sexes aged between 10 and 18 years. Laboratory tests and imaging studies were performed before, during wash-out, and at the end of 13 months. RESULTS: The percentage of patients who lost 10% of their initial weight in the placebo group was 46%, and in the sibutramine group was 75%. When placebo was used, average weight rose by 1.61 kg, and BMI decreased by 0.24 kg/m(2) whereas with the use of sibutramine, weight decreased by 4.47 kg, and average BMI decreased, 2.38 kg/m(2), with p < 0.001. CONCLUSIONS: Sibutramine induced significantly more weight loss in obese adolescents compared with placebo, without significant side effects. The weight loss curve was different depending on the moment sibutramine was introduced. This finding indicates that the best time to start sibutramine is when adhesion begins to fail.

Diâmetro abdominal sagital de adolescentes obesos e sua associação com os critérios da síndrome metabólica / Sagittal abdominal diameter of obese adolescents and its association with the criteria of metabolic syndrome

INTRODUÇÃO: O diâmetro abdominal sagital (DAS) é uma medida antropométrica relacionada com a gordura visceral e utilizada para avaliar a obesidade abdominal, uma variável associada à síndrome metabólica (SM). Sua utilização é indicada na prática clínica para avaliação de risco cardiometabólico em adolescentes obesos. Este estudo consiste em verificar a correlação entre o DAS e a circunferência abdominal (CA) na avaliação da obesidade central e sua associação com os critérios da SM e Home-ostatic Model Assessment Insulin Resistance (HOMA-IR) em adolescentes obesos. MÉTODO: Estudo de corte transversal constituído por adolescentes obesos matriculados nos ambulatórios das Unidades de Endocrinologia Pediátrica e de Adolescentes do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. As variáveis antropométricas avaliadas foram: índice de massa corporal (IMC), Escore Z do IMC, %GC, CA, DAS. As variáveis laboratoriais e clínicas foram: HDL-c, triglicérides, glicemia e insulina para o cálculo do HOMA-IR e pressão arterial sistólica e diastólica. RESULTADOS: De acordo com os critérios utilizados pelo IDF, 27,7% dos 83 adolescentes, com idade entre 14 e 18 anos apresentaram SM e o DAS demonstrou estar significantemente associado com as variáveis pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e HOMA-IR nos grupos geral, feminino e masculino. A concordância entre a CA e o DAS é significante nos grupos geral (Kappa 0,511; p<0,001), feminino e masculino com SM (Kappa 1,00; p<0,001) e o DAS oferece vantagem metodológica na sua mensuração. Conclusão: Nas condições deste estudo, conclui-se que as medidas antropométricas CA e DAS se equivalem para o grupo avaliado na classificação da SM. O DAS é preditor de PAS, PAD e de HOMA-IR e é forte indicador de risco cardiometabólico em adolescentes obesos

Futsal improve body composition and cardiorespiratory fitness in overweight and obese children. A pilot study

The aim of this study was to verify body composition, cardiorespiratory fitness, and biochemical markers of prepubertal overweight and obese boys to a 16-week futsal training program. Methods: Sixteen boys (age: 7-10 y, body mass index>thanat 95th percentileaccording to Center for Disease Control and Prevention; 35.5±7.4 percent fat) participated to futsal training program. The assessment of body composition was estimated using skinfold thickness, and the following variables were evaluated: total body mass, body mass index, body fat percentage, and lean body mass. Aerobic fitness measurementwas performed by gas exchange analysis in treadmill. In addition, an evaluation of the biochemical profile was conducted: triglycerides, total cholesterol, low density lipoprotein cholesterol, high-density lipoprotein cholesterol, plasma concentrations of glucose, and insulin. The futsal intervention included 60-min sessions performed two times/week. The mean intensity during training was between 57 to 88% of maximal heart rate of the age-predicted. Individual portable heart rate monitor controlled training intensity. Results: Significant increases in total body mass (4%), height (3%), lean body mass (8%), and significant 6%-decrease in body fat percentage was observed. Body mass index remained unchanged. Maximal oxygen uptake was elevated (p<0.018) by 11%. Biochemical markers were not modified after intervention. No association was found between body composition and metabolic variables. The effect size of futsal training on most variables was small (<0.5). Conclusion: Controlled intensity and adherence to this 16-week futsal training program were determinant to enhance body composition, and cardiorespiratory fitness in this group of prepubertal boys.(AU)

Síndrome de prader willi: o que o pediatra geral deve fazer - uma revisão / Prader-willi syndrome: what is the general pediatrician supposed to do? - a review

RESUMO Objetivo: Realizar uma revisão sobre a Síndrome de Prader-Willi (SPW) com base nas publicações mais recentes e fornecer recomendações ao pediatra geral para diagnóstico precoce e seguimento. Fonte de dados: Artigos publicados nas bases Pubmed e SciELO. A pesquisa não foi limitada a um período e incluiu todos os artigos das bases de dados. Síntese dos dados: A SPW é uma síndrome genética rara, resultante da perda do imprinting gênico expresso no cromossomo paterno 15q11-q13, sendo caracterizada por alterações endocrinológicas, como deficiência de hormônio de crescimento, obesidade, insuficiência adrenal central, hipotireoidismo, hipogonadismo, além de alterações comportamentais e déficit intelectual. Há outras comorbidades associadas, como distúrbios de sono, escoliose, constipação, problemas dentários e alterações de coagulação. O protocolo de seguimento da SPW do Instituto da Criança da Universidade de São Paulo se baseia em quarto pilares principais: dieta, exercício físico, terapia com hormônio de crescimento humano recombinante (rhGH) e manejo comportamental e cognitivo. A dieta deve ser restrita a 900 kcal/dia, de acordo com a Pirâmide Alimentar do Prader-Willi, e o exercício físico deve ser diário, aeróbico e postural. A terapia com rhGH é fortemente recomendada pela literatura científica internacional e deve ser iniciada assim que for realizado o diagnóstico da síndrome. O manejo do comportamento é realizado com estratégias para estabelecer rotina e regras. Conclusões: Se a SPW se tornar mais familiar ao pediatra geral, o diagnóstico e o tratamento começarão mais precocemente, o que irá melhorar a qualidade de vida e os cuidados desses pacientes.

ABSTRACT Objective: To carry out a review about Prader-Willi Syndrome based on the most recent data about the subject and to give recommendation for the general pediatricians for early diagnoses and follow-up. Data sources: Scientific articles in the PubMed and SciELO databases. The research was not limited to a specific time period and included all articles in such databases. Data synthesis: The Prader-Willi Syndrome (PWS) is a rare genetic disorder resulting from the loss of imprinted gene expression within the paternal chromosome 15q11-q13. PWS is characterized by endocrine abnormalities, such as growth hormone (GH) deficiency, obesity, central adrenal insufficiency, hypothyroidism, hypogonadism and complex behavioral and intellectual difficulties. PWS individuals also may present other comorbidities, such as sleep disorders, scoliosis, constipation, dental issues and coagulation disorders. The follow-up protocol of the Children's Institute at Universidade de São Paulo is based on four main pillars: diet, exercise, recombinant human growth hormone (rhGH) therapy and behavioral and cognitive issues. The diet must include a caloric restriction of 900 kcal/day, according to the Prader-Willi Eating Pyramid and exercise plan is focused on daily aerobic exercises and postural therapy. The rhGH therapy is highly recommended by the international scientific literature and must be started as soon as the diagnostic is made. The management of behavioral issues is based on strategies to establish routine and rules. Conclusions: If the general pediatrician becomes more familiar with PWS, the diagnosis and treatment will start earlier, which is essential to improve the quality of life and care for these individuals.

Laparoscopic sleeve gastrectomy in severely obese adolescents: effects on metabolic profile

ABSTRACT Objective: The objective was to conduct clinical and metabolic evaluations of obese adolescents before and after laparoscopic sleeve gastrectomy (LSG) (up to 24 months). Subjects and methods: This was designed as a retrospective, descriptive series of cases study, conducted in Instituto da Criança, São Paulo, Brazil. Analysis of clinical and laboratory data from 22 obese adolescents between 14 and 19 years old submitted to LSG between 2007 and 2014. Patients had BMI > 40 kg/m2 or BMI > 35 kg/m2 with comorbidities. Anthropometric, clinical and laboratory assessments were performed: before surgery, 6, 12, 18, and 24 months after surgery. We assessed weight loss and metabolic changes up to 24 months after LSG. Results: The mean preoperative weight and BMI were 128.5 kg (SD = 23.1) and 46.5 kg/m2 (SD = 74), respectively. There was an average weight loss of 34.5 kg in the first 12 months' post LSG, corresponding to a 60% excess weight loss (EWL), as well as an average reduction in BMI of 12.3 kg/m2. However, after 24 months, the average EWL was 45%, corresponding to an average weight regain (WR) of 13.3 kg (15%) within two years. LSG improved dyslipidemia in 67.8% of patients, a significant remission of hepatic steatosis 47% and 37.7% systemic arterial hypertension; type 2 diabetes remission was complete. Conclusions: LSG proved to be a safe and effective procedure and seems to be the new hope for the obesity epidemic.

O efeito da sibutramina na perda de peso de adolescentes obesos / The effect of sibutramine on weight loss in obese adolescents

Objetivo : Avaliar o efeito da sibutramina na perda de peso de adolescentes obesos.Sujeitos e métodos : Estudo duplo-cego placebo controlado tipo cross over com duração de 13 meses. Foram incluídos no estudo 73 adolescentes obesos de ambos os sexos com idades entre 10 e 18 anos. A avaliação antropométrica foi realizada a cada 40 dias em média. Os exames laboratoriais e de imagem foram realizados antes, no período de wash-out e ao final dos 13 meses.Resultados : A porcentagem de pacientes que perderam 10% do peso inicial no placebo foi de 46% e, no grupo sibutramina, foi de 75%. Quando usaram o placebo, o peso em média se elevou em 1,61 kg, e o IMC reduziu em média 0,24 kg/m2, enquanto com o uso da sibutramina o peso reduziu em média 4,47 kg e o IMC reduziu em média 2,38 kg/m2 com p < 0,001.Conclusões : A sibutramina induziu significantemente mais perda de peso em adolescentes obesos em comparação ao placebo, sem efeitos colaterais significativos. A curva de evolução ponderal foi diferente de acordo com o momento em que a sibutramina foi introduzida. Esse achado indica que o melhor momento de introdução da sibutramina é quando a adesão começa a falhar. Arq Bras Endocrinol Metab. 2014;58(3):243-50.

Objective : To evaluate the effect of sibutramine on weight loss in obese adolescents.Subjetcs and methods A double-blind controlled study lasting 13 months. The study included 73 obese adolescents of both sexes aged between 10 and 18 years. Laboratory tests and imaging studies were performed before, during wash-out, and at the end of 13 months.Results : The percentage of patients who lost 10% of their initial weight in the placebo group was 46%, and in the sibutramine group was 75%. When placebo was used, average weight rose by 1.61 kg, and BMI decreased by 0.24 kg/m2 whereas with the use of sibutramine, weight decreased by 4.47 kg, and average BMI decreased, 2.38 kg/m2, with p < 0.001.Conclusions : Sibutramine induced significantly more weight loss in obese adolescents compared with placebo, without significant side effects. The weight loss curve was different depending on the moment sibutramine was introduced. This finding indicates that the best time to start sibutramine is when adhesion begins to fail. Arq Bras Endocrinol Metab. 2014;58(3):243-50.

Síndrome metabólica em adolescentes com sobrepeso e obesidade / Metabolic syndrome in obese and overweight adolescents

OBJETIVO: Estudar a prevalência da síndrome metabólica em adolescentes acompanhados em ambulatório de obesidade. MÉTODOS: Foram avaliados 84 adolescentes com idades entre dez e 19 anos, divididos em dois grupos, de acordo com o escore Z do índice de massa corpórea (Z IMC), sendo um o grupo de adolescentes com sobrepeso (GSP) e o outro, o grupo de adolescentes obesos (GOB). GSP: Z IMC>1 e <2 (1,6±0,2, 13M/13F), e GOB: Z IMC>2 (2,4±0,6, 32M/26F). Três ou mais dos critérios a seguir foram considerados no diagnóstico da síndrome metabólica e avaliados pelo teste do qui-quadrado entre os grupos: Z IMC>2; triglicérides em jejum >130mg/dL; lipoproteína de alta densidade <35mg/dL; glicemia em jejum >100mg/dL ou homeostatic model assessment index (HOMA) >2,5; elevação da pressão arterial acima do percentil 90 ajustada para gênero, estatura e idade. RESULTADOS: A prevalência da síndrome metabólica esteve significantimente elevada nos adolescentes obesos (GOB: 40 por cento versus GSP: 4 por cento, p=0,0008). O grupo GOB mostrou maiores valores referentes a insulinismo (54 por cento versus 19 por cento, p=0,003), HOMA (66 por cento versus 38 por cento, p=0,01) e trigliceridemia (21 por cento versus 4 por cento; p=0,04). CONCLUSÕES: É importante que o pediatra fique atento aos sinais de síndrome metabólica em adolescentes obesos. A detecção precoce pode ser feita por meio de simples parâmetros e permite a adoção de medidas preventivas para o desenvolvimento da doença cardiovascular em adolescentes.

OBJECTIVE: Evaluate the prevalence of metabolic syndrome in adolescents followed in an outpatient obesity clinic. METHODS: 84 adolescents (ten to 19 years old) were divided in two groups, one composed by overweight adolescents (OWG) and the other, by obese adolescents (OBG), according to Z scores of the body mass index (Z BMI). OWG: Z BMI>1 and <2 (1.6±0.2; 13M/13F) and OBG: Z BMI>2 (2.4±0.6; 32M/26F). Three or more criteria were considered to define the presence of metabolic syndrome and tested by chi-square: Z BMI>2; fasting triglycerides >130mg/dL; high-density lipoprotein cholesterol <35mg/dL; fasting glucose >100mg/dL or homeostatic model assessment index (HOMA) >2.5 and blood pressure above the 90th percentile, adjusted for age, gender and length. RESULTS: The prevalence of metabolic syndrome was significantly elevated in obese adolescents (OBG: 40 percent versus OWG: 4 percent, p=0.0008). The major differences between groups were observed regarding the presence in OBG adolescents of hyperinsulinism (54 percent versus 19 percent, p=0.003), HOMA (66 percent versus 38 percent, p=0.01) and hypertriglyceridemia (21 percent versus 4 percent, p=0.04). CONCLUSIONS: It is important to be aware of the early signs of metabolic syndrome in obese adolescents, which can be screened by simple techniques. As the syndrome correlates to chronic illnesses, early detection and adequate prevention by pediatricians is mandatory.