Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Non-inferiority comparative clinical trial between early oral REFEEDING and usual oral REFEEDING in predicted mild acute biliary pancreatitis.

BACKGROUND: The aim of the study was to compare the onset of oral feeding in the first 24 h after hospital admission with usual oral refeeding and determine whether the timing of the onset of oral feeding influences the recurrence of pain or alters the blood levels of pancreatic enzymes in patients with predicted mild acute biliary pancreatitis. METHODS: This non-inferiority randomized controlled trial was carried out between September 2018 and June 2019 after receiving authorization from the ethics committee for health research. Patients with a diagnosis of predicted mild acute biliary pancreatitis were divided into Group A (early oral refeeding, EOR) and Group B (usual oral refeeding, UOR). Outcome measures included pancreatic lipase levels, the systemic inflammatory response (concentrations of leukocytes), feasibility (evaluated by abdominal pain recurrence), the presence and recurrence of gastrointestinal symptoms and the length of hospital stay. RESULTS: Two patients in the EOR group experienced pain relapse (3.2%), and four patients in the UOR group experienced pain relapse (6.77%) after oral refeeding (p = 0.379). The presence of nausea or vomiting after the onset of oral refeeding was not different between the two groups (p = 0.293). The onset of oral refeeding was approximately 48 h later in the UOR group. The length of hospital stay was 5 days in the EOR group and 8 days in the UOR group (p = 0.042), and this difference was also manifested in higher hospital costs in the UOR group (p = 0.0235). CONCLUSION: Compared with usual oral refeeding, early oral refeeding is safe in predicted mild acute biliary pancreatitis patients, does not cause adverse gastrointestinal events, and reduces the length of hospital stay and costs. TRIAL REGISTRATION: Early oral refeeding in mild acute pancreatitis (EORVsUOR). NCT04168801 , retrospectively registered (November 19, 2019).

The effects of metformin on inflammatory mediators in obese adolescents with insulin resistance: controlled randomized clinical trial.

OBJECTIVE: To compare serum concentrations of inflammatory cytokines, interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), adiponectin, and tumor necrosis factor alpha (TNFalpha), before and after 3 months treatment with metformin in obese adolescents with insulin resistance (IR). DESIGN AND SUBJECTS: This was a randomized, double-blinded, clinical trial of two groups of obese adolescents with IR, aged 9-18 years: a placebo group (n=14) and a metformin group (n=12) who received 500 mg metformin every 12 h for 3 months. Anthropometric and biochemical (metabolic and inflammatory cytokines) assessments were compared at the beginning and end of treatment. RESULTS: After 3 months of treatment, body mass index (kg/m2) was reduced in both groups: placebo group (32.82 +/- 6.37-32.10 +/- 6.52; p=0.011) and metformin group (33.44 +/- 5.82-32.71 +/- 5.77; p=0.015). Serum fasting insulin concentrations (pmol/L) increased in the placebo group (189.45 +/- 112.64-266.06 +/- 167.79; p=0.01) and showed a slight decrease in the metformin group (256.82 +/- 113.89-229.25 +/- 86.53; p=0.64). Adiponectin concentrations (microg/mL) decreased in the placebo group (13.17 +/- 7.31-5.65 +/- 6.69; p=0.02), while these remained stable in the metformin group (8.57 +/- 3.98-7.86 +/- 6.23; p=0.64). In the metformin group, significant reductions were found in the variances of serum TNFalpha concentrations (p=0.006; Levene test). CONCLUSION: These results suggest that treating obese adolescents with IR using metformin for 3 months is an option for patients without response to traditional lifestyle change because metformin improves inflammatory activity, which is an etiological factor in cardiovascular disease development.

Factors Associated with Dietary Restriction and Emotional and Uncontrolled Eating in Adults from Spanish-Speaking Countries during the COVID-19 Confinement: Results of the CoV-Eat Project.

The first COVID-19 confinement has led to changes in the population's behaviour. However, little has been analysed about the changes in eating behaviour beyond the decrease in adherence to healthy dietary patterns. The aim of the CoV-Eat project was to identify factors related to each of the following eating behaviours (EB): cognitive restraints (CR), uncontrolled eating (UE), and emotional eating (EE) in adults from Spanish-speaking countries. Participants completed an anonymous online survey. EB was assessed using the Three-Factor Eating Questionnaire and the scores were classified into tertiles. Socio-demographic characteristics and lifestyle habits including physical activity, sleep quality, screen use, smoking consumption, and relationship with food were also collected. A total of 9849 participants from 21 countries were included in this study. The median of CR, UE, and EE behaviours was 15, 24, and 9, respectively. We observed that higher age, days of confinement, number of times leaving home in the last week, changes in sleep quality, and their relationship with food were negatively associated with CR, EE, and UE, while being a man was positively associated with an increased in all these EBs. A higher household income was negatively associated with a higher score of CR, and a higher education level (>primary) was positively associated with a medium score of EE. Lower physical activity was a factor negatively associated with a medium score of EE and UE. Higher screen use showed the same negative association for a medium score of EE and UE and a high score of CR. In addition, higher tobacco consumption was found to be a protective factor against having a medium or high score of CR and EE. In conclusion, some sociodemographic characteristics and lifestyle changes may be important factors for EB and should be considered in emergency situations such as confinement to prevent risky eating behaviour.

Hepatocellular Carcinoma of Fibrolamellar Type in an Adolescent: Case Report and Literature Review.

We present a female patient, 13 years old, with diagnosis of hepatocellular carcinoma of fibrolamellar type, which was rapidly evolving. The fibrolamellar hepatocellular carcinoma invaded more than 80% of the hepatic parenchyma without surgical possibility or liver transplantation. Measures applied corresponded to chemotherapy of 1 cycle of cisplatin 40 mg/s/5 days + vincristine 1.5 mg/m2/day, 5-fluorouracil, doxorubicin, and dexrazoxane. The case presented aggressive evolution of hepatocellular carcinoma, which led to acute liver failure, with hyperammonemia, sepsis, pulmonary focus plus septic shock, grade III-IV encephalopathy, portal hypertension, and ascites with intra-abdominal hypertension. Death occurred due to multiple organ failure, which involved respiratory failure type KDIGO 1 and 2, acute liver failure, severe pneumonia, pericardial effusion, AKIN 2 acute kidney injury, carcinoma, and pulmonary metastasis. This type of ailment is infrequent in children and adolescents, and the first symptoms are crucial to achieve treatment possibilities.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

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Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Waist-to-Height Ratio Is a Better Anthropometric Index than Waist Circumference and BMI in Predicting Metabolic Syndrome among Obese Mexican Adolescents.

Objective. To identify the degree of association between anthropometric indices and components of metabolic syndrome (MS) and to determine optimal cut-off points of these indices for predicting MS in obese adolescents. Methods. A cross-sectional study with a sample of (n = 110) Mexican obese adolescents grouped by sex and the presence/absence of MS. BMI percentile, waist circumference (WC), and waist-to-height ratio (WHtR) were tested. ROC curves of the anthropometric indices were created to identify whether an index was a significant predictor of MS. Results. BMI percentile, WC, and WHtR were significantly correlated with systolic and diastolic blood pressure. As predictors of MS overall patients, the BMI percentile generated an area under curve (AUC) of 0.651 (P = 0.008), cut-off point above the 99th percentile. WC generated an AUC of 0.704 (P < 0.001), cut-off point of ≥90 cm. WHtR demonstrated an AUC of 0.652 (P = 0.008), cut-off point of 0.60. WHtR ≥0.62 and WHtR ≥0.61 generate AUC of 0.737 (P = 0.006) and AUC of 0.717 (P = 0.014) for predicting hypertension and insulin resistance, respectively, in females. Conclusion. WHtR is a better tool than WC and BMI for identifying cardiometabolic risk. The overall criterion (WHtR ≥ 0.6) could be appropriate for predicting MS in obese Mexican adolescents.

Metabolic syndrome and its components among obese (BMI >=95th) Mexican adolescents.

The aim of this study was to estimate the prevalence of metabolic syndrome (MS) and its components in obese Mexican adolescents and to compare the clinical, anthropometric, and biochemical characteristics between patients with and without MS by sex. We conducted a cross-sectional study with a sample of 110 obese adolescents (boys and girls) from 8 to 16 years old (BMI ≥95th percentile), who were recruited in the pediatric obesity clinic of a third-level care hospital. A frequency analysis was used to estimate the prevalence of MS and its components, and the assessments were compared between the sexes and between the groups with and without MS using the Kruskal-Wallis test. The prevalence of MS was 62%. IN ORDER OF PREVALENCE, THE FOLLOWING COMPONENTS OF MS WERE OBSERVED IN THE SAMPLE: abdominal obesity (88%), high triglycerides (TG) (85%), low HDL-C (60%), hypertension (35%), and hyperglycemia (5%). In the groups with MS, hypertension (P<0.001), waist circumference (P=0.003), and TG (P=0.012) were significantly higher, and HDL-C (P<0.001) was significantly lower. In conclusion the prevalence of MS and its components is high among obese Mexican-Hispanic children. These findings show the importance of preventing and treating obesity in the early stages of life in order to decrease the incidence rates of cardiovascular disease and type 2 diabetes mellitus.