Reliability of the Brazilian version of the questionnaire on eating and weight patterns-5 (QEWP-5).

PURPOSE: The Questionnaire on Eating and Weight Patterns-5 (QEWP-5) is a self-report instrument developed to screen individuals for binge eating disorder (BED) and bulimia nervosa (BN) as diagnosed by the DSM-5. This instrument was cross-culturally adapted for the Brazilian Portuguese and well understood by the target sample. The present study aimed to assess the test-retest reliability of the Brazilian version of QEWP-5 in a sample of undergraduate students from Dietitian and Psychology courses. METHODS: The Brazilian version of QEWP-5 was administered to a sample of 345 male and female undergraduate students, from dietitian (n = 179) and psychology (n = 166) courses. The instrument was applied twice with a time interval of 2 weeks between the applications. The kappa coefficient was used to assess the temporal stability of the questionnaire in the screening of BED and BN. RESULTS: Overall, the kappa coefficient for the screening of BED was .48, and for the screening of BN was .71. In the dietitian course, the temporal stability was .60 (for the assessment of BED) and .80 (for BN). In the psychology course, the kappa values for the assessment of BED and BN were .27 and .60, respectively. All values were statistically significant (p < .001). CONCLUSION: In general, the stability of the Brazilian version of QEWP-5 was considered moderate to assess BED and substantial for the screening of BN in undergraduate students. Stratifying by course, the questionnaire had higher stability for the assessment of BED and BN in dietitian students. LEVEL OF EVIDENCE: Level V, descriptive study.

Influence of attention-deficit/hyperactivity disorder on binge eating behaviors and psychiatric comorbidity profile of obese women.

OBJECTIVE: Previous studies have reported higher prevalence rates of attention-deficit/hyperactivity disorder (ADHD) both in eating disorders (ED) and in obese patients. We compared the psychiatric comorbidity profile of obese ADHD women with non-ADHD obese women and how ADHD symptoms impact in binge eating behaviors. DESIGN: Cross-sectional study of a clinical sample. SUBJECTS: 171 adult women were evaluated at a specialized clinic in obesity and ED. MEASUREMENTS: Participants complete a semi-structured interview and psychopathology rating scales. A hierarchical regression model was employed to predict binge eating behavior. RESULTS: Obese ADHD patients had a larger number of psychiatric comorbidities (p<0.001), especially Substance Abuse Disorders, and higher scores on psychopathology rating scales (p<0.05). The highest prediction for binge eating in the regression model was the presence of depressive symptoms, followed by ADHD inattention symptoms and trait-impulsivity. CONCLUSION: ADHD should be routinely evaluated in obese since it is related with more severe psychopathology. Depressive symptoms can predict the presence of binge eating in obese patients.

Concurrent validity of the Brazilian Portuguese version of the Questionnaire on Eating and Weight Patterns-5 (QEWP-5) in the general population.

The Questionnaire on Eating and Weight Patterns-5 is a self-report instrument developed for the screening of Binge Eating Disorder (BED) and Bulimia Nervosa (BN) according to DSM-5. The present study aimed to examine the concurrent validity of the Brazilian version of QEWP-5 to assess BED and BN in the general population. The Brazilian version of QEWP-5 was administered to 2297 subjects, aged from 18 to 60 years. All screen-positive and a subset of screen-negative participants were also interviewed by telephone using the eating disorders (ED) module of Structured Clinical Interview for DSM-IV - Patients Version (SCID-I-P) for the assessment of BED, BN, and their subthreshold forms. For the assessment of BED, the sensitivity of QEWP-5 was 0.41 and its specificity was 0.90. The positive and negative predictive values were 0.48 and 0.87, respectively. Regarding the assessment of BN, QEWP-5 showed a sensitivity of 0.56, a specificity of 0.90, a positive predictive value of 0.35, and a negative predictive value of 0.95. For the global screening of ED (BED, BN, and subthreshold forms), QEWP-5 showed a sensitivity of 0.71, a specificity of 0.83, a positive predictive value of 0.64 and a negative predictive value of 0.87. QEWP-5 can be a useful instrument for the initial screening of diagnostic threshold ED psychopathology in general population samples. However, it has less utility in identifying cases of BED and BN independently.

Assessment of executive functions in obese individuals with binge eating disorder.

OBJECTIVE: The aim of this study was to assess executive functions of obese individuals with binge eating disorder. METHOD: Thirty-eight obese individuals with binge eating disorder were compared to thirty-eight obese controls without binge eating disorder in terms of their executive functions. All individuals were assessed using the following instruments: Digit Span, Trail Making Tests A and B, Stroop Test and the Wisconsin Card Sorting Test. In addition, four subtests from the Behavioral Assessment of the Dysexecutive Syndrome Battery were also used, namely the Zoo Map Test, the Modified Six Elements Test, the Action Program Test and the Rule Shift Cards Test. RESULTS: When compared to obese controls, obese individuals with binge eating disorder presented significant impairment in the following tests: Digit Span backward, Zoo Map Test, Modified Six Elements Test, and Action Program Test. Subjects with binge eating disorder also showed significant more set shifting and perseverative errors in the Wisconsin Card Sorting Test. In other measures such as the Digit Span Forward, the Trail Making Test, the Stroop Test and the Rule Shift Cards Test, obese subjects with binge eating disorder did not differ significantly from obese subjects without binge eating disorder. CONCLUSION: These results suggest that, in the present sample, obese individuals with binge eating disorder presented executive deficits, especially impairments relating to problem-solving, cognitive flexibility and working memory.

Cross-cultural adaptation of the Brazilian version of the Questionnaire on Eating and Weight Patterns-5 (QEWP-5).

INTRODUCTION: The Questionnaire on Eating and Weight Patterns-5 (QEWP-5) is a self-report instrument developed to screen individuals for binge eating disorder (BED), as defined by the DSM-5. However, this version of the instrument had not been adapted for the Brazilian population. OBJECTIVE: To describe translation and cross-cultural adaptation of the QEWP-5 into Brazilian Portuguese. METHODS: Translation and cross-cultural adaptation of the QEWP-5 included the following steps: forward translation, comparison of translations and a synthesis version, blind back-translations, comparison of the back translations with the original version, and a comprehensibility test. The comprehensibility test was conducted with a sample of 10 participants with BED or bulimia nervosa and 10 eating disorders experts. Additionally, a Content Validity Index (CVI-I) was calculated for each item and then averaged to produce an index for the entire scale (CVI-Ave), to assess content equivalence. RESULTS: Some inconsistencies emerged during the process of translation and adaptation. However, the expert committee solved them by consensus. The participants of the comprehensibility test understood the Brazilian version of QEWP-5 well. Only 2 patients (20%) had doubts about items related to subjective binge eating episodes. Content equivalence analysis rated all items relevant, with CVI-I ranging from 0.8 to 1.0 and an overall CVI-Ave of 0.94. In view of the good overall assessment of the pre-final version of the instrument, additional changes were not made to the final version. CONCLUSION: The Brazilian version of the QEWP-5 was cross-culturally adapted and was well understood by the target population. Further studies are required to assess its psychometric properties.

Prevalence of binge eating and associated factors in a Brazilian probability sample of midlife women.

OBJECTIVE: To estimate the prevalence of binge eating (BE) and inappropriate behaviors of weight control in a population sample of Brazilian midlife adult women and to correlate the prevalence of BE with self-rated health (SRH). METHOD: A household sample of 1,298 females aged 35 years or older answered a face-to-face interview including questions on eating behaviors and had their weight and height measured. RESULTS: The prevalence of regular BE (twice or more episodes by week) and inappropriate methods of weight control was 11.5 and 10.2%, respectively. BE episodes were positively correlated with BMI and negatively correlated with age and SRH. These correlations persisted when mutually adjusted by BMI, age, and SRH. CONCLUSION: These findings show the relevance of BE on the overall health of women of this age group and emphasize the need for expanding research on eating disorders to beyond the populations more frequently assessed of teenagers and young adults.

ADHD Rate in Obese Women With Binge Eating and Bulimic Behaviors From a Weight-Loss Clinic.

OBJECTIVE: Few studies have demonstrated a possible association between ADHD and obesity in adults. The aim of this study was to investigate the prevalence of ADHD in a sample of obese women seeking treatment, and its relations with binge eating and bulimic behaviors. METHOD: We performed a cross-sectional study in a clinical sample of one hundred fifty-five women, with a mean age of 38.9 (+10.7) years and a mean body mass index (BMI) of 39.2 (+5.29). Participants were evaluated with semistructured interviews and completed self-report psychiatric rating scales. RESULTS: The rate of ADHD in the sample was of 28.3%. The presence of ADHD was significantly correlated with more severe binge eating, bulimic behaviors, and depressive symptomatology. CONCLUSION: Similar to previous studies, a higher than expected rate of ADHD was observed among obese women. ADHD in obese individuals may be a risk factor for greater severity of disordered eating patterns.

Comportamento reprodutivo em mulheres ribeirinhas: inquérito de saúde em uma comunidade isolada do Médio Solimões, Amazonas, Brasil / Reproductive behavior in riverside women: health survey in an isolated community in the Middle Solimões, Amazonas, Brazil

RESUMO Os inquéritos de saúde conduzidos em comunidades geograficamente isoladas auxiliam na caracterização do comportamento reprodutivo e seus condicionantes. O objetivo deste estudo foi conhecer o perfil da saúde sexual, reprodutiva e aspectos socioculturais e econômicos de mulheres ribeirinhas do Médio Solimões, Amazonas, Brasil. Estudo retrospectivo e descritivo feito com mulheres da comunidade da Vila Sião, Alvarães (AM). No total, 28 mulheres, com idades entre 18 e 57 anos, foram individualmente entrevistadas, utilizando formulário para a obtenção de dados socioculturais, históricos de vida sexual e reprodutiva. Os resultados das análises descritivas indicaram que as entrevistadas eram mestiças, com ensino fundamental, casadas e atuavam na agricultura familiar. Em relação à história de vida sexual das entrevistadas, notou-se que os relacionamentos eram duradouros, com os mesmos parceiros, e as primeiras gestações ocorreram ainda na adolescência. Os indicadores gestacionais mostraram predomínio de parto domiciliar. Essas mulheres apresentaram elevado coeficiente de fecundidade. No entanto, os históricos de perdas gestacionais atribuídos à eclâmpsia, a acidentes domésticos e a doenças enfatizam a importância do acompanhamento pré-natal para a promoção da saúde da gestante e do bebê. A partir desses resultados, conclui-se que a interiorização dos serviços de saúde é essencial para que uma assistência médica especializada chegue até as comunidades ribeirinhas e isoladas do Amazonas, Brasil.

ABSTRACT Health surveys conducted in geographically isolated communities help to characterize reproductive behavior and its conditioning factors. The aim of this study was to know the sexual and reproductive health profile and the socio-cultural and economic aspects related to riverside women from Middle Solimões, Amazonas, Brazil. This is a retrospective and descriptive study carried out with women from Vila Sião community, Alvarães (AM). Twenty-eight women, 18-57 years old, were individually interviewed using a survey form to obtain socio-cultural data, sexual and reproductive life histories. The results of the descriptive analyses indicated that the respondents were of mixed race, with elementary education, married and worked in family-based agriculture. Regarding the respondents' sexual life history, it was noted that the relationships are long-lasting, with the same partner, and that the first pregnancy occurred during adolescence. Gestational indicators showed a predominance of home birth. These women had a high fertility coefficient. However, the history of gestational loss attributed to eclampsia, home accidents, and illnesses emphasizes the importance of prenatal care for the promotion of the pregnant woman and the baby. From these results it is concluded that the internalization of health services is essential for specialized medical assistance to reach the riverside and isolated communities of Amazonas, Brazil.

Prevalência e fatores sociodemográficos em hipertensos Amazônicos, Brasil / Prevalence and sociodemographic factors in Amazonian hypertensive population, Brazil

Objetivo: Descrever a prevalência da hipertensão arterial sistêmica (HAS) segundo características demográficas (idade, gênero) e socioeconômicas (escolaridade e renda familiar mensal) em Amazônicos residentes no município de Tefé/AM. Metodologia:Trata-se de estudo transversal, de base populacional, realizado por meio de inquérito domiciliar com 451 adultos, com idade variando de 20 a 78 anos. A amostra da pesquisa foi obtida por amostragem complexa. Consideraram-se hipertensos aqueles que apresentaram pressão arterial ≥140/90mmHg e/ou que referiram uso de medicação anti-hi-pertensiva. Testes descritivos e de regressão logística foram aplicados para estimar o efeito da idade, gênero, escolaridade e renda familiar mensal na prevalência da HAS. Resultados: As prevalências da HAS atingiram 26,8% da amostra total, 34% dos homens e 21% das mulheres. Entre os homens, apenas a idade contribuiu para o aumento da prevalência da HAS. Neste caso, a frequência da doença foi 3,24 vezes maior em homens com idade superior a 35 anos quando comparada à faixa de 20 a 35 anos (Intervalo de 95% de Confiança [IC95%]: 1,52-6,89). Nas mulheres, o aumento da prevalência da hipertensão arterial sistêmica foi relacionado com a variação etária e o número de anos de estudo. Entre as mulheres investigadas, a frequência da HAS aumenta 3,64 vezes (IC95%: 1,71-7,78) entre as par-ticipantes com idade acima de 35 anos e 7,78 vezes (IC95%: 1,77-34,27) naquelas com baixa escolaridade. Conclusão:Os achados do presente estudo reforçam a necessidade da vigilância dos indicadores demográficos e socioeconômicos de suscetibilidade como medida de prevenção e detecção precoce da hipertensão arterial sistêmica. (AU)

Objective: To describe the prevalence of systemic arterial hypertension (SAH) according to demographic (age, gender) and socioeconomic characteristics (schooling and monthly family income) in Amazonian residents in the municipality of Tefé/AM. Methodology: This cross-sectional, population-based study was conducted through a household survey of 451 adults, ranging in age from 20 to 78 years. The research sample was obtained by complex sampling. Those who had blood pressure ≥140/90mmHg and/or who reported use of antihypertensive medication were considered hypertensive. Descriptive and logistic regression tests were applied to estimate the effect of age, gender, schooling and monthly family income on the prevalence of SAH. Results: The prevalence of hypertension was 26.8% of the total sample, 34% of men and 21% of women. Among men, only age contributed to the increased prevalence of SAH. In this case, the frequency of the disease was 3.24 times higher in men over 35 years of age than in the 20-35 age group (95%CI: 1.52-6.89). In women, the increase in the prevalence of systemic arterial hypertension was related to the age variation and the number of years of study. Among the women investigated, the frequency of SAH increased 3.64 times (95%CI: 1.71-7.78) among participants aged over 35 years and 7.78 times (95%CI: 1.77-34, 27) in those with low schooling. Conclusion: The findings of the present study reinforce the need for surveillance of demographic and socioeconomic indicators of susceptibility as a preventive measure and early detection of systemic arterial hypertension. (AU)

Adult avoidant/restrictive food intake disorder: a case report / Transtorno alimentar evitativo/restritivo em uma adulta: um relato de caso

ABSTRACT The aim this report is to present an adult case of avoidant/restrictive food intake disorder (ARFID) in a patient with atypical development. To emphasize the diagnostic and behavioral characteristics of this new nosological category included in the Feeding and Eating Disorders (FED) section of DSM-5. A woman with Down Syndrome in early adulthood who developed restriction and avoidance symptoms of food until the total eating refusal with weight loss, malnutrition and dependence exclusively on enteral feeding by gastrostomy tube. This case exemplified how ARFID may remain a hidden diagnosis and even be misdiagnosed as other eating disorders, such as anorexia nervosa. The increase in diagnostic suspicion for this nosological entity with neurobiological/behavioral mechanisms involved in its clinical presentations in mind, might increase knowledge about this serious eating disorder, aiming the development of evidence-based interventions.

RESUMO O objetivo deste relato é apresentar um caso de transtorno alimentar evitativo/restritivo (TARE) em uma paciente adulta com desenvolvimento atípico e salientar as características diagnósticas e comportamentais dessa nova categoria nosológica incluída na seção de Transtornos Alimentares da DSM-5. Mulher com síndrome de Down que, no início da vida adulta, evoluiu com sintomas de restrição e evitação alimentar até a recusa total da alimentação, com perda de peso, desnutrição e dependência total de alimentação enteral por gastrostomia. Este caso elucida como o diagnóstico de TARE pode permanecer oculto e ser confundindo com outras condições patológicas alimentares, como a anorexia nervosa. O aumento da suspeição diagnóstica para essa entidade nosológica, tendo em mente os mecanismos neurobiológicos/comportamentais envolvidos em suas apresentações clínicas, possibilitará o aumento do conhecimento sobre esse grave transtorno alimentar, visando ao desenvolvimento de intervenções eficazes baseadas em evidências.

Assessment of interpersonal skills in obese women with binge eating disorder.

Based upon interpersonal theory that suggests an association between binge eating disorder (BED) and interpersonal problems, the present study examined empathy and other social skills of obese women with BED. The findings showed that five social skills were statistically associated with the chance of presenting BED. Obese women with less assertiveness, lower ability to express feelings, lower capacity to deal with strangers, lower ability to understand the perspective of others, and with higher levels of distress in interpersonal situations had a higher probability of presenting the diagnosis of BED. These results highlight an association between social skills deficits and BED.

Prevalência e fatores associados ao excesso de peso em uma população urbana do interior do Amazonas, Brasil / Excess weight prevalence and associated factors in an urban population from the Amazonas countryside, Brazil / Prevalencia y factores asociados con el exceso de peso de uma población urbana del interior de Amazonas, Brasil

Objetivo: Descrever a prevalência do sobrepeso na população adulta residente no município de Tefé, Amazonas, segundo características sociodemográficas, de estilo de vida e de saúde. Métodos: Estudo descritivo, transversal, de base populacional, avaliou, por meio de inquérito domiciliar, 451 indivíduos com idade ≥18 anos, em 2015. Utilizou-se questionário para descritores sociodemográficos (gênero, idade, estado civil, escolaridade, renda familiar), estilo de vida (tabagismo, etilismo, sedentarismo), saúde (perfil nutricional, obesidade, diabetes mellitus, hipertensão), e risco para sobrepeso e obesidade, com α=0,05. Resultados: Encontrou-se 22,7% (n=102) da população de Tefé com sobrepeso (IC95%: 20,1-24,6). Contudo, a prevalência do sobrepeso é 1,42 vezes maior nos indivíduos com idade ≥ 36 anos quando comparada à faixa de 18 a 35 anos (IC95%: 1,00-2,02). Prevalência maior observada entre hipertensos (1,58; IC95%: 1,11-2,25), os que não consomem pescado com regularidade (8,98; IC95%:6,37-12,68) e naqueles com circunferência abdominal alterada (3,5; IC95%: 2,41-5,07). A análise mostrou associação do aumento do IMC em função do gênero e da circunferência abdominal. Na análise ajustada para a idade, consumo de pescado e hipertensão, o risco para o sobrepeso foi de 10,07 para indivíduos com circunferência abdominal aumentada (IC95%: 5,01-20,26; p=0,00) e de 3,94 para os homens (IC95%: 2,04-7,61; p=0,00). Conclusão: Os resultados apontam que na população adulta de Tefé, a prevalência do sobrepeso é maior entre os homens com acentuado índice de gordura abdominal.

Objective: To describe the prevalence of overweight in the adult population from the municipality of Tefé, Amazonas, according to sociodemographic, lifestyle and health-related characteristics. Methods: Descriptive cross-sectional population-based study that assessed 451 individuals aged ≥18 years in 2015 using a household survey. A questionnaire was used to assess sociodemographic descriptors (gender, age, marital status, education, household income), lifestyle (smoking, drinking, physical inactivity) and health (nutritional profile, obesity, diabetes mellitus, hypertension) and risk for overweight and obesity, with α=0.05. Results: It was found that 22.7% (n=102) of the population of Tefé is overweight (95%CI: 20.1-24.6). However, the prevalence of overweight is 1.42 times higher in individuals aged ≥ 36 years compared to those aged 18-35 years (95%CI: 1.00-2.02). Higher prevalence rates were observed among hypertensive individuals (1.58; 95%CI: 1.11-2.25), those who do not eat fish frequently (8.98; 95%CI: 6.37-12.68) and those with increased abdominal circumference (3.5; 95%CI: 2.41-5.07). The analysis demonstrated an association between increased BMI by gender and abdominal circumference. In the analysis adjusted for age, fish consumption and hypertension, the risk for overweight was 10.07 for individuals with increased abdominal circumference (95%CI: 5.01-20.26, p=0.00) and 3.94 for men (95%CI: 2.04-7.61; p=0.00). Conclusion: The results show that the prevalence of overweight in the population of Tefé is higher among men with increased abdominal fat.

Objetivo: Describir la prevalencia de sobrepeso de la población adulta del municipio de Tefé/Amazonas, según las características sociodemográficas, de estilo de vida y de salud. Métodos: Estudio descriptivo, transversal, de base poblacional que evaluó a través de una encuesta domiciliaria 451 individuos con edad ≥18 años, en 2015. Se utilizó un cuestionario para los descriptores sociodemograficos (género, edad, estado civil, escolaridad, renta familiar), el estilo de vida (tabaquismo, etilismo, sedentarismo), la salud (perfil nutricional, obesidad, diabetes mellitus, hipertensión) y el riesgo para el sobrepeso y la obesidad, con α=0,05. Resultados: Se encontró el 22,7% (n=102) de la población de Tefé con sobrepeso (IC95%: 20,1- 24,6). Sin embargo, la prevalencia del sobrepeso es 1,42 veces mayor en los individuos con edad ≥ 36 años al comparar a la franja de edad entre 18 y 35 años (IC95%: 1,00-2,02). Se observo mayor prevalencia entre los hipertensos (1,58; IC95%: 1,11-2,25), los que no consumen pescado con regularidad (8,98; IC95%:6,37- 12,68) y aquellos con alteración de la circunferencia abdominal (3,5; IC95%: 2,41-5,07). El análisis mostró la asociación entre el aumento del IMC en función del género y de la circunferência abdominal. En el análisis ajustado para la edad, el consumo del pescado e hipertensión, el riesgo para el sobrepeso fue de 10,07 para los individuos con la circunferencia abdominal aumentada (IC95%: 5,01-20,26; p=0,00) y de 3,94 para los hombres (IC95%: 2,04-7,61; p=0,00). Conclusión: Los resultados señalan que em la población adulta de Tefé la prevalencia del sobrepeso es mayor para los hombres con elevado índice de grasa abdominal.

Combined analysis of genetic and environmental factors on essential hypertension in a brazilian rural population in the Amazon region.

OBJECTIVE: In the present study, we evaluated the contribution of six genetic polymorphisms of the Renin-Angiotensis-Aldosterone system (RAAS) and clinical risk factors in the development of essential hypertension in a Brazilian rural population in the Amazon region. METHODS: Eighty-two hypertensive patients and seventy-eight normotensive individuals were evaluated. Genotyping for renin (REN G1051A), angiotensinogen (AGT) M235T, insertion/deletion of angiotensin-converting enzyme (ACE I/D), angiotensin II type 1 receptor (AGTR1) A1166C and aldosterone synthase (CYP11B2) C344T polymorphisms were performed using polymerase chain reaction, with further restriction analysis when required. The influence of genetic polymorphisms and clinical risk factors on blood pressure variation was assessed by stepwise linear regression. RESULTS: We report the co-occurrence of clinical risk factors and angiotensin-converting enzyme (ACE) gene polymorphism in a Brazilian rural population in the Amazon region. Our results indicate that increase of systolic blood pressure (SBP) is favored by ACE I/D- D allele and advanced age, while alcohol consumption and aging are associated with high diastolic blood pressure (DBP). CONCLUSION: These findings suggest that in the Santa Isabel do Rio Negro population, the residents that carry ACE-D allele or have an alcohol consumption habit present higher values of SBP and DBP, respectively, with the passing of years.

Assessment of executive functions in obese individuals with binge eating disorder / Avaliação de funções executivas em indivíduos obesos com transtorno da compulsão alimentar periódica

OBJECTIVE: The aim of this study was to assess executive functions of obese individuals with binge eating disorder. METHOD: Thirty-eight obese individuals with binge eating disorder were compared to thirty-eight obese controls without binge eating disorder in terms of their executive functions. All individuals were assessed using the following instruments: Digit Span, Trail Making Tests A and B, Stroop Test and the Wisconsin Card Sorting Test. In addition, four subtests from the Behavioral Assessment of the Dysexecutive Syndrome Battery were also used, namely the Zoo Map Test, the Modified Six Elements Test, the Action Program Test and the Rule Shift Cards Test. RESULTS: When compared to obese controls, obese individuals with binge eating disorder presented significant impairment in the following tests: Digit Span backward, Zoo Map Test, Modified Six Elements Test, and Action Program Test. Subjects with binge eating disorder also showed significant more set shifting and perseverative errors in the Wisconsin Card Sorting Test. In other measures such as the Digit Span Forward, the Trail Making Test, the Stroop Test and the Rule Shift Cards Test, obese subjects with binge eating disorder did not differ significantly from obese subjects without binge eating disorder. CONCLUSION: These results suggest that, in the present sample, obese individuals with binge eating disorder presented executive deficits, especially impairments relating to problem-solving, cognitive flexibility and working memory.

OBJETIVO: O objetivo desse estudo foi avaliar as funções executivas de indivíduos obesos com transtorno da compulsão alimentar periódica. MÉTODO: Trinta e oito indivíduos obesos com transtorno da compulsão alimentar periódica foram comparados com 38 controles obesos sem transtorno da compulsão alimentar periódica em termos de suas funções executivas. Todos os indivíduos foram avaliados utilizando os seguintes instrumentos: Digit Span, Trail Making Tests A e B, Stroop Test e Wisconsin Card Sorting Test. Adicionalmente, quatro subtestes da Behavioral Assessment of the Dysexecutive Syndrome Battery foram também utilizados, a saber: Zoo Map Test, Modified Six Elements Test, Action Program Test e The Rule Shift Cards Test. RESULTADOS: Quando comparados a controles obesos, indivíduos obesos com transtorno da compulsão alimentar periódica apresentaram déficits significativos no Digit Span Backward, Zoo Map Test, Modified Six Elements Test e no Action Program Test. Os indivíduos com transtorno da compulsão alimentar periódica também apresentaram significativamente mais erros perseverativos e de mudança de set no Wisconsin Card Sorting Test. Em outras medidas, tais como Digit Span Forward, Trail Making Test, Stroop Test e The Rule Shift Cards Test, os indivíduos obesos com transtorno da compulsão alimentar periódica não diferiram significativamente dos obesos sem transtorno da compulsão alimentar periódica. CONCLUSÃO: Esses resultados sugerem que, neste estudo, os indivíduos obesos com transtorno da compulsão alimentar periódica apresentaram déficits executivos evidenciados por dificuldades na capacidade para resolução de problemas, na flexibilidade cognitiva e na memória operacional.

Analysis of the DMPK gene CTG repeat in healthy Brazilians

Myotonic dystrophy (DM) is a neuromuscular disorder caused by the expansion of the cytosine-thymine-guanine (CTG) repeat of the myotonic dystrophy protein kinase gene (DMPK). This repeat is highly polymorphic in healthy individuals [(CTG)5-37], and it has been proposed that expanded CTG alleles originated from larger sized normal alleles [(CTG)19-37]. According to this hypothesis, a positive correlation should be expected between the frequency of these large-sized normal alleles and the prevalence of the disorder in a population. We determined the distribution of CTG alleles of the DMPK gene in 156 healthy Brazilians from Rio de Janeiro city. Our analyses of 312 chromosomes detected 20 different alleles ranging in size from 5 to 27 CTG repeats, with 24 alleles having more than 18 repeats (7.69 percent). This frequency of (CTG)3(19) alleles observed in our population suggests that the prevalence of DM in Rio de Janeiro should not be different from the prevalence in European populations.

Análise combinada de fatores genéticos e ambientais na hipertensão essencial em um município da região Amazônica / Combined analysis of genetic and environmental factors on essential hypertension in a brazilian rural population in the Amazon region

OBJETIVO: Este estudo avaliou a contribuição de seis polimorfismos genéticos presentes em genes do sistema renina-angiotensina-aldosterona (SRAA) e fatores de risco clínicos para o desenvolvimento da hipertensão arterial essencial em um município da região Amazônica. MÉTODOS: Oitenta e dois indivíduos hipertensos e setenta e oito indivíduos normotensos foram genotipados quanto à presença de polimorfismos REN-G1051A (renina), AGT-M235T (angiotensinogênio), ECA-Alu I/D (enzima conversora de angiotensina I), AGTR1-A1166C (receptor tipo 1 da angiotensina II) e CYP11B2-C344T (aldosterona sintetase) pela técnica de reação em cadeia da polimerase (PCR), com análise de restrição quando necessário. A influência de polimorfismos genéticos e fatores de risco clínicos na variação da pressão arterial foi avaliada por meio de regressão linear stepwise. RESULTADOS: Relatamos a co-ocorrência de fatores de risco clínicos e polimorfismo do gene da enzima conversora de angiotensina (ECA) na população de um município da região amazônica. Nossos resultados mostram que a elevação da pressão arterial sistólica é favorecida pelo alelo D do polimorfismo de inserção/deleção do gene da ECA e pelo aumento da idade, enquanto consumo de bebida alcoólica e envelhecimento estão associados ao aumento da pressão arterial diastólica (PAD). CONCLUSÃO: Esses achados indicam que os moradores de Santa Isabel do Rio Negro que possuem o alelo D da ECA ou têm o hábito de beber apresentam valores mais elevados de PAS e PAD, respectivamente, com o passar dos anos.

OBJECTIVE: In the present study, we evaluated the contribution of six genetic polymorphisms of the Renin-Angiotensis-Aldosterone system (RAAS) and clinical risk factors in the development of essential hypertension in a Brazilian rural population in the Amazon region. METHODS: Eighty-two hypertensive patients and seventy-eight normotensive individuals were evaluated. Genotyping for renin (REN G1051A), angiotensinogen (AGT) M235T, insertion/deletion of angiotensin-converting enzyme (ACE I/D), angiotensin II type 1 receptor (AGTR1) A1166C and aldosterone synthase (CYP11B2) C344T polymorphisms were performed using polymerase chain reaction, with further restriction analysis when required. The influence of genetic polymorphisms and clinical risk factors on blood pressure variation was assessed by stepwise linear regression. RESULTS: We report the co-occurrence of clinical risk factors and angiotensin-converting enzyme (ACE) gene polymorphism in a Brazilian rural population in the Amazon region. Our results indicate that increase of systolic blood pressure (SBP) is favored by ACE I/D- D allele and advanced age, while alcohol consumption and aging are associated with high diastolic blood pressure (DBP). CONCLUSION: These findings suggest that in the Santa Isabel do Rio Negro population, the residents that carry ACE-D allele or have an alcohol consumption habit present higher values of SBP and DBP, respectively, with the passing of years.

Epidemiologia genética da hipertensão arterial primária em populações brasileiras: estudo de polimorfismos em genes do sistema renina-angiotensina-aldosterona e fatores clínicos/antropométricos / Genetic epidemiologuy of primary the arterial hypertension in brazilian populations: study of polymorphisms in genes of the renin-angiotensin-aldosterone system and clinical/anthropometrical factors

A hipertensão arterial(HA)é uma doença multifatorial cuja presença de fatores genéticos e ambientais contribuem para a sua expressão.Estudos epidemiológicos sugerem que variantes genéticas,principalmente as descritas nos genes do angiotensinogênio(AGT),enzima conversora de angiotensina(ECA),receptor tipo 1 de angiotensina II (AGTR1),aldosterona sintetase(CYP11B2)e do receptor de mineralocorticóide(RM),podem contribuir para o desenvolvimento da HA.Entretanto,estudos de associação de polimorfismos genéticos e a HA têm apresentado resultados conflitantes em diferentes populações.Este cenário... do indivíduo e fatores ambientais.Neste trabalho,estabelecemos como objetivos avaliar a associação entre os polimorfismos AGT*M235T,ECA*AluI/D,AGTR1*A1166C,CYP11B2*C344T, RM*G3514C e RM*A4582C;e fatores clínicos/antropométricos (gênero,idade,etnia,índice de massa corporal[IMC],fumo e consumo de bebidas alcoólicas),para o desenvolvimento do quadro hipertensivo em 2 populações brasileiras.Foram avaliados 221 indivíduos(106 hipertensos e 115 normotensos)provenientes do município do Rio de Janeiro/RJ e 160 indivíduos(82 hipertensos e 78 normotensos)do município de Santa Isabel do Rio Negro/AM. A caracterização genotípica foi conduzida com auxílio da técnica de reação em cadeia da polimerase,enquanto que a caracterização clínica foi realizada através de entrevista e exame clínico.A contribuição dos polimorfismos genéticos e dos fatores clínico-antropométricos na variação da pressão arterial foi avaliada pelo cálculo de ODDS Ratio e por regressão linear–stepwise.Os resultados obtidos no Rio de Janeiro indicaram que os genótipos AGT*235T/235T, AGTR1*1166A/1166A,AGTR1*1166A/1166A,CYP11B2*344T/344T e RM*4582C/4582C apresentam maior suscetibilidade para a hipertensão(p<0,05).Além disso,combinações haplotípicas entre estes polimorfismos contribuem para um aumento gradual no risco de desenvolver HA(p<0,05).Nesta população,os fatores idade,IMC e etnia também foram relacionados...

Tradução, adaptação para o português e validação da binge eating scale (BES): escala de compulsão alimentarperiódica / Translation, adaptation and validation into Portuguese of the binge eating scale (BES): scale of compulsion alimentarperiódica

O transtorno da compulsão alimentar periódica (TCAP) é uma categoria diagnóstica classificada no DMS-IV como um transtorno alimentar sem outras especificações (TASOE). Caracteriza-se, sobretudo, pela presença de episódios de compulsão alimentar periódica (CAP), na ausência de mecanismos para compensar o execsso ingerido e o ganho de peso. Desde a década de 60, esse comportamento alimentar alterado vem sendo reconhecido numa parcela substancial de obesos que procuram tratamento para emagrecer. Pesquisas apontam para uma prevalência de cerca de 30% nessa população. A identificação desse subgrupo de pacientes obesos poderá auxiliar na instituição de estratégias terapêuticas mais adequadas, que contemplem o controle da CAP. No Brasil, não há ainda instrumentos validados para tal propósito. Nesta dissertação são apresentados dois artigos que versam sobre a tradução e a validação da Bibge Eating Scale (BES) - Escala de Compulsão Alimentar periódica (ECAP) -, instrumento construído para identificar compulsão alimentar periódica e estabelecer níveis de gravidade em indívíduos que procuram tratamento para obesidade. A primeira etapa do estudo (artigo 1) constatou, inicialmente, do processo de tradução e adaptação da escala para o idioma português, de acordo com as recomendações atuais para esse processo. Em seguida, para avaliar sua aplicabilidade, o instrumento final foi submetido a um pré-teste em 32 pacientes obesos com TCAP que procuravam tratamento para emagrecer no ambulatório do Grupo de Obesidade e Transtornos Alimentares (GOTA), do Instituo Estadual de Diabetes e Endocrinologia (IEDE -RJ). A versão final para o português da BES foi considerada para uso clínico...