Beneficial Short-Term Effects of Bariatric Surgery on Nutritional Inflammatory Profile and Metabolic Biomarkers.

PURPOSE: Bariatric surgery (BS) has several potential metabolic benefits. However, little is known about its impact on changes in the inflammatory potential of diet and its effect on inflammatory and metabolic markers. This study aimed to assess the short-term beneficial effects of BS on dietary inflammatory potential and inflammatory and metabolic markers. MATERIALS AND METHODS: Participants (n = 20) were evaluated 3 months before and after BS. Body mass, body mass index, anthropometric measurements, fat mass, fat-free mass, visceral fat, skeletal muscle mass, basal metabolic rate, serum lipids, HOMA-IR, QUICKI and inflammatory markers, including leptin, adiponectin, adiponectin/leptin ratio and plasminogen activator inhibitor-1 (PAI-1), were evaluated. Diet data were collected using a 3-day diet record and the dietary inflammatory index (DII®) and energy-adjusted dietary inflammatory index (E-DIITM) scores were computed. RESULTS: There was a reduction in DII® (2.56 vs 2.13) and E-DIITM (2.18 vs 0.45) indicating an improvement in inflammatory nutritional profile. Moreover, there were increases in the adiponectin/leptin ratio (0.08 vs 0.21) and QUICKI scores (0.31 vs 0.37), and reductions in leptin (36.66 vs 11.41 ng/ml) and HOMA-IR scores (3.93 vs 1.50). There were also improvements in body composition and anthropometric parameters. CONCLUSIONS: BS promotes changes in metabolic profile, inflammatory state and food intake and these modifications appeared to be associated with improvements in diet-related inflammation, an increase in the adiponectin/leptin ratio and a reduction in leptin. These results contribute to knowledge on the contribution bariatric surgery can make to the treatment of obesity and the reduction of related comorbidities.

Severe Obesity in Women Can Lead to Worse Memory Function and Iron Dyshomeostasis Compared to Lower Grade Obesity.

Objective: Obesity is one of the modifiable risk factors for dementia. Insulin resistance, the abundance of advanced glycated end-products, and inflammation are some of the mechanisms associated with the lower cognitive performance observed in obesity. This study aims to evaluate the cognitive function of subjects with distinct degrees of obesity, comparing class I and II obesity (OBI/II) to class III obesity (OBIII), and to investigate metabolic markers that can distinguish OBIII from OBI/II. Study Design. This is a cross-sectional study, in which 45 females with BMI varying from 32.8 to 51.9 kg/m2 completed a set of 4 cognitive tests (verbal paired-associate test, stroop color, digit span, and Toulouse-Pieron cancellation test) and their plasma metabolites, enzymes, and hormones related to glycemia, dyslipidemia, and liver function, as well as the biomarkers of iron status, were concomitantly analyzed. Results: OBIII showed lower scores in the verbal paired-associate test compared to OBI/II. In other cognitive tests, both groups showed similar performance. OBIII presented a lower iron status compared to OBI/II based on total iron binding capacity, degree of transferrin saturation, hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin. The levels of indicators for glycemia, liver function, and lipid metabolism were similar in both groups. Analysis of plasma metabolites showed that OBIII had lower levels of pyroglutamic acid, myoinositol, and aspartic acid and higher levels of D-ribose than OBI/II. Conclusion: Iron is an essential micronutrient for several metabolic pathways. Thus, iron dyshomeostasis observed in severe obesity may aggravate the cognitive impairment by altering metabolic homeostasis and enhancing oxidative stress. These findings can contribute to searching for biomarkers that indicate cognitive performance in the population with obesity.

Eating patterns and food choice as determinant of weight loss and improvement of metabolic profile after RYGB.

OBJECTIVE: Significant changes in the preference for different dietary components have been observed after Roux-en-Y gastric bypass (RYGB). The aim of this study was to evaluate the early post-RYGB changes in quality of eating patterns and their relationship to weight loss and metabolic parameters. METHODS: The sample was composed of 41 extremely obese individuals undergoing RYGB. Dietary data were collected using a validated food frequency questionnaire in Brazil. A food intake evaluation was conducted with a focus on the frequency of consumption (≥4 times/wk) of markers for healthy eating and markers for unhealthy eating. Furthermore, anthropometric and metabolic markers were collected before surgery and 6 mo post-RYGB. RESULTS: Compared with baseline, the postsurgery body mass index was reduced by 12.9 kg/m2, corresponding to an excess weight loss of 63.5%. Blood glucose, insulin, ferritin, cholesterol, low-density lipoprotein-cholesterol, triacylglycerol (TG), and hemoglobin were reduced 6 mo after RYGB (P < 0.05). The consumption frequency of many foods defined as unhealthy decreased after surgery (e.g., from 15.4% to 5.1% for pizza and 18% to 0% for hamburger), and some healthy food increased (e.g., from 0% to 5.1% for fish and from 0% to 25.6% for plain yogurt). There was a decrease in the frequency of individuals who reported consuming fruit and vegetables. Conversely, insulin, glucose, and TG levels were positively associated with intake of chocolates/truffles and ice cream/sundaes. CONCLUSION: Participants in the present study appeared to develop a healthier dietary pattern by 6 mo after RYGB. These results show that a healthier dietary pattern is associated with a significant improvement of metabolic profile and weight loss.

Serum myristic fatty acid negatively correlates with anti-inflammatory adiponectin/leptin ratio in obese adolescents: effects of long- term therapy / O ácido graxo mirístico sérico correlaciona-se negativamente com a razão adiponectina/leptina anti-inflamatória em adolescentes obesos: efeitos da terapia de longo prazo

Obesity is related to metabolic disorders partially mediated by inflammatory state. In this way, adiponectin/leptin ratio is considered an anti-inflammatory biomarker related to cardiovascular risks. Evidence suggest that decrease in saturated fatty acid intake is an important dietary recommendation to reduce cardiovascular risk factors. Thus, the purpose of the present study was to evaluate if serum myristic fatty acid can modulate metabolic profile and inflammatory process in obese adolescents after weight-loss therapy. Twenty-nine obese post-pubertal obese adolescents, aged 14 to 19 years, were submitted to the long-term interdisciplinary treatment, including physical exercise, clinic, nutritional and psychological intervention. The blood samples were collected to glycaemia, insulin, lipid profile, leptin and adiponectin analysis. Serum fatty acid composition was performed by technical of chromatography in fizzy phase. The therapy promoted significant improvement in body mass, BMI, subcutaneous and visceral fat, insulin, lipid profile, leptin and leptin/adiponectin ratio. Significant decrease in myristic fatty acid was observed. Simple linear regression analysis showed that myristic fatty acid was positively associated with changes in triglycerides and very low density lipoprotein cholesterol, and was negatively associated with adiponectin/leptin ratio. In summary, we observed that long-term weight loss therapy was effective to improve metabolic/inflammatory profile and serum myristic fatty acid. Moreover, our results suggested the relation between changes in serum myristic fatty acids with the anti-inflammatory adiponectin/ leptin ratio, which may modulate metabolic and inflammatory process related to obesity

A obesidade está relacionada a distúrbios metabólicos parcialmente mediados por um estado inflamatório. Desta forma, a razão a diponectina/leptina é considerada um biomarcador anti-inflamatório relacionado aos riscos cardiovasculares. Evidências sugerem que a diminuição na ingestão de ácidos graxos saturados seja uma recomendação dietética importante para reduzir os fatores de risco cardiovascular. Assim, o objetivo do presente estudo foi avaliar se o ácido graxo mirístico sérico pode modular o perfil metabólico e processos inflamatórios em adolescentes obesos após a terapia para perda de peso. Vinte e nove adolescentes pós-púberes e obesos de 14 a 19 anos de idade foram submetidos a um tratamento interdisciplinar de longo prazo, incluindo exercício físico, intervenção clínica, nutricional e psicológica. As amostras de sangue foram coletadas para análise da glicemia, insulina, perfil lipídico, leptina e adiponectina. A composição de ácidos graxos séricos foi realizada por técnicas de cromatografia em fase gasosa. A terapia promoveu uma melhora significativa na massa corporal, IMC, gordura subcutânea e visceral, insulina, perfil lipídico, leptina e a razão leptina/adiponectina. Observou-se uma diminuição significativa na concentração sérica de ácido graxo mirístico. A análise de regressão linear simples mostrou que o ácido graxo mirístico foi positivamente associado a alterações nos triglicerídeos e colesterol de lipoproteínas de muito baixa densidade e foi associado negativamente à proporção de adiponectina/leptina. Em resumo, observamos que a terapia de perda de peso a longo prazo foi efetiva na melhora do perfil metabólico/inflamatório e do ácido graxo mirístico sérico. Além disso, nossos resultados sugerem uma relação entre as alterações no ácido graxo mirístico séricos e a razão adiponectina/leptina antiinflamatória, que podem modular processos metabólicos e inflamatórios relacionados à obesidade

Clinical performance of 3-body fat measurements in obese adolescents 15 to 18 years-old / Medidas da gordura corporal em adolescentes obesos de 15 a 18 anos

There is a lack of information about the performance and clinical use of body fat measurements in children and adolescents, particularly in obese people. Objective: the purpose of this study was to compare percentage body fat (%BF) among 3 different methodologies, including hydrostatic weighing (HW), dual energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP), in obese adolescents. Subjects: A total of 36 obese adolescents were evaluated, which 15 males (16.00 + 0.9 yrs, 105.0 + 10.9 kg, 179.9 + 7.2 cm, 34.9 + 4.4 kg/m2) and 21 females (16.5 + 1.5 yrs, 91.1 + 10.5 kg, 163.6 + 4.2 cm, 34.1 + 3.7 kg/m2). All of them performed HW, total body DXA and ADP. Results: For males, the means of %BF regarding HW, DXA and ADP were 45.7 + 9.0, 42.3 + 5.2 and 35.6 + 7.9, respectively. For females, the means of %BF were 47.7 + 6.8, 50.7 + 4 and 42.4 + 5.3, respectively. No significant difference was found between HW and DXA. In general, the %BF values provided by ADP measurements were lower than other two methods. Conclusion: There was a good agreement between DXA and HW methods, but ADP measurements can underestimate the %BF in obese adolescents.

Roux-en-Y gastric bypass decreases pro-inflammatory and thrombotic biomarkers in individuals with extreme obesity.

BACKGROUND: The low-grade inflammatory state in obesity leads to insulin resistance and endothelial dysfunction, which promote cardiovascular diseases in individuals with obesity. The purpose of this study was to evaluate the early effects of weight loss achieved through bariatric surgery on the inflammatory and prothrombotic states. This study also aimed to identify the role of hyperleptinemia on the prothrombotic state. METHODS: The sample was composed of 41 extremely obese who underwent Roux-en-Y gastric bypass (RYGB). Anthropometric and clinical data, and biochemical markers of inflammation were collected prior to surgery and 6 months post-RYGB. RESULTS: It was found that plasminogen activator inhibitor-1 (PAI-1) concentrations were higher among extremely obese individuals with hyperleptinemia than in those without hyperleptinemia (p < 0.01).In relation to the baseline, post-surgery body mass index (BMI) was reduced by 12.9 kg/m(2), corresponding to 63.50 % of excess weight loss. Additionally, waist circumference was found to decrease significantly from 126.2 to 101.4 cm. Plasma total cholesterol (p < 0.01), LDL cholesterol (p = 0.02), triglycerides (p < 0.01), and glucose (p = 0.01) were also found to decrease. Pro-inflammatory biomarkers were observed to decrease: PAI-1 by 55.9 ± 6.0 % (p < 0.01), C-reactive protein (CRP) by 18.8 ± 3.4 % (p < 0.01), intercellular adhesion molecule-1 (ICAM-1) by 89.9 ± 5.7 % (p < 0.01), leptin by 27.9 ± 3.2 % (p < 0.01), and resistin by 69.3 ± 5.8 % (p < 0.01). Additionally, significant decreases of tumor necrosis factor alpha (TNF-α) and leptin/adiponectin ratio were observed. Anti-inflammatory cytokines adiponectin and interleukin-10 (IL-10) were significantly increased (170.7 ± 82.5 %, p < 0.01; 122.7 ± 55.1 %, p = 0.02). CRP levels were predictive of ICAM-1 (p = 0.04), and changes in leptin concentrations were associated with decreased PAI-1 levels (p = 0.03). CONCLUSIONS: We observed that individuals with obesity that have hyperleptinemia have higher circulating PAI-1 levels, which could indicate increased risk for cardiovascular disease. The biomarkers of inflammation and thrombosis measured in this study decreased after RYGB, suggesting that the surgery may be effective in reducing pro-inflammatory and thrombotic risk in individuals with extreme obesity.

Lipotoxicity: effects of dietary saturated and transfatty acids.

The ingestion of excessive amounts of saturated fatty acids (SFAs) and transfatty acids (TFAs) is considered to be a risk factor for cardiovascular diseases, insulin resistance, dyslipidemia, and obesity. The focus of this paper was to elucidate the influence of dietary SFA and TFA intake on the promotion of lipotoxicity to the liver and cardiovascular, endothelial, and gut microbiota systems, as well as on insulin resistance and endoplasmic reticulum stress. The saturated and transfatty acids favor a proinflammatory state leading to insulin resistance. These fatty acids can be involved in several inflammatory pathways, contributing to disease progression in chronic inflammation, autoimmunity, allergy, cancer, atherosclerosis, hypertension, and heart hypertrophy as well as other metabolic and degenerative diseases. As a consequence, lipotoxicity may occur in several target organs by direct effects, represented by inflammation pathways, and through indirect effects, including an important alteration in the gut microbiota associated with endotoxemia. Interactions between these pathways may perpetuate a feedback process that exacerbates an inflammatory state. The importance of lifestyle modification, including an improved diet, is recommended as a strategy for treatment of these diseases.

Long-term interdisciplinary therapy reduces endotoxin level and insulin resistance in obese adolescents.

AIM: The purpose of the present study was to assess the dietary fat intake, glucose, insulin, Homeostasis model assessment for insulin resistance HOMA-IR, and endotoxin levels and correlate them with adipokine serum concentrations in obese adolescents who had been admitted to long-term interdisciplinary weight-loss therapy. DESIGN: The present study was a longitudinal clinical intervention of interdisciplinary therapy. Adolescents (n = 18, aged 15-19 y) with a body mass index > 95th percentile were admitted and evaluated at baseline and again after 1 year of interdisciplinary therapy. We collected blood samples, and IL-6, adiponectin, and endotoxin concentrations were measured by ELISA. Food intake was measured using 3-day diet records. In addition, we assessed glucose and insulin levels as well as the homeostasis model assessment for insulin resistance (HOMA-IR). RESULTS: The most important finding from the present investigation was that the long-term interdisciplinary lifestyle therapy decreased dietary fat intake and endotoxin levels and improved HOMA-IR. We observed positive correlations between dietary fat intake and endotoxin levels, insulin levels, and the HOMA-IR. In addition, endotoxin levels showed positive correlations with IL-6 levels, insulin levels and the HOMA-IR. Interestingly, we observed a negative correlation between serum adiponectin and both dietary fat intake and endotoxin levels. CONCLUSIONS: The present results indicate an association between dietary fat intake and endotoxin level, which was highly correlated with a decreased pro-inflammatory state and an improvement in HOMA-IR. In addition, this benefits effect may be associated with an increased adiponectin level, which suggests that the interdisciplinary therapy was effective in improving inflammatory pathways.

Influence of visceral and subcutaneous fat in bone mineral density of obese adolescents / A influência da gordura visceral e subcutânea na densidade mineral óssea de adolescentes obesos

OBJECTIVE: To verify the influence of visceral and subcutaneous fat, as well adipokines in bone mineral density (BMD) in obese adolescents. SUBJECTS AND METHODS: The study involved 125 postpubertal obese adolescents (45 boys and 80 girls). Anthropometric measurements, body composition, visceral and subcutaneous fat, and BMD were determined. Leptin, adiponectin, and insulin levels also analyzed. RESULTS: Data demonstrated a negative relationship between BMD with insulin resistance, visceral fat and leptin concentration; and bone mineral content with visceral/subcutaneous ratio. Positive association between BMD and subcutaneous fat was observed. CONCLUSIONS: Visceral fat and insulin resistance, as well as visceral/subcutaneous ratio and leptin concentration, were negative predictors of BMD in boys and girls, respectively. However, subcutaneous fat had a protective influence in BMD only in boys.

OBJETIVO: Verificar a influência da gordura visceral e subcutânea, assim como das adipocinas na densidade mineral óssea (DMO) em adolescentes obesos. SUJEITOS E MÉTODOS: O estudo envolveu 125 adolescentes obesos pós-púberes. Medidas antropométricas, composição corporal, gordura visceral e subcutânea e DMO foram determinadas. Níveis de leptina, adiponectina e insulina foram analisados. RESULTADOS:Os dados demonstraram associação negativa entre DMO com resistência insulínica, gordura visceral e concentração de leptina; e conteúdo mineral ósseo com a razão visceral/subcutânea. Associação positiva entre DMO e gordura subcutânea foi observada. CONCLUSÕES: Gordura visceral, resistência insulínica, razão visceral/subcutânea e concentração de leptina foram preditores negativos da DMO em meninos e meninas, respectivamente. Entretanto, a gordura subcutânea demonstrou exercer influência positivamente na DMO somente nos meninos.

Alterations in downstream mediators involved in central control of eating behavior in obese adolescents submitted to a multidisciplinary therapy.

OBJECTIVE: The aim of this study was to verify the effects of a multidisciplinary therapy (24 weeks) on neurohormonal control of food intake, specifically in orexigenic (total ghrelin, agouti-related protein [AgRP], neuropeptide Y [NPY], and melanin-concentrating hormone) and anorexigenic factors (leptin, insulin, and alpha-melanocyte stimulating hormone [α-MSH]), in obese adolescents. METHODS: A total of 88 adolescents (38 boys and 50 girls), including 62 obese and 26 normal-weight, aged 15-19 years were recruited. Obese adolescents were submitted to a 24-week multidisciplinary therapy. AgRP, NPY, melanin-concentrating hormone, leptin, insulin, glucose, α-MSH, total ghrelin, and food intake were measured at three stages (at baseline, after 12 weeks, and after 24 weeks). RESULTS: At baseline, obese adolescents showed hyperleptinemia (circulating leptin levels, which were, in boys and girls, 40 and 35 times higher than in normal-weight subjects, respectively). After 24 weeks, these values decreased in all obese patients. Our results showed no differences in ghrelin levels between obese and normal-weight adolescents, in both genders. However, obese boys reduced their plasma ghrelin concentration after 24 weeks of therapy (p < .05). The multidisciplinary therapy decreased NPY and AgRP values and increased α-MSH; simultaneously with these changes there was a decrease in total food intake after 24 weeks of therapy. CONCLUSIONS: We can conclude that the multidisciplinary therapy was efficient to modulate neurohormonal control of food intake in obese adolescents.

Visceral fat decreased by long-term interdisciplinary lifestyle therapy correlated positively with interleukin-6 and tumor necrosis factor-α and negatively with adiponectin levels in obese adolescents.

The purpose of this study was to assess the level of cytokine expression in correlation with visceral and subcutaneous fat in obese adolescents admitted to long-term interdisciplinary weight loss therapy. The study was a longitudinal clinical intervention of interdisciplinary therapy. Adolescents (18, aged 15-19 years) with body mass indexes greater than the 95th percentile were admitted and evaluated at baseline and again after 1 year of interdisciplinary therapy. Visceral and subcutaneous fat was analyzed by ultrasonography. Blood samples were collected to analyze tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), and adiponectin concentrations that were measured by enzyme-linked immunosorbent assay. The most important finding in the present investigation is that the long-term interdisciplinary lifestyle therapy decreased visceral fat. Positive correlations between IL-6 levels and visceral fat (r = 0.42, P < .02) and TNF-α levels and visceral fat (r = 0.40, P < .05) were observed. Negative correlations between TNF-α levels and subcutaneous fat (r = -0.46, P < .01) and adiponectin levels and subcutaneous fat (r = -0.43, P < .03) were also observed. In addition, we found a positive correlation between TNF-α levels and the visceral to subcutaneous fat ratio (r = 0.42, P < .02) and a negative correlation between adiponectin level and the visceral to subcutaneous fat ratio (r = -0.69, P < .001). Despite the limitation of sample size, our results indicate that the observed massive weight loss (mainly visceral fat) was highly correlated with a decreased inflammatory state, suggesting that the interdisciplinary therapy was effective in decreasing inflammatory markers.

Exercise training in rats impairs the replenishment of white adipose tissue after partial lipectomy.

The aim of this study was to evaluate the effect of exercise training on the metabolism of rats following the partial removal of fat pads. Three-month-old male Wistar rats were subjected to the partial removal (L) of retroperitoneal white adipose tissue (RET) and epididymal white adipose tissue (EPI), or a sham operation (Sh). Seven days after surgery, both sets of rats were subdivided into exercised (LE or ShE) (swimming 90 min/day, 5 days/week, 6 weeks) and sedentary (LS or ShS) groups. Partial removal of the fat pads increased the lipogenesis rates in both the RET and EPI and decreased the weight and lypolysis rate of the EPI, while the RET weight was not significantly affected by lipectomy. In both lipectomized and sham-operated groups, exercise training caused a reduction in carcass lipid content, food intake, RET and EPI weights, and RET lipogenesis rate. On the other hand, the exercise training increased the percentage of diet-derived lipid accumulation in both tissues, either in sham and lipectomized rats. These results confirmed that regrowth is not uniform and depends on the particular fat pad that is excised. They also demonstrated that exercise training following the partial removal of fat pads modified adipose tissue metabolism, impaired the replenishment of adipose tissue, and decrease body adiposity.

Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy.

BACKGROUND: Obesity has adverse physical, social, and economic consequences that can negatively affect quality of life (QOL). Thus the aim of this study was to verify the effects of a long-term multidisciplinary lifestyle intervention on QOL, body image, anxiety, depression and binge eating in obese adolescents. METHODS: Sixty-six obese adolescents (41 girls and 25 boys; BMI: 35.62 +/- 4.18 kg/m2) were recruited from the Multidisciplinary Obesity Intervention Program outpatient clinic, and were submitted to a multidisciplinary lifestyle therapy (short-term = 12 weeks and long-term = 24 weeks), composed of medical, dietary, exercise and psychological programs. Validated self-report questionnaires were used to assess symptoms of anxiety Trait/State (STAI); depression (BDI); binge eating (BES), body image dissatisfaction (BSQ) and QOL (SF-36). Data were analyzed by means of scores; comparisons were made by ANOVA for repeated measures, and Turkey's test as post-hoc and Students T test. RESULTS: Long-term therapy decreased depression and binge eating symptoms, body image dissatisfaction, and improved QOL in girls, whereas, for boys, 24 weeks, were effective to reduce anxiety trait/state and symptoms of binge eating, and to improve means of dimensions of QOL (p < .05). CONCLUSION: A long-term multidisciplinary lifestyle therapy is effective to control psychological aspects and to improve QOL in obese adolescents.

Efeitos da terapia multidisciplinar de longo prazo sobre a composição corporal de adolescentes internados com obesidade severa / Effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents

OBJETIVO: Descrever os efeitos da terapia multidisciplinar de longo prazo sobre a composição corporal de adolescentes obesos severos internados. MÉTODOS: Um total de 728 adolescentes obesos extremos, incluindo 249 meninos (15,25±1,56 anos) e 479 meninas (15,34±1,59 anos), recebeu terapia multidisciplinar durante um período de 3 a 9 meses. A terapia consistiu de redução da ingestão energética, orientação dietética, exercícios físicos e terapia psicológica. A composição corporal foi analisada pela bioimpedância elétrica, e a aptidão física foi avaliada pelo teste em ciclo ergômetro multiestágios. O tipo e duração de cada atividade foram avaliados através de recordatório diário de atividade física. RESULTADOS: Foi verificada redução significante (p < 0,05) na massa corporal (27,84±12,49 kg para meninos e 21,60±9,87 kg para meninas), índice de massa corporal (9,19±3,88 kg/m² para meninos e 7,72±3,98 kg/m² para meninas) e da gordura corporal. Além disso, a porcentagem de massa magra aumentou significantemente (p < 0,05) nos meninos (de 58,8±6,41 para 69,98±7,43 por cento) e nas meninas (de 51,86±4,96 para 60,04±5,65 por cento). CONCLUSÃO: A terapia multidisciplinar de longo prazo permite reduzir acentuadamente a obesidade severa, preservando o crescimento e a porcentagem de massa magra.

OBJECTIVE: To describe the effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents. METHODS: A total of 728 extremely obese adolescents, including 249 boys (aged 15.25±1.56 years) and 479 girls (aged 15.34±1.59 years) received multidisciplinary therapy during a period of 3 to 9 months. The therapy consisted of reduced energy intake, dietetic education, physical exercises and psychological therapy. Body composition was assessed by bioelectrical impedance analysis, and physical capacity was assessed by the multistage cycle ergometer test. Type and duration of each activity were recorded using a daily controlled activity diary. RESULTS: There was a significant decrease (p < 0.05) in body mass (27.84±12.49 kg for boys and 21.60±9.87 kg for girls), body mass index (9.19±3.88 kg/m² for boys and 7.72±3.98 kg/m² for girls) and fat mass. In addition, the percentage of fat free mass increased significantly (p < 0.05) in boys (from 58.8±6.41 to 69.98±7.43 percent) and in girls (from 51.86±4.96 to 60.04±5.65 percent). CONCLUSION: Long-term multidisciplinary approach allows significant reduction in severe obesity, preserving growth and percentage of fat free mass.

Plaqueta e leptina em adolescentes com obesidade / Platelet and leptin in obese adolescents

OBJETIVOS: Analisar a influência de obesidade na contagem de células imunológicas e na concentração dos hormônios cortisol e leptina, a fim de estabelecer uma relação entre as variáveis analisadas. MÉTODOS: Foram recrutados 27 adolescentes obesos [índice de massa corporal (IMC) ≥ percentil 95[ e 21 não-obesos (IMC ≤ percentil 75), de ambos os sexos, com idade entre 15 e 19 anos, na fase pós-púbere. O IMC foi calculado através da divisão do peso pela altura ao quadrado e a composição corporal foi estimada por pletismografia no sistema Bod PodTM. Amostras de sangue foram colhidas para análise de leucócitos, neutrófilos, linfócitos, monócitos, plaquetas, cortisol e leptina. O teste de Kolmogorov-Smirnov foi utilizado, seguido pelo teste t de Student independente supondo distribuição normal. O nível de significância estabelecido foi p < 0,05 e expresso como média ± desvio padrão. Os dados foram analisados utilizando o programa SPSS para Windows versão 12.0. RESULTADOS: Não houve diferença entre o grupo obeso e o não-obeso na concentração sérica de leucócitos, neutrófilos, linfócitos, monócitos e cortisol. O grupo de adolescentes obesos apresentou maiores concentrações de plaquetas e leptina (p < 0,01). A prevalência de hiperleptinemia foi de 25,92 por cento nos adolescentes obesos (15,38 por cento, sexo masculino e 35,7 por cento, feminino). CONCLUSÕES: Os adolescentes obesos apresentaram maiores concentrações de plaquetas e leptina em comparação aos não-obesos. Observou-se que as adolescentes obesas apresentaram maior prevalência de hiperleptinemia do que os adolescentes obesos.

OBJECTIVE: To analyze the influence of obesity status on immune cell count and concentration of the hormones cortisol and leptin, in order to establish a relationship among the variables analyzed. METHODS: We recruited 27 obese [body mass index (BMI) ≥ 95th percentile[ and 21 non-obese (BMI ≤ 75th percentile) adolescent boys and girls, aged 15-19 years at the post-pubertal stage. BMI was calculated as body weight divided by height squared, and body composition was estimated by plethysmography in the Bod PodTM system. Blood samples were collected to analyze leukocytes, neutrophils, lymphocytes, monocytes, platelets, cortisol, and leptin. The Kolmogorov-Smirnov test was performed, followed by the independent Student t test in case of normal distribution. Significance values were set at p < 0.05 and expressed as means ± standard deviation. The statistical package SPSS for Windows version 12.0 was used. RESULTS: There was no difference between obese and non-obese adolescents in terms of leukocyte, neutrophil, lymphocyte, monocyte and cortisol serum concentrations. The group of obese adolescents presented higher platelet and leptin concentrations (p < 0.01). The prevalence of hyperleptinemia was 25.92 percent in the obese adolescents (15.38 percent in boys and 35.7 percent in girls). CONCLUSIONS: Obese adolescents have higher platelet and leptin concentrations in comparison with non-obese adolescents. It was also found that obese girls presented a higher prevalence of hyperleptinemia than obese boys.

Efeito da desnutrição protéica pré e pós-natal sobre a morfologia, a diferenciação e o metabolismo do tecido muscular estriado esquelético em ratos / The effects of prenatal and postnatal malnutrition on the morphology, differentiation, and metabolism of skeletal striated muscle tissue in rats

OBJETIVO: Estudar características morfológicas, metabolismo e habilidades contráteis do músculo submetido a desnutrição protéica pré e pós-natal. MÉTODOS: Distribuição dos animais em dois grupos: controle, dieta normoprotéica (GC; n = 15; 5/5/5) e desnutrido, dieta hipoprotéica (GD; n = 15; 5/5/5), observados respectivamente no sétimo, 14º e 28º dia do período experimental. Foram avaliados massa corporal total, peso, habilidades contráteis e a morfologia do músculo tibial anterior. Amostras de tecidos com 8 m de espessura de ratos com idades de 7, 14 e 28 dias, corados por hematoxilina e eosina, e outros submetidos aos métodos histoquímicos nicotinamida adenina tetrazólio redutase (NADH-TR) e miofibrilar (m-ATPase) (pH = 4,4). RESULTADOS: Os pesos corporal e muscular apresentaram-se menores nos grupos desnutridos. Aos 7 dias de desnutrição, o músculo apresentou fibras com menor diâmetro, maior polimorfismo e maior teor de tecido conjuntivo endomisial. Nas histoquímicas, tipos de fibras sem delimitação segura. Aos 14 dias de desnutrição, fibras menores, mais polimórficas, muitas com núcleos centrais e moderado teor de tecido conjuntivo endomisial. Quanto à contração, a reação m-ATPase evidenciou fibras lentas e rápidas. A reação NADH-TR revelou os tipos de fibras slow oxidative, fast oxidative glycolytic e fast glycolytic. Aos 28 dias de desnutrição, fibras menores, agrupadas com contornos variáveis. Quanto ao tipo de contração e metabolismo, os três tipos de fibras apresentaram limites de reconhecimento indistinto. CONCLUSÃO: Os resultados experimentais sugerem que, além da redução no número de fibras, a desnutrição promove um retardamento na diferenciação das características morfológicas, metabólicas e contráteis dos tipos de fibras musculares esqueléticas em ratos na fase de crescimento.

OBJECTIVE: To study the contractile properties, metabolism and morphological characteristics of muscles submitted to prenatal and postnatal protein malnutrition. METHODS: Animals were distributed into two groups: Control, normoprotein diet (CG; n = 15; 5/5/5), and Malnourished, hypoprotein diet (MG; n = 15; 5/5/5), and examined on the 7th, 14th, and 28th days of the experiment. Total body mass, weight, and the contractile properties and morphology of the anterior tibial muscle were assessed. Several 8 µm-thick tissue samples were taken from 7, 14, and 28 day old rats and stained with HE or subjected to NADH-TR or m-ATPase (pH = 4.4) techniques. RESULTS: Body and muscle weight were lower in the malnourished group. On the 7th day of malnutrition, muscle samples exhibited fibers with smaller diameter, higher polymorphism and higher endomysial conjunctive tissue content. Histochemical methods were unable to precisely determine the types of fiber present. On the 14th day, there were smaller muscle fibers, more polymorphism, many of them with central nuclei and moderate endomysial conjunctive tissue content. With reference to contractile properties, the m-ATPase reaction identified both slow and fast fibers. The NADH-TR reaction revealed the following types of fiber: slow oxidative (SO), fast oxidative glycolytic (FOG) and fast glycolytic (FG). On the 28th day smaller, bunched muscle fibers varying shapes. All three types of fiber exhibited unclear recognition limits with respect to contraction and metabolism. CONCLUSION: Our experimental results suggest that, in addition to the reduction in numbers of fibers, malnutrition retards the differentiation of the morphological, metabolic, and contractile characteristics of skeletal muscle fibers in growing rats.

Tratamento multidisciplinar reduz o tecido adiposo visceral, leptina, grelina e a prevalência de esteatose hepática não alcoólica (NAFLD) em adolescentes obesos / Multidisciplinary treatment reduces visceral adiposity tissue, leptin, ghrelin and the prevalence of non-alcoholic fat liver disease (NAFLD) in obese adolescents

O objetivo do presente estudo foi avaliar as alterações promovidas, por intervenção multidisciplinar, nas concentrações plasmáticas de grelina e leptina, adiposidade visceral e prevalência de esteatose hepática não alcoólica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m²) e 12 meninos (IMC 37,08 ± 3,17kg/m²), com idade entre 15 e 19 anos, quanto à concentração de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnóstico de NAFLD pelo método de ultra-sonografia. Os resultados demonstraram redução significante na concentração circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda redução percentual na prevalência de NAFLD, sendo este um resultado relevante, visto que esta doença pode progredir para cirrose, tanto em crianças quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabólico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

The aim of this study was to assess the changes promoted by a multidisciplinary therapy in ghrelin and leptin concentrations, visceral adiposity and non-alcoholic fat liver disease-NAFLD, in obese adolescents. A total of 28 obese adolescents, 16 girls (BMI 34.58 ± 3,86 wt/ht²) and 12 boys (BMI 37.08 ± 3.17 wt/ht²), aged between 15 and 19 years old, was evaluated to leptin, ghrelin and insulin concentrations, visceral adiposity and NAFLD through ultrasonography. The results showed a significant decrease in ghrelin, leptin concentrations and visceral adiposity (p < 0.01). Moreover, a decrease in the NAFLD prevalence was observed. It is an important result, since this disease can progress to cirrhosis, not only in children but also in obese adolescents. This kind of treatment can be efficient to improve metabolic and hormonal profile, as well as, to control obesity and related co-morbidities in obese adolescents.

El objetivo del presente trabajo ha sido evaluar las alteraciones promovidas por la intervención multidisciplinar, en las concentra- ciones plasmáticas de grelina y leptina, adiposidad visceral y prevalencia de esteatosis hepática no alcohólica - NAFLD, en adolescentes obesos. 28 adolescentes obesos, 16 chicas (IMC 34,58 ± 3,86 kg/m²) y 12 chicos (IMC 37,08 ± 3,17 kg/m²), con edades entre 15 y 19 años, fueron evaluados respecto a la concentración de leptina, grelina, insulina, así como a la adiposidad visceral y el diagnóstico de NAFLD por el método de ultrasonografía. Los resultados demostraron una reducción significante en la concentra- ción circulante de grelina y leptina y en la adiposidad visceral (p < 0,01). Hubo aún una reducción porcentual en la prevalencia de NAFLD, siendo este un resultado relevante, ya que esta enfermedad puede progresar hasta la cirrosis, tanto en niños como en adolescentes obesos. Este tipo de tratamiento demostró ser eficiente en la mejora del perfil metabólico y hormonal, contribuyendo para el control de la obesidad y su comorbilidad en adolescentes obesos.

Perfil antropométrico e ingestão de macronutrientes em atletas profissionais brasileiros de futebol, de acordo com suas posições / Anthropometric profile and macronutrient intake in professional Brazilian soccer players according to their field positioning

O objetivo do presente estudo foi avaliar o perfil antropométrico, o valor energético total da dieta (VET) e a ingestão de macronutrientes em atletas profissionais de futebol, assim como verificar se existem diferenças entre as posições: goleiros (n = 12), zagueiros (n = 20), meio-campistas (n = 41), laterais (n = 21) e atacantes (n = 24) dentre as variáveis estudadas. A amostra foi composta por 118 futebolistas (23 anos ± 5 anos), profissionais da elite do Estado de São Paulo. Todas as avaliações foram realizadas durante o período competitivo. A composição corporal foi determinada através da medida das dobras cutâneas e os dados nutricionais obtidos por inquérito alimentar. Os goleiros e zagueiros mostraram-se mais altos, pesados e com maior quantidade de massa magra do que os demais atletas, porém sem diferenças significativas em relação à percentagem de gordura. Em relação aos hábitos alimentares destes atletas, verificou-se que os mesmos apresentaram dieta com baixa ingestão de carboidratos, hiperprotéica e tendência à hiperlipídica. Assim, pode-se concluir que existem diferenças antropométricas entre as posições estudadas e inadequações nutricionais. Os resultados do presente estudo sugerem que sejam realizadas intervenções nutricionais em futebolistas de elite, visando melhorar o desempenho.

The aim of this study was to evaluate the anthropometric profile, total energy value of the diet and macronutrient intake of professional soccer players, as well as verifying the differences among tactical positions: goalkeepers (n = 12), center backs (n = 20), median fields (n = 41), running backs (n = 21) and strikers (n = 24) in the studied variables. The sample was composed by 118 professional players (23 years ± 5 years) of the elite of the São Paulo state. All the evaluations were accomplished during the competitive period. Body composition was determined through skin folds measurement and the dietary data obtained through usual food intake. The goalkeepers and center backs were shown taller, heavier and with larger amount of lean mass than the other athletes, even so without significant differences among body fat percentage. The dietary habits of these athletes indicate a lower carbohydrate ingestion, hyperprotein and tendency to hyperlipidic diet. Thus, we can conclude that there are nutritional inadequacies and anthropometric differences among the players and their tactical positions. The results of the present study suggest that nutritional interventions are accomplished in the soccer elite, seeking to maximize the athletic performance.

El objetivo del estudio presente era evaluar el perfil antropométrico, el total del valor energético de la dieta (VED) y la ingestión de macronutrientes en los atletas profesionales de fútbol, así como verificar si existen diferencias entre las posiciones: el arquero (el n = 12), defensa (el n = 20), mediocampistas (el n = 41), laterales (el n = 21) y atacantes (el n = 24) entre las variables estudiadas. La muestra estaba compuesta por 118 jugadores del fútbol (23 años ± 5 años), profesionales de élite del Estado de San Paulo. Todas las evaluaciones fueron realizadas durante el período competitivo. La composición corporal se estableció a través de la medida de los pliegues cutáneos y los datos nutricionales obtenidos por encuesta alimentaría. Se mostraron el arqueros y defensas superiores, y fuertes y con una cantidad más grande de masa magra que los otros atletas, sin embargo hubo diferencias significantes respecto al porcentaje de gordura. Respecto a los hábitos alimentarios de estos atletas, se verificó que los mismos presentaron la dieta con baja ingestión de carbohidratos, hiperprotéica y con tendencia a la hiperlipidez. Así, puede concluirse que existen diferencias antropométricas entre las posiciones estudiadas e insuficiencias nutritivas. Los resultados del estudio presente sugieren que las intervenciones nutritivas sean cumplidas en jugadores de fútbol de elite, mientras intentando buscar mejorar la acción física.

Avaliação da composição corporal em adolescentes obesos: o uso de dois diferentes métodos / Body composition evaluation in obese adolescents: the use of two different methods

A pletismografia é um método rápido e fácil para determinação da composição corporal que utiliza a relação inversa entre pressão e volume. O objetivo do presente estudo foi o de comparar os valores obtidos com o método pletismografia com os valores observados com o DEXA em uma população de adolescentes obesos. Participaram da amostra 88 adolescentes pós-púberes de ambos os sexos, com idades entre 15 e 19 anos (17,01 ± 1,6) ingressantes de um programa de atividade física multidisciplinar. Os voluntários foram submetidos a uma avaliação da composição corporal em dias distintos dentro da mesma semana, pelo método de pletismografia e outra avaliação pelo método DEXA. Quando os métodos foram comparados, não se observaram diferenças significativas entre eles; além disso, foram observadas correlações significativas entre os parâmetros comuns dos dois métodos (massa magra, massa gorda (kg) e massa gorda ( por cento), r = 0,88 p < 0,05; r = 0,92 p < 0,05; r = 0,75 p < 0,05, respectivamente). Nossos dados sugerem que, para esta população específica, a pletismografia pode ser utilizada como um método de avaliação da composição corporal.