Estratificação de risco dos pacientes na fila de espera para cirurgia bariátrica no Hospital do Servidor Público Municipal para elaboração de pontuação do Protocolo de Gravidade SOS (Score de Obesidade do Servidor) / Risk stratification of patients on the waiting list for bariatric surgery at the Hospital do Servidor Público Municipal to prepare a score for the SOS Severity Protocol (Server Obesity Score)

A obesidade é confirmada como um dos principais fatores de risco de doenças cardiovasculares, diabetes mellitus e doença renal crônica, entre outros. Na projeção para os próximos 12 anos, o Brasil terá 41% de sua população adulta com obesidade, segundo a nova edição do Atlas Mundial da Obesidade 2023. O número é confirmado para 2035 a partir das tendências projetadas na prevalência de obesidade. Para os adultos, o crescimento será de 2,8% por ano, enquanto nas crianças, fator mais preocupante, o crescimento anual será de 4,4%. O objetivo deste estudo é a estratificação de risco dos pacientes que estão aguardando cirurgia bariátrica pelo HSPM (Hospital do Servidor Público Municipal), através do protocolo SOS (Score de Obesidade do Servidor), ao definir critérios de gravidade e priorização desses pacientes, correlacionando a obesidade ao grau de disfunções orgânicas dos mesmos. Em nosso serviço o tempo na fila de espera para a cirurgia bariátrica gira em torno de 6 a 7 anos, para todos os pacientes, não levando em consideração as comorbidades e riscos destes indivíduos, e no Brasil não há até hoje nenhum protocolo de priorização por comorbidades descrito para a cirurgia bariátrica. Foi realizada a estratificação de gravidade dos pacientes que aguardam pela cirurgia bariátrica no HSPM, com elaboração de pontuação de risco alto (maior ou igual que cinco pontos: prioridade vermelha), médio (3 a 4 pontos: prioridade amarela) e baixo (0 a 2 pontos: prioridade verde), através do protocolo SOS (Score de Obesidade do Servidor). Palavras-chave: Cirurgia bariátrica. Obesidade. Listas de espera. Priorização. Manejo de Obesidade.

Tyramine exerts hypolipidemic and anti-obesity effects in vivo

Abstract Obesity and dyslipidemia are conditions often associated with cardiovascular risk, inflammation, oxidative stress, and death. Thus, a new approach has been highlighted to promote research and development of pharmacological tools derived from natural sources. Among the most widely studied groups of substances, polyphenols such as tyramine stand out. This study investigated hypolipidemic and anti-obesity properties of tyramine. Oral toxicity evaluation, models of dyslipidemia and obesity were used. To induce dyslipidemia, Poloxamer-407 (P-407) was administered intraperitoneally. In the hypercholesterolemic and obesity model, specific diet and oral tyramine were provided. After 24h of P-407 administration, tyramine 2 mg/kg (T2) decreased triglycerides (TG) (2057.0 ± 158.5 mg/dL vs. 2838 ± 168.3 mg/dL). After 48h, TG were decreased by T2 (453.0 ± 35.47 vs. 760.2 ± 41.86 mg/dL) and 4 mg/kg (T4) (605.8 ± 26.61 760.2 ± 41.86 mg/dL). T2 reduced total cholesterol (TC) after 24h (309.0 ± 11.17 mg/dL vs. 399.7 ± 15.7 mg/dL); After 48h, 1 mg/kg (T1) (220.5 ± 12.78 mg/dL), T2 (205.8 ± 7.1 mg/dL) and T4 (216.8 ± 12.79 mg/dL), compared to P-407 (275.5 ± 12.1 mg/dL). The treatment decreased thiobarbituric acid reactive substances and nitrite in liver, increased superoxide dismutase, reduced the diet-induced dyslipidemia, decreasing TC around 15%. Tyramine reduced body mass, glucose, and TC after hypercaloric feed. Treatment with 5 mg/L (0.46 ± 0.04 ng/dL) and 10 mg/L (0.44 ± 0.02 ng/dL) reduced plasma insulin (1.18 ± 0.23 ng/dL). Tyramine increased adiponectin at 5 mg/L (1.02 ± 0.02 vs. 0.83 ± 0.02 ng/mL) and 10mg/L (0.96 ± 0.04 ng/mL). In conclusion, tyramine has low toxicity in rodents, has antioxidant effect, reduces plasma triglycerides and cholesterol levels. However, further studies should be conducted in rodents and non-rodents to better understand the pharmacodynamic and pharmacokinetic properties of tyramine

Efeitos da ingestão do suco de laranja Pera e suco de laranja Moro na microbiota intestinal e marcadores inflamatórios em indivíduos com obesidade / Effect of Pera and Moro orange juice consumption on the gut microbiota and inflammatory parameters in volunteers with obesity

A obesidade é uma doença complexa que está associada inflamação crônica de baixo grau que contribui para o desenvolvimento de diversos distúrbios metabólicos como a resistência à insulina e estudos recentes sugerem a influência da microbiota intestinal no desenvolvimento e manutenção da doença. Diversos estudos apontam para o benefício da ingestão de frutas e vegetais na prevenção e tratamento de doenças crônicas. O suco de laranja contém diversos compostos bioativos com ações anti-inflamatórias, antioxidantes com efeitos na composição da microbiota intestinal. Deste modo, o objetivo principal deste estudo foi avaliar os efeitos da ingestão do suco de laranja Pera e Moro sobre a composição da microbiota intestinal e de parâmetros inflamatórios em voluntários com obesidade e resistência à insulina. Foi realizado um ensaio clínico crossover com suplementação de suco de laranja (400ml/dia) por 15 dias com um período de washout de 40 dias. As análises de sangue, fezes, urina, composição corporal, consumo alimentar foram realizadas antes e após cada intervenção. A comparação entre os tratamentos foi realizada utilizando equações de estimativas generalizadas e adotou-se um nível de significância de 5%. Em relação à microbiota intestinal, em ambos os tratamentos, os dois filos mais abundantes foram Firmicutes e Actinobateria. Dos gêneros analisados, observou-se maior abundância de Bifidobacterium após a suplementação com o suco de laranja Moro. O suco de laranja Pera promoveu uma diminuição da zonulina e o suco de laranja Moro contribuiu para redução de citocinas inflamatórias, diminuição da pressão arterial e aumento nos níveis de acetato nas fezes. Após a separação dos voluntários por grau de obesidade, observamos que o suco de laranja Moro contribuiu para o aumento na abundância de Akkermansia, Alistipes, Bacteroides e Catenibacterium em indivíduos com obesidade grau 3. Além disso, em ambos os sucos encontramos redução da razão Firmicutes/Bacteroidetes e aumento da excreção de metabólitos de flavonoides após os tratamentos. Diante destes resultados, conclui-se que o suco de laranja Pera apresentou ações positivas sobre a permeabilidade intestinal e o suco de laranja Moro promoveu efeitos mais expressivos na modulação da inflamação associada à obesidade e da microbiota intestinal

Obesity is a complex disease that is associated with low-grade chronic inflammation, and it contributes to the development of several metabolic disorders such as insulin resistance, and recent studies suggest the influence of the intestinal microbiota in the development and maintenance of the disease. Several studies have suggested the benefit of fruits and vegetables consumption in the prevention and treatment of chronic diseases. The orange juice contains some bioactive compounds with anti-inflammatory and antioxidant actions with effects in the composition of the gut microbiota. Thus, the main objective of this study was to evaluate the effects of Pera and Moro orange juice consumption on the composition of the gut microbiota and inflammatory parameters in volunteers with obesity and insulin resistance. A crossover clinical trial was carried out with orange juice supplementation (400ml/day) for 15 days with a washout period of 40 days. Blood, feces, urine, body composition, food consumption were analyzed before and after each intervention. Comparison between treatments was performed using generalized estimating equations and a significance level of 5% was adopted. In relation to gut microbiota, in both treatments, the two most abundant phyla were Firmicutes and Actinobateria. In the analysis of bacterial genera, a greater abundance of Bifidobacterium was observed after supplementation with Moro orange juice. The Pera orange juice reduced zonulin and Moro orange juice contributed to a reduction on inflammatory cytokines, a decrease in blood pressure and an increase in acetate levels in the stool. After separating the volunteers by degree of obesity, we observed that Moro orange juice contributed to the increase in the abundance of Akkermansia, Alistipes, Bacteroides and Catenibacterium in individuals with grade 3 obesity. Furthermore, in both juices we found a reduction in the Firmicutes/Bacteroidetes ratio and increased excretion of flavonoid metabolites after treatments. Therefore, we concluded that Pera orange juice had positive actions on intestinal permeability and Moro orange juice promoted more expressive effects on the modulation of inflammation associated with obesity and on the intestinal microbiota

Machine Learning to Identify Metabolic Subtypes of Obesity: A Multi-Center Study.

Background and objective: Clinical characteristics of obesity are heterogenous, but current classification for diagnosis is simply based on BMI or metabolic healthiness. The purpose of this study was to use machine learning to explore a more precise classification of obesity subgroups towards informing individualized therapy. Subjects and Methods: In a multi-center study (n=2495), we used unsupervised machine learning to cluster patients with obesity from Shanghai Tenth People's hospital (n=882, main cohort) based on three clinical variables (AUCs of glucose and of insulin during OGTT, and uric acid). Verification of the clustering was performed in three independent cohorts from external hospitals in China (n = 130, 137, and 289, respectively). Statistics of a healthy normal-weight cohort (n=1057) were measured as controls. Results: Machine learning revealed four stable metabolic different obese clusters on each cohort. Metabolic healthy obesity (MHO, 44% patients) was characterized by a relatively healthy-metabolic status with lowest incidents of comorbidities. Hypermetabolic obesity-hyperuricemia (HMO-U, 33% patients) was characterized by extremely high uric acid and a large increased incidence of hyperuricemia (adjusted odds ratio [AOR] 73.67 to MHO, 95%CI 35.46-153.06). Hypermetabolic obesity-hyperinsulinemia (HMO-I, 8% patients) was distinguished by overcompensated insulin secretion and a large increased incidence of polycystic ovary syndrome (AOR 14.44 to MHO, 95%CI 1.75-118.99). Hypometabolic obesity (LMO, 15% patients) was characterized by extremely high glucose, decompensated insulin secretion, and the worst glucolipid metabolism (diabetes: AOR 105.85 to MHO, 95%CI 42.00-266.74; metabolic syndrome: AOR 13.50 to MHO, 95%CI 7.34-24.83). The assignment of patients in the verification cohorts to the main model showed a mean accuracy of 0.941 in all clusters. Conclusion: Machine learning automatically identified four subtypes of obesity in terms of clinical characteristics on four independent patient cohorts. This proof-of-concept study provided evidence that precise diagnosis of obesity is feasible to potentially guide therapeutic planning and decisions for different subtypes of obesity. Clinical Trial Registration: www.ClinicalTrials.gov, NCT04282837.

Circulating IL-6, clusterin and irisin in obese subjects with different grades of obesity: association with insulin resistance and sexual dimorphism.

OBJECTIVE: There are discrepancies about the relationship of IL-6, clusterin and irisin with obesity and obesity associated insulin resistance and also about their sexual dimorphism. This study aimed at evaluating the circulating levels of IL-6, clusterin and irisin in obese subjects of both sexes who had different grades of obesity and examining their sexual dimorphism and their association with insulin resistance. METHODS: This study included 176 non-diabetic subjects of both sexes who were classified according to their sex into two groups; the male and the female groups. The male group (88 men) was classified according to BMI into; group 1 (22 lean men), group 2 (22 class I obese men), group 3 (22 class II obese men) and group 4 (22 class III obese men). The female group (88 women) was classified according to BMI exactly as the male group. Metabolic parameters, IL-6, clusterin, and irisin levels were measured. Data were analyzed by ANOVA test, post hoc Tukey's test and independent t-test. Pearson correlation was used to assess the association between variables. RESULTS: In obese subjects of both sexes, circulating IL-6, clusterin and irisin levels were significantly elevated and positively correlated with HOMA-IR. Obese males showed significantly higher HOMA-IR, IL-6, clusterin and irisin levels than obese females. CONCLUSION: Obesity in both sexes, especially in males was associated with high levels of IL-6, clusterin and irisin and worsened the metabolic pattern. Circulating IL-6, clusterin and irisin may represent possible therapeutic targets for insulin resistance in obese subjects.

Circulating IL-6, clusterin and irisin in obese subjects with different grades of obesity: association with insulin resistance and sexual dimorphism

ABSTRACT Objective: There are discrepancies about the relationship of IL-6, clusterin and irisin with obesity and obesity associated insulin resistance and also about their sexual dimorphism. This study aimed at evaluating the circulating levels of IL-6, clusterin and irisin in obese subjects of both sexes who had different grades of obesity and examining their sexual dimorphism and their association with insulin resistance. Subjects and methods: This study included 176 non-diabetic subjects of both sexes who were classified according to their sex into two groups; the male and the female groups. The male group (88 men) was classified according to BMI into; group 1 (22 lean men), group 2 (22 class I obese men), group 3 (22 class II obese men) and group 4 (22 class III obese men). The female group (88 women) was classified according to BMI exactly as the male group. Metabolic parameters, IL-6, clusterin, and irisin levels were measured. Data were analyzed by ANOVA test, post hoc Tukey's test and independent t-test. Pearson correlation was used to assess the association between variables. Results: In obese subjects of both sexes, circulating IL-6, clusterin and irisin levels were significantly elevated and positively correlated with HOMA-IR. Obese males showed significantly higher HOMA-IR, IL-6, clusterin and irisin levels than obese females. Conclusion: Obesity in both sexes, especially in males was associated with high levels of IL-6, clusterin and irisin and worsened the metabolic pattern. Circulating IL-6, clusterin and irisin may represent possible therapeutic targets for insulin resistance in obese subjects.

Recognizing obesity as a disease.

Obesity is a chronic, progressive, relapsing disease that impairs health and quality of life and shortens lifespan. Genetic and environmental factors contribute to its development and persistence. If left untreated, it worsens and leads to serious health consequences for those affected, as well as their offspring and future generations. Obesity complications drive many of the conditions that are seen routinely in clinical practice. By treating obesity first, many of these conditions improve or resolve. Given the seriousness of the disease, it is imperative that clinicians in primary and specialty care settings diagnose and treat or refer so that patients can receive appropriate treatment. Evidence-based treatment that is individualized and patient centered improves health and quality of life.

Insights to the neural response to food cues in class III compared with class I and II obese adults using a sample of endometrial cancer survivors seeking weight loss.

BACKGROUND: The rates of severe or Class III obesity (BMI ≥ 40.0 kg/m2) and endometrial cancer (EC) incidence and mortality have been increasing significantly in the United States. Adults with severe obesity are more likely to die and women with severe obesity have a higher risk of EC development and mortality than those with Class I/II obesity (BMI: 30-<40 kg/m2). However, no prior studies have evaluated the neural response to food cues by obesity severity/class in adults with or without cancer. METHODS: We conducted a functional magnetic resonance imaging visual food cue task in 85 obese Stage I EC survivors who were seeking weight loss in a lifestyle intervention at baseline. We evaluated the neural response to high-calorie vs. non-food images after an overnight fast (fasted state) and after eating a standardized meal (fed state), and grouped patients by obesity class (Class I/II: n = 38; Class III: n = 47). RESULTS: In the fasted state, we found increased activation in several regions including the dorsolateral prefrontal cortex (DLPFC) in Class III and Class I/II patients (whole brain cluster corrected (WBCC), p < 0.05), which was significantly higher in Class III vs. Class I/II (p < 0.05). We found decreased activation in the insula in the fasted state, which was significantly lower in Class I/II vs. Class III (p = 0.03). In the fed state, we found increased activation in the DLPFC in Class III and Class I/II (WBCC, p < 0.05). The increased activation in cognitive control/inhibition regions (DLPFC) is consistent with the summative literature; however, the decreased activation in taste information processing regions (insula) was unexpected. CONCLUSIONS: Our results provide novel insights on food cue response between different classes of obesity and highlight the importance of targeting the DLPFC in weight loss interventions, particularly in severely obese patients. Additional studies examining food-related neural circuitry between different classes of obesity are needed.

Comparing the predictive ability of the Edmonton Obesity Staging System with the body mass index for use of health services and pharmacotherapies in Australian adults: A nationally representative cross-sectional study.

We assessed the value of the Edmonton Obesity Staging System (EOSS) compared with the body mass index (BMI) for determining associations with use of health services and pharmacotherapies in a nationally representative sample of participants in the 2011-2013 Australian Health Survey. A subsample of participants aged 18 years or over, with at least overweight (BMI ≥ 25 kg/m2 ) or central obesity (waist measurement of ≥102 cm for men; ≥88 cm for women), and who had provided physical measurements (n = 9730) were selected for analysis. For statistical significance of each predictor, we used logistic regression for model comparisons with the BMI and EOSS separately, and adjusted for covariates. For relative explanatory ability, we used the Nagelkerke pseudo R2 , receiver operating characteristic curve, and area under curve statistic. The EOSS was significantly better than the BMI for predicting polypharmacy and most of the health service use variables. Conversely, the BMI was significantly better than the EOSS for predicting having discussed lifestyle changes relevant to weight loss with the primary care physician. Clinicians, health care professionals, consumers, and policy makers should consider the EOSS a more accurate predictor of polypharmacy and health service use than the BMI in adults with overweight or obesity.

Conventional weight loss interventions across the different BMI obesity classes: A systematic review and quantitative comparative analysis.

OBJECTIVE: The recommendation for conventional body weight loss (BWL) treatment in obesity is 5-10%. It is not clear whether BWL is similar across the three different body mass index (BMI) obesity classes. The aim was to provide an overview on BWL across these classes in moderate lifestyle/diet intervention programs. METHOD: A systematic literature search was conducted and the evidence of randomized controlled trials (RCTs) and pre-post design studies synthesized. The outcome was BWL. RESULTS: For RCTs, mean BWL in the intervention group was 3.6 kg (class I) and 5.3 kg (class II), which equates to 4 and 5% BWL, respectively. None of the assessed class III obesity studies met the inclusion criteria. For pre-post design studies, mean BWL was 5.4 kg (class I), 5.5 kg (class II) and 7.9 kg (class III), with high variation within and across studies in the latter. This equates to 6, 5 and, 6% BWL, respectively. CONCLUSIONS: BWL of moderate BWL programs are similar across the different obesity classes. For class I obesity, the results differ between RCT and pre-post design studies by 2% BWL. The high variation of BWL in class III obesity might reflect different states of motivation such as the attitude towards bariatric surgery.

Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US.

Importance: Prior studies have identified an association between obesity and prescription opioid use in the US. However, the pain conditions that are factors in this association remain unestablished. Objective: To investigate the association between obesity and pain diagnoses recorded by primary care clinicians as reasons for prescription of opioids. Design, Setting, and Participants: A cross-sectional study including 565 930 patients aged 35 to 64 years with a body mass index (BMI) measurement recorded in 2016 was conducted. Electronic health records of patients seen by primary care clinicians in the US in the multipayer athenahealth network from January 1, 2015, to December 31, 2017, were reviewed, and data were analyzed from March 1 to September 15, 2019. Main Outcomes and Measures: Any prescription of opioids in the 365 days before or after the first BMI measurement in 2016 were identified. All International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, claims within 7 days before each opioid prescription were captured and classified using a pain diagnosis typologic system. Weight was categorized as underweight (BMI, 18.5-19.9), normal weight (BMI, 20.0-24.9), overweight (BMI, 25.0-29.9), obese I (BMI, 30-34.9), obese II (BMI, 35.0-39.9), obese III (BMI, 40.0-49.9), and obese IV (BMI, 50.0-80.0). Results: Among 565 930 patients, 329 083 (58.1%) were women. A total of 125 093 patients (22.1%) were aged 35 to 44 years, 199 384 patients (35.2%) were 45 to 54 years, and 241 453 patients (42.7%) were 55 to 64 years. A total of 177 631 patients (31.4%) were overweight and 273 135 patients (48.2%) were obese at baseline. Over 2 years, 93 954 patients (16.6%) were prescribed opioids. The risk of receiving prescription opioids increased progressively with BMI (adjusted relative risk for overweight: 1.08; 95% CI, 1.06-1.10; obese I: 1.24; 95% CI, 1.22-1.26; obese II: 1.33; 95% CI, 1.30-1.36; obese III: 1.48; 95% CI, 1.45-1.51; and obese IV, 1.71; 95% CI, 1.65-1.77). The percentage of patients with opioid prescriptions attributable to an overweight or obese BMI was 16.2% (95% CI, 15.0%-17.4%). Prescription opioids for management of osteoarthritis (relative risk for obese vs normal weight, 1.90; 95% CI, 1.77-2.05) and other joint disorders (relative risk, 1.63; 95% CI, 1.55-1.72) both had stronger associations with obesity than the mean for any pain diagnosis (relative risk, 1.33; 95% CI, 1.31-1.36). Osteoarthritis, other joint disorders, and other back disorders comprised a combined 53.4% of the absolute difference in prescription of opioids by obesity. Conclusions and Relevance: Joint and back disorders appear to be the most important diagnoses in explaining the increased receipt of opioid prescriptions among patients with obesity. Addressing the opioid crisis will require attention to underlying sources of demand for prescription opioids, including obesity, through its associations with pain.

Does body mass index affect the rate of adverse outcomes in total hip and knee arthroplasty? A retrospective review of a total joint replacement database

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are reliable surgical options to treat pain and disability resulting from degenerative conditions around the hip and knee. Obesity is a modifiable risk factor that contributes to significant morbidity. The purpose of this study was to retrospectively compare outcomes in primary hip and knee arthroplasty for patients with increased body mass index (BMI) and those with normal BMI, using data from the registry of the Alberta Bone and Joint Health Institute (ABJHI). Methods: We retrospectively reviewed the data compiled in the ABJHI registry between March 2010 and July 2016. We reviewed outcomes with respect to length of stay, discharge destination, 30-day readmission, postoperative infection, postoperative transfusion requirements, postoperative adverse events and in-hospital postoperative mechanical complications. Results: A total of 10 902 patients (6076 women, 4826 men) who underwent THA and 16 485 patients (10 057 women, 6428 men) who underwent TKA were included in the study. For both THA and TKA, patients with increased BMI had an increased number of in-hospital medical events, had an increased rate of deep infection, were less likely to be discharged home (p < 0.001) and had decreased transfusion requirements (p < 0.001) than patients whose weight was in the normal range. Increased BMI increased the rate of 30-day readmission and length of stay in the THA cohort but not in the TKA cohort. Increased BMI had no effect on acute postoperative dislocation or periprosthetic fractures. Patients with a BMI of 30 kg/m2 or greater required a THA 1.7 years earlier than patients of normal weight, patients whose BMI was 35 kg/m2 or greater required a THA 3.4 years earlier, and patients whose BMI was 40 kg/m2 or greater required a THA 5.8 years earlier. In the TKA cohort, patients with a BMI of 30 kg/m2 or greater required a TKA 2.7 years earlier than patients whose weight was in the normal range, patients with a BMI of 35 kg/m2 or greater required a TKA 4.6 years earlier, and patients whose BMI was 40 kg/m2 or greater required a TKA 7.6 years earlier. Conclusion: Our study quantifies the effects of obesity in primary hip and knee arthroplasty. It provides a greater understanding of the risks in the obese population when contemplating joint arthroplasty.

Contexte: La prothèse totale de la hanche (PTH) et la prothèse totale du genou (PTG) sont des options chirurgicales fiables pour traiter la douleur et l'invalidité résultant de maladies dégénératives de la hanche et du genou. L'obésité est un facteur de risque modifiable qui contribue significativement à la morbidité. Le but de cette étude était de comparer de manière rétrospective le résultat des interventions primaires pour prothèses de la hanche et du genou selon que les patients avaient un indice de masse corporelle (IMC) normal ou élevé à partir des données du registre de l'Alberta Bone and Joint Health Institute (ABJHI). Méthodes: Nous avons analysé de manière rétrospective les données compilées par le registre de l'ABJHI entre mars 2010 et juillet 2016. Nous avons passé en revue les paramètres suivants : durée du séjour hospitalier, destination post-congé, réadmissions dans les 30 jours, infections postopératoires, besoins transfusionnels postopératoires, complications postopératoires et complications mécaniques postopératoires perhospitalières. Résultats: En tout, 10 902 patients (6076 femmes, 4826 hommes) ayant subi une PTH et 16 485 patients (10 057 femmes, 6428 hommes) ayant subi une PTG ont été inclus dans l'étude. Tant pour la PTH que pour la PTG, les patients ayant un IMC élevé ont présenté un plus grand nombre de complications médicales en cours d'hospitalisation; ils ont aussi présenté un nombre plus élevé d'infections profondes, étaient moins susceptibles de pouvoir retourner chez eux au moment de leur congé (p < 0,001) et ont eu moins besoin de transfusions (p < 0,001) comparativement aux patients dont le poids se situait dans l'éventail des valeurs normales. L'IMC élevé a été en corrélation avec une augmentation du taux de réadmission à 30 jours et de la durée du séjour dans la cohorte soumise à une PTH, mais non dans la cohorte soumise à une PTG. L'IMC élevé n'a exercé aucun effet sur la dislocation postopératoire aiguë ou les fractures périprothétiques. Les patients ayant un IMC de 30 kg/m2 ou plus ont eu besoin d'une PTH 1,7 an plus tôt que les patients de poids normal, les patients ayant un IMC de 35 kg/m2 ou plus ont eu besoin d'une PTH 3,4 ans plus tôt, et les patients ayant un IMC de 40 kg/m2 ou plus ont eu besoin d'une PTH 5,8 ans plus tôt. Dans la cohorte soumise à la PTG, les patients ayant un IMC de 30 kg/m2 ou plus ont eu besoin d'une PTG 2,7 ans plus tôt que les patients de poids normal, les patients ayant un IMC de 35 kg/m2 ou plus ont eu besoin d'une PTG 4,6 ans plus tôt, et les patients ayant un IMC de 40 kg/m2 ou plus ont eu besoin d'une PTG 7,6 ans plus tôt. Conclusion: Notre étude quantifie les effets de l'obésité sur le recours aux interventions primaires pour prothèse de la hanche et du genou. Elle permet de mieux comprendre les risques auxquels est exposée la population obèse lorsqu'une intervention pour prothèse articulaire est envisagée.

Higher Edmonton Obesity Staging System scores are associated with complications following laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: The Edmonton Obesity Staging System (EOSS) is a staging system describing comorbidities and functional limitations associated with obesity, thus facilitating the prioritization of patients for bariatric surgery. Our objective was to elucidate any associations of EOSS scores with major complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A retrospective chart review examined patients who received primary LRYGB from 2009 to 2015 at a single center. Collected data included patient comorbidities, preoperative EOSS stage, body mass index (BMI), age, percent excess weight loss, and 1-year major complications. Major complications were defined by a Clavien-Dindo classification ≥ IIIa. RESULTS: 378 patients (81.7% female) receiving primary LRYGB were reviewed with the following EOSS stages: 0 (3.7%), 1 (10.8%), 2 (78.6%), 3 (6.9%), and 4 (0.0%). The mean preoperative BMI was 45.9 (SD 6.3) kg/m2. The overall major complication rate was 9.3%. Major complication rates for EOSS stages 0, 1, 2, and 3 were 7.1%, 4.9%, 8.8%, and 23.1%, respectively. Follow-up rates at 12 months were 76.6% with a mean overall follow-up of 10.9 (2.1) months. Multivariable analysis showed that patients undergoing LRYGB with an EOSS of 3 were more likely to experience major complications (OR 2.94; CI 1.04 to 8.35, p = 0.043). CONCLUSION: Our findings suggest that undergoing LRYGB with EOSS stage 3 has increased odds of major complications. As such, the EOSS demonstrates utility in identifying bariatric surgery candidates at risk of major postoperative morbidity. Further studies are required to assess the applicability of the EOSS for patients undergoing other forms of bariatric surgery.

Relationship between normal weight obesity and mild cognitive impairment is reflected in cognitive-related genes in human peripheral blood mononuclear cells.

AIM: Obesity contributes to the development of mild cognitive impairment, but the potential role of normal weight obesity in this disease has not been explored in humans. The aim of the study was to reveal the relationship between normal weight obesity and mild cognitive impairment in elderly individuals. METHODS: This study consisted of 360 patients with amnestic mild cognitive impairment and 360 cognitively normal controls. Normal weight obesity was defined as having metabolic syndrome but a normal weight. Metabolic health meant having no metabolic syndrome. Reverse transcription quantitative real-time polymerase chain reaction was adopted to measure the messenger RNA expression of four cognitive-related genes (amyloid precursor protein, cyclic adenosine monophosphate-responsive element-binding protein 1, sortilin-related receptor 1, and synapsin I) in peripheral blood mononuclear cells. RESULTS: Normal weight obesity was related to a higher risk of amnestic mild cognitive impairment (odds ratio = 3.14, 95% confidence interval: 2.13-4.60). In the patients, the expression of each gene in the peripheral blood mononuclear cells was linearly related to Mini-Mental State Examination and Montreal Cognitive Assessment scores (P < 0.05). The expression of these genes in the patients with metabolic health deviated from the normal levels found in the controls (P < 0.05), and the deviations were more significant in the patients with normal weight obesity (P < 0.05). CONCLUSION: Normal weight obesity may be a potential risk factor for amnestic mild cognitive impairment in elderly. This relationship was reflected in the abnormal expression of several cognitive-related genes in peripheral blood mononuclear cells.

The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services.

BACKGROUND: Limited access to publicly funded, insurance-covered, and self-paid obesity surgery is a reality worldwide. Waiting lists for procedures are usually based on chronologic criteria and body mass index (BMI)-defined obesity categorization. Obesity classification systems assess overall health and have been proposed as an alternative. OBJECTIVE: To investigate the correlation between BMI-based classification and the Edmonton Obesity Staging System (EOSS) to support current evidence that the assessment of the clinical severity of obesity could be a helpful tool to maximize access to surgery. SETTING: University hospital, Brazil. METHODS: Retrospective analysis of all 2011 to 2014 adult patients who underwent obesity surgery under the public health system. Data on sex, age, presurgical BMI, and co-morbidities were extracted from hospital records. Spearman correlation coefficients were used to assess the strength and direction of the relationship between BMI classification and EOSS. RESULTS: Of 565 patients, 79% were female, mean age 44.1 ± 10.9 years and mean BMI 46.9 ± 6.2 kg/m2. The most common EOSS stage was 2 (86.5%), followed by stages 3 (8.5%) and 1 (4.9%). There was no correlation between the severity of obesity measured by BMI and EOSS (ρ = -.030, P = .475). Older patients had higher Edmonton scores (ρ = .308, P < .001). No difference was observed regarding sex. CONCLUSIONS: No correlation was found between EOSS and BMI and between these and sex. Age correlated with both obesity indicators. EOSS was reproducible in Brazilian surgical patients and may be an important tool from a health services perspective contributing to the more efficient use of limited resources for obesity surgery.

Conicity index in people with hypertension followed in the Brazil's Family Health Strategy / Índice de conicidad en personas con hipertensión en seguimiento con la Estrategia de Salud Familiar / Índice de conicidade em pessoas com hipertensão arterial acompanhadas pela Estratégia Saúde da Família

ABSTRACT Objectives: to analyze the conicity index in people with hypertension followed in the Brazil's Family Health Strategy. Methods: cross-sectional study conducted in a medium-sized municipality located in the state of Paraná. Data collection took place in the first semester of 2016. using an adapted and validated instrument. which addresses attributes of Primary Health Care. Sociodemographic and anthropometric variables and blood pressure were used in the study. The analysis of variance and linear regression was used to analyze the variables. Results: a total of 417 people participated in the study. most were women. elderly. married. with less than eight years of education and retired. Conicity index was prevalent in most of the study population. being significantly associated with the group of people with inadequate blood pressure control and high anthropometric parameters. Conclusions: most of the study participants had altered conicity index. especially those with inadequate blood pressure control.

RESUMEN Objetivos: analizar el índice de conicidad en personas con hipertensión en tratamiento de seguimiento con la Estrategia de Salud Familiar. Métodos: estudio transversal realizado en un municipio de tamaño medio ubicado en el estado de Paraná. Los datos se recopilaron en el primer semestre de 2016. utilizando un instrumento adaptado y validado. que aborda los atributos de la Atención Primaria de Salud. En este estudio. se utilizaron las variables sociodemográficas. antropométricas y las mediciones de la presión arterial. El análisis de varianza y regresión lineal se utilizó para tratar las variables. Resultados: participación de 417 personas en el estudio. la mayoría mujeres. ancianos. casados. con menos de ocho años de estudio y jubilados. El índice de conicidad prevaleció en la mayoría de la población de estudio. con una asociación significativa con el grupo de personas con control inadecuado de la presión arterial y parámetros antropométricos altos. Conclusiones: la mayoría de los participantes en el estudio tenían un índice de variación alterado. especialmente aquellos con un control inadecuado de la presión arterial.

RESUMO Objetivos: analisar o índice de conicidade em pessoas com hipertensão arterial acompanhadas pela Estratégia Saúde da Família. Métodos: estudo transversal, realizado em um município de médio porte localizado no estado do Paraná. Os dados foram coletados no primeiro semestre de 2016, utilizando instrumento adaptado e validado, que aborda atributos da Atenção Primária à Saúde. Neste estudo, foram utilizadas variáveis sociodemográficas, antropométricas e medidas de pressão arterial. Empregou-se a análise de variância e regressão linear para o tratamento das variáveis. Resultados: participação de 417 pessoas, a maioria mulheres, idosas, casadas, com menos de oito anos de estudo e aposentadas. O índice de conicidade foi prevalente na maior parte da população estudada, com significativa associação ao grupo de pessoas com controle pressórico inadequado e parâmetros antropométricos elevados. Conclusões: a maioria dos participantes do estudo apresentou índice de conicidade alterado, principalmente as pessoas com controle pressórico inadequado.

Lupine as a potential agent against diet-induced obesity through adenosine monophosphate-activated protein kinase pathway: crude oil versus nanoemulsion formulations

Obesity represents a major challenge to the pharmaceutical community due to the minimal availability of anti-obesity drugs and the drawbacks of current weight-loss agents. The study described herein presents lupine oil, in two pharmaceutical formulations, as a potential anti-obesity agent via its effect on different physiological, biochemical, and hormonal parameters. Rats were divided into two groups; one group was continued on a standard commercial rodent diet and served as the non-obese control. The other group was fed a high-fat diet for 7 weeks to prepare an obese rat model. Then, the obese rats were divided into groups to receive 100 mg/kg of the crude lupine oil or nanoemulsion for 10 or 20 days. Lupine oil showed a potent body weight-reducing effect and improved insulin resistance. The oil altered obesity-induced hyperlipidemia and it enhanced the leptin/adiponectin/AMPK hormonal system in epididymal fat, serum, and liver, to which all the above physiological activities could be attributed. The nanoemulsion formulation of lupine oil significantly amplified the activity for all the above physiological and hormonal parameters when compared to the crude oil formulation. Lupine oil nanoemulsion could be used as a potential drug against diet-induced obesity.

The effects of maternal obesity during gestation and lactation and orange juice intake on the metabolic profile of male offspring exposed to control and obesogenic diets and breast cancer risk of female offspring / A obesidade materna durante a gestação e lactação e o consumo do suco de laranja: efeitos nos parâmetros metabólicos da prole masculina exposta a dieta controle e obesogênica e programação do risco do câncer de mama da prole feminina de camundongos

Obesity is a worldwide public health problem and the main risk factor for a number of chronic diseases. Breast cancer is another worrisome disease: it is the leading cause of cancer amongst women and has an elevated mortality rate. Approximately 30 years ago, Barker and Trichopoulos suggested that cardiovascular disease and breast cancer, respectively, may be originated in utero. In subsequent years, studies proved both hypotheses correct. Understanding how in-utero environment can affect development of obesity and breast cancer in adulthood is key for preventing these diseases. Nutrition during gestation and lactation is considered a modifiable factor to impact in-utero environment. Orange juice (OJ) is an excellent source of bioactive compounds, including vitamin C and flavonoids, and reports suggests that intake of orange juice minimizes damaging effects of obesity. The objective of this thesis was to evaluate the effects of maternal obesity during gestation and lactation and OJ intake on (a) metabolic profile of male offspring exposed to control and obesogenic diets and (b) breast cancer risk of female offspring. Four-week-old C57BL/6 female mice were assigned into three groups: control- fed a control diet and water ad libitum, obese- fed obesogenic diet and water ad libitum and obese+OJ- fed obesogenic diet and OJ. After three weeks on the diet, females were mated to control males. Male offspring from each group were weaned into control or obesogenic diets for 21 weeks. Female offspring was either euthanized for evaluation of mammary gland development or submitted to a chemically induced breast carcinogenesis protocol. Parameters to assess metabolism (as body composition and adipose tissue expression of obesity-related genes), breast cancer risk (as epithelial elongation and number of terminal end buds) and tumorigenesis (incidence, latency and multiplicity of mammary tumors) were collected. ANOVA followed by Tukey or Fischer´s LSD test were used to investigate differences between groups and a p<0.05 was considered significant. Male offspring of obese mothers fed control diet presented increased glucose concentrations and expression of F4/80 and interleukin-6 compared to control offspring. Male offspring of obese+OJ mothers fed a control diet presented expression of F4/80 and interleukin-6 similar to control offspring. Male offspring to control mothers fed obesogenic diet presented increased glucose concentrations and epidydimal fat tissue compared to offspring of obese mothers. Offspring to obese+OJ mothers presented increased expression of leptin and tumor necrosis factor-α. Female offspring of obese mothers had decreased terminal end buds and increased latency of first tumor and OJ intake decreased epithelial elongation compared to offspring of control/obese mothers. Maternal obesity had greater impact in offspring exposed to control than obesogenic environment. OJ intake by mothers helped with harmful effects induced by maternal obesity on male offspring fed control diet. Control offspring exposed to obesogenic diet presented worse metabolic profile than offspring from obese mothers. In this particular case, OJ was not beneficial to male offspring. Whereas obesity induced by a high-fat high-sugar diet presented a somewhat protective effect on breast cancer risk, OJ further protected offspring of obese mothers

A obesidade é um problema de saúde pública e o principal fator de risco para uma série de doenças crônicas. O câncer de mama é outra doença preocupante: é a principal causa de câncer entre as mulheres e tem elevada taxa de mortalidade. Há 30 anos, Barker e Trichopoulos sugeriram que a doença cardiovascular e o câncer de mama, respectivamente, podem ser originados no útero. Nos anos seguintes essas hipóteses foram confirmadas. Compreender como o ambiente intrauterino pode afetar o desenvolvimento da obesidade e o câncer de mama na idade adulta, portanto, é fundamental para prevenir essas doenças. O estado nutricional e a nutrição durante a gestação e lactação são considerados fatores modificáveis e que pode influenciar o ambiente intrauterino. O suco de laranja (SL) é uma excelente fonte de compostos bioativos, incluindo vitamina C e flavonoides, e estudos sugerem que a ingestão de suco de laranja pode minimizar os efeitos deletérios da obesidade. O objetivo dessa tese foi de avaliar os efeitos da obesidade materna durante a gestação e lactação e a ingestão de SL no (a) perfil metabólico da prole masculinas expostos à dietas controle e obesogênica e (b) risco de câncer de mama da prole feminina. Camundongos fêmeas C57BL/6, com quatro semanas de idade, foram distribuídos em três grupos: controle - alimentados com uma dieta de controle e água ad libitum, obesosalimentados com dieta obesogênica e água ad libitum e obesos+SL- alimentados com dieta obesogênica e SL. Após três semanas na dieta, as fêmeas foram acasaladas com machos controle. A prole masculina de cada grupo foi desmamada e alimentadas com dieta obesogênica ou controle por 21 semanas. A prole feminina foi eutanasiada para a avaliação do desenvolvimento da glândula mamária ou submetida a um protocolo de carcinogênese mamária quimicamente induzida. Parâmetros para avaliar o metabolismo (como a composição corporal e expressão de genes relacionados à obesidade do tecido adiposo), risco de câncer de mama (como desenvolvimento epitelial e número de terminal end buds) e tumorigênese (incidência, latência e multiplicidade dos tumores mamários) foram coletados. Para investigar diferença estatística entre os grupos foi realizada ANOVA, seguida pelo teste de Tukey ou LSD de Fischer e um p<0,05 foi considerado significante. A prole masculina de mães obesas alimentadas com dieta de controle apresentou aumento das concentrações de glicose e aumento das expressões de F4/80 e interleucina-6 em relação a prole controle. A prole masculina de mães obesas+SL alimentadas com dieta controle apresentou expressão de F4/80 e interleucina-6 similar à da prole de controle. A prole masculina de mães controle e alimentada com dieta obesogênica apresentou aumento das concentrações de glicose e aumento do tecido adiposo epididimal em comparação à prole de mães obesas. A prole de mães obesas+SL apresentou maior expressão de leptina e TNF-α. A prole feminina de mães obesas apresentou redução do número de terminal end buds e aumento da latência para o aparecimento do primeiro tumor. O consumo de SL diminuiu o desenvolvimento epitelial comparado as proles de mães controles e obesas. A obesidade materna teve maior impacto na prole masculina exposta a dieta controle do que na obesogênica. A ingestão materna de SL ajudou com efeitos danosos induzidos pela obesidade materna na prole masculina alimentada com dieta controle. A prole de fêmeas controles e alimentada com dieta obesogênica apresentou perfil metabólico pior que a prole das mães obesas. Neste caso, o SL não foi benéfico para a prole masculina. A obesidade materna induzida por uma dieta rica em banha e açúcares apresentou discreto efeito protetor no risco de câncer de mama, o SL acentuou esta proteção

Caracterização de compostos bioativos de maracujá (Passiflora tenuifila) e efeito do seu consumo sobre marcadores bioquímicos, microbiota intestinal em indivíduos eutróficos e obesos / Characterization of bioactive compounds of passion fruit (Passiflora tenuifila) and effect of consumption on biochemical markers, intestinal microbiota in eutrophic and obese subjects

O maracujá (Passiflora ssp.) é conhecido por suas características sensoriais e por apresentar diversos compostos bioativos. Estudos prévios demonstraram que o consumo a longo prazo de maracujá melhorou os parâmetros bioquímicos, inflamatórios e antioxidantes. Uma espécie que tem despertado interesse é a Passiflora tenuifila Killip consumida pela população local, porém, ainda com baixa expressão comercial. Assim, o objetivo deste trabalho consiste em avaliar o efeito da ingestão a médio prazo de maracujá (P. tenuifila Killip) em indivíduos eutróficos e obesos. Inicialmente foi realizada uma caracterização do fruto em dois estágios de amadurecimento (verde e maduro), uma vez que são consumidas nestas duas formas. Foram avaliadas características físicoquímicas e o perfil de flavonoides por HPLC-ESI-MS/MS. O conteúdo de Sólidos Totais Solúveis variou entre 20,80 e 23,55° Brix, porém não foi observada diferença significativa entre os dois estágios. Os principais açúcares identificados foram a sacarose e glicose, variando entre 4,0-8,5%, apresentando maior conteúdo no estádio verde (p<0.05). Os principais ácidos orgânicos encontrados foram o cítrico, tartárico e málico, no entanto os teores variaram entre os lotes analisados. Os frutos nos dois estádios apresentaram o mesmo perfil de flavonoides, apresentando como compostos majoritários a procianidinaTipo B e flavonas C -glicosiladas (luteolina e apigenina). Após a caracterização do fruto, foram recrutados indivíduos adultos (entre 19 e 59 anos), eutróficos (IMC= 19,0- 24,99 Kg/m2) ou obesos (IMC > 30,00) que ingeriram durante 30 dias uma dose diária do maracujá (P. tenuifila Killip). Foram avaliados marcadores antropométricos, perfil bioquímico sérico, do estresse oxidativo e permeabilidade intestinal. Foi avaliado também a excreção de flavonoides na urina por HPLC-ESI-QTOF-MS/MS e a microbiota intestinal por 16s rRNA. A ingestão diária por somente 30 dias de uma porção de P. tenuifila Killip demonstrou grandes benefícios. O consumo da P. tenuifila Killip foi responsável pela redução da concentração de colesterol total e LDL sérico dos indivíduos obesos (p<0,05). Foi observado tendência na redução da permeabilidade intestinal e redução significativa (p<0,05) no biomarcador do estresse oxidativo 8-OHdG (associado à dano à estrutura do DNA). O consumo do maracujá P. tenuifila Killip aumentou a excreção de metabólitos na urina produzidos a partir da metabolização de flavonas-C-glicosiladas e flavan-3-ol e, por fim, foi capaz de modular a microbiota reduzindo a abundância relativa do filo Firmicutes (associada a obesidade) e aumentando a proporção de Lachonospiraceae (família associada à redução de inflamação local e ao metabolismo de compostos fenólicos)

Passion fruit (Passiflora ssp.) is known for its sensory characteristics and for presenting various bioactive compounds. Previous studies shown that long-term passion fruit consumption has improved biochemical, inflammatory and antioxidant parameters. A species that has aroused interest is Passiflora tenuifila Killip consumed by the local population, but has no commercial expression yet. The objective of this study is to evaluate the effect of medium-term intake of passion fruit (P. tenuifila Killip) on eutrophic and obese subjects. Initially, the fruit was characterized in two ripening stages (green and ripe), which are the most consumed stages. Physico-chemical characteristics and flavonoid profile were evaluated by HPLC-ESI-MS/MS. The total soluble solids content ranged from 20.80 to 23.55 ° Brix, but no significant difference was observed between the two stages. The main sugars identified were sucrose and glucose, ranging from 4.0- 8.5%, with higher content in the green stage (p<0.05). The main organic acids found were citric, tartaric and malic, however the levels varied between the lots analyzed. The fruits in both stages presented the same profile of flavonoids, presenting as major compounds procianidin Type B and C-glycosylated flavones (luteolin and apigenin). After fruit characterization, adult (between 19 and 59 years), eutrophic (BMI = 19.0-24.99 Kg/m2) or obese (BMI>30.00) ingested for 30 days a daily dose of passion fruit (P. tenuifila Killip) and anthropometrics indicators, serum biochemical profile, oxidative stress and intestinal permeability were evaluated. The excretion of flavonoids in urine by HPLC-ESI-QTOF-MS/MS and intestinal microbiota by 16s rRNA was also evaluated. Daily intake for only 30 days of a portion of P. tenuifila Killip has shown great benefits. The P. tenuifila Killip consumption was responsible for reduction of total cholesterol and LDL in obese subjects (p<0.05). There was a tendency to reduce intestinal permeability and a significant reduction (p<0.05) of 8-OHdG (oxidative stress biomarker, associated with damage to DNA structure). P. tenuifila Killip consumption increased the excretion of urine metabolites produced by metabolization of flavones-C-glycosylated and flavan-3-ol and, finally, was able to modulate the microbiota, reducing the relative abundance of the Firmicutes (phylum associated with obesity) and increasing the proportion of Lachonospiraceae (family associated with reduced local inflammation and metabolism of phenolic compounds)

Excess Costs and Economic Burden of Obesity-Related Cancers in the United States.

BACKGROUND: Obesity is a significant risk factor of several cancers that imposes a substantial economic burden on US healthcare that remains to be quantified. We estimated the excess costs and economic burden of obesity-related cancers in the United States. METHODS: From the Medical Expenditure Panel Survey (2008-2015) data, we identified 19 405 cancer survivors and 175 498 non-cancer individuals. We estimated annual health expenditures using generalized linear regression with log link and gamma distribution by cancer types (stratified by 11 obesity-related cancers and other cancer types), controlling for sociodemographic and clinical characteristics. All cost estimates were adjusted to 2015 USD value. RESULTS: The average annual total health expenditures were $21 503 (95% CI, $20 946-$22 061) for those with obesity-related cancer and $13 120 (95% CI, $12 920-$13 319) for those with other cancer types. There was a positive association between body mass index and health expenditures among cancer survivors: for each additional 5-unit increase in body mass index, the average predicted expenditures increase by $1503 among those with obesity-related cancer and by $722 among those with other cancers. With adjustments for sociodemographic and clinical characteristics, the mean incremental expenditures of treating obesity-related cancer were 2.1 times higher than those of other cancers ($4492 vs $2139) and more considerable among the non-elderly cancer population. Obesity-related cancers accounted for nearly 43.5% of total direct cancer care expenditures, estimated at $35.9 billion in 2015. CONCLUSION: The economic burden of obesity-related cancer in the United States is substantial. Our findings suggest a need for the inclusion of comprehensive obesity prevention and treatment in cancer care.