Peak serum luteinising hormone cut-off during gonadotropin-releasing hormone analogue test for diagnosing central precocious puberty was lower in girls with obesity as compared with girls with normal weight.

OBJECTIVE: Serum luteinising hormone (LH) concentration has been reported to be lower in girls with overweight and obesity (OW/OB) as compared with girls with normal weight (NW). This study aimed to evaluate peak serum LH concentration during gonadotropin-releasing hormone analogue (GnRHa) test in girls with OW/OB and NW who had central precocious puberty (CPP) and to determine peak serum LH cut-off for diagnosing CPP in girls with OW/OB. DESIGN, PATIENTS AND MEASUREMENTS: Medical records of 971 girls with premature breast development who underwent subcutaneous GnRHa (100 µg of triptorelin acetate) test were reviewed. All girls were classified as either CPP or premature thelarche. All of them were further classified into two groups according to their body mass index as NW and OW/OB groups for each Tanner stage. RESULTS: There were 634 and 337 girls in NW and OW/OB groups, respectively. CPP was diagnosed in 600 girls (249 had Tanner stage II and 351 had Tanner stage III). There were no differences in peak serum LH concentrations between CPP girls with NW and OW/OB. Peak serum LH cut-off of 5 IU/L (the current widely used cut-off) had a sensitivity and a specificity of 75% and 90%, respectively in NW group. Peak serum LH cut-off for CPP diagnosis was lower at 4 IU/L in the OW/OB group with greater sensitivity and specificity of 86% and 93%, respectively. The results were reproducible for each Tanner stage of breasts. CONCLUSION: Lower peak serum LH cut-off to 4 IU/L for diagnosing CPP in girls with OW/OB should be considered to avoid underdiagnosis of the condition.

Obesity Management in Adults: A Review.

Importance: Obesity affects approximately 42% of US adults and is associated with increased rates of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and premature death. Observations: A body mass index (BMI) of 25 or greater is commonly used to define overweight, and a BMI of 30 or greater to define obesity, with lower thresholds for Asian populations (BMI ≥25-27.5), although use of BMI alone is not recommended to determine individual risk. Individuals with obesity have higher rates of incident cardiovascular disease. In men with a BMI of 30 to 39, cardiovascular event rates are 20.21 per 1000 person-years compared with 13.72 per 1000 person-years in men with a normal BMI. In women with a BMI of 30 to 39.9, cardiovascular event rates are 9.97 per 1000 person-years compared with 6.37 per 1000 person-years in women with a normal BMI. Among people with obesity, 5% to 10% weight loss improves systolic blood pressure by about 3 mm Hg for those with hypertension, and may decrease hemoglobin A1c by 0.6% to 1% for those with type 2 diabetes. Evidence-based obesity treatment includes interventions addressing 5 major categories: behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures. Comprehensive obesity care plans combine appropriate interventions for individual patients. Multicomponent behavioral interventions, ideally consisting of at least 14 sessions in 6 months to promote lifestyle changes, including components such as weight self-monitoring, dietary and physical activity counseling, and problem solving, often produce 5% to 10% weight loss, although weight regain occurs in 25% or more of participants at 2-year follow-up. Effective nutritional approaches focus on reducing total caloric intake and dietary strategies based on patient preferences. Physical activity without calorie reduction typically causes less weight loss (2-3 kg) but is important for weight-loss maintenance. Commonly prescribed medications such as antidepressants (eg, mirtazapine, amitriptyline) and antihyperglycemics such as glyburide or insulin cause weight gain, and clinicians should review and consider alternatives. Antiobesity medications are recommended for nonpregnant patients with obesity or overweight and weight-related comorbidities in conjunction with lifestyle modifications. Six medications are currently approved by the US Food and Drug Administration for long-term use: glucagon-like peptide receptor 1 (GLP-1) agonists (semaglutide and liraglutide only), tirzepatide (a glucose-dependent insulinotropic polypeptide/GLP-1 agonist), phentermine-topiramate, naltrexone-bupropion, and orlistat. Of these, tirzepatide has the greatest effect, with mean weight loss of 21% at 72 weeks. Endoscopic procedures (ie, intragastric balloon and endoscopic sleeve gastroplasty) can attain 10% to 13% weight loss at 6 months. Weight loss from metabolic and bariatric surgeries (ie, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass) ranges from 25% to 30% at 12 months. Maintaining long-term weight loss is difficult, and clinical guidelines support the use of long-term antiobesity medications when weight maintenance is inadequate with lifestyle interventions alone. Conclusion and Relevance: Obesity affects approximately 42% of adults in the US. Behavioral interventions can attain approximately 5% to 10% weight loss, GLP-1 agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists can attain approximately 8% to 21% weight loss, and bariatric surgery can attain approximately 25% to 30% weight loss. Comprehensive, evidence-based obesity treatment combines behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures as appropriate for individual patients.

Spatial and temporal trends of overweight/obesity and tobacco use in East Africa: subnational insights into cardiovascular disease risk factors.

BACKGROUND: Cardiovascular disease (CVD) is increasing in Sub-Saharan Africa (SSA). Overweight/obesity and tobacco use are modifiable CVD risk factors, however literature about the spatiotemporal dynamics of these risk factors in the region at subnational or local scales is lacking. We describe the spatiotemporal trends of overweight/obesity and tobacco use at subnational levels over a 13-year period (2003 to 2016) in five East African nations. METHODS: Cross-sectional, nationally representative Demographic and Health Surveys (DHS) were used to explore the subnational spatiotemporal patterns of overweight/obesity and tobacco use in Burundi, Kenya, Rwanda, Tanzania, and Uganda, five East African Community (EAC) nations with unique cultural landscapes influencing CVD risk factors. Adaptive kernel density estimation and logistic regression were used to determine the spatial distribution and change over time of CVD risk factors on a subnational and subpopulation (rural/urban) scale. RESULTS: Subnational analysis shows that regional and national level analysis masks important trends in CVD risk factor prevalence. Overweight/obesity and tobacco use trends were not similar: overweight/obesity prevalence increased across most nations included in the study and the inverse was true for tobacco use prevalence. Urban populations in each nation were more likely to be overweight/obese than rural populations, but the magnitude of difference varied widely between nations. Spatial analysis revealed that although the prevalence of overweight/obesity increased over time in both urban and rural populations, the rate of change differed between urban and rural areas. Rural populations were more likely to use tobacco than urban populations, though the likelihood of use varied substantially between nations. Additionally, spatial analysis showed that tobacco use was not evenly distributed across the landscape: tobacco use increased in and around major cities and urban centers but declined in rural areas. CONCLUSIONS: We highlight the importance of de-homogenizing CVD risk factor research in SSA. Studies of national or regional prevalence trends mask important information about subpopulation and place-specific behavior and drivers of risk factor prevalence. Spatially explicit studies should be considered as a vital tool to understand local drivers of health, disease, and associated risk factor trends, especially in highly diverse yet low-resourced, marginalized, and often homogenized regions.

A comparison of the portfolio low-carbohydrate diet and the ketogenic diet in overweight and obese women with polycystic ovary syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine disorders among women of fertile age. Women with PCOS manifest clinical symptoms like menstrual dysfunction, hirsutism, insulin resistance, and hyperinsulinemia. As excessive amounts of insulin levels directly increase ovarian production of androgens, hyperinsulinemia and insulin resistance are considered as the pathogenesis factors of PCOS. The portfolio low-carbohydrate diet (PLCD) is a plant-based diet with 40% carbohydrates combined with five cholesterol-lowering foods and nutrients. On the other hand, the ketogenic diet (KD) is a nutritional protocol with 10% carbohydrates. The purpose of this study is to determine whether PLCD or KD is more effective in alleviating PCOS symptoms. METHODS: Forty-six overweight or obese women diagnosed with PCOS will be randomly stratified to receive either PLCD or KD for 8 weeks. Measures related to anthropometric and body composition, glucose, and insulin level, HOMA-IR, sex hormones, lipid profile, quality of life, dietary intake, physical activity, and Ferriman-Gallwey score of all participants will be accessed before and after the intervention. DISCUSSION: Since the first line treatment of PCOS is lifestyle adjustment including diet control and exercise, there has not been determined the optimal diet for this population of women yet. Hence, the goal of conducting this study is to determine whether the PLCD or the KD could have more advantageous effects on attenuating PCOS manifestations. The result of this investigation will give us new insight into curing this disease and will provide evidence-based recommendations for prescribing an optimal diet for PCOS women. TRIAL REGISTRATION: IRCT20200912048693N3, Trial registered 2022-12-14. https://www.irct.ir/trial/67548.

Effects of weight loss in heart failure patients with overweight and obesity: a systematic review and meta-analysis.

AIMS: To perform a systematic review and meta-analysis to evaluate the impact of weight loss (WL) on the prognosis of overweight and obese patients with heart failure (HF). METHODS AND RESULTS: We reviewed the literature up to 1 February 2023 from PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases for cohort studies, and randomized controlled trials (RCTs). Data from eligible studies were extracted, and statistical analyses were performed using Review Manager 5.3. A total of 19 studies (involving 449 882 patients) were included in the systematic review and meta-analyses. The results showed that WL did not reduce the mortality and rehospitalization rates in overweight and obese HF patients, but could improve the quality of life (P = 0.002), cardiac function (P = 0.0001), and exercise capacity (P = 0.03). The subgroup analysis showed that WL from bariatric surgery (BS) reduced the risk of death (P < 0.00001), WL from medication or exercise was not significantly associated with the risk of death (P = 0.18), and WL was associated with a higher mortality in the subgroup with unspecified WL modality or unintentional WL (P < 0.00001). In addition, it did not reduce the risk of short-term rehospitalization (P = 0.11), but reduced the rehospitalization rates over the long-term (P = 0.03). CONCLUSION: WL improves the long-term rehospitalization (>3 months), quality of life, cardiac function, and exercise capacity in overweight and obese HF patients. Although overall WL is not proven effective, subgroup analysis shows that BS can reduce mortality.

We used mortality, rehospitalization rates, quality of life, the New York Heart Association (NYHA), and 6-min walk test (6 MWT) to assess the impact of weight loss (WL) on the prognosis of overweight and obese heart failure (HF) patients. Key findings: WL is associated with improvements in long-term rehospitalization rates, quality of life, cardiac function, and exercise capacity.Bariatric surgery (BS) may reduce mortality in overweight and obese HF patients. Unintentional WL of more than 5% may mean a bad condition and could increase mortality.

Arterial Stiffness in Overweight and Obesity: Association with Sex, Age, and Blood Pressure.

INTRODUCTION: Obesity has been associated with increased arterial stiffness. Sex-differences in arterial stiffness in obesity have been less explored. AIM: To explore sex-differences in arterial stiffness by applanation tonometry in 323 women and 225 with overweight and obesity, free of cardiovascular disease. METHODS: Covariables of arterial stiffness were identified in multivariable linear regression analyses in the total cohort and separately in women and men. RESULTS: In the total study cohort, women had higher augmentation pressure (AP) and augmentation index (AIx), and lower carotid-femoral pulse wave velocity (cf-PWV) than men, independent of confounders (all p < 0.001). In sex-specific analyses, higher AP was associated with higher age and 24-hours systolic blood pressure (BP), and with lower heart rate in women (all p < 0.001), and with higher age and BP in men (all p < 0.001). Similarly, higher AIx was associated with higher age and BP, and lower body mass index (BMI) and heart rate in women (all p < 0.05), and with higher age in men (all p < 0.001). Higher cf-PWV correlated with higher age and BP in women (all p < 0.005), and additionally with higher heart rate and non-smoking in men (all p < 0.05). When replacing BMI with waist-hip ratio, higher waist-hip ratio was associated with higher cf-PWV in men only (p < 0.05). CONCLUSIONS: Among subjects with overweight and obesity, AP and AIx were higher in women, and cf-PWV was higher in men. Age and 24-hours systolic BP were the main factors associated with arterial stiffness in both sexes, while measures of adiposity had little impact on arterial stiffness.

Validity of the neck circumference for the diagnosis of obesity in school children living at high altitude.

Introduction: Background: body mass index (BMI) is commonly used to diagnose overweight and obesity, and waist circumference (WC) is used to estimate visceral fat. The measurement of WC is demanding, therefore, different studies proposed the use of neck perimeter. Objective: exploring diagnostic validity of neck perimeter to diagnose overweight and obesity in 10-12 years old children in La Paz (Bolivia). Methods: this is a cross-sectional study with a random sample of school children in El Alto (Bolivia). Weight, height, abdominal circumference and neck perimeter were measured, classifying the nutritional status with BMI-z according to the cut-off point of the World Health Organization (WHO) classification. The sample size was calculated for 95 % confidence level, an alpha level of 0.05 and 80 % power for diagnosis test design. To evaluate neck perimeter validity for diagnosing obesity, sensibility, specificity and positive and negative ratio likelihood were calculated using BMI gold standard according to age and sex. Results: a number of 371 school children between 10-12 years old were included and 34 % of them presented malnutrition by excess. Sensibility and specificity of the neck perimeter to diagnose overweight and obesity were 87.5-100 % and 75.7-86.3 %, respectively. Conclusion: neck perimeter in 10-12-year-old school children is a valid indicator for carrying out obesity diagnosis.

Introducción: Introducción: el índice de masa corporal (IMC) se usa comúnmente para diagnosticar el sobrepeso y la obesidad, y la circunferencia de la cintura (CC), para estimar la grasa visceral. La medición de la CC es exigente y, por ello, diferentes estudios propusieron el uso del perímetro del cuello. Objetivo: explorar la validez diagnóstica del perímetro del cuello para diagnosticar sobrepeso y obesidad en niños de 10-12 años en La Paz (Bolivia). Métodos: estudio transversal con una muestra aleatoria de escolares de El Alto (Bolivia). Se midieron peso, talla, circunferencia abdominal y perímetro de cuello, clasificando el estado nutricional con IMC-z según el punto de corte de la clasificación de la Organización Mundial de la Salud (OMS). El tamaño de la muestra se calculó para un nivel de confianza del 95 %, un nivel alfa de 0,05 y una potencia del 80 % para el diseño de la prueba de diagnóstico. Para evaluar la validez del perímetro del cuello para el diagnóstico de obesidad, se calcularon la sensibilidad, la especificidad y la razón de verosimilitud positiva y negativa utilizando el patrón oro del IMC según edad y sexo. Resultados: se incluyeron 371 escolares de 10-12 años, de los cuales el 34 % presentaba malnutrición por exceso. La sensibilidad y especificidad del perímetro del cuello para diagnosticar sobrepeso y obesidad estuvo entre 87,5-100 % y 75,7-86,3 %, respectivamente. Conclusión: el perímetro del cuello en escolares de 10-12 años es un indicador válido para realizar el diagnóstico de obesidad.

Combination of Risks of BMI and Health-Related Lifestyles on Kidney Function in the Prediabetic Japanese Population: A Prospective Cohort Study.

Diabetic overweight patients are more likely to show the progression of kidney damage than the general population. The majority of people in the early stages of kidney damage do not recognize the importance of risk modification, mainly due to the asymptomatic nature of the disease. This study aimed to examine specific risk combinations of lifestyle and BMI regarding the deterioration of kidney function and to explore whether there are gender-based differences among the prediabetic population. Prediabetic participants with normal kidney function were identified via annual health examination from April 2016 to March 2019. The information on health status and lifestyle was collected at enrollment. The study subjects were followed until March 2021 to observe the progression of kidney damage. There were 2241 participants enrolled in this study. Smoking (HR = 3.5, p < 0.001), eating snacks (HR = 3.2, p < 0.001), not engaging in regular exercise (HR = 2.9, p < 0.001), and not having adequate sleep (HR = 3.0, p < 0.001) showed accelerated risks for kidney damage progression among the prediabetic population in males. These lifestyle effects were not observed in females. In conclusion, risk-based modification of lifestyle behavior is important to prevent kidney function damage among the overweight prediabetic population in males.

Differential diagnosis of precocious puberty in girls during the COVID-19 pandemic: a pilot study.

BACKGROUND: To investigate the differential diagnosis of girls aged 6 to 8 years with idiopathic premature thelarche (IPT) and central precocious puberty (CPP) during the COVID-19 pandemic. We explored predicted adult height (PAH) discrepancy to guide appropriate diagnosis and treatment. METHODS: From January 2020 to December 2021, Chinese girls aged 6 to 8 years with precocious puberty were recruited. They were divided into IPT and CPP groups. Clinical characteristics, including height, weight, body mass index (BMI), basal luteinizing hormone (LH), oestradiol, uterine length and volume, follicle numbers (d > 4 mm) and bone age (BA) were recorded. We analysed differential diagnosis and PAH discrepancy in both groups. Binary logistic regression analysis was used to explore risk factors for CPP, and receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic value of related indexes. RESULTS: Sixty patients, including 40 girls with IPT and 20 girls with CPP, were recruited. The prevalence of overweight and obesity in the entire cohort was 25% (15/60) and was significantly higher in IPT than CPP, 32.5% (13/40) vs. 10% (2/20), respectively (P=0.045). There were significant differences in LH, uterine volume, follicle numbers and BA (P<0.05). The impaired PAH of IPT and CPP was 0.01 ± 1.19 SD and 0.62 ± 0.94 SD with significant differences (P=0.047). Logistic regression analysis showed that LH and follicle numbers were independent risk factors for CPP. The ROC curve showed that the area under the curve (AUC) of LH and follicle numbers were 0.823 and 0.697. The sensitivity and specificity of LH with a cut off of 0.285 IU/L were 78.9% and 77.8%. The sensitivity and specificity of follicle numbers with a cut off of 3.5 were 89.5% and 52.8%. CONCLUSION: The prevalence of overweight and obesity in 6- to 8-year-old girls with precocious puberty was high. Auxological data should not be used in the differential diagnosis of IPT and CPP. Basal LH above 0.285 IU/L and follicle numbers greater than 4 were important features suggestive of CPP. PAH was impaired in individuals with CPP, but it was not impaired in individuals with IPT.

The effect of maternal obesity and lipid profile on first-trimester serum progesterone levels.

BACKGROUND: Prepregnancy overweight increases the risk of adverse perinatal outcomes. Maternal lipid profile plays a key role in the production of pregnancy hormones. The influence that obesity has on the specific mechanisms that may be involved and the potential associations with abnormal conditions in pregnancy are still poorly understood. OBJECTIVE: This study aimed to evaluate the effect of maternal body mass index and lipid profile on first-trimester serum progesterone levels. STUDY DESIGN: This was a prospective cohort study including 734 pregnant people. First-trimester maternal serum progesterone, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured between 9 and 11 weeks' gestation. Free ß-hCG, PAPP-A, age, body mass index, smoking status, gestational age at delivery, fetal sex, and birthweight were also recorded. Pregnant people were classified according to their body mass index into underweight (n=21), normal weight (n=395), overweight (n=221), obesity class I (n=64), and obesity class II/III (n=33) groups. RESULTS: Gestational age at sampling was 10.0 4±1.12 weeks. Serum progesterone levels decreased as maternal body mass index increased (35.84±12.00 ng/mL, 33.08±11.27 ng/mL, 28.04±8.91 ng/mL, 24.37±8.56 ng/mL, and 19.87±11.00 mL for underweight, normal weight, overweight, obesity class I, and obesity class II/III groups, respectively; P<.000001). There were statistically significant negative correlations between maternal progesterone and body mass index, triglycerides, and cholesterol/high-density lipoprotein cholesterol ratio, and positive correlations with gestational age at sampling, maternal age, cholesterol, high-density lipoprotein cholesterol, crown-rump length, free ß-hCG, and PAPP-A. Linear regression showed that the only independent predictor variables for progesterone levels were body mass index (P<.0001), PAPP-A (P<.0001), high-density lipoprotein cholesterol (P<.0001), and free ß-hCG (P<.0001) (R2=0.33; P<.0000001). CONCLUSION: First-trimester serum progesterone levels were lower in overweight pregnant people and markedly decreased in those with obesity, especially obesity class II/III. Maternal high-density lipoprotein cholesterol was independently related to progesterone levels as a protective factor. Benefits of progesterone supplementation in pregnant people with obesity need further evaluation.

Effect of body mass index trajectory on lifetime risk of cardiovascular disease in a Chinese population: A cohort study.

BACKGROUND AND AIMS: The longitudinal trajectories of body mass index (BMI) can reflect the pattern of BMI changes. Lifetime risk quantifies the cumulative risk of developing a disease over the remaining life of a person. We aimed to identify the trajectory of BMI and explore its association with cardiovascular disease (CVD) in the Chinese population. METHODS AND RESULTS: A total of 68,603 participants with a mean age of 55.46 years were included from the Kailuan cohort in Tangshan, China, who were free of CVD and cancer and with repeated measurements of BMI from 2006 to 2010. A latent mixture model was used to identify BMI trajectories. An improved Kaplan-Meier estimator was used to predict the lifetime risk of CVD according to BMI trajectories. During a median follow-up of 7.0 years, 3325 participants developed CVD. Five BMI trajectories were identified at three index ages (35, 45, and 55) respectively. For index age 35 years, compared with the stable low-normal weight group (22.7% [95% CI, 20.0%-25.4%]), the stable high-normal weight (27.6% [25.6%-29.5%]), stable overweight (29.4% [27.4%-31.4%]), stable-low obesity (32.8% [30.0%-35.5%]), and stable-high obesity (38.9% [33.3%-44.5%]) groups had a higher lifetime risk of CVD (P < 0.05). We observed similar patterns for stroke and myocardial infarction. Similarly, the lifetime risk of CVD was higher in the long-term overweight and obese groups at 45 and 55 index ages. CONCLUSIONS: Long-term overweight and obesity were associated with an increased lifetime risk of CVD. Our findings could assist in predicting the population burden of CVD.

Neighborhood disadvantage is associated with decreased ovarian reserve in women with overweight and obesity.

OBJECTIVE(S): To evaluate the association between neighborhood disadvantage and ovarian reserve stratified by body mass index (BMI). DESIGN: Cross-sectional cohort study. SETTING: Single academic medical center. PATIENT(S): A total of 193 healthy reproductive-age women with regular menstrual cycles in the St. Louis, Missouri metropolitan area. INTERVENTION(S): Residence in a disadvantaged neighborhood. MAIN OUTCOME MEASURE(S): Ovarian reserve as assessed by ovarian antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) concentration. RESULT(S): Women (n = 193) ranged from 20 to 44 years. The majority had overweight or obesity (59%, n = 117) with mean BMI of 28±7 kg/m2. Forty-eight women lived in the most disadvantaged neighborhood quartile, of which 75% had overweight or obesity, compared with 54% of the 145 women living in the 3 less disadvantaged neighborhood quartiles. When controlling for age, race, and smoking status, women with overweight or obesity living in the most disadvantaged neighborhoods had significantly lower AMH compared with those living in the less disadvantaged neighborhoods. Antral follicle count did not differ among women with overweight or obesity by neighborhood of residence. Neighborhood disadvantage was not associated with ovarian reserve by AFC or AMH in women with normal weight or underweight status. CONCLUSION(S): Living in a socioeconomically deprived area is associated with lower markers of ovarian reserve among women with an elevated BMI.

Rethinking the association between overweight/obesity and ADHD in children: a longitudinal and psychosocial perspective.

OBJECTIVE: This study examines the association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity in a large-scale longitudinal study of children, while controlling for a range of psychosocial factors. METHOD: Data were obtained from Growing Up in Ireland, a nationally representative and longitudinal study of approximately 6500 children who were assessed at 9 and 13 years of age. Body mass index (BMI) was determined using measured height and weight, ADHD status was determined by parent reports of professional diagnoses and ADHD symptoms were measured using the Strengths and Difficulties Questionnaire (SDQ). RESULTS: The associations between ADHD status, ADHD symptoms (SDQ) and BMI category at age 9 and 13 years were evaluated using logistic regression. Adjustments were made for child factors (sex, developmental coordination disorder, emotional symptoms, conduct problems, birth weight and exercise) and parental factors (socio-economic status, parental BMI, parental depression, and maternal smoking and alcohol use during pregnancy). Logistic regression indicated that ADHD status was not associated with BMI category at 9 or at 13 years of age, but children with ADHD at 9 years were significantly more likely to be overweight/obese at 13 years than those without ADHD. However, when other child and parental factors were adjusted for, ADHD status was no longer significantly associated with weight status. Female sex, low levels of exercise, overweight/obese parents and prenatal smoking during pregnancy consistently increased the odds of childhood overweight/obesity. CONCLUSIONS: While ADHD and overweight/obesity co-occur in general populations, this relationship is largely explained by a variety of psychosocial factors.

Diagnóstico da gestão das ações de alimentação e nutrição nos municípios de Mato Grosso do Sul no contexto da má nutrição / Diagnostic de la gestion des actions d'alimentation et de nutrition dans les municipalités du Mato Grosso do Sul dans le contexte de la malnutrition

O Observatório de Condições Crônicas e Alimentação, o OCCA ­ MS, é uma iniciativa sul-mato grossense que conta com o apoio da Secretaria de Estado de Saúde (SES/MS) através da Gerência de Alimentação e Nutrição (GAN) para desenvolvimento de materiais educativos e pesquisa que apoiem a implementação da Política Nacional de Alimentação e Nutrição (PNAN) no estado. A iniciativa está financiada por meio de duas chamadas públicas de pesquisa CNPq/MS/SAS/DEPROS/CGAN que juntas contam com quase 700 mil reais em recursos. A situação da má nutrição no território do estado segue descrita por via de inquéritos nacionais de saúde e de demografia, indicando que a obesidade no Mato Grosso do Sul é grave. Também mediante aos dados de vigilância anuais, como o VIGITEL, há indícios de constante aumento e agravamento dessa condição. Portanto, a ação do Ministério da Saúde, com o financiamento através do Fundo Nacional de Saúde, concretizou a chamada 26/2018 para capacitação e formação de iniciativas estaduais a fim de iniciar no Brasil uma frente de enfrentamento para tal situação. Ademais, no ano de 2020, o grupo OCCA, então Rede de Enfrentamento e Controle da Obesidade no âmbito da Atenção Básica de Mato Grosso do Sul ­ REDE ECO-AB, iniciou a consulta aos gestores municipais envolvidos acerca das ações de alimentação e nutrição para enfrentamento da obesidade e da implantação da Política Nacional de Alimentação e Nutrição (PNAN). Assim, o presente documento cogita demonstrar a situação relatada pelos gestores em relação à alimentação e nutrição no relatório para que o SUS e, principalmente, a Atenção Primária à Saúde do estado do Mato Grosso do Sul possam se organizar no enfrentamento e controle dessa conjuntura. Ao aplicar o questionário sobre a gestão das ações de alimentação e nutrição nos municípios do estado de Mato Grosso do Sul, o OCCA compilou uma série de informações até então inéditas no estado sobre a gestão e qualificação do cuidado no SUS em relação à alimentação e nutrição. O esforço de se entender esse processo dentro da saúde no estado pode nos fazer pensar e apoiar estratégias de manejo e enfrentamento da carga de má nutrição no território e a entendê-la como determinante da saúde e como parte da solução dos desafios diários do SUS. A Política Nacional de Alimentação e Nutrição (PNAN) tem como propósito a melhoria das condições de alimentação, nutrição e saúde da população brasileira, mediante a promoção de práticas alimentares adequadas e saudáveis, a vigilância alimentar e nutricional, a prevenção e o cuidado integral dos agravos relacionados à alimentação e nutrição (BRASIL, 2013). O cenário epidemiológico brasileiro vem apresentando nuances de uma transição epidemiológica e nutricional mista (COUTINHO; GENTIL; TORAL, 2008), no qual ainda há a coexistência do excesso de peso e Doenças Crônicas Não Transmissíveis (DCNT) com desnutrição e carências de nutrientes. Nesse cenário, há aumento significativo do sobrepeso e obesidade: em 2021, o país já apresentava 63% da população adulta com excesso de peso e 28,5% diagnosticados com obesidade. A elevada prevalência de obesidade é fator de risco para o desenvolvimento de Doenças Crônicas Não Transmissíveis (DCNT) e também está associada à perda de qualidade de vida e maiores custos ao sistema de saúde. Portanto, as DCNT são consideradas um dos maiores problemas de saúde pública. No Brasil, o percentual de mortes prematuras por DCNT corresponde a 74% (BRASIL, 2020). Como referência estadual para a PNAN no Mato Grosso do Sul, a Gerência de Alimentação e Nutrição da Secretaria de Estado de Saúde (GAN/CAS/DGAS/SES) busca divulgar, implantar, apoiar e implementar ações de promoção e proteção da alimentação adequada e saudável e prevenção da obesidade e demais agravos aos 79 municípios deste território. As ações partem das visitas in loco; apoio remoto via e-mail, WhatsApp e afins; oficinas e eventos de formação; formação de rede com Instituições de Ensino Superior (IES), a exemplo da Rede ECO-AB; investido na qualificação da força de trabalho; apoiado pesquisas e inovação científica; monitorado os sistemas de informação e ações, programas e estratégias do Ministério da Saúde ao nível local. Entendendo que a questão de saúde é dependente e correlacionada com a situação do estado nutricional da população, parte-se para a consciência de outros achados no relatório. De modo que quando se analisa os processos decisórios e a gestão das ações de alimentação e nutrição, o primeiro dado que precisa ser explorado é a ausência da ATAN nos organogramas das SMS, que apesar de não ser obrigatória por lei, é o ponto focal das ações de alimentação e nutrição no SUS e é quem poderia prestar o auxílio técnico para enfrentamento da situação epidemiológica anteriormente exposta. Ainda chama a atenção dentro da ideia de uma área ou um ponto focal encarregado pelas ações de alimentação e nutrição, outro dado de que apenas 40 dos 79 municípios do estado têm um responsável técnico pelas ações de alimentação e nutrição. Essa conjuntura pode impactar profundamente a gestão para o enfrentamento da carga de má nutrição nos municípios porque sem um RT, não há nenhum tipo de ação coordenada com os demais dados e serviços do município. Assim, o que pode ocorrer é uma sobrecarga sobre alguns profissionais da gestão municipal - como o gerente da APS, o secretário municipal de saúde, e até de outros profissionais que trabalham no atendimento da população - mesmo que vistos como ponto focal "não oficiais" da alimentação e nutrição por não serem os nutricionistas das equipes multiprofissionais, os nutricionistas da atenção especializada e alta complexidade, e o nutricionista da merenda escolar, entre outros.

Nutritional assessment of servicemen in relation to area of duty and feeding habits: a Pakistani prospective / Avaliação nutricional de militares em relação à área de dever e hábitos alimentares: uma perspectiva paquistanesa

The present study was carried out to determine incidence of overweight and obesity in Pakistani servicemen with reference to their area of duty, feeding habits and also to identify risk factors. Accordingly, 2,501 servicemen selected from all over Pakistan using multiple stage stratified sampling protocol. Nutrition assessment performed using body mass index (BMI), waist to hip ratio (WHR) and dietary assessment using food frequency questionnaire. Collected data was analyzed using the SPSS version 25. Regression was used to find risk factors of obesity and WHR. Results indicated that about 1/4th of servicemen were smokers. Approximately, 1/5th of them were overweight and about one quarter were eating fruits and vegetables for <3 days/ week and <4 days/week, respectively. Only 1/3rd of them were physically active for at least <40 minutes per day. Age and fruits intake were significantly predicting BMI with a direct relation and vegetable intake was negatively correlated to BMI of the servicemen. Age and rank were significant predictors of WHR while, physical activity was negatively correlated to WHR. It is concluded and suggested from our study that there is a need to modify eating patterns and habits as well as improving physical activity on daily basis for healthy and long life of the servicemen.

O presente estudo foi realizado para determinar a incidência de sobrepeso e obesidade em militares paquistaneses com referência à sua área de serviço, hábitos alimentares e também para identificar fatores de risco. Assim, 2.501 militares selecionados de todo o Paquistão usando protocolo de amostragem estratificada de múltiplos estágios. Avaliação nutricional realizada por meio do índice de massa corporal (IMC), relação cintura-quadril (RCQ) e avaliação alimentar por meio de questionário de frequência alimentar. Os dados coletados foram analisados por meio do SPSS versão 25. A regressão foi usada para encontrar fatores de risco para obesidade e RCQ. Os resultados indicaram que cerca de 1/4 dos militares eram fumantes. Aproximadamente, 1/5 deles estava com sobrepeso e cerca de um quarto comia frutas e vegetais por <3 dias / semana e <4 dias / semana, respectivamente. Apenas 1/3 deles era fisicamente ativo por pelo menos <40 minutos por dia. Idade e ingestão de frutas foram preditores significativos do IMC com uma relação direta e ingestão de vegetais foi negativamente correlacionada com o IMC dos militares. Idade e posição foram preditores significativos de RCQ, enquanto a atividade física foi negativamente correlacionada com RCQ. Conclui-se e sugere-se a partir de nosso estudo que há necessidade de modificar os padrões e hábitos alimentares, bem como melhorar a atividade física no dia a dia para uma vida longa e saudável dos militares.

Fatores de riscos cardiovasculares de estudantes do curso de enfermagem de uma universidade particular / Cardiovascular ricks factors of nursing students at a private university / Factores de riesgo cardiovascular de los estudiantes de enfermería de una universidad privada

Introdução: Os riscos de desenvolvimento de doenças cardiovasculares são altamente prevalentes em indivíduos idosos, contudo essa condição tem crescido de maneira preocupante em adultos jovens, principalmente em acadêmicos de graduação. Essa condição pode estar relacionada a vários comportamentos de risco, associados às doenças cardiovasculares, como má alimentação, baixos níveis de atividade física, sobrepeso, etc. Objetivo: Identificar a prevalência dos riscos cardiovasculares em acadêmicos do Curso de Enfermagem de uma universidade particular do Sudoeste do Paraná. Metodologia: Pesquisa transversal, realizada em acadêmicos do Curso de Enfermagem de uma universidade particular do Sudoeste do Paraná. Avaliaram-se 99 acadêmicos do Curso de Enfermagem, que assinaram o Termo de Consentimento Livre e Esclarecido. Utilizou-se para coleta de dados um formulário eletrônico, disponibilizado nos endereços eletrônicos, WhatsApp e Classroom dos acadêmicos. O instrumento continha questões sobre autorrelato de medidas antropométricas (peso, estatura, circunferência de cintura) e pressão arterial, além de questões objetivas sobre consumo de álcool, medicamentos, doença existente, nível de atividade física habitual e bem-estar geral. Para análise dos dados, empregou-se estatística descritiva e Teste U de Mann- Withney, com nível de significância de p<0,05. Resultados: Observou-se que nos fatores de riscos cardiovasculares de Índice de Massa Corporal, Pressão Arterial e Circunferência Abdominal, os acadêmicos apresentaram valores médios adequados de acordo com tabelas normativas, cujos dados dos homens foram significativamente maiores em todas as variáveis analisadas (p<0,05). Para hábito de fumar e consumo de álcool diário, observou-se percentual baixo (3% e 2%, respectivamente). Verificou-se que 28,3% dos estudantes relataram ter alguma doença preexistente e 58,6% informaram fazer uso contínuo de alguma medicação. Observou-se, ainda, os percentuais de inadequação para pressão arterial (6,5%), Circunferência Abdominal (27%), Índice de Massa Corporal (28,3%) e Nível de Atividades Físicas Habitual (46,6%). A agregação de dois e quatro ou mais fatores de risco foi mais prevalente em mulheres, ao passo que os homens apresentaram maior agregação e três fatores. Conclusão: Os universitários do Curso de Enfermagem analisado apresentaram percentuais importantes de fatores de riscos cardiovasculares, principalmente em relação ao estado de sobrepeso ou obesidade e sedentarismo.

Introduction: The risks of developing cardiovascular diseases are highly prevalent in elderly individuals, however, this condition has grown alarmingly in young adults, especially in undergraduate students. This condition may be due to various risk behaviors associated with cardiovascular diseases, such as poor diet, low levels of physical activity, overweight, etc. Objective: To identify the prevalence of cardiovascular risks in undergraduate Nursing students at a private university in the southwest of Paraná. Methodology: It was a cross-sectional research, carried out in Nursing students from a private university in the Southwest of Paraná. 99 students of the Nursing Course were evaluated, who signed the Informed Consent Term. An electronic form was used for data collection, available at the academic addresses, WhatsApp and Classroom. The instrument contained self-reported anthropometric measurements (weight, height, waist circumference) and blood pressure, and objective questions about alcohol consumption, medication, existing disease, habitual physical activity level and well be general. For data analysis, was used descriptive statistics and Mann-Withney U test with a significance level of p <0.05. Results: It was observed that in the cardiovascular risk factors of body mass index, blood pressure and waist circumference, the students presented adequate average values according to normative tables, and the data of men were significantly higher in all variables analyzed (p <0.05). For smoking habits and daily alcohol consumption, a low percentage was observed (3% and 2% respectively). It was found that 28.3% of the students reported having a pre-existing disease and 58.6% reported making continuous use of some medication. It also observed the percentage of inadequacy for blood pressure (6.5%), waist circumference (27%), Body Mass Index (28.3%) and habitual physical activity level (46.6%). The aggregation of two and, four or more risk factors was more prevalent in women, whereas men showed greater aggregation and three factors. Conclusion: The university students of the analyzed nursing course presented important percentages of cardiovascular risk factors, mainly in relation to the state of overweight or obesity and physical inactivity.

Introducción: Los riesgos de desarrollar enfermedades cardiovasculares son altamente prevalentes en individuos de edad avanzada, sin embargo esta condición ha ido aumentando de manera preocupante en adultos jóvenes, especialmente en estudiantes de pregrado. Esta afección puede estar relacionada con varios comportamientos de riesgo asociados a las enfermedades cardiovasculares, como la mala alimentación, los bajos niveles de actividad física, el sobrepeso, etc. Objetivo: Identificar la prevalencia de riesgos cardiovasculares en estudiantes de pregrado de enfermería de una universidad privada del suroeste de Paraná. Metodología: Investigación transversal, realizada en académicos del Curso de Enfermería de una universidad particular del Sudoeste de Paraná. El estudio evaluó a 99 estudiantes de enfermería que firmaron el formulario de consentimiento libre e informado. Para la recogida de datos, se utilizó un formulario electrónico que se puso a disposición de los alumnos en sus direcciones electrónicas, WhatsApp y Aula. El instrumento contenía preguntas sobre las medidas antropométricas (peso, altura, perímetro de la cintura) y la presión arterial declaradas por el propio paciente, así como preguntas objetivas sobre el consumo de alcohol, la medicación, las enfermedades existentes, el nivel de actividad física habitual y el bienestar general. Para el análisis de los datos se emplearon estadísticas descriptivas y la prueba U de Mann-Withney, con un nivel de significación de p<0,05. Resultados: Se observó que en los factores de riesgo cardiovascular de Índice de Masa Corporal, Presión Arterial y Circunferencia Abdominal, los académicos mostraron valores medios adecuados según tablas normativas, cuyos datos de los hombres fueron significativamente mayores en todas las variables analizadas (p<0,05). En cuanto al hábito de fumar y al consumo diario de alcohol, se observó un bajo porcentaje (3% y 2%, respectivamente). Se comprobó que el 28,3% de los estudiantes declaró tener alguna enfermedad preexistente y el 58,6% informó del uso continuo de algún medicamento. También se observaron los porcentajes de inadecuación para la presión arterial (6,5%), el perímetro abdominal (27%), el índice de masa corporal (28,3%) y el nivel de actividad física habitual (46,6%). La agregación de dos y cuatro o más factores de riesgo fue más frecuente en las mujeres, mientras que los hombres mostraron una mayor agregación y tres factores. Conclusión: Los estudiantes de pregrado del Curso de Enfermería analizados presentaron porcentajes importantes de factores de riesgo cardiovascular, especialmente en relación con el estado de sobrepeso u obesidad y el sedentarismo.

A diagnostic model for overweight and obesity from untargeted urine metabolomics of soldiers.

Soldiers in active military service need optimal physical fitness for successfully carrying out their operations. Therefore, their health status is regularly checked by army doctors. These inspections include physical parameters such as the body-mass index (BMI), functional tests, and biochemical studies. If a medical exam reveals an individual's excess weight, further examinations are made, and corrective actions for weight lowering are initiated. The collection of urine is non-invasive and therefore attractive for frequent metabolic screening. We compared the chemical profiles of urinary samples of 146 normal weight, excess weight, and obese soldiers of the Mexican Army, using untargeted metabolomics with liquid chromatography coupled to high-resolution mass spectrometry (LC-MS). In combination with data mining, statistical and metabolic pathway analyses suggest increased S-adenosyl-L-methionine (SAM) levels and changes of amino acid metabolites as important variables for overfeeding. We will use these potential biomarkers for the ongoing metabolic monitoring of soldiers in active service. In addition, after validation of our results, we will develop biochemical screening tests that are also suitable for civil applications.

Obesity and "obesity-related" cancers: are there body mass index cut-points?

BACKGROUND: Despite compelling links between excess body weight and cancer, body mass index (BMI) cut-points, or thresholds above which cancer incidence increased, have not been identified. The objective of this study was to determine if BMI cut-points exist for 14 obesity-related cancers. SUBJECTS/METHODS: In this retrospective cohort study, patients 18-75 years old were included if they had ≥2 clinical encounters with BMI measurements in the electronic health record (EHR) at a single academic medical center from 2008 to 2018. Patients who were pregnant, had a history of cancer, or had undergone bariatric surgery were excluded. Adjusted logistic regression was performed to identify cancers that were associated with increasing BMI. For those cancers, BMI cut-points were calculated using adjusted quantile regression for cancer incidence at 80% sensitivity. Logistic and quantile regression models were adjusted for age, sex, race/ethnicity, and smoking status. RESULTS: A total of 7079 cancer patients (mean age 58.5 years, mean BMI 30.5 kg/m2) and 270,441 non-cancer patients (mean age 43.8 years, mean BMI 28.8 kg/m2) were included in the study. In adjusted logistic regression analyses, statistically significant associations were identified between increasing BMI and the incidence of kidney, thyroid, and uterine cancer. BMI cut-points were identified for kidney (26.3 kg/m2) and uterine (26.9 kg/m2) cancer. CONCLUSIONS: BMI cut-points that accurately predicted development kidney and uterine cancer occurred in the overweight category. Analysis of multi-institutional EHR data may help determine if these relationships are generalizable to other health care settings. If they are, incorporation of BMI into the screening algorithms for these cancers may be warranted.

Comparative effectiveness of aerobic exercise versus Yi Jin Jing on ovarian function in young overweight/obese women with polycystic ovary syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common heterogeneous endocrine disease among women of childbearing age, characterized by androgen excess and ovarian dysfunction. Aerobic exercise is an important solution used to manage PCOS, due to its multiple benefits. Yi Jin Jing is an important component of traditional Chinese exercise (TCE), based on the root of traditional Chinese medicine theory (TCM), which focuses on keeping the body as a whole in a harmonious state. However, to date there is no literature on the benign effects of Yi Jin Jing on PCOS. The primary purpose of this protocol is to assess the effectiveness of aerobic exercise versus Yi Jin Jing, on the management of ovarian function in young overweight/obese women with PCOS. METHODS: The study will conduct a controlled randomized, superiority trial with three-arm parallel groups, recruiting 90 women diagnosed with PCOS, ages between 18 and 35 years, with a body mass index (BMI) ≥ 23 kg/m2. Women will be randomly assigned to either control group (combined oral contraceptives) or one of the intervention groups (Yi Jin Jing group or aerobic exercise group) with an allocation rate of 1:1:1. After randomization, the intervention will be conducted within a 12-week period. The primary outcome would be anti-Mullerian hormone (AMH) level; the secondary outcomes would be biochemical profiles, ovarian volume, antral follicle count, BMI, menstrual frequency, and homeostasis model assessment of insulin resistance (HOMA-IR). Outcome measures would be collected during baseline and end of treatment. Reporting of the study will follow the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement. DISCUSSION: This proposed study will be the first randomized clinical trial to evaluate the comparative effectiveness of aerobic exercise versus Yi Jin Jing on the management of ovarian function in young overweight/obese women with PCOS. The results may provide a new evidence-based management strategy for young women with PCOS. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900022385 . Registered on 9 April 2019.