Retinal venous pressure is higher than the airway pressure and the intraocular pressure during the Valsalva manoeuvre.

PURPOSE: The aims of this prospective experimental study were to explore the influence of the Valsalva manoeuvre (VM) on retinal venous pressure (RVP) in human volunteers in a university setting and to establish correlations for RVP with the increase in airway pressure (∆AirP) and in intraocular pressure (∆IOP). METHODS: In total, 31 healthy young volunteers (age: 24 ± 1.7 years) were investigated. The instruments used included a dynamic contour tonometer, a contact lens dynamometer (Imedos) and an electronic pressure transducer for measuring airway pressure. The following measurements were successively performed in left eyes: tonometry, dynamometry, repeated simultaneous dynamometry and airway pressure measurement during the VM and tonometry during the VM. The pressures obtained during the VM were determined at 10, 20 and 30 seconds after onset of the VM by linear interpolation. RESULTS: The pressures (in mmHg) at baseline and during the VM (median and range with outliers) were as follows: ∆AirP: 10 seconds: 10.0 (7.5); 20 seconds: 12.5 (11.0); and 30 seconds: 11.0 (10.0); and RVP: Start: 17.1 (2.4); 10 seconds: 26.0 (7.5); 20 seconds: 25.0 (6.5); and 30 seconds: 24.0 (6.0). During the VM, the RVP was significantly increased compared with the ∆AirP (p = 0.0017). The IOP during the VM was 13.5 (2.7), and the increase in IOP (∆IOP) was 0.8 (5.6). CONCLUSION: During the VM, the RVP was increased compared with the ∆AirP. The increase in RVP (∆RVP) was significantly greater than the ∆IOP. During the VM, the calculated retinal perfusion pressure may be more strongly reduced by the ∆RVP than by the ∆IOP. These properties may influence retinal and optic nerve head pathophysiology.

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

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

Good weight loss responders and poor weight loss responders after Roux-en-Y gastric bypass: clinical and nutritional profiles.

BACKGROUND: Bariatric surgery is one of the main treatments for severity obesity, but weight regain after surgery is an important issue. OBJECTIVES: To compare the clinical and nutritional profiles of good and poor weight loss responders in the late postoperative period after bariatric surgery. METHODS: A cross-sectional study with patients undergoing Roux-en-Y gastric bypass in a University Hospital. Patients were divided into good weight loss responders (GWLR) and poor weight loss responders (PWLR) defined as ≥ 50% or < 50% excess weight loss (EWL), respectively, at least 2 years post-surgery. RESULTS: The sample included 204 individuals (87.7% women; mean age 50.15 ± 11.1 years; mean time after surgery 67.38 ± 30.76 months). Two years post-surgery, 71.1% were considered GWLR and 28.9% PWLR (mean EWL 72.33% ± 13.86%, and 35.06% ± 12.10%, respectively; p = 0.000). Weight regain was < 10% for 36.3% of patients, 10.1-20% for 36.3%, and > 20% for 21.3%, compared with the lowest post-surgery weight. Among PWLR, 49.0% regained > 20% of the lowest post-surgery weight. GWLR lost most weight at all time points analyzed (p < 0.05). GWLR presented improvement or remission of diabetes, dyslipidemia and hypertension more frequently compared to PWLR (p < 0.05). Eating patterns was similar between GWLR and PWLR (p > 0.05, study's power 100%). Quality of life improved in 79.5% of the total study sample, with greater improvements in the GWLR (p < 0.05). CONCLUSIONS: Greater weight loss correlated with improved remission in comorbidities and better quality of life.

Early effects of Roux-en-Y gastric bypass on peptides and hormones involved in the control of energy balance.

INTRODUCTION: Body weight varies depending on the prevailing direction of environmental pressures; however, physiological factors also play a significant role in the control of body weight. The aim of the present study was to assess the impact of Roux-en-Y gastric bypass (RYGB) on hormones and peptides involved in the control of energy balance and their possible implications in appetite/satiety. METHODS: The sample included 39 individuals with extreme obesity (37 women and two men) who underwent RYGB. Anthropometric and biochemical markers were collected before surgery and 6 months after RYGB. RESULTS: The BMI decreased from 44.3±6.4 to 31.7±5.7 kg/m (P<0.001) at the sixth month. Percentage of excess weight lost was 63.2±25.0%. Leptin and glucose levels decreased significantly 6 months after RYGB (P<0.001). Interestingly, a significant correlation was confirmed between the anorexigenic gut hormone peptide YY (PYY) and the central anorexigenic mediator α-melanocyte-stimulating hormone after 6 months of RYGB (r=0.35, P=0.004). In contrast, PYY concentrations were correlated negatively with BMI (r=-0.34, P=0.002). CONCLUSION: In the present investigation, it was found that there is a relationship between α-melanocyte-stimulating hormone and PYY concentrations, and it supports the role of the PYY to POMC signal in appetite regulation after RYGB.

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

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

Efeitos de Exercícios Aquáticos e Orientação Nutricional na Composição Corporal de Crianças e Adolescentes Obesos / Effects of aquatic exercise and nutritional guidance on the body composition of obese children and adolescents

O objetivo do estudo foi analisar os efeitos de exercícios físicos aquáticos e orientação nutricional sobre a composição corporal em crianças e adolescentes obesos. Foram estudados 30 obesos com índice de massa corporal (IMC) acima do percentil 95, de acordo com o índice de massa corporal (IMC) proposto pela classificação de Center for Disease Control and Prevention (CDC, 2000), entre 10 e 16 anos, divididos em dois grupos:o primeiro grupo com iniciação e aprendizagem à natação (GNat, n=10) e o segundo com caminhada aquática em suspensão (Gcam =20). Na fase inicial e após 12 semanas, foram avaliados: peso, estatura, Índice de Massa Corporal (IMC), IMC-Escore Z, gordura relativa e absoluta, massa corporal magra relativa e absoluta. O programa consistiu de 12 encontros para a orientação nutricional (uma vez por semana) e 36 sessões de exercício físico (três vezes por semana). Utilizaram-se MANOVA e Teste Exato Fischer para a análise estatística, com nível de significância p<0,05. Após 12 semanas, o GCam apresentou redução significativa do IMC, IMC-Escore Z, gordura relativa e absoluta e aumento da massa corporal magrarelativa e absoluta. Quando comparados os grupos, houve diferenças significativas para o GCam quanto à redução da gordura corporal (p = 0,014) e aumento da massa magra (p= 0,006) em relação ao GNat. O programa de caminhada aquática em suspensão aliado a um programa nutricional, pode resultar em importantes modificações na composição corporal de crianças e adolescentes obesos pela característica cíclica da atividade em relação ao grupo de aprendizado de natação.

The objective of this study was to analyze the effects of aquatic exercise and nutritional guidance on the body composition of obese children and adolescents. Thirty obese children aged 10 to 16 years, with a body mass index (BMI) above the 95th percentile according to the classification proposed by the Centers for Disease Control and Prevention (CDC, 2000), were divided into two groups: the first group started learning to swim (GSwim, n = 10) and the second group underwent a deep water running program (GDeep, n = 20). Weight, height, BMI, BMI Z-scores, relative and absolute fat, and relative and absolute lean body mass were evaluated atbaseline and after 12 weeks. The program consisted of 12 meetings for nutritional guidance (once a week) and 36 sessions of exercise (three times per week). MANOVA and Fisher?s exact test were used for statistical analysis, with the level of significance set at p < 0.05. After 12 weeks, GDeep showed a significant reduction in BMI, BMI Z-scores and relative and absolute fat, and an increase in relative and absolute lean body mass. Significant differences were observed between GDeep and GSwim in terms of the reduction in body fat (p = 0.014) and the increasein lean mass (p = 0.006). A program of deep water running together with nutritional guidance may promote significant changes in the body composition of obese children and adolescents due to the cyclic characteristic of this physical activity.

Impacto do estado nutricional no peso ao nascer de recém-nascidos de gestantes adolescentes / Nutritional status impact on the birth weight of newborns pregnant adolescents

OBJETIVO: avaliar o impacto do estado nutricional de gestantes adolescentes no peso do recém-nascido. MÉTODOS: EM Estudo de coorte histórica foram avaliadas 97 gestantes adolescentes atendidas no período de maio a junho de 2004 e seus recém-nascidos. Foram incluídas gestantes entre 10 e 19 anos, internadas em trabalho de parto, e excluídas aquelas com gravidez múltipla, complicações gestacionais, idade gestacional menor do que 37 semanas e dados incompletos no prontuário. A avaliação do estado nutricional materno incluiu altura, índice de massa corporal (IMC) pré-gestacional, ganho de peso gestacional (GPG) e consumo calórico e protéico, obtidos por relatórios de consumo alimentar habitual no final do terceiro trimestre gestacional. A associação entre as variáveis maternas (altura, IMC pré-gestacional, GPG e consumo) e o peso do recém-nascido foi analisada pelo teste de correlação de Spearman. O nível de significância de erro alfa foi de 5 por cento (p<0,05). RESULTADOS: a média de idade foi de 17,8±1,12 anos. A maioria (66 por cento) iniciou a gestação eutrófica, 29 por cento com baixo peso e 5 por cento com sobrepeso. A maioria apresentou GPG e consumo calórico e protéico inadequados. Observou-se que 7 por cento dos recém-nascidos apresentaram baixo peso e 37 por cento peso insuficiente. A altura e o GPG apresentaram correlação positiva e significante com o peso ao nascer. O IMC pré-gestacional e o consumo protéico apresentaram correlação inversa e estatisticamente significante com o peso ao nascer. Não foi observada correlação entre consumo calórico e o peso ao nascer. CONCLUSÃO: A ALtura materna e o GPG influenciaram o estado nutricional do recém-nascido.

PURPOSE: to evaluate the impact of the nutritional status of pregnant adolescents on the birth weight. METHODS: a cohort study including 97 adolescents and their respective newborns, evaluated from May to June, 2004. Pregnant women from 10 to 19 years old in labor were included in the study, and those with multiple pregnancies, complications, less than 37 weeks gestation, and incomplete data records were excluded. Maternal nutritional status evaluation included height, body mass index (BMI) before pregnancy, gestational weight gain (GWG) and caloric-proteic intake, obtained by habitual food intake recordatory by the end of the third gestational trimester. The association between maternal variables (height, pre-gestational BMI, GWG and intake) and the newborn weight was analyzed by Spearman's correlation test. Statistical significance was assumed when p<0.05. RESULTS: the mean age was 17.8±1.12 years old. Most adolescents (66 percent) started pregnancy with adequate weight, 29 percent had low weight and 5 percent overweight. Most adolescents showed inadequate GWG, caloric and proteic intake. Low birth weight was recorded in 7 percent of the newborns and insufficient weight was recorded in 37 percent of them. Maternal height and GWG showed positive and significant BW relation. Pre-gestational BMI and protein intake showed statistically significant inverse correlation with birth weight. No correlation between caloric intake and BW was demonstrated. CONCLUSION: maternal height and GWG influence the newborn nutritional status.

Implementando modificações no estilo de vida / Implementing changes in the life style

Recomendações para a prevenção e tratamento da hipertensão incluem modificações no estilo de vida. Modificações de longa duração nos hábitos alimentares dependem da adesão. A aderência às mudanças nos hábitos é altamente dependente da comunicação e interação entre o profissional de saúde e o cliente. Fatores importantes incluem: compreensão da doença, modelo multidimensional para alimentos e doenças e uso extensivo de analogias para integração de perspectivas científicas. Intervenção na dieta envolve modificações comportamentais e os estágios pré-contemplativo, contemplativo, preparatório, de ação, manutenção e relapso. Intervenção motivacional é o ponto-chave no estabelecimento da empatia, atenção, atitudes de não-julgamento e reação de colaboração. O objetivo do aconselhamento centrado no cliente amplia o conhecimento sobre riscos dietéticos, discute fatos nutricionais, aumenta a autoconfiança em introduzir mudanças e melhora a compreensão da adesão ao tratamento. O cliente deve estar ativamente envolvido no estabelecimento de estratégias, e o profissional de saúde deve prestar assistência na aquisição de conhecimento, atitudes e habilidades para a adoção de um comportamento dietético saudável

Avaliação da composição corporal, nível de hemoglobina e perfil nutricional de atletas adolescentes / Evaluation of the body composition, hemoglobin level and profile nutritional of adolescentes athetes

Com o objetivo de avaliar o estado nutricional de atletas adolescentes foram estudados o IMC, a composiçao corporal, os níveis de hemoglobina, a dieta habitual e o consumo de lanches e bebidas de 583 atletas, de ambos os sexos, participantes dos Jogos da Juventude Brasileiros, realizados na cidade de Curitiba, Paraná, no ano de 1996. Os resultados demonstraram que a grande maioria dos adolescentes avaliados era eutrófica. A composiçao corporal dos atletas, obtida por meio de dobras cutâneas, apresentou valores medianos de gordura corporal em torno de 12 por cento para os meninos e de 22 por cento para as meninas. A prevalência de anemia entre os adolescentes avaliados foi de, aproximadamente, 15 por cento entre os meninos e 17 por cento entre as meninas, nao sendo observada diferença estatisticamente significante, de acordo com o sexo e classe socioeconômica. A dieta habitual, obtida por questionário de freqüência de alimentos, foi comparada com as recomendaçoes do Guia da Pirâmide Alimentar e verificou-se que estes adolescentes apresentavam um padrao alimentar inadequado, com uma parcela muito pequena, aproximadamente 4 por cento dos atletas, consumindo o número adequado de porçoes recomendadas de todos os grupos de alimentos preconizados. O consumo habitual de doces, salgados, salgadinhos e bebidas foi bastante elevado, demonstrando que estes adolescentes obtêm grande proporçao de energia deste tipo de alimento, geralmente muito rico em carboidratos simples e gorduras' Os resultados apontam para a necessidade de adequado acompanhamento nutricional deste grupo, com implantaçao de açoes de educaçao nutricional, tendo em vista a importância da nutriçao adequada nesta faixa etária para a prevençao de doenças, manutençao da saúde e performance esportiva

Avaliaçäo biológica de dietas: estudo de dietas habituais e de uma proposta de cesta básica de baixo custo / Biological evaluation of diets: study of habitual diets and the propose of low-cost diet

A qualidade nutricional da proteína de dietas habituais da populaçäo do bairro Jardim América, Goiânia, Goiás, e de uma proposta de cesta básica de baico custo foi avaliada através de métodos biológicos relacionados com ganho e retençäo de nitrogênio corporal. A avaliaçäo biológica através de métodos relacionados com ganho de peso demonstrou que a dieta proposta foi superior às dietas habituais, quando avaliadas por PER e CEA, mas näo apresentou diferença estatística das dietas habituais, quando avaliadas por NPR. Na avaliaçäo através de métodos relacionados com retençäo de nitrogênio corporal as dietas testadas näo apresentaram diferença significativa, entre si quando foram utilizados os métodos de VB, D e BN. No método de NPU a dieta proposta apresentou resultados superiores aos das dietas habituais. As dietas habituais e a dieta proposta, que atendia às recomendaçöes proteico-energéticas da OMS, apresentaram resultados inferiores que diferiram significativamente dos apresentados pela dieta controle caseína, em todos os métodos utilizados. Ao comparar a composiçäo proteica das dietas teste obtidas através de tabela de composiçäo química de alimentos com os resultados obtidos através de determinaçöes efetuadas em laboratório pode ser observado que as dietas habituais apresentaram valores maiores que os da análise teórica enquanto que a dieta proposta apresentou teor menor