Who is getting screened for diabetes according to body mass index and waist circumference categories in Peru? a pooled analysis of national surveys between 2015 and 2019.

BACKGROUND: At the population level we would expect that people with obesity undergo diabetes screening tests more often than people with overweight and much more often than people with normal weight. We described the trends of diabetes screening according to body mass index (BMI) and waist circumference (WC) in Peru. METHODS: Pooled analysis of health national surveys (2015-2019); men and women aged 35-70 years. We used relative frequencies to study: among those who have had a glucose test in the last year, how many there were in each BMI and WC category. We fitted a Poisson model to study whether people with high BMI or WC were more likely to have had a glucose test. RESULTS: People with overweight (PR = 1.34; 95% CI: 1.29-1.38), obesity (PR = 1.57; 95% CI: 1.51-1.63) and central obesity (PR = 1.63; 95% CI: 1.35-1.96) were more likely to have had a glucose test. At the sub-national level, there was one (of twenty-five) region in which men with obesity were more often screened for diabetes than men with overweight and much more than men with normal weight. There were seven regions in which women with obesity were the most often screened for diabetes. CONCLUSIONS: Consistent with a risk-based prevention approach, people with obesity would be screened for diabetes more often than those with overweight and those with normal weight. This ideal profile was only observed in few regions. Diabetes screening strategies should be strengthened and homogenised, so that they reach those at high risk of diabetes.

La falacia de los niños gordos anémicos / The fallacy of the fat anemic child

Fundamento: los estudios sugieren la presencia de deficiencia de hierro en niños obesos, lo que conduciría a una mayor incidencia de anemia en este grupo. Objetivo: evaluar la prevalencia de anemia entre niños con sobrepeso y obesidad de dos niveles socioeconómicos y dos regiones diferentes en Brasil. Métodos: se obtuvieron datos de hemoglobina y antropometría de 598 niños y adolescentes con sobrepeso y obesidad de dos servicios especializados en la atención de estos niños. Resultados: la prevalencia global de anemia fue del 5,8% y el nivel medio de hemoglobina fue de 13,2 mg / dL, sin diferencia estadística para los dos indicadores según sobrepeso u obesidad y grupo de edad. Sin embargo, la hemoglobina media fue mayor entre los varones y, en el servicio con atención prestada a una población de menor nivel socioeconómico, la prevalencia de anemia fue mayor. Conclusión: la prevalencia de anemia encontrada en niños y adolescentes con sobrepeso y obesidad fue bastante baja, siendo mayor en la población más pobre. Para los niños y adolescentes con sobrepeso, la anemia parece estar más relacionada con el nivel socioeconómico que con la presencia de exceso de peso.

Background: studies suggest the presence of iron deficiency among obese children, which would lead to a higher incidence of anemia in this group. Aim: to assess the prevalence of anemia among overweight and obese children from two socioeconomic levels and two different regions in Brazil. Methods: hemoglobin and anthropometric data on 598 overweight and obese children and adolescents were obtained from two services specialized in the care of these children. Results: the overall prevalence of anemia was 5.8% and mean hemoglobin level was 13.2 mg/dL, with no statistical difference for the two indicators according to overweight or obesity and age group. However, the mean hemoglobin was higher among boys and, in the service with care provided to a population of lower socioeconomic status, the prevalence of anemia was higher. Conclusion: the prevalence of anemia found among overweight and obese children and adolescents was quite low, being higher in the poorest population. For overweight children and adolescents, anemia seems to be more related to socioeconomic status than to the presence of excess weight.

Medication use and obesity in Brazil: results from the National Health Survey.

Noncommunicable diseases (NCDs) associated with obesity generally require drug treatment. The use of medications in individuals with obesity has not been extensively investigated. The objective of this study was to analyze the relation between obesity and medication use. Data from the Brazilian National Health Survey 2013 was used, including 59,402 individuals. Weight and height measures were used to calculate body mass index (BMI) and categorized individuals according to BMI classification (exposure). The number of medications used for treating nine obesity-related NCDs was the outcome variable. Multinomial regression analyses were performed. The risk of use of medications to treat at least one NCD increased progressively with rising BMI, where this risk was even higher for treating two or more diseases. The risk of having to treat two or more NCDs with medications was approximately 70% greater among individuals with overweight (adjusted RR = 1.66; 95%CI 1.46-1.89), 170% greater in those with class I obesity (adjusted RR = 2.68; 95%CI 2.29-3.12), 340% greater for class II obesity (adjusted RR = 4.44; 95%CI 3.54-5.56) and 450% greater among individuals with class III obesity (adjusted RR = 5.53; 95%CI 3.81-8.02), compared with normal-weight subjects. Obesity was directly associated with drug utilization and the number of medications used to treat obesity-related NCDs.

Decreased levels and activity of Sirt1 are modulated by increased miR-34a expression in adipose tissue mononuclear cells from subjects with overweight and obesity: A pilot study.

BACKGROUND AND AIMS: Overweight and obesity are important risk factors for chronic disorders. Fat accumulation is one of the central manifestations; it occurs via a complex mechanism where multiple metabolic signals converge. Sirtuins are an enzyme family with deacetylase functions that are implicated in the regulation of several genes. Sirt1 and its upstream regulator (miR-34a) are elements of a converging mechanism that integrates the dynamic metabolic state. In this work, we hypothesized that elevated levels of miR-34a in overweight/obese group inhibits Sirt1 activity. Therefore, we studied the miR-34a/Sirt1 axis in mononuclear cells obtained from adipose tissue. METHODS: Adipose tissue samples were collected from 36 subjects, and they were categorized according to body mass index (BMI) as overweight/obesity and normoweight. Subcutaneous adipose tissue samples were enzymatically dissociated, and mononuclear cells from adipose tissue were isolated by Ficoll Hypaque. Sirt1-positive cells and relative Sirt1 expression were determined by flow cytometry and real-time polymerase chain reaction (qPCR), respectively. Finally, Sirt1 activity was measured with a luminescence assay. RESULTS: The percentage of Sirt1-positive mononuclear cells from adipose tissue decreased along with Sirt1 enzymatic activity in overweight/obese participants. miR-34a expression increased in the overweight/obese group compared to normoweight individuals. There was a negative association between the relative miR-34a expression and Sirt1-positive cells and a synergistic effect on Sirt1-positive cells mediated by the miR-34a inhibitor and Sirt1 agonist. CONCLUSIONS: Our results describe for the first time the presence of miR-34a and Sirt1 in mononuclear cells isolated from subcutaneous adipose tissue. Additionally, these results suggest altered sirtuin function in overweight/obese patients and open the possibility for new therapies that involve these metabolic targets.

Effect of pioglitazone treatment on brown adipose tissue volume and activity and hypothalamic gliosis in patients with type 2 diabetes mellitus: a proof-of-concept study.

AIMS: This study aimed to evaluate the effect of pioglitazone on brown adipose tissue function and hypothalamic gliosis in humans. Brown adipose tissue and the hypothalamus are regarded as important potential pharmacological targets to metabolic diseases, and defining the impact of current therapies on their structure and/or function could provide therapeutic advance in this field. METHODS: Six patients with type 2 diabetes were treated for 24 weeks with pioglitazone 30 mg/day as an add-on therapy. Brown adipose tissue glucose uptake and volume were determined using 18F-FDG PET/CT scans; hypothalamic gliosis was determined using MRI scans; blood was collected for hormone and biochemistry measurements. All tests were performed at inclusion and six months after pioglitazone introduction. RESULTS: Pioglitazone treatment led to a significant 3% body mass increase. There were neither changes in cold-induced brown adipose tissue glucose uptake and volume nor changes in hypothalamic gliosis. CONCLUSIONS: This is a proof-of-concept study that provides clinical evidence for a lack of action of a thiazolidinedione, pioglitazone, to promote homogeneous and measurable changes in brown adipose tissue volume and also in hypothalamic gliosis after 6 months of treatment.

Sex and Ethnic Differences in the Relationship between Changes in Anthropometric Measurements and Visceral Fat in Adolescents with Obesity.

OBJECTIVE: To examine sex and ethnic differences in how baseline and changes in anthropometric measures relate with change in visceral fat with interventions in adolescents. STUDY DESIGN: Black and white adolescents (n = 143: body mass index [BMI] ≥85th percentile, 12-18 years) who participated in intervention studies (3-6 months) were included and had assessments of anthropometric measures (weight, BMI, waist circumference, waist-to-hip ratio [WHR], and waist-to-thigh ratio) and visceral fat at L4-L5 by magnetic resonance imaging before and after interventions. RESULTS: At baseline, all of the anthropometric measures were positively associated with visceral fat (P < .05), with weight, waist circumference, and WHR having the largest variance explained (model adjusted R2 = 0.35-0.47 vs 0.32-0.35). Blacks had 11.5-23.3 cm2 less visceral fat compared with whites for a given anthropometric value. Girls tended to have less visceral fat for a given anthropometric value, but the sex differences were not consistently significant (range: 0.7-12.9 cm2). Changes in waist circumference, BMI, and weight, but not WHR, remained significantly associated with changes in visceral fat. There were no sex differences, and much more minimal ethnic differences (<4.9 cm2). CONCLUSIONS: At baseline, there are sex and ethnic differences in how anthropometric measures correlate with visceral fat. However, there were minimal sex and ethnic differences in how changes in anthropometric measures related with changes in visceral fat. Although all of the anthropometric measures were associated with visceral fat at baseline, waist circumference, BMI, and weight, but not WHR were associated with changes in visceral fat. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00739180, NCT01323088, and NCT01938950.

Hematopoietic changes in the offspring induced by maternal overweight: Effect on placenta and fetal liver populations.

INTRODUCTION: Bone marrow cells (BMC) from obese adult mice display an increased apoptosis rate over proliferation. Hematopoietic stem cells (HSC) form all blood cells and are important BMC used in cell therapy. Because it is known that prenatal development can be affected by adverse metabolic epigenetic programming from the maternal organism, this work aimed to investigate the effects of maternal overweight on placenta and fetal liver hematopoietic niches. METHODS: Overweight was induced in female mice by overfeeding during lactation. After Swiss females were mated with healthy males, fetuses at 19 dpc (day post conception) and placentas were analyzed. Maternal biometric parameters were compared, and hematopoiesis in the dissociated placenta and fetal liver cells was analyzed by flow cytometry. Placenta morphology and protein content were also studied. RESULTS: The model induced accumulation of adipose tissue, weight gain, and maternal hyperglycemia. Placentas from the overfed group (OG) displayed altered morphology, higher carbohydrate and lipid deposition, and increased protein content of fibronectin and PGC-1α. Cytometric analysis showed that placentas from OG presented a higher percentage of circulating macrophages, endothelial progenitor cells, HSC, and progenitor cells. No difference was detected in the percentage of neutrophil granulocytes and total leukocytes or in the proliferation of total cells, HSC, or total leukocytes. With regard to liver analysis of the OG group, there was a significant increase in circulating macrophages, primitive HSC, and oval cells but no difference in hematopoietic progenitor cells, total leukocytes, or leukocyte or total cell proliferation. CONCLUSION: Unregulated maternal metabolism can affect hematopoietic populations within the placenta and fetal liver.

Body weight concerns: Cross-national study and identification of factors related to eating disorders.

BACKGROUND: Body weight concerns are common among individuals with eating disorders, and this construct can be assessed using psychometric instruments. The Weight Concerns Scale (WCS) is commonly used to assess body weight concerns. AIMS: To evaluate the psychometric properties of the WCS with Brazilian, Portuguese, and Mozambican female college students; to estimate body weight concerns; and to identify factors related to eating disorders. METHODS: Confirmatory factor analysis was performed. Factorial, convergent, concurrent, and divergent validity, as well as reliability, were assessed. Cross-national invariance was tested by means of multigroup analysis. Structural models were tested using the WCS as the dependent variable, while demographic and academic variables and body mass index were used as independent variables. Logistic models were tested to estimate the likelihood of eating disorders being developed in specific groups. RESULTS: Participants were 2,068 female students. The psychometric properties of the WCS were adequate for the Portuguese sample; however, for the Brazilian and Mozambican samples, it was necessary to correlate the errors of two items to improve model fit. The WCS did not show cross-national invariance. The variables "thoughts about dropping out of college," "medication use because of studies," "medication and supplements use for body change," "body mass index," "socioeconomic status," "age," and "performance in course" were significant predictors of body weight concerns. Overall, 24.4% (95% confidence interval = 22.9-26.7) of the students were likely to develop eating disorders. Students under 21 years old, who use medication and supplements for body change, and who were classified as overweight/obese have increased likelihood of developing eating disorders. CONCLUSION: The WCS showed good psychometric properties with Brazilian, Portuguese, and Mozambican students; however, it did not show cross-national invariance. We identified important aspects for investigating body weight concerns and factors related to eating disorders.

Predictive models for estimating visceral fat: The contribution from anthropometric parameters.

BACKGROUND: Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. OBJECTIVE: Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. METHODS: A cross-sectional study involving overweight individuals whose AVT was evaluated (using computed tomography-CT), along with the following anthropometric parameters: body mass index (BMI), abdominal circumference (AC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), sagittal diameter (SD), conicity index (CI), neck circumference (NC), neck-to-thigh ratio (NTR), waist-to-thigh ratio (WTR), and body adiposity index (BAI). RESULTS: 109 individuals with an average age of 50.3±12.2 were evaluated. The predictive equation developed to estimate AVT in men was AVT = -1647.75 +2.43(AC) +594.74(WHpR) +883.40(CI) (R2 adjusted: 64.1%). For women, the model chosen was: AVT = -634.73 +1.49(Age) +8.34(SD) + 291.51(CI) + 6.92(NC) (R2 adjusted: 40.4%). The predictive ability of the equations developed in relation to AVT volume determined by CT was 66.9% and 46.2% for males and females, respectively (p<0.001). CONCLUSIONS: A quick and precise AVT estimate, especially for men, can be obtained using only AC, WHpR, and CI for men, and age, SD, CI, and NC for women. These equations can be used as a clinical and epidemiological tool for overweight individuals.

Daytime increase in caloric intake without change in total 24-h caloric intake can increase adiposity but not total bodyweight in rats with inverted feeding pattern.

The goal of this study was to evaluate the effect of the food availability period on body weight, self-selection of macronutrients, adiposity, lipoprotein, and serum glucose profiles without changing energy intake. Young male rats were divided into 2 groups according to the availability of food during the light and dark phases of the cycle, forming 2 groups: control group (CG) and group with inverted feeding pattern (IFPG). Before inversion of food availability on the 80th day, circadian food intake was measured every 4 h over 24 h during 3 days. The glycemic curve, an oral test for glucose tolerance, and self-selection of macronutrients were evaluated. Blood samples were collected for analysis of fasting glucose, triglycerides, and total cholesterol fractions. The IFPG showed an increase in fasting glucose in the dark phase of the cycle, changes in the glycemic curve, and oral glucose tolerance test. It also showed increased abdominal and liver fat and distinct choice of macronutrients compared with the CG. A change in the availability of food according to the phase of the circadian cycle produces changes in glucose and feeding circadian rhythm culminating in increased abdominal and hepatic fat. These effects can increase the risk of metabolic disorders and installation of chronic diseases.

Cytokine and adipokine are biofactors can act in blood and colostrum of obese mothers.

Breast milk contains bioactive components that contribute to newborn development. However, colostrum may undergo biochemical and immunological changes as a function of maternal overweight and obesity. To investigate this hypothesis, this study determined the levels of hormones and immunological markers in the serum and colostrum of overweight and obese mothers. Colostrum and serum samples were collected from 15 normoweight, 15 overweight, and 15 obese women for determination of leptin, adiponectin, cytokines (TNF-α, IL-6, IL-10), and C-reactive protein (CRP). Obese mothers exhibited higher levels of serum TNF-α, IL-6, and CRP, serum and colostrum leptin and colostrum adiponectin and lower levels of serum adiponectin. Leptin levels in maternal serum and colostrum were positively correlated, as was pre-pregnancy BMI and serum TNF-α, IL-6, CRP, and leptin. Adiponectin levels in colostrum and serum were negatively correlated. The results suggest that obesity changes hormonal and immunological components of maternal serum and colostrum. The modifications can have short-term and long-term effects on newborn development. © 2016 BioFactors, 43(2):243-250, 2017.

Neuroendocrine Inflammatory Responses in Overweight/Obese Infants.

Childhood obesity is related to a cascade of neuroendocrine inflammatory changes. However, there remains a gap in the current literature regarding the possible occurrence of these changes in overweight/obese infants. The objective of this study was to evaluate adipokines, cortisol, brain-derived neurotrophic factor (BDNF) and redox status in overweight/obese infants versus normal-weight peers. A cross-sectional study was conducted with 50 infants (25 in the overweight/obese group and 25 in the normal-weight group) between 6 and 24 months. Plasma levels of leptin, adiponectin, resistin, soluble tumor necrosis factor (TNF) receptors, chemokines, BDNF, serum cortisol and redox status were measured. Unpaired Student's t-test was used to analyze the results and a probability of p<0.05 was acceptable for rejection of the null hypothesis. The Pearson correlation was used to verify the association between the biomarkers analyzed in each group. Plasma levels of leptin (p = 0.0001), adiponectin (p = 0.0007) and BDNF (p = 0.003), and serum cortisol (p = 0.048) were significantly higher in overweight/obese infants than normal-weight infants. In contrast, the concentration of thiobarbituric acid reactive substances (TBARS) (p = 0.004), and catalase (p = 0.045) and superoxide dismutase activity (p = 0.02) were lower in overweight/obese infants than normal-weight peers. All the results together indicate neuroendocrine inflammatory response changes in overweight/obese infants between 6 and 24 months. Although there is already an environment that predisposes for a subsequent pro-inflammatory response, neuroendocrine secretion changes that permit the control of the inflammatory process in this age interval can be observed.

Overweight explains the increased red blood cell aggregation in patients with obstructive sleep apnea.

Sleep apnea patients and obese subjects are overexposed to cardiovascular diseases. These two health conditions may be associated with hemorheological alterations which could increase the cardiovascular risk. The present study investigated the hemorheological characteristics in patients with overweight and/or sleep apnea to identify the main predictor of red blood cell (RBC) abnormalities in sleep apnea patients. Ninety-seven patients were subjected to one night sleep polygraphy to determine their sleep apnea status. Body mass index (BMI) and the apnea/hypopnea index (AHI) were determined for categorization of obesity and sleep apnea status. Blood was sampled for hematocrit, blood viscosity, RBC deformability, aggregation and disaggregation threshold measurements. BMI and AHI were positively associated and were both positively associated with RBC aggregation. Analyses of covariance and multiple regression analyses revealed that BMI was more predictive of RBC aggregation than AHI. No association of BMI classes and AHI classes with RBC deformability or blood viscosity was observed. This study shows that increased RBC aggregation in sleep apnea patients is caused by overweight. Therapies to improve blood rheology in sleep apnea patients, and therefore reduce the risk for cardiovascular disorders, should focus on weight-loss.

Measurement of neck circumference and its correlation with body composition in a sample of students in São Paulo, Brazil.

PURPOSE: The purpose of this study was to verify the correlation between neck circumference (NC) and body mass index (BMI) in children, and to determine NC percentiles for Brazilian children. METHODS: The subjects of this cross-sectional study were students between the ages of 6 and 19 years from five schools in São Paulo, Brazil. Clinical and anthropometric data were collected from the students from April 2011 to June 2012. NC was measured at the level of the cricoid cartilage. We calculated Pearson correlation coefficients between NC and other indices of obesity with Sigma Stat 3.5. NC percentiles were produced using the LMS (lambda, mu, and sigma) method (STATA 12.0). RESULTS: Among 2,794 students, 49.9% were male. NC was significantly correlated with age, BMI, waist circumference (WC), and body fat percentage (%BF). The NC of boys was greater than that of girls. The NC curves of smoothed 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were constructed by age and sex. CONCLUSIONS: NC can be used in the assessment of obesity in childhood. There was a positive correlation between NC and BMI, WC and %BF. This study was the first to provide NC percentiles for children in Brazil.

[Hepatic steatosis, visceral fat and metabolic alterations in apparently healthy overweight/obese individuals]. / Esteatosis hepática, grasa visceral y alteraciones metabólicas, en individuos con sobrepeso/obesidad aparentemente sanos.

Clinical observation indicates that many obese individuals do not display important metabolic alterations. Consequently, the objective of this study was to establish whether simple obesity, non concurrent with other important risk factors, was associated with metabolic alterations; or if the phenomenon known as "obesity paradox" was present. A clinical history, measurements of anthropometric and metabolic parameters and estimation of hepatic steatosis and visceral fat, were determined in 30, apparently healthy, individuals from Maracaibo, Venezuela, between 20 and 59 years of age and a body mass index (BMI) above 25 kg/m2, and compared to a lean control group of 11 individuals with BMI less than 25 kg/m2. The study demonstrated that only one third of overweight/obese individuals (OW/OB), with high body mass index (BMI) and waist circumference (WC), presented elevated values of insulin, HOMA-IR and triglycerides. Nevertheless, the presence of hepatic steatosis was elevated in the OW/OB group (91%) vs. 9% in the control group. The visceral fat in the lean control group was associated with both, WC and glycemia; however, it was not related to the BMI or insulin, HOMA-IR and HDLc. The visceral fat in the OW/OB group, although elevated in relation to the lean group, revealed a loss of these associations. In the OW/OB it was the BMI that was associated with insulin and HOMA-IR. The results emphasize the importance of investigating for the presence of hepatic steatosis, rather than visceral fat, in individuals with OW/OB, to identify subjects with high cardiometabolic risk.

DNA methylation pattern in overweight women under an energy-restricted diet supplemented with fish oil.

Dietary factors modulate gene expression and are able to alter epigenetic signatures in peripheral blood mononuclear cells (PBMC). However, there are limited studies about the effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) on the epigenetic mechanisms that regulate gene expression. This research investigates the effects of n-3-rich fish oil supplementation on DNA methylation profile of several genes whose expression has been reported to be downregulated by n-3 PUFA in PBMC: CD36, FFAR3, CD14, PDK4, and FADS1. Young overweight women were supplemented with fish oil or control in a randomized 8-week intervention trial following a balanced diet with 30% energy restriction. Fatty acid receptor CD36 decreased DNA methylation at CpG +477 due to energy restriction. Hypocaloric diet-induced weight loss also reduced the methylation percentages of CpG sites located in CD14, PDK4, and FADS1. The methylation patterns of these genes were only slightly affected by the fish oil supplementation, being the most relevant to the attenuation of the weight loss-induced decrease in CD36 methylation after adjusting by baseline body weight. These results suggest that the n-3 PUFA-induced changes in the expression of these genes in PBMC are not mediated by DNA methylation, although other epigenetic mechanisms cannot be discarded.

Esteatosis hepática, grasa visceral y alteraciones metabólicas, en individuos con sobrepeso/obesidad aparentemente sanos / Hepatic steatosis, visceral fat and metabolic alterations in apparently healthy overweight/obese individuals

La observación clínica indica que muchos obesos no presentan alteraciones metabólicas importantes, por lo que el objetivo del presente estudio fue comprobar si el sobrepeso/obesidad (SP/OB) simple, no asociado a otros factores de riesgo, se acompañaba de alteraciones metabólicas; o si estaba presente el fenómeno conocido como “paradoja de la obesidad”. A 30 individuos aparentemente sanos de Maracaibo, Venezuela, entre 20 y 59 años de edad, e índice de masa corporal (IMC) superior a 25 kg/m², y a un grupo control de 11 individuos con IMC inferior a 25 kg/m², se les realizó una historia clínica, medida de parámetros antropométricos, determinaciones basales de glicemia, insulina y lípidos, medición ultrasonográfica para esteatosis hepática y ultrasonografía e impedancia bioeléctrica para estimar la grasa visceral. El estudio demostró que solo en un tercio de los individuos con SP/OB, con elevado IMC y circunferencia de cintura (CC), se encontraron concentraciones elevadas de insulina, HOMA-IR y triglicéridos. A pesar de ello, la presencia de esteatosis hepática fue muy elevada (91%) en el grupo SP/OB, si se compara con 9% en el grupo control. La grasa visceral, en el grupo control, estuvo asociada a la CC y a la glicemia; sin embargo, no se relacionó con el IMC, insulina, HOMA-IR o HDLc; mientras que en el grupo SP/OB, aunque estadísticamente elevada en relación al grupo control, reveló una pérdida de estas asociaciones. Los resultados resaltan la importancia de investigar más la presencia de esteatosis hepática en los individuos con SP/OB, que la estimación de la grasa visceral, para identificar sujetos con alto riesgo cardiometabólico.

Clinical observation indicates that many obese individuals do not display important metabolic alterations. Consequently, the objective of this study was to establish whether simple obesity, non concurrent with other important risk factors, was associated with metabolic alterations; or if the phenomenon known as “obesity paradox” was present. A clinical history, measurements of anthropometric and metabolic parameters and estimation of hepatic steatosis and visceral fat, were determined in 30, apparently healthy, individuals from Maracaibo, Venezuela, between 20 and 59 years of age and a body mass index (BMI) above 25 kg/m²,and compared to a lean control group of 11 individuals with BMI less than 25 kg/m². The study demonstrated that only one third of overweight/obese individuals (OW/OB), with high body mass index (BMI) and waist circumference (WC), presented elevated values of insulin, HOMA-IR and triglycerides. Nevertheless, the presence of hepatic steatosis was elevated in the OW/OB group (91%) vs. 9% in the control group. The visceral fat in the lean control group was associated with both, WC and glycemia; however, it was not related to the BMI or insulin, HOMA-IR and HDLc. The visceral fat in the OW/OB group, although elevated in relation to the lean group, revealed a loss of these associations. In the OW/OB it was the BMI that was associated with insulin and HOMA-IR. The results emphasize the importance of investigating for the presence of hepatic steatosis, rather than visceral fat, in individuals with OW/OB, to identify subjects with high cardiometabolic risk.

Low serum concentrations of carotenoids and vitamin E are associated with high adiposity in Mexican-American children.

Mexican-American children have a high prevalence of overweight/obesity. Micronutrient deficiencies may be contributing to the development of greater adiposity in these children. This study investigated the relations between adiposity and serum concentrations of carotenoids, retinol, and vitamin E among Mexican-American children 8-15 y of age included in the 2001-2004 U.S. NHANES. Associations of the outcomes of children's body mass index (BMI), truncal fat mass (TrFM), and total body fat mass (TBFM) with serum concentrations of α-carotene, cis-ß-carotene, trans-ß-carotene, retinol, and α-tocopherol were determined by using linear, quantile, and multinomial regression models. BMI was inversely associated with serum concentrations of α-carotene (ß = -0.88, P < 0.05), trans-ß-carotene (ß = -2.21, P < 0.01), cis-ß-carotene (ß = -2.10, P < 0.01), and α-tocopherol adjusted for total cholesterol ratio (ß = -3.66, P < 0.01), respectively. Similar inverse associations were found with TrFM and TBFM. Higher cis-ß-carotene and α-tocopherol serum concentrations were associated with reduced probability of overweight (OR: 0.57; 95% CI: 0.37, 0.89; P < 0.05; and OR: 0.56; 95% CI: 0.37, 0.86; P < 0.05; respectively) and obesity (OR: 0.39; 95% CI: 0.26, 0.58; P < 0.01; and OR: 0.38; 95% CI: 0.24, 0.60; P < 0.01; respectively). Higher retinol serum concentrations were associated with increased probability of overweight and obesity (OR: 2.01; 95% CI: 1.26, 3.22; P < 0.01; and OR: 2.90; 95% CI: 1.65, 5.09; P < 0.01; respectively). Significant inverse associations were found between serum concentrations of carotenoids and vitamin E and adiposity among Mexican-American children, but serum retinol concentrations were positively associated with adiposity. Future research is needed to understand the causes and consequences of micronutrient status on adiposity and comorbidities.

Hepatic adverse effects of fructose consumption independent of overweight/obesity.

The chronic intake of fructose has been linked to insulin resistance, obesity, dyslipidemia and nonalcoholic fatty liver disease (NAFLD), which in turn, may progress to nonalcoholic steatohepatitis (NASH). We aimed to evaluate the magnitude of the effects of the chronic consumption of high-fructose (HFr) and high fat (HF) alone or combined. Four groups of male mice were fed different diets for 16 weeks: standard chow (9% fat: SC), HF diet (42% fat), HFr diet (34% fructose) and HF/HFr diet (42% fat, 34% fructose). The food intake was not different among the groups, and the body mass was not greater in the HFr group than in the SC group. The homeostasis model assessment for insulin resistance (HOMA-IR), as well as plasmatic total cholesterol and triglycerides were greater in the groups HF, HFr, and HF/HFr group than in the SC group. We observed in the groups HF, HFr and HF/HFr, compared to the group SC, nonalcoholic fatty liver disease (NAFLD) with a predominance of lipogenesis mediated by SREBP-1c and PPAR-γ, and a reduction of the oxidation mediated by PPAR-α. We also observed an increase in gluconeogenesis mediated by the GLUT-2 and the PEPCK. Importantly, we identified areas of necroinflammation indicating a transition from NAFLD to nonalcoholic steatohepatitis in the HFr and HF/HFr groups. This study is relevant in demonstrating that fructose consumption, even in the absence of obesity, causes serious and deleterious changes in the liver with the presence of the dyslipidemia, insulin resistance (IR), and NAFLD with areas of necroinflammation. These conditions are associated with a poor prognosis.