Physical Function, Quality of Life, and Energy Expenditure During Activities of Daily Living in Obese, Post-Bariatric Surgery, and Healthy Subjects.

OBJECTIVES: This study aimed to evaluate physical function (PF), quality of life (QOL), and energy expenditure (EE) during activities of daily living (ADL) in late outcome post-bariatric surgery (BS) patients and to compare them to severe obese individuals and matched controls. METHODS: Sixty-three subjects were included: 21 patients in post-operative (PO) of BS (3-4 years post-Roux-en-Y gastric bypass) with a stable weight for at least 6 months (16 women, 41 ± 11 years old, BMI = 28 ± 4 kg m-2) (group PO); 21 obese individuals with BS indication (16 women, 44 ± 9 years old, BMI = 44 ± 6 kg m-2) (group OB); and 21 controls matched to PO by gender, age, and BMI (16 women, 42 ± 12 years old, BMI = 27 ± 6 kg m-2) (group MC). PF was objectively assessed by the Glittre and modified Glittre ADL-tests. QOL (SF-36), EE (activity monitoring during ADL), and body composition (bioelectrical impedance) were also assessed. RESULTS: OB had worse PF (Glittre ADL-test) compared to PO and MC (OB = 224 ± 76 s; PO = 143 ± 39 s; and MC = 118 ± 17 s; p < 0.0001). The same was observed for QOL (p < 0.05 for all SF-36 domains). OB also had higher total EE in the Glittre ADL-test. However, 63% of the activity time was in low-intensity EE. In the Glittre modified protocol, OB had poorer performance than PO and MC when walking up/downstairs, rising/sitting in a chair, and moving objects on a shelf. CONCLUSIONS: Post-BS patients have better PF and QOL and perform activities under lower total EE than obese subjects, very similar to matched controls.

Validity and Reproducibility of the Glittre ADL-Test in Obese and Post-Bariatric Surgery Patients.

BACKGROUND: Obese and post-bariatric surgery (BS) subjects often present limitations in physical functioning (PF). The Glittre ADL-test is a simple and useful way to evaluate this outcome. It includes functional activities such as rising from a chair, lifting, carrying weights, and bending over and was never studied in the obese population. This study aimed to determine the validity and reproducibility of the Glittre ADL-test to evaluate PF in obese, post-BS, and healthy control subjects. METHODS: Twenty-one post-BS patients (3-4 years post-surgery) (16 women, 41 ± 11 years, BMI = 28 ± 4 kg m-2) (group PO); 21 obese individuals (16 women, 44 ± 9 years, BMI = 44 ± 6 kg.m-2) (group OB) and 21 control individuals matched to PO (16 women, 42 ± 12 years old, BMI = 27 ± 6 kg m-2) (group MC) were included. For the reproducibility analysis, the Glittre ADL-test was performed twice, with a 30-min interval. As criterion methods for the validation, subjects performed two walking tests and answered a health status questionnaire (SF-36). RESULTS: High intraclass correlation (OB: r = 0.91 and PO: r = 0.89; MC: r = 0.86; P < 0.0001 for all) and good Bland-Altman agreement between the two tests were found in all groups. However, learning effect ranged between 8.8 and 11.8 % and significant test-retest differences occurred. The test was valid for all groups (moderate-to-high significant correlations with the criterion methods). CONCLUSIONS: Glittre ADL-test is valid and reproducible to evaluate PF of obese, post-BS, and healthy control subjects. However, due to the large learning effect, two tests are required for accurate assessment.

Fatores associados à melhora da composição corporal em indivíduos com DPOC após treinamento físico / Factors associated with the improvement of body composition in subjects with COPD after physical training

Introdução A redução da massa magra corpórea (MMC) é um fator independente de mortalidade em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) e a literatura mostra que exercícios físicos aumentam a MMC. Objetivo Identificar fatores associados à melhora da composição corporal em indivíduos com DPOC após treinamento físico de alta intensidade. Métodos 37 pacientes com DPOC (19 H; 66 ± 7 anos; IMC = 27 ± 6 kg/m2; VEF1 = 38 ± 16 %pred) foram avaliados segundo sua composição corporal, função pulmonar, força muscular respiratória e periférica, capacidade funcional de exercício (teste de caminhada dos seis minutos, TC6M), nível de atividade física diária (DynaPort®), sensação subjetiva de dispneia (escala Medical Research Council) e qualidade de vida (Saint George Respiratory Questionnaire). O treinamento conteve exercícios de endurance e força muscular (3 vezes por semana por três meses). Após três meses, os pacientes foram reavaliados. Aqueles que apresentaram incremento de MMC incorporaram à estatística. Resultados No pré-treinamento, a MMC se correlacionou significativamente (p ≤ 0,05) com gasto energético total (r = 0,57), TC6M em %predito (r = 0,46), pressão expiratória máxima (PEmax) (r = 0,57), volume expiratório forçado no primeiro segundo em %predito (r = 0,47), força muscular de quadríceps femoral (r = 0,54), bíceps (r = 0,62) e tríceps braquial (r = 0,63). Contudo, o incremento da MMC após treinamento correlacionou-se significativamente somente com a melhora das escalas MRC (r = 0,4; p = 0,05) e PEmax (r = 0,35; p = 0,04). Conclusão Apesar de a MMC de pacientes com DPOC estar relacionada com a capacidade funcional de exercício, força muscular respiratória e periférica, obstrução pulmonar e gasto energético no pré-tratamento, a melhora da composição corporal está relacionada somente ao incremento da força muscular expiratória e sensação de dispneia após treinamento físico de alta intensidade.

Introduction The fat free mass (FFM) reduction is an independent predictor factor of mortality in patients with chronic obstructive pulmonary disease (COPD) and the literature shows that exercise increases the FFM. Objective To identify factors associated with improvement in body composition in patients with COPD after high intensity physical training. Methods Thirty-seven patients with COPD (19M; 66 ± 7 years; BMI = 27 ± 6 kg/m2; VEF1 = 38 ± 16 %pred) were evaluated according to their body composition, lung function, respiratory and peripheral muscle strengh, functional exercise capacity (six minutes walk test, 6 MWT), level of daily physical activity (activity monitor, DynaPort®), the sensation of Dyspnea (Medical Research Council scale) and quality of life (Saint George Respiratory Questionnaire). The physical training contained muscle strength and endurance exercises (3 times/week, for 3 months). After 3 months patients were reevaluated. Those who exhibited an increase in FFM entered in the statistics. Results At the baseline, FFM significantly (p ≤ 0.05) correlated with total energy expenditure (r = 0.57), 6MWT in %predict (r = 0.46), maximum expiratory pressure (MEP) (r = 0.57), forced expiratory volume in the first second in %predict (r = 0.47), quadriceps strength (r = 0.54), biceps strength (r = 0.62) and triceps strength (r = 0.63). However, the improvement in the FFM after training significantly correlate only with increases in the MRC scale (r = 0.47; p = 0.05) and MEP (r = 0.35; p = 0.04). Conclusion Despite the FFM in patients with COPD be related to functional exercise capacity, respiratory and peripheral muscle strength, pulmonary obstruction and energy expenditure in the baseline, improved in FFM after exercise training is related only with increases in expiratory muscle strength and with the dyspnea sensation.

Obesity and physical activity in the daily life of patients with COPD.

BACKGROUND: The aim of this study was to investigate the differences in body composition between physically active and inactive patients with chronic obstructive pulmonary disease (COPD) and the relationship of obesity [according to body mass index (BMI) and percentage of fat mass (%FM)] with physical activity in the daily life (PADL) in this population. METHODS: Body composition (bioelectrical impedance analysis) and level of PADL (activity monitors DynaPort and SenseWear) were evaluated in 74 patients with COPD (45 men, 65 ± 9 years old, FEV(1) = 40 ± 15%pred, BMI = 27 ± 6 kg m(-2)). Patients were divided in two groups: physically active (>30 min/day of physical activity of at least moderate intensity, or TPA > moderate) and inactive (did not achieve these recommendations). The sample was also classified according to BMI (underweight, normal weight, overweight, and obese) and their %FM (moderate obesity, high obesity, and morbid obesity). RESULTS: In the whole group, TPA > moderate correlated weakly with BMI (r = -0.28; p = 0.02) and FM (r = -0.30; p = 0.001) but not with fat-free mass (FFM) (r = -0.18; p = 0.13). Physically inactive patients had higher body weight (p = 0.002), FM (p = 0.0005), and lower FFM as % of body weight (p = 0.03) than active patients. Obese patients (according to BMI) had a worse PADL level than underweight and normal-weight patients (p < 0.0001). A poorer PADL level occurred in morbidly obese patients (p = 0.01) despite the weak correlation between FM and TPA > moderate in the whole group. CONCLUSION: Physically active patients with COPD have proportionally more FFM and less FM than inactive patients. More pronounced physical inactivity occurs in obese patients, although body composition does not qualify as an important correlate factor of the level of PADL in patients with COPD.

Effect of mesoionic 4-phenyl-5-(cinnamoyl)-1,3,4-thiadiazolium-2-phenylamine chloride derivative salts on the activities of the nitric oxide synthase and arginase of Leishmania amazonensis.

L-arginine is involved in the production of both nitric oxide (NO), mediated by nitric oxide synthase (NOS) and L-ornithine, by arginase activity. It is generally accepted that NO regulation occurs mainly at the transcriptional level of NOS. In a previous work we purported that there is evidence that Leishmania sp. can produce NO from L-arginine. An arginase activity in its gene sequence has also been reported in Leishmania parasites. In a search for intracellular targets as potential antileishmanicidal agents, such as the L-arginine metabolism, we used 1,3,4-thiadiazolium mesoionic compounds, that have been demonstrated to be cytotoxic to the Leishmania amazonensis, when compared to Pentamidine isethionate as a reference drug. Parasites were assayed in absence/presence of 4'- and 3'-methoxy mesoionic derivatives in order to verify the effect on NO production and arginase activity in L. amazonensis. The results indicated that the drugs reduce from 70 to 90% of the NO production by the parasite and act on a soluble nitric oxide synthase purified from L. amazonensis promastigotes and axenic amastigotes.

Leishmania amazonensis trypanothione reductase: evaluation of the effect of glutathione analogs on parasite growth, infectivity and enzyme activity.

Trypanothione reductase (TR) is a major enzyme in trypanosomatids. Its substrate, trypanothione is a molecule containing a tripeptide (L-glutamic acid-cysteine-glycine) coupled to a polyamine, spermidine. This redox system (TR/Trypanothione) is vital for parasite survival within the host cell and has been described as a good target for chemotherapy anti-Leishmania. The use of tripeptides analogs of glutathione would result in a decrease in trypanothione synthesis and as a consequence in TR activity. In this work, besides the enzyme potential inhibition, it also evaluated the influence of those analogs on parasite growth and on its infective capacity. The results showed a significant effect on parasite growth and infectivity and in addition TR activity was highly inhibited. These results are very promising, suggesting a potential use of those analogs as therapeutic drugs against experimental diseases caused by trypanosomatids.

Nitric oxide biosynthesis by Leishmania amazonensis promastigotes containing a high percentage of metacyclic forms.

Due to the diversity of its physiological and pathophysiological functions and general ubiquity, the study of nitric oxide (NO) has become of great interest. In this work, it was demonstrated that Leishmania amazonensis promastigotes produces NO, a free radical synthesized from L: -arginine by nitric oxide synthase (NOS). A soluble NOS was purified from L. amazonensis promastigotes by affinity chromatography (2', 5'-ADP-agarose) and on SDS-PAGE the enzyme migrates as a single protein band of 116.2 (+/-6) kDa. Furthermore, the presence of a constitutive NOS was detected through indirect immunofluorescence using anti-cNOS and in NADPH consumption assays. The present work show that NO production, detected as nitrite in culture supernatant, is prominent in promastigotes preparations with high number of metacyclic forms, suggesting an association with the differentiation and the infectivity of the parasite.

Nitric oxide synthase (NOS) characterization in Leishmania amazonensis axenic amastigotes.

BACKGROUND: Although Leishmania virulence may be modulated by environmental and genetic factors of their mammalian hosts and sand fly vectors, molecular determinants of Leishmania sp. are the key elements. This work evidences that Leishmania amazonensis axenic amastigotes produce comparatively more NO than infective promastigotes. METHODS: A soluble NOS was purified from L. amazonensis axenic amastigotes by affinity chromatography (2',5'-ADP-agarose), and on SDS-PAGE the enzyme migrates as a single protein band. RESULTS: The presence of a constitutive NOS was detected through immunofluorescence using antibody against neuronal NOS (nNOS) and in NADPH consumption assays. CONCLUSIONS: The present data show that NOS is prominent in axenic amastigote preparations, suggesting an association with the infectivity and/or an escaping mechanism of the parasite. The relationship between the NO-generating systems in the parasite and in their host cell warrants further investigation.