Nonalcoholic fatty liver disease in asymptomatic Brazilian adolescents.

AIM: To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease (NAFLD) among asymptomatic Brazilian adolescents. METHODS: Transversal observational study included asymptomatic adolescents with central obesity from private and public schools in Salvador-Bahia, northeastern Brazil. The children answered a questionnaire that included age, gender, race, and medical history, and were submitted to a complete physical exam and abdominal ultrasound. Biochemical exams included: ALT, AST, GGT, C reactive protein (CRP), fasting glucose, insulin, cholesterol and triglycerides. Criteria for NAFLD included: the presence of steatosis in ultrasound and/or high level of ALT, negative or occasional historic of intake of alcohol (

Blood pressure: effect of body mass index and of waist circumference on adolescents.

BACKGROUND: Increased body mass index (BMI) and waist circumference (WC) have been associated with blood pressure elevation. OBJECTIVE: To evaluate the effect of BMI and WC on blood pressure (BP) of adolescents. METHODS: Cross-sectional analytical study including 536 adolescents from public and private schools. BMI was calculated and classified as high-normal (> or =50th p and < 85th p), overweight (> or =85th p and < 95th p), and obesity (> 95th p). WC was measured and considered increased if > 75th p. BP was considered elevated if > 90th p. RESULTS: 319 (59.5%) adolescents were girls, the mean age was 14.0+/- 1.99 years, high-normal weight was found in 39.6%, overweight in 37.1% and obesity in 23.3%. The percentage of high SBP and DBP followed the increase in BMI (p=0.000), reaching 46.4% among boys and 39.3% among obese girls for SBP and 42.0% and 44.6% for DBP, respectively. High SBP and DBP were 3.9 and 3.4 times more frequent among boys and 2.2 to 2.0 times more frequent among girls with WC > 75th p, respectively. Using simple linear regression analysis, each increment in BMI would increase SBP by 1.198 mmHg, and in WC by 0.622 mmHg. The PR for elevated SBP and DBP in relation to BMI > or =85th p was 3.9 (95% CI 2.0-7.4[p=0.000]) and 4.3(95% CI 2.2-8.5[p=0.000]), respectively; in relation to WC > 75th p was 1.8(95% CI 1.0 to 3.0 [p=0.036]) and 1.4 (95% CI 0.8 to 2.4). BP > 90th p with WC < or =75th p was found in 16/181 (8.8%) of the adolescents with high-normal weight. CONCLUSION: BMI and WC values have a strong influence on BP values in adolescents.

Pressão arterial: efeito do índice de massa corporal e da circunferência abdominal em adolescentes / Blood pressure: effect of body mass index and of waist circumference on adolescents

FUNDAMENTO: Aumento do índice de massa corporal (IMC) e da circunferência abdominal (CA) tem sido associado a elevação da pressão arterial. OBJETIVO: Avaliar o efeito do IMC e da CA sobre a pressão arterial (PA) de adolescentes. MÉTODOS: Estudo analítico de corte transversal. Selecionados 536 adolescentes, alunos de escolas públicas e privadas. Foram calculados IMC, classificado como normal alto (>p50 p85 p95). Mediu-se a CA, aumentada se>p75 e a PA, elevada se >p90. RESULTADOS: Trezentos e dezenove (59,5 por cento) indivíduos eram meninas, idade de 14,0± 1,99 anos, peso normal alto em 39,6 por cento, sobrepeso em 37,1 por cento e obesidade em 23,3 por cento. O percentual de PAS e PAD elevadas acompanhou a elevação do IMC (p=0,000), alcançando 46,4 por cento nos meninos e 39,3 por cento nas meninas obesas (PAS) e 42,0 por cento e 44,6 por cento (PAD), respectivamente. PAS e PAD elevadas foram 3,9 a 3,4 vezes mais freqüente nos meninos, e 2,2 a 2,0 vezes mais nas meninas com CA > p75, respectivamente. Pela análise de regressão linear simples cada aumento no IMC aumentaria a PAS em 1,198 mmHg e da CA em 0,622 mmHg. A razão de prevalência (RP) de PAS e PAD elevadas em razão do IMC>p85 foi 3,9(I.C. 95 por cento 2,0-7,4[p=0,000]) e 4,3(I.C. 95 por cento 2,2-8,5[p=0,000]), respectivamente, e em razão da CA>p75 de 1,8(IC 95 por cento 1,0 a 3,0 [p=0,036]) e 1,4(IC 95 por cento 0,8 a 2,4). Encontrou-se em 16/181(8,8 por cento) dos adolescentes com peso normal alto, PA>P90 com CA>p75. CONCLUSÃO: Os valores do IMC e da CA têm forte influência sobre os valores da PA de adolescentes.

BACKGROUND: Increased body mass index (BMI) and waist circumference (WC) have been associated with blood pressure elevation. OBJECTIVE: To evaluate the effect of BMI and WC on blood pressure (BP) of adolescents. METHODS: Cross-sectional analytical study including 536 adolescents from public and private schools. BMI was calculated and classified as high-normal (> 50th p and < 85th p), overweight (> 85th p and < 95th p), and obesity (> 95th p). WC was measured and considered increased if > 75th p. BP was considered elevated if > 90th p. RESULTS: 319 (59.5 percent) adolescents were girls, the mean age was 14.0± 1.99 years, high-normal weight was found in 39.6 percent, overweight in 37.1 percent and obesity in 23.3 percent. The percentage of high SBP and DBP followed the increase in BMI (p=0.000), reaching 46.4 percent among boys and 39.3 percent among obese girls for SBP and 42.0 percent and 44.6 percent for DBP, respectively. High SBP and DBP were 3.9 and 3.4 times more frequent among boys and 2.2 to 2.0 times more frequent among girls with WC > 75th p, respectively. Using simple linear regression analysis, each increment in BMI would increase SBP by 1.198 mmHg, and in WC by 0.622 mmHg. The PR for elevated SBP and DBP in relation to BMI > 85th p was 3.9 (95 percent CI 2.0-7.4[p=0.000]) and 4.3(95 percent CI 2.2-8.5[p=0.000]), respectively; in relation to WC > 75th p was 1.8(95 percent CI 1.0 to 3.0 [p=0.036]) and 1.4 (95 percent CI 0.8 to 2.4). BP > 90th p with WC < 75th p was found in 16/181 (8.8 percent) of the adolescents with high-normal weight. CONCLUSION: BMI and WC values have a strong influence on BP values in adolescents.

Fatty liver disease in severe obese patients: diagnostic value of abdominal ultrasound.

AIM: To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis. METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard. RESULTS: The study included 105 patients. The mean age was 37.2+/-10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis on US was associated to advanced grades of steatosis on histology (P=0.016). CONCLUSION: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery.

Preoperative upper gastrointestinal endoscopy in obese patients undergoing bariatric surgery: is it necessary?

BACKGROUND: Obesity has been shown to be an important risk factor for several gastrointestinal diseases. However, the indication for preoperative upper gastrointestinal endoscopy (UGE) for all patients before bariatric surgery is controversial. The aim of the present study was to evaluate the spectrum of gastrointestinal diseases detected during preoperative UGE in patients undergoing bariatric surgery and the relevance of this procedure. METHODS: A series of severely obese patients, who had undergone UGE before Roux-en-Y gastric bypass from October 2004 to May 2005 were consecutively enrolled in this study. The demographic and clinical data and endoscopic diagnoses were evaluated. Gastric biopsies were performed in elective patients according to the endoscopic findings. RESULTS: The study included 162 patients, 69.8% of whom were women. The mean age was 36.7 +/- 10.8 years. Abnormal findings were observed in 77.2% of patients. Esophagitis was present in 38.9%, gastritis in 51.2% (erosive gastritis in 49.3% and nonerosive gastritis in 50.7%), gastric ulcers in 1.9%, hiatal hernia, in 8.6%, gastric polyp in .6%, and duodenitis in 6.8% of patients. No patient had esophageal or gastric varices. Helicobacter pylori infection was investigated in 96 patients and was detected in 37.5%. Gastric biopsies were performed in 36 patients, with chronic inflammation found in 72.2%, inflammatory activity in 30.6%, and intestinal metaplasia in 11.1%. Glandular atrophy was not found in any patient. CONCLUSION: The results of our study have shown that the spectrum of gastrointestinal diseases observed in severely obese patients who underwent bariatric surgery is broad. Although this issue remains highly controversial, these findings suggest that systematic preoperative UGE and H. pylori testing should be performed in all patients scheduled to undergo bariatric surgery.

Common mental disorders among medical students

OBJECTIVE: Common mental disorders (CMD) have a high impact on interpersonal relationships and quality of life and are potential underlying causes for the development of more serious disorders. Medical students have been indicated as a risk population for the development of CMD. The aim of this study was to determine the frequency of CMD in undergraduate medical students and to identify related factors. METHODS: A cross-sectional study was performed in a sample population of medical students. CMD was identified according to the 20-item Self-Report Questionnaire. RESULTS: Two hundred and twenty-three students completed the questionnaire. The overall prevalence of CMD was 29.6 percent and its presence was independently associated with sleep disorders, not owning a car, not working and sedentary lifestyle. CONCLUSIONS: These findings indicate a high prevalence of CMD in the sample studied and are important for supporting actions to prevent mental disorders in future doctors and for reflecting on the curricula currently in use in medical schools.

OBJETIVO: Transtornos mentais comuns (TMC) possuem alto impacto nos relacionamentos interpessoais e na qualidade de vida, sendo potenciais substratos para o desenvolvimento de transtornos mais graves. Estudantes de medicina vêm sendo apresentados como população de risco para o desenvolvimento de TMC. O objetivo deste estudo é estimar a freqüência de TMC em acadêmicos de medicina da Universidade Federal da Bahia e identificar fatores relacionados. MÉTODOS: Realizou-se estudo transversal entre uma amostra de estudantes de medicina. A identificação dos TMC foi feita por meio do 20-item Self-Report Questionnaire. RESULTADOS: Foram avaliados 223 estudantes. A prevalência de TMC foi de 29,6 por cento, sendo independentemente associada a alterações do padrão do sono, não possuir transporte próprio, não trabalhar e não realizar exercício físico. CONCLUSÕES: Estes dados demonstram uma elevada prevalência de TMC na amostra pesquisada e são importantes para subsidiar ações de prevenção de transtornos mentais entre futuros médicos e reflexões sobre o modelo curricular vigente nas escolas médicas.