Pharmacotherapy for obesity: moving towards efficacy improvement.

Obesity is a chronic, recurring, progressive disease and a major public health problem associated with several other diseases that lead to disability, morbidity, and mortality. The prevalence of obesity has increased at pandemic levels, along with increasing weight-related comorbidities and deaths worldwide. Lifestyle interventions alone provide clinically significant long-term weight loss in only a small proportion of individuals, and bariatric surgery is not suitable or desirable for all patients. Historically, anti-obesity medications achieved a mean efficacy with weight loss between 5 and 10%, which significantly impacted several comorbidities and risk factors, but the average efficacy of these medications remained lower than that expected by both patients and health care professionals and eventually curbed long-term use. Moreover, there is no direct evidence on the impact of anti-obesity medications on cardiovascular outcomes. Semaglutide is a newer anti-obesity medication that changes the overall landscape, as phase 3 studies show a mean weight loss near the 15% threshold and significant proportions of patients with a weight loss of greater than 20%. In this review, we focus on the currently available anti-obesity medications, discuss the results of semaglutide, and present perspectives on the future of obesity treatment after semaglutide.

Patient motivation to lose weight: Importance of healthcare professional support, goals and self-efficacy.

BACKGROUND: People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. METHODS: PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. RESULTS: Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86-2.88]), comfort in talking to their HCP about weight (1.46 [1.24-1.72), agreement that it is easy to lose weight (1.73 [1.30-2.31]), and a goal of reducing risks from excess weight (1.45 [1.22-1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41-0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus <1 time a week (2.77 [2.09-3.68]) than those who reported they were not motivated. CONCLUSIONS: Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. CLINICAL TRIAL REGISTRATION: NCT03584191.

The 3Ds - Discussion, diagnosis and direction: Elements for effective obesity care by healthcare professionals.

BACKGROUND: The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). METHODS: An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. RESULTS: Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43-1.76] and 2.16 [1.94-2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39-1.69] and 1.15 [1.04-1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21-1.53]) and schedule follow-up appointments (1.21 [1.06-1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74-0.92]) or schedule follow-up appointments (0.69 [0.62-0.78]). CONCLUSION: Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. CLINICAL TRIAL REGISTRATION: NCT03584191.

Effectiveness of Pharmacologic Interventions in the Management of Weight Gain in Patients With Severe Mental Illness: A Systematic Review and Meta-Analysis.

OBJECTIVE: To collate and analyze randomized controlled trials (RCTs) that evaluated pharmacologic interventions to reduce weight gain in patients with severe mental illness (SMI). DATA SOURCES: Searches were conducted in PubMed, Web of Science, and PsycINFO databases from inception through May 9, 2019, using the terms ("severe mental disease" OR "severe mental illness" OR "severe mental disorder" OR schizophre* OR bipolar OR antipsychotic*) AND (weight) AND (pharmacologic* OR treatment). There was no language restriction, and the electronic search was complemented by a manual search for additional articles in reference lists and previous reviews. STUDY SELECTION: Fifty-two studies investigating different pharmacologic weight loss interventions in SMI were retrieved. Only RCTs assessing pharmacologic interventions to manage weight gain in adult subjects with SMI and reporting change in body weight as a primary outcome were included. DATA EXTRACTION: Two reviewers independently extracted data about the name and dose of the pharmacologic agent used to manage weight gain, trial duration, agent used for index disease, psychiatric diagnostics, and the mean change in body weight over the course of the trial. A meta-analysis was performed using a random effects model to pool mean body weight change over the course of the trial. RESULTS: The most-studied agent was metformin (14 studies), followed by topiramate (6 studies), nizatidine (4 studies), and sibutramine (3 studies). Other agents were investigated in 1 or 2 isolated studies. A meta-analytical procedure showed a significant pooled mean difference of -3.27 kg (95% CI, -4.49 to -2.06) for metformin compared with placebo and -5.33 kg (95% CI, -7.20 to -3.46) favoring topiramate. CONCLUSIONS: Metformin and topiramate were the most-studied agents for weight control in SMI and were considered efficacious and safe in promoting weight reduction compared to placebo in this population. More studies are required with larger sample sizes and in line with the recommendations from research from the obesity and metabolic field to better define guidelines for use of pharmacologic interventions to reduce weight gain in patients with SMI.

Does binge-eating matter for glycemic control in type 2 diabetes patients?

BACKGROUND: Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) treatment and may have an impact on glycemic control. Previous reports showed elevated prevalence of eating disordered behaviors, especially binge eating disorder in clinical samples of type 2 diabetes patients. However, results regarding the impact of an eating disorder on the glycemic and clinical control of T2DM is inconsistent. The purpose of this study was to assess the impact of a comorbid eating disorder on glycemic control (GC) in a group of patients with T2DM. METHODS: Eating behaviors of 70 consecutive patients with T2DM were assessed using a Structured Clinical Interview for DSM-IV and the Binge Eating Scale. The GC was examined with fasting blood glucose (FBG) and glycated hemoglobin (A1c) levels. In addition, secondary clinical variables were assessed, including body mass index (BMI) and lipids. Chi-square and Student's T tests were used to compare clinical and psychopathological characteristics of patients with and without an ED. In order to evaluate the relationship between GC and eating disorder (ED) a linear regression analysis was performed, controlling for BMI. A significance level of 5% was adopted. RESULTS: Seventy-seven percent of the sample (n = 54) were female and 50% were obese. Fourteen patients exhibited an ED, mostly binge eating disorder (BED). In a regression analysis, both FBG (beta coefficient = 47.4 (22.3); p = 0.037) and A1c (beta coefficient = 1.12 (0.57); p = 0.05) were predicted by the presence of an ED. However, the presence of an ED lost its impact on glycemic control outcomes after the addition of the BMI in the models. CONCLUSIONS: Eating psychopathology is frequently observed in patients with T2DM. Among individuals with T2DM, co-morbid ED is associated with a poorer glycemic control in the presence of a higher BMI. The presence of an eating disordered behavior in patients with T2DM seems to have clinical relevance in the usual care of patients with diabetes. Therefore, we recommend eating psychopathology should be routinely assessed in T2DM patients.

Overview of meta-analysis on prevention and treatment of childhood obesity / Visão geral das meta-análises sobre prevenção e tratamento da obesidade infantil

Abstract Objectives: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. Data source: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. Summary of data: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. Conclusion: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Resumo Objetivos: Este estudo teve como objetivo avaliar a qualidade das revisões sistemáticas sobre prevenção e tratamento não farmacológico do sobrepeso e da obesidade em crianças e adolescentes. Fontes de dados: Foi realizada uma busca em bases de dados eletrônicas (Medline via Pubmed, Web of Science, Scopus, LILACS, The Cochrane Library e Ensaios Clínicos), incluindo apenas revisões sistemáticas com meta-análise. As revisões foram selecionadas por dois pesquisadores e um terceiro resolveu as divergências. A lista de recomendações do PRISMA foi seguida. Síntese dos dados: Foram identificados 4.574 publicações, e 24 foram incluídas após seleção. Seis publicações eram sobre prevenção da obesidade, 17 sobre tratamento da obesidade e 1 sobre intervenções mistas para prevenção e tratamento da obesidade. As intervenções eram muito heterogêneas e mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal. Intervenções mistas que incluíam dieta, exercícios, ações para reduzir o comportamento sedentário e programas que envolviam a escola ou as famílias mostraram alguns efeitos positivos de curto prazo. Revisões que analisaram fatores de risco cardiovascular demonstraram melhoras significativas em curto prazo. Conclusão: As revisões sistemáticas de intervenções para prevenir ou reduzir a obesidade em crianças e adolescentes geralmente mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal, embora o perfil cardiovascular possa ter melhorado. Intervenções mistas demonstraram melhores efeitos, mas o impacto em longo prazo dos tratamentos da obesidade de crianças e adolescentes ainda não está claro.

Epidemiological study of metabolic syndrome in Brazilian soldiers

ABSTRACT Objective: The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. Subjects and methods: Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from 2014 to 2016. Characteristics: age = 27.77 (± 8.59) years and BMI = 25.15 (± 3.41) kg/m2. Blood tests and anthropometric measures were performed following the criteria of the International Diabetes Federation Task Force on MS Epidemiology and Prevention, 2009. The epidemiological analysis was based on Odds ratio (OR) with confidence interval (CI). Results: The prevalence of MS found was 12.21%. Both WC and BMI proved to be good predictors of changes in MS physiological markers. Increased WC and BMI were strongly associated with all physiological markers. Soldiers with WC ≥ 90 were more likely to present MS with OR = 33.37 (24.37-45.7). Soldiers with WC ≥ 90 also presented high risk of: high triglycerides with OR = 5.98 (4.69-7.61); low HLD-c with OR = 1.78 (1.47-2.16); and increased systolic blood pressure OR = 3.10 (2.55-3.76). Soldiers with BMI ≥ 30 had a high risk of: increased glucose with OR = 2.69 (1.93-3.75); and increased diastolic blood pressure with OR = 3.02 (2.22-4.10). Conclusion: Both WC and BMI can be considered as good predictors of changes in MS physiological markers. We believe that WC and BMI should be used as screening tools to indicate the soldiers that must undergo blood tests to monitor MS prevalence.

Is weight regain after bariatric surgery associated with psychiatric comorbidity? A systematic review and meta-analysis.

Bariatric surgery has been recognized as the gold standard treatment for severe obesity. Although postbariatric surgery patients usually achieve and maintain substantial weight loss, a group of individuals may exhibit weight regain. Several factors are proposed to weight regain, including psychiatric comorbidity. The objective of the study is to conduct a systematic review and meta-analysis of studies investigating the relationship between psychiatric comorbidity and weight regain. A systematic review through PubMed, Web of Science, Cochrane Library, Scopus, and PsycINFO was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After a stepwise selection, 13 articles were included in the qualitative analysis and 5 were included for a meta-analysis. Women was majority in most of the studies (87.6%), and a bypass procedure was the bariatric intervention most evaluated (66.8%), followed by gastric banding (32.1%) and sleeve (1.1%). Higher rates of postbariatric surgery eating psychopathology were reported in patients with weight regain. However, the association between general psychopathology and weight regain was not consistent across the studies. In the meta-analysis, the odds of eating psychopathology in the weight regain group was higher compared with the nonweight regain group (OR = 2.2, 95% CI 1.54-3.15). Postbariatric surgery eating psychopathology seems to play an important role in weight regain.

Gaps to bridge: Misalignment between perception, reality and actions in obesity.

AIMS: Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). MATERIALS AND METHODS: An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care. RESULTS: A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow-up appointments are required. CONCLUSIONS: Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations.

Epidemiological study of metabolic syndrome in Brazilian soldiers.

OBJECTIVE: The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. SUBJECTS AND METHODS: Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from 2014 to 2016. Characteristics: age = 27.77 (± 8.59) years and BMI = 25.15 (± 3.41) kg/m2. Blood tests and anthropometric measures were performed following the criteria of the International Diabetes Federation Task Force on MS Epidemiology and Prevention, 2009. The epidemiological analysis was based on Odds ratio (OR) with confidence interval (CI). RESULTS: The prevalence of MS found was 12.21%. Both WC and BMI proved to be good predictors of changes in MS physiological markers. Increased WC and BMI were strongly associated with all physiological markers. Soldiers with WC ≥ 90 were more likely to present MS with OR = 33.37 (24.37-45.7). Soldiers with WC ≥ 90 also presented high risk of: high triglycerides with OR = 5.98 (4.69-7.61); low HLD-c with OR = 1.78 (1.47-2.16); and increased systolic blood pressure OR = 3.10 (2.55-3.76). Soldiers with BMI ≥ 30 had a high risk of: increased glucose with OR = 2.69 (1.93-3.75); and increased diastolic blood pressure with OR = 3.02 (2.22-4.10). CONCLUSION: Both WC and BMI can be considered as good predictors of changes in MS physiological markers. We believe that WC and BMI should be used as screening tools to indicate the soldiers that must undergo blood tests to monitor MS prevalence.

Overview of meta-analysis on prevention and treatment of childhood obesity.

OBJECTIVES: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. DATA SOURCE: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. SUMMARY OF DATA: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. CONCLUSION: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Relation between weight loss and causes of death in patients with cardiovascular disease: finding from the SCOUT trial.

AIMS: Obesity is associated with an increased incidence of mortality. The Sibutramine Cardiovascular Outcomes (SCOUT) trial can provide the first evidence of the effect of intentional weight loss on mortality in an obese population at high risk. METHODS: SCOUT was a randomized, double-blind, placebo-controlled trial testing sibutramine vs. placebo. Eligibility for the trial required both men and women aged at least 55 years, with BMI of at least 27 kg/m and 45 kg/m or less. Study participants with type 2 diabetes mellitus (T2DM) only should have at least one other risk factor defined as hypertension, dyslipidaemia, smoking, or diabetic nephropathy, and/or they had a history of cardiovascular disease. Study participants were stratified in three groups: patients with T2DM, patients with a prior cardiovascular event but without diabetes, and patients with both T2DM and a prior cardiovascular event.The relationship between weight loss and mortality (all-cause, cardiovascular, and noncardiovascular) was investigated with Cox regression models. RESULTS: The main study showed that all-cause mortality was not different in patients allocated to sibutramine or placebo. This ancillary analysis demonstrates that there is a general trend showing higher mortality in patients with the greatest weight loss (weight reduction >10 kg) and in those with increasing weight (>1 kg). If integrated weight loss (area under the curve from baseline to 12 months) is used, these observations are confirmed. The impact of substantial weight loss on mortality is marked in those dying of noncardiovascular causes, specifically cancer. CONCLUSION: The relationship between weight change and mortality differs for cardiovascular and noncardiovascular mortality.

TRANSCULTURALIZATION RECOMMENDATIONS FOR DEVELOPING LATIN AMERICAN CLINICAL PRACTICE ALGORITHMS IN ENDOCRINOLOGY--PROCEEDINGS OF THE 2015 PAN-AMERICAN WORKSHOP BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY.

The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) convened their first Workshop for recommendations to optimize Clinical Practice Algorithm (CPA) development for Latin America (LA) in diabetes (focusing on glycemic control), obesity (focusing on weight loss), thyroid (focusing on thyroid nodule diagnostics), and bone (focusing on postmenopausal osteoporosis) on February 28, 2015, in San Jose, Costa Rica. A standardized methodology is presented incorporating various transculturalization factors: resource availability (including imaging equipment and approved pharmaceuticals), health care professional and patient preferences, lifestyle variables, socio-economic parameters, web-based global accessibility, electronic implementation, and need for validation protocols. A standardized CPA template with node-specific recommendations to assist the local transculturalization process is provided. Participants unanimously agreed on the following five overarching principles for LA: (1) there is only one level of optimal endocrine care, (2) hemoglobin A1C should be utilized at every level of diabetes care, (3) nutrition education and increased pharmaceutical options are necessary to optimize the obesity care model, (4) quality neck ultrasound must be part of an optimal thyroid nodule care model, and (5) more scientific evidence is needed on osteoporosis prevalence and cost to justify intervention by governmental health care authorities. This 2015 AACE/ACE Workshop marks the beginning of a structured activity that assists local experts in creating culturally sensitive, evidence-based, and easy-to-implement tools for optimizing endocrine care on a global scale.

Transcultural Diabetes Nutrition Algorithm: Brazilian Application.

The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D) is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy) and regular physical activity (structured exercise) represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA) is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.

Diabetes Care in Brazil.

BACKGROUND: The diabetes epidemic affects most countries across the world and is increasing at alarming rates in Latin America. Nearly 12 million individuals have diabetes in Brazil, and the current prevalence ranges from 6.3% to 13.5%, depending on the region and the diagnostic criteria adopted in each study. OBJECTIVE: To provide an overview of diabetes care in Brazil, focusing on studies of diabetes epidemiology, prevalence of patients within the standard targets of care, and economic burden of diabetes and its complications. METHODS: SciELO and PubMed searches were performed for the terms "diabetes," "Brazil," "Brazilian," and "health system"; relevant literature from 1990 to 2015 was selected. Additional articles identified from reference list searches were also included. All articles selected were published in Portuguese and/or English. FINDINGS: Recent studies detected a prevalence of gestational diabetes mellitus of nearly 20%. Among patients with type 1 diabetes, almost 90% fail to reach target of glycemic control, with less than 30% receiving treatment for both hypertension and dyslipidemia. More than 75% of patients with type 2 diabetes are either overweight or obese. Most of these patients fail to reach glycemic targets (42.1%) and less than 30% reached the target for systolic and diastolic blood pressure, body mass index, or low-density lipoprotein cholesterol. Only 0.2% of patients reach all these anthropometric and metabolic targets. CONCLUSIONS: Brazil is the fourth country in the world in number of patients with diabetes. Regardless of the diabetes type, the majority of patients do not meet other metabolic control goals. The economic burden of diabetes and its complications in Brazil is extremely high, and more effective approaches for preventions and management are urgently needed.

Association of hypoglycemic treatment regimens with cardiovascular outcomes in overweight and obese subjects with type 2 diabetes: a substudy of the SCOUT trial.

OBJECTIVE: To assess the association of hypoglycemic treatment regimens with cardiovascular adverse events and mortality in a large population of type 2 diabetic patients at increased cardiovascular risk. RESEARCH DESIGN AND METHODS: This analysis included 8,192 overweight patients with type 2 diabetes from the Sibutramine Cardiovascular Outcomes (SCOUT) trial randomized to lifestyle intervention with or without sibutramine for up to 6 years. Patients were grouped according to hypoglycemic treatment at baseline. The primary end point was the time from randomization to the first occurrence of a primary outcome event (POE), nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death. Multivariable Cox proportional hazards regression models were used to assess the impact of antiglycemic treatment on POE and all-cause mortality. RESULTS: Treatments for type 2 diabetes were as follows: diet alone (n = 1,394 subjects), metformin monotherapy (n = 1,631), insulin monotherapy (n = 1,116), sulfonylurea monotherapy (n = 1,083), metformin plus sulfonylurea (n = 1,565), and metformin plus insulin (n = 1,000); 905 subjects experienced a POE and 708 died. Metformin monotherapy was associated with lower risk of POE than insulin (hazard ratio [HR], 0.74; 95% CI, 0.57-0.95; P = 0.02). Diet alone also was associated with lower risk of POE (HR, 0.65; 95% CI, 0.48-0.87; P = 0.004). Metformin monotherapy also was associated with lower mortality (HR, 0.73; 95% CI, 0.54-0.99; P < 0.05), whereas no other monotherapies or combination therapies were significantly associated with POE or all-cause mortality compared with insulin as monotherapy. CONCLUSIONS: In obese patients with type 2 diabetes and high risk of cardiovascular disease, monotherapy with metformin or diet-only treatment was associated with lower risk of cardiovascular events than treatment with insulin.

Uric acid as a risk factor for cardiovascular disease and mortality in overweight/obese individuals.

BACKGROUND: The predictive value of serum uric acid (SUA) for adverse cardiovascular events among obese and overweight patients is not known, but potentially important because of the relation between hyperuricaemia and obesity. METHODS: The relationship between SUA and risk of cardiovascular adverse outcomes (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality, respectively, was evaluated in a post-hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. Participants enrolled in SCOUT were obese or overweight with pre-existing diabetes and/or cardiovascular disease (CVD). Cox models were used to assess the role of SUA as an independent risk factor. RESULTS: 9742 subjects were included in the study; 83.6% had diabetes, and 75.1% had CVD. During an average follow-up time of 4.2 years, 1043 subjects had a primary outcome (myocardial infarction, resuscitated cardiac arrest, stroke, or cardiovascular death), and 816 died. In a univariate Cox model, the highest SUA quartile was associated with an increased risk of cardiovascular adverse outcomes compared with the lowest SUA quartile in women (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.20-2.10). In multivariate analyses, adjusting for known cardiovascular risk factors the increased risk for the highest SUA quartile was no longer statistically significant among women (HR: 0.99; 95% CI: 0.72-1.36) nor was it among men. Analyses of all-cause mortality found an interaction between sex and SUA. In a multivariate Cox model including women only, the highest SUA quartile was associated with an increased risk in all-cause mortality compared to the lowest SUA quartile (HR: 1.51; 95% CI: 1.08-2.12). No relationship was observed in men (HR: 1.06; 95% CI: 0.82-1.36). CONCLUSION: SUA was not an independent predictor of cardiovascular disease and death in these high-risk overweight/obese people. However, our results suggested that SUA was an independent predictor of all-cause mortality in women.

Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda / Healthy eating, schooling and being overweight among low-income women

OBJETIVO: Analisar os fatores associados à prevalência do excesso de peso e obesidade em uma população de mulheres adultas de baixa renda, moradoras de uma região metropolitana; e sua associação com variáveis socioeconômicas, demográficas, reprodutivas e comportamentais, destacando a alimentação saudável. MÉTODOS: Foi realizado um estudo transversal de base populacional com uma amostra probabilística de 758 mulheres de 20 anos ou mais moradoras de Campos Elíseos - Duque de Caxias. Utilizou-se análise bivariada e regressão multivariada hierarquizada para identificar fatores associados ao excesso de peso e obesidade. RESULTADOS: Encontrou-se uma prevalência de obesidade de 23% e prevalências de 56,0%, quando somados o excesso de peso e a obesidade. Encontrou-se associação inversa entre anos de estudo, excesso de peso e obesidade. A maioria das mulheres referiu alimentação saudável (73,6%), que aumentou positivamente com a renda, escolaridade e idade. Não consumir semanalmente verduras esteve associado ao excesso de peso e não realizar alimentação saudável esteve associado à obesidade. CONCLUSÕES: Os resultados demonstraram que mesmo em uma população com renda baixa, um maior nível de escolaridade tem impacto na prevenção deste agravo e nas escolhas alimentares.

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Elíseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.

[Healthy eating, schooling and being overweight among low-income women]. / Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda.

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Elíseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.