Interdisciplinary Therapy Improves the Mediators of Inflammation and Cardiovascular Risk in Adolescents with Obesity.

Obesity is associated with inflammation and an increased risk of cardiovascular disease and premature mortality, as well as a range of other conditions. Obesity is a growing global problem, not only in adults, but also in children and adolescents. Therefore, the present study aimed to assess the effects of a one-year interdisciplinary intervention on the cardiometabolic and inflammatory profiles of adolescents with obesity. Twenty-two adolescents completed the intervention, which included clinical, nutritional, psychological and physical exercise counselling. Body composition, and metabolic, inflammatory, and cardiovascular risk biomarkers were analyzed before and after one year of intervention. Visceral and subcutaneous fat were determined ultrasonographically. The homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) equation were used to estimate insulin resistance and insulin sensitivity, respectively. A reduction in body mass, adiposity, glucose, and insulin and an improved lipid profile were observed after the therapy. Hyperleptinemia was reduced from 77.3% to 36.4%. Plasminogen activator inhibitor-1 (PAI-1), intercellular adhesion molecule 1 (ICAM-1), leptin, the leptin/adiponectin ratio, and the adiponectin/leptin ratio were also significantly improved. Metabolic changes were associated with a reduction in visceral fat and waist circumference, and adiponectin and the leptin/adiponectin ratio were associated with HOMA-IR. The interdisciplinary therapy promoted improvements in hyperleptinemia and metabolic, inflammatory, and cardiovascular biomarkers.

Percepções e práticas parentais associadas ao consumo alimentar e estado nutricional em crianças pré-escolares / Perceptions and parenting practices associated with food consumption and nutritional status in preschool children

Understanding infant diet is of great importance to elucidate its determining factors. It is known that parents exert great influence on the formation of their children's eating behavior and are able to define their children's eating patterns at other moments in their future life cycles. However, the effects of parental practices and perceptions on the food consumption and nutritional status of their children need to be elucidated more clearly. This study aimed to verify the association of parental practices and perceptions with food consumption and nutritional status of children. This is a cross-sectional study, conducted with parents and children aged two to six years old. Questionnaires were applied using the Google Forms® platform to investigate parental practices and perceptions, sociodemographic data, weight and height, child food consumption, and family food routine. The instruments used in data collection were the Child Feeding Questionnaire, the Child Feeding Frequency Questionnaire, and the authors' own questions. For statistical analysis, p<0.05 was considered significant. Sixty-eight parents of children were interviewed, of which 89.7% were mothers and 72.1% worked outside the home. Among children, 54.4% were male and 60.3% eutrophic. Among those parents who worked outside the home, preschoolers had most of their meals at school. There was an association between the parents' perception of the child's weight and nutritional status, frequency of parental responsibility in deciding the right type of food with the child's nutritional status, and parents' education. Controlling the intake of sweets was associated with parental age. Snack consumption by children was associated with parental education. It was concluded that parental practices and perceptions were associated with the nutritional status of preschoolers, but there was no association with food consumption.

Entender a alimentação infantil é de grande importância para elucidar os seus determinantes. Sabe-se que os pais exercem grande influência sobre a formação do comportamento alimentar da criança, podendo definir os padrões alimentares de seus filhos em outros momentos de seus ciclos de vida futuro. Entretanto, os efeitos das práticas e percepções parentais sobre o consumo alimentar e estado nutricional de seus filhos precisam ser elucidados com mais clareza. Este estudo teve como objetivo verificar a associação das práticas e percepções parentais com o consumo alimentar e estado nutricional de crianças. Trata-se de um estudo transversal, conduzido com pais e crianças de dois a seis anos. Aplicou-se questionários pela plataforma Google Forms®, para investigar as práticas e percepções parentais, dados sociodemográficos, peso e estatura, consumo alimentar infantil e rotina alimentar da família. Os instrumentos utilizados na coleta de dados foram o Questionário de Alimentação da Criança, Questionário de Frequência Alimentar da Criança e questões de autoria própria. Para análise estatística considerou-se significativo p<0,05. Foram entrevistados 68 pais de crianças, sendo que 89,7% eram mães e 72,1% trabalhavam fora de casa. Entre as crianças, 54,4% eram do sexo masculino e 60,3% eutróficos. Dentre aqueles pais que trabalhavam fora de casa, os pré-escolares realizavam a maior parte das refeições na escola. Verificou-se associação entre a percepção dos pais sobre o peso da criança e estado nutricional; frequência da responsabilidade dos pais em decidir o tipo correto de comida com o estado nutricional infantil e com a escolaridade dos pais. O controle da ingestão de doces associou-se à idade dos pais. O consumo de lanches pelas crianças associou-se a escolaridade dos pais. Concluiu-se que as práticas e percepções parentais foram associadas ao estado nutricional de pré-escolares, porém não houve associação com o consumo alimentar.

Redes sociais e insatisfação com a imagem corporal em estudantes da área da saúde / Social networks and dissatisfaction with body image among healthcare students

A insatisfação com a imagem corporal é um importante fator relacionado à transtornos alimentares. Nota-se que as redes sociais divulgam continuamente o corpo magro e musculoso, o que contribuiu para a internalização do corpo ideal. Entretanto, precisa ser melhor esclarecida a influência das redes sociais sobre a insatisfação com a imagem corporal em universitários da saúde. O objetivo deste estudo foi investigar a relação entre a insatisfação com a imagem corporal e o uso de redes sociais em estudantes de graduação da área da saúde. Realizou-se pesquisa transversal, com coleta de dados online pela plataforma Google Forms®. A amostra foi composta por 203 estudantes da área da saúde, na faixa etária entre 18 e 40 anos. Aplicou-se o questionário Body Shape Questionnaire (BSQ) para avaliar a insatisfação com a imagem corporal. A influência das redes sociais sobre estilo de vida e foi investigada pelo escore gerado pela somatória de seis questões, com respostas em escala Likert. Foram coletadas informações socioeconômicas, peso e altura autoreferidos. A análise estatística foi realizada pelo software JAMOVI, considerando-se o nível de significância p≤0,05. O escore de insatisfação com a imagem corporal foi significativamente superior nas mulheres, de maneira que se verificou que 65,4% delas apresentam algum grau de insatisfação. O IMC, número de redes sociais acessadas e o escore total de influência da mídia associaram-se positivamente à insatisfação com a imagem corporal. Conclui-se que a insatisfação com a imagem corporal se associou ao IMC, número de redes sociais e escore de influência das redes sociais, sendo observado principalmente em mulheres.

Dissatisfaction with body image is an essential factor related to eating disorders. It is noted that social networks continually publicize the lean and muscular body types, which have contributed to the internalization of the ideal body. However, social networks' influence on body image dissatisfaction in health university students must be clarified. This study aimed to investigate the relationship between dissatisfaction with body image and the use of social networks among undergraduate healthcare students. A cross-sectional survey was conducted, with online data collection using the Google Forms® platform. The sample consisted of 203 healthcare course students aged between 18 and 40 years. The Body Shape Questionnaire (BSQ) was applied to assess body image dissatisfaction. The influence of social networks on lifestyle was investigated by the score generated by the sum of six questions, with answers on a Likert scale. Socioeconomic information and selfreported weight and height were collected. Statistical analysis was performed using the JAMOVI software, considering a significance level of p≤0.05. The body image dissatisfaction score was significantly higher in women, and 65.4% had some degree of dissatisfaction. BMI, number of social networks accessed, and the overall media influence score were positively associated with dissatisfaction with body image. It is concluded that dissatisfaction with body image was associated with BMI, number of social networks, and social network influence score and was observed mainly in women.

The relationship between serum fatty acids and depressive symptoms in obese adolescents.

Depression and obesity are highly prevalent and are considered inflammatory pathologies; in addition, they are also associated with dietary patterns including types of fatty acids (FA). Changes in the FA composition in the brain are determined by changes in the content and quality of dietary and serum FA. The aim of this study was to verify the relationships between serum-free FA, inflammatory processes and depressive symptoms in obese adolescents. This was a cross-sectional study that analysed a database composed of 138 post-pubertal adolescents. Data regarding the depressive symptoms, body composition, glucose metabolism, lipid profile, FA profile, leptin concentration, as well as adiponectin, IL-A, IL-6, IL-10, TNF-α, C-reactive protein and plasminogen activator inhibitor-1 levels of the subjects were collected. A total of 54·6 % of the adolescents presented with depressive symptoms, and there were positive correlations between depressive symptoms and serum saturated fatty acids (SFA) content, body fat, and inflammatory adipokines, such as leptin, IL-6, and the leptin/adiponectin ratio. Moreover, the content of n-3 polyunsaturated fatty acids (PUFA) was negatively correlated with depressive symptoms, suggesting that eicosatrienoic acid (C20:2n6) and dihomo-γ-linolenic acid (C20:3n-6) are independently associated with depressive symptom scores and can be critical predictors of poor mental health in humans. These results point to the relationship between SFA and depressive symptoms in obese adolescents. However, longitudinal studies are needed to confirm the causality between dietary SFA and depression in obese individuals.

Percepções e práticas parentais associadas ao consumo alimentar e estado nutricional em crianças pré-escolares / Perceptions and parenting practices associated with food consumption and nutritional status in preschool children

Entender a alimentação infantil é de grande importância para elucidar os seus determinantes. Sabe-se que os pais exercem grande influência sobre a formação do comportamento alimentar da criança, podendo definir os padrões alimentares de seus filhos em outros momentos de seus ciclos de vida futuro. Entretanto, os efeitos das práticas e percepções parentais sobre o consumo alimentar e estado nutricional de seus filhos precisam ser elucidados com mais clareza. Este estudo teve como objetivo verificar a associação das práticas e percepções parentais com o consumo alimentar e estado nutricional de crianças. Trata-se de um estudo transversal, conduzido com pais e crianças de dois a seis anos. Aplicou-se questionários pela plataforma Google Forms®, para investigar as práticas e percepções parentais, dados sociodemográficos, peso e estatura, consumo alimentar infantil e rotina alimentar da família. Os instrumentos utilizados na coleta de dados foram o Questionário de Alimentação da Criança, Questionário de Frequência Alimentar da Criança e questões de autoria própria. Para análise estatística considerou-se significativo p<0,05. Foram entrevistados 68 pais de crianças, sendo que 89,7% eram mães e 72,1% trabalhavam fora de casa. Entre as crianças, 54,4% eram do sexo masculino e 60,3% eutróficos. Dentre aqueles pais que trabalhavam fora de casa, os pré-escolares realizavam a maior parte das refeições na escola. Verificou-se associação entre a percepção dos pais sobre o peso da criança e estado nutricional; frequência da responsabilidade dos pais em decidir o tipo correto de comida com o estado nutricional infantil e com a escolaridade dos pais. O controle da ingestão de doces associou-se à idade dos pais. O consumo de lanches pelas crianças associou-se a escolaridade dos pais. Concluiu-se que as práticas e percepções parentais foram associadas ao estado nutricional de pré-escolares, porém não houve associação com o consumo alimentar.

Understanding infant diet is of great importance to elucidate its determining factors. It is known that parents exert great influence on the formation of their children's eating behavior and are able to define their children's eating patterns at other moments in their future life cycles. However, the effects of parental practices and perceptions on the food consumption and nutritional status of their children need to be elucidated more clearly. This study aimed to verify the association of parental practices and perceptions with food consumption and nutritional status of children. This is a cross-sectional study, conducted with parents and children aged two to six years old. Questionnaires were applied using the Google Forms® platform to investigate parental practices and perceptions, sociodemographic data, weight and height, child food consumption, and family food routine. The instruments used in data collection were the Child Feeding Questionnaire, the Child Feeding Frequency Questionnaire, and the authors' own questions. For statistical analysis, p<0.05 was considered significant. Sixty-eight parents of children were interviewed, of which 89.7% were mothers and 72.1% worked outside the home. Among children, 54.4% were male and 60.3% eutrophic. Among those parents who worked outside the home, preschoolers had most of their meals at school. There was an association between the parents' perception of the child's weight and nutritional status, frequency of parental responsibility in deciding the right type of food with the child's nutritional status, and parents' education. Controlling the intake of sweets was associated with parental age. Snack consumption by children was associated with parental education. It was concluded that parental practices and perceptions were associated with the nutritional status of preschoolers, but there was no association with food consumption.

Parental feeding practices and ultra-processed food consumption in preschool children / Práticas alimentares parentais e consumo de alimentos ultraprocessados em pré-escolares

ABSTRACT: Objective: To investigate the association between parental feeding practices and the consumption of ultra-processed foods in preschool children. Methods: Cross-sectional study with 140 parents (father and mother) and their children (2-6 year-old). Parental feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire. Children's body weight and height were measured, and body mass index z-score per age was calculated. Parental anthropometric measurements (body weight and height) were obtained by self-report, and body mass index was calculated. The consumption of ultra-processed foods was assessed through the Child Food Frequency Questionnaire and the daily intake score was calculated. Multivariable linear regression analyses were performed to investigate the association between parental feeding practices and the consumption of ultra-processed foods. Results: Children's ultra-processed food consumption was negatively associated with the "Monitoring" parental feeding practices. On the other hand, "Emotion Regulation" and "Health restriction" parental feeding practices were positively associated with the ultra-processed food consumption score. Conclusion: Ultra-processed food consumption was associated to the "Monitoring", "Emotion regulation" and "Health restriction" parental feeding practices in preschool children. These results support the importance of using successful parental feeding practices to promote healthy eating in preschoolers.

RESUMO: Objetivo: O estudo buscou investigar a associação entre as práticas alimentares parentais e o consumo de alimentos ultraprocessados em crianças pré-escolares. Métodos: Estudo transversal realizado com 140 pares de pais e crianças de 2 a 6 anos de idade. As práticas parentais foram avaliadas pelo questionário Comprehensive Feeding Practices Questionnaire. O peso e a estatura das crianças foram aferidos e o escore z de índice de massa corporal para idade, calculado. A avaliação antropométrica dos pais foi realizada por meio do autorrelato de peso e altura e cálculo do índice de massa corporal. O consumo de alimentos ultraprocessados foi avaliado pelo Questionário de Frequência Alimentar da Criança e pelo cálculo de escore de consumo diário. Realizaram-se análises de regressão linear múltipla para avaliar a associação entre as práticas alimentares parentais e o consumo de alimentos ultraprocessados. Resultados: O consumo de alimentos ultraprocessados pelas crianças associou-se negativamente à prática parental de "Monitoramento". Por outro lado, as práticas alimentares parentais de "Regulação da emoção" e "Restrição para saúde" associaram-se positivamente ao escore de consumo de alimentos ultraprocessados. Conclusão: Conclui-se que o consumo de alimentos ultraprocessados por crianças pré-escolares relacionou-se às práticas alimentares parentais de "Monitoramento", "Regulação da emoção" e "Restrição para saúde". Esses resultados ressaltam a importância do uso de práticas alimentares parentais com desfecho positivo para a promoção de uma alimentação saudável em pré-escolares.

Semi-intensive and Intensive Interdisciplinary Treatments Have Similar Effects on Metabolic Syndrome and Selected Inflammatory Markers in Adolescents with Obesity.

BACKGROUND: The purpose of the present study was to compare the impact of semi-intensive and intensive interdisciplinary weight-loss therapies on the treatment of metabolic syndrome (MS) and selected inflammatory markers in adolescents with obesity. METHODS: The study included 166 adolescents enrolled in two groups for 22 weeks: the intensive group (in-person aerobic and resistance exercise three times a week, and psychological and nutritional counselling once a week), or the semi-intensive group (six in-person exercise orientation meetings and six in-person psychological support sessions with an online nutritional and exercise program). Anthropometric parameters, blood pressure, fasting glucose, insulin, lipid profile, triglycerides (TG), leptin and adiponectin were assessed before and after the interventions. RESULTS: Body weight and waist circumference decreased in both groups (P<0.001) and large effect sizes (η2= 0.586 and η2=0.465, respectively) were noted. Significant time and group interactions were found (P=0.001) with medium effect sizes (η2=0.095 and η2=0.105, respectively). The prevalence of MS decreased from 27.9% to 13.1% (P=0.012) and 29.4% to 5.9% (P=0.004) in the semi-intensive and intensive groups, respectively. All MS risk factors decreased significantly over time (P<0.001) and a significant time*group interaction was observed (P<0.05), except for fasting TG (P=0.832) and glucose (P=0.128, η2=0.021). CONCLUSION: The results suggested that both approaches promoted significant clinical improvement in the condition of adolescents with MS and reduced associated risk factors. Studies that consider the cost effectiveness of both treatments are still needed to determine whether semi-intensive care, with its lower financial costs, may be a suitable option to treat obesity and MS in adolescents with obesity.

Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity

ABSTRACT Objective: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. Subjects and methods: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. Results: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. Conclusions: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity.

OBJECTIVE: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. METHODS: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. RESULTS: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. CONCLUSION: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Adipocytokine and appetite-regulating hormone response to weight loss in adolescents with obesity: Impact of weight loss magnitude.

OBJECTIVE: The aim of this study was to investigate the association between the magnitude of weight loss (WL) and serum concentrations of the main adipocytokines and appetite-regulating hormones in adolescents with obesity. METHODS: After completion of informed consent,108 adolescents with obesity (14-19 y of age; postpubertal) were submitted to clinical, nutritional, psychological, physical exercise, and physiotherapy support for 1 y. Body composition (BC) and plasma levels of neuropeptides (neuropeptide Y [NPY], agouti-related peptide [AgRP], and α-melanocyte-stimulating hormone [α-MSH]) and leptin were measured at baseline and post-intervention. RESULTS: After therapy, adolescents who lost <10% body weight and <10% body weight (were compared. Both groups presented improvements in BC and reduced leptin. The Δα-MSH, Δα-MSH/AgRP ratio, and Δα-MSH/NPY ratio were lower and AgRP and NPY variations were higher in the low weight loss group. The leptin concentration was close to normal in the high weight loss only. The ΔWeight, Δα-MSH and Δleptin were associated with body fat loss by multiple linear regressions for all samples. CONCLUSION: Weight loss >10% seems to reverse obesity-induced hyperleptinemia while stabilizing the neuropeptides that control appetite in adolescents with obesity. We were able to produce a prognostic mathematical model to predict body fat loss using weight, leptin, and α-MSH variations.

Interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet in obese women / La terapia interdisciplinaria tuvo efectos positivos en el estado inflamatorio, mediado por la leptina, la adiponectina y la calidad de la dieta en mujeres obesas

BACKGROUND: obesity is a chronic disease associated with inadequate eating habits and reduced levels of physical activity. Because of obesity, the risk for comorbidities is increased, especially for cardiovascular diseases, insulin resistance, and increased pro-inflammatory factors. The aim of the present investigation was to analyze potential correlations between pro/anti-inflammatory adipokines, glycemic index, and other markers of diet quality using a metabolic profile in women undergoing interdisciplinary weight loss therapy. METHODS: thirty-two women with obesity were enrolled in a 12-week program of interdisciplinary therapy combining a clinical, nutritional, and physical exercise approach. Body composition, quality of diet, metabolic profile, and pro/anti-inflammatory adipokines were analyzed. RESULTS: the therapy showed to be effective in reducing body weight (from 93.16 ± 16.96 to 88.36 ± 16.23; p = 0.0000001), body mass index (from 34.01 ± 4.00 to 32.29 ± 3.96; p = 0.0000001), and body fat (from 38.25 ± 5.05 to 36.13 ± 5; p = 0.0000001). There was also an improvement in lipid profile, including total cholesterol (from 196.16 ± 34.78 to 183.53 ± 43.15; p = 0.001), non-HDL-cholesterol (from 142 ± 30.05 to 1333.69 ± 35.41; p = 0.01), VLDL-cholesterol (from 27.13 ± 12.4 to 22.06 ± 8.55; p = 0.002), triglycerides (from 135.88 ± 61.21 to 110.75 ± 43.09; p = 0.002) and glucose metabolism, including glucose (from 97.13 ± 10.43 to 92.6 ± 6.6; p = 0.004), and insulin (from 13.05 ± 5.54 to 11.29 ± 4.85; p = 0.03). As for food intake, there was a decrease in calorie consumption (from 1991.45 ± 677.78 to 1468.88 ± 390.56; p = 0.002), carbohydrates (from 50.37 ± 6 to 47.04 ± 8.67; p = 0.04), lipids (from 31.83 ± 5.53 to 30.37 ± 7.04; p = 0.3), and glycemic load (from 80.53 ± 39.88 to 54.79 ± 23.69; p = 0.02), and an increased consumption of proteins (from 18.3 ± 2.39 to 22.89 ± 4.9; p = 0.002). Positive correlations were demonstrated between insulin concentration and waist circumference (r = 0.82; p = 0.003); leptin and body fat and abdominal circumference (r = 0.74; p = 0.01); and LDL-cholesterol fraction and total cholesterol consumption (r = 0.69; p = 0.027). Negative correlations were demonstrated between leptin and monosaturated fat consumption (r = -0.71; p = 0.02); and adiponectin and liver enzyme GGT levels (r = -0.65; p = 0.04). CONCLUSIONS: interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet. Our findings suggest the effectiveness and clinical relevance of the interdisciplinary clinical therapy applied for obesity

INTRODUCCIÓN: la obesidad es una enfermedad crónica asociada con hábitos alimentarios inadecuados y niveles reducidos de actividad física. Debido a la obesidad, el riesgo de comorbilidad aumenta, especialmente el de las enfermedades cardiovasculares, la resistencia a la insulina y el aumento de los factores proinflamatorios. El objetivo de la presente investigación fue analizar las posibles correlaciones entre las adipocinas pro/antiinflamatorias, el índice glucémico y otros marcadores de calidad de la dieta con el perfil metabólico en mujeres sometidas a terapia interdisciplinaria para perder peso. MÉTODOS: treinta y dos mujeres con obesidad participaron en 12 semanas de terapia interdisciplinaria en la que se combinaron los enfoques clínico, nutricional y de ejercicio físico. Se analizaron la composición corporal, la calidad de la dieta, el perfil metabólico y las adipocinas pro/antiinflamatorias. RESULTADOS: la terapia demostró ser efectiva para reducir el peso corporal (de 93,16 ± 16,96 a 88,36 ± 16,23; p = 0,0000001), el índice de masa corporal (de 34,01 ± 4,00 a 32,29 ± 3,96; p = 0,0000001) y la grasa corporal (de 38,25 ± 5,05 a 36,13 ± 5,00; p = 0,0000001). También hubo una mejora del perfil lipídico, incluidos el colesterol total (de 196,16 ± 34,78 a 183,53 ± 43,15; p = 0,001), el colesterol no HDL (de 142,00 ± 30,05 a 1333,69 ± 35,41; p = 0,01), el VLDL-colesterol (de 27,13 ± 12,4 a 22,06 ± 8,55; p = 0,002), y el metabolismo de la glucosa, incluyendo la glucosa (de 97,13 ± 10,43 a 92,6 ± 6,6; p = 0,004) y la insulina (de 13,05 ± 5,54 a 11,29 ± 4,85; p = 0,03). En cuanto a la ingesta de alimentos, hubo disminución en el consumo de calorías (de 1991,45 ± 677,78 a 1468,88 ± 390,56; p = 0,002), carbohidratos (de 50,37 ± 6,00 a 47,04 ± 8,67; p = 0,04), lípidos (de 31,83 ± 5,53 a 30,37 ± 7,04; p = 0,3) y carga glucémica (de 80,53 ± 39,88 a 54,79 ± 23,69; p = 0,02), y aumento del consumo de proteínas (de 18,3 ± 2,39 a 22,89 ± 4,90; p = 0,002). Se demostraron correlaciones positivas entre la concentración de insulina y la circunferencia de la cintura (r = 0,82; p = 0,003); la leptina, la grasa corporal y la circunferencia abdominal (r = 0,74; p = 0,01), y la fracción de colesterol LDL y el consumo total de colesterol (r = 0,69; p = 0,027). Se demostraron correlaciones negativas entre la leptina y el consumo de grasa monosaturada (r = -0,71; p = 0,02), y la adiponectina y la enzima hepática GGT (r = -0,65; p = 0,04). CONCLUSIONES: la terapia interdisciplinaria tuvo efectos positivos sobre el estado inflamatorio, mediado por la leptina, la adiponectina, y la calidad de la dieta. Nuestros hallazgos sugieren la efectividad y la relevancia clínica de la terapia clínica interdisciplinaria aplicada a la obesidad

Interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet in obese women.

INTRODUCTION: Background: obesity is a chronic disease associated with inadequate eating habits and reduced levels of physical activity. Because of obesity, the risk for comorbidities is increased, especially for cardiovascular diseases, insulin resistance, and increased pro-inflammatory factors. The aim of the present investigation was to analyze potential correlations between pro/anti-inflammatory adipokines, glycemic index, and other markers of diet quality using a metabolic profile in women undergoing interdisciplinary weight loss therapy. Methods: thirty-two women with obesity were enrolled in a 12-week program of interdisciplinary therapy combining a clinical, nutritional, and physical exercise approach. Body composition, quality of diet, metabolic profile, and pro/anti-inflammatory adipokines were analyzed. Results: the therapy showed to be effective in reducing body weight, body mass index, and body fat. There was also an improvement in lipid profile, including total cholesterol, non-HDL-cholesterol, VLDL-cholesterol, triglycerides and glucose metabolism, including glucose, and insulin. As for food intake, there was a decrease in calorie consumption, carbohydrates, lipids, and glycemic load, and an increased consumption of proteins. Positive correlations were demonstrated between insulin concentration and waist circumference; leptin and body fat and abdominal circumference; and LDL-cholesterol fraction and total cholesterol consumption. Negative correlations were demonstrated between leptin and monosaturated fat consumption; and adiponectin and liver enzyme GGT levels. Conclusions: interdisciplinary therapy had positive effects on inflammatory state, mediated by leptin, adiponectin, and quality of diet. Our findings suggest the effectiveness and clinical relevance of the interdisciplinary clinical therapy applied for obesity.

INTRODUCCIÓN: Introducción: la obesidad es una enfermedad crónica asociada con hábitos alimentarios inadecuados y niveles reducidos de actividad física. Debido a la obesidad, el riesgo de comorbilidad aumenta, especialmente el de las enfermedades cardiovasculares, la resistencia a la insulina y el aumento de los factores proinflamatorios. El objetivo investigación fue analizar las posibles correlaciones entre las adipocinas pro/antiinflamatorias, el índice glucémico y otros marcadores de calidad de la dieta con el perfil metabólico en mujeres sometidas a terapia interdisciplinaria para perder peso. Métodos: treinta y dos mujeres con obesidad participaron en 12 semanas de terapia interdisciplinaria en la que se combinaron los enfoques clínico, nutricional y de ejercicio físico. Se analizaron la composición corporal, la calidad de la dieta, el perfil metabólico y las adipocinas pro/antiinflamatorias. Resultados: la terapia demostró ser efectiva para reducir el peso corporal, el índice de masa corporal y la grasa corporal. También hubo una mejora del perfil lipídico, incluidos el colesterol total, el colesterol no HDL, el VLDL-colesterol , y el metabolismo de la glucosa, incluyendo la glucosa y la insulina. En cuanto a la ingesta de alimentos, hubo disminución en el consumo de calorías, carbohidratos, lípidos y carga glucémica, y aumento del consumo de proteínas. Se demostraron correlaciones positivas entre la concentración de insulina y la circunferencia de la cintura ; la leptina, la grasa corporal y la circunferencia abdominal, y la fracción de colesterol LDL y el consumo total de colesterol. Se demostraron correlaciones negativas entre la leptina y el consumo de grasa monosaturada, y la adiponectina y la enzima hepática GGT. Conclusiones: la terapia interdisciplinaria tuvo efectos positivos sobre el estado inflamatorio, mediado por la leptina, la adiponectina, y la calidad de la dieta. Nuestros hallazgos sugieren la efectividad y la relevancia clínica de la terapia clínica interdisciplinaria aplicada a la obesidad.

Recursos terapêuticos e motivação para mudança de comportamento em adultos encaminhados para cirurgia bariátrica / Therapeutic resources and motivation for behavioral changes in adults referred for bariatric surgery

A cirurgia bariátrica é considerada uma importante estratégia para controle da obesidade, entretanto deve ser indicada após insucesso do tratamento clínico. O objetivo deste estudo foi investigar o grau de obesidade, presença de comorbidades e recursos terapêuticos utilizados no tratamento da obesidade em pacientes encaminhados para a cirurgia bariátrica, bem como identificar o estágio de motivação para mudança de comportamento alimentar. Estudo transversal que investigou 44 pacientes encaminhados para a cirurgia bariátrica no município de Diadema-SP. Consultou-se o prontuário eletrônico para coleta de dados antropométricos, exames bioquímicos, presença de comorbidades e tratamento prévio da obesidade. Entrevistas presenciais foram realizadas com uma sub amostra (n=16) para investigação mais detalhada sobre os recursos terapêuticos: realização de dieta, prática de exercício físico e uso de fármacos. O estágio de motivação para a mudança comportamental foi avaliado por um questionário baseado no modelo transteórico, contendo 5 perguntas fechadas sobre mudanças dos hábitos alimentares nos últimos seis meses. Verificou-se que 91% dos indivíduos apresentaram obesidade grau II e III, 43% hipertensão arterial e 34% diabetes mellitus. Dentre os entrevistados, 88% relataram acompanhamento no SUS há mais de 2 anos, 81% realizaram tratamento farmacológico, 38% praticam exercício físico, 88% seguiram alguma dieta e 19% referiram acompanhamento com nutricionista. O estágio de motivação para mudança de comportamento alimentar mais observado foi a ação (56%). Conclui-se que os indivíduos encaminhados para a cirurgia bariátrica apresentaram grau elevado de obesidade e risco de comorbidades, e que diversas estratégias terapêuticas, principalmente tratamento farmacológico e dieta das modas, já foram adotadas.

Bariatric surgery is considered an important strategy to control obesity, however it must be indicated only after the failure of clinical treatments. The aim of this study was to investigate the degree of obesity, the presence of comorbidities and therapeutic resources used in the treatment of obesity in patients referred for bariatric surgery, as well as to identify the stage of motivation for changing their dietary behavior. This was a cross-sectional study that investigated 44 patients referred for bariatric surgery in the municipality of Diadema-SP. The electronic medical records were consulted to collect anthropometric data, biochemical tests, presence of comorbidities and previous treatments for obesity. Face-to-face interviews were conducted with a sub-sample (n=16) for a more detailed investigation of the therapeutic resources: dieting, physical exercise and use of drugs. The motivational stage for changing behavior was assessed by a questionnaire based on the trans-theoretical model, containing 5 closed questions about changes in eating habits within the previous six months. It was found that 91% of individuals had grade II and III obesity, 43% arterial hypertension and 34% diabetes mellitus. Among the interviewees, 88% reported monitoring with SUS for more than 2 years, 81% underwent pharmacological treatment, 38% practiced physical exercise, 88% followed some diet and 19% reported monitoring with a nutritionist. The most observed motivational stage for changing dietary behavior was action (56%). It is concluded that the individuals referred for bariatric surgery had a high degree of obesity and risk of comorbidities, and that several therapeutic strategies, mainly pharmacological treatments and trending diets, had already been adopted.

An Interdisciplinary Weight Loss Program Improves Body Composition and Metabolic Profile in Adolescents With Obesity: Associations With the Dietary Inflammatory Index.

Background and Aims: The prevalence of overweight and obesity consitutes a global epidemic and it is growing around the world. Food and nutrition are essential requirements for promoting health and protecting against non-communicable chronic diseases, such as obesity and cardiovascular disease. Specific dietary components may modulate inflammation and oxidative stress in obese individuals. The Dietary Inflammatory Index (DII®) was developed to characterize the anti- and pro-inflammatory effects of individuals' diet. Few studies have investigated the role of diet-associated inflammation in adolescents with obesity. The present study aims to investigate the effects of an interdisciplinary weight loss therapy on DII scores and cardiometabolic risk in obese adolescents and possibles correlations. Methods: A total of 45 volunteers (14-19 years old) were recruited and enrolled for long-term interdisciplinary therapy including clinical, nutritional, psychological counseling, and exercise training. Adolescents had access to videos about health education weekly. Body composition and inflammatory and serum profiles were evaluated at baseline and after intervention. The food intake was obtained by 24-h food recall. Data was used to calculate energy-adjusted DII (E-DII) scores. Negative scores indicate an anti-inflammatory diet and positive scores indicates a pro-inflammatory diet. The sample was divided according to whether individuals increased or decreased E-DII scores after therapy. Results: After therapy the body mass index (BMI), body weight, body fat, abdominal, waist, neck, and hip circumferences decreased significantly. The mean of high-density lipoprotein cholesterol (HDL-c) increased after the therapy. There was found an improvement of inflammatory and cardiometabolic parameters. In exploratory analyses, this occurred mainly when the EDII improved. Conclusion: Long-term interdisciplinary therapy combined with a health education website improved inflammatory serum markers in obese adolescents. Reduction in DII scores was associated with reduction of cardiometabolic parameters, suggesting that an anti-inflammatory diet may be an effective strategy to prevent and treat obesity and related comorbidities. Trial: http://www.ensaiosclinicos.gov.br/rg/RBR-6txv3v/, Register Number: RBR-6txv3v.

Effects of magnitude of visceral adipose tissue reduction: Impact on insulin resistance, hyperleptinemia and cardiometabolic risk in adolescents with obesity after long-term weight-loss therapy.

AIM: To investigate the association between visceral adipose tissue loss and insulin resistance and hyperleptinemia in adolescents with obesity submitted to interdisciplinary weight-loss therapy. METHODS: A total of 172 post-pubertal adolescents (body mass index greater than the 95th percentile of the Centers for Disease Control and Prevention reference growth charts) were recruited for the study. The adolescents were assigned to long-term weight-loss therapy. Body composition, visceral and subcutaneous fat, glucose metabolism, lipid profile, hepatic enzymes and leptin concentration were measured. After the therapy, the adolescents were allocated to three different groups according to the tertile of visceral fat reduction. RESULTS: Positive effects on body composition were observed in all analysed groups independent of visceral fat reduction. It was found that visceral fat was an independent predictor of insulin resistance in the investigated population. Obese adolescents who lost a higher proportion of visceral adipose tissue (>1.8 cm) demonstrated improved metabolic and inflammatory parameters twice as much than those who presented smaller losses. Positive correlations between visceral fat reduction and glucose metabolism, lipid profile, hepatic enzymes and homeostasis model assessment of insulin resistance index were demonstrated. CONCLUSION: The magnitude of the reduction in visceral fat was an independent predictor of insulin resistance, hyperleptinemia and metabolic disorders related to obese adolescents.

Relationship between fatty acids intake and Clostridium coccoides in obese individuals with metabolic syndrome.

Dietary habits exert a strong influence on gut microbial composition and may result in an imbalance of gut microbes, representing a predisposition to obesity and metabolic disorders. We aimed to investigate a potential relationship between gut bacterial species and metabolic parameters and dietary intake. Bacterial DNA was extracted from feces of 34 obese subjects with and without metabolic syndrome (MS and n-MS group, respectively). We then used real-time polymerase chain reaction (qPCR) for quantifying specific sequences to Akkermansia muciniphila, Bifidobacterium spp., Clostridium coccoides, and Lactobacillus spp. and analyzed them with respect to clinical characteristics. Our data showed that the MS group had a 6.7-fold higher level of C. coccoides in their stool samples than the n-MS group. The abundance of C. coccoides was positively correlated with a high intake of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids. Furthermore, an excessive dietary level of MUFA was identified as a predictor of C. coccoides abundance. Alterations in the gut microbial ecology were positively correlated with levels of triacylglycerol in obese individuals. Therefore, the type and quantity of dietary fat may alter the gut microbial ecology in obese individuals with MS and may predispose them to dyslipidemia.

Relationship between adiponectin and leptin on osteocalcin in obese adolescents during weight loss therapy.

OBJECTIVES: Obesity is a multifactorial disease characterized by the presence of the pro-inflammatory state associated with the development of many comorbidities, including bone turnover marker alterations. This study aimed to investigate the role of the inflammatory state on bone turnover markers in obese adolescents undergoing interdisciplinary weight loss treatment for one year. SUBJECTS AND METHODS: Thirty four post-pubescent obese adolescents with primary obesity, a body mass index (BMI) greater than > 95th percentile of the CDC reference growth charts, participated in the present investigation. Measurements of body composition, bone turnover markers, inflammatory biomarkers and visceral and subcutaneous fat were taken. Adolescents were submitted to one year of interdisciplinary treatment (clinical approach, physical exercise, physiotherapy intervention, nutritional and psychological counseling). RESULTS: Reduction in body mass, body fat mass, visceral and subcutaneous fat, as well as, an increase in the body lean mass and bone mineral content was observed. An improvement in inflammatory markers was seen with an increase in adiponectin, adiponectin/leptin ratio and inteleukin-15. Moreover, a positive correlation between the adiponectin/leptin ratio and osteocalcin was demonstrated. Further, both lean and body fat mass were predictors of osteocalcin. Negative associations between leptin with osteocalcin, adiponectin with Beta CTX-collagen, and visceral fat with adiponectin were observed. CONCLUSIONS: It is possible to conclude that the inflammatory state can negatively influence the bone turnover markers in obese adolescents. In addition, the interdisciplinary weight loss treatment improved the inflammatory state and body composition in obese adolescents. Therefore, the present findings should be considered in clinical practice.

Relationship between adiponectin and leptin on osteocalcin in obese adolescents during weight loss therapy

ABSTRACT Objectives: Obesity is a multifactorial disease characterized by the presence of the pro-inflammatory state associated with the development of many comorbidities, including bone turnover marker alterations. This study aimed to investigate the role of the inflammatory state on bone turnover markers in obese adolescents undergoing interdisciplinary weight loss treatment for one year. Subjects and methods: Thirty four post-pubescent obese adolescents with primary obesity, a body mass index (BMI) greater than > 95th percentile of the CDC reference growth charts, participated in the present investigation. Measurements of body composition, bone turnover markers, inflammatory biomarkers and visceral and subcutaneous fat were taken. Adolescents were submitted to one year of interdisciplinary treatment (clinical approach, physical exercise, physiotherapy intervention, nutritional and psychological counseling). Results: Reduction in body mass, body fat mass, visceral and subcutaneous fat, as well as, an increase in the body lean mass and bone mineral content was observed. An improvement in inflammatory markers was seen with an increase in adiponectin, adiponectin/leptin ratio and inteleukin-15. Moreover, a positive correlation between the adiponectin/leptin ratio and osteocalcin was demonstrated. Further, both lean and body fat mass were predictors of osteocalcin. Negative associations between leptin with osteocalcin, adiponectin with Beta CTX-collagen, and visceral fat with adiponectin were observed. Conclusions: It is possible to conclude that the inflammatory state can negatively influence the bone turnover markers in obese adolescents. In addition, the interdisciplinary weight loss treatment improved the inflammatory state and body composition in obese adolescents. Therefore, the present findings should be considered in clinical practice.

The Long-Term Impact of High Levels of Alpha-Melanocyte-Stimulating Hormone in Energy Balance Among Obese Adolescents.

BACKGROUND: Deregulation of orexigenic and anorexigenic pathways occurs among adolescents with obesity. Alpha-melanocyte-stimulating hormone (α-MSH) is a key catabolic mediator of energy homeostasis and an important anorexigenic neuropeptide in the control of energy balance and thermogenesis. However, it was not well explored if α-MSH can modulate long-term weight loss therapy responses in a dependent manner according to its concentration. Our hypothesis is that a high α-MSH concentration at baseline promotes better modulation of anorexigenic/orexigenic pathways in obese adolescents. METHODS: One hundred ten post-pubertal obese adolescents (body mass index >95th percentile) were submitted to 1 year of interdisciplinary therapy (clinical, nutritional, psychological, physical exercise, and physiotherapy support). Body composition and plasma levels of α-MSH, neuropeptide Y (NPY), melanin-concentrating hormone, and agouti-related peptide (AgRP) were measured before and after therapy. The volunteers were grouped on the basis of Tertiles of α-MSH concentration: Low (<0.75 ng/mL), Medium (≤0.76 to ≥1.57 ng/mL), and High (>1.57 ng/mL). Significance was set as p < 0.05. RESULTS: The treatment promoted a significant improvement in body adiposity and fat free mass for all groups. It is important to note that only in the high α-MSH group, a significant increase of the α-MSH/NPY ratio and decrease NPY/AgRP ratio post treatment were observed. CONCLUSION: The high α-MSH concentration promotes better modulation of anorexigenic/orexigenic pathways in obese adolescents following long-term weight loss therapy and this is important in clinical practice.

The effects of exercise training associated with low-level laser therapy on biomarkers of adipose tissue transdifferentiation in obese women.

Investigations suggest the benefits of low-level laser therapy (LLLT) to improve noninvasive body contouring treatments, inflammation, insulin resistance and to reduce body fat. However, the mechanism for such potential effects in association with exercise training (ET) and possible implications in browning adiposity processes remains unclear. Forty-nine obese women were involved, aged between 20 and 40 years with a body mass index (BMI) of 30-40 kg/m2. The volunteers were divided into Phototherapy (808 nm) and SHAM groups. Interventions consisted of exercise training and phototherapy applications post exercise for 4 months, with three sessions/week. Body composition, lipid profile, insulin resistance, atrial natriuretic peptide (ANP), WNT5 signaling, interleukin-6 (IL-6), and fibroblast growth factor-21 (FGF-21) were measured. Improvements in body mass, BMI, body fat mass, lean mass, visceral fat, waist circumference, insulin, HOMA-IR, total cholesterol, LDL-cholesterol, triglycerides, and ANP in both groups were demonstrated. Only the Phototherapy group showed a reduction in interleukin-6 and an increase in WNT5 signaling. In addition, it was possible to observe a higher magnitude change for the fat mass, insulin, HOMA-IR, and FGF-21 variables in the Phototherapy group. In the present investigation, it was demonstrated that exercise training associated with LLLT promotes an improvement in body composition and inflammatory processes as previously demonstrated. The Phototherapy group especially presented positive modifications of WNT5 signaling, FGF-21, and ANP, possible biomarkers associated with browning adiposity processes. This suggests that this kind of intervention promotes results applicable in clinical practice to control obesity and related comorbidities.