Obese patients lose weight independently of nutritional follow-up after bariatric surgery.

OBJECTIVE: to examine the association between preoperative body weight, adherence to postsurgical nutritional follow-up, length of postoperative period, and weight loss during the first 18 months among adults who have undergone bariatric surgery. METHODS: a retrospective cohort study was conducted on 241 consecutive patients who underwent open Roux-en-Y gastric bypass (RYGBP) from January 2006 to December 2008, in a teaching hospital in São Paulo (Brazil). Data were collected through hospital records review and the variables analyzed included sex, age, immediate preoperative weight, adherence to postsurgical nutritional visits and length of postoperative period. Proportional body weight reductions during the 18-month follow-up period were examined using generalized estimating equations. RESULTS: 81% (n = 195) of participants were female, with overall mean age of 44.4 ± 11.6 years, mean preoperative weight of 123.1 ± 21.2 kg and mean preoperative body mass index of 47.2 ± 6.2 kg/m2. The overall adherence to postoperative follow- up schedule was 51% (95%CI: 44.5-57.5%). Preoperative body weight and adherence were not associated with proportional weight reduction (Wald's test p > 0.18). Weight loss leveled off at the end of the 18-month follow-up period for both compliant and non-compliant patients (Wald's test p = 0.00). CONCLUSIONS: our study showed that weight loss occurred steadily over the first 18 months after RYGBP, leveling off at around 40% weight reduction. It was associated with neither presurgical weight, nor nutritional follow-up and it may be primarily dependent on the surgical body alterations themselves. This finding may have implications for intervention strategies aimed at motivating patients to comply with early postsurgical and life-long follow-up.

Obese patients lose weight independently of nutritional follow-up after bariatric surgery / Pacientes obesos perdem peso independentemente do seguimento nutricional pós-cirurgia bariátrica

Summary Objective: to examine the association between preoperative body weight, adherence to postsurgical nutritional follow-up, length of postoperative period, and weight loss during the first 18 months among adults who have undergone bariatric surgery. Methods: a retrospective cohort study was conducted on 241 consecutive patients who underwent open Roux-en-Y gastric bypass (RYGBP) from January 2006 to December 2008, in a teaching hospital in São Paulo (Brazil). Data were collected through hospital records review and the variables analyzed included sex, age, immediate preoperative weight, adherence to postsurgical nutritional visits and length of postoperative period. Proportional body weight reductions during the 18-month follow-up period were examined using generalized estimating equations. Results: 81% (n=195) of participants were female, with overall mean age of 44.4 ± 11.6 years, mean preoperative weight of 123.1± 21.2 kg and mean preoperative body mass index of 47.2± 6.2 kg/m2. The overall adherence to postoperative follow- up schedule was 51% (95%CI: 44.5-57.5%). Preoperative body weight and adherence were not associated with proportional weight reduction (Wald’s test p > 0.18). Weight loss leveled off at the end of the 18-month follow-up period for both compliant and non-compliant patients (Wald’s test p = 0.00). Conclusions: our study showed that weight loss occurred steadily over the first 18 months after RYGBP, leveling off at around 40% weight reduction. It was associated with neither presurgical weight, nor nutritional follow-up and it may be primarily dependent on the surgical body alterations themselves. This finding may have implications for intervention strategies aimed at motivating patients to comply with early postsurgical and life-long follow-up. .

Resumo Objetivo: examinar a perda de peso nos primeiros 18 meses em pacientes submetidos à cirurgia bariátrica. Métodos: um estudo de coorte retrospectiva foi realizado com 241 adultos submetidos à gastroplastia, entre janeiro/2006 e dezembro/2008, em um centro em São Paulo (Brasil). Foi feita a revisão dos prontuários e as variáveis analisadas foram sexo, idade, peso pré-cirúrgico imediato, adesão ao seguimento nutricional pós-operatório e duração do período pós-operatório. A proporção do peso inicial perdido durante os 18 primeiros meses pós-cirurgia foi analisada pela técnica de equações generalizadas de estimação. Resultados: 81% (n=195) eram mulheres; média de idade 44,4 ± 11,6 anos; média de peso pré-operatório 123,1± 21,2 kg; média do índice de massa corporal 47.2± 6.2 kg/m2. A prevalência de adesão ao seguimento nutricional pós-cirúrgico foi de 51% (IC95% = 44,5-57,5%). Peso pré-cirúrgico e adesão não se mostraram significativamente associados à redução da proporção do peso inicial (Teste de Wald p>0,18). A perda de peso tendeu a diminuir no final do período de 18 meses pós-cirúrgico nos grupos de pacientes aderentes e não aderentes (Teste de Wald p=0,00). Conclusão: nosso estudo mostrou que a perda de peso durante os primeiros 18 meses após a cirurgia chega a 40% do peso. O emagrecimento não foi associado ao peso pré-operatório, nem à adesão ao seguimento nutricional pós-cirúrgico e pode depender, principalmente, das alterações promovidas pelo procedimento cirúrgico em si. Esse achado poderá levar à proposição de intervenções para motivar os pacientes ao seguimento pós-operatório. .

Fuzzy linguistic model for bioelectrical impedance vector analysis.

BACKGROUNDS & AIMS: The boundaries between the categories of body composition provided by vectorial analysis of bioimpedance are not well defined. In this paper, fuzzy sets theory was used for modeling such uncertainty. METHODS: An Italian database with 179 cases 18-70 years was divided randomly into developing (n = 20) and testing samples (n = 159). From the 159 registries of the testing sample, 99 contributed with unequivocal diagnosis. Resistance/height and reactance/height were the input variables in the model. Output variables were the seven categories of body composition of vectorial analysis. For each case the linguistic model estimated the membership degree of each impedance category. To compare such results to the previously established diagnoses Kappa statistics was used. This demanded singling out one among the output set of seven categories of membership degrees. This procedure (defuzzification rule) established that the category with the highest membership degree should be the most likely category for the case. RESULTS: The fuzzy model showed a good fit to the development sample. Excellent agreement was achieved between the defuzzified impedance diagnoses and the clinical diagnoses in the testing sample (Kappa = 0.85, p < 0.001). CONCLUSIONS: fuzzy linguistic model was found in good agreement with clinical diagnoses. If the whole model output is considered, information on to which extent each BIVA category is present does better advise clinical practice with an enlarged nosological framework and diverse therapeutic strategies.

Correlation between the components of the insulin-like growth factor I system, nutritional status and visceral leishmaniasis.

The role of the insulin-like growth factor I (IGF-I) system and nutritional status was studied in 241 children from a Brazilian area endemic for visceral leishmaniasis (VL). Thirty-nine children had the active form, 20 were oligosymptomatic, 38 were asymptomatic and 144 were not infected. Serum concentrations of growth hormone (GH), total and free IGF-I and IGF binding-protein 3 (IGFBP3) were measured by radioimmunoassay. Nutritional status was evaluated by anthropometric indicators and biochemical measurements. Total and free IGF-I and IGFBP3 were significantly reduced in the active form. Z scores for total and free IGF-I and for IGFBP3 were found to be significantly lower for active VL and oligosymptomatic individuals than for asymptomatic individuals, but never reached values

[Risk factors associated with acute myocardial infarction in the São Paulo metropolitan region: a developed region in a developing country]. / Fatores de risco associados com infarto agudo do miocárdio na região metropolitana de São Paulo: uma região desenvolvida em um país em desenvolvimento.

OBJECTIVE: To identify the risk factors associated with acute myocardial infarction (AMI) and their respective powers of association in the São Paulo metropolitan region. METHODS: The cases comprised patients diagnosed with first AMI with an ST segment elevation. The controls were individuals with no known cardiovascular disease. The study comprised 271 cases and 282 controls from 12 hospitals. Risk factors were as follows: ethnic group; educational level; marital status; family income; family history of coronary artery disease; antecedents of arterial hypertension and of diabetes mellitus; hormonal replacement in women; smoking; physical activity; alcohol consumption; total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, and glucose levels; body mass index; and waist-hip ratio (WHR). RESULTS: The following risk factors showed and independent association with AMI: smoking [odds ratio (OR) = 5.86; 95% confidence interval (CI) 3.25-10.57; P < 0.00001); waist-hip ratio (first vs. third tertile) (OR = 4.27; 95% CI 2.28-8.00; P < 0.00001); antecedents of arterial hypertension (OR = 3.26; 95% CI 1.95-5.46; P < 0.00001); waist-hip ratio (first vs second tertile) (OR = 3.07; 95% CI 1.66-5.66; P = 0.0003); LDL-cholesterol level (OR = 2.75; 95% CI 1.45-5.19; P = 0.0018); antecedents of diabetes mellitus (OR = 2.51; 95% CI 1.45-5.19; P = 0.023); family history of coronary artery disease (OR = 2.33; 95% CI 1.44-3.75; P = 0.0005); and HDL-cholesterol level (OR = 0.53; 95% CI 0.32-0.87; P = 0.011). CONCLUSION: Smoking, waist-hip ratio, antecedents of arterial hypertension and of diabetes mellitus, family history of coronary artery disease, and LDL-cholesterol and HDL-cholesterol levels showed to be independently associated with AMI within the São Paulo metropolitan region.

Fatores de risco associados com infarto agudo do miocárdio na região metropolitana de São Paulo: uma região desenvolvida em um país em desenvolvimento / Risk factors associated with acute myocardial infarction in the São Paulo metropolitan region: a developed region in a developing country

OBJETIVO: Identificar os fatores de risco, associados com infarto agudo do miocárdio (IAM), com as respectivas forças de associação, na região metropolitana de São Paulo. MÉTODOS: Os casos eram pacientes com diagnóstico de primeiro IAM com elevação do segmento ST e os controles eram indivíduos sem doença cardiovascular conhecida. Foram incluídos 271 casos e 282 controles provenientes de 12 hospitais. Os fatores avaliados: raça, escolaridade, estado civil, renda familiar, história familiar de insuficiência coronariana, antecedentes de hipertensão arterial e de diabetes mellitus, reposição hormonal em mulheres, tabagismo, atividade física, consumo de álcool, colesterol total, LDL-colesterol, HDL-colesterol, triglicérides e glicose, índice de massa corporal e relação cintura-quadril. RESULTADOS: Os seguintes fatores de risco apresentaram associação independente com IAM: tabagismo (razão de chances [OR]=5,86; intervalo de confiança [IC] 95 por cento 3,25-10,57; p<0,00001), relação cintura-quadril [tercil superior vs. inferior] (OR=4,27; IC 95 por cento 2,28-8,00; p<0,00001), antecedentes de hipertensão arterial (OR=3,26; IC 95 por cento 1,95-5,46; p<0,00001), relação cintura-quadril [tercil intermediário vs. inferior] (OR=3,07; IC95 por cento 1,66-5,66; p=0,0003), nível sérico de LDL-colesterol (OR=2,75; IC 95 por cento 1,45-5,19; p=0,0018), antecedentes de diabetes mellitus (OR=2,51; IC 95 por cento 1,45-5,19; p=0,023), história familiar de insuficiência coronariana (OR=2,33; IC 95 por cento 1,44-3,75; p=0,0005) e HDL-colesterol (OR=0,53; IC 95 por cento 0,32-0,87; p=0,011). CONCLUSAO: Tabagismo, relação cintura-quadril, antecedentes de hipertensão arterial e de diabetes, história familiar de insuficiência coronariana, níveis séricos de LDL-colesterol e de HDL-colesterol encontram-se independentemente associados com IAM na região metropolitana de São Paulo.

Risk factors for myocardial infarction in Brazil.

BACKGROUND: Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management. METHODS: The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital-based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI. RESULTS: A total of 1279 pairs, matched by age (+/- 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: > or =5 cigarettes per day (odds ratio [OR] 4.90, P <.00001); glucose > or =126 mg/dL (OR 2.82, P <.00001); waist/hip ratio > or =0.94 (OR 2.45, P <.00001); family history of CAD (OR 2.29, P <.00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P <.00001); reported hypertension (OR 2.09, P <.00001); <5 cigarettes per day (OR 2.07, P =.0171); low-density lipoprotein-cholesterol >120 mg/dL (OR 1.75, P <.00001); reported diabetes mellitus (OR 1.70, P =.0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P =.0212); alcohol intake (up to 2 days/week) (OR 0.75, P <.0309); alcohol intake (3-7 days/week) (OR 0.60, P =.0085); family income R$600 to R$1200 and college education (OR 2.92, P =.0499); family income >R$1200 and college education (OR 0.68, P = 0.0239) CONCLUSIONS: The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.

Risk factors for myocardial infarction in Brazil

Background Approximately three-quarters of cardiovascular disease deaths in the world come from developing countries, and acute myocardial infarction (AMI) is an important cause of death. Brazil is one of the largest countries in Latin America and the contemporary evaluation of risk factors for AMI is crucial for a more efficacious disease management. Methods The Acute Myocardial Infarction Risk Factor Assessment in Brazil (AFIRMAR) study is a case-control, hospital- based study involving 104 hospitals in 51 cities in Brazil, designed to evaluate risk factors for a first ST-segment elevation AMI. Results A total of 1279 pairs, matched by age ( 5 years) and sex, were enrolled. The conditional multivariable analysis of 33 variables showed the following independent risk factors for AMI: 5 cigarettes per day (odds ratio [OR] 4.90, P .00001); glucose 126 mg/dL (OR 2.82, P .00001); waist/hip ratio 0.94 (OR 2.45, P .00001); family history of CAD (OR 2.29, P .00001), low-density lipoprotein-cholesterol 100 to 120 mg/dL (OR 2.10, P .00001); reported hypertension (OR 2.09, P .00001); 5 cigarettes per day (OR 2.07, P .0171); low-density lipoprotein- cholesterol 120 mg/dL (OR 1.75, P .00001); reported diabetes mellitus (OR 1.70, P .0069); waist/hip ratio 0.90 to 0.93 (OR 1.52, P .0212); alcohol intake (up to 2 days/week) (OR 0.75, P .0309); alcohol intake (3–7 days/week) (OR 0.60, P .0085); family income R$600 to R$1200 and college education (OR 2.92, P .0499); family income R$1200 and college education (OR 0.68, P 0.0239) Conclusions The independent risk factors for AMI in Brazil showed a conventional distribution pattern (smoking, diabetes mellitus and central obesity among others) with different strengths of association; most of them being preventable by implementation of adequate policies.

Assesment and prediction of asthma and its severity in the paediatric community

Foram submetidos a exames, juntamente com grupos controle segundo idade e sexo, 74 crianças asmáticas, com idade de 7 a 11 anos. Exames clínicos e laboratoriais precederam um acompanhamento de 28 dias, quando foram registrados dados sobre a taxa de pico do fluxo respiratório (PEF), sintomas e tratamento. Observou-se que o coeficiente de variaçäo do PEF É uma medida objetiva do grau de gravidade da asma, que tem uma correlaçäo estatística significativa, tanto com os sintomas (r(s) = .036), quanto com o tratamento (r(s) = .60)). AlÉm disso, separa os asmáticos graves e leves, como foi confirmado pelas diferenças estatisticamente significantes (p = 008 ou menos) nos sintomas, tratamentos, alergias da pele e resposta das vias aÉreas ao exercício. Estas duas últimas foram consideradas elementos prognosticadores tanto da doença como grau de gravidade. Pela regressäo logística foi possível estabelecer a probabilidade para a asma grave quando as crianças, apresentando ou näo essas características, foram comparadas. Um único teste de pelo positivo representa uma probabilidade de 88 por cento para o desenvolvimento de asma, e de 70 por cento para doença grave. A reduçäo do PEF de 10 por cento, depois de um teste de exercício, leva a uma probabilidade de 73 por cento e de 64 por cento para doença grave. Aumentos nessas variáveis implicam riscos aumentados geometricamente, cuja presença conjunta tem efeito multiplicativo no risco final

The engine of the caboose: health policy in developing countries

É discutida a política de saúde em países em desenvolvimento. Defende-se a proposta de que esses países devem adotar uma abordagem progressista quanto a sua política de saúde, rejeitando o sistema que se apóia em dois pilares - o da saúde pública e privada. Salienta-se que a ideologia näo pode ser seu único sustentáculo. Um sistema de saúde progressista deve utilizar as ciências administrativas, sociais e comportamentais na formulaçäo e implementaçäo do conjunto de seus programas e propostas, para que possa servir à populaçäo de nidi eficaz. O sistema de saúde näo pode se eximir em relaçäo a meta da eficácia